Ihe mkpali ovarian bụ ọgwụgwọ hormonal ezubere, dị ka aha ya na-egosi, iji kpalie ovaries iji nweta ovulation dị mma. Nke a na-ekpuchi n'ezie usoro dị iche iche nke usoro ha dị iche dị ka ihe ngosi ahụ si dị, ma ihe mgbaru ọsọ ya bụ otu: iji nweta afọ ime. Enwere ike ịdepụta mkpali ovarian naanị ma ọ bụ bụrụ akụkụ nke ụkpụrụ ART, ọkachasị n'ihe gbasara in vitro Fertilization (IVF).

Schematically, e nwere ụzọ abụọ:

Ngwọta ntinye nwa nwa dị mfe, edepụtara n'ọnọdụ nsogbu nke ovulation (dysovulation ma ọ bụ anovulation) n'ihi ihe atụ n'ihi oke ibu ma ọ bụ oke ibu, polycystic ovary syndrome (PCOS) nke amabeghị.

Mkpali Ovarian dịka akụkụ nke protocol ART :

• intrauterine insemination (IUU): mkpali nke ovulation (obere na nke a) na-eme ka o kwe omume ịhazi oge nke ovulation ma si otú a na-edebe spam (nke anakọtara na mbụ) n'oge kwesịrị ekwesị. cervix. Ihe mkpali na-emekwa ka o kwe omume inweta uto nke follicles abụọ ma si otú a na-eme ka ohere nke ịga nke ọma nke mmepụta ihe.
• IVF ma ọ bụ IVF na intra-cytoplasmic sperm injection (ICSI): ebumnuche nke mkpali bụ mgbe ahụ ka tozuo ọnụ ọgụgụ buru ibu nke oocytes tozuru okè iji nwee ike were ọtụtụ follicles n'oge follicular puncture, ma si otú ahụ na-amụba ohere nke inweta ezigbo mma. embrayo site na IVF.

Enwere usoro dị iche iche nke ogologo dị iche iche, na-eji mkpụrụ ndụ dị iche iche dabere na ihe ngosi. Iji dị irè ma zere mmetụta ndị dị n'akụkụ, ọgwụgwọ mkpali ovarian bụ nke ahaziri onwe ya n'ezie.

Ihe a na-akpọ "mfe" induction ovulation

Ebumnuche ya bụ ịkwalite uto follicular iji nweta mmepụta nke otu oocytes ma ọ bụ abụọ tozuru okè. A na-eji ọgwụgwọ dị iche iche dabere na onye ọrịa, afọ ndụ ya, ihe ngosi yana omume nke ndị na-eme ya:

• anti-estrogens: a na-enye ọnụ, clomiphene citrate na-eme site na igbochi estrogen receptors na hypothalamus, nke na-eduga n'ịbawanye na nzuzo nke GnRH nke na-ebuli ọkwa FSH na mgbe ahụ nke LH. Ọ bụ usoro ọgwụgwọ mbụ n'ọnọdụ nke infertility nke mmalite ovulatory, ma e wezụga nke sitere na mmalite dị elu (hypothalamus). Enwere usoro dị iche iche mana ọgwụgwọ kpochapụwo na-adabere na ụbọchị 5 nke ịnara site na 3rd ma ọ bụ 5th ụbọchị nke okirikiri (1);
• gonadotropins FSH, LH, FSH + LH ma ọ bụ gonadotropins urinary (HMG). A na-elekọta ya kwa ụbọchị n'oge usoro follicular site na ụzọ subcutaneous, FSH na-achọ ịkwalite uto nke oocytes. Ihe dị iche iche nke ọgwụgwọ a: naanị otu ìgwè follicles kwadoro site na ovary na-akpali. Ya mere a na-edobe ọgwụgwọ a maka ndị inyom nwere nnukwu ìgwè follicle zuru oke. Ọ ga-enyekwa agbam ume iji weta follicles ruo ntozu okè nke na-amalitekarị ngwa ngwa ruo nbibi. Ọ bụkwa ụdị ọgwụgwọ a ka a na-eji elu IVF. Enwere ụdị FSH 3 ugbu a: FSH urinary dị ọcha, FSH recombinant (nke mmepụta mkpụrụ ndụ ihe nketa mepụtara) na FSU nwere ọrụ ogologo oge (eji naanị IVF dị elu). A na-eji gonadotropins mmamịrị (HMGs) eme ihe mgbe ụfọdụ n'ọnọdụ FSH recombinant. A na-ejikarị LH na-ejikọta ya na FSH, tumadi na ndị ọrịa nwere ụkọ LH.
• GnRH mgbapụta Edebere maka ụmụ nwanyị nwere anovulation nke mmalite dị elu (hypothalamus). Ngwá ọrụ dị arọ ma dị oke ọnụ, ọ dabeere na nchịkwa nke gonadorelin acetate nke na-eme ka GnRH na-eme ihe iji kpalie nzuzo nke FSH na LH.
• metformin a na-ejikarị agwọ ọrịa shuga, mana a na-eji ya mgbe ụfọdụ dị ka ihe na-akpata ovulation na ụmụ nwanyị nwere PCOS ma ọ bụ oke ibu / oke ibu, iji gbochie hyperstimulation ovarian (2).

Iji chọpụta ịdị irè nke ọgwụgwọ, belata ihe ize ndụ nke hyperstimulation na ọtụtụ afọ ime, nyochaa ovulation na ultrasounds (iji nyochaa ọnụọgụgụ na nha nke follicles na-eto eto) na nyocha nke hormonal (LH, estradiol, progesterone) site na nyocha ọbara na-eguzobe ogologo oge niile. nke protocol.

A na-ahazi mmekọ nwoke na nwanyị n'oge ovulation.

Mkpali Ovarian na ọnọdụ nke ART

Mgbe mkpali ovarian na-ewere ọnọdụ dị ka akụkụ nke IVF ma ọ bụ protocol insemination AMP, ọgwụgwọ ahụ na-ewere ọnọdụ na usoro atọ:

• oge mgbochi : a na-etinye ovaries "na-ezu ike" ekele GnRH agonists ma ọ bụ GnRH antagonists, nke na-egbochi pituitary gland;
• oge mkpali ovarian : A na-enye ọgwụgwọ gonadotropin iji kpalie uto follicular. Nleba anya nke ovulation na-enye ohere nlekota nke nzaghachi ziri ezi maka ọgwụgwọ na uto follicle;
• mmalite nke ovulation Mgbe ultrasound na-egosi follicles tozuru okè (n'etiti 14 na 20 mm na dayameta na nkezi), ovulation na-amalite site na nke ọ bụla:
  • igba ogwu nke urinary (intramuscular) ma ọ bụ recombinant (subcutaneous) HCG (chorionic gonadotropin);
  • ogwu ogbugba nke recombinant LH. Dị oke ọnụ, a na-edobe ya maka ụmụ nwanyị nọ n'ihe ize ndụ nke hyperstimulation.

Mgbe awa 36 gachara ihe mkpali hormonal, ovulation na-ewere ọnọdụ. Mgbe ahụ, mgbapu follicular na-ewere ọnọdụ.

Nkwado nkwado nke akụkụ luteal

Iji meziwanye ogo endometrium ma kwalite ịkụnye nwa embrayo, enwere ike ịnye ọgwụgwọ n'oge usoro luteal (akụkụ nke abụọ nke okirikiri, mgbe ovulation gasịrị), dabere na progesterone ma ọ bụ ihe ndị ọzọ: dihydrogesterone (site na ọnụ) ma ọ bụ micronized progesterone (ọnụ ma ọ bụ ọnụ). ikpu).

Isi mgbagwoju anya nke ọgwụgwọ mkpali ovarian bụ Ovarian hyperstimulation syndrome (OHSS). Ahụ na-anabata ọgwụgwọ siri ike na ọgwụgwọ hormonal, na-ebute ihe ịrịba ama dị iche iche nke ụlọ ọgwụ na nke ndu nke ịdị arọ dị iche iche: ahụ erughị ala, mgbu, ọgbụgbọ, afọ ọsịsa, mmụba nke olu ovarian, dyspnea, ma ọ bụ nke na-adịghị ahụkebe ihe ndị dị ndụ (mmụba hematocrit, creatinine dị elu, elu, elu). enzymes imeju, wdg), ịba ụba ngwa ngwa, na n'ọnọdụ kachasị njọ, nnukwu nsogbu iku ume na nnukwu ọdịda akụrụ (3).

Ọkpụkpụ venous ma ọ bụ akwara akwara na-apụta mgbe ụfọdụ dị ka mgbakasị ahụ nke OHSS siri ike. Amara ihe ize ndụ:

• polycystic ovary syndrome
• a ala uka index
• afọ na-erughị afọ 30
• ọnụ ọgụgụ dị elu nke follicles
• nnukwu mkpokọta estradiol, ọkachasị mgbe ị na-eji agonist
• mmalite nke afọ ime (4).

Usoro mkpali ovarian ahaziri iche na-enyere aka belata ihe egwu nke OHSS siri ike. N'ọnọdụ ụfọdụ, enwere ike ịnye ọgwụ mgbochi mgbochi ọbara.

Ọgwụgwọ na clomiphene citrate nwere ike iduga n'ọdịdị nke ọrịa anya nke ga-achọ nkwụsị ọgwụgwọ (2% nke ikpe). Ọ na-abawanye ohere nke ime otutu afọ site na 8% na ndị ọrịa anovulatory yana site na 2,6 ruo 7,4% na ndị ọrịa na-agwọ maka infertility idiopathic (5).

Achọpụtara ihe ize ndụ dị ukwuu nke etuto ahụ na-arịa ọrịa cancer na ndị ọrịa na-emeso ndị na-emepụta ovulation, gụnyere clomiphene citrate, na nchọpụta ọrịa abụọ na-efe efe, ma ọtụtụ n'ime nchọpụta ndị a akwadoghị ihe kpatara na mmetụta mmekọrịta (6).

Ọmụmụ OMEGA, gụnyere ihe karịrị ndị ọrịa 25 bụ ndị nwere mkpali ovarian dị ka akụkụ nke usoro IVF, kwubiri, mgbe ihe karịrị afọ 000 gasịrị, na ọ dịghị ihe ize ndụ nke ọrịa ara ara na ihe omume nke mkpali ovarian. (20).