Ukugqugquzelwa kwe-Ovarian kuyindlela yokwelapha yama-hormone okuhloswe ngayo, njengoba igama layo libonisa, ukuvuselela ama-ovari ukuze kutholwe i-ovulation yekhwalithi. Lokhu empeleni kuhlanganisa amaphrothokholi ahlukene amasu awo ahluka ngokwezinkomba, kodwa inhloso yawo efanayo: ukuthola ukukhulelwa. Ukugqugquzelwa kwe-ovarian kunganqunywa kukodwa noma kube yingxenye yephrothokholi ye-ART, ikakhulukazi kumongo we-in vitro fertilization (IVF).

Ngokohlelo, kunezimo ezimbili:

Ukwelashwa kokungeniswa kwe-ovulation okulula, enqunywe uma kwenzeka ukuphazamiseka kwe-ovulation (i-dysovulation noma i-anovulation) ngenxa yesibonelo sokukhuluphala ngokweqile noma ukukhuluphala, i-polycystic ovary syndrome (PCOS) engaziwa imvelaphi.

Ukukhuthazwa kwe-Ovarian njengengxenye yephrothokholi ye-ART :

• i-intrauterine insemination (IUU): ukugqugquzelwa kwe-ovulation (kancane kulokhu) kwenza kube nokwenzeka ukuhlela umzuzu we-ovulation futhi ngaleyo ndlela kufakwe isidoda (esiqoqwe ngaphambili futhi silungiselelwe) ngesikhathi esifanele. umlomo wesibeletho. Ukugqugquzela futhi kwenza kube nokwenzeka ukuthola ukukhula kwama-follicles amabili futhi ngaleyo ndlela kwandiswe amathuba okuphumelela kokufakelwa kokufakelwa.
• I-IVF noma i-IVF enomjovo we-intra-cytoplasmic sperm (ICSI): inhloso yokuvuselela iwukuba ukuvuthwa inani elikhulu lama-oocyte avuthiwe ukuze ukwazi ukuthatha ama-follicle amaningana ngesikhathi sokubhoboza kwe-follicular, futhi ngaleyo ndlela andise amathuba okuthola ikhwalithi enhle. imibungu nge-IVF.

Kunamaphrothokholi ahlukene anobude obuhlukahlukene, kusetshenziswa ama-molecule ahlukene kuye ngezinkomba. Ukuze kusebenze futhi kugweme imiphumela emibi, ukwelashwa kokuvuselela i-ovarian kwenziwa kube ngokwakho.

Okubizwa ngokuthi "okulula" ovulation induction

Inhloso yayo ukukhuthaza ukukhula kwe-follicular ukuze kutholwe ukukhiqizwa kwe-oocyte eyodwa noma amabili avuthiwe. Izindlela zokwelapha ezihlukene zisetshenziswa ngokuya ngesiguli, iminyaka yaso, inkomba kodwa futhi nemikhuba yabasebenzi:

• ama-anti-estrogens: alawulwa ngomlomo, i-clomiphene citrate isebenza ngokuvimbela ama-estrogen receptors ku-hypothalamus, okuholela ekwandeni kokukhushulwa kwe-GnRH okubuye kuphakamise izinga le-FSH bese kuba yi-LH. Ukwelashwa komugqa wokuqala ezimeni zokungazali komsuka we-ovulatory, ngaphandle kwaleyo yomsuka ophezulu (hypothalamus). Kunezimiso eziyisisekelo ezihlukene kodwa ukwelashwa kwakudala kusekelwe ezinsukwini ezi-5 zokuthatha kusukela osukwini lwesi-3 noma lwesi-5 lomjikelezo (1);
• i-gonadotropins : FSH, LH, FSH + LH noma i-gonadotropin yomchamo (HMG). Ilawulwa nsuku zonke phakathi nesigaba se-follicular ngomzila ongaphansi kwesikhumba, i-FSH ihlose ukugqugquzela ukukhula kwama-oocyte. Okukhethekile kwalokhu kwelashwa: kuphela iqoqo le-follicles elilungiselelwe i-ovary liyakhuthazwa. Ngakho-ke lokhu kwelashwa kugcinelwe abesifazane abaneqoqo le-follicle elikhulu ngokwanele. Izobe isinikeza amandla ukuletha ama-follicles ekuvuthweni okuvame ukuvela ngokushesha kakhulu ekuwohlokeni. Kuphinde kube yilolu hlobo lokwelapha olusetshenziswa enhla ne-IVF. Njengamanje kunezinhlobo ezi-3 ze-FSH: i-purified urinary FSH, i-FSH ephindayo (ekhiqizwe ubunjiniyela bezakhi zofuzo) kanye ne-FSU enomsebenzi omude (esetshenziswa kuphela enhla nomfula we-IVF). I-Urinary gonadotropins (HMGs) ngezinye izikhathi isetshenziswa esikhundleni se-FSH ehlanganisiwe. I-LH ngokuvamile isetshenziswa ngokuhambisana ne-FSH, ikakhulukazi ezigulini ezinokuntuleka kwe-LH.
• iphampu ye-GnRH igcinelwe abesifazane abane-anovulation yemvelaphi ephezulu (hypothalamus). Idivayisi esindayo futhi ebizayo, isekelwe ekuphathweni kwe-gonadorelin acetate elingisa isenzo se-GnRH ukuze ikhuthaze ukukhishwa kwe-FSH ne-LH.
• i-metformin imvamisa isetshenziswa ekwelapheni isifo sikashukela, kepha kwesinye isikhathi isetshenziswa njenge-ovulation inducer kwabesifazane abane-PCOS noma ukukhuluphala ngokweqile / ukukhuluphala, ukuvimbela i-ovarian hyperstimulation (2).

Ukuhlola ukusebenza kahle kokwelashwa, nciphisa ubungozi be-hyperstimulation kanye nokukhulelwa okuningi, ukuqapha i-ovulation nge-ultrasounds (ukuhlola inombolo nosayizi wama-follicle akhulayo) kanye nokuhlolwa kwamahomoni (LH, estradiol, progesterone) ngokuhlolwa kwegazi kusethwa kuso sonke isikhathi. yephrothokholi.

Ukuya ocansini kuhlelwe ngesikhathi se-ovulation.

Ukugqugquzelwa kwe-Ovarian kumongo we-ART

Uma ukugqugquzelwa kwesibeletho kwenzeka njengengxenye ye-IVF noma i-artificial insemination AMP protocol, ukwelashwa kwenzeka ngezigaba ezi-3:

• isigaba sokuvimba : ama-ovari "aphumule" ngenxa ye-GnRH agonists noma abaphikisi be-GnRH, abavimba indlala ye-pituitary;
• isigaba sokuvuselela i-ovarian : Ukwelashwa kwe-gonadotropin kunikezwa ukukhuthaza ukukhula kwe-follicular. Ukuqapha kwe-ovulation kuvumela ukuqapha impendulo efanele ekwelapheni nasekukhuleni kwe-follicle;
• ukuqala kwe-ovulation : uma i-ultrasound ibonisa ama-follicle avuthiwe (phakathi kuka-14 no-20 mm ububanzi ngokwesilinganiso), ukukhishwa kweqanda kuqalwa ngokuthi:
  • umjovo we-urinary (intramuscular) noma i-recombinant (subcutaneous) HCG (chorionic gonadotropin);
  • umjovo we-recombinant LH. Okubiza kakhulu, kugcinelwe abesifazane abasengozini ye-hyperstimulation.

Emahoreni angama-36 ngemuva kokuqalwa kwe-hormonal, i-ovulation iyenzeka. Khona-ke i-follicular puncture iyenzeka.

Ukwelashwa okusekelayo kwesigaba se-luteal

Ukuze kuthuthukiswe ikhwalithi ye-endometrium futhi kukhuthaze ukufakwa kombungu, ukwelashwa kunganikezwa ngesikhathi sesigaba se-luteal (ingxenye yesibili yomjikelezo, ngemva kokuphuma kweqanda), ngokusekelwe ku-progesterone noma okuphuma kuyo: i-dihydrogesterone (ngomlomo) noma i-progesterone encane (ngomlomo noma isitho sangasese sowesifazane).

Inkinga eyinhloko yokwelashwa kwe-ovarian stimulation i-ovarian hyperstimulation syndrome (OHSS). Umzimba usabela ngokuqinile ekwelashweni kwama-hormone, okuholela ezimpawu ezahlukahlukene zomtholampilo nezebhayoloji zobunzima obuhlukahlukene: ukungaphatheki kahle, izinhlungu, isicanucanu, isisu esivulekile, ukwanda kwevolumu yesibeletho, i-dyspnea, ukungahambi kahle kwebhayoloji okungaphezulu noma okuncane kakhulu (ukwanda kwe-hematocrit, i-creatinine ephakeme, ukuphakama okuphakeme). ama-enzyme esibindi, njll.), ukuzuza kwesisindo esisheshayo, futhi ezimeni ezinzima kakhulu, i-acute Respiratory Distress Syndrome kanye nokwehluleka kwe-renal acute (3).

I-venous noma i-arterial thrombosis ngezinye izikhathi kwenzeka njengenkinga ye-OHSS enzima. Izici zobungozi ziyaziwa:

• isifo se-polycystic ovary syndrome
• inkomba yesisindo somzimba ephansi
• iminyaka engaphansi kweminyaka engama-30
• inani eliphezulu lama-follicles
• ukuhlushwa okuphezulu kwe-estradiol, ikakhulukazi uma usebenzisa i-agonist
• ukuqala kokukhulelwa (4).

Iphrothokholi yomuntu siqu yokuvuselela i-ovarian isiza ukunciphisa ubungozi be-OHSS eqinile. Kwezinye izimo, ukwelashwa kwe-anticoagulant yokuvimbela kungase kunqunywe.

Ukwelashwa nge-clomiphene citrate kungaholela ekubukeni kokuphazamiseka kwamehlo okuzodinga ukuyeka ukwelashwa (2% wamacala). Kuphinde kwenyuse ingozi yokukhulelwa kaningi ngamaphesenti angu-8 ezigulini ezikhishwa i-anovulatory kanye namaphesenti angu-2,6 kuya kwangu-7,4 ezigulini ezilashelwa ukungazali kwe-idiopathic (5).

Ingozi eyengeziwe yezimila ezinomdlavuza ezigulini eziphathwa ngama-ovulation inducers, kuhlanganise ne-clomiphene citrate, yaphawulwa ezifundweni ezimbili ze-epidemiological, kodwa iningi lezifundo ezilandelayo azizange ziqinisekise ubuhlobo bembangela nomphumela (6).

Ucwaningo lwe-OMEGA, okuhlanganisa iziguli ezingaphezu kuka-25 ezathola ukukhuthazwa kwe-ovarian njengengxenye ye-IVF protocol, lwaphetha, ngemva kweminyaka engaphezu kwe-000 yokulandelela, ukuthi kwakungekho ingozi yomdlavuza webele uma kwenzeka ukukhuthazwa kwe-ovarian. (20).