Nrhiav seb yuav txiav txim siab ntxiv rau cov poj niam li cas. Qhov kev kuaj mob no tau tsim rau tus poj niam yog tias, hauv 1 xyoos lossis ntau dua, nrog kev sib deev tsis tu ncua, tsis siv tshuaj tiv thaiv, cev xeeb tub tsis tshwm sim. Kev tsis muaj menyuam tsis muaj tseeb yog kuaj tau yog tias tus poj niam muaj kev hloov pauv tsis zoo ntawm lub cev uas ua rau kev xav tsis tau (tsis muaj cov hlab ntsha, lub tsev menyuam, zes qe menyuam). Nrog tus txheeb ze infertility, kev kho mob yog nqa tawm thiab kev ua me nyuam rov qab los.
Tsis tas li ntawd, thawj qhov kev xeeb tub yog qhov txawv, uas yog tus cwj pwm los ntawm qhov tsis muaj cev xeeb tub hauv tus poj niam keeb kwm thiab theem nrab - qhov ua tsis tau rov qab xav. Infertility tshwm sim hauv 10-15% ntawm cov niam txiv. Ntawm cov no, nyob rau hauv kwv yees li 40% ntawm cov neeg mob, txiv neej infertility yog pom, nyob rau hauvtshuav 60% yog poj niam.
Ua rau poj niam tsis muaj menyuam
Yuav kom nkag siab yuav ua li cas txiav txim siab tsis muaj menyuam hauv cov poj niam, cia peb saib cov laj thawj ntawm cov kab mob pathology. Lub ntsiab provoking yam yuav ua txhaum ntawm lub cev noj qab haus huv. Ib tug poj niam muaj teeb meem hauv zej zog, tsev neeg thiab kev puas siab puas ntsws tuaj yeem ua rau muaj menyuam tsis taus. Txhawm rau xaiv txoj kev kho mob, nws yog ib qho tsim nyog los txiav txim siab qhov laj thawj uas ua rau nws.
Qhov feem ntau ua rau muaj menyuam hauv cov poj niam uas muaj txij nkawm muaj xws li:
- nce tso tawm ntawm prolactin;
- qog neoplasms ntawm pituitary caj pas;
- ntau hom kev coj khaub ncaws (oligomenorrhea, amenorrhea, thiab lwm yam) provoked los ntawm hormonal imbalance;
- congenital anatomical defects ntawm qhov chaw mos;
- endometriosis;
- ob sab obstruction ntawm cov hlab ntsha fallopian;
- adhesions hauv cheeb tsam pelvic;
- kis malformations ntawm qhov chaw mos;
- ntau yam autoimmune pathologies;
- tuberculous lesions ntawm lub cev xeeb tub;
- kev puas siab puas ntsws;
- negative postcoital test;
- tsis paub meej vim li cas.
Degrees of infertility
Hauv tshuaj, muaj peb theem ntawm kev xeeb tub hauv cov poj niam. Thawj (1st degree) yog tus cwj pwm los ntawm qhov tseeb tias tus poj niam tsis tau xeeb tub. 2nd degree infertility txhais li cas? Tus poj niam nyob rau hauv cov ntaub ntawv no yav tas los cev xeeb tub, thiab rov qab sim ntawm conception twb tsis tiav. Peb tuaj yeem hais txog kev xeeb tub ntawm 3rd degree tias qhov no yog hom thib ob, tab sis cov kws kho mobKev kuaj mob feem ntau tsis siv. Nws yog to taub tias ib tug poj niam tsis muaj peev xwm tsim tau tas mus li.
Ntau yam
Classify kuj cov ntaub ntawv ntawm infertility hauv cov poj niam:
- endocrine (hormonal);
- tubal-peritoneal;
- uterine;
- kev muaj menyuam tsis taus vim yog kev txhim kho ntawm endometriosis;
- immune;
- tsis muaj menyuam tsis paub txog etiology.
Qhia rau txhua tus.
YEndocrine infertility
Endocrine daim ntawv ntawm poj niam tsis muaj menyuam yog tshwm sim los ntawm kev ua txhaum ntawm hormonal kev tswj ntawm lub voj voog, uas ua kom ovulation. Daim ntawv no yog tus cwj pwm los ntawm anovulation vim tsis txaus maturation ntawm lub qe los yog nws tsis tuaj ntawm lub follicle. Qhov no feem ntau yog vim kev raug mob los yog pathologies ntawm thaj av hypothalamic-pituitary, ntau dhau ntawm prolactin, polycystic zes qe menyuam, progesterone deficiency, inflammatory thiab qog formations ntawm zes qe menyuam.
Tubal infertility
Daim ntawv no tsim kho nyob rau hauv cov xwm txheej uas muaj teeb meem anatomical raws txoj kev ntawm lub qe los ntawm cov hlab ntsha fallopian mus rau lub tsev menyuam, piv txwv li ob lub raj tsis tuaj yeem lossis tsis tuaj. Nrog peritoneal infertility, ib qho kev cuam tshuam tshwm sim tsis nyob hauv cov hlab ntsha lawv tus kheej, tab sis nruab nrab ntawm lawv thiab zes qe menyuam. Hom tubal-peritoneal feem ntau tshwm sim los ntawm cov txheej txheem nplaum los yog tom qab atrophy ntawm cilia nyob rau hauv lub raj thiab ua kom lub zog ntawm lub qe. Tej zaum yuav ua rau adhesions nyob rau hauv cov hlab ntsha fallopianReproductive system phais.
Uterine infertility
daim ntawv no ntawm pathology yog tshwm sim los ntawm anatomical (kuj los yog congenital) anomalies ntawm lub tsev menyuam. Congenital defects yog nws underdevelopment, ob npaug, eeb duab los yog muaj ib tug intrauterine septum. Tau txais qhov tsis xws luag ntawm lub tsev menyuam yog nws cov cicatricial deformity, intrauterine synechia lossis qog. Tau txais kev tsis txaus ntseeg tshwm sim los ntawm kev cuam tshuam kev phais, xws li tom qab rho menyuam.
Kev xeeb tub vim endometriosis: nws tshwm sim li cas thiab vim li cas nws tshwm sim?
Ntau zaus, infertility provokes endometriosis nyob rau hauv cov poj niam (cov tsos mob thiab kev kho mob yog txiav txim los ntawm tus kws kho mob). Cov kab mob no tau kuaj pom hauv kwv yees li 30% ntawm kev sib deev ncaj ncees. Cov cim tseem ceeb: kev coj khaub ncaws hnyav, mob mob, tsis xis nyob thaum sib deev.
Lub tswv yim ntawm qhov cuam tshuam ntawm tus kab mob no rau kev xeeb tub tseem tsis tau paub meej, tab sis nws tuaj yeem ntseeg tau hais tias qhov chaw endometriosis hauv zes qe menyuam thiab cov hlab ntsha tiv thaiv qhov kev ua haujlwm ntawm ovulation thiab kev txav ntawm lub qe los ntawm lub cev. cov raj. Cov tsos mob thiab kev kho mob ntawm endometriosis hauv cov poj niam muaj kev cuam tshuam. Yuav ua li cas kho daim ntawv no ntawm infertility, peb yuav qhia hauv qab no.
Immune infertility
Kev txhim kho ntawm lub cev tiv thaiv kab mob ntawm cov kab mob no cuam tshuam nrog kev muaj cov tshuaj tiv thaiv kab mob hauv lub cev - ib qho kev tiv thaiv tshwj xeeb uas tsim tawm tawm tsam embryo lossis spermatozoa. Nyob rau hauv ib nrab ntawm cov xwm txheej, xws li infertility yog provoked tsis yog los ntawm ib qho tseem ceeb, tab sis los ntawm ib tug complex ntawm ob peb yam. Hauv tus lejcov xwm txheej, lawv tseem tsis tau pom dua txawm tias tom qab kuaj xyuas kom zoo.
Kev kuaj poj niam fertility
Muaj ntau ntau txoj hauv kev los txiav txim siab tsis muaj menyuam hauv cov poj niam. Txawm li cas los xij, cov no tsis yog cov kev sim uas tuaj yeem txiav txim siab qhov muaj menyuam hauv tsev. Ib hom kev xeeb tub zoo sib xws tuaj yeem ua rau cov txiv neej los txiav txim siab phev motility thiab zoo. Rau cov poj niam, kuaj thiab ntsuas ntsuas tau pom zoo.
Yog li, yuav ua li cas thiaj txiav txim siab tsis muaj menyuam hauv cov poj niam? Txoj kev yooj yim tshaj plaws thiab pheej yig tshaj plaws kom tsis txhob lees paub qhov pathology yog kev kuaj ovulation, uas tuaj yeem ua tau hauv tsev. Cov txheej txheem no zoo ib yam li nthuav qhia txoj hauv kev kom paub meej tias cev xeeb tub. Nyob rau hauv cov ntaub ntawv no, ib tug tshwj xeeb strip yog muab tso rau hauv cov zis. Ua ntej tso lub qe los ntawm lub follicle, muaj qhov nce hauv LH, uas qhov kev sim no tshwm sim. Yog tias cev xeeb tub tsis tuaj yeem ua tau, kev kuaj mob feem ntau tsis zoo.
Qhov kev kuaj no rau cov poj niam cev xeeb tub tsuas yog siv yog tias xav tias muaj kab mob endocrine. Hauv lwm qhov xwm txheej, ovulation yuav tshwm sim, tab sis cev xeeb tub tsis tshwm sim rau lwm yam laj thawj, piv txwv li, yog tias lub qe tsis dhau los ntawm txoj hlab ntshav vim nws qhov cuam tshuam.
Cov lus qhia kho mob rau poj niam tsis muaj menyuam
Kev txiav txim siab ntawm kev kho tsis muaj menyuam yog tus kws kho mob tom qab ntsuas cov txiaj ntsig ntawm txhua qhov kev kuaj mob thiab tsim kom raugcov laj thawj uas ua rau nws. Kev kho mob feem ntau pib nrog kev tshem tawm ntawm qhov tshwm sim thawj zaug. Cov txheej txheem siv hauv qhov no yog tsom rau:
- txhawm rau kho tus neeg mob lub cev ua haujlwm ntawm kev ua me nyuam los ntawm kev phais lossis kev saib xyuas;
- siv cov cuab yeej pab thaum lub tswv yim tsis tuaj yeem ua tau.
Nyob rau hauv daim ntawv endocrine ntawm pathology, hormonal tsis meej yog kho thiab lub zes qe menyuam raug txhawb. Hom kev kho tsis yog tshuaj muaj xws li qhov hnyav normalization (thaum rog dhau) los ntawm kev noj zaub mov thiab ua kom lub cev muaj zog, kho lub cev.
Kev kho mob tsis muaj menyuam hauv endocrine
Hom tshuaj tseem ceeb rau kev kuaj mob ntxiv rau cov poj niam ntawm hom endocrine yog kev kho hormonal. Cov txheej txheem ntawm maturation ntawm lub follicle yog tswj los ntawm ultrasound xyuas thiab saib xyuas cov ntsiab lus ntawm cov tshuaj hormones hauv cov ntshav. Nrog rau kev xaiv cov tshuaj hormonal txaus, 70-80% ntawm cov neeg mob uas muaj daim ntawv no tsis muaj menyuam tau xeeb tub.
YKev tshem tawm ntawm tubal-peritoneal daim ntawv ntawm pathology
Nyob rau hauv daim ntawv tubo-peritoneal ntawm tus kab mob, lub hom phiaj ntawm kev kho mob yog los kho qhov qub patency ntawm cov hlab ntsha hauv plab siv laparoscopy. Qhov ua tau zoo ntawm txoj kev no yog kwv yees li 30-40%. Nrog rau kev cuam tshuam ntev ntev los yog nrog kev ua haujlwm tsis zoo ntawm kev ua haujlwm dhau los, kev siv tshuaj tua kabmob raug pom zoo.
Kev kho mob ntawm lub tsev menyuam ntawm tus kab mob
Nyob rau hauv cov ntaub ntawv ntawm kev loj hlob ntawm uterine daim ntawv ntawm poj niam infertility thiab lub xub ntiag ntawm nws anatomical defectsua reconstructive yas phais. Kev xeeb tub tshwm sim hauv kwv yees li 15-20% ntawm cov neeg mob. Yog tias nws tsis tuaj yeem kho lub tsev menyuam ntawm lub cev tsis muaj menyuam sai thiab yug tus menyuam ntawm nws tus kheej, cov kev pabcuam ntawm tus niam lossis tus menyuam yuav raug siv rau.
Yuav ua li cas kho tsis muaj menyuam vim endometriosis?
Kev muaj menyuam tsis taus vim endometriosis yog kho los ntawm laparoscopic endocoagulation, thaum lub sijhawm pathological foci raug tshem tawm. Qhov tshwm sim ntawm kev kho mob phais yog kho los ntawm ib chav kawm ntawm cov tshuaj. Kev xeeb tub tom qab no yog li 30-40%.
Immune infertility: Yuav ua li cas sib ntaus?
Nyob rau hauv kev tiv thaiv kab mob tiv thaiv kab mob, feem ntau, kev siv tshuaj tua kab mob yog ua los ntawm kev siv tshuaj tua kab mob. Cov txheej txheem no tso cai rau koj kom kov yeej lub cev tiv thaiv kab mob ntawm lub ncauj tsev menyuam thiab hauv 40% ntawm cov neeg mob ua rau muaj qhov pib tshwm sim.
Kev kho mob ntawm tus menyuam uas tsis tau piav qhia hauv cov poj niam
Kev kho mob ntawm cov ntaub ntawv tsis pom ntawm cov kab mob no yog qhov teeb meem nyuaj heev. Hauv cov xwm txheej no, feem ntau siv rau kev siv cov cuab yeej pab tu menyuam. Tsis tas li ntawd, cov lus qhia rau IVF yog:
- tsis muaj cov hlab ntsha lossis cov hlab ntsha;
- mob tom qab kev saib xyuas kev kho mob thiab laparoscopy rau kev tshem tawm ntawm endometriosis;
- kev muaj menyuam tsis taus ntawm tus khub deev;
- zes qe menyuam;
- kev kho tsis tau zoo ntawm cov ntawv endocrine ntawm kev xeeb tub;
- relatedpathologies uas cev xeeb tub yog tsis yooj yim sua;
- qee zaus ntawm uterine infertility.
YIn vitro fertilization method
Cov txheej txheem tseem ceeb ntawm kev tsim cov khoom tsim tawm yog:
- Intrauterine insemination nrog tus khub lossis tus pub phev.
- Intracellular txhaj ntawm spermatozoon rau hauv lub qe.
- Surrogacy.
- YIn vitro fertilization.
- Siv tus pub embryo lossis lub qe pub dawb.
Lub hnub nyoog ntawm cov txij nkawm cuam tshuam rau kev ua haujlwm ntawm kev muaj menyuam tsis taus, tshwj xeeb tshaj yog rau cov poj niam (tom qab 37 xyoo, qhov ua tau zoo ntawm kev xeeb tub tau txo qis). Yog li ntawd, kev kho mob ntawm cov kab mob pathology no yuav tsum tau pib sai li sai tau, uas ua rau muaj kev pheej hmoo ntawm cov xeeb ntxwv noj qab haus huv thiab tso cai rau koj los ntawm cov nqi tshuaj tsawg tsawg. Nws yuav tsum nco ntsoov tias txoj kev phais ntawm kev kho mob tsuas yog siv rau hauv cov xwm txheej hnyav thiab ntau hom kab mob tuaj yeem kho nrog txoj kev khaws cia.
Peb tau saib yuav ua li cas txiav txim siab tsis muaj menyuam hauv cov poj niam.
