Natürliche Konzeption
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Die natürliche Konzeption sowie Kenntnisse der Vorgänge sind eine gute Voraussetzung, damit Sie Ihre spontanen Chancen optimal nutzen können.
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Die im Kinderwunsch Centrum München angebotenen Therapiemöglichkeiten beruhen auf den grundlegenden physiologischen Gegebenheiten der natürlichen Konzeption. Deshalb möchten wir Ihnen einen kurzen Überblick geben, wie die natürliche Konzeption, also die menschliche Fortpflanzung, funktioniert. Vor allem das sorgfältig aufeinander abgestimmte Wechselspiel zwischen den Eierstöcken und ihren übergeordneten Signalgebern ist dabei von entscheidender Bedeutung.
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Zentrale Steuerung
Eibläschenreifung
Eisprung und Befruchtung
Gelbkörperbildung
Frühe Schwangerschaft
Zentrale Steuerung
Im Sexualzentrum des Zwischenhirns (Hypothalamus) wird das Steuerhormon GnRH (Gonadotropin Releasing Hormon) gebildet. Die rhythmische Ausschüttung des GnRH bewirkt in der Hirnanhangsdrüse (Hypophyse) anschließend die Freisetzung der zentralen Sexualhormone FSH (follikelstimulierendes Hormon) und LH (luteinisierendes bzw. gelbkörperbildendes Hormon). Diese beiden Hormone werden auch Gonadotropine genannt, weil sie auf die Keimdrüsen (Gonaden) wirken, also die Eierstöcke der Frau und die Hoden des Mannes. Dorthin gelangen sie über den Blutweg.
Eibläschenreifung
Unter Anregung durch FSH wächst in den Eierstöcken in der ersten Zyklushälfte ein einziges Eibläschen (Follikel) heran, an dessen Innenwand sich eine Eizelle befindet. Die Granulosazellen der Eibläschenwand bilden weibliche Hormone, Östrogene, die den Aufbau der Gebärmutterschleimhaut und eine zunehmende Schleimbildung im Gebärmutterhals bewirken.
Überschreiten die Östrogene im Blut einen Schwellenwert, wird das zweite Gonadotropin (LH) freigesetzt. Der Follikel hat zu diesem Zeitpunkt eine Größe von etwa 15-25 mm.
Eisprung und Befruchtung
Das Gonadotropin LH löst dann den Eisprung aus, bei dem die Eizelle umgeben von Granulosazellen aus dem Eibläschen ausgestoßen wird. Bei einer Zykluslänge von 28 Tagen geschieht dies etwa am 14. Zyklustag.
Das Ende des Eileiters steht in engem Kontakt mit dem Eierstock, so dass der Eizellkomplex durch den sog. Fimbrientrichter mit seinen fransenartigen Fortsätzen aufgefangen werden kann. Im Inneren des Eileiters kann die Eizelle nun befruchtet werden, wenn eine ausreichende Anzahl an Samenzellen (Spermien) nach dem Geschlechtsverkehr den Weg durch den Gebärmutterhals und die Gebärmutterhöhle bis in den Eileiter gefunden hat.
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Da die Eizelle für weniger als 24 Stunden befruchtungsfähig ist, ist der optimale Zeitpunkt für Geschlechtsverkehr ein bis zwei Tage vor dem Eisprung.
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Spermien sind einige Tage im weiblichen Körper überlebensfähig, sodass eine eintretende Schwangerschaft bis zu sieben Tage nach Verkehr möglich ist.
Auch unter optimalen Bedingungen gelingt es nur wenigen Spermien, gleichzeitig die Eizelle zu erreichen. Nur eine Samenzelle wird durch die Wand der Eizelle ins Innere hineingelassen. Dort lagern sich die mütterlichen und väterlichen Erbanlagen aneinander und verschmelzen.
Gelbkörperbildung
Der gesprungene Follikel formt sich zum Gelbkörper um und bildet nun zusätzlich zu den Östrogenen das Gelbkörperhormon (Progesteron). Dieses wandelt die Gebärmutterschleimhaut um und bereitet sie auf die Einnistung des Embryos vor. Bis dieser den Weg durch den Eileiter in die Gebärmutterhöhle zurückgelegt hat und sich in der Schleimhaut einnisten kann, dauert es nach der Befruchtung noch 5-6 Tage. Für den ungestörten Transport ist die Eigenbeweglichkeit des Eileiters und seines Flimmerepithels entscheidend.
Beginn der Schwangerschaft
In der Gebärmutter bildet sich das Frühstadium des Mutterkuchens aus. Hier wird das Schwangerschaftshormon gebildet, über das der Embryo mit dem Gelbkörper kommuniziert und dessen Funktion aufrechterhält. Nach der 9. Schwangerschaftswoche wird der Gelbkörper nicht mehr benötigt und bildet sich langsam zurück. Die Progesteronbildung wird dann von der Fruchthöhle übernommen.
Kommt es nicht zur Einnistung eines Embryos, bleiben die Signale an den mütterlichen Organismus aus. Der Gelbkörper bildet sich zurück, das Progesteron fällt ab und die Gebärmutterschleimhaut wird abgestoßen. Es kommt zur Regelblutung und der Zyklus beginnt von neuem.
Bleibt die natürliche Konzeption zur Erfüllung eines Kinderwunsches über längere Zeit erfolglos, ist ein vertrauensvoller Partner an Ihrer Seite wichtig. Wir vom Kinderwunsch Centrum München stehen Ihnen auf Ihrem Weg zum Start in die Familienplanung zur Seite.
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Erste Kontrolluntersuchung:
Entweder in den ersten Menstruationstagen, (nach erfolgter Down-Regulation durch Decapeptyl oder das Nasenspray) bzw. vor dem eigentlichen Stimulationsbeginn und ansonsten zwischen dem 6. und 8. Zyklustag. Zeitlich planen Sie hierfür bitte je nach Andrang ca. 1 Stunde in unserer Praxis ein.
Zweite Kontrolluntersuchung: Planen Sie hierfür ca. eine halbe Stunde in unserer Praxis ein.
Weitere Kontrolluntersuchungen können hinzukommen. Eine besonders schwierige Stimulation kann zum Beispiel hierfür verantwortlich sein, wenn nämlich Ihre Eierstöcke nur verzögert oder aber deutlich stärker im Sinne einer Überstimulation, als erwartet reagieren.
Eisprungspritze (meist in der Zeit von 21 Uhr bis 24 Uhr): Sie wird erst auf unsere ganz besondere Anordnung etwa 34 bis 36 Stunden vor der Eizellentnahme (Follikelpunktion) gegeben.
Für diese Spritze ist es besonders wichtig, dass Sie selber spritzen gelernt haben.
Sehr wichtig ist, dass es sich dabei auch wirklich um die Eisprungspritze (Brevactid/Ovitrelle) handelt. Eine Verwechslung darf hier auf keinen Fall vorkommen, da sonst am Punktions- bzw. Entnahmetag keine oder nur unreife, d. h. nicht befruchtungsfähige Eizellen vorliegen würden!
Für die jetzt folgenden Tage können Sie von der Punktion (= Eizellentnahme) bis zum Tag des Transfers (= Zurücksetzen der befruchteten Eizellen) eine Arbeitsunfähigkeitsbescheinigung (= AU) erhalten.
Punktionstag: An diesem Tag bitte nüchtern zu uns kommen. Die Aufnahme erfolgt im IVF-Liegeraum meist zwischen 7.30 Uhr und 10.00 Uhr, und ca. zwei Stunden vor dem Eingriff, damit unsere Narkoseärztinnen noch mit Ihnen sprechen und Sie sich in Ruhe vorbereiten können.
Diesen Tag planen Sie bitte komplett als Fehlzeit ein, auch weil wir Sie schon aus medizinischen und rechtlichen Gründen mindestens noch zwei Stunden nach der Punktion bei uns beobachten möchten. Dafür stehen Ihnen unsere Liegeräume, gegebenenfalls auch mit Ein- oder Zweibettsystem zur Verfügung. An diesem Tag gibt Ihr Mann eine Samenprobe ab.
Die Entlassung darf dann auch nur in Begleitung Ihres Ehemannes oder Partners oder einer anderen Begleitperson erfolgen.
Zusammenfassend heißt das also, dass Sie zur Eizellentnahme immer nüchtern kommen müssen, sich von einer Begleitperson abholen lassen müssen und an diesem Tag nicht selber Auto fahren dürfen.
Der nächste Tag ist Ihr so genannter Ruhetag. Sie können sich von den (hoffentlich nicht allzu großen) Strapazen der Behandlung etwas erholen. Zwischen 12 und 14 Uhr erfahren Sie telefonisch in unserem Labor, ob die Eizellen befruchtet sind und wann der Transfer in den nächsten Tagen stattfinden soll. Abweichungen hiervon sind gelegentlich möglich (z. B. sonn- und feiertags) und werden Ihnen dann speziell mitgeteilt.
Am Transfertag werden jetzt die befruchteten und geteilten Eizellen in die Gebärmutter zurückgesetzt (= transferiert). Dies geschieht meist zwei bis drei Tage nach der Eizellentnahme. Auch diesen Tag planen Sie bitte möglichst ebenfalls komplett als Fehlzeit ein.
Die Aufnahme erfolgt wiederum morgens im IVF-Liegeraum, meist allerdings nicht vor 10 Uhr.
Nach dem Embryotransfer sollten Sie noch Zeit für eine Ruhephase von etwa einer Stunde mitbringen. Am Mittag oder frühen Nachmittag können Sie dann – diesmal auch ohne Begleitung – nach Hause gehen. Selbstverständlich kann Ihr Ehemann oder Partner Sie zum und beim Transfer gerne begleiten.
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Weiterführende Links
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– Kryokonservierung von Embryonen
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ICSI Behandlung
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Diese Methode wird dann angewandt, wenn der Spermiogrammbefund deutlich eingeschränkt ist. Aufgrund zu weniger, eingeschränkt beweglicher oder vermehrt unregelmäßig geformter Samenzellen ist das selbstständige Eindringen eines Spermiums in die Eizelle oft nicht möglich, d. h. eine spontane Befruchtung der Eizelle sehr unwahrscheinlich oder gar ausgeschlossen.
Alle Schritte bis zur Eizellentnahme verlaufen genauso wie bei der konventionellen IVF Behanldung. Dann, nach der Entnahme (Punktion) der Eizellen, erfolgen im Labor unter dem Mikroskop die technisch sehr aufwendigen Schritte der ICSI.
Die entnommenen Eizellen müssen zunächst von den um sie herum gelegenen Zellen (Granulosa) gereinigt („geputzt“) werden. Erst wenn diese Granulosazellen von der Eizelle entfernt worden sind, kann die Eizelle (besonders bezüglich ihres Reifegrades) begutachtet werden und ist jetzt, wenn sie reif ist, für die Injektion des Spermiums vorbereitet.
Die Eizelle muss mit einer speziellen Haltepipette fixiert werden. Erst dann kann ein einzelnes Spermium, das in eine noch wesentlich dünnere Injektionspipette aufgezogen wurde, direkt in die Eizelle überführt (injiziert = eingespritzt) werden. ICSI wird auch Mikroinjektion genannt, weil es unter dem Mikroskop durchgeführt wird. Das natürliche Eindringen eines Spermiums in die Eizelle wird also hier mechanisch nachgeahmt. Abgesehen von der Auswahl des Spermiums und seiner Übertragung in die Eizelle bleibt alles weitere genauso der Natur überlassen wie sonst auch.
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Weiterführende Links
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text“]Dies könnte Sie auch interessieren:[/ffb_param][/ffb_section-heading_2][/ffb_column_1][ffb_column_1 unique_id=“3nui15fs“ 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Viele Ursachen für eine ausbleibende Schwangerschaft können durch Überprüfung der grundlegenden physiologischen Faktoren rasch aufgedeckt werden. Dabei gilt, dass sich bei unerfülltem Kinderwunsch beide Partner untersuchen lassen sollten.
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Unser größtes Anliegen ist die Verbesserung der Voraussetzungen für eine natürliche Empfängnis. Dazu können Änderungen im Lebensstil beitragen.
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Durch einfache Blut-und Ultraschalluntersuchungen kann bei Frauen ab Anfang 30 eine Einschätzung der Fruchtbarkeitsreserve erfolgen. Unter den hormonellen Parametern ist die Höhe des Wertes für das Anti-Müller-Hormon (AMH) am aussagekräftigsten.
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