MIDWIVES ROLE IN THE TREATMENT INFERTILITY

U zapadnim zemljama, pa tako i u Hrvatskoj 12-15 % parova je neplodno. Uzroci neplodnosti pronalaze se kod oba bračna partnera te su izvor zabrinutosti i frustracije za oboje. Uzrok ženske neplodnosti može biti patologija unutarnjih spolnih organa žene: priraslice u maloj zdjelici, obliteracija jajovoda, destrukcija cilija u jajovodu, anovulacija, PCOS, miomi i anomalije uterusa, endometrioza itd. Ne treba zaboraviti endokrinološke, genske i razvojne poremećaje koji mogu utjecati na plodnost, a ukoliko se na njih ne misli, proširuje se kategorija kriptogene neplodnosti (danas prelazi 10%) koja posebno frustrira i liječnike i bračni par. Najčešći izlječivi uzrok neplodnosti u muškaraca je varikokela. U neplodnih muškaraca i žena treba razmišljati i o kromosomopatijama. Obrada neplodnog para treba biti iscrpna kako bi što manji broj bio klasificiran kao kriptogena neplodnost. Prvo valja pribaviti točne anamnestičke podatke o općem i ginekološkom zdravlju žene, o trajanju neplodnosti i stvarnoj izloženosti mogućnosti zanošenja. Zatim slijedi ginekološki pregled i uzimanje citološkog obriska te evaluacija plodnosti supruga analizom ejakulata. U žene se dokazuje sposobnost ovulacije te osnovno stanje oplodnog puta (prohodnost jajovoda), a u muškarca se temeljem rezultata analize ejakulata odlučuje o potrebi ponavljanja nalaza ili o daljnjim dijagnostičkim postupcima. Najčešće korištene metode MPO u našem istraživanju koje je provedeno na 467 ispitanika liječenih na Klinici za ženske bolesti i porode KBC-a Split bile su inseminacija u prirodnom ciklusu te IVF/ICSI u stimuliranom ciklusu po standardnom protokolu. Primalja kao dio medicinskog tima, kod medicinski potpomognute oplodnje ima zadaću umanjiti strah, informirati i pružati potporu prije, tijekom i nakon provedenog postupka. Neki radovi pokazuju kako će uloga primalje u samim postupcima medicinski potpomognute oplodnje rasti te će određene postupke biti sposobna i sama izvoditi uz dodatnu edukaciju. Primalja u laboratoriju za humanu reprodukciju ima ulogu i u vođenju administracije, protokoliranju svih pacijenata odnosno uputnica kroz poseban program u računalu.In Western countries, including Croatia, 20% of couples are infertile. The causes of infertility are found in both spouses and are a source of concern and frustration for both. The cause of female infertility can be a pathology of internal female genitals: pelvic adhesions, obliteration of the fallopian tubes, the destruction of the cilia in the fallopian tube, anovulation, Polycystic Ovary Syndrome (PCOS), fibroids and anomalies of the uterus, endometriosis and so on. We should not forget endocrine, genetic and developmental disorders that can affect fertility, and so far as they are not considered, the category of cryptogenic infertility is expanded (today exceeds 10%) that particularly frustrates physicians and a married couple alike. The most common treatable cause of infertility in men is a varicocele. The infertile men and women should also consider chromosomal abnormalities. Treatment of the infertile couple should be elaborated in order to classify as smaller amount as possible of cryptogenic infertility. Firstly it is necessary to obtain accurate details of the history and general gynecological health of women, the duration of infertility and the real exposure and possibility of carrying. Then follows a gynecological examination and taking a cytological swab and evaluation of husband's fertility by semen analysis. The woman's medical analysis are proving information about the ability of ovulation and the general state of fertility tubes (tubal patency). In the man's medical analysis, based the results of ejaculate test, it is decided to repeat findings or to make the further diagnostic procedures. The most commonly used method of assisted reproduction in our study that was conducted on 467 patients treated at the Clinic of Gynecology and Obstetrics, at University Hospital Center Split were Insemination in the natural cycle and IVF / ICSI in a stimulated cycle per standard protocol. The midwife, as part of the medical team, at assisted reproduction, has the task to reduce the fear, inform and provide support before, during and after the procedure. Some studies show that the role of the midwife in some medical procedures of assisted reproduction will grow and certain procedures will be able to perform herself with additional training. The midwife in the laboratory of Human Reproduction has a role in running the administration, registration process of all patients and referral slips through a special computer program