26Частота непліддя 0,5%-30%

Станом на 1 липня 2013 чисельність населення України становила 45500000 осіб в 25 регіонах. Число всіх жінок 52,4% (23800000), жінки репродуктивного віку –11700000.

Сьогодні, народжуваність в Україні становить 1,2 (необхідність, принаймні 2.2).

Для підтримки населення, яка в даний час є в Україні (що 45500000 чоловік), кожна жінка повинна народити 3-4 дітей.

Профілактика неплідності:

  1. Гігієнічне виховання дітей з раннього віку
  2. Здоровий спосіб життя
  3. Правильна сексуальна поведінка
  4. Раннє виявлення латентних інфекцій
  5. Уникнення забруднення довкілля

70 % подружжя можна повернути фертильність

У 30 % – неплідність є незворотною

Частота непліддя в Україні

  • Найвищий рівень діагностики жіночого безпліддя на 1000 жінок фертильного віку зареєстровано
  • у Запорізькій області – 12
  • у Чернігівській – 4,9
  • у Вінницькій – 4,7
  • у Житомирській – 4,8
  • у Волинській – 4,5
  • найнижчий – у Луганській області – 2,2.
  • Найвищий рівень діагностики чоловічого безпліддя на 1000 чоловіків дітородного віку зафіксовано у Запорізькій області – 7,7
  • в Одеській – 1,98
  • в Дніпропетровській – 1,48
  • в Хмельницькій – 1,5.
  • Найнижчий рівень чоловічого безпліддя зареєстровано у Миколаївській області відповідно – 0,1 ,в Чернівецькій – 0,08; в Харківській – 0,06.

Етіологія неплідності у чоловіків:

  • секреторні зміни сперми
  • екскреторні (вроджена агенезія сім’явивідної протоки)
    • азооспермія
    • астеноспермія
    • тератоспермія

 

Етіологія неплідності у жінок:

  • ендокринні зміни
  • механічні (вади розвитку)
  • імунологічні
  • інфекції
  • ендометріоз

Застосування методів штучного запліднення спричиняє численні ризики:

  • медичні
  • психологічні
  • соціальні
  • правові
  • етичні

Неможливість “досконалого” обстеження донорів на спадкові хвороби, вади розвитку та хвороби зі спадковою схильністю

 

Методи допоміжних репродуктивних технологій (ДРТ)

in vivo

  1. Штучна інсемінація
  2. GIFT (gamete intrafallopian transfer) – перенесення гамет у маткову трубу

 

in vitro

Ембріон переноситься у матку або маткові труби

Види in vitro (FIVET)

  • PZD (Pazzial Zona Dissection) – частковий розтин прозорої зони яйцеклітини
  • SUZI (Sub Zonal Injection) –впорскування сперматозоїда під прозору зону яйцеклітини
  • ICSI (Intra Сytoplasmic Sperm Injection) – ін’єкція сперматозоїда в цитоплазму яйцеклітини
  • Успішність PZD – 15 %
  • Успішність SUZI – 20 %
  • Успішність ICSI – 40 %

Покази до FIVET

  • трубна неплідність
  • ендометріоз
  • олігоастеноспермія
  • нез’ясована причина

Негатив – високий відсоток мимовільних викиднів до 20%,  після 40 років – до 60%

Види in vivo

Штучна інсемінація:

  • інтрацервікальна
  • внутрішньоматкова
  • інтраперитонеальна

Успішність при наявності маткових труб – 16-20%

GIFT – перенесення яйцеклітин і сперматозоїдів у маткові труби лише лапароскопічним шляхом (2-3 яйцеклітини на 1 маткову трубу та 50-100 тисяч сперматозоїдів, відокремлених бульбашкою повітря)

Успішність  – 20 – 25%

Негатив – високий ризик виникнення хромосомної патології в плода

Штучне запліднення

  • Гомологічне (гаметами того ж подружжя)
  • Гетерологічне
  • гаметами одного або двох донорів
  • сурогатна матка

 

Спільні етапи різних методів штучного запліднення:

  • взяття сперми (МЕSА – пункція придатка яєчка)
  • стимуляція вироблення яйцеклітин та їх забір трансвагінальний із ендовагінальним

 

Методи допоміжних репродуктивних технологій (ДРТ)

 

Покази

  • анатомічні труднощі
  • відсутність цервікального слизу
  • олігоастеноспермія
  • антиспермальні антитіла у цервікальному слизі
  • невідома причина непліддя

 

Протипокази

  • запальні захворювання жіночої сфери
  • серцево-судинна та ниркова патологія
  • аномалія розвитку матки

 

Роль церкви

Етичні проблеми

Запліднення in vitro започаткувало низку різних експериментів:

  • дослідження ліків, абортивних засобів, вакцин, онкогенів
  • утворення близнят з одного ембріона
  • міжвидове запліднення
  • клонування
  • Ембріони стають”об’єктами”, продуктами селекції чи вибракування

Профілактика неплідності

  • І – залежить від індивідуальної та колективної поведінки
  • ІІ – застосування адекватних методів лікування
  • ІІІ – допомога подружжю реалізувати себе, будучи безплідним (всиновлення, опіка)

Гельнер Н.В. к.м.н., завідувач Львівського міжобласного медико-генетичного центру

Тенета М.М. лікар акушер-гінеколог, генетик

ДУ “Інститут спадкової патології НАМН України”, директор проф. О.З.Гнатейко

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