|
#1
10.02.2014, 21:18
|
|||
|
|||
|
Èìóíîãëîáóëèíû ïðè ïîëèìîðôèçìå PAI
Çäðàâñòâóéòå. Ìíå 45 ãîòîâëþñü êî âòîðîé ïîïûòêå ýêî(êðèî ñ ÄÎÍ.ßÊ). Ïåðâàÿ ïîïûòêà, ðåçóëüòàò, çàìåðøàÿ àíýìáðèîíèÿ. Ðåøèëà ïðîâåðèòü êðîâü. Ïî ðåçóëüòàòàì èññëåäîâàíèÿ âñå õîðîøî, êðîìå êàê íàøëè íåêîòîðûå ïîëîìêè â ïîëèìîðôèçå PAI(ñìîòðèòå âî âëîæåíèè), êàê ìíå ñêàçàëà ãåìàòîëîã. Îíà æå è ïðîïèñàëà ìíå â/â èìóíîãëîáóëèí îòå÷åñòâ. 3 ðàçà, çà 6äíåé, çà 3äíÿ, è â äåíü ïåðåíîñà. Âîïðîñ ïðî èìóíîãëîáóëèí, êàê âû ñ÷èòàåòå, ñòîèò ëè â ìîåì ñëó÷àå åãî äåëàòü, íà ñêîëüêî ìíå èçâåñòíî, âòîðãàòüñÿ â èììóíèòåò ýòî íå áåçîïàñíî. Íåñóò ëè â ñåáå ýòè ïîëîìêè ðåàëüíóþ ïðîáëåìó çàáåðåìåíåòü è âûíîñèòü.  àíàìíåçå ó ìåíÿ äâîå äåòåé â ÅÁ. Îäíà çàìåðøàÿ ÅÁ(40 ëåò) , è îäíà çàìåðøàÿ ïîñëå ýêî ñ Äß. Íåêîòîðûå àíàëèçû ïèøó òóò, íåêîòîðûå âî âëîæåíèè. î÷åíü íàäåþñü íà âàø ñêîðåéøèé îòâåò.
Áèîõèìèÿ: Íàèìåí. Ðåçóë. Åä. èçìåð. Íîðìà ÀÒ ê ÕÃ× Ig G 0,61 ÊÏ < 1 – îòðèö. > 1 – ïîëîæ. ÀÒ ê ÕÃ× Ig M 0,69 ÊÏ < 1 – îòðèö. > 1 – ïîëîæ Àíòèñïåðìàëüíûå àíòèòåëà - 20,55 Åä/ìë íîðìà 0-60 Ò3 ñâîáîäíûé - 3,29 ïã/ìë íîðìà 1,8-4,2 Èììóíîëîãè÷åñêîå èññëåäîâàíè Èññëåäóåìûé ìàòåðèàë: ñûâîðîòêà êðîâè Íàèìåíîâàíèå Ðåçóëüòà Åäèí. èçìåð. Íîðìà Àíòè ôîñôîëèïèä ñêðèíèíã - IgG 0,693 Åä/ìë <10 Àíòè ôîñôîëèïèä ñêðèíèíã - IgM 0,327 Åä/ìë <10 Àíòèòåëà ê êàðäèîëèïèíó ñêðèíèíã (ñóììàðíûå IgA, IgM, IgG) <3,3 Åä/ìë <10 Àíòèòåëà ê áåòà2- ãëèêîïðîòåèíó I, ñêðèíèíã (ñóììàðíûå IgA, IgM, IgG) 4,355 Åä/ìë <10 Àíòèôîñôîëèïèä ñêðèíèíã IgG 0,00 Åä/ìë <10 Àíòèôîñôîëèïèä ñêðèíèíã IgM 0,00 Åä/ìë <10 Èììóíîñåðîëîãè÷åñêîå èññëåäîâàíèå ÀÒ-ÒÏÎ -10,7 Åä/ìë íîðìà äî 50 ëåò<35 ñòàðøå 50 ëåò<100 ÀÒ-Òà - <20 Åä/ìë íîðìà äî 50ëåò <40 CMV(ÖÌÂ)IgM - 0,079 åä. èçì. ÎÏ íîðìà <0.299-îòðèö. CMV(ÖÌÂ)IgG - 2,078 åä. èçì. ÎÏ íîðìà >=0.299-ïîëîæèò. Toxoplasma gondii IgM - 0,091 åä. èçì. ÎÏ íîðìà <0.409-îòðèö. Toxoplasma gondii IgG - 36,452 åä. èçì. Ìå/ìë íîðìà >10-ïîëîæ. Rubella (êðàñíóõà) IgM - 0,123 åä. èçì. ÎÏ <0.329-îòðèö. Rubella (êðàñíóõà) IgG - 1,339 åä. èçì. ÎÏ >=0.336-ïîëîæèò. HSV (ÂÏà 1+2)IgM - 0,066 åä. èçì. ÎÏ <0.210-îòðèö. HSV (ÂÏà 1+2)IgG - 3,656 åä. èçì. ÎÏ >=0.174-ïîëîæèò. Àãðåãàöèè òðîìáîöèòîâ â íîðìå. Ñèñòåìà ïðîòåèí Ñ - 0,70 Èíäåêñ ðåôåðåíòíûå ïðåäåëû >0,69 ÀÒ ê b2- ãëèêîïðîòåèíó1 - 0,40 îòðèöàòåëüíûé åä. èçìåðåíèÿ ÊÏ. Ãîìîöèñòåèí - 10,16 åä. èçìåðåí ìêìîëü/ë íîðìà 5-15 Ä-Äèìåð - 204 íã/ìë íîðìà <443 Ôåððèòèí - 10.75 íã/ìë íîðìà 10-150 Êîàãóëîãð. ðàñøèð.- âñå â íîðìå êðîìå ÐÔÌÊ ïîëîæèò. íîðìà îòðèöàò. Âîò íàçíà÷åíèÿ äîêòîðà. 1. Âåññåë-äóý-ô ïî 1 êàïñ â äåíü çà 1 ìåñ äî ïåðåíîñà, ïðîäîëæèòü ïîñëå ïåíåíîñà äî íàñòóïëåíèÿ áåðåìåííîñòè. 2. Àíãèîâèò ïî 1 òàá â äåíü çà 1 ìåñ äî ïåðåíîñà è ïðîäîëæèòü âî âðåìÿ áåðåìåííîñòè 3. Âíóòðèâåííûé èììóíîãëîáóëèí (èììóíîãëîáóëèí ÷åëîâå÷åñêèé) ïî 25 ìë 1 ðàç â 3 äíÿ - ïåðâîå ââåäåíèå - çà 6 äíåé, âòîðîå - çà 3 äíÿ è òðåòüå ââåäåíèå â äåíü ïåðåíîñà ýìáðèîíà. 4. Ïíåâìîêîìïðåññèÿ - òîíîìåòð äëÿ èçìåðåíèÿ äàâëåíèÿ(ìåõàíè÷åñêèé) - îäåòü ìàíæåòêó íà ðóêó è íàêà÷àòü äàâëåíèå 50 ìì ðò ñò è äåðæàòü 5 ìèíóò â äåíü - åæåäíåâíî - 4 äíÿ äî ïåðåíîñà è 5 äíåé ïîñëå ïåðåíîñà. 5. Îïðåäåëèòü Ä-äèìåð ÷åðåç 4 äíÿ ïîñëå ïîäñàäêè - åñëè îí áóäåò óâåëè÷åí, òî îòìåíèòü âåññåë è ïåðåéòè íà êëåêñàí 0,4 - ï.ê æèâîòà 1 ðàç â äåíü - 10 äíåé. 
|
|
#2
11.02.2014, 00:43
|
||||
|
||||
|
Âàø âîçðàñò - ãëàâíîå ïðåïÿòñòâèå äëÿ óñïåøíîãî çà÷àòèÿ êàê ÷åðåç ÅÁ òàê è ïóòåì ÝÊÎ, àìåðèêàíöû ïîêàçàëè, ÷òî â âîçðàñòå 45.4 (+/-0.73) ëåò, 45-49 ëåò, øàíñû çàáåðåìåííåòü ïóòåì ÝÊÎ 21% (èëè îäèí èç ïÿòè ïîïûòîê), à äîíîñèòü è ðîäèòü - òîæå ó 15-16% èëè ïîÿâëåíèå íà ñâåò ðåáåíêà â 45 ëåò - 3% ïóòåì ÝÊÎ - è íèêàêèå àíàëèçû èëè âäóâàíèå ãëîáóëèíîâ èëè äðóãèå "øàìàíñêèå ïàññû", ïðîïèñàííûå äîêòîðîì â ïóíêòàõ 1-5 ýòè øàíñû íå ïîâûñÿò:
Fertil Steril. 2007 Jan;87(1):74-6. Outcome of in vitro fertilization in women 45 years and older who use autologous oocytes. Spandorfer SD, Bendikson K, Dragisic K, Schattman G, Davis OK, Rosenwaks Z. The Center for Reproductive Medicine and Infertility, The New York Presbyterian Hospital/Weill Medical College of Cornell University, New York, New York 10021, USA. OBJECTIVE: To determine the IVF outcome in women over the age of 44 years. DESIGN: Retrospective analysis. SETTING: University-based IVF center. PATIENT(S): Two hundred eighty-eight consecutive IVF cycles in women over the age of 44 years. INTERVENTION(S): IVF. MAIN OUTCOME MEASURE(S): Ovarian response and cycle outcome. RESULTS: The mean age of the patients was 45.4 (+/-0.73) years, with a range of 45-49 years. Fifty-seven of 288 (19.8%) did not start because of an elevated FSH or ovarian cyst. Just over 30% (70/231) had their cycle cancelled before retrieval. The mean number of oocytes was 6.8 (+/-3.8), and the mean number of fertilized zygotes was 5.4 (+/-3.4). On average, the mean numbers of embryos replaced were 3.2 (+/-1.5). An overall pregnancy rate of 21.1% (34/161) per retrieval was found. Of these, 85.3% (29/34) experienced a pregnancy loss. The overall delivery rate was 3.1% (5/161) per retrieval. Only patients at 45 years of age with a good response (>5 oocytes) achieved a delivery. CONCLUSION(S): We have shown that IVF is a reasonable option for women of very advanced maternal age (>44 years) but is limited to those at the age of 45 years with a response of >5 oocytes.
|
|
#3
11.02.2014, 00:51
|
||||
|
||||
|
òà æå ñòàòèñòèêà è â äð. ñòðàíàõ íàïðèìåð â Åãèïòå:
The live-birth rate per initiated cycle was for women women ≥43 years old, 7 out of 620 (1.1%). The miscarriage rate was 15 out of 23 (65.2%)... Once women have attained age 43 years, alternative methods such as oocyte donation cycles or previously cryopreserved embryos are likely to be more effective. èç Fertil Steril. 2010 Oct;94(5):1707-12. Analysis of 2,386 consecutive cycles of in vitro fertilization or intracytoplasmic sperm injection using autologous oocytes in women aged 40 years and above.
|
|
#4
11.02.2014, 19:26
|
|||
|
|||
|
Ñïàñèáî çà îòâåò, ñêàæèòå ÿ âû íå óïóñòèëè èç âèäó òî, ÷òî ÿ èìåëà ââèäó Äß, òî åñòü, â ìîåì ñëó÷àåò ÿ äåëàþ ýêî ñ äîíîðñêîé ÿéöåêëåòêîé, à íå ñî ñâîåé. ß ê ñîæàëåíèþ àíãëèéñêèì íå âëàäåþ.
|
|
#5
11.02.2014, 19:35
|
||||
|
||||
|
Äîíîðñêèå ÿéöåêëåòêè ïîâûøàþò øàíñû íî íå äî 100% óñïåõà, à âñåãî â 17.5% ñîãëàñíî èññëåäîâàíèþ èç Èçðàèëÿ, åñëè Âû òðàòèòå ñðåäñòâà íà âðà÷åé èëè äð. äîðîãîñòîÿùåå ëå÷åíèå, òî ïîòðàòèòü íåñêîëüêî åùå íà î÷íîãî ìåä. ïåðåâîä÷èêà, ÷òîáû óçíàòü ñâîè øàíñû è íà ÷òî äåéñòâèòåëüíî ñëåäóåò òðàòèòü äåíçíàêè, à íà ÷òî íåò, áûëî áû áîëåå ðàöèîíàëüíûì...
|
|
#6
11.02.2014, 20:07
|
|||
|
|||
|
Ñïàñèáî çà ñîâåò, âñå òàêè âîïðîñû îñòàëèñü.
1. Ñêàæèòå à î÷íûé ìåä. ïåðåâîä÷èê ýòî êàê? 2. ß ïðàâèëüíî ïîíÿëà, ÷òî ê 21% íàäî äîáàâèòü 17,5% è òîãî ó ìåíÿ 38% øàíñîâ, òàê? 3.  øàìàíñêèå íàçíà÷åíèÿ ïîïàëè èìóíîãëîáóëèíû è ïíåâìîêîìïðåññèÿ òîëüêî, èëè è äîáðûé ñòàðûé ïðåïàðàò Àíãèîâèò ?
|
|
#7
11.02.2014, 20:27
|
||||
|
||||
|
1. Íå çíàþ, äîëæíû áûòü â Ð-í-Ä êàêèå-òî ïåðåâîä÷åñêèå óñëóãè, êîòîðûå ìîãóò ïåðåâåñòè ìåä. äîêóìåíòàöèþ/òåêñòû ñ àíãë. íà ðóññêèé èëè îáðàòíî;
2. íåò, óñïåõ íà áåðåìåííîñòü (íå íà ðîæäåíèå ðåáåíêà!) áûë 17.5%, íî ýòî íà îñíîâàíèè îäíîé ðàáîòû èç Èçðàèëÿ, ïðèìåðíûå ñâîè øàíñû Âû ìîæåòå îöåíèòü, åñëè çàäàäèòå êîíêðåòíûé âîïðîñ íà ôîðóìå â ðàçäåëå Áåñïëîäíûé áðàê, ãäå êîíñóëüòèðóþò ñïåöèàëèñòû ðåïðîäóêòîëîãè èç ÑÏá èëè Ìîñêâû. 3. âñåì ïëàíèðóþøèì áåðåìåííîñòü íåîáõîäèìà ôîëèåâàÿ â äîçå 0.5-2 ìã â äåíü, êîìïëåêñíûå âèòàìèíû Â-ãðóïïû íóæíû òîëüêî ïðè íàëè÷èè âûñîêîãî ãîìîöèñòåèíà (áîëåå 10-12), öèôðû êîòîðîãî íå íîðìàëèçóþòñÿ íà ìîíîïðåïàðàòå ôîëèåâîé.
|
|
#8
11.02.2014, 21:04
|
|||
|
|||
|
Ñïàñèáî, ïðî ïðîöåíòû óñïåõà ÿ êîíñóüòèðîâàëàñü ó ìíîãèõ ðåïðîäóêòîëîãîâ, â òîì ÷èñëå è èç ÑÏÁ è Ìîñêâû. Ïðîöåíò ó íèõ áûë îçâó÷åí îò 30-90%. Òóò íà ôîðóìå òîæå ñïðîøó ïî âàøåìó ñîâåòó, ïîñìîòðþ òî ñêàæóò òóò. ß òàê ïîíÿëà ÷òî èììóíîãëîáóëèíû íå èìååò ñìûñë äåëàòü îíè ìíå íåèêàê íå ïîìîãóò, ñêàæèòå à âðåä îíè ìîãóò íàíåñòè?
|
Ëèíåéíûé âèä
