#1
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6 ñîâïàäåíèé ïî HLA
Óâàæàåìûå äîêòîðà, ïîìîãèòå ìíå ñîâåòîì.
6 ëåò áåñïëîäèÿ è íè îäíîãî íàìåêà íà áåðåìåííîñòü. Ó íàñ ñ ìóæåì ïîëíîå ñîâïàäåíèå ïî HLA. Ñäàíà ÑÊË - âÿëàÿ ðåàêöèÿ íà êëåòêè ìóæà. Âðà÷îì áûë ðåêîìåíäîâàí ËÈÒ äîíîðîì è Èà âî âðåìÿ ñòèìóëÿöèè è ïîñëå ïîëîæèòåëüíîãî õã÷. Ó ìåíÿ áûëî 2 ïåðåíîñà ýìáðèîíîâ. Âî âòîðîì ñëó÷àå óäà÷à. Èà êàïàëà êàæäûå 10 äíåé. Íî íà 8 íåäåëÿõ ñëó÷èëñÿ âûêèäûø. ×òî ìíå äåëàòü äàëüøå? Ïðè÷èíà âûêèäûøà - ØËÀ? Ìû îáñëåäîâàíû âäîëü è ïîïåðåê. Äðóãèõ äèàãíîçîâ íåò. Ìíå áóäåò öåííî óñëûøàòü ëþáîå ìíåíèå. Çàðàíåå ñïàñèáî |
#2
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 2000 Dec;74(6):1108-13.
Treatment of repeated unexplained in vitro fertilization failure with intravenous immunoglobulin: a randomized, placebo-controlled Canadian trial. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ], [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]. Department of Obstetrics and Gynaecology, University of British Columbia, British Columbia, Vancouver, Canada. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] OBJECTIVE: To evaluate the effect of intravenous immunoglobulin (IVIG) on pregnancy outcome in couples with repeated unexplained in vitro fertilization (IVF) failure. DESIGN: Prospective, randomized, double blind, placebo-controlled clinical trial. SETTING: A university-based and a free-standing IVF program. PATIENT(S): Fifty-one couples with a history of repeated unexplained IVF failure who were preparing for another fresh IVF cycle or replacement of cryopreserved embryos. INTERVENTION(S): Eligible women underwent a standard IVF stimulation using a long luteal phase GnRH analog protocol. Cryopreserved embryos were replaced after endometrial preparation with oral micronized estradiol and subsequent vaginal progesterone. The women were randomly selected to receive IVIG (500 mg/kg) or an equivalent volume of normal saline. The first infusion was given on the day of embryo transfer or during the preceding 72 hours. The second infusion was given 4 weeks later if a clinical pregnancy was confirmed by ultrasound. MAIN OUTCOME MEASURE(S): Live-birth rates. RESULT(S): Overall, the live-birth rates were 4/26 (15%) for the IVIG group and 3/25 (12%) for the placebo group (P=0. 52). There were 39 fresh IVF cycles, which yielded a clinical pregnancy rate of 28%, with live-birth rates of 4/21 (19%) for the IVIG group and 3/18 (17%) for the placebo group (P=0.59). CONCLUSION(S): In this randomized clinical trial, IVIG did not improve the live-birth rate in couples with repeated unexplained IVF failure, stringently defined by known determinants of IVF outcome. PMID: 11119735 [PubMed - indexed for MEDLINE]  ïðèâåäåííîì èññëåäîâàíèè âíóòðèâåííîå ïðèìåíåíèå èììóíîãëîáóëèíà íå óâåëè÷èâàëî ÷àñòîòó ðîäîâ ó ïàð ñ ïîâòîðíûìè íåóäà÷íûìè ïîïûòêàìè ÝÊÎ è íå ïîçâîëÿåò îïðåäåëåííî ãîâîðèòü î âëèÿíèè íà èñõîä ÝÊÎ. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 1998 Jan;13(1):39-43. Parental human leukocyte antigens and implantation failure after in-vitro fertilization. Creus M, Balasch J, Fábregues F, Martorell J, Boada M, Peñarrubia J, Barri PN, Vanrell JA.Department of Obstetrics and Gynecology, Faculty of Medicine, University of Barcelona, Hospital Clínic i Provincial, Spain. At present, it is well accepted that maternal recognition of paternally derived fetal antigens occurs during normal pregnancy and may be beneficial for implantation and maintenance of gestation. Thus, we have investigated the compatibility of human leukocyte antigens (HLA) in couples with successive failed in-vitro fertilization (IVF) cycles. Study group 1 included 50 couples with prior primary infertility who had not achieved a pregnancy after > or = 3 (range 3-7, mean 3.7) IVF cycles where at least two embryos (mean 3.3, range 2-4) were transferred in each attempt. An infertile control group (group 2) included 50 infertile couples undergoing IVF with the same indications as couples in group 1, who achieved a viable pregnancy with their first IVF attempt. The results were compared with those found in a population sample including 100 men and 100 women from the local population (group 3). We found a statistically significant (P < 0.05) excess of HLA sharing (> or = 2 antigens) between partners in group 1 as compared to groups 2. There was a trend toward increased HLA sharing in group 1 when groups 1 and 3 were compared. We conclude that some cases of implantation failure after IVF and embryo transfer might be caused by underlying close histocompatibility between partners. In conclusion, our study shows that > or =3 implantation failures after IVF are associated with > or =2 shared HLAs between partners. Further studies on HLA sharing, including the HLA C recently discovered in trophoblast, are desirable in order to confirm our results. If so, it would be worthwhile to screen couples for HLA compatibility who fail multiple IVF attempts.Gamete or embryo donation would be a therapeutic alternative in these cases in order to provide the wide antigenic difference between mother and fetus necessary for successful implantation. Ìû çàêëþ÷àåì, ÷òî íåêîòîðûå ñëó÷àè îòñóòñâèÿ èìïëàíòàöèè ïîñëå IVF è ïåðåíîñà ýìáðèîíà ìîãëè áû áûòü âûçâàíû, ïðè÷èíàìè â îñíîâå êîòîðûõ ëåæèò áëèçêàÿ òêàíåâàÿ ñîâìåñòèìîñòü ìåæäó ïàðòíåðàìè.Íàøå èññëåäîâàíèå ïîêàçûâàåò, ÷òî 3 è áîëåå íåóäà÷ èìïëàíòàöèè ïîñëå IVF ñâÿçàíû ñ 2-ìÿ è áîëåå ñîâïàäåíèÿìè HLA ìåæäó ïàðòíåðàìè. Äîíàöèÿ îîöèòîâ èëè ýìáðèîíîâ áûëè áû òåðàïåâòè÷åñêîé àëüòåðíàòèâîé â ýòèõ ñëó÷àÿõ, ÷òîáû îáåñïå÷èòü äîñòàòî÷íîå àíòèãåííîå ðàçëè÷èå ìåæäó ìàòåðüþ è ïëîäîì, íåîáõîäèìûì äëÿ óñïåøíîé èìïëàíòàöèè. |
#3
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ñïàñèáî çà áûñòðûé îòâåò.
ïî ïîâîäó ýôôåêòèâíîñòè Èà ÿ ñ Âàìè ñîãëàñíà. Áîëüøå íà íèõ ÿ íå ðàññ÷èòûâàþ. À óìåñòíî ëè â êà÷åñòâå àëüòåðíàòèâû èñïîëüçîâàòü äîíîðñêóþ ñïåðìó? Ýòî äåøåâëå è òåõíè÷åñêè ïðîùå. À ïî Âàøåìó ËÈÒ íå ïîìîæåò ïîìî÷ü ïðåîäàëåòü "ïîõîæåñòü" è ñîõðàíèòü áåðåìåííîñòü? |
#4
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Öèòàòà:
ß îòíîøóñü ê ïîäîáíîé òåðàïèè ñêåïòè÷åñêè. |
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#6
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Öèòàòà:
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Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |
#7
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Êàðèîòèï â íîðìå, ãåíåòèêà íå óäàëàñü. Òàê è íàïèñàëè ÷òî îïåðåäåëèòü êàðèîòèï íåâîçìîæíî. Ó ìóæà ñïåðìîãðàììà îòëè÷íàÿ. Ìîè ãîðìîíû âñå â íîðìå. Äàæå åñòü ñâîÿ ðåãóëÿðíàÿ îâóëÿöèÿ. Òðóáû àáñîëþòíî ïðîõîäèìû. Ïðîâåðÿëèñü 3 ðàçà. Ñâåðòûâåìîñòü êðîâè â íîðìå. Äâà ãîäà íàçàä íà ãèñòåðîðåçåêòîñêîðèè óäàëèëè ïîëóþ ïåðåãîðîäêó â ïîëîñòè ìàòêè.Ãîä íàçàä íà ëàïàðîñêîïèè óäàëèëè ìèîìó.
Ïðàâäà èìååòñÿ åùå îäèí àíàëèç íà íåñîâìåñòèìîñòü. Ñïåðìà ìóæà âî ìíå íå æèâåò - âñÿ è ñðàçó. Íî ïî÷åìó äàæå ÝÊÎ ïîëó÷èëîñü íå ñ ïåðâîãî ðàçà? Íó è êîíå÷íî ïî÷åìó ñëó÷èëñÿ âûêèäûø? Ïîääåðæêà áûëà ñèëüíàÿ. |
#8
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ÝÊÎ - ýòî 40-50% ÷àñòîòà íàñòóïëåíèÿ áåðåìåííîñòè íà îäíó ïîïûòêó, ïîýòîìó ñïèñûâàòü íà HLA íåóäà÷ó îäíîé ïîïûòêè ïî ìåíüøåé ìåðå ñòðàííî. Âûêèäûø äàæå áåç ÝÊÎ ó âïîëíå ôåðòèëüíûõ æåíùèí ñëó÷àåòñÿ â 17-30% ñëó÷àåâ. Ðóáåö â ïîëîñòè ìàòêè - äîñòàòî÷íî ñåðüåçíàÿ ïðè÷èíà äëÿ îáúÿñíåíèÿ âàøèõ ïðîáëåì.
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Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |
#9
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ýòî îäíà èç ìîèõ ñîáñòâåííûõ âåðñèé. òåì áîëåå ÷òî ðóáåö íà ìàòêå ó ìåíÿ äîñòàòî÷íî áîëüøîé. ò.å. âûêèäûøè ó ìåíÿ òàê è áóäóò ïîâòîðÿòüñÿ? èëè âñ¸ çàâèñèò îò òîãî ãäå ïðîèçîéäåò ïðèêðåïëåíèå?
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#10
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Ìíîãîå çàâèñèò îò ìåñòà èìïëàíòàöèè
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Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |
#11
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ìíîãèå âåäü âûíàøèâàþò ïîñëå êåñàðåâî ñå÷åíèÿ, äàæå ïîñëå íåîäíîêðàòíîãî.
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#12
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Âî-ïåðâûõ, ýòî íå îäíî è òî æå, à âî-âòîðûõ, ðàçâå ÿ ñêàçàëà, ÷òî âû íå âûíîñèòå áåðåìåííîñòü? Óñëîâèÿ äëÿ ýòîãî ïðè íàëè÷èè ðóáöà â ýíäîìåòðèè è â ìèîìåòðèè (ïîñëå óäàëåíèÿ ìèîìû) íå èäåàëüíû, íî ðå÷ü â âàøåì ñëó÷àå î äðóãîì: ïðè÷åì çäåñü ñîâïàäåíèÿ ïî HLA? È êàê òåïåðü ïîíÿòíî, äîíîðñòâî - òî÷íî íå ðåøåíèå âàøèõ ïðîáëåì.
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Àíøèíà Ìàðãàðèòà Áåíèàìèíîâíà, äèðåêòîð êëèíèêè ÔåðòèÌåä, ã. Ìîñêâà. Âèöå-ïðåçèäåíò Ðîññèéñêîé Àññîöèàöèè Ðåïðîäóêöèè ×åëîâåêà, ×ëåí ñîâåòà ESHRE. Çàïèñü íà êîíñóëüòàöèþ: (495) 504-15-26, (499) 165-70-77 Äèàãíîñòèêà è ëå÷åíèå âñåõ âèäîâ áåñïëîäèÿ ìåòîäàìè ÝÊÎ, ÈÊÑÈ è äð. Ãåíåòè÷åñêàÿ äèàãíîñòèêà è ïðîôèëàêòèêà íàñëåäñòâåííûõ çàáîëåâàíèé. Äîíîðñêèå ïðîãðàììû. Ñóððîãàòíîå ìàòåðèíñòâî. Áàíê ïîëîâûõ êëåòîê. Âåäåíèå ïàöèåíòîâ îò íà÷àëà ëå÷åíèÿ áåñïëîäèÿ äî ðîäîâ. |