Khov khov ... Rau qee tus poj niam uas raug mob hnyav lossis mob hnyav, cov txheej txheem no ntawm kev kho mob pab kho mob qee zaum tsuas yog kev rov qab los txhawm rau khaws lawv cov kev muaj menyuam thiab cia siab tias yuav pom lawv txoj kev npaj yug menyuam ib hnub dhau los. Tab sis oocyte cryopreservation tseem muaj lwm yam qhia uas feem ntau tsis paub zoo. Txheej txheem cej luam ntawm qhov kev xyaum no hauv Fab Kis.

Khov oocytes, tseem hu ua oocyte cryopreservation, yog ib txoj hauv kev khaws cia kev muaj menyuam. Nws muaj nyob hauv kev noj cov oocytes, tom qab zes qe menyuam txhawb lossis tsis, ua ntej khov lawv hauv cov kua nitrogen thiab khaws cia rau tom qab cev xeeb tub.

Hauv Fab Kis, oocyte cryopreservation tau tswj hwm los ntawm txoj cai lij choj thiab tshwj xeeb tshaj yog tsab xov xwm L-2141-11 ntawm Txoj Cai Kev Noj Qab Haus Huv, zoo li txhua yam kev kho kom muaj menyuam kom ruaj khov (embryonic lossis phev khov, khaws cov ntaub so ntswg los yog cov ntaub so ntswg). Cov ntawv no tau teev tseg tias "txhua tus neeg uas muaj kev saib xyuas mob nkeeg yuav ua rau muaj menyuam tsis taus, lossis muaj kev phom sij rau kev yug menyuam ua ntej tsis taus, tuaj yeem tau txais txiaj ntsig los ntawm kev sau thiab khaws cia ntawm lawv cov gametes [...] pab kev xeeb tub, lossis nrog kev saib xyuas kom khaws thiab rov ua nws txoj kev yug menyuam. "

Qhov no yog qhov tseem ceeb tshaj plaws rau qhov khov ntawm oocyte: tso cai rau cov poj niam khaws lawv cov kev muaj menyuam thaum noj tshuaj hnyav tuaj yeem ua rau lawv puas tsuaj rau zes qe menyuam. Oocyte cryopreservation yog li ntawd feem ntau yog npaj rau cov poj niam uas yuav tsum tau siv tshuaj kho mob (tshwj xeeb yog cov cuam tshuam nrog kev hloov pob txha pob txha) lossis kho hluav taws xob, tshwj xeeb tshaj yog nyob hauv thaj av pelvic.

Nug:

• Cov kev kho mob no muaj tshuaj lom rau lub zes qe menyuam (lawv tau hais tias yog gonadotoxic), cov qe thaum ub (tsis paub qab hau oocytes) thiab ua haujlwm ntawm zes qe menyuam;
• Lawv kuj tseem xav kom cov neeg mob tshem tawm lawv cov phiaj xwm kev yug menyuam ntev, qee zaum los ntawm ob peb xyoos, lub sijhawm los kho qhov kev kho mob thiab kom ntseeg tau tias yuav tsum tau rov qab mus kuaj cev xeeb tub.

Tab sis mob qog noj ntshav tsis yog kab mob nkaus xwb uas tuaj yeem thov khaws cia kev muaj menyuam. Yog li, khov oocyte tuaj yeem pom zoo thaum muaj:

• noj lwm txoj kev kho gonadotoxic. Qhov no yog rooj plaub, piv txwv li, hauv kev tswj hwm kev hloov pauv hauv lub cev lossis kab mob ntawm lub cev tiv thaiv kab mob (tshuaj tiv thaiv kab mob) lossis qee yam kab mob hematological xws li mob ntshav tsis txaus;
• phais uas tuaj yeem cuam tshuam rau kev yug menyuam;
• congenital zes qe menyuam kab mob. Feem ntau yog caj ces, cov kab mob no, xws li Turner syndrome, tuaj yeem ua rau zes qe menyuam tsis tiav ntxov.

Nco tseg: thaum muaj mob, khov lub qe tshwj xeeb tshaj yog pom zoo rau cov poj niam pubescent, feem ntau muaj hnub nyoog qis dua 37 xyoos. Ntawm qhov tod tes, yog tias kev khaws cia ntawm kev yug menyuam tau qhia hauv tus menyuam ntxhais lossis tus tub ntxhais hluas npaj ua ntej, kev rov qab khaws cia cov ntaub so ntswg ntawm zes qe menyuam tuaj yeem nyiam nrog saib ua qhov ua tiav ntawm cov ntaub so ntswg tom qab.

Nyob deb ntawm cov xwm txheej no tshwj xeeb cuam tshuam nrog tus kab mob, muaj lwm qhov qhia txog qhov khov ntawm oocytes: kev hloov poj niam txiv neej.

Qhov tseeb, thaum lub sijhawm hloov pauv poj niam txiv neej, kev pom zoo kho mob lossis phais kho mob kuj tseem tuaj yeem ua rau muaj menyuam tsis taus. Yog li, yog tias koj tab tom pib taug kev li txiv neej, koj yuav raug qhia kom khaws thiab yog li khov koj cov oocytes. Tam sim no tseem muaj qhov tsis paub zoo: kev siv cov khov nab kuab no nyob hauv lub moj khaum ntawm MAP (kev pab kho mob), uas tseem raug txwv los ntawm txoj cai Bioethics siv txij li xyoo 2011. rau cov neeg mob no.

Ib khub niam txiv twb tau cuv npe hauv MAP chav kawm rau kev muaj menyuam ntxiv kuj tseem yuav tsum tau mus rau oocyte cryopreservation yog:

• qhov ua rau nws ua tau kom tau txais supernumerary oocytes uas tsis tuaj yeem ua chiv;
• phev sau tsis nyob rau hnub ntawm hauv vitro fertilization. Lub hom phiaj yog qhov yooj yim: kom tsis txhob "poob" cov gametes raug tshem tawm thiab khaws cia kom txog thaum kev sim tom ntej ntawm IVF.

Ntau lub tebchaws nyob sab Europe tam sim no tso cai rau qhov khov ntawm qhov hu ua "kev nplij siab" oocytes txhawm rau tso cai rau cov poj niam khaws lawv cov khoom noj rau lub cev xeeb tub tom ntej yam tsis muaj kev qhia paub kho mob. Yog li lub hom phiaj yog qhov tseem ceeb kom muaj peev xwm thim rov qab muaj hnub nyoog ntawm kev ua niam tsis muaj kev txom nyem poob qis hauv kev muaj menyuam yaus txuas nrog lub hnub nyoog nce qib.

Hauv Fab Kis, qhov khov ntawm kev nplij siab oocytes (tseem hu ua kev khaws cia tus kheej ntawm oocytes) tam sim no tsuas yog tso cai hauv ib kis: oocyte pub dawb. Thaum pib tshwj tseg rau cov poj niam laus uas twb muaj menyuam lawm, qhov nyiaj pub dawb no tau hloov pauv nrog Txoj Cai Bioethics ntawm Lub Xya Hli 7, 2011. Qhov tshiab ntawm cov ntawv no: nulliparas (poj niam uas tsis muaj menyuam) tam sim no muaj cai pub lawv cov menyuam. oocytes thiab tso cai khaws qee yam ntawm lawv cia siab tias yuav muaj cev xeeb tub tom ntej.

Qhov no khov ntawm oocytes yam tsis muaj ntawv kho mob tseem nyob, txawm li cas los xij, muaj tsawg heev:

• Tus neeg pub nyiaj yuav tsum tau ceeb toom ua ntej ntawm nws txoj kev pheej hmoo ntawm cev xeeb tub los ntawm cov oocytes uas nws muaj peev xwm khaws tau;
• Nws lees paub tias ib nrab ntawm cov oocytes sau yuav raug mob siab rau pub dawb raws li tsawg kawg 5 oocytes (yog tias 5 oocytes lossis tsawg dua tau noj, txhua tus mus pub dawb thiab tsis muaj qhov khov tau rau tus pub dawb);
• Tus neeg pub dawb tsuas tuaj yeem ua ob qho pub dawb xwb.

Qhov tseeb tseem hais tias kev hloov kho ntawm oocyte pub dawb qhib qhov tseeb qhov tseeb rau kev khaws cia tus kheej uas tseem muaj kev sib cav: nws puas yuav qhib rau txhua tus poj niam sab nraud ntawm kev pub dawb, muab qhov kev vam meej ntawm hnub nyoog ntawm kev yug menyuam? Ntawm no dua, kev kho dua ntawm Txoj Cai Bioethics sai sai tuaj yeem muab cov lus teb raug cai rau cov lus nug no. Nyob rau lub sijhawm no, kev kawm hauv zej zog thiab Academy of Medicine tshwj xeeb tau tawm los.

Kev khov ntawm oocytes hnub no yog qhov tseem ceeb raws li txheej txheem: oocyte vitrification. Txoj cai? Cov oocytes tau raus dej ncaj qha rau hauv cov kua nitrogen qhov uas lawv khov heev sai sai ntawm qhov kub ntawm -196 ° C. Muaj txiaj ntsig ntau dua li cov txheej txheem ntawm khov khov yav tas los siv, vitrification ua rau nws muaj peev xwm ua kom muaj kev muaj sia nyob zoo ntawm khov oocytes, tshwj xeeb los ntawm tiv thaiv kev tsim cov muaju uas yav dhau los hloov pauv cov gametes, ua rau lawv siv tsis tau.

Yuav kom ua tau, khov ntawm oocyte yog ib feem ntawm cov txheej txheem kev kho mob. Qhov no txawv nyob ntawm qhov kev kho mob sai thiab tus kab mob uas nug. Yog tias koj txhawj xeeb koj yuav, hauv txhua kis, yuav tsum muaj kev sib tham thawj zaug nrog koj tus kws kho mob uas yuav piav qhia rau koj:

• toxicity ntawm kev kho;
• cov kev daws teeb meem kev txuag menyuam yaus muaj rau koj;
• muaj feem yuav xeeb tub (uas tsis tau lees paub) thiab muaj peev xwm xaiv tau;
• kev tiv thaiv kom tsis txhob muaj menyuam thaum tos rau qhov pib kho.

Tom qab ntawd nws yuav nug koj kom teem sijhawm rau kev sib tham ntau txoj hauv kev los khaws kev muaj menyuam, uas yuav txiav txim siab qhov xwm txheej rau koj kev kho mob. Ob txoj kev xaiv yog ua tau:

• Yog tias koj yog menyuam yaus hnub nyoog, tsis muaj qhov txwv tsis pub siv tshuaj hormonal thiab koj kho (tshuaj kho mob, kho hluav taws xob, thiab lwm yam) tsis nrawm heev, koj txoj kev kho mob yuav pib nrog kev txhawb siab ntawm zes qe menyuam los txhawb kev tuaj txog ntawm qhov loj tshaj ntawm oocytes. Hauv cov ntsiab lus no, koj yuav tau txais txiaj ntsig los ntawm "qub" kev taug qab hauv vitro fertilization: kev txhawb siab, ultrasound thiab tshuaj lom neeg rov qab ua rau, ua rau ovulation thiab oocyte puncture;
• Yog tias koj tsis tuaj yeem muaj kev txhawb siab (koj txoj kev kho mob nrawm, koj muaj qog nqaij hlav cancer-xws li mob qog noj ntshav), koj tus kws kho mob feem ntau yuav pom zoo cov txheej txheem vitrification yam tsis muaj kev txhawb siab. Nws suav nrog dab tsi? Tom qab qhov kev txiav txim ntawm oocytes tsis paub qab hau, cov gametes tau cog qoob loo hauv chav kuaj rau 24 txog 48 teev kom mus txog qhov loj hlob. Qhov no hu ua in vitro maturation (IVM).

Cov laus oocytes yog li tau txais (los ntawm kev txhawb lossis los ntawm IVM) tom qab ntawd khov ua ntej tau siv tom qab hauv cov ntsiab lus ntawm kev kho mob uas tsim nyog yug. Nco tseg: hauv qee kis, tus kws kho mob tuaj yeem pom zoo hauv vitro fertilization ua ntej khov. Tsis txhob ua siab deb tham txog qhov teeb meem nrog koj tus kws kho mob.

Thaum muaj feem yuav xeeb tub tom qab khov khov tau nce ua tsaug rau cov txuj ci tshiab xws li vitrification, nws yog ib qho tseem ceeb kom nco ntsoov tias cev xeeb tub tsis tau lees paub.

Qee cov nuj nqis lees paub qhov no, suav sau los ntawm Academy of Medicine:

• Thaum lub sijhawm vitrification txheej txheem, nruab nrab ntawm 8 thiab 13 oocytes raug sau nyob rau nruab nrab ib hlis;
• Tom qab yaj, 85% ntawm cov tib oocytes no muaj sia nyob;
• Tom qab ntawd, IVF los ntawm ICSI, uas ua rau nws muaj peev xwm fertilize cov oocytes uas seem, muaj qhov ua tiav ntawm 70%.

Cov txiaj ntsig: tag nrho tus nqi cev xeeb tub nrog thaw ntawm oocytes hloov pauv ntawm 4,5 thiab 12% nyob ntawm hnub nyoog thiab kev noj qab haus huv. Nws yog vim li ntawd kwv yees tias nws yog qhov tsim nyog kom ua tiav khov ntawm 15 thiab 20 oocytes kom cia siab tias yuav muaj menyuam. Qhov no feem ntau cuam tshuam ntau qhov kev sau thiab ntau qhov khov kom thaum kawg cia siab tias yuav yog niam txiv.