Ovarian stimulation yog ib qho kev kho hormonal aimed, raws li nws lub npe qhia, txhawb lub zes qe menyuam kom thiaj li tau txais ovulation zoo. Qhov no yeej suav nrog cov txheej txheem sib txawv uas nws cov txheej txheem sib txawv raws li cov lus qhia, tab sis nws lub hom phiaj yog tib yam: kom tau txais cev xeeb tub. Kev txhawb nqa ntawm zes qe menyuam tuaj yeem raug sau tseg ib leeg lossis yog ib feem ntawm ART raws tu qauv, tshwj xeeb tshaj yog nyob rau hauv cov ntsiab lus ntawm in vitro fertilization (IVF).

Schematically, muaj ob qhov xwm txheej:

Yooj yim ovulation induction kev kho mob, tau sau tseg nyob rau hauv cov ntaub ntawv ntawm ovulation teeb meem (dysovulation los yog anovulation) vim piv txwv li rog dhau los yog rog, polycystic zes qe menyuam syndrome (PCOS) tsis paub keeb kwm.

Ovarian stimulation raws li ib feem ntawm ART raws tu qauv :

• intrauterine insemination (IUU): stimulation ntawm ovulation (me ntsis nyob rau hauv cov ntaub ntawv no) ua rau nws muaj peev xwm mus programme lub sij hawm ntawm ovulation thiab yog li tso cov phev (yav tas los sau thiab npaj) nyob rau hauv lub sij hawm. lub ncauj tsev menyuam. Lub stimulation kuj ua rau nws muaj peev xwm kom tau txais kev loj hlob ntawm ob follicles thiab yog li ua rau kom muaj kev vam meej ntawm cov khoom tsim insemination.
• IVF los yog IVF nrog intra-cytoplasmic phev txhaj (ICSI): lub hom phiaj ntawm qhov stimulation yog ces kom loj hlob ib tug loj tus naj npawb ntawm oocytes mature thiaj li yuav noj tau ob peb follicles thaum lub sij hawm follicular puncture, thiab yog li ua rau kom muaj feem tau zoo. IVF embryo.

Muaj cov txheej txheem sib txawv ntawm qhov sib txawv ntawm qhov ntev, siv cov molecules sib txawv nyob ntawm qhov qhia. Yuav kom ua tau zoo thiab tsis txhob muaj kev phiv, kev kho ntawm zes qe menyuam stimulation yog tus kheej tiag tiag.

Qhov hu ua "yooj yim" ovulation induction

Nws lub hom phiaj yog los txhawb kev loj hlob ntawm follicular thiaj li yuav tau txais kev tsim tawm ntawm ib lossis ob lub oocytes paub tab. Kev kho mob sib txawv yog siv nyob ntawm tus neeg mob, nws lub hnub nyoog, qhov qhia tab sis kuj yog cov kev coj ua ntawm cov kws kho mob:

• tshuaj tiv thaiv estrogens: muab tshuaj rau qhov ncauj, clomiphene citrate ua los ntawm kev thaiv cov tshuaj estrogen receptors hauv hypothalamus, uas ua rau muaj kev nce ntxiv hauv kev zais ntawm GnRH uas ua rau nce qib FSH thiab tom qab ntawd ntawm LH. Nws yog thawj kab kev kho mob nyob rau hauv cov ntaub ntawv ntawm infertility ntawm ovulatory keeb kwm, tshwj tsis yog hais tias ntawm high keeb kwm (hypothalamus). Muaj cov txheej txheem sib txawv tab sis kev kho mob classic yog raws li 5 hnub ntawm kev noj ntawm hnub 3 lossis 5 ntawm lub voj voog (1);
• gonadotropins : FSH, LH, FSH + LH lossis urinary gonadotropins (HMG). Kev tswj hwm txhua hnub thaum lub sijhawm follicular los ntawm txoj kev subcutaneous, FSH lub hom phiaj txhawb kev loj hlob ntawm oocytes. Qhov tshwj xeeb ntawm qhov kev kho mob no: tsuas yog cov follicles npaj los ntawm zes qe menyuam tau txhawb nqa. Qhov kev kho no yog li tshwj tseg rau cov poj niam uas muaj cov follicle loj txaus. Tom qab ntawd nws yuav muab kev txhawb nqa kom coj cov follicles mus rau kev loj hlob uas feem ntau hloov zuj zus sai heev rau degeneration. Nws kuj yog hom kev kho mob no uas yog siv los ntawm IVF. Tam sim no muaj 3 hom FSH: purified urinary FSH, recombinant FSH (tsim los ntawm genetic engineering) thiab FSU nrog kev ua haujlwm ntev (siv tsuas yog ntws ntawm IVF). Urinary gonadotropins (HMGs) qee zaum siv rau qhov chaw ntawm FSH recombinant. LH feem ntau yog siv ua ke nrog FSH, feem ntau hauv cov neeg mob uas tsis muaj LH.
• lub twj tso kua mis GnRH yog tseg rau cov poj niam uas muaj anovulation ntawm lub hauv paus loj (hypothalamus). Ib qho khoom siv hnyav thiab kim, nws yog raws li kev tswj hwm ntawm gonadorelin acetate uas ua raws li qhov kev txiav txim ntawm GnRH txhawm rau txhawm rau txhawb kev tso tawm ntawm FSH thiab LH.
• metformin tshuaj feem ntau yog siv rau hauv kev kho mob ntshav qab zib, tab sis qee zaum siv los ua ovulation inducer rau cov poj niam uas muaj PCOS lossis rog dhau / rog, txhawm rau tiv thaiv zes qe menyuam hyperstimulation (2).

Txhawm rau ntsuas qhov ua tau zoo ntawm kev kho mob, txwv tsis pub muaj kev pheej hmoo ntawm hyperstimulation thiab ntau lub cev xeeb tub, kev soj ntsuam ovulation nrog ultrasounds (los ntsuas tus naj npawb thiab qhov loj ntawm cov follicles loj hlob) thiab kev soj ntsuam hormonal (LH, estradiol, progesterone) los ntawm kev kuaj ntshav yog teem rau txhua lub sijhawm. ntawm tus txheej txheem.

Kev sib deev yog teem caij thaum ovulation.

Kev tsim lub zes qe menyuam hauv cov ntsiab lus ntawm ART

Thaum lub zes qe menyuam stimulation tshwm sim raws li ib feem ntawm IVF los yog cov khoom tsim tawm AMP raws tu qauv, kev kho mob tshwm sim hauv 3 theem:

• lub sijhawm thaiv : lub zes qe menyuam yog "tso tseg" ua tsaug rau GnRH agonists lossis GnRH antagonists, uas thaiv cov qog pituitary;
• theem ntawm zes qe menyuam stimulation : Gonadotropin therapy yog muab los txhawb kev loj hlob ntawm follicular. Kev soj ntsuam ovulation tso cai saib xyuas cov lus teb kom raug rau kev kho mob thiab kev loj hlob ntawm follicle;
• pib ntawm ovulation : Thaum lub ultrasound qhia cov pob txha loj (nruab nrab ntawm 14 thiab 20 mm nyob rau hauv txoj kab uas hla ntawm qhov nruab nrab), ovulation yog tshwm sim nrog ob qho tib si:
  • txhaj tshuaj urinary (intramuscular) los yog recombinant (subcutaneous) HCG (chorionic gonadotropin);
  • txhaj tshuaj recombinant LH. Ntau kim, nws yog tshwj tseg rau cov poj niam uas muaj kev pheej hmoo ntawm hyperstimulation.

36 teev tom qab hormonal tshwm sim, ovulation tshwm sim. Tom qab ntawd lub follicular puncture yuav tshwm sim.

Txhawb kev kho mob ntawm luteal theem

Txhawm rau txhim kho qhov zoo ntawm endometrium thiab txhawb kev cog qoob loo ntawm embryo, kev kho mob tuaj yeem muab rau lub sijhawm luteal (thib ob ntawm lub voj voog, tom qab ovulation), raws li progesterone los yog derivatives: dihydrogesterone (los ntawm qhov ncauj) lossis micronized progesterone (qhov ncauj lossis qhov chaw mos).

Qhov teeb meem tseem ceeb ntawm kev kho zes qe menyuam stimulation yog zes qe menyuam hyperstimulation syndrome (OHSS). Lub cev teb rau cov kev kho mob hormonal ntau dhau, ua rau muaj ntau yam kev kho mob thiab cov cim qhia txog kev sib txawv ntawm qhov hnyav: tsis xis nyob, mob, xeev siab, plab plab, nce hauv qhov ntim ntawm zes qe menyuam, ua tsis taus pa, ntau dua lossis tsawg dua kev puas siab puas ntsws loj (nce hematocrit, siab creatinine, daim siab enzymes, thiab lwm yam), qhov hnyav nce sai, thiab qhov mob hnyav tshaj plaws, mob ua pa nyuaj siab thiab mob raum tsis ua haujlwm (3).

Venous lossis arterial thrombosis qee zaum tshwm sim raws li qhov teeb meem ntawm OHSS hnyav. Cov xwm txheej txaus ntshai tau paub:

• polycystic zes qe menyuam mob
• tsawg lub cev huab hwm coj index
• muaj hnub nyoog qis dua 30 xyoo
• muaj pes tsawg leeg ntawm follicles
• ib tug siab concentration ntawm estradiol, tshwj xeeb tshaj yog thaum siv ib tug agonist
• qhov pib ntawm cev xeeb tub (4).

Tus kheej txoj cai stimulation ntawm zes qe menyuam pab txo qhov kev pheej hmoo ntawm OHSS hnyav. Qee zaum, kev tiv thaiv anticoagulant kho yuav raug sau tseg.

Kev kho mob nrog clomiphene citrate tuaj yeem ua rau pom qhov muag tsis pom kev uas yuav tsum tau txiav kev kho mob ntxiv (2% ntawm cov neeg mob). Nws kuj ua rau muaj kev pheej hmoo ntau ntawm cev xeeb tub los ntawm 8% hauv cov neeg mob anovulatory thiab los ntawm 2,6 txog 7,4% hauv cov neeg mob kho rau idiopathic infertility (5).

Muaj kev pheej hmoo ntawm cov qog nqaij hlav cancer hauv cov neeg mob kho nrog ovulation inducers, suav nrog clomiphene citrate, tau sau tseg hauv ob txoj kev tshawb fawb txog kev kis mob, tab sis feem ntau ntawm cov kev tshawb fawb hauv qab no tsis tau lees paub qhov ua rau thiab kev sib raug zoo (6).

Txoj kev tshawb fawb OMEGA, suav nrog ntau dua 25 tus neeg mob uas tau txais kev txhawb nqa ntawm zes qe menyuam raws li ib feem ntawm IVF raws tu qauv, xaus lus, tom qab ntau tshaj 000 xyoo ntawm kev soj ntsuam, tias tsis muaj kev pheej hmoo ntawm mob qog noj ntshav hauv qhov tshwm sim ntawm zes qe menyuam stimulation. (20).