Makaleler

Makaleler

Tüp Bebek ve Bağışıklık

DÜŞÜKLERİN ÖNLENMESİNDE BAĞIŞIKLIK TEDAVİSİ İnsan vücudu hastalıklardan gelen saldırılara karşı kendi doğal savunma sistemine sahiptir. Hamilelik,bebeğin rahme tutunduğu eşsiz bir durumdur. Hamilelik sırasında annenin farklı genetik özelliklere sahip olmasından dolayı bebek bağışıklık sistemi tarafından “ben olmayan” veya “yabancı” olarak tanınır. Annenin bağışıklık sistemi gebeliğin doğuma kadar sürebilmesi için hem bunun farkında olmalı hem de bu istilayı ‘kabul etmeli’dir. Natural killer hücreler adlı bağışıklık hücrelerinin, yabancı maddeleri ve kanser hücrelerini ortadan kaldırdığı bilinmektedir. Kandaki natürel killer hücreler doğal olarak bağışıklık sisteminde hayati bir rol oynayan hücrelerdir. Bunlar, kan dolaşımına girmeden önce kemik iliği, dalak ve vücudun diğer bölgelerinde üretilen lenfositlerdir (beyaz kan hücreleri). Bu hücrelerin amacı, vücuda ait olmayan hücreleri tanımak ve hedeflemektir; Tümörler, virüsler, bakteriler. Natural killer hücreler gebelikte önemli bir rol oynar ve rahmin içindeki bağışık hücrelerinin % 90’ını oluşturur. Doğurganlık problemi olan, tekrarlayan düşük veya tekrarlayan IVF başarısızlığı yaşayan kadınlar Natural killer hücrelerle ilgili bir sorun yaşayabilir. Annenin vücudunda ve rahminde yüksek uNATURAL KİLLER hücreler aktivitesi varsa bu durum bebeğin rahme tutunmasını etkiler ve bu istilanın gerçekleşmesine izin vermediği için tutunmayı zorlaştırır ve nihayetinde düşüğe neden olur. Naturel killer hücreler düşük ve infertiliteye yol açar. Bu sorunun önlenmesi ve tedavisi de doğurganlığın artmasını sağlar. Yüksek Natural Killer hücreleri için tedavi sunan klinikler çoğunlukla bu hizmeti IVF ve diğer yardımcı üreme teknolojileri ile birlikte sunmaktadır. IVF’te bağışıklığa bağlı sorunun en yaygın nedenlerinden biri bebeğin rahime tutunamamasıdır. Bu durumda başarılı implantasyona zarar veren anne adayının bağışıklık sistemindeki anormalliklerdir. Natürel killer hücrelerinin seviyeleri, örneğin kanser veya otoimmün bir hastalığa maruz kalmış bir kimseyle aynı değildir. Naturel killer hücreleri yüksek olan kadınlar embriyoya saldıran ve implantasyonu önleyen çok fazla bağışıklık faktörü üretir. Saldırgan Natural Killer aktivitesi yüksekse embriyo tutunamaz, erken gebelikler düşükle sonuçlanabilir ve daha sonra annenin veya bebeğin komplikasyonları oluşabilir. Özel testlerle bu sorunların ortaya çıkma riski olan çiftleri belirleyebilir. Annedeki uygun bağışıklık tepkisini (immüno modülasyon) uyaran tedavi başarılı bir hamilelik ve doğuma ulaşma şansını artırabilir. Nasıl test edilir? İki tür Natural killer hücre vardır. Kanda Natural Killer Hücreler (periferik Natural Killer Hücreler). Natural Killer Hücreler rahmin zarında bulunur ve bunlara uterus Natural Killer hücreleri denir. Bu, rahmin zarından bir numune alarak ve analiz için bir patoloji laboratuvarına gönderilerek tespit edilebilir. NATURAL KİLLER teşhis panelinde kanda periferik kandaki naturel killer hücrelerinin sayısı, rahimden alınan biyopside rahimdeki NATURAL KİLLER hücreleri ölçülür. Genellikle Natural Killer hücrelerinin ölçümleri, bir venöz kan örneği yoluyla periferik dolaşımdaki kan hücrelerinin sayımlarından alınır. Eğer biyopsi yapılarak rahim...

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omega 3 doğumdan ölene kadar elzem

The available evidence from epidemiologic studies and clinical trials presents a mixed picture regarding the health benefits and potential risks of fish consumption and omega-3 fatty acid supplementation for pregnant women, the fetus and young children. For virtually all of the outcomes we considered where research is available – length of gestation and risk of prematurity, birthweight, hypertension and preeclampsia, depression in pregnancy and postpartum depression, fetal brain development and early childhood IQ, allergy and asthma in children – there is evidence suggestive of benefit for fish intake or omega-3 supplementation; however, there are also many studies showing no benefit, or, in a few instances, possible harmful effects. Evidence from the available randomized, controlled trials is most suggestive of benefit for the outcome of preterm birth before 34 weeks, particularly among women with a prior preterm birth. Results of clinical trials of omega-3 fatty acid supplementation are summarized in Table 2. In assessing their findings of no impact or negative effect, investigators raised a number of issues, including noncompliance to study protocol requirements on the part of participants,[36] the type of fish products consumed,[49] the possible role of industrial contamination,[41] and the timing of intervention.[56,58,67] It is also worth noting in considering inconsistent findings that data collection methodology varies across studies with use of food frequency questionnaires, surveys, measurement of acid levels and other approaches, making consistent cross-study comparisons difficult. For some outcomes, such as childhood neurodevelopment, the few intervention studies that are available vary in terms of time points used for assessment (i.e., age of children studied), the specific subtests that are considered (e.g., mental processing, intelligence, verbal skills, visual acuity, problem solving, quantitative skills, communication abilities, presocial behavior and attention), and the tools used to evaluate these aspects of behavior. Appropriately powered, randomized, controlled trials are needed that can address these and other issues. Using the highly purified omega-3 fatty acid supplements now available, future trials should benefit from improved participant compliance, which should allow for better determination of true treatment effects. We feel that more investigation is needed to clarify the possible benefits of omega-3 fatty acid supplementation in perinatal depression, early childhood cognitive functioning (including IQ, attention and behavior), and risk for allergic diseases. Current evidence does not support a role for omega-3 fatty acid supplementation for prevention of preeclampsia, pregnancy-induced hypertension, or intrauterine growth restriction. More needs to be learned regarding whether the effects...

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sağlıklı yaşam biçimi gebelik şansını arttırır

Lifestyle Management Before Infertility Treatment Peter Kovacs, MD, PhD Peter Kovacs, MD Clinical Reproductive Endocrinologist, Research and Scientific Coordinator, The Kaali Institute-IVF Center, Budapest, Hungary It is well known that women who are under- or overweight have difficulty with reproduction. Obese women are at risk for miscarriage, gestational diabetes, gestational hypertension, preterm delivery, macrosomia, low birth weight, stillbirth, delivery via operative route, and postoperative complications. Underweight women are also at risk for miscarriage, low birth weight, preterm delivery, and stillbirth. Therefore, preconceptional counseling about weight and lifestyle management is very important. During this counseling, one should evaluate the patient’s diet, frequency and intensity of exercise, toxic habits, and use of drugs that affect body weight. The best way to assess weight is to calculate the body mass index (BMI) using the following equation: weight (kg)/height2 (m2). A BMI between 18.5 and 24.9 kg/m2 is considered normal. Women with a BMI < 18.5 kg/m2 are underweight, whereas women with a BMI > 25 kg/m2 are overweight, and those with a BMI > 30 kg/m2 are obese. Underweight women should be screened for eating disorders and thyroid dysfunction. In some cases, it may be appropriate to work together with a nutritionist and a psychologist. Low body weight is associated with ovulatory dysfunction. Usually, minimal weight gain (3 to 5 kg) is sufficient to restore ovulation and to improve the outcome of a subsequent pregnancy. Overweight women also need to undergo a throrough endocrinologic evaluation (thyroid function, Cushing’s syndrome, polycystic ovary syndrome [PCOS]). They should be screened for diabetes, lipid abnormalities, and hypertension and should be advised about a lower-calorie diet with approriate nutrients. Women with PCOS may benefit from a diet that is low in saturated fat and high in low-glycemic-index-carbohydrate. Besides adhering to a healthy diet, regular exercise is needed to burn excess calories and to help to maintain a lower weight. Daily moderate exercise for about 30 minutes is recommended. Very often ovarian activity is restored by losing 5% to 10% of weight, even without reaching the ideal range. Drugs that improve insulin resistance also improve reproductive outcome among women with PCOS. They should not be used alone, however, but rather should be combined with a healthy diet and regular exercise. Adequate folic acid intake is essential for reproductive-age women, as it can reduce the incidence of fetal neural tube defects and cardiac anomalies. Weight control is very important...

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yağ alımı arttıkça endometriosis artıyor

From Human Reproduction A Prospective Study of Dietary Fat Consumption and Endometriosis Risk Stacey A. Missmer; Jorge E. Chavarro; Susan Malspeis; Elizabeth R. Bertone-Johnson; Mark D. Hornstein; Donna Spiegelman; Robert L. Barbieri; Walter C. Willett; Susan E. Hankinson Abstract Background: Endometriosis is a prevalent but enigmatic gynecologic disorder for which few modifiable risk factors have been identified. Fish oil consumption has been associated with symptom improvement in studies of women with primary dysmenorrhea and with decreased endometriosis risk in autotransplantation animal studies. Methods: To investigate the relation between dietary fat intake and the risk of endometriosis, we analyzed 12 years of prospective data from the Nurses’ Health Study II that began in 1989. Dietary fat was assessed via food frequency questionnaire in 1991, 1995 and 1999. We used Cox proportional hazards models adjusted for total energy intake, parity, race and body mass index at age 18, and assessed cumulatively averaged fat intake across the three diet questionnaires. Results: During the 586 153 person-years of follow-up, 1199 cases of laparoscopically confirmed endometriosis were reported. Although total fat consumption was not associated with endometriosis risk, those women in the highest fifth of long-chain omega-3 fatty acid consumption were 22% less likely to be diagnosed with endometriosis compared with those with the lowest fifth of intake [95% confidence interval (CI) = 0.62–0.99; P-value, test for linear trend (Pt) = 0.03]. In addition, those in the highest quintile of trans-unsaturated fat intake were 48% more likely to be diagnosed with endometriosis (95% CI = 1.17–1.88; Pt = 0.001). Conclusion: These data suggest that specific types of dietary fat are associated with the incidence of laparoscopically confirmed endometriosis, and that these relations may indicate modifiable risk. This evidence additionally provides another disease association that supports efforts to remove trans fat from hydrogenated oils from the food...

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stresli yaşam olayları ivf başarısını olumsuz etkiliyor

Stressful Life Events are Associated with a Poor In-vitro Fertilization (IVF) Outcome: A Prospective Study S.M.S. Ebbesen; R. Zachariae; M.Y. Mehlsen; D. Thomsen; A. Højgaard; L. Ottosen; T. Petersen; H.J. Ingerslev From Human Reproduction Abstract Background: There is preliminary evidence to suggest an impact of stress on chances of achieving a pregnancy with in-vitro fertilization (IVF). The majority of the available research has focused on stress related to infertility and going through IVF-treatment, and it is still unclear whether non-fertility-related, naturally occurring stressors may influence IVF pregnancy chances. Our aim was to explore the association between IVF-outcome and negative, i.e. stressful, life-events during the previous 12 months. Methods: Prior to IVF, 809 women (mean age: 31.2 years) completed the List of Recent Events (LRE) and questionnaires measuring perceived stress and depressive symptoms. Results: Women who became pregnant reported fewer non-fertility-related negative life-events prior to IVF (Mean: 2.5; SD: 2.5) than women who did not obtain a pregnancy (Mean: 3.0; SD: 3.0) (t(465.28) = 2.390, P = 0.017). Logistic regression analyses revealed that the number of negative life-events remained a significant predictor of pregnancy (OR: 0.889; P = 0.02), when controlling for age, total number of life-events, perceived stress within the previous month, depressive symptoms, and relevant medical factors related to the patient or treatment procedure, including duration of infertility, number of oocytes retrieved and infertility etiology. Mediation analyses indicated that the association between negative life events and IVF pregnancy was partly mediated by the number of oocytes harvested during oocyte retrieval. Conclusion: A large number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end-points such as oocyte retrieval...

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Pentoxifylline embryo hasarını azaltıyor

Effect of pentoxifylline in reducing oxidative stress-induced embryotoxicity1 Xiaoyan Zhang,2 Rakesh K. Sharma,2,3 Ashok Agarwal,2 and Tommaso Falcone2 Submitted May 13, 2005; accepted July 6, 2005 Purpose: To 1) evaluate the embryotoxic effects of hydrogen peroxide on mouse embryo development and 2) examine if pentoxifylline can reverse hydrogen peroxide induced embryotoxicity. Methods: Prospective in vitro study examining the effects of varying concentrations of hydrogen peroxide and pentoxifylline on the blastocyst development rate alone as well as in combination. Results: A dose-dependent decrease in % BDR was seen with increasing concentrations of H2O2. High concentrations of hydrogen peroxide (>60μM) were embryotoxic. Pentoxifylline (500μM) was able to reduce the embryotoxic effect of hydrogen peroxide. Percent blastocyst development rate increased from 44% in hydrogen peroxide alone to 85% in hydrogen peroxide and pentoxifylline coincubation. Conclusions: Pentoxifylline may be beneficial in reducing hydrogen peroxide induced embryo damage and improve IVF outcome. Patients with endometriosis-associated infertility may benefit from the use of pentoxifylline without significantly affecting embryo...

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