Dobrý den, paní doktorko,
ráda bych znala váš názor na výsledky krve a na možnost otěhotnění. Je mi 34 let. Před rokem jsem měla potrat a revizi dělohy - trojčata otěhotněla jsem normálně. Dva roky zpátky jsem byla na zprůchodnění vejcovodu laparoskopicky. Ted se nám s manželem rok nedaří otěhotnět, tak jsem se rozhodla jít do CAR. Hormonální profil mi vyšel: TSH - 3,310, fT4 16,89, aTPO 11, EST 178 pmol/l, PRL 526,2 mlU/l, FSH 13,8 IU/l, LH 8,9 IU/l. Lékařka mi řekla jen, že FSH je vysoké a že zažádá o umělé oplodnění... Také je podezření na znovu ucpaný vejcovod. Jeden lékar mi řekl, že by bylo dobré vejcovod odstranit před zahájením umělého oplodnění a lékařka, která mi sdělovala výsledky krve řekla zase opak, že nejdříve by zkusila první pokus a pak až případné odstranění vejcovodu. Jaký je váš názor? Může mi laparoskopie ještě nějak uškodit z hlediska plodnosti? Je možnost otěhotnět i přirozenou cestou jako před rokem?
Předem moc děkuji.
Odpověď:
Dobrý den,
děkuji za Váš dotaz a projevenou důvěru. Hladina FSH je skutečně vyšší, může znamenat že Vaše vaječníky již nepracují zcela správně, respektive, že zásoba vajíček ve vaječnících je nízká. Pokud si necháte ještě vyšetřit hladinu tzv. antimülleriánského hormonu (AMH), získáte přesnější informaci o tzv. vaječníkové rezervě, tedy zásobě vajíček. Vzhledem k hodnotě FSH bych nyní doporučila volit IVF.
Odstranění vejcovodu, pokud je patologicky změněný v tzv. sactosalpinx (vejcovod je na svém konci uzavřený, probíhá v něm chronický zánět a je naplněný tekutinou) se doporučuje před přenosem embrya do dělohy odstranit, prootže jeho přítoimnost negativně ovlivňuje děložní dutiny a její schopnost přijmout embryo. Ze zkušeností ale víme, že operace v malé pánvi může poškodit pozdější reaktivitu vaječníků na podávaný stimulační hormon. Jestliže Vaše vaječníky mají nižší rezervu vajíček již nyní a předpokládá se proto jejich nepříliš vysoká odpověď na stimulaci, po operaci by se mohla situace ještě zhoršit. Doporučila bych tedy podstoupit stimulaci vaječníků, odběr vajíček a jejich oplození, vzniklá kvalitní embrya kryokonzervovat, následně laparoskopicky vejcovod odstranit a teprve poté provést embryotransfer. Vzhledem k Vašemu věku a prodělanému potratu bych také doporučila v rámci umělého oplození využít i možnosti genetického vyšetření embryí na počet všech chromozomů, tzv. preimplantační genetický screening (PGS). Tento postup Vám navýší pravděpodobnost otěhotnění a porodu zdravého dítěte a dramaticky sníží riziko potratu.
Držím Vám palce.
Se srdečným pozdravem
MUDr. Lenka Hromadová
vedoucí lékař IVF ambulance
Sanatorium REPROMEDA
Viniční 235
615 00 Brno
tel. +420 533 306 351
Těhotenství.cz
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