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Jak probíhá umělé oplodnění a kolik za něj zaplatíte

umele-oplodneni-tehotenstvi.cz

Pokoušíte se počít potomka, ale nedaří se vám? Pokud provozujete se svým partnerem pravidelný nechráněný pohlavní styk jeden rok a stále ne a ne otěhotnět, je na čase vyhledat lékařskou pomoc.

Určitým problémům s otěhotněním aktuálně vzdoruje každý pátý pár. Neplodnost je jedna z civilizačních chorob, která zásadně ovlivňuje život noha ženám i mužům. S vyřešením velmi často může pomoci až odborná lékařská pomoc a umělé oplodnění. Jak vše probíhá, prozradí odborníci z klinik GynCentrum a ISCARE.

Co očekávat na začátku umělého oplodnění

První úkol pro lékaře je zřejmý, nalézt příčinu neplodnosti. V případě žen je neplodnost často spojená s nedostatkem vajíček. K tomuto problému může dojít kvůli dlouhodobému užívání hormonální antikoncepce.

Pokud nebylo tělu v mládí dopřáno dozrát a naučit se fungovat přirozeně, může se po vysazení antikoncepce stát, že žena nebude nějakou dobu vůbec menstruovat a produkovat vajíčka, její cyklus nepoběží,“ potvrzuje primář kliniky GynCentrum Daniel Struppl.

Naproti tomu muži mnohdy trpí malým počtem pohyblivých spermií v důsledku varikokély. Jedná se o rozšířené cévy v oblasti varlat.  

Pro zjištění příčiny je třeba provést různá vyšetření. 

Jaké vyšetření čeká ženu

  • gynekologické
  • ultrazvukové
  • hormonální vyšetření
  • vyšetření na pohlavně přenosné nemoci (HIV, syfilis, hepatitida B a C)

Jaké vyšetření čeká může

  • spermiogram
  • vyšetření na pohlavně přenosné nemoci (HIV, syfilis, hepatitida B a C)

Co se děje, když výsledky potvrdí neplodnost

Pokud výsledky vyšetření potvrdí, že neplodnost nelze léčit jinak než umělým oplodněním, je třeba vše společně s lékařem naplánovat a v dalším cyklu realizovat. Umělé oplodnění probíhá v rámci jednoho cyklu. Většinou druhý den menstruace začíná stimulace vaječníků, odběr vajíček je obvykle mezi 10.-14. dnem cyklu a o 5 dnů později transfer embrya. V době očekávané menstruace už může být žena těhotná (tzn. 2 týdny po přenosu embrya). 

Nejdříve stimulace vaječníků

Prvním krokem v samotném procesu je stimulace vaječníků – tzv. ovariální stimulace. Při ní se aplikují injekce folikulostimulačního hormonu, aby došlo k dozrání více vajíček, z kterých pak bude moct být více embryí.

Čím více embryí máme, tím více stoupá šance na otěhotnění. Obvykle se úspěšnost po transferu 1 embrya pohybuje mezi 35-40%. V případech, kdy žena stimulaci odmítá nebo je kontraindikovaná, lze udělat odběr jednoho dominantního folikulu v přirozeném cyklu,“ vysvětluje MUDr. Jan Lacheta, primář IVF klinického centra ISCARE.

Folikostimulační hormon (FSH) je hormon hypofýzy, který stimuluje růst folikulů. Kromě toho způsobuje zvýšení hladin estrogenů (cca 10x oproti přirozenému cyklu). 

Následně odběr a oplození vajíček

Po stimulaci následuje odběr vajíček. Ten probíhá v krátké celkové anestezii. Trvá obvykle kolem 15 minut, záleží na počtu folikulů (čím více jich je, tím je výkon delší). Po výkonu může pacientka pociťovat mírné bolesti v podbřišku, které bývají tlumeny běžnými analgetiky. Před odběrem je nutné absolvovat standardní předoperační vyšetření (krevní testy, EKG, vyšetření moči). Ještě ten den dochází k dalšímu kroku a sice k oplození vajíček dodanými spermiemi. 

Díky novému monitorovacímu přístroji, do kterého jsou embrya (oplozená vajíčka) následně na 5 dní uložena, je možné snímání a analýza dynamiky embryonálního vývoje 24 hodin denně bez ohrožení vývoje. Technologie umožňuje lékařům ponechat embrya v inkubátoru, zatímco kamera pořizuje obraz celého vývoje. To poskytuje neomezené možnosti při vyhodnocování embryí bez jejich stresování při manipulaci a také přináší o každém embryu komplexní informace. Lékaři jsou tak schopni vybrat to nejkvalitnější embryo vhodné pro embryotransfer, čímž se zvyšuje šance na prosperující těhotenství.

Nakonec transfer vajíček

Posledním krokem je samotný transfer.

V dnešní době se nejčastěji transferuje 1 embryo. V případech, kdy se opakovaně nedaří, lze zavést embrya dvě - pacientka ovšem nemůže mít jizvu na děloze, například po císařském řezu, operace myomů apod. Pokud by totiž takováto žena měla dvojčetné těhotenství, hrozí riziko ruptury jizvy. Většina center 3 nebo více embryí již nezavádí,“ říká MUDr. Lacheta.

Těhotenský test by si pak měla žena provést za 14 dnů po transferu. 

Kolik zaplatím za umělé oplodnění?

V České republice hradí zdravotní pojišťovna 4 cykly ženám ve věku mezi 18 a 39 lety. Pokud si žena nechá v prvních 2 cyklech zavést 1 čerstvé embryo (nezapočítávají se do toho transfery mrazených embryí). V opačném případě má nárok na 3 pokusy.

Doplatek pacientky má 2 části - léky (záleží kolik hormonů se celkem aplikuje) a laboratorní metody, které pojišťovna nehradí (nejčastěji se jedná i metodu ICSI - injekce spermie do vajíčka, prodlouženou kultivaci a mrazení embryí). K podstoupení umělého oplodnění je třeba být vdaná nebo mít souhlas partnera.

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