Ntau tshaj nees nkaum xyoo, cov niam txiv uas muaj teeb meem xeeb tub thiab muaj menyuam tau muaj txoj hauv kev los ntawm txoj haujlwm hauv vitro fertilization program. Ntawm chav kawm, lub sijhawm no yog ib txoj kev kim kim, qhov tshwm sim ntawm qhov tsis yog ib txwm ua tau raws li qhov kev cia siab ntawm cov neeg mob, tab sis tseem qhov no yog lub caij nyoog rau cov neeg uas xav kom lawv cov menyuam muaj caj ces. Kev cog qoob loo ntawm embryos ua rau nws tuaj yeem xaiv tsuas yog cov khoom siv tau zoo tshaj plaws, nrog rau tsis suav nrog qee cov kab mob noob.
Terminology
In vitro fertilization yog ib ceg ntawm kev yug me nyuam technologies uas koom nrog kev fertilization ntawm leej niam lub qe sab nraum lub tsev menyuam thiab implantation ntawm lub tiav lawm embryo rau ib lub sij hawm ntawm tsib mus rau xya hnub.
Kev cog qoob loo ntawm embryos yog kev saib xyuas ntawm kev loj hlob thiab kev ua haujlwm tseem ceeb ntawm tib neeg embryos ua ntej hloov mus rau hauv lub tsev menyuam.
IVF theem
Cov txheej txheem kev tsim cov khoom tsim tawm muaj ob peb kauj ruam ua tiav lossis cov kauj ruam:
1. Stimulation ntawm superovulation, nyob rau hauv parallel nrog kev saib xyuas ntawm folliculogenesis thiabkev loj hlob ntawm endometrium.
2. Follicle puncture.
3. Ovum fertilization thiab in vitro embryo culture.
4. Kev kho tus kheej ntawm luteal theem ntawm kev coj khaub ncaws. 5. Embryo hloov thiab kuaj cev xeeb tub.
Rau cov poj niam hluas IVF yam tsis muaj superovulation yog ua tau.
Indications thiab contraindications rau IVF
Kev pom zoo rau qhov kev kho mob no yog qhov muaj menyuam tsis taus ntawm tus poj niam uas feem ntau tsis tuaj yeem kho tau, yog tias IVF muab qhov muaj feem ntau ntawm kev xeeb tub.
Contraindications kuj muaj xws li:
- extragenital pathologies uas hem rho menyuam;
- malformations thiab deformities ntawm lub tsev menyuam;
- neoplasms ntawm lub tsev menyuam thiab zes qe menyuam;- mob inflammatory kab mob (tsis tsuas yog ntawm lub cev xeeb tub);
- keeb kwm ntawm oncology.
Kev npaj rau txoj kev IVF
Thawj theem yog kev sau cov kev txheeb xyuas thiab kev txheeb xyuas cov kab mob. Txhawm rau ua qhov no, tus neeg mob yuav tsum tau kuaj ntshav rau cov tshuaj hormones poj niam txiv neej, nrog rau cov ncauj lus kom ntxaws txog kev kuaj ntshav biochemistry thiab glucose kam rau ua. Kev tshuaj xyuas tag nrho rau cov kab mob urogenital thiab kuaj ultrasound ntawm cov kab mob hauv lub cev xeeb tub tau ua tiav.
Tus khub yuav tsum ua tus spermogram kom paub tseeb tias tsis muaj txiv neej ntxiv lawm tshob. Nws yog ib qho tsim nyog yuav tsum tau noj smear rau cytology thiab colposcopy thiaj li tsis suav nrog cov mob precancerous. Tus niam uas xav tias yuav raug kuaj rau tus kab mob TORCH(rubella, toxoplasmosis, herpes, cytomegalovirus thiab chlamydia), vim qhov no yuav cuam tshuam rau kev loj hlob ntawm tus menyuam hauv plab. Thaum kawg, ib qho ultrasound ntawm cov qog mammary thiab thyroid caj pas.
theem ob yog ua tiav tam sim ua ntej pib kho. Nws muaj peb lub ntsiab lus:
- tus txij nkawm yuav tsum xeem dhau HIV, kab mob siab viral, syphilis, tau txais cov txiaj ntsig ntawm lawv cov ntshav thiab Rh yam;
- tus poj niam yuav tsum tau kuaj ntshav qab zib, kev tshuaj ntsuam dav dav ntawm cov ntshav, zis thiab biochemistry, nrog rau kom paub lub sijhawm khov; - tus niam uas xav tau yuav tsum muaj tus kws kho mob qhov xaus tias tsis muaj contraindications rau cev xeeb tub.
IVF txheej txheem
Ua ntej, tus kws kho mob, tom qab tag nrho cov kev sim tsim nyog, txhawb tus poj niam lub zes qe menyuam kom tau txais ntau lub qe noj qab haus huv. Kev qhia txog tshuaj pib rau hnub 21st ntawm kev coj khaub ncaws, thiab kav ib hlis. Thaum lub sij hawm no, tus kws kho mob tas li saib xyuas seb lub follicle matures thiab endometrium loj hlob nyob rau hauv lub uterine kab noj hniav siv ultrasound. Thiab tseem, cov poj niam raug kuaj rau cov tshuaj hormones kom pom tag nrho cov duab. Sai li cov qe loj hlob tuaj, cov txheej txheem rau kev tshem tawm yog nqa tawm ntawm tus neeg mob sab nraud. Txawm li cas los xij, qee yam tuaj yeem cuam tshuam rau cov txheej txheem no:
- tsis muaj zes qe menyuam teb rau stimulation;
- muaj cov adhesions hauv lub plab kab noj hniav;
- ovulation ntxov ntxov;- anovulatory voj voog (thaum laus follicles tsis muaj qe). Tag nrho cov nta no yuav tsum tau coj mus rau hauv tus account ua ntejtxhawb ob niam txiv kom pib IVF.
Thaum leej txiv yav tom ntej lossis tus neeg tsis qhia npe pub dawb pub nws cov khoom siv caj ces, txoj kev fertilization tuaj yeem ua tiav. Kev cog qoob loo ntev ntev ntawm embryos hauv vitro yog qhov tsim nyog txhawm rau xaiv cov embryos uas siv tau tshaj plaws. Tsib lossis rau hnub tom qab fertilization, ob peb embryos tau muab tso rau hauv niam lub tsev menyuam. Ob lub lis piam tom qab, tus niam-rau-tus yuav tau kuaj ntshav rau tib neeg chorionic gonadotropin (hCG) los txiav txim cev xeeb tub.
Long-term embryo culture
Feem ntau, cov neeg mob uas nrhiav kev kho mob tshwj xeeb muaj ntau cov lus nug. Ib tug ntawm lawv suab ib yam dab tsi zoo li no: "Cultivation ntawm gametes thiab embryos, nws yog dab tsi?", lo lus teb yog heev yooj yim thiab complex nyob rau tib lub sij hawm. Qhov no yog ib txoj kev uas tus fetus tseem ciaj sia mus txog thaum nws muab tso rau hauv niam lub cev. Kev cog qoob loo mus sij hawm ntev ntawm embryos hauv vitro yog ib qho kim, high-tech txheej txheem uas yuav tsum tau muaj kev paub tshwj xeeb thiab kev txawj ntse. Niaj hnub nimno cov chaw soj nstuam yog niaj hnub txhim kho nyob rau hauv fertilization cov tswv yim thiab cov cuab yeej. Qhov tseeb novelty yog kev cog qoob loo ntawm embryos hauv nruab nrab EmbryoGen. Lwm yam kev loj hlob ntxiv muab qhov muaj feem ntau ntawm kev cog cov embryo hauv phab ntsa uterine.
Yav dhau los, kab lis kev cai embryos tau yug los tsuas yog mus rau theem cleavage thiab muab tso rau hauv lub tsev menyuam thaum ntxov li peb hnub tom qab "kev xav", tab sis lawv tau pib hauv paus tsuas yog ib feem peb ntawm tag nrho cov IVF. Tab sis tom qab kev txhim kho ntawm txoj kev cog qoob looembryos hauv vitro mus txog rau theem blastocyst, qhov ua tau zoo ntawm txoj kev tau nce. Qhov no yuav tsum tau muaj kev loj hlob tshiab thiab incubators.
Qhov zoo thiab qhov tsis zoo ntawm cov txheej txheem
txheej txheem no yuav siv sij hawm cog embryos mus rau theem tshiab.
- Pab xaiv cov embryos pheej hmoo tshaj plaws ntawm kev cog qoob loo.
- Chromosomal abnormalities txo qis vim lawv tuaj yeem kuaj pom thiab tiv thaiv ntawm theem blastocyst.
- Muaj ib txoj hauv kev zoo dua qub.
- Qhov kev pheej hmoo ntawm kev xeeb tub ntau yam txo qis vim tias tsuas yog ob lub embryos xav tau, tsis yog tsib, raws li yav dhau los, kom cev xeeb tub.
- Kev cev xeeb tub tsis tshua muaj ntau dua li ua ntej.
Txawm li cas los xij, tseem muaj qhov tsis zoo ntawm cov txheej txheem no. Thawj qhov yog tias tsis yog txhua lub embryos tuaj yeem loj hlob mus rau theem yuav tsum tau ua. Tseem, incubation systems thiab nutrient media tseem yuav tsum tau txhim kho, coj lawv kom ze li sai tau rau tej yam ntuj tso. Thiab yog tias tsawg tshaj li plaub lub embryos muaj sia nyob, qhov tshwm sim uas lawv yuav npaj rov qab yog qhov tsawg heev. Qhov thib ob qhov tsis zoo, zoo li yav dhau los versions ntawm IVF, yog qhov tsis muaj 100% lav ntawm kev ua tiav. Tsis yog ib tus kws kho mob yug me nyuam hauv ntiaj teb yuav lees paub tshaj tawm tias txoj kev no muaj tseeb hauv qhov kawg piv txwv. Cov kws tshawb fawb tseem muaj ib yam dab tsi los siv zog rau.
IVF phiv
Cov teebmeem uas tsis xav tau tom qab IVF, thaum lub sijhawm siv sijhawm ntev embryo kab lis kev cai, suav nrog:
- ntau lub cev xeeb tub, txij li thaumob peb embryos tau cog ib zaug;
- cev xeeb tub ectopic (kev txav ntawm lub embryo hauv lub tsev menyuam tsis tuaj yeem txiav tawm); - ntau dhau ntawm zes qe menyuam stimulation (ovarian hyperstimulation syndrome ua rau infertility);- kab mob thiab los ntshav.
