GIẢI PHÁP GIÚP TIÊN LƯỢNG KHẢ NĂNG SINH SẢN CỦA BUỒNG TRỨNG BẰNG XÉT NGHIỆM AMH (Anti-Mullerian Hormone)

DANH MỤC CHIA SẼ
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  * Xét nghiệm AMH giúp tiên lượng khả năng sinh sản của buồng trứng.

  * Những tiến bộ về khoa học gần đây cho thấy xét nghiệm AMH là xét nghiệm chính xác nhất để đánh giá khả năng sinh sản của buồng trứng. Xét nghiệm mới này đóng vai trò rất quan trọng trong chẩn đoán và điều trị hiếm muộn, đặc biệt là trước khi thực hiện kích thích buồng trứng và thụ tinh trong ống nghiệm.

  * AMH chỉ mới được triển khai rộng rãi trên thế giới trong vài năm trở lại đây. Trước đây, bệnh nhân ở Việt Nam không có cơ hội tiếp cận với xét nghiệm quan trọng này.

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I. AMH là gì?

  - AMH là từ viết tắt của Anti-Mullerian Hormone. AMH được tiết trực tiếp bởi các tế bào hạt của nang noãn buồng trứng và có liên quan trực tiếp với số lượng nang noãn nguyên thủy trong buồng trứng.

  - AMH được sản xuất nhiều nhất ở nang noãn sơ cấp, tiền hốc (preantral) và có hốc nhỏ dưới 4mm (antral), nghĩa là những nang noãn còn non và đang phát triển ở buồng trứng. Do đó, nồng độ AMH cho biết số nang noãn non hiện có trong buồng trứng, hay còn gọi là dự trữ buồng trứng. Cho nên xét nghiệm này có thể dùng để chẩn đoán khả năng sinh sản và tiên lượng thời gia cần can thiệp điều trị để có con.

  - Nồng độ AMH sẽ hằng định, không thay đổi theo chu kỳ kinh nên có thể thực hiện vào bất kỳ ngày nào của chu kỳ kinh và kết quả ổn định ngay cả khi đang dùng thuốc ngừa thai hay GnRH đồng vận để điều trị lạc nội mạc tử cung. Đặc điểm này của AMH giúp việc xét nghiệm nội tiết đánh giá buồng trứng trở nên thuận tiện rất nhiều cho bệnh nhân. Trước đây, các xét nghiệm đánh giá chức năng buồng trứng (FSH, LH, E2) và đếm số nang noãn thứ cấp phải thực hiện vào đầu chu kỳ kinh (ngày 2-4).

II. Xét nghiệm AMH so với FSH trước đây:

  - Tiêu chuẩn cũ để đánh giá dự trữ buồng trứng là FSH cơ bản vào ngày 2-4 vòng kinh. Tuy nhiên, việc đo nồng độ FSH có nhiều nhược điểm so với nồng độ AMH vì các lý do sau:

(1) Nồng độ FSH dao động và thay đổi và phụ thuộc vào ngày của vòng kinh nên kết quả không chính xác.

(2) Phụ thuộc vào nồng độ estradiol (khi nồng độ estradiol cao sẽ ức chế nồng độ FSH).

(3) Nồng độ FSH sẽ thay đổi nếu bệnh nhân đang sử dụng thuốc ngừa thai.

(4) FSH phải được thử vào ngày 2-4 của chu kỳ kinh.

   – Do đó, hiện nay xét nghiệm AMH là yếu tố đánh giá chính xác nhất dự trữ buồng trứng và thuận tiện cho bệnh nhân.

  - Hiện nay, trên thế giới các chuyên gia điều trị hiếm muộn có khuynh hướng đánh giá dự trữ buồng trứng dựa vào AMH và đếm nang noãn thứ cấp hơn là dựa vào nồng độ FSH cơ bản (ngày 2-4).

III. AMH và khả năng có thai nhờ thụ tinh trong ống nghiệm:

  - Phụ nữ có nồng độ AMH cao sẽ có xu hướng đáp ứng với kích thích buồng trứng tốt và số trứng chọc hút được nhiều hơn. Và khi thụ tinh trong ống nghiệm có được nhiều trứng thì tỷ lệ thành công sẽ cao hơn.

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  - Nồng độ AMH thường không đánh giá được chất lượng trứng nhưng khi tiên lượng chọc hút được nhiều trứng thì chúng ta có khả năng chọn lưạ được phôi có chất lượng tốt để chuyển vào buồng tử cung cao hơn và khả năng có phôi dư trữ lạnh cũng nhiều hơn.

  - Đánh giá nồng độ AMH cũng rất có ích ở những phụ nữ muốn trì hoãn việc sinh con và lập kế hoạch cho việc có thai trong tương lai. Có rất nhiều phụ nữ hiện nay muốn trì hoãn việc sinh con để tập trung cho công việc và học hành. Khả năng sinh sản của người phụ nữ bắt đầu suy giảm sau 30 tuổi. Tuy nhiên, có một số trường hợp khả năng sinh sản của buồng trứng giảm sớm hơn và nhanh hơn, nếu không phát hiện ra điều này, phụ nữ có thể sẽ hối tiếc khi sau này nếu bắt đầu muốn có con khi khả năng sinh sản của buồng trứng đã giảm.

  - Hầu hết phụ nữ đều có khái niệm sai lầm về khả năng sinh sản khi cho rằng kinh nguyệt còn đều nghĩa là họ có đủ số lượng và chất lượng trứng để có thai. Tuy nhiên, điều này không phải luôn luôn đúng, buồng trứng khi suy giảm chỉ tiết ra một lượng nội tiết tố đủ để ra kinh, chứ chất lượng buồng trứng không đủ điều kiện để có thai. Đối với đa số phụ nữ, việc có thai sẽ trở nên rất khó khăn sau 35 tuổi. AMH có thể giúp đánh giá khả năng sinh sản của buồng trứng qua đó giúp tiên lượng được khả năng có con của phụ nữ.

IV. Phụ nữ cần xét nghiệm AMH khi nào?

   – Hiếm muộn, vô sinh, buồng trứng đa nang.

   – Suy buồng trứng sớm, rối loạn kinh, kinh ít, thưa kỳ và vô kinh

   – Theo dõi hiệu quả quá trình điều trị vô sinh

   – Dự đoán khả năng sinh sản trong tương lai

   – Chẩn đoán mức độ tổn thương buồng trứng sau phẫu thuật

   – Ung thư buồng trứng.

   – Tiên lượng mãn kinh: nếu AMH < 0,2ng/mL, lứa tuổi 35-39 sẽ mãn kinh sau 10 năm, lứa tuổi 45-48 sẽ mãn kinh sau 6 năm.

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V. Hiểu về các kết quả xét nghiệm AMH ở nữ giới:

  Xét nghiệm AMH trong máu vào bất kỳ thời gian nào mà không phụ thuộc vào chu kỳ kinh.

  - Nồng độ AMH bình thường luôn luôn rơi vào khoảng từ 2-6,8 ng/ml

  - Nồng độ AMH thấp:

  + AMH giảm dần theo tuổi tác. Khi một người phụ nữ bắt đầu có kinh cho đến mãn kinh, chỉ số xét nghiệm AMH sẽ luôn luôn giảm theo đồ thị hướng đi xuống và cuối cùng về mức zero.

  + Khi AMH < 1ng/ml thì kết luận buồng trứng yếu, dự trữ buồng trứng giảm.

  - Nồng AMH 15 ng/ml – 20ng/ml được kết luận là cao và quá cao.

  Ngoài ra, các sai số của các xét nghiệm AMH có thể xảy ra là do phương pháp tiến hành, thiết bị và kỹ thuật đo và chuẩn tham khảo.

VI. Các bệnh lý trong xét nghiệm chỉ số AMH:

1. Phụ nữ có nồng độ AMH thấp:

     AMH < 1ng/ml hầu hết là khó có thai.

   – Nếu kết quả điều trị có đáp ứng thì nang noãn hoạt động mạnh, tế bào hạt gia tăng sản xuất AMH, nên chỉ só AMH sẽ tăng cao trong mức độ nào đó. Điều này cho phép bệnh nhân chuyển sang giai đoạn kích trứng bằng phương pháp Tây y.

  - Nhưng có những trường hợp buồng trứng quá yếu, không đáp ứng điều trị thì không nên kích trứng .Vì trứng thu được ít, mà không có trứng loại I, nên cơ hội đậu thai vô cùng hiếm. Trường hợp này nên xin trứng để làm TTON (IVF).

2. Phụ nữ có nồng độ AMH quá cao:

  - Hội chứng buồng trứng đa nang: nồng độ AMH trong máu thường > 6,8 ng/mL.

  - Kích trứng bằng uống như Clomid, Serophene, Clostilbegyt, Duinum, Profertil, Ovophene, Ovuclon… AMH quá cao sẽ gây thất bại khá nhiều.

  - Kích trứng bằng thuốc tiêm: nếu AMH quá cao sẽ khó canh liều và dễ xảy ra quá kích. Có thể phình to buồng trứng và vỡ buồng trứng.

  - Buồng trứng yếu: nếu AMH tăng vừa phải thì sẽ đáp ứng điều trị tình trạng trứng yếu, nhỏ, lép… khá tốt.

  - Ung thư tế bào granulosa buồng trứng (độ nhạy khoảng 76 đến 93%). AMH giảm vài ngày sau phẫu thuật khối u buồng trứng. Nếu AMH tăng lại sau một thời gian đã phẫu thuật cho phép kết luận ung thư tái phát.

VII. Hạn chế của xét nghiệm AMH:

  - Giá thành tương đối cao.

  - Chưa được phát triển rộng rãi tại các Tỉnh thành.

  AMH là gì? Xét nghiệm AMH khi nào? Cách hiểu về kết quả xét nghiệm chỉ số AMH… Bài viết trên đã giúp bạn trả lời được hết những câu hỏi và thắc mắc trên rồi. Bạn hãy đi xét nghiệm AMH ngay nếu có những dấu hiệu như trong bài viết để đảm bảo sức khỏe và tương lai của bạn nhé.

Tóm lại:

  - Xét nghiệm đánh giá nồng độ AMH dễ thực hiện và có thể thực hiện vào bất kỳ ngày nào của vòng kinh.

  - Kết quả AMH nhạy hơn và chính xác hơn so với FSH cơ bản trong đánh giá khả năng sinh sản của buồng trứng.

  - Dựa vào nồng độ AMH, bác sĩ cũng có thể tiên lượng khả năng đáp ứng và điều chỉnh liều thuốc kích thích buồng trứng phù hợp hơn cho bệnh nhân.

  - AMH còn giúp cho bệnh nhân biết được khả năng sinh sản của buồng trứng nhằm có kế hoạch phù hợp cho việc có con trong tương lai

  - Trong tương lai gần, AMH có thể sẽ là xét nghiệm thường qui cho bệnh nhân tại các trung tâm điều trị hiếm muộn ở Việt nam.

CN. Tôn Hoàng Dũng

Nguồn:
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https://www.vinmec.com
http://www.tamanhhospital.vn
http://benhvienphusanhanoi.vn
http://benhvienphusantrunguong.org.vn
BS. Vũ Nhật Khang (Theo http://ivfvanhanh.com.vn)
Bác sĩ Phạm thị Mai( http://new.suckhoeloisong.vn/news)

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