Ƙarfafawar Ovarian magani ne na hormonal da ake nufi, kamar yadda sunansa ya nuna, don tayar da ovaries don samun ingancin ovulation. Wannan haƙiƙa ya ƙunshi ka'idoji daban-daban waɗanda tsarinsu ya bambanta bisa ga alamu, amma waɗanda burinsu ɗaya ne: samun ciki. Za'a iya ba da izinin kuzarin Ovarian shi kaɗai ko zama wani ɓangare na ka'idar ART, musamman a cikin mahallin in vitro hadi (IVF).

A cikin tsari, akwai lokuta biyu:

Sauƙaƙan maganin shigar ovulation, wanda aka wajabta idan akwai ciwon ovulation (dysovulation ko anovulation) saboda misali ga kiba ko kiba, polycystic ovary syndrome (PCOS) wanda ba a san asalinsa ba.

Ƙarfafa Ovarian a matsayin wani ɓangare na ka'idar ART :

• intrauterine insemination (IUU): ƙarfafa ovulation (dan kadan a cikin wannan yanayin) ya sa ya yiwu a tsara lokacin ovulation kuma ta haka ne a saka maniyyi (wanda aka tattara da kuma shirya) a daidai lokacin. cervix. Har ila yau, ƙarfafawa yana ba da damar samun ci gaban nau'i biyu na follicles kuma don haka ƙara yawan damar samun nasara na ƙwayar wucin gadi.
• IVF ko IVF tare da alluran intra-cytoplasmic sperm injection (ICSI): manufar ƙarfafawa ita ce don girma yawan adadin oocytes masu girma don samun damar ɗaukar nau'i-nau'i da yawa yayin huda follicular, don haka ƙara damar samun inganci mai kyau. embryos ta hanyar IVF.

Akwai ka'idoji daban-daban na tsayi daban-daban, ta amfani da kwayoyin halitta daban-daban dangane da alamun. Don zama mai tasiri da kuma guje wa illa, maganin ƙarfafawar ovarian hakika keɓantacce ne.

Abin da ake kira "sauƙaƙe" shigar da ovulation

Manufarsa ita ce haɓaka haɓakar follicular don samun samar da oocytes ɗaya ko biyu balagagge. Ana amfani da jiyya daban-daban dangane da mai haƙuri, shekarunta, nunin amma har da ayyukan masu aikin:

• anti-estrogens: gudanar da baki, clomiphene citrate yana aiki ta hanyar toshe masu karɓar isrogen a cikin hypothalamus, wanda ke haifar da karuwa a cikin ƙwayar GnRH wanda hakan ya haifar da matakin FSH sannan kuma na LH. Ita ce jiyya ta farko a lokuta na rashin haihuwa na asalin ovulatory, sai dai na asali mai girma (hypothalamus). Akwai ka'idoji daban-daban amma maganin gargajiya yana dogara ne akan kwanaki 5 na ɗauka daga ranar 3rd ko 5th na sake zagayowar (1);
• gonadotropins FSH, LH, FSH + LH ko gonadotropins na fitsari (HMG). Ana gudanar da shi kowace rana yayin lokacin follicular ta hanyar subcutaneous, FSH yana nufin haɓaka haɓakar oocytes. Muhimmancin wannan jiyya: kawai ƙungiyar follicles da aka shirya ta ovary ana motsa su. Don haka an keɓance wannan maganin ga mata masu isassun ƙungiyar follicle. Sannan zai ba da ƙarfi don kawo ɓangarorin zuwa balaga waɗanda galibi suna tasowa da sauri zuwa lalacewa. Har ila yau, irin wannan nau'in magani ne ake amfani dashi a sama na IVF. A halin yanzu akwai nau'ikan FSH guda 3: FSH mai tsaftataccen fitsari, FSH recombinant (wanda injiniyan kwayoyin halitta ke samarwa) da kuma FSU tare da aiki mai tsawo (amfani da IVF kawai). Ana amfani da gonadotropins na fitsari (HMGs) wani lokaci a madadin FSH recombinant. Ana amfani da LH gabaɗaya a haɗe tare da FSH, galibi a cikin marasa lafiya da ƙarancin LH.
• GnRH famfo An tanada don mata tare da anovulation na babban asali (hypothalamus). Na'ura mai nauyi da tsada, ta dogara ne akan gudanar da gonadorelin acetate wanda ke kwaikwayon aikin GnRH don tada siginar FSH da LH.
• metformin yawanci ana amfani da shi wajen maganin ciwon sukari, amma wani lokaci ana amfani dashi azaman inducer ovulation a cikin mata masu PCOS ko kiba / kiba, don hana hauhawar jini na ovarian (2).

Don tantance tasirin jiyya, iyakance haɗarin hyperstimulation da ciki da yawa, saka idanu ovulation tare da duban dan tayi (don tantance adadin da girman girman follicles) da ƙididdigar hormonal (LH, estradiol, progesterone) ta hanyar gwajin jini an saita a duk tsawon lokacin. na yarjejeniya.

An tsara jima'i a lokacin ovulation.

Ƙarfafawar Ovarian a cikin mahallin ART

Lokacin da kuzarin ovarian ya faru a matsayin wani ɓangare na IVF ko ka'idar AMP ta wucin gadi, maganin yana faruwa a cikin matakai 3:

• lokacin toshewa : ovaries suna "hutawa" godiya ga GnRH agonists ko GnRH antagonists, wanda ke toshe glandan pituitary;
• da ovarian stimulating lokaci : Ana ba da maganin gonadotropin don haɓaka haɓakar follicular. Kulawa da ovulation yana ba da damar saka idanu akan amsa daidai ga jiyya da haɓakar follicle;
• farkon ovulation : lokacin da duban dan tayi ya nuna balagagge follicles (tsakanin 14 zuwa 20 mm a diamita akan matsakaici), ovulation yana haifar da ko dai:
  • allura na urinary (intramuscularly) ko recombinant (subcutaneous) HCG (chorionic gonadotropin);
  • allurar recombinant LH. Mafi tsada, an tanada shi ga mata a hadarin hyperstimulation.

Sa'o'i 36 bayan farawar hormonal, ovulation yana faruwa. Sannan ana huda follicular.

Maganin tallafi na lokaci na luteal

Don inganta ingancin endometrium da inganta dasawa na amfrayo, ana iya ba da magani a lokacin lokacin luteal (sashe na biyu na sake zagayowar, bayan ovulation), dangane da progesterone ko abubuwan da suka samo asali: dihydrogesterone (ta baka) ko micronized progesterone (na baka ko na baka). farji).

Babban mawuyacin jiyya na motsa jiki na ovarian shine Ovarian hyperstimulation ciwo (OHSS). Jiki yana amsawa da ƙarfi ga maganin hormonal, yana haifar da alamun asibiti daban-daban da na ilimin halitta na nau'ikan nau'ikan nau'ikan: rashin jin daɗi, jin zafi, tashin zuciya, distended ciki, haɓakar ƙarar ovarian, dyspnea, ƙari ko žasa ƙarancin ilimin halitta (ƙaramar hematocrit, haɓakar creatinine, haɓakawa). enzymes na hanta, da dai sauransu), saurin samun nauyi, kuma a cikin mafi tsanani lokuta, ciwo mai tsanani na numfashi mai tsanani da gazawar koda (3).

Jijiya ko bugun jini wani lokaci yana faruwa azaman rikitarwa na OHSS mai tsanani. An san abubuwan haɗari:

• polycystic ovary ciwo
• ƙananan ma'aunin jiki
• shekaru kasa da 30
• babban adadin follicles
• babban taro na estradiol, musamman lokacin amfani da agonist
• farkon ciki (4).

Ƙa'idar ƙarfafa kwai ta keɓaɓɓen tana taimakawa rage haɗarin OHSS mai tsanani. A wasu lokuta, ana iya ba da maganin rigakafin ciwon zuciya.

Jiyya tare da clomiphene citrate zai iya haifar da bayyanar cututtuka na ido wanda zai buƙaci dakatar da magani (2% na lokuta). Hakanan yana ƙara haɗarin yawan ciki da 8% a cikin marasa lafiya na anovulatory da 2,6 zuwa 7,4% a cikin marasa lafiya da aka bi da rashin haihuwa na idiopathic (5).

Ƙara yawan haɗarin ciwace-ciwacen daji a cikin marasa lafiya da aka bi da su tare da masu haifar da ovulation, ciki har da clomiphene citrate, an lura da su a cikin nazarin cututtukan cututtuka guda biyu, amma yawancin binciken da ke biyo baya ba su tabbatar da dalili da tasiri ba (6).

Binciken OMEGA, ciki har da fiye da marasa lafiya 25 da suka sami karfin ovarian a matsayin wani ɓangare na ka'idar IVF, ya ƙare, bayan fiye da shekaru 000 na biyo baya, cewa babu haɗarin ciwon nono a cikin yanayin motsa jiki na ovarian. (20).