Ho tsosoa ha mahe a mahe ke phekolo ea li-hormone e reretsoeng, joalo ka ha lebitso la eona le fana ka maikutlo, ho susumetsa mae a bomme e le ho fumana ovulation ea boleng. Sena se hlile se akaretsa liprothokholo tse fapaneng tseo mekhoa ea tsona e fapaneng ho ea ka lipontšo, empa sepheo sa tsona se tšoana: ho fumana bokhachane. Tšusumetso ea mahe a bomme e ka laeloa e le 'ngoe kapa ea ba karolo ea protocol ea ART, haholo-holo maemong a in vitro fertilization (IVF).

Ka mokhoa o hlophisitsoeng, ho na le linyeoe tse peli:

Kalafo e bonolo ea ovulation induction, e behiloeng tabeng ea mathata a ho hlahisa mahe (dysovulation kapa anovulation) ka lebaka la mohlala oa ho ba boima bo feteletseng kapa botenya, polycystic ovary syndrome (PCOS) e sa tsejoeng.

Ho tsosoa ha mahe a mae e le karolo ea protocol ea ART :

• intrauterine insemination (IUU): stimulation of ovulation (hanyenyane tabeng ena) e etsa hore ho khonehe ho hlophisa nako ea ovulation 'me kahoo ho beha peō ea botona (e neng e bokelloa pele le ho lokisoa) ka nako e nepahetseng. molomo oa popelo. Ho tsosoa ho boetse ho etsa hore ho khonehe ho fumana kholo ea li-follicle tse peli 'me kahoo ho eketsa menyetla ea katleho ea ho kenya li-intrificial insemination.
• IVF kapa IVF e nang le intra-cytoplasmic sperm injection (ICSI): sepheo sa ts'usumetso ke ho holisa palo e kholoanyane ea li-oocyte tse hōlileng tsebong e le hore li khone ho nka li-follicle tse 'maloa nakong ea ho phunyeha ha follicular, kahoo ho eketsa menyetla ea ho fumana boleng bo botle. mahe a emolisitsoeng ka IVF.

Ho na le liprothokholo tse fapaneng tsa bolelele bo fapaneng, ho sebelisoa limolek'hule tse fapaneng ho latela matšoao. Ho sebetsa hantle le ho qoba litlamorao, kalafo ea ho hlasimolla mahe a bomme e hlile e etselitsoe motho ka mong.

Seo ho thoeng ke "bonolo" ovulation induction

Sepheo sa eona ke ho khothalletsa kholo ea follicular e le ho fumana tlhahiso ea oocyte e le 'ngoe kapa tse peli tse hōlileng tsebong. Liphekolo tse fapaneng li sebelisoa ho latela mokuli, lilemo tsa hae, sesupo, empa le litloaelo tsa lingaka:

• anti-estrogens: e tsamaisoa ka molomo, clomiphene citrate e sebetsa ka ho thibela li-receptor tsa estrogen hypothalamus, e leng se lebisang ho eketseha ha secretion ea GnRH e leng eona e phahamisang boemo ba FSH ebe joale ea LH. Ke mokhoa oa pele oa phekolo maemong a ho hloka thari ho tsoa ho ovulatory, ntle le ea tlhaho e phahameng (hypothalamus). Ho na le liprothokholo tse fapaneng empa kalafo ea khale e thehiloe matsatsing a 5 a ho nka ho tloha ka letsatsi la 3 kapa la 5 la potoloho (1);
• li-gonadotropins : FSH, LH, FSH + LH kapa gonadotropin ea urinary (HMG). E tsamaisoa letsatsi le leng le le leng nakong ea karolo ea follicular ka tsela e ka tlas'a letlalo, FSH e ikemiselitse ho susumetsa kholo ea oocyte. Ntho e ikhethang ea phekolo ena: feela sehlopha sa follicles se lokiselitsoeng ke ovary se hlohlelletsoa. Ka hona, phekolo ena e boloketsoe basali ba nang le sehlopha se lekaneng sa follicle. Joale e tla fana ka matla a ho tlisa follicles ho butle-butle e atisang ho fetoha ka potlako ho ea ho senyeha. Hape ke mofuta ona oa phekolo o sebelisoang holimo ho IVF. Hona joale ho na le mefuta e 3 ea FSH: FSH e hloekisitsoeng ea urinary, FSH e kopanyang hape (e hlahisoang ke boenjiniere ba liphatsa tsa lefutso) le FSU e nang le ts'ebetso e telele (e sebelisoang feela ka holimo ho IVF). Ka linako tse ling li-gonadotropin tsa urinary (HMGs) li sebelisoa sebakeng sa li-recombinant FSH. LH hangata e sebelisoa hammoho le FSH, haholo-holo ho bakuli ba nang le khaello ea LH.
• pompo ea GnRH e boloketsoe basali ba nang le anovulation ea tlhaho e phahameng (hypothalamus). Sesebelisoa se boima le se theko e boima, se itšetlehile ka tsamaiso ea gonadorelin acetate e etsisang ketso ea GnRH e le ho susumetsa secretion ea FSH le LH.
• metformin hangata e sebelisoa ho alafa lefu la tsoekere, empa ka linako tse ling e sebelisoa e le sehlahisoa sa ovulation ho basali ba nang le PCOS kapa boima bo feteletseng / botenya, ho thibela hyperstimulation ea mahe a bomme (2).

Ho hlahloba katleho ea phekolo, fokotsa kotsi ea hyperstimulation le bokhachane bo bongata, ho hlahloba ovulation ka ultrasounds (ho hlahloba palo le boholo ba follicles tse ntseng li hōla) le litlhahlobo tsa li-hormone (LH, estradiol, progesterone) ka tlhahlobo ea mali e thehoa ho pholletsa le nako. ea protocol.

Ho kopanela liphate ho lokiselitsoe nakong ea ovulation.

Ho tsosoa ha mae a bomme maemong a ART

Ha ts'usumetso ea mahe a bomme e etsahala e le karolo ea IVF kapa AMP protocol ea insemination, kalafo e etsahala ka mekhahlelo e meraro:

• mokhahlelo oa ho thibela : mae a bomme a "ikhutsa" ka lebaka la li-agonists tsa GnRH kapa bahanyetsi ba GnRH, ba thibelang lesela la pituitary;
• mohato oa ts'usumetso ea mahe a bomme : Phekolo ea gonadotropin e fanoa ho susumetsa kholo ea follicular. Tlhokomelo ea ovulation e lumella ho lekola karabelo e nepahetseng kalafong le kholong ea follicle;
• ho qala ha ovulation : ha ultrasound e bonts'a follicles tse holileng (pakeng tsa 14 le 20 mm ka bophara ka karolelano), ovulation e hlahisoa ka tse ling:
  • ente ea urinary (intramuscular) kapa recombinant (subcutaneous) HCG (chorionic gonadotropin);
  • ente ea recombinant LH. E theko e boima haholo, e boloketsoe basali ba kotsing ea hyperstimulation.

Ka mor'a lihora tse 36 ka mor'a ho qala ha li-hormone, ovulation e etsahala. Joale ho phunya follicular ho etsahala.

Kalafo e tšehetsang karolo ea luteal

Ho ntlafatsa boleng ba endometrium le ho khothalletsa ho kenngoa ha lesea le sa tsoa emoloa, phekolo e ka fanoa nakong ea luteal phase (karolo ea bobeli ea potoloho, ka mor'a hore ovulation), e thehiloeng ho progesterone kapa derivatives: dihydrogesterone (ka molomo) kapa progesterone ea micronized (ka molomo kapa botshehadi).

Bothata bo ka sehloohong ba phekolo ea ho susumetsa mahe a bomme ke Ovarian hyperstimulation syndrome (OHSS). 'Mele o arabela ka matla haholo kalafong ea li-hormone, e bakang matšoao a fapaneng a kliniki le a tlhaho a matla a fapaneng: ho se thabise, bohloko, ho nyekeloa ke pelo, mpa e phasolohileng, ho eketseha ha molumo oa mahe a bomme, dyspnea, ho se tloaelehe ho hoholo hoa tlhaho (keketseho ea hematocrit, creatinine e phahameng, ho phahama). li-enzyme tsa sebete, joalo-joalo), ho eketsa boima ba 'mele ka potlako,' me maemong a boima ka ho fetesisa, lefu le matla la ho hema le ho hloleha ho matla ha renal (3).

Ka linako tse ling venous kapa arterial thrombosis e etsahala e le complication ea OHSS e matla. Mabaka a kotsi a tsejoa:

• lefu la polycystic ovary
• palo e tlase ea boima ba 'mele
• lilemo tse ka tlase ho lilemo tse 30
• palo e phahameng ea follicles
• khatello e phahameng ea estradiol, haholo-holo ha u sebelisa agonist
• ho qala ha bokhachane (4).

Protocol ea motho ka mong ea stimulation ovarian e thusa ho fokotsa kotsi ea OHSS e matla. Maemong a mang, ho ka fanoa ka kalafo ea anticoagulant.

Kalafo ka clomiphene citrate e ka lebisa ponahalong ea mathata a mahlo a tla hloka ho khaotsa ho phekola (2% ea linyeoe). E boetse e eketsa kotsi ea ho ima ha makhetlo a mangata ka 8% ho bakuli ba tlositsoeng ka mpeng le ka 2,6 ho isa ho 7,4% ho bakuli ba alafshoang ho hloka thari ea idiopathic (5).

Kotsi e eketsehileng ea lihlahala tsa kankere ho bakuli ba tšoaroang ka li-inducers tsa ovulation, ho akarelletsa le clomiphene citrate, e ile ea hlokomeloa lithutong tse peli tsa epidemiological, empa boholo ba lithuto tse latelang ha lia ka tsa tiisa kamano ea sesosa le phello (6).

Boithuto ba OMEGA, ho kenyeletsoa bakuli ba fetang 25 ba bileng le ts'usumetso ea mahe a bomme e le karolo ea protocol ea IVF, ba fihletse qeto, kamora lilemo tse fetang 000 tsa ho latela, hore ho ne ho se kotsi ea mofets'e oa matsoele ha ho ka ba le ts'usumetso ea mahe a bomme. (20).