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Particularitati fiv cu spermatozoizi obtinuti prin prelevare chirurgicala

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Odata cu aparitia tehnicii de ICSI (microinjectie intra-citoplasmatica a spermatozoizilor), abordarea pacientilor infertili cu azoospermie s-a schimbat radical. Obtinerea spermatozoizilor prin tehnici de prelevare chirurgicala, testiculara sau epididimara, a permis realizarea ICSI in bune conditii si totodata, a permis acestor pacienti sa-si transmita genele descendentilor.

Initial, aceasta tehnica a fost propusa pacientilor cu azoospermie obstructiva (excretorie): FSH si volum testicular normal, dilatarea sau agenezia de cai seminale, volum scazut al ejaculatului si biochimie seminala anormala. Dintre cauzele mai frecvent intalnite in azoospermia obstructiva se numara infectiile genitale si agenezia deferentiala (mucoviscidoza). Sansele de a obtine o sarcina la acesti pacienti sunt de aproximativ 30%.

Ulterior s-a demonstrat ca prelevarea chirurgicala a spermatozoizilor poate fi utila si in cazul pacientilor cu azoospermie non-obstructiva (secretorie): FSH crescut, Inhibina B scazuta, testicule mici, cai seminale si biochimie seminala normale, volum normal al ejaculatului, celule germinale prezente.

Aceasta patologie se poate intalni in urmatoarele cazuri : insuficienta testiculara, criptorhidie, orhita, varicocel, infectii, traumatisme sau torsiune a testiculelor, tumori testiculare, postchimioterapie, insuficienta renala sau hepatica, insuficienta hipogonadotropica congenitala, hiperprolactinemie, etc. Bilantul genetic prezinta o importanta deosebita in cazul azoospermiilor non-obstructive datorita frecventei crescute a anomaliilor genetice regasite, precum si datorita consecintelor in cazul conceperii unui copil (sanse de aproximativ 10%).

Prelevarea chirurgicala se poate face la nivelul canalului deferent, epididimului sau testicolului in cazul azoospermiei obstructive, fie prin explorare chirurgicala deschisa sub anestezie generala, fie prin punctie percutana cu anestezie locala. Alegerea tehnicii nu are importanta in termen de rezultate, deoarece in ambele cazuri vom avea suficienti spermatozoizi pentru realizarea microinjectiei.

fecundarea


Din contra, in cazul azoospermiei non-obstructive prelevarea se va face intotdeauna la nivel testicular, studiile demonstrand ca biopsia testiculara se insoteste de rezultate superioare in comparatie cu punctia percutana.

In general spermatozoizii obtinuti prin prelevare chirurgicala se congeleaza, disocierea prelevarii testiculare de cea ovocitara avand ca avantaj evitarea punctiilor ovariene inutile in caz de biopsie negativa, precum si datorita faptului ca in urma unei singure interventii testiculare congelarea spermatozoizilor ar permite realizarea mai multor tentative ICSI.

Dezavantajul obtinerii la decongelare a unui numar mai mic de spermatozoizi si deasemenea mai putin mobili, poate fi ameliorat de utilizarea unui stimulant al mobilitatii cum este pentoxifilina. Studiile au aratat ca nu exista nici o diferenta in ceea ce priveste rata de fecundare, de implantare si de sarcina in grupul la care s-a utilizat pentoxifilina spre deosebire de cel la care acest lucru nu a fost necesar.

Numeroasele progrese in domeniul reproducerii umane asistate au permis pacientilor infertili prezentand azoospermie realizarea unor proiecte parentale ce nu pareau a fi posibile in urma cu doar cativa ani si le-au oferit sansa de a avea propriul copil.

FERTILIA - CENTRUL MEDICAL ULTRASPECIALIZAT IN INFERTILITATE, MEDICINA MATERNO-FETALA SI GINECOLOGIE COMPLEXA

Suntem o echipa medicala cu experienta de peste 17 ani in sistem particular si de stat, cu specializari recunoscute international si rezultate foarte bune chiar si in cazuri complexe, de afectiuni incomplet elucidate in alte clinici. Stim sa propunem cea mai eficienta varianta de tratament pentru fiecare pacienta si avem impreuna acelasi scop, sa aveti un copil sanatos!

Avem tehnologie de ultima ora, unica in tara, respectam cele mai stricte standarde de operare si avem personal medical foarte calificat - ceea ce garanteaza cele mai bune rezultate.

Fertilia - Sapiens este o clinica medicala privata cu specializari in infertilitate , tehnici de fertilizare in vitro si prezervarea fertilitatii, oferind la acest moment o gama complete de servicii medicale de un inalt professionalism ce pornesc de la diagnostic pana la obtinerea si urmarirea sarcinii.

 

de Dr. Cerasella Nicolicea – Clinica Medicala Fertilia-Sapiens

www.fertilia.ro





Cuvinte cheie: Perioada de ovulatie , Conceptie


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