Tüp Bebek ve Polikistik Over Sendromu

Dr. Burak Hacıhanefioğlu

polikistikover.net internet sitesinde yer alan tıp içerikli yazıların tümü Kadın Hastalıkları ve Doğum Uzmanı Dr. Burak Hacıhanefioğlu tarafından hazırlanmış olup, telif hakları yasal olarak koruma altına alınmıştır. İzin almadan kaynak gösterilerek dahi başka bir yerde yayınlanamaz.

Gerçekten uygulanması gereken durumlar olan ileri derecede sperm bozukluğu ve her iki tüpünde tıkalı olması dışında polikistik over sendromu olanlarda tüp bebek uygulanması doğru değildir…

Polikistik over sendromu olan ve çocuk sahibi olmak isteyen kadınlara çeşitli nedenlerle ”senin çocuğun olmaz, sen kısırsın” veya ”tüp bebek yapılmasından başka çaren yok” deniliyor. Halbuki, tam tersine polikistik over sendromu olan kadınların yumurtalık rezervleri ve üreme kapasiteleri teorik olarak diğer kadınlardan daha fazladır(1,2,3,4,5,6,7,8). Polikistik over sendromu olan kadınların yarısından fazlası gebeliği engelleyen başka bir neden yoksa herhangi bir tedaviye ihtiyaç duymadan gebe kalabilmektedir(44). Hatta, gerek olmadığı halde yapılan tüp bebek tedavisi ile gebe kalamayanların bir kısmı da kendiliğinden bir süre sonra gebe kalmaktadır(49,50,51,52,53,54). Polikistik over sendromu olanların sadece bir kısmı yumurta gelişimi ve yumurtlama olmaması veya gecikmeli olması nedeniyle gebe kalmakta zorluk yaşamaktadır(1,2,3,4,5,6,7,8,9).

Polikistik over sendromu nedeniyle gebe kalmakta zorluk yaşayanlara tüp bebek tedavisi yapılmasına gerek yoktur(10,11,12,13,14,15,16,17,18,19,20,21,22). Günümüzde en çok kullanılan tüp bebek yöntemi olan ICSI (Intra Cytoplasmic Sperm Injection) ile doğal seleksiyon (seçim) gerçekleşmediği için yenidoğan bebekte ve daha sonraki gelişim dönemlerinde otizm (autism) gibi yan etkiler görülmektedir. Çeşitli genlerin etkinliğinin (expression) değişmesi (DNA methylation) (epigenetics) sonucunda bu yan etkiler ortaya çıkmaktadır. (23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43). Gerçekten uygulanması gereken durumlar olan ileri derecede sperm bozukluğu ve her iki tüpünde (fallop tüpleri) tıkalı olması nedenleri dışında polikistik over sendromu olanlarda tüp bebek uygulanması doğru değildir. Halbuki, polikistik over sendromu nedeniyle gebe kalmakta zorluk yaşayan kadınlar çok daha zararsız, kolay uygulanan ve az masraflı yumurta gelişimi ve yumurtlamayı sağlayan (ovulation induction) ilaçlarla birlikte, aşılama (Intrauterine Insemination) yöntemi ile zaten çocuk sahibi olabilmektedir. (10,11,12,13,14,15,16,17,18,19,20,21,22).

Polikistik over sendromu nedeniyle çocuk isteği tedavisine yeni başlayan kadınların bir kısmında eşinin sperm sayısında ve hareketinde azlık veya şeklinde bozukluk görülürken, bir kısmının da tüplerinden birinin ya da her ikisinin tıkalı olduğu saptanmaktadır(45,46,47,48). Bu nedenle çocuk isteği tedavisine başlamadan önce polikistik over sendromu ile birlikte, sperm ile ilgili ve sperm ile yumurtanın birleştiği yer olan tüplerin (fallop tüpleri) bütünlüğünün bozulmasından kaynaklanan sorunların olup olmadığının belirlenmesi gerekmektedir(45,46). Ancak, polikistik over sendromu’na ek olarak sperm ve tüplerle ilgili sorunların da olması durumunda tüp bebek tedavisi düşünülmelidir.

Kaynaklar

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Dr. Burak Hacıhanefioğlu ∗polikistikover.net internet sitesinde yer alan tıp içerikli yazıların tümü Kadın Hastalıkları ve Doğum …