تنشيط الإباضة

 كيفية تنشيط الإباضة عند المرأة

تنشيط الإباضة – إذا كنت تراقبين وقت إباضتك كل شهر، قد تلاحظين بأن الإباضة لا تحدث بانتظام أوأنها

في بعض الحالات لا تحدث أبداً، وهذا يتطلب منك مراجعة طبيبك.

على الرغم من أن بعض العوامل مثل الضغط النفسي والحمية الغذائية قد تؤثر على دقة يوم الإباضة من شهر لآخر،

إلا أنه توجد حالات طبية مثل متلازمة المبيض متعدد الكيسات أو انقطاع الطمث،

يمكنها أن تجعل الإباضة غير منتظمة أو تسبب توقفها كلياً.

قد تسبب هذه الحالات أعراض أخرى مرتبطة باضطراب التوازن الهرموني، بما في ذلك زيادة شعر الوجه أو الجسم، وحب الشباب وحتى العقم.

ما هو تنشيط الإباضة؟

تنشيط الإباضة هو استخدام أدوية تساعد مبيضيك على إنتاج وتحرير بويضة. تاريخياً صُممت

هذه الأدوية لتحريض الإباضة عند النساء اللواتي تحدث عندهن بشكل غير منتظم أو لا تحدث إطلاقاً،

وكان الهدف إنتاج بويضة واحدة سليمة. الاستخدام الآخر لتنشيط الإباضة كان زيادة عدد البويضات التي تصل لمرحلة النضج في الدورة الواحدة، لزيادة فرص حدوث الحمل.

كيف يتم تحفيز الإباضة؟

يتم تحفيز  FSH والهرمون الملوتن LH. يجب مراقبة حدوث الإباضة أثناء تناول هذه الأدوية، ويتم ذلك

الإباضة باستخدام معالجة هرمونية حيث تعمل هذه الأدوية عمل الهرمونات الطبيعية ومنها الهرمون المنبه للجريب

بمراقبة دورتك الشهرية أو باستخدام جهاز اختبار التبويض (اختبار للبول في المنزل)،

ويفضل العديد من الأطباء المراقبة عن طريق إجراء اختبار دم أو تصوير بالأمواج فوق الصوتية (الإيكو). تشمل أدوية تنشيط الإباضة ما يلي:

  • كلوميفين سيترات Clomiphene citrate

يؤخذ الكلوميفين سيترات عبر الفم ويُنشط الإباضة عن طريق حصار مستقبلات الأستروجين.

هذا التأثير المصطنع المعاكس للأستروجين يجعل  FSH وLH، والذين يحفزان بدورهما نمو جريب مبيضي يحتوي على

الجسم يعتقد أن مستويات الأستروجين منخفضة مما يجعل الغدة النخامية تطلق المزيد من هرموني

بويضة. يعمل الكلوميفين سيترات كعامل إخصاب عند المرأة عن طريق تحريض فرط الإباضة أي إنتاج عدة بويضات في الدورة الشهرية الواحدة.

بعض أشكال المراقبة ضرورية أثناء تناول عقار الكلوميفين سيترات،  (LH) في البول.

وتشمل هذه المراقبة التصوير بالأمواج فوق الصوتية ومستويات الأستروجين في الدم واختبار نسبة الهرمون الملوتن

يوصف الكلوميفين سيترات في حالة العقم غير المفسر مع الإلقاح داخل الرحم (IUI). أما عندما يستخدم لتنشيط الإباضة عند النساء اللواتي لا تحدث عندهن فإن التلقيح داخل الرحم غير ضروري.

موجهات الغدد التناسلية عند انقطاع الطمث Human Menopausal Gonadotropins (hMG)

يحفز هذا العلاج والذي يؤخذ عن طريق الحقن المبيض مباشرةً  FSH وLH. كما يوجد دواء آخر من موجهات

لإنتاج عدة بويضات، بدلاً من تحفيز الغدة النخامية لإطلاق المزيد من الهرمونات. يتكون هذا الدواء من هرموني

وهو يستخدم لإنضاج البويضات وتحفيز إطلاقها في موعد الإباضة. بسبب التباين الكبير في الاستجابة من مريضة لأخرى،

الغدد التناسلية هو موجه الغدد التناسلية المشيمي البشري (Ovidrel, Pregnyl)،  لا يمكن التوصية

بنظام جرعات ثابت لهذا العقار، لذلك يجب تقييم كل مريضة بشكل منفرد. بشكل عام يعتبر هذا العلاج عاملاً

مسبباً لحدوث فرط الإباضة أكثر من الأدوية الفموية. يمكن استخدام هذا الدواء مع التلقيح داخل الرحم أو التلقيح في

المختبر (IVF).

توجد مخاوف من ازدياد خطر حمل التوائم والولادة المبكرة عند استعمال موجهات الغدد التناسلية،

لذلك من الضروري القيام بمراقبة استجابة المبيض لتقليل خطر هذه الاختلاطات، ويتم ذلك بقياس مستوى الأستروجين في

الدم (E2) والتصوير بالأمواج فوق الصوتية.

  • ميتفورمين Metformin

يستخدم الميتفورمين عندما تكون مقاومة  PCOS. يساعد الميتفورمين على تحسين مقاومة الأنسولين، والذي

الأنسولين سبباً معروفاً أو مشتبهاً به للعقم، ويستخدم عادةً عند النساء المصابات بمتلازمة المبيض متعدد الكيسات

من شأنه أن يحسن احتمالية الإباضة.

  • ليتروزول Letrozole

لصنف من الأدوية يعرف بمثبطات الأروماتاز ويعمل بطريقة مشابهة للكلوميفين. يمكن أن يحفز الليتروزول الإباضة،

ينتمي الليتروزول (Femara) ومع ذلك تأثير هذا الدواء على الحمل الباكر غير معروف، لذلك لا

يستخدم في تنشيط الإباضة مثل باقي الأدوية.

  • بروموكريتين Bromocriptine

يمكن استخدام البروموكريبتين (Cycloset) وهو من مناهضات الدوبامين عندما تكون مشاكل الإباضة ناتجة عن إنتاج زائد من البرولاكتين (فرط البرولاكتين) من قبل الغدة النخامية.

مخاطر تنشيط الإباضة

استخدام أدوية تنشيط الإباضة يحمل بعض المخاطر مثل:

  • الحمل المتعدد

تحمل الأدوية الفموية خطراً منخفضاً إلى حد ما لحدوث الحمل المتعدد (أقل من 10%) وغالباً ما يكون توأم، أما مع الأدوية المحقونة ترتفع النسبة إلى 30%. تحمل أدوية الإخصاب المحقونة أيضاً خطر كبير للتوأم الثلاثي أو أكثر.

بشكل عام كلما زاد عدد الأجنة التي تحملينها كلما زاد خطر المخاض الباكر ووزن الولادة المنخفض ولاحقاً مشاكل النمو. يقلل ضبط الأدوية أحياناً من خطر الحمل المتعدد إذا تطورت عدة جريبات.

  • متلازمة فرط تنشيط المبيض

تسبب هذه المتلازمة مبايض متورمة ومؤلمة. تختفي الأعراض والعلامات عادةً بدون علاج وتشمل ألم بطني خفيف، انتفاخ، غثيان، إقياء وإسهال. غير أن الأعراض قد تستمر عدة أسابيع في حال حصول الحمل. نادراً ما يتطور شكل أكثر شدة من هذه المتلازمة يشمل زيادة وزن سريعة، مبيضان متضخمان مؤلمان، سائل في البطن وضيق نفس.

  • خطر طويل المدى لأورام المبيض

تقترح معظم الدراسات أن النساء اللواتي يستخدمن أدوية الخصوبة قد يواجهن خطراً قليلاً على المدى الطويل إن وجد. من جهة أخرى تقترح بعض الدراسات ارتفاع احتمال حدوث أورام المبيض عند النساء اللواتي يتناولن أدوية الخصوبة لمدة 12 شهر أو أكثر بدون حدوث حمل.

النساء اللواتي لم يحملن مسبقاً لديهن خطر متزايد لسرطان المبيض، لذلك قد يكون هذا هو سبب المشكلة أكثر من كون السبب هو الأدوية.

نظراً لأن معدلات النجاح عادةً ما تكون أعلى في المرات القليلة الأولى، فإن من المناسب إعادة تقييم استخدام الدواء كل بضعة أشهر والتركيز على العلاجات التي حققت أكبر قدر من النجاح.

بامكانكم قراءة المزيد عن تنشيط الإباضة عند المرأة من خلال الرابط 

 

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