#1
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Ïðèâû÷íîå íåâûíàøèâàíèå, ÷òî åùå ïðîâåðèòü?
Äîáðûé äåíü! Ìíå 37 ëåò, ðîñò 168, âåñ ñåé÷àñ 60 êã.
4 ãîäà â áðàêå. Îò ïåðâîãî áðàêà äî÷ü 17 ëåò. 4 ãîäà ïûòàåìñÿ ðîäèòü ðåáåíêà, â 2015 ãîäó áûëî äâà âûêèäûøà ìàëîãî ñðîêà. Ïîñòàâèëè äèàãíîç ïðèâû÷íàÿ íåâûíàøèâàåìîñòü. ×åðåç ìåñÿö íàøëè ïîëèï ýíäîìåòðèÿ è ñâÿçàëè âûêèäûøè ñ íèì. Ïîñëå óäàëåíèÿ ïîëèïà 2 ãîäà íå ïîëó÷àëîñü çàáåðåìåíåòü âîâñå.Áûëà ñäåëàíà ëàïàðîñêîïèÿ, òðóáû ïðîõîäèìû. È ãäå òî ãîä íàçàä ñòàëè ñêóäíûå ìåñÿ÷íûå, ïðè÷åì ïîñëå ëàïàðîñêîïèè ñíîâà áûëè îáèëüíû, à ÷åðåç ìåñÿö îïÿòü îäèí äâà äíÿ è ìàçíÿ.. Ó ãèíåêîëîãîâ íàáëþäàþñü êàæäûé ìåñÿö, âñå àíàëèçû â ïîðÿäêå, ãîðìîíû â íîðìå, àìã õîðîøèé, îâóëÿöèÿ ñâîåâðåìåííàÿ, òîíêîâàò ýíäîìåòðèé, ïîýòîìó âòèðàþ äèâèãåëü. Ìóæ â èþëå 2017 ãîäà äåëàë ñïåðìîãðàììó ïî Êðþãåðó, ðåçóëüòàò ïî Êðþãåðó 4,95, òåðàòîçîîñïåðìèÿ, àããëþòèíàöèÿ. Àããëþòèíàöèþ ïðîëå÷èë, ïîâòîðíî ïîêà íå ñäàâàë, åùå ïîñåùàåò äîêòîðà. Ñîáðàëèñü èäòè â ïðîãðàììó ÝÊÎ, íî â äåêàáðå 2017 ãîäà ïîëó÷èëîñü çà÷àòèå, ñîõðàíÿëè óòðîæåñòàíîì, íî ÷åðåç 7äíåé ÕÃ× óïàë è åùå äíåé ÷åðåç 5 ñàìîïðîèçâîëüíûé âûêèäûø. Ñäàëè HLA òèïèðîâàíèå, è íàì âûäàëè ðåçóëüòàò 6 ñîâïàäåíèé èç 6. Íî ïî÷èòàâ ôîðóìû ïîíÿëà, ÷òî ýòî íè î ÷åì íå ãîâîðèò. Äà è òàêîãî ðåçóëüòàòà â ïðèíöèïå áûòü íå ìîæåò, ìû äàæå èç ðàçíûõ ñòðàí. Âðà÷ ãèíåêîëîã, ó êîòîðîãî íàáëþäàþñü òÿíåò íà ÝÊÎ, ñ êàïåëüíèöàìè èììóíîãëîáóëèíà è ïðîãåñòåðîíîì. Íåäåëþ íàçàä ñäàëà ãîðìîíû ùèòîâèäêè, ðåçóëüòàòû òàêèå: Ò3 îáùèé 1,6, ðåô. çíà÷åíèÿ 0,89-2,44 Ò3 ñâîáîäíûé 4,8, ðåô çíà÷åíèÿ 2,6-5,7 Ò4 îáùèé 84,9, ðåô çíà÷åíèÿ 55-137 Ò4 ñâîáîäíûé 14,65, ðåô çíà÷åíèÿ 9-19,05 ÒÒà 1,73, ðåô çíà÷åíèÿ 0,4-4 Òà 20,5, ðåô çíà÷åíèÿ <55 ß íå ïîíèìàþ, ãäå åùå îáñëåäîâàòüñÿ, òàê êàê â ÝÊÎ íå âèæó äëÿ ñåáÿ ïåðñïåêòèâ, òàê êàê çà÷àòèå ó íàñ ïðîèñõîäèò, íåò ñîõðàíåíèÿ áåðåìåííîñòè. Ïîìîãèòå, ñîâåòîì ïîæàëóéñòà, ÷òî åùå îáñëåäîâàòü è íàéòè ïðè÷èíó íåâûíàøèâàåìîñòè. |
#2
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Çà÷åì Âû äóáëèðóåòå òåìó ?
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Ã.À. Ìåëüíè÷åíêî |
#3
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Èçâèíÿþñü.  ýíäîêðîëîãèè óòî÷íÿëà èìåííî ïðî ùèòîâèäêó, à çäåñü ïðî hla è äðóãèå ïðè÷èíû íåâûíàøèìîñòè. È åñòü îè ñìûñë äåëàòü ýêî..
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#4
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ß ñïîñîáíà, êàê è äðóãèå âðà÷è, ïðî÷åñòü íàïèñàííûé Âàìè òåêñò - íî Âû íå ïðîñëè ññûëêè.
Âàì óæå áûë äàí îòâåò î ôàêòüðå AZF è î íîðìàëüíîé ðàáî å æåëåçû - íî Âû è íå ïîäóìàëè ñäåëàòü ññûëêó äëÿ ãèíåêîëîãîâ, ãðóçèòå âðà÷åé óæå îáðàáîòàííîé èíôîðìàöèåé è ïðåêðàñíî ìû ìîãëè ïðèãëàñèòü ãèíåêîëîãîâ â òåìó. Íå èãðàéòå â ïîëèêëèíè÷åñêóþ áåãîòíþ ïî êàáèíåòàì ñ ïîòåðÿííîé èñòîðèåé
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Ã.À. Ìåëüíè÷åíêî |
#5
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ß åùå ðàç ïðèíîøó ñâîè èçâèíåíèÿ. Íà ôîðóìå ïåðâûé äåíü. Òåïåðü áóäó çíàòü, ÷òî ìîæíî ïðèãëàñèòü âðà÷åé â òåìó.
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#6
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1. Êàðèîòèïèðîâàíèå îáîèõ ñóïðóãîâ.
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#7
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Áîðèñ, ñïàñèáî! Ïî÷åìó òî íà êàðèîòèï íàñ íå îòïðàâëÿëè.  áëèæàéøåå âðåìÿ ñäåëàåì.
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#8
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Âñåì äîáðûé âå÷åð!  ïðîäîëæåíèè òåìû.
Êàðèîòèï ñäåëàëè. È ó ìåíÿ è ó ìóæà âñå õîðîøî. Â àïðåëå ñíîâà áûë âûêèäûø íà 5-6 íåäåëå. Ïîñëå ýòîãî ñäàëè áåëîê S è C - îáà â íîðìå; ãåíû F2 è f5 - òîæå íîðìà; ÄÍÊ ôðàãìåíòàöèÿ ó ìóæà ÷óòü âûøå íîðìû 17% (0-15)æ ãàììà èíòåðôåðîí - íîðìà; öèòîêòèíû IL 2 4 ïîâûøåíû; öèòîêòèíû 6 10 â íîðìå; ñóáïîïóëÿöèÿ ëèìôîöèòîâ - â íîðìå. Áûëè â öåíòðå Ýêî - ðåêîìåíäóþò ýêëî ñ ãåíåòèêîé + êîððåêöèÿ öèòîêòèíîâ ïðè íåîáõîäèìîñòè. Åùå ïî ðåçóëüòàòàì îáñëåäîâàíèÿ ó íàñ ñ ìóæåì 6 ñîâïàäåíèé èç 6 ïî hla. Ìîðàëüíî ÿ ãîòîâà ê ÝÊÎ, íî äåéñòâèòåëüíî ëè äåëî â ãåíåòèêå? åñòü ëè åùå êàêèå íèáóäü ôàêòîðû, êîòîðûå ìû íå îáñëåäîâàë èëè êîòîðûå ìîãóò äàâàòü âûêèäûøû 5-6 íåäåëè? Ñïàñèáî! |
#9
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Íåâîçìîæíî êîððåêòèðîâàòü öèòîêèíû, íî åñòü âîçìîæíîñòü âïàðèâàòü êàêóþ-òî ÷åïóõó çà áîëüøèå äåíüãè è ãîâîðèòü, ÷òî åòî äëÿ êîððåêöèè öèòîêèíîâ, âñå ñäàííûå àíàëèçû ãåìîñòàçà - ÍÅ íóæíû áûëè; êàðèîòèïèðîâàòü íóæíî áûëî è ìàòåðèàë àáîðòóñà - èìåííî èç-çà åãî ãåíåòè÷. äåôåêòîâ è ïðîèñ õîäÿò áîëüøèíñòâî ïðåðûâàíèé íà ñðîêå äî 10-12 íåäåëü
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#10
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ÄÍÊ ôðàãìåíòàöèÿ ó ñïåðìàòîçîèäîâ ìîæåò áûòü ôàêòîðîì ðèñêà ïðèâû÷íîãî íåâûíàøèâàíèÿ, òåîðåòè÷åñêè, åñëè ó ñóïðóãà èìåþòñÿ ïðîèçâîäñòâåííûå/áûòîâûå âðåäíîñòè (èíòîêñèêàöèÿ íà ðàáîòå, êóðåíèå, èçáûòî÷íûé âåñ è òï), òî èõ óñòðàíåíèå ìîæåò ñíèçèòü % ôðàãìåíòàöèè è ïîâûñèòü øàíñû íà âûíàøèâàíèå
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#11
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Âàäèì Âàëåðüåâè÷, ñïàñèáî Âàì çà îòâåò!
Áåðåìåííîñòü ïðåðûâàåòñÿ íà óðîâíå ÕÃ× äî 200, ñàìûé ìàêñèìàëüíûé áûë, äàæå íà óçè íå îïðåäåëÿåòñÿ. ß òàê ïîíèìàþ, ÷òî ïðè òàêîì õã÷ ïî÷òè íå ðåàëüíî êàðèîòèïèðîâàòü àáîðòóñ? Ò.å. âñå òàêè ïðîáëåìà ñ ãåíåòèêîé? Ìíå 38, ìîæåò áûòü èç-çà âîçðàñòà? Äîñòàòî÷íî ëè ÏÃÄ äèàãíîñòèêè èëè êîïàòü ãëóáæå? |
#12
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Öèòàòà:
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#13
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ñîâñåì íå ñïåöèàëèñò, íî âîò ìîæåòå ñàìè ïî÷èòàòü (ñ ïåðåâîä÷èêîì)
Sperm DNA fragmentation (SDF) and URPL Standard semen parameters do not seem to be associated with the risk of pregnancy loss.143 However, in vitro and in vivo studies have now shown that an elevated SDF negatively affects fertility,144 and it has been proposed as a cause of miscarriage.145 There are several methods to test SDF, the most commonly used being the terminal deoxynucleotidyl transferase dUTP nick end labeling assay, the sperm chromatin dispersion test, and the sperm chromatin structure assay. A meta-analysis of 16 cohort studies involving 2,969 couples found a significant increase in miscarriage in patients with high SDF.146 Two recent cohort studies found SDF, measured with sperm chromatin dispersion test, to be significantly higher in couples in the URPL group compared to a control group of fertile men.147,148 Therefore, it seems reasonable to offer SDF testing to couples with otherwise URPL. Besides advanced paternal age, many environmental factors, such as cigarette smoking, obesity, exogenous heat, and exposure to toxins, have been associated with increased SDF. Even though SDF is still not recommended by many societies as part of the workup for RPL,2,7 ordering the test could be useful and could help strengthen the decision to pursue lifestyle modifications.149
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#14
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Êàê Âû èñêëþ÷èëè àíòèôîñôîëèï. ñ-ì êàê ïðè÷èíó íåâûíàøèâàíèÿ? Íàçâàíèÿ àíàëèçîâ
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#15
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Öèòàòà:
2) ÀÒ ê êàðäèîëèïèíó, ñóììàðíûå IgG+A+M < 1.2 îòí.åä./ìë <12 <12 - àíòèòåë íå îáíàðóæåíî 12-40 - íèçêàÿ êîíöåíòðàöèÿ àíòèòåë >40 - âûñîêàÿ êîíöåíòðàöèÿ àíòèòåë 3) D-äèìåð 96 íã/ìë < 243 Îðèåíòèðîâî÷íûå ïðåäåëû ïðè áåðåìåííîñòè: 1 òðèìåñòð: < 286 2 òðèìåñòð: < 457 3 òðèìåñòð: < 644 4) Âîë÷àíî÷íûé àíòèêîàãóëÿíò îòðèöàò îòðèöàò. Òåñò ñ ÿäîì ãàäþêè Ðàññåëà |