Kicinta ugxansidaha waa daawaynta hoormoonka loogu talagalay, sida magaceeda ka muuqata, si loo kiciyo ugxan-sidaha si loo helo ugxan tayo leh. Tani dhab ahaantii waxay dabooshaa hab-maamuusyo kala duwan oo hababkoodu ku kala duwan yihiin sida calaamadaha, laakiin hadafkoodu waa isku mid: si loo helo uur. Kicinta ugxansidaha waxa lagu qori karaa kaligii ama waxa ay noqon kartaa qayb ka mid ah borotokoolka ART, gaar ahaan marka la eego macnaha bacriminta vitro (IVF).

Schematically, waxaa jira laba xaaladood:

Daawaynta kicinta ugxanta fudud, oo loo qoray xaaladaha cilladaha ugxan-sidaha (dysovulation ama anovulation) oo ay ugu wacan tahay tusaale ahaan culeyska ama buurnaanta, polycystic ovary syndrome (PCOS) oo aan la garanayn meesha uu ka yimid.

Kicinta ugxansidaha oo qayb ka ah borotokoolka ART :

• intrauterine insemination (IUU): kicinta ugxan-sidaha (wax yar kiiskan) ayaa suurtogal ka dhigaya in la qorsheeyo xilliga ugxanta iyo sidaas darteed in lagu shubo shahwada (horay loo ururiyey oo loo diyaariyey) wakhtiga saxda ah. makaanka afkiisa Kicinta ayaa sidoo kale suurtogal ka dhigaysa in la helo korriinka laba follicles sidaas darteedna waxay kordhisaa fursadaha guusha ee bacriminta macmalka ah.
• IVF ama IVF oo leh cirbadeynta shahwada intra-cytoplasmic (ICSI): Ujeedada kicinta ayaa markaa ah in la bisleeyo tiro badan oo oocytes ah si ay u awoodaan inay qaataan dhowr follicles inta lagu jiro daloolinta follicular, oo sidaas awgeed kordhiso fursadaha helitaanka tayo wanaagsan embriyaha ee IVF.

Waxaa jira xeerar kala duwan oo dhererkoodu kala duwan yahay, iyadoo la isticmaalayo unugyo kala duwan iyadoo ku xiran calaamadaha. Si aad u noqoto mid waxtar leh oo looga fogaado dhibaatooyinka soo raaca, daaweynta kicinta ugxan-sidaha dhab ahaantii waa mid shakhsi ahaaneed.

Waxa loogu yeero "fudud" ugxansidaha

Ujeeddadeedu waa in kor loo qaado koritaanka follicular si loo helo wax soo saarka hal ama laba oocytes oo qaan-gaar ah. Daawooyin kala duwan ayaa loo isticmaalaa iyadoo ku xiran bukaanka, da'deeda, tilmaanta laakiin sidoo kale dhaqamada takhaatiirta:

• anti-estrogens: afka laga maamulo, clomiphene citrate citrate u dhaqmo iyada oo xannibaya reseptors estrogen ee hypothalamus, taas oo keenta in kororka dheecaanka GnRH taas oo kor u qaadaysa heerka FSH ka dibna LH. Waa daaweynta safka koowaad ee kiisaska dhalmo la'aanta asalka ugxan-sidaha, marka laga reebo kuwa asalkoodu sarreeyo (hypothalamus). Waxaa jira hab-maamuusyo kala duwan laakiin daaweynta caadiga ah waxay ku saleysan tahay 5 maalmood oo ka soo qaadashada maalinta 3rd ama 5th ee wareegga (1);
• gonadotropins FSH, LH, FSH + LH ama gonadotropins kaadida (HMG). Waxaa la maamulaa maalin kasta inta lagu jiro marxaladda follicular ee dariiqa maqaarka hoostiisa, FSH waxay rabta in ay kiciso koritaanka oocytes. Gaar ahaan daaweyntan: kaliya kooxda follicles ee ay diyaarisay ugxan-sidaha ayaa la kiciyaa. Sidaa darteed daawayntan waxaa loogu talagalay haweenka leh koox follicle ah oo ku filan. Waxay markaas siin doontaa korriin si ay xubnuhu u koraan kuwaas oo caadi ahaan si degdeg ah ugu xuubsiibtaa xumaansho. Sidoo kale waa daaweynta noocaan ah ee loo isticmaalo kor u kaca IVF. Hadda waxa jira 3 nooc oo FSH ah: FSH kaadida oo la safeeyey, FSH recombinant (oo ay soo saartay injineernimada hidde-sideyaasha) iyo FSU oo leh hawlo daba dheeraada (loo isticmaalo oo keliya korka IVF). Gonadotropins-ka kaadida (HMGs) ayaa mararka qaarkood loo isticmaalaa meel FSH-da dib-u-habaynta. LH waxaa guud ahaan loo isticmaalaa marka lagu daro FSH, badiyaa bukaanada qaba yaraanta LH.
• bamka GnRH waxaa loogu talagalay haweenka leh anovulation asal ahaan sare (hypothalamus). Qalab culus oo qaali ah, waxay ku salaysan tahay maamulka gonadorelin acetate kaas oo u ekeysiiya ficilka GnRH si loo kiciyo dheecaanka FSH iyo LH.
• metformin inta badan waxaa loo isticmaalaa daawaynta sonkorowga, laakiin mararka qaarkood waxaa loo isticmaalaa sidii kicinta ugxan-sidaha haweenka qaba PCOS ama cayilka xad dhaafka ah, si looga hortago kicinta ugxan-sidaha (2).

Si loo qiimeeyo waxtarka daaweynta, xaddid khatarta hyperstimulation iyo uur badan, la socodka ugxan-sidaha ee ultrasounds (si loo qiimeeyo tirada iyo cabbirka follicles sii kordhaya) iyo baaritaanka hormoonnada (LH, estradiol, progesterone) by baaritaanka dhiigga ayaa la dhigay inta lagu guda jiro muddada. ee borotokoolka.

Galmada waxaa la qorsheeyey xilliga ugxan-sidaha.

Kicinta ugxansidaha ee macnaha guud ee ART

Marka kicinta ugxan-sidaha ay u dhacdo qayb ka mid ah IVF ama borotokoolka bacriminta macmalka ah ee AMP, daaweyntu waxay u dhacdaa 3 waji:

• marxaladda xannibaadda : ugxan-sidaha ayaa "la nasiyaa" iyada oo ay ugu mahadcelinayaan GnRH agonists ama GnRH antagonists, kuwaas oo xannibaya qanjidhada pituitary;
• wajiga kicinta ugxansidaha : Daaweynta gonadotropin waxaa la siiyaa si loo kiciyo koritaanka follicular. La socodka ugxantu waxay ogolaataa la socodka jawaabta saxda ah ee daaweynta iyo koritaanka follicle;
• bilawga ugxansidaha : marka ultrasound uu muujiyo follicles bislaaday (inta u dhaxaysa 14 iyo 20 mm dhexroor celcelis ahaan), ugxantu waxa ay kacdaa midkood:
  • cirbadeynta kaadida (muruqa gudaha) ama dib-u-habaynta (subcutaneous) HCG (gonadotropin chorionic);
  • irbad dib-u-habayn LH. Aad qaali u ah, waxaa loogu talagalay dumarka khatarta ugu jira kicinta.

36 saacadood kadib kicinta hormoonka, ugxantu waxay dhacdaa. Daloolinta follicular ayaa markaa dhacaysa.

Daaweynta taageerada ah ee wajiga luteal

Si loo hagaajiyo tayada endometrium iyo kor u qaadista embriyaha, daaweynta waxaa la bixin karaa inta lagu jiro marxaladda luteal (qaybta labaad ee wareegga, ka dib ugxan), oo ku salaysan progesterone ama derivatives: dihydrogesterone (afka) ama progesterone micronized (afka ama siilka).

Dhibaatada ugu weyn ee daaweynta kicinta ugxansidaha waa Cudurka hyperstimulation ugxansidaha (OHSS). Jidhku wuxuu si adag uga jawaabaa daaweynta hoormoonka, taasoo keentay calaamado kala duwan oo caafimaad iyo bayooloji ah oo kala duwan oo kala duwan: raaxo la'aan, xanuun, lallabbo, calool xanuun, korodhka mugga ugxan-sidaha, dyspnea, cillado bayooloji oo badan ama ka yar (kordhinta hematocrit, creatinine oo sarreeya, kor u kaca). enzymes beerka, iwm), miisaanka oo kordha oo degdeg ah, iyo xaaladaha ugu daran, xanuunka neef-mareenka ee degdega ah iyo cillad kelyaha oo degdeg ah (3).

Xididdada xididdada dhiigga ama xididdada dhiigga marmarka qaarkood waxay u dhacdaa sidii dhibka OHSS ee daran. Qodobbada khatarta ah waa la yaqaan:

• polycystic syndrome
• index of mass index hoose
• da'da ka yar 30 sano
• tiro badan oo follicles ah
• estradiol oo aad u badan, gaar ahaan marka la isticmaalayo agonist
• Uurka bilawga (4).

Hab-maamuuska kicinta ugxan-sidaha ee shakhsi ahaaneed wuxuu caawiyaa dhimista khatarta OHSS ee daran. Xaaladaha qaarkood, daawaynta xinjirowga lidka ku ah ee ka hortagga ah ayaa la qori karaa.

Daawaynta citrate clomiphene waxay u horseedi kartaa muuqaalka cilladaha indhaha oo u baahan doona joojinta daaweynta (2% kiisaska). Waxa kale oo ay kordhisaa halista uurka badan 8% bukaanada anovulatory iyo 2,6 ilaa 7,4% bukaanada lagu daaweeyay dhalmo la'aanta idiopathic (5).

Khatarta sii kordheysa ee burooyinka kansarka ee bukaanada lagu daaweeyay kicinta ugxan-sidaha, oo ay ku jiraan clomiphene citrate, ayaa lagu xusay laba cilmi-baaris oo epidemiological ah, laakiin badi daraasadaha soo socda ma aysan xaqiijin sababta iyo xiriirka saameynta (6).

Daraasadda OMEGA, oo ay ku jiraan in ka badan 25 bukaan oo lagu sameeyay kicinta ugxan-sidaha oo qayb ka ah nidaamka IVF, ayaa soo gabagabeeyay, ka dib in ka badan 000 sano oo dabagal ah, in aysan jirin khatar ah kansarka naasaha haddii ay dhacdo kicinta ugxan-sidaha. (20).