ʻO ka hoʻoulu ʻana i ka ovarian kahi lapaʻau hormonal i manaʻo ʻia, e like me ka manaʻo o kona inoa, e hoʻoulu i nā ovaries i mea e loaʻa ai ka ovulation maikaʻi. Hoʻopili maoli kēia i nā protocols ʻokoʻa kona ʻano hana e like me nā hōʻailona, ​​​​akā ʻo ka pahuhopu like ʻole: ka loaʻa ʻana o ka hāpai ʻana. Hiki ke kuhikuhi ʻia ka hoʻoulu ʻana i ka ovarian wale nō a i ʻole he ʻāpana o ka protocol ART, ʻoi aku ka nui o ka pōʻaiapili o ka in vitro fertilization (IVF).

Ma ka schematically, ʻelua mau hihia:

Hoʻomaʻamaʻa maʻalahi ovulation induction, kuhikuhi ʻia i ka hihia o nā maʻi ovulation (dysovulation a i ʻole anovulation) ma muli o ka laʻana i ke kaumaha nui a i ʻole ka momona, polycystic ovary syndrome (PCOS) ʻike ʻole ʻia ke kumu.

ʻO ka hoʻoulu ʻana o Ovarian ma ke ʻano he ʻāpana o kahi protocol ART :

• intrauterine insemination (IUU): stimulation o ka ovulation (liʻiliʻi i loko o keia hihia) hiki ke papahana i ka manawa o ka ovulation a pela e waiho ai i ka sperm (i ohi mua ia a hoomakaukauia) i ka manawa kupono. ʻōpū. ʻO ka hoʻouluʻana hoʻi e hiki ai ke loaʻa ka uluʻana o nā folliclesʻelua a pēlā e hoʻonui ai i ka holomua o ka insemination artificial.
• IVF a i ʻole IVF me ka intra-cytoplasmic sperm injection (ICSI): ʻo ka pahuhopu o ka hoʻoulu ʻana ʻo ia ke oʻo i ka nui o nā oocytes makua i hiki ke lawe i kekahi mau follicles i ka wā follicular puncture, a pēlā e hoʻonui ai i ka manawa e loaʻa ai ka maikaʻi maikaʻi. nā embryos e IVF.

Aia nā protocols like ʻole o ka lōʻihi, me ka hoʻohana ʻana i nā molekala like ʻole e pili ana i nā hōʻailona. No ka maikaʻi a pale i nā hopena ʻaoʻao, hoʻopilikino maoli ʻia ka lāʻau hoʻoulu ʻana o ka ovarian.

ʻO ka mea i kapa ʻia ʻo "maʻalahi" ovulation induction

ʻO kāna pahuhopu ka hoʻoikaika ʻana i ka ulu follicular i mea e loaʻa ai ka hana ʻana o hoʻokahi a ʻelua paha oocytes makua. Hoʻohana ʻia nā lāʻau lapaʻau like ʻole e pili ana i ka mea maʻi, kona mau makahiki, ka hōʻailona akā ʻo nā hana a nā mea hoʻomaʻamaʻa:

• anti-estrogens: lawelawe waha, clomiphene citrate hana ma ka ālai 'ana i ka estrogen receptors i loko o ka hypothalamus, e alakai i ka hoonui i ka huna o GnRH i ka mea e hoala i ka pae o FSH a laila o LH . ʻO ia ka lāʻau lapaʻau mua i nā hihia o ka infertility o ke kumu ovulatory, koe wale nō ke kumu kiʻekiʻe (hypothalamus). Aia nā protocols ʻokoʻa akā ʻo ka mālama maʻamau e pili ana i nā lā 5 o ka lawe ʻana mai ka lā 3 a i ʻole 5 o ka pōʻai (1);
• nā gonadotropins : FSH, LH, FSH + LH a i ʻole gonadotropins mimi (HMG). Hoʻohana ʻia i kēlā me kēia lā i ka wā follicular ma ke ala subcutaneous, manaʻo ʻo FSH e hoʻoulu i ka ulu ʻana o nā oocytes. ʻO ka ʻokoʻa o kēia lapaʻau: ʻo ka cohort o nā follicles i hoʻomākaukau ʻia e ka ovary e hoʻoulu ʻia. No laila ua mālama ʻia kēia lāʻau lapaʻau no nā wahine me ka nui o ka follicle cohort. A laila e hāʻawi i ka hoʻoikaika e lawe i nā follicles i ka oʻo ʻana e ulu wikiwiki loa i ka degeneration. ʻO ia hoʻi kēia ʻano lapaʻau i hoʻohana ʻia i luna o IVF. Aia i kēia manawa 3 ʻano FSH: FSH mimi hoʻomaʻemaʻe, FSH recombinant (i hana ʻia e ka ʻenekinia genetic) a me FSU me ka hana lōʻihi (hoʻohana ʻia i luna o IVF wale nō). Hoʻohana ʻia nā gonadotropins urinary (HMGs) ma kahi o FSH recombinant. Hoʻohana pinepine ʻia ʻo LH i ka hui pū ʻana me FSH, ka mea nui i nā maʻi me ka hemahema LH.
• ka paila GnRH Ua mālama ʻia no nā wahine me ka avulation o ke kumu kiʻekiʻe (hypothalamus). ʻO kahi mea kaumaha a me ke kumukūʻai, ua hoʻokumu ʻia ma ka hoʻokele ʻana o ka gonadorelin acetate e hoʻohālike i ka hana a GnRH i mea e hoʻoulu ai i ka huna o FSH a me LH.
• metformin Hoʻohana maʻamau i ka mālama ʻana i ka maʻi diabetes, akā hoʻohana ʻia i kekahi manawa ma ke ʻano he ovulation inducer i nā wahine me ka PCOS a i ʻole ke kaumaha nui / ka momona, e pale ai i ka hyperstimulation ovarian (2).

No ka loiloi ʻana i ka maikaʻi o ka mālama ʻana, e kaupalena i ka hopena o ka hyperstimulation a me ka hāpai ʻana he nui, ka nānā ʻana i ka ovulation me nā ultrasounds (e loiloi i ka helu a me ka nui o nā follicles e ulu ana) a me nā hoʻāʻo hormonal (LH, estradiol, progesterone) e ka hoʻāʻo koko i hoʻonohonoho ʻia a puni ka lōʻihi. o ka protocol.

Hoʻonohonoho ʻia ka moe kolohe i ka wā o ka ovulation.

ʻO ka hoʻoulu ʻana o ka ovarian i ka pōʻaiapili o ART

Ke hana ʻia ka hoʻoulu ʻana o ka ovarian ma ke ʻano he ʻāpana o ka IVF a i ʻole ka insemination artificial AMP protocol, e mālama ʻia ka mālama ʻana i 3 mau manawa:

• ka hana ālai : "hoʻomaha" nā ovaries i nā agonists GnRH a i ʻole GnRH antagonists, nāna e pale i ka pituitary gland;
• ka pae hoʻoulu ovarian : Hāʻawi ʻia ka lāʻau gonadotropin e hoʻoulu i ka ulu follicular. ʻO ka nānā ʻana i ka ovulation hiki ke nānā i ka pane pololei i ka mālama ʻana a me ka ulu ʻana o ka follicle;
• ka hoʻomaka ʻana o ka ovulation : ke hōʻike ka ultrasound i nā follicles makua (ma waena o 14 a me 20 mm ke anawaena ma ka awelika), hoʻomaka ka ovulation me kekahi:
  • hoʻokomo ʻia o ka mimi (intramuscular) a i ʻole recombinant (subcutaneous) HCG (chorionic gonadotropin);
  • he injection o LH recombinant. ʻOi aku ke kumukūʻai, ua mālama ʻia no nā wahine i ka pilikia o ka hyperstimulation.

36 mau hola ma hope o ka hoʻomaka ʻana o ka hormonal, hoʻomaka ka ovulation. A laila e hana ʻia ka ʻoki follicular.

Kākoʻo ka mālama ʻana i ka pae luteal

No ka hoʻomaikaʻi ʻana i ka maikaʻi o ka endometrium a hoʻoikaika i ka hoʻokomo ʻana o ka embryo, hiki ke hāʻawi ʻia ka lāʻau lapaʻau i ka wā luteal (hapa ʻelua o ka pōʻai, ma hope o ka ovulation), e pili ana i ka progesterone a i ʻole derivatives: dihydrogesterone (ma ka waha) a i ʻole micronized progesterone (waha a i ʻole. vaginal).

ʻO ka pilikia nui o nā lāʻau hoʻoikaika ovarian ovarian hyperstimulation syndrome (OHSS). Ke pane ikaika nei ke kino i ka mālama ʻana i ka hormonal, ka hopena i nā hōʻailona like ʻole o ke kino a me ke ʻano o ka ʻino: ʻeha, ʻeha, nausea, ʻōpū ʻōpū, hoʻonui i ka nui o ka ovarian, dyspnea, ʻoi aku a ʻoi aku ka liʻiliʻi o nā mea ola kino (hoʻonui hematocrit, kiʻekiʻe creatinine, kiʻekiʻe. nā enzymes o ke akepaʻa, a me nā mea'ē aʻe), ka piʻi wikiwikiʻana o ke kaumaha, a ma nā hihia koʻikoʻi loa, ka maʻi pilikia o ka hanu hanu a me ka hanaʻole o ka renal (3).

ʻO ka thrombosis venous a i ʻole arterial thrombosis i kekahi manawa ma ke ʻano he hoʻopiʻi o ka OHSS koʻikoʻi. ʻIke ʻia nā kumu pilikia:

• ʻO ka maʻi o ka polycystic ovary
• he helu helu kino haʻahaʻa
• makahiki ma lalo o 30 makahiki
• he helu kiʻekiʻe o nā follicles
• kahi kiʻekiʻe o ka estradiol, ʻoi aku ka nui o ka hoʻohana ʻana i kahi agonist
• ka hoʻomaka ʻana o ka hāpai ʻana (4).

ʻO kahi protocol hoʻoikaika kino ovarian e kōkua i ka hōʻemi i ka pilikia o ka OHSS koʻikoʻi. I kekahi mau hihia, hiki ke kuhikuhi ʻia ka anticoagulant therapy.

ʻO ka mālama ʻana me ka clomiphene citrate hiki ke alakaʻi i ke ʻano o nā maʻi maka e koi ai e hoʻopau i ka mālama ʻana (2% o nā hihia). Hoʻonui ia i ka nui o ka hāpai ʻana e 8% i nā mea maʻi anovulatory a me 2,6 a i 7,4% i nā maʻi i mālama ʻia no ka infertility idiopathic (5).

ʻO ka nui o ka pilikia o nā maʻi maʻi kanesa i nā maʻi i mālama ʻia me nā inducers ovulation, me ka clomiphene citrate, i ʻike ʻia i loko o ʻelua mau noiʻi epidemiological, akā ʻo ka hapa nui o kēia mau haʻawina ʻaʻole i hōʻoia i kahi pilina kumu a me ka hopena (6).

ʻO ke aʻo ʻana o OMEGA, me ka ʻoi aku o 25 mau maʻi i loaʻa i ka hoʻoulu ʻana o ka ovarian ma ke ʻano he ʻāpana o ka protocol IVF, ua hoʻoholo ʻia, ma hope o 000 mau makahiki o ka hahai ʻana, ʻaʻohe pilikia o ka umauma maʻi i ka wā o ka hoʻoulu ʻana o ka ovarian. (20).