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რა რეზერვი აქვს საკვერცხეებს

თარიღი: 04 ივნისი, 2025

საკვერცხეების ოვარიული რეზერვი ანუ ჯანსაღი კვერცხუჯრედების რაოდენობა გენეტიკურად არის განსაზღვრული და ყველა ქალისთვის ჯერ კიდევ დაბადებამდეა კოდირებული. ამ რეზერვის გაზრდა შეუძლებელია. მისი ხარჯვა პირველი მენსტრუალური ციკლიდან იწყება და მთელი რეპროდუქციული ასაკის განმავლობაში გრძელდება. ოვარიული რეზერვი თანდათან იწურება, ხოლო როცა კრიტიკულ წერტილს აღწევს, დგება მენოპაუზა. მაგრამ ზოგჯერ ეს ნაადრევად ხდება, რასაც უშვილობამდე მივყავართ. ასეთ დროს ძალიან მნიშვნელოვანია საკვერცხეების დარჩენილი რეზერვის განსაზღვრა, რაც ლაბორატორიული კვლევებითაა შესაძლებელი.

ამის შესახებ ზურაბ საბახტარაშვილის რეპროდუქციული კლინიკის ლაბორატორიული დიაგნოსტიკის ხელმძღვანელი, ბიოლოგიის დოქტორი რუსუდან გვენეტაძე გვესაუბრება:

მიზეზთა გამო ოვარიული რეზერვის შემცირება და განლევა შესაძლოა ახალგაზრდობაშივე დაიწყოს, რასაც თავისთავად მოჰყვება უნაყოფობა. ოვარიული რეზერვის განლევა კანონზომიერი და ხანგრძლივი პროცესია, რომელიც რამდენიმე სტადიას გაივლის, ანუ რეპროდუქციული ფუნქცია ერთბაშად არ ითიშება, თუმცა შვილოსნობის უნარი მენოპაუზამდე გაცილებით ადრე იკარგება, ჯერ კიდევ მანამდე, სანამ კვერცხუჯრედების მარაგი ამოიწურება. აქედან გამომდინარე, ქალის უნაყოფობის დიაგნოსტირებისას საჭიროა ოვარიული რეზერვის სკრინინგი, რის საშუალებასაც თანამედროვე მაღალინფორმაციული ლაბორატორიული ტესტები გვაძლევს. მათ შედეგებზე დაყრდნობით გარკვეულწილად შესაძლებელია პაციენტის რეპროდუქციული პოტენციალის პროგნოზირება.

რისი ბრალია ოვარიული რეზერვის შემცირება?
რეზერვის შემცირების მიზეზად შეიძლება იქცეს ქალის ასაკი, ინფექცია, ქირურგიული ჩარევა... თუ ინ ვიტრო ანუ ექსტრაკორპორალურ განაყოფიერებაზე ვისაუბრებთ, განსაკუთრებით პრობლემურია ამ პროცესში მონაწილე ჰორმონების ფუნქციობაც (IVF – ფოლიკულის განვითარების სტიმულაცია), ჰორმონული დისბალანსი კი წარმატებული ოოციტოზის, განაყოფიერების, ემბრიონის გადატანის და, შესაბამისად, ჩასახვის ალბათობასაც ამცირებს.

როგორ ადგენენ ოვარიულ რეზერვს?
ოვარიული რეზერვის სკრინინგტესტი გულისხმობს იმ ჰორმონების კვლევას, რომელთა ნორმალური კონცენტრაცია ქალის ორგანიზმში ფოლიკულების წარმოქმნას არეგულირებს. ესენია ფოლიკულმასტიმულირებელი ჰორმონი (FSH), ინჰიბინ B და ანტიმიულერის ჰორმონი (AMH).

ფოლიკულმასტიმულირებელი ჰორმონის განსაზღვრა, რაც ციკლის პირველ-მესამე დღეს ხდება, ფოლიკულური რეზერვის შეფასების ერთ-ერთი წამყვანი მეთოდია. საკვერცხეებში ფოლოკულების შემცირებას თან ახლავს ჰიპოფიზის მიერ ამ ჰორმონის ჭარბი გამომუშავება. ასაკთან ერთად ქალის სისხლში, წესისამებრ, FSH-იც იმატებს, რაც მენოპაუზამდე დაახლოებით ხუთი წლით ადრე შეიმჩნევა. სისხლში ამ ჰორმონის მაღალი კონცენტრაციის დროს კი უარესდება კვერცხუჯრედების ხარისხი და მცირდება მათი განაყოფიერების უნარი.

საკვერცხის გრანულარული უჯრედების მიერ წარმოქმნილი ჰორმონი ინჰიბინ B უკუკავშირშია FSH ის წარმოქმნის პროცესთან. ინჰიბინ B-ს დონე ქალის საკვერცხეებში ფუნქციურად აქტიური ფოლიკულების რაოდენობას ასახავს: რაც უფრო მაღალია ის, მით მეტია ფოლიკულიც. მენოპაუზის პერიოდში ინჰიბინ B-ს რაოდენობა ძალიან მცირდება.

ანტიმიულერის ჰორმონი გრანულარულ უჯრედებში წარმოიქმნება. მას ერთობლივად გამოიმუშავებს მოცემულ მომენტში ქალის ყველა ფოლიკული. ახალგაზრდა, ჯანმრთელ ქალებთან მისი კონცენტრაცია მაღალია, ხოლო ასაკოვნებთან, ასევე – ახალგაზრდა ქალებთან ოვარიული რეზერვის ამოწურვისას, მცირდება. ამ ჰორმონის მიმართ განსაკუთრებული ინტერესი იმითაა გამოწვეული, რომ ის არ კონტროლდება გონადოტროპინებით და ასახავს მხოლოდ ფოლიკულების პოპულაციას, არ არის დამოკიდებული ციკლზე და მოქმედებს რეგულაციის არა როგორც სისტემური, არამედ როგორც ადგილობრივი ფაქტორი.

ოვარიული რეზერვის სწორი შეფასებისთვის რომელიმე ერთ მაჩვენებელზე ორიენტირება არ შეიძლება; საჭიროა ყველა მონაცემის გაანალიზება და შეჯერება.

რას გულისხმობს სტიმულაციის მეთოდი?
საკვერცხეების ფუნქციური რეზერვის შესაფასებელად მიღებულია ფოლიკულმასტიმულირებელი ჰორმონით სტიმულაციის მეთოდიც – EFORT-ტესტი, რომელიც საშუალებას იძლევა, შეფასდეს საკვერცხეების ფიზიოლოგიური რეაქცია აღნიშნულ სტიმულაციაზე.

ტესტის მეშვეობით ვადგენთ ინჰიბინ B-სა და ანტიმიულერის ჰორმონების დონეს. საწყის ეტაპზე განისაზღვრება მალუთეინიზებელი და ფოლიკულმასტიმულირებელი ჰორმონების კონცენტრაციაც.

თუ ოვარიული რეზერვი ნორმალურია, გონადოტროპული ჰორმონის შეყვანამ AMH-ის შემცირება და ინჰიბინ B-ს მომატება უნდა გამოიწვიოს, მისი განლევის შემთხვევაში კი ინჰიბინ B-სა და AMH-ის მაჩვენებლები საწინააღმდეგოდ შეიცვლება ან საწყის დონეზე დარჩება.

EFORT-ტესტის შედეგების მიხედვით ექიმი ასკვნის, რამდენადაა შემცირებული პაციენტის ოვარიული რეზერვი და მკურნალობის სტრატეგიას განსაზღვრავს. გარდა ამისა, გამოკვლევის შედეგებს იყენებენ ნაადრევი მენოპაუზისა და მასთან დაკავშირებულ დაავადებათა განვითარების რისკის, უნაყოფობისა და ექსტრაკორპორალური (ეკო) განაყოფიერების მიზანშეწონილობის შესაფასებლად.

ვის სჭირდება ოვარიული რეზერვის შემოწმება?
რა თქმა უნდა, ყველა ქალს არა, მაგრამ თუ გეცოდინებათ, რომ რეზერვის ამოწურვის რისკჯგუფს მიეკუთვნებით, აღარ დაკარგავთ ძვირფას დროს და კონსულტაციისათვის დროულად მიმართავთ ექიმს.

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