Tus poj niam lub cev yog ib ntus rov tsim dua tshiab (natural cyclical hloov) vim yog kev cuam tshuam ntawm cov tshuaj hormones uas tswj cov txheej txheem nyuaj uas cuam tshuam txog nws txoj kev ua me nyuam (cov kab ke uas ua kom cov txheej txheem ntawm fertilization). Rau qhov pib ntawm cev xeeb tub, qhov yuav tsum tau ua ua ntej yuav tsum tau ua - kev loj hlob thiab kev loj hlob ntawm zes qe menyuam follicles, uas ua raws li ib tug "khoom" rau cov qe fertilized.
Kev txhais lub tswvyim ntawm "follicle"
Qhov no yog ib qho me me anatomical tsim uas zoo li lub caj pas los yog ib lub hnab ntim nrog intracavitary secretions. Lub zes qe menyuam follicles nyob rau hauv lawv cortical txheej. Lawv yog lub hauv paus reservoir rau lub qe maj mam maturing.
Thaum pib, cov hauv paus hauv cov ntsiab lus ntau tau ncav cuag qhov tseem ceeb hauv ob lub zes qe menyuam (200 - 500 lab), txhua qhov, dhau los, muaj ib lub xov tooj ntawm tes. Txawm li cas los xij, rau tag nrho lub sijhawm puberty ntawm tus poj niam (30-35 xyoo)Tsuas yog 400-500 tus qauv mus txog qhov puv puv.
txheej txheem sab hauv ntawm follicle evolution
Lawv ntws hauv lawv lub hnab thiab yog tus cwj pwm los ntawm kev sib npaug ntawm granulosa lossis granular cells uas sau tag nrho cov kab noj hniav.
Tom qab ntawd, cov hlwb granular tsim cov kua dej uas thawb thiab thawb lawv sib nrug, thaum coj lawv mus rau qhov chaw ntawm lub hauv paus (txoj kev sau cov kab noj hniav nrog cov kua follicular).
Raws li rau cov hauv paus hniav nws tus kheej, nws nce ntau qhov loj thiab ntim (txog li 15-50 hli). Thiab hais txog cov ntsiab lus, nws twb yog kua nrog ntsev, proteins thiab lwm yam khoom.
Sab nraud, nws yog npog nrog cov ntaub so ntswg sib txuas. Thiab nws yog qhov tseeb ntawm lub xeev ntawm cov follicle uas suav tias yog cov neeg laus, thiab nws yog hu ua Graaffian vesicle (hauv kev hwm ntawm Dutch anatomist thiab physiologist Renier de Graaf, uas nrhiav pom cov qauv ntawm lub zes qe menyuam hauv 1672). Ib tug paub tab "npub" cuam tshuam nrog kev loj hlob ntawm nws cov counterparts.
Lub follicle yuav loj npaum li cas?
Nrog rau qhov pib ntawm kev puberty (14-15 xyoo), nws ua tiav nws txoj kev loj hlob. Nws yog suav hais tias yog ib txwm yog thaum lub sij hawm follicular theem, thaum lub sij hawm cev xeeb tub pib, ob peb follicles paub tab nyob rau hauv ob qho tib si zes qe menyuam, uas tsuas yog ib tug mus txog ib tug loj loj, uas yog vim li cas nws thiaj li pom tau hais tias tseem ceeb. Cov qauv seem tau txais atresia (rov qab kev loj hlob). Cov khoom ntawm lawv cov haujlwm tseem ceeb yog estrogen, poj niam txiv neej cov tshuaj hormones uas cuam tshuam rau kev xeeb tub, yug menyuam, nrog rau cov ntsiab lus calcium thiab metabolism.
Cov follicle tseem ceeb, uas nce qhov loj ntawm qhov nruab nrab ntawm 2-3 hli txhua hnub, ncav cuag nws txoj kab uas hla (18-24 hli) thaum lub sijhawm ovulation.
Generative function as priority
Los ntawm sab hauv, cov follicle mature yog lined nrog stratified epithelium, nws yog nyob rau hauv nws (nyob rau hauv lub thickened cheeb tsam - lub qe-cov kabmob tubercle) uas muaj ib tug loj hlob qe muaj peev xwm fertilization. Raws li tau hais los saum no, qhov loj me ntawm lub hauv paus yog 18-24 hli. Thaum pib ntawm kev coj khaub ncaws, nws protrusion (zoo ib yam li tubercle) yog pom nyob rau saum npoo ntawm zes qe menyuam.
Tsis tas li ntawd, cov phab ntsa ntawm cov follicle ua thinner, uas ua rau nws tawg. Yog li, nyob rau hauv qhov chaw ntawm Graaffian vesicle, ib tug corpus luteum tshwm - ib qho tseem ceeb endocrine caj pas.
Vim vim muaj ntau yam hormonal ntshawv siab, qhov sib txawv no yuav tsis tuaj, thiab yog li ntawd lub qe tsis tawm ntawm zes qe menyuam thiab cov txheej txheem ovulation tsis tshwm sim. Nws yog lub sijhawm no uas tuaj yeem dhau los ua qhov tseem ceeb ua rau muaj menyuam tsis taus thiab tsis ua haujlwm los ntshav ntawm lub tsev menyuam.
Folliculometry: txhais, muaj peev xwm
Qhov no yog kev tshawb nrhiav ultrasound, los ntawm kev taug qab txoj kev loj hlob thiab kev loj hlob ntawm cov follicles. Feem ntau, cov poj niam ua rau nws, raug kev txom nyem los ntawm infertility los yog kev coj khaub ncaws irregularities. Lub manipulation nyob rau hauv nqe lus nug tso cai rau koj mus taug qab lub zog ntawm ovulation los ntawm ultrasound.
Thaum pib ntawm kev coj khaub ncawsNws ua tau los soj ntsuam cov txheej txheem ntawm endometrial kev loj hlob, thiab nyob rau hauv ib tug tom qab lub sij hawm - lub evolution ntawm lub follicle. Yog li, koj tuaj yeem txiav txim siab qhov loj me ntawm cov hauv paus hniav los ntawm hnub ntawm lub voj voog.
Thaum twg yuav tsum tau folliculometry?
Qhov kev kuaj mob no tso cai rau koj mus:
- teeb tsa qhov pib ntawm ovulation raug rau hnub tshwj xeeb;
- txiav txim siab qhov loj ntawm lub hauv paus ua ntej ovulation;
- tshuaj xyuas qhov ua tau zoo ntawm cov cuab yeej follicular;
- npaj poj niam txiv neej;
- teeb tsa kev ncaj ncees ntawm cov theem ntawm kev coj khaub ncaws;
- xam hnub zoo tshaj plaws kom xeeb tub;
- saib xyuas qhov kev vam meej ntawm ntau lub cev xeeb tub;
- tshuaj ntsuam xyuas kev coj khaub ncaws;
- ntsuas tus kheej hormonal keeb kwm ntawm tus neeg mob;
- saib xyuas kev ua tiav ntawm kev kho mob tsim nyog.
Tus nqi ntawm cov ntsuas ntawm cov qauv thiab pathology ntawm kev loj hlob hauv follicle
Thaum pib ntawm nws cov evolution, qhov taw qhia nyob rau hauv cov xwm txheej ntawm "tus qauv" yog qhov loj ntawm cov follicle hauv txoj kab uas hla ntawm 15 hli. Ntxiv mus, raws li tau hais ua ntej, nws nce 2-3 hli ib hnub.
Ntau tus poj niam xav txog cov lus nug: "Qhov loj ntawm lub hauv paus ntawm ovulation yog dab tsi?" Nws yog suav hais tias yog ib txwm - txog 18-24 mm. Tom qab ntawd lub corpus luteum tshwm. Tib lub sijhawm, qib ntawm progesterone hauv cov ntshav yuav tsum tau nce.
Ib leeg ultrasound tsis muaj peev xwm tsim kom tiav daim duabkev loj hlob (maturation) ntawm follicle, vim nws yog ib qho tseem ceeb tshwj xeeb los tswj txhua theem ntawm tus kheej.
Lub ntsiab pathologies uas cuam tshuam qhov kev loj hlob ntawm cov hauv paus hniav yog:
1. Atresia yog ib qho kev cuam tshuam ntawm cov follicle uas tsis muaj ovulation. Yuav kom meej meej, tom qab tsim, nws loj hlob mus rau ib qho chaw, thiab tom qab ntawd khov thiab rov ua dua, yog li ovulation yeej tsis tshwm sim.
2. Persistence - kev khaws cia ntawm tus kab mob, thaum nws tseem ua haujlwm zoo, nyob rau hauv cov hlwb ntawm cov kab lis kev cai ntawm cov ntaub so ntswg los yog lub cev dhau lub sij hawm tus yam ntxwv ntawm tus kab mob. Nyob rau hauv cov ntaub ntawv no, lub follicle yog tsim thiab tsim, tab sis nws rupture tsis tshwm sim, vim hais tias ntawm cov tshuaj hormone luteinizing tsis nce. Daim ntawv no ntawm anatomical tsim yog khaws cia kom txog thaum kawg ntawm lub voj voog.
3. Follicular cyst yog ib hom kev ua haujlwm tsim nyob rau hauv cov ntaub so ntswg ntawm zes qe menyuam. Nyob rau hauv cov xwm txheej no, lub hauv paus ntawm lub unovulated follicle tsis rupture, nws tseem nyob mus li, thiab cov kua feem ntau accumulates nyob rau hauv nws, thiab tom qab ib tug cyst loj dua 25 hli yog tsim.
4. Luteinization yog tsim ntawm corpus luteum, uas qee zaum tsim tsis muaj kev tawg ntawm lub hauv paus, uas tom qab kuj tsim. Qhov xwm txheej no tuaj yeem ua tau yog tias muaj qhov nce ntxiv ntawm LH tus nqi lossis kev puas tsuaj rau cov qauv ntawm zes qe menyuam.
Folllicle qhov ntau thiab tsawg los ntawm hnub ntawm lub voj voog
Los ntawm thawj hnub ntawm lub voj voog tom ntej, nrog kev pab ntawm ultrasound, nws tuaj yeem pom tau tias muaj ntau qhov antral anatomical formations nyob rau hauv zes qe menyuam, uas tom qab ntawd yuav loj hlob. Lawv qhov nce yog vim muaj kev cuam tshuamCov tshuaj hormones tshwj xeeb, cov tseem ceeb yog follicle-stimulating hormone (FGS) thiab estradiol. Muab hais tias lawv cov qib sib raug raws li cov qauv tsim rau cov ntsiab lus ntawm cov tshuaj no hauv cov ntshav, ib tug poj niam feem ntau muaj ovulation ruaj khov, thiab lub voj voog anovulatory tsis pub ntau tshaj ob zaug hauv ib xyoos.
Antral follicles hauv zes qe menyuam, qhov loj ntawm qhov tsis tseem ceeb, yuav tsum muaj tam sim no, raws li tus qauv, hauv ob qho tib si gonads hauv ib qho nyiaj tsis tshaj cuaj daim. Raws li txoj cai, lawv tsis ntau tshaj 8-9 mm nyob rau hauv lub cheeb. Tom qab ntawd, nws yog antral follicles, nyob rau hauv kev cuam tshuam ntawm cov tshuaj hormones sib raug zoo, uas yuav ua rau muaj qhov tseem ceeb anatomical tsim raws li cov follicle tseem ceeb, qhov loj ntawm txoj kab uas hla tshaj lawv los ntawm 2.5 npaug..
Qhov nruab nrab ntawm kev coj khaub ncaws yog 30 hnub. Ib qhov twg los ntawm hnub thib kaum, qhov tseem ceeb tshaj plaws tau piav qhia los ntawm tag nrho cov txheej txheem ntawm antral follicles.
Ntau zaus, cov neeg mob muaj lus nug: "Yuav ua li cas loj npaum li cas lub follicle yuav tsum nyob rau theem no?" Nyob rau thawj zaug ntawm folliculometry, nws xyaum tsis txawv ntawm qhov loj ntawm tus so (12-13 mm). Nws tsim nyog nco qab tias qhov kev kuaj mob ultrasound tso cai rau koj los txiav txim qhov loj ntawm cov hauv paus hniav los ntawm hnub ntawm lub voj voog.
Tsis tas li ntawd, thaum lub sijhawm thawj zaug, tus kws tshaj lij yuav muaj peev xwm qhia tau meej tias muaj pes tsawg tus follicles uas twb tau tsim lawm. Feem ntau nws tsuas yog ib qho (hauv sab xis lossis sab laug zes qe menyuam). Txawm li cas los xij, nyob rau hauv cov ntaub ntawv thaum tus neeg mob tau txais kev kawm tshwj xeeb ovulation stimulation, tej zaum yuav muaj xws li follicles.ob peb, ua rau muaj ntau lub cev xeeb tub, tau kawg, raug rau kev loj hlob ntawm ob lossis ntau dua cov qauv anatomical tseem ceeb.
Lub rooj sib tham thib ob tau tuav tom qab peb hnub. Hauv nws chav kawm, tus kws kho mob:
- lees paub tias muaj cov follicle tseem ceeb;
- txiav txim siab qhov loj ntawm cov hauv paus hniav los ntawm kev voj voog ntawm kev coj khaub ncaws;
- kho (yog tias qhov no yog qhov teeb meem) qhov rov qab txhim kho ntawm lub hauv paus.
Tus kws kho mob ua tib zoo tshuaj xyuas ob lub zes qe menyuam ntawm tus poj niam. Yog tias koj taug qab qhov loj ntawm cov hauv paus hniav los ntawm hnub ntawm lub voj voog, tom qab kev sib kho thib ob nws yog 17-18 hli inch. twb dhau hnub 13 lawm.
Thaum lub sijhawm thib peb (transvaginal ultrasound), koj tuaj yeem pom tias qhov loj ntawm lub hauv paus ua ntej ovulation (lub ncov ntawm nws qhov loj me) coj tus nqi sib npaug li 22-25 hli. Qhov no qhia tau hais tias yuav tshwm sim (nyob rau hauv ob peb teev tom ntej no) rupture, raws li ib tug tshwm sim ntawm cov laus lub qe yuav nkag mus rau hauv lub plab kab noj hniav, thiab ces nkag mus rau hauv lub fallopian raj. Txog ib hnub, nws raug rau fertilization, thiab tom qab ntawd tuag. Nws yuav tsum raug sau tseg tias qhov kev muaj peev xwm ntawm lub qe yog ob peb zaug tsawg dua li cov spermatozoa.
Tseem muaj cov xwm txheej thaum cov follicle tseem ceeb loj hlob ntawm tus nqi sib txawv, uas yog vim li cas ntau tshaj peb zaug ntawm qhov ultrasound no yuav xav tau. Yog hais tias tus neeg mob tau rov sau nws regression, raws li txoj cai, tus kws kho mob tau sau nws txhua hnub folliculometry (txij hnub 9-10 ntawm lub voj voog). Qhov no yuav txheeb xyuas qhov pib ntawm kev thim rov qab, thiab tom qab ntawd tsim qhov ua rau ntawm qhov tshwm sim.
Yog li, nws tsim nyog rov qab hais dua ib zaug tias nws tuaj yeem txiav txim siab qhov loj ntawm cov hauv paus hniav los ntawm kev voj voog hauvLub sijhawm ntawm kev kuaj mob ultrasound kuaj - folliculometry. Nws yuav tso cai rau tsis tsuas yog tswj lub maturation ntawm lub dominant anatomical tsim nyob rau hauv kev txiav txim siab, tab sis kuj yuav txheeb xyuas qhov ua rau deviations uas cuam tshuam cov txheej txheem kev loj hlob (yog tias muaj).
Ovulation Stimulation
Ib txoj hauv kev, nws induction. Qhov no yog ib tug complex ntawm ntau yam kev kho mob manipulations, lub hom phiaj ntawm uas yog qhov pib ntawm cev xeeb tub. Nws yog nyob rau hauv kev thov nyob rau hauv lub moj khaum ntawm niaj hnub gynecology nyob rau hauv relation mus poj niam infertility vim ntau yam.
Pib nrog, nws tsim nyog txhais lub ntsiab lus ntawm kev xeeb tub - ib qho mob thaum tus poj niam hnub nyoog qis dua 35 xyoos tsis tuaj yeem xeeb menyuam tau 12 lub hlis, raug rau lub neej kev sib deev, nrog rau ob peb tug (poj niam) tshaj 35, thiab ib tug txiv neej - 40), uas nws cev xeeb tub tsis tshwm sim rau ntau tshaj rau lub hlis.
Indications thiab contraindications rau stimulation
Induction yog ua nyob rau hauv ob kis:
- anovulatory infertility;
- kev tsis muaj menyuam tsis paub keeb kwm.
Lub ntsiab contraindications rau cov txheej txheem no yog:
- kev ua txhaum ntawm patency ntawm cov hlab ntsha fallopian;
- tsis tuaj yeem ntawm kev kuaj mob tag nrho los ntawm ultrasound;
- txiv neej infertility;
- depletion ntawm cov follicular reserve.
Ovulation induction tsis yog ua nrog kev kho mob ntev ntawm cov teeb meem tsis muaj menyuam (ntau tshaj ob xyoos).
Schemes ntawm txheej txheem
Lawv tau hais hauv ob txoj cai:
- nce koob tshuaj tsawg kawg;
- txo qis koob tshuaj ntau.
Hauv thawj kis, thaum lub sijhawm ua haujlwm no, cov tshuaj "Clomiphene" (non-steroidal hluavtaws estrogen), uas thaiv cov estradiol receptors, yog thawj zaug. Tom qab ntawd cov tshuaj raug tso tseg, thiab yog li cov tswv yim tawm tswv yim tau tshwm sim: kev nce hauv kev sib txuas ntawm gonadotropic tso cov tshuaj hormones thiab kev tso tawm ntawm luteinizing thiab follicle-stimulating hormones. Thaum kawg, qhov no yuav ua rau kom loj hlob ntawm cov follicles. Yog li, peb tuaj yeem hais tias Clomiphene yog qhov ntsuas ovulation.
Thaum lub sijhawm ua haujlwm no, hais txog qhov ua rau ntawm ovulation, tsuas yog ib qho follicle matures, uas yog, qhov tshwm sim ntawm ob qho tib si cev xeeb tub thiab lwm yam teeb meem (piv txwv li, zes qe menyuam hyperstimulation syndrome) yog xyaum tsis suav nrog.
Tom qab lub sijhawm thaum qhov loj ntawm cov follicles thaum lub sij hawm stimulation raws li thawj lub tswv yim nce mus txog 18 mm nyob rau hauv txoj kab uas hla (nrog ib tug endometrial thickness ntawm 8 hli), triggers yog qhia (cov tshuaj uas ua raws li cov kev tso tawm ntawm LH). Tom qab ntawd, tom qab kev taw qhia ntawm hCG, ovulation tshwm sim kwv yees li ob hnub tom qab.
Lub tswv yim thib ob ntawm kev tswj hwm feem ntau yog siv rau cov poj niam uas muaj zes qe menyuam qis thiab qhov muaj feem cuam tshuam los ntawm cov tshuaj me me ntawm FSH.
Yuav tsum tau qhia rau qhov kev tswj hwm no:
- poj niam hnub nyoog tshaj 35;
- FSH tus nqi siab dua 12IU / L (hnub 2-3 ntawm lub voj voog);
- zes qe menyuam ntim txog 8 cc saib;
- secondary amenorrhea thiab oligomenorrhea;
- muaj kev phais zes qe menyuam, kws khomob lossis kws khomob.
Pom tau qhov tshwm simyuav tsum tshwm sim los ntawm hnub rau. Ib qho kev phiv tseem ceeb cuam tshuam rau zes qe menyuam nrog rau txoj kev ntawm ovulation induction yog qhov kev pheej hmoo ntawm lawv cov hyperstimulation syndrome. Nyob rau hauv rooj plaub thaum, thaum lub sij hawm tom ntej ultrasound, cov follicles nyob rau hauv lub zes qe menyuam raug kuaj pom, qhov loj tshaj 10 mm inch, tus kws kho mob suav hais tias qhov no yog lub teeb liab rau cov txheej txheem tiv thaiv tus mob no.
Control ultrasound
Nws yog qhov xav tau kom paub meej tias ovulation los ntawm transvaginal ultrasound. Qhov no tseem ceeb npaum li kev saib xyuas nws tus kheej. Nws tau hais dhau los hais tias qhov loj npaum li cas ntawm cov follicle yog ua ntej ovulation (18-24 mm inch), txawm li cas los xij, txawm tias qhov loj me yuav tsum tau mus txog, cov tshuaj ntsiav yuav tsis tawg, thiab lub qe loj yuav tsis tso rau hauv plab kab noj hniav. Kev tswj hwm ultrasound tau ua 2-3 hnub tom qab kwv yees lub sijhawm ntawm ovulation.
Nyob rau ntawm qhov kev sib tham no, tus kws kho mob yuav tshuaj xyuas qhov mob ntawm zes qe menyuam rau cov tsos mob ntawm ovulation:
- tsis muaj qhov tseem ceeb;
- lub corpus luteum yog tam sim no;
- muaj kua dej nyob hauv qhov chaw tom qab lub tsev menyuam.
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias yog tus kws kho mob tshwj xeeb ua kev soj ntsuam xyuas ultrasound tom qab lub sijhawm, nws yuav tsis pom cov kua dej los yog corpus luteum lawm.
Thaum kawg, nws yuav muaj txiaj ntsig los teb cov lus nug ib zaug ntxiv: "Lub follicle loj npaum li cas thaum lub sij hawm ovulation?" Qhov no tseem ceeb anatomical tsim thaum lub sij hawm ntawm ovulation matures mus rau ib tug loj ntawm kwv yees li 18 - 24 mm nyob rau hauv lub cheeb. Nws yog ib qho tsim nyog nco ntsoov tias qhov loj ntawm endometrium thiab follicles hloov pauv nyob ntawm hnub ntawm kev coj khaub ncaws.
