SARS-CoV2 SALGININDA GEBELİK, İNFERTİLİTE VE YARDIMCI ÜREME TEKNİKLERİNİN KULLANIMI

Abstract

Pandemi sürecinde üreme sağlığının olumsuz yönde etkilenebileceği ve üreme sağlığı hizmetlerinin sunumunda güçlüklerin ortaya çıkabileceği belirtilmiştir. Gebe kadınların genel popülasyona kıyasla daha fazla risk altında olup olmadığı ve SARS-CoV2’nin gebe kadınlar üzerindeki etkisi açık değildir. Bu sebeple, üremeye yardımcı tedaviler dışında, pandemi döneminde gebe kalınmaması gerektiği ile ilgili bir açıklamada bulunulmamıştır. Human Papilloma Visüsü, İnsan İmmün Yetmezlik Virüsü, Herpes Simpleks Virüsü ve Zika virüsü gibi çeşitli viral etkenler fertilite üzerinde olumsuz etkileri gösterebilmektedir. Şimdiye kadar, SARS-CoV2 ile enfekte olan hastalarda üreme sistemine yönelik bir zarar bildirilmemiştir. Ancak, etkenin ACE2 reseptörü aracılığı ile etki etmesi sebebiyle oosit ve spermatozoalar üzerinde olası bir olumsuz etkisinin olabileceği düşünülmektedir. Bu durumlar göz önünde bulundurulduğunda bu süreçte üremeye yardımcı tedavilerin kullanımı ile ilgili tartışmalar ortaya çıkmıştır. Amerikan Üreme Tıbbı Derneği, İnsan Fertilizasyon ve Embriyoloji Kurumu, Avrupa İnsan Üreme ve Embriyoloji Derneği gibi bazı organizasyonlar hem virüsün yayılımını azaltmak hem de infertilite tedavileri ve gebeliğe bağlı gelişebilecek olası komplikasyonları önlemek amacıyla infertiliteye yönelik tedavilerin bu süreçte ara verilmesi gerektiğini belirtmişlerdir. Ancak kemoterapi veya radyoterapi tedavisi gören hastalar gibi acil fertilite koruyucu müdahaleler gerektiren durumlar bunun dışında tutulmuştur. Bu süreçte hemşirelerin halk sağlığı, enfeksiyonların önlenmesi, enfeksiyon kontrolü ve izolasyon önlemleri konularında birçok sorumlulukları bulunmaktadır. Multidisipliner bir ekip içinde yer alan infertilite hemşiresi de infertil bireylerin değerlendirerek eğitim ve gerekli danışmanlık hizmetlerinin verilmesini sağlamaktadır. Pandemi sürecinde mevcut tedavilerin ertelenmesi ya da yapılmamasına bağlı olarak hastaların yaşayacağı psikolojik semptomların azaltılması/önlenmesi ve hastaların enfeksiyonlardan korunabilmesinde hemşireler danışman rollerinden faydalanabilirler.

Keywords

• Gebelik
• İnfertilite
• SARS-CoV2
• yardımcı üreme teknikleri

PREGNANCY, INFERTILITY AND USE OF ASSISTED REPRODUCTIVE TECHNIQUES IN SARS-COV2 OUTBREAK

Abstract

It has been stated that reproductive health may be negatively affected and difficulties may arise in the provision of reproductive health services during pandemic process. It is not clear whether pregnant women are at higher risk compared to the general population and the effect of SARS-CoV2 on pregnant women. For this reason, no statement has been made about the need to avoid pregnancy during the pandemic period, except for assisted reproductive treatments. Various viral agents such as Human Papillomavirus, Human Immumodeficiency Virus, Herpes Simplex Virus and Zika virus can have negative effects on fertility. To date, no damage to the reproductive system has been reported in patients infected with SARS-CoV2. However, it is thought that the agent may have a possible negative effect on oocytes and spermatozoa due to its effect through the ACE2 receptor. Considering these conditions, discussions have arisen regarding the use of assisted reproductive therapies in this process. Some organizations such as American Society for Reproductive Medicine, Human Fertilisation and Embryology Authority, European Society of Human Reproduction and Embryology stated that the treatments for infertility should be suspended in this process in order to reduce the spread of the virus and to prevent possible complications due to infertility treatments and pregnancy. However, situations requiring emergency fertility-sparing interventions such as patients undergoing chemotherapy or radiotherapy are excluded. In this process, nurses have many responsibilities in public health, infection prevention, infection control and isolation measures. The infertility nurse, who is in a multidisciplinary team, evaluates infertile individuals and provides training and necessary consultancy services. During the pandemic process, nurses can benefit from consultant roles in reducing/preventing the psychological symptoms that patients will experience and protecting patients from infections, depending on the postponement or non-application of existing treatments.

Keywords

• Pregnancy
• infertility
• SARS-CoV2
• assisted reproductive tecniques

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