EKO: dangers real and imaginary
the “Children from a test tube“ conceived by means of EKO ceased to be perceived as exotic. Moreover: now extracorporal fertilization around the world - the main way to solve an infertility problem. Nevertheless EKO - rather new method with which various myths and doubts are connected.
Stages of a big way
Process of EKO consists of several stages.
- Complex inspection of couple. Before beginning treatment, it is worth finding out in what the problem reasons. Some types of infertility do not need carrying out EKO, rather medicinal or surgical treatment, happens also that conception is impossible in principle as try. If carrying out EKO is expedient
- , to the woman appoint hormonal preparations for stimulation of growth and maturing in ovaries of several follicles containing ova at once (usually for one monthly cycle 1 - 2 ova ripen). Stimulation of ovaries is necessary to be hit a stock of embryos for transfer in a uterus.
- After maturing of follicles from them under anesthetic a special needle under control of ultrasonography are taken by ova. The man by this moment needs to hand over sperm. If its development is broken, spermatozoa receive by a puncture or a biopsy of a small egg.
- In embryological laboratory suspension of spermatozoa which impregnate the ova which are in a special nutrient medium prepares. In case spermatozoa cannot get into an ovum, the decision is provided again: IKSI (intratsitoplazmatichesky injection of spermatozoa). By means of a glass microneedle under a microscope the only spermatozoon is entered into an ovum. the Impregnated ova place
- in an incubator where development of germs begins. For the third day when embryos consist of only eight cages, they by means of a catheter are transferred to a cavity of a uterus of the woman for incubation. Usually place several embryos in a uterus (under the Russian laws - no more than three) to increase probability of approach of pregnancy.
. But lack of exhaustive information on consequences of this method gives to sceptics food for doubts. One assume that intervention in natural process of conception leads to appearance of “defective“ children, others - that EKO threatens a mankind gene pool, not to mention influence on health of mother and the child.
We asked experts to comment on the most widespread fears.
the First: a syndrome of hyper stimulation of ovaries
34 - summer Nadezhda Mitrofanova from Moscow addressed to clinic of EKO about one and a half years ago - adhesive process after several abortions in youth did not allow to become pregnant. At the husband with genital function too not everything was smooth. After delivery of necessary analyses and detailed inspection the woman was included in the EKO protocol and began to carry out hormonal stimulation of ovaries. Everything went normally, but after transfer of embryos and approach of pregnancy pains in a stomach bottom began, the general health worsened, nausea developed.
the obstetrician Observing Nadezhda - the gynecologist told that the syndrome of hyper stimulation of ovaries developed, and in an abdominal cavity liquid began to accumulate.“ It was very terrible, - Nadezhda tells, - really long-awaited pregnancy will be interrupted? It was necessary even to pierce a stomach to lower liquid... But, thanks to doctors, everything managed, and I three months as mother“.
is Commented by the doctor of medical sciences, professor of department of obstetrics and gynecology of RGMU, the director of clinic of EKO “Lera“ Valery Mstislavovich Zdanovsky:
“At EKO needs to receive at the same time several germs. But in usual conditions in the woman`s organism for one menstrual cycle only one ovum is formed. To overcome this contradiction, to women carry out hormonal stimulation of ovaries - and then for one cycle in an ovary ripens several follicles containing full-fledged ova. At the same time own hormonal activity of a female organism is suppressed the corresponding preparations as spontaneous maturing of follicles during stimulation is inadmissible.
But hormonal balance - a thing thin and quite individual, and approximately in 5% of cases standard doses of the stimulating preparations are excessive. Then the syndrome of hyper stimulation of ovaries develops: a condition of excessive activation of these bodies at which all organism begins to suffer. Ovaries become painful and increase in volume, permeability of blood vessels increases, properties of blood change (occurs it condensation ) . As a result, urine removal decreases, liquid in an abdominal cavity collects, work of respiratory and digestive systems is broken, temperature, and there already nearby and before more dangerous complications can rise.
In mild cases business is limited to a nagging pain in a stomach bottom (as in the first day of monthly), loss of appetite, nausea, a diarrhea and increased fatigue. Such state demands only a bed rest and supervision of the doctor. In heavy cases (which, fortunately, meet very seldom) the zavorota of an appendage, a renal failure, a thrombembolia (obstruction of vessels blood clots) and other serious complications, life-threatening can reach hemorrhage in an ovary. Therefore if the syndrome proceeds hard, the woman is hospitalized and carry out intensive therapy, and if necessary - surgical treatment.
Most often should deal with a late form of a syndrome of hyper stimulation when its manifestations arise not during stimulation, and after the beginning of development of a fruit as it occurred at Nadezhda. However, in most cases all undesirable manifestations take place until the end of the first trimester of pregnancy.
to minimize risk of a syndrome of hyper stimulation of ovaries, many clinics try to manage the minimum stimulation now, or to take ova absolutely without it, on the natural cycle . Of course, such tactics is applicable not to all women and ova turn out less that reduces probability of approach of pregnancy. But the risk for health of the woman considerably decreases.Optimism inspires in
that with increase in quantity of EKO which are carried out in the world necessary experience is saved up. Therefore it is quite probable that it will be soon found golden mean that is the minimum stimulation of ovaries at which enough ova ripens“.
the Second: possible malformations of the childwere published by
results of the American statistical research which found the increased risk of developing of some malformations in children “from a test tube“ Recently. For example, at them “cleft lip“ (the crack dividing an upper lip), defects of a mezhpredserdny or interventricular partition of heart and an underdevelopment of a gullet or rectum several times are more often observed.
is Commented by the candidate of medical sciences, the scientific expert in medical genetics of the Ministry of Health and Social Development Victoria Yurevna Voinova:
“Yes, it is valid, some malformations at the children born by means of EKO meet more often. The reasons of this phenomenon are not found out, necessary additional researches yet to understand its mechanisms. Perhaps, thus future child is influenced by the EKO procedure, but it is impossible to exclude that the reason is covered in preparations which are accepted by the woman, or in any component of a nutrient medium on which grow up an embryo before transfer in a uterus.
But the increased risk of separate defects will hardly keep the spouses dreaming of the child from the request for EKO. The possibility of the birth of the child with any congenital defect exists always, but people from it do not cease to breed.
Besides all listed malformations are not life-threatening the child presently - they give in to surgical correction then practically do not influence further life. And they are not descended.
As for more serious anomalies, such as the Down syndrome and other chromosomal and genetic mutations - at their increased risk at concrete couple is carried out predymplantatsionny genetic diagnostics. Before transfer from an embryo take one cage in a uterus and subject it to research on the most widespread genetic diseases. Such procedure does not influence further development of a germ.by
Besides, at certain stages of pregnancy carries out monitoring for detection of anomalies of development: Ultrasonography of a fruit, blood test of mother on markers of genetic diseases, if necessary - research of cells of amniotic liquid and others. Not to mention that if the embryo has serious genetic defects, then pregnancy, most likely, will cease to develop on early terms or will not come at all.
By the way, the first children from a test tube - Louise Brown and Elena Dontsova became mothers recently. Their children were born absolutely healthy, at the same time conception in both cases happened in the natural way, without any auxiliary manipulations. The best proof that the people born by means of EKO differ in nothing from all others and cannot be thought up“.
the Third: mnogoplody
32 - summer Anna Mazurkevich from Nizhny Novgorod for the first time addressed to the Moscow clinic of EKO three years ago - in 5 years of marriage with the husband not an udalost to become them parents. The first attempt ended with failure - in spite of the fact that to the woman transferred two embryos to a uterus, pregnancy did not come. After a one-and-a-half-year break procedure was repeated with three germs, and normally all three began to develop this time. However from - for tiny a constitution and the insufficient sizes of a basin incubation of triplets was recognized excessively risky, and it was necessary to make a reduction - removal of one of embryos for normal development of other two.“ It was very morally heavy, - Anna remembers, - but now when at me healthy twins grow up, I understand that everything was made correctly“.
is Commented by the gynecologist - the endocrinologist of clinic of EKO “Life Flowers“, the member of the Russian association of gynecologists - endocrinologists Oksana Valentinovna Starkova:“Problem sources a mnogoplodiya are covered with
in the technology of carrying out EKO. At transfer in a cavity of a uterus only of one embryo from a test tube the success of procedure is small - often pregnancy does not develop. Even considering that in most cases several germs place in a uterus, no more than 30 - 35% come to an end with pregnancy, and the birth of the healthy child - about 25% of all carried-out EKO - too many factors influence the normal course of process.
But quite often the situation when begins to develop several postponed germs arises. If everything goes normally, pregnancy is conducted as usual polycarpous, however, as in case of Anna, incubation of all embryos is accompanied by high risk for fruits and for health of mother. In such situation it is necessary to resort to a reduction - removal of one of germs. Certainly, this intervention bears a certain risk, however it less risk, connected with development of polycarpous pregnancy at not ready to it anatomic women is incomparable.the EKO Procedure is constantly improved by
, and recently need for a reduction arises very seldom. Now, as a rule, to the woman no more than two embryos are transferred, hormonal preparations the necessary minimum so a problem is appointed; superfluous the fruit practically does not rise“.