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Η ιδανική ηλικία για τεκνοποίηση είναι μεταξύ των 20 και των 35 ετών, για μαιευτική, καθώς και για λόγους αναπαραγωγικής υγείας.
Κοινωνικές αλλαγές κατά τη διάρκεια των τελευταίων τεσσάρων δεκαετιών έχουν οδηγήσει σε μεγάλο αριθμό γυναικών να αναβάλουν τις προσπάθειες για τεκνοποίηση μέχρι και μετά τα 30 έτη τους.
Οι περισσότερες θα είναι σε θέση να συλλάβουν με φυσικό τρόπο και να αποκτήσουν ένα υγιές παιδί, αν συλλάβουν μέχρι τα 35 έτη.
Το ποσοστό των γυναικών που αντιμετωπίζουν υπογονιμότητα, αποβολή ή εμβρυικές χρωμοσωμικές ή γενετικές ανωμαλίες, αυξάνεται γρήγορα, στα μετέπειτα έτη, έτσι ώστε μόνο δύο στις πέντε, από όσες επιθυμούν να αποκτήσουν ένα παιδί σε ηλικία 40 ετών, θα είναι σε θέση να το πράξουν.
Η καλύτερη συμβουλή για γυναίκες που αισθάνονται ότι θέλουν να έχουν μια οικογένεια είναι να ολοκληρώσουν την αναπαραγωγική διαδικασία τους μέχρι την ηλικία των 35. Ωστόσο, αυτή η φιλοδοξία μπορεί να μην ταιριάζει με τις συνθήκες της ζωής τους.
Είναι γνωστό πως η γυναικεία γονιμότητα μειώνεται με την ηλικία, και αυτό οφείλεται στη γήρανση των ωοθηκών και των ωαρίων. Σε αντίθεση με τους άνδρες, οι οποίοι παράγουν σπερματοζωάρια κατά το μεγαλύτερο μέρος της ζωής τους, οι γυναίκες γεννιούνται ήδη με όλα τους τα ωάρια: έχουν περίπου 2.000.000 ανώριμα ωάρια στη γέννηση, όταν φτάσουν στην εφηβεία μένουν περίπου 300.000 και κάθε μήνα χάνονται αρκετές χιλιάδες. Στα 30 μας έτη το 90% των ωαρίων έχει ήδη φύγει, και μόνο το 3% παραμένει στα 40.
Σε αντίθεση με τα ωάρια, η μήτρα δεν επηρεάζεται από τη γήρανση και μπορεί υποστηρίξει μια εγκυμοσύνη, ακόμα και στα 50 έτη. Αυτό ισχύει και για γυναίκες σε εμμηνόπαυση.
Ωοθηκικό απόθεμα και η σημασία του όσων αφορά την ωοθηκική γήρανση.
Ο όρος ωοθηκικό απόθεμα περιγράφει την ποσότητα των ωαρίων που απομένουν στις ωοθήκες μιας γυναίκας σε ένα ορισμένο χρονικό σημείο. Αυτό θα μειωθεί με τη γήρανση μέχρι την εμμηνόπαυση, όταν ωορρηξία παύει.
FSH ορού, antimüllerian ορμόνη (ΑΜΗ) και μετρήσεις ινχιμπίνης
Η μέτρηση της συγκέντρωσης της FSH στον ορό του αίματος στην πρώιμη θυλακιώδη φάση του κύκλου ήταν ο ακρογωνιαίος λίθος της αξιολόγησης των ωοθηκών αποθεματικών στην εξωσωματική γονιμοποίηση για τρεις δεκαετίες.
Ως εκ τούτου, οι υψηλές συγκεντρώσεις της FSH αντανακλούν χαμηλό αποθεματικό ωοθηκών.
Η μέτρηση της ΑΜΗ έχει κερδίσει γρήγορα αποδοχή στην εξωσωματική γονιμοποίηση και φαίνεται πιθανό να αντικαταστήσει την FSH ως τον προτιμώμενο βιοχημική προγνωστικό δείκτη της ανταπόκρισης των ωοθηκών.
Τα επίπεδα ΑΜΗ είναι αρκετά σταθερά καθ’ όλη τη διάρκεια του κύκλου.
Καταμέτρηση ωοθυλακίων (AFC)
Το αποθεματικό των ωοθηκών μπορεί να εκτιμηθεί με τη χρήση διακολπικού υπερηχογράφηματος για να μετρήσει τα μικρά ωοθυλάκια 2-10 mm σε διάμετρο. Η AFC συσχετίζεται με την απόδοση των ωαρίων στην εξωσωματική γονιμοποίηση και με τους διάφορους βιοχημικούς δείκτες.
Αποθήκευση Ωαρίων
Η κατάψυξη ωαρίων, ή κρυοσυντήρηση ωαρίων, έχει ξεκινήσει εδώ και αρκετά χρόνια, ωστόσο, τον τελευταίο καιρό έχει συζητηθεί εκτενώς από τα μέσα ενημέρωσης
Η κατάψυξη ωαρίων είναι μία νέα τεχνική υποβοηθούμενης αναπαραγωγής που δίνει τη δυνατότητα στις γυναίκες να καταψύχουν τα ωάριά τους ώστε να μπορούν να επιλέγουν το πότε θέλουν να γίνουν μητέρες. Στην Ευρώπη έχουν ήδη γεννηθεί αρκετά παιδιά μέσω αυτής της διαδικασίας, η οποία μάλιστα έχει και παρόμοια ποσοστά επιτυχίας με τη χρήση μη κατεψυγμένων (φρέσκων) ωαρίων. Αυτή η τεχνική θα συνεχίσει να χρησιμοποιείται ευρέως στο μέλλον εξαιτίας των πλεονεκτημάτων που προσφέρει σε μία γυναίκα.
Καταρχήν, με τη μέθοδο αυτή, μία γυναίκα μπορεί να διατηρήσει τη γονιμότητά της σε περίπτωση που χρειάζεται ιατρική θεραπεία που την επηρεάζει (όπως χημειοθεραπεία για καρκίνο). Επίσης, δίνει τη δυνατότητα στις γυναίκες να καθυστερήσουν τη μητρότητα διατηρώντας παράλληλα το γενετικό υλικό των δικών της ωαρίων.
Καταψύχοντας τα ωάρια κατά τη διάρκεια της γονιμότερης περιόδου στη ζωή μιας γυναίκας μας δίνει καλύτερες πιθανότητες για την απόκτηση ενός υγιούς παιδιού.
Συνεπώς, αν παίρνουμε τα ωάρια μιας γυναίκας και τα παγώνουμε, η ποιότητα των ωαρίων θα παραμείνει αμετάβλητη στον χρόνο: ας πούμε ότι παγώνεις τα ωάριά σου όταν είσαι 30 ετών, και τα χρησιμοποιείς στα 40 σου, τα ωάρια θα εξακολουθήσουν να είναι 30 χρονών!
Σε ποιες περιπτώσεις εφαρμόζεται η κατάψυξη ωαρίων
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Για τη διατήρηση της γονιμότητας των γυναικών μέχρι την εύρεση του κατάλληλου για αυτές συντρόφου, είτε ζευγαριών που αναβάλλουν την τεκνοποίηση για εκπαιδευτικούς, επαγγελματικούς ή άλλους κοινωνικούς λόγους.
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Πριν την θεραπεία για τον καρκίνο. Η χημειοθεραπεία και οι ακτινοβολίες προκαλούν μη αναστρέψιμη βλάβη των ωαρίων. Ο μόνος τρόπος για τη διατήρηση της γονιμότητας είναι η κατάψυξη των ωαρίων πριν τη θεραπεία.
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Άλλοι ιατρικοί λόγοι, όπως για παράδειγμα η αφαίρεση των ωοθηκών.
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Για ηθικούς λόγους σε έναν κύκλο εξωσωματικής, όταν η κατάψυξη εμβρύων είναι ενάντια στις επιθυμίες του ζευγαριού.
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Για να αυξηθούν τα ποσοστά επιτυχίας σε γυναίκες με χαμηλό αποθεματικό ωαρίων. Γίνεται η γονιμοποίηση όλων των ωαρίων μετά από αρκετούς κύκλους διέγερσης των ωοθηκών.
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–Γυναίκες με υψηλό κίνδυνο πρόωρης εμμηνόπαυσης:
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–Ορισμένα ζευγάρια που υποβάλλονται σε εξωσωματική γονιμοποίηση (IVF).
Πώς γίνεται η κατάψυξη των ωαρίων
Για να γίνει η κατάψυξη ωαρίων, η γυναίκα θα πρέπει να υποβάλλεται σε μια ορμονική θεραπεία, με στόχο να διεγείρει τις ωοθήκες να παράγουν πολλαπλά ωάρια. Υπάρχουν διάφορα πρωτόκολλα γι’ αυτό – τα λεγόμενα βραχύ και μακρύ πρωτόκολλα – ανάλογα με την ωοθηκική λειτουργία και το πόσο επείγουσα είναι η διαδικασία (π.χ. όταν η κατάψυξη ωαρίων γίνεται πριν από τη θεραπεία του καρκίνου).
Όταν τα ωάρια είναι ώριμα, αναρροφούνται με μια βελόνα διαμέσου του κόλπου, με υπερηχογραφική καθοδήγηση. Η διαδικασία γίνεται συνήθως κάτω από ήπια αναισθησία (“μέθη”). Τα αυγά καταψύχονται αμέσως, στα περισσότερα κέντρα με τη μέθοδο της υαλοποίησης.
Μόλις η γυναίκα αποφασίσει να προσπαθήσει να μείνει έγκυος – αυτό μπορεί να είναι μήνες ή χρόνια αργότερα – τα ωάρια αποψύχονται, εγχέονται με ένα σπερματοζωάριο και αφήνονται σε έναν επωαστήρα να γονιμοποιηθούν. Μετά από δύο έως πέντε ημέρες, τα προκύπτοντα έμβρυα μεταφέρονται στη μήτρα με ένα λεπτό καθετήρα.
Θα πρέπει να αναφερθεί ότι κάποιες γυναίκες που έχουν λίγα ωάρια μπορεί να χρειαστεί να υποβληθούν σε πολλούς κύκλους διέγερσης, προκειμένου να έχουν έναν καλό αριθμό κατεψυγμένων ωαρίων (ο ιδανικός αριθμός είναι περίπου 20 – 30).
Διάρκεια Ζωής Κατεψυγμένων Ωαρίων
Η κατάψυξη ωαρίων είναι μια σχετικά πρόσφατη διαδικασία, αλλά η πρακτική της κατάψυξης εμβρύων γίνεται εδώ και πολλά χρόνια, και έχουν επιτευχθεί εγκυμοσύνες με έμβρυα που ήταν κατεψυγμένα για περισσότερο από 20 χρόνια. Γι’ αυτό αναμένουμε ότι, κατά πάσα πιθανότητα, το ίδιο θα ισχύει και για τα κατεψυγμένα ωάρια.
Δεν υπάρχει ημερομηνία λήξης για τα κατεψυγμένα ωάρια, θεωρητικώς μπορεί να αποψυχθούν, να γονιμοποιηθούν και να εμφυτευθούν οποτεδήποτε στη ζωή της γυναίκας.
Ωστόσο οι προσπάθειες για απόκτηση παιδιού πρέπει να έχουν ολοκληρωθεί έως τα 50 έτη, διότι αυτή είναι η μέγιστη ηλικία για εμβρυομεταφορά που ορίζει η ελληνική νομοθεσία.
Πιθανότητες απόκτησης παιδιού μετά την απόψυξη των ωαρίων
Σύμφωνα με μελέτες της Αμερικανικής Εταιρείας Αναπαραγωγικής Ιατρικής (ASRM), ένα και μόνο κατεψυγμένο ωάριο έχει 2% έως 12% πιθανότητες να οδηγήσει στη γέννηση ενός ζωντανού βρέφους, αναλόγως με διάφορους παράγοντες (τη μέθοδο κατάψυξης που εφαρμόζεται, την ηλικία της γυναίκας, την ποιότητα του σπέρματος κ.λπ.).
Μελέτη που δημοσιεύθηκε τον Μάιο του 2013 στην επιθεώρηση «Fertility and Sterility» έδειξε ότι μια 30χρονη γυναίκα, που θα καταψύξει 2 έως 6 ωάρια, έχει 24% πιθανότητες να αποκτήσει μωρό, όταν η κατάψυξη έχει γίνει με την προηγμένη μέθοδο της υαλοποίησης.
Με την ίδια μέθοδο, όμως, μία 40χρονη γυναίκα έχει 5-13% πιθανότητες να αποκτήσει μωρό με την κατάψυξη του ιδίου αριθμού ωαρίων.
Η διαφορά μεταξύ των δύο ηλικιών υποδηλώνει και πόσο γρήγορα φθίνει η γονιμότητα της γυναίκας. Αυτός είναι και ο λόγος που καταψύχουμε κατά μέσον όρο 10 ωάρια, ενώ σε κάθε κύκλο γονιμοποιούνται τρία ή το πολύ τέσσερα από αυτά, από τα οποία συνήθως προκύπτουν το πολύ δύο έμβρυα που εμφυτεύονται στη γυναίκα.
Με τη διαδικασία αυτή υπολογίζεται ότι οι πιθανότητες επιτυχούς εγκυμοσύνης φθάνουν ή υπερβαίνουν το 50%.
Πόσα ωάρια θα πρέπει να καταψύξω ώστε να έχω πιθανότητες να πετύχω εγκυμοσύνη στο μέλλον;
Έρευνες έχουν δείξει ότι κατά την απόψυξη μπορεί να καταστραφεί το 40% των κατεψυγμένων ωαρίων. Αυτό σημαίνει ότι εάν καταψύξετε 10, από αυτά τα έξι αναμένεται να είναι αξιοποιήσιμα μετά την απόψυξη. Από αυτά, τα 4 με 5 θα καταφέρουν να γονιμοποιηθούν και να εξελιχθούν σε έμβρυα. Γενικά, συνιστάται η συλλογή δέκα ωραίων για κάθε προσπάθεια εγκυμοσύνης.
Ποια είναι η καλύτερη ηλικία για να καταψύξεις τα ωάριά σου;
Από βιολογική άποψη, η απάντηση είναι απλή: όσο νεότερη, τόσο καλύτερα. Και αυτό για τον εξής λόγο: μια γυναίκα στα 20 της αναμένεται να έχει 15 με 25 ωάρια για κατάψυξη. Δεδομένου ότι τα ωάρια είναι καλής ποιότητας, θα χρειαστούν περίπου 4-5 ωάρια για να αποκτήσει ένα μωρό (μερικά δε θα επιβιώσουν τη διαδικασία της απόψυξης, άλλα δε θα γονιμοποιηθούν και άλλα θα παράγουν ανώμαλα έμβρυα). Μια γυναίκα 40 ετών, όμως, θα έχει στην καλύτερη των περιπτώσεων 8-10 ωάρια, ενώ μπορεί να χρειαστούν 25 ωάρια για να προκύψει μια εγκυμοσύνη, επειδή τα ωάρια είναι κατώτερης ποιότητας.
Ποιο είναι το ανώτερο όριο ηλικίας για να παγώσω τα ωάριά μου;
Σε πολλά κέντρα εξωσωματικής γονιμοποίησης, το ανώτατο όριο είναι τα 43 έτη, γιατί σε αυτή την ηλικία τα ποσοστά εγκυμοσύνης μειώνονται δραματικά. Και πάλι, μπορεί να υπάρχουν εξαιρέσεις ανάλογα με την ωοθηκική λειτουργία κάθε γυναίκας.
Ποιο είναι το ανώτερο όριο ηλικίας για να χρησιμοποιήσω των παγωμένα ωάρια;
Όπως αναφέρθηκε πριν, η μήτρα “δεν γερνάει”. Υπάρχουν αναφορές για γυναίκες που έχουν γεννήσει ένα παιδί – με δωρεά ωαρίων από νεότερη γυναίκα – στα 60 τους. Η ASRM δε συμβουλεύει την εμβρυομεταφορά σε γυναίκες άνω των 55 ετών, επειδή πάνω από αυτή την ηλικία υπάρχει μεγαλύτερος κίνδυνος τόσο για τη γυναίκα όσο και για το έμβρυο. Πολλά κέντρα στο εξωτερικό θέτουν ως όριο τα 50 έτη. φρέσκα ή με κατεψυγμένα ωάρια είναι 50 ετών.
Πόσο αποτελεσματική είναι η κατάψυξη ωαρίων;
Από όλα τα κατεψυγμένα ωάρια, περίπου το 90-95% θα επιβιώσει τη διαδικασία της απόψυξης. Όταν αυτά τα ωάρια γονιμοποιούνται, τα αποτελέσματα είναι συγκρίσιμα με εκείνα της εξωσωματικής γονιμοποίησης χρησιμοποιώντας φρέσκα ωάρια: 36-65% ποσοστό εγκυμοσύνης, ανάλογα με διάφορες μελέτες. Όπως και με την εξωσωματική γονιμοποίηση, τα ποσοστά επιτυχίας είναι καθαρά συνδεδεμένα με την ηλικία της μητέρας τη στιγμή της κατάψυξης: όσο νεότερη η γυναίκα, τόσο υψηλότερο το ποσοστό εγκυμοσύνης.
Τα αποτελέσματα αυτά, αν και εντυπωσιακά, δείχνουν ότι η κατάψυξη ωαρίων δεν είναι μια εγγύηση 100% επιτυχίας
Μέχρι σήμερα, περισσότερα από 5.000 παιδιά έχουν γεννηθεί από κατεψυγμένα ωάρια .
Συμπεράσματα…
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Η ηλικία της γυναίκας είναι ανασταλτικός παράγοντας γονιμότητας. Συνεπώς, όσο η ηλικίας της γυναίκας αυξάνεται, τόσο η γονιμότητα μειώνεται.
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Η κατάψυξη ωαρίων δεν είναι εγγύηση για μια μελλοντική εγκυμοσύνη. Όσο καθυστερεί η τεκνοποίηση, τόσο μειώνεται η πιθανότητα απόκτησης ενός παιδιού.
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Η διαδικασία αυτή θα πρέπει να θεωρηθεί ως το «σχέδιο Β»: ένα μέτρο έκτακτης ανάγκης σε περίπτωση που συνθήκες το απαιτούν.
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Προτού αποφασίσεις να παγώσεις τα ωάριά σου, θα πρέπει να συζητήσεις εκτενώς τη διαδικασία με έναν εξειδικευμένο επαγγελματία, προκειμένου να μάθεις τους κινδύνους και τις πιθανότητες επιτυχίας στη συγκεκριμένη περίπτωσή σου.
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