I pericoli taciuti della Fecondazione in vitro

pericoli Fiv

La provetta non è tutto rose e fiori come vogliono far credere: le percentuali di successo del cosiddetto “bambino in braccio” sono bassissime e numerose sono le problematiche e i rischi, anche gravi, per la donna che si sottopone ai trattamenti, come innumerevoli e pesanti sono le complicanze e i pericoli a carico dei bambini concepiti in vitro. Queste evidenze sono perlopiù taciute alle coppie che si avvicinano alla provetta convinte che essa realizzerà senza troppi problemi e fatica il loro desiderio di genitorialità.

La professoressa Elena Ramilli, specialista in ostetricia e ginecologia, ha evidenziato che

alle tecniche artificiali è dato molto più credito di ciò che in realtà meritino” alimentando “tante speranze” nelle coppie a cui “spesso e purtroppo seguono profonde e amare delusioni”. “In effetti – spiega Ramilli – sono riferite percentuali di successo generiche pari o poco superiori al 25%, ma non è spiegato alla coppia che la percentuale di gravidanze ottenute con le tecniche di pma non corrisponde al numero di bambini che nasce. Quindi ad ogni ciclo di pma non corrisponde una gravidanza e ad ogni gravidanza insorta non corrisponde la nascita di un bambino[1].

La ginecologa Joelle Balaisch-Allart, vice-presidente del Collegio Nazionale dei ginecologi e ostetrici francesi (CNGOF), ha messo in guardia contro la faciloneria con cui si parla di Fiv: “Contrariamente a quel che si pensa, la Fiv non permette di lottare contro il crollo della fertilità. Non è la bacchetta magica che ripara l’invecchiamento delle ovaie[2]. E il ginecologo Filippo Maria Boscia, già professore di Fisiopatologia della Riproduzione umana all’Università di Bari e presidente nazionale dell’Associazione medici cattolici italiani, ha sottolineato che

le tecniche di procreazione medicalmente assistita non sono esenti da rischi di cui troppo spesso le donne non sono adeguatamente informate” domandandosi, a proposito della sottoscrizione del consenso informato: quante donne sono effettivamente “avvisate che l’iperstimolazione ovarica può provocare una sindrome pericolosa per la vita? Quante lo hanno letto o almeno percepito parlando col medico? E quante sono avvisate dei risultati modesti di queste tecniche, ben lontani dal bimbo in braccio per tutte?

Si parla di gravidanza e di successo – continua Boscia – perché si è fatta strada l’idea che la fecondazione artificiale sia la via maestra per assicurare la qualità del concepire e del concepito. Ma non c’è un controllo reale sulle indicazioni per l’accesso: ci sono donne che vengono avviate alla Pma anche se potrebbero avere altre possibilità per concepire un figlio[3].

Anche Ludovico Muzii, professore associato della clinica ostetrica e ginecologica Università Sapienza di Roma, mette in luce la mancanza di una corretta informazione: “I reali risultati della Fivet in termini di gravidanze a termine sono fermi al 14,7% in Italia e al 21-22% in Europa. E nemmeno viene detto che la gravidanza da provetta non è priva di rischi e che per ragioni psicologiche, mediche o economiche le percentuali di abbandono dal percorso di Pma sono il 40% dopo il primo ciclo e il 62% dopo il quarto[4].

Vogliamo quindi cercare di sopperire a questa mancanza di informazione elencando qui di seguito i rischi e le complicanze a cui vanno incontro le donne che accedono alla Fiv e i nascituri concepiti in laboratorio.

 

FIV: RISCHI e COMPLICANZE PER LE DONNE

donna

1) Sindrome da iperstimolazione ovarica

Nel 2004 è uscito sul prestigioso mensile Le Scienze uno studio[5] sulla fecondazione assistita di Nora Frontali e Flavia Zucco: la prima, per molti anni dirigente di ricerca all’Istituto superiore di sanità e, la seconda, primo ricercatore all’Istituto di neurobiologia e medicina molecolare del Cnr, a Roma.

Le autrici scrivono che “i rischi della Pma per le madri comprendono sia complicazioni della gravidanza sia effetti a lungo termine” specificando che tra le complicazioni in gravidanza risultano “ormai ben note la sindrome da iperstimolazione ovarica” e “l’aumentata frequenza di gravidanze ectopiche e aborti”. In particolare, riguardo alla sindrome da iperstimolazione ovarica, le autrici spiegano: “Nel più comune procedimento di procreazione medicalmente assistita, la Fivet (fecondazione in vitro con embrio-transfer), la donna è sottoposta a un intenso trattamento ormonale per ottenere la superovulazione, cioè la maturazione contemporanea di più ovuli. Questo trattamento non è privo di rischi, e non sono rari i casi in cui si assiste alla ‘sindrome da iperstimolazione ovarica’, un evento assai sgradevole e pericoloso (vi sono stati anche casi mortali)”.

Carlo Flamigni, uno tra i maggiori esperti italiani in campo di Fiv, nel suo libro “La procreazione assistita” (Il Mulino) scrive che l’iperstimolazione ovarica è “una sindrome pericolosa persino per la vita” (p. 29), “una complicanza abbastanza pericolosa” (p. 36). Succede infatti che “l’ovaio cresce in modo anomalo fino a raggiungere un volume pari a quello di un grosso melone. Successivamente, e soprattutto se l’iperstimolazione è grave, si forma un’ascite e compaiono raccolte di liquido nelle cavità pleuriche e nel pericardio. Il sangue si ispessisce e perde proteine e la funzionalità renale diminuisce pericolosamente. A causa di grossolane anomalie della coagulazione si possono determinare trombosi e tromboflebiti, talché esiste addirittura un rischio di vita nei casi più sfortunati (pp. 63, 64)[6].

Anche il professore e chirurgo Carlo Bulletti, Direttore dell’Unità Operativa di Fisiopatologia della Riproduzione all’Ospedale Cervesi di Cattolica, puntualizza che esistono “rischi inevitabilmente legati all’attuazione dei protocolli di iperstimolazione ovarica controllata” ed elenca tutte le complicanze legate ai trattamenti di Fiv[7]. Tra queste – scrive Bulletti – “la sindrome da iperstimolazione ovarica costituisce un’evenienza a volte drammatica e pericolosa per la salute della paziente” con un’incidenza del 1%-10% nelle forme medie-severe e dello 0,5% nelle forme gravi. Nelle forme lievi si assiste a distensione e dolore addominale, nausea, vomito, diarrea e ingrandimento ovarico (5-12 cm). Nelle forme moderate si aggiunge la formazione di un’ascite e nelle forme gravi, oltre ai sintomi precedenti, si possono presentare anche idrotorace, compromissione respiratoria, ipovolemia, emoconcentrazione, anomalie della coagulazione, diminuzione della funzionalità e della perfusione renale.

 

2) Altre complicanze legate ai trattamenti

Ancora Flamigni – nel libro sopra citato – scrive: “Altre complicazioni possono conseguire all’anestesia, alla laparoscopia e al prelievo degli ovociti, che può essere causa di una lesione vascolare o della rottura di una cisti endometriosica misconosciuta (p. 65).

Dopo aver ricordato che esistono rischi legati “alle possibili complicanze che gli interventi diagnostici comportano”, il prof. Bulletti specifica che in tale ambito “uno dei maggiori rischi è costituito dalle infezioni pelviche e tubariche, sostenute principalmente da batteri anaerobi che, anche se si verificano in meno dell’1% dei casi, possono comportare occlusione tubarica e compromettere definitivamente la fertilità della paziente”.

Poi Bulletti spiega che diversi e gravi rischi per la salute possono derivare anche dall’esecuzione della laparoscopia, poiché “essendo una procedura chirurgica, può presentare gravi complicanze che possono mettere a rischio la vita della paziente… Le maggiori complicanze risultano essere più frequenti in corso di interventi di laparoscopia operativa (0,34%) dove l’assetto anatomico della pelvi può risultare alterato da processi patologici e cicatriziali in atto, mentre sono più rare in corso di laparoscopia diagnostica (0,22%)”.

Gli strumenti usati per la laparoscopia (ago di Veress, trocar…) possono causare lesioni dei grossi vasi retroperitoneali (aorta, cava, iliaca comune) e delle arterie epigastriche inferiori e superficiali… Allo stesso modo tali strumenti possono essere responsabili di lesioni viscerali a carico soprattutto del colon e stomaco”. Inoltre “l’induzione dello pneumoperitoneo può indurre insufflazione extraperitoneale, enfisema mediastinico, pneumotorace e pneumo-omento”.

A questo si devono aggiungere “i rischi presenti in corso di anestesia generale” che “sono quelli legati a ciascun anestetico, ma – puntualizza Bulletti – le pazienti sottoposte a laparoscopia sono particolarmente soggette alla comparsa di aritmie cardiache”.

Altri problemi si possono presentare durante la procedura di prelievo degli ovociti: “L’esperienza ecografica dell’operatore e l’attenta esecuzione dell’intervento a volte non sono sufficienti ad azzerare il rischio di complicanze rappresentate principalmente da lesioni vascolari con conseguente emoperitoneo, perforazione delle anse intestinali, infezioni o esacerbazioni di processi infiammatori pelvici e rottura di cisti endometriosiche”. Inoltre – aggiunge Bulletti: “Nello 0,16% dei casi”, l’anestesia locale applicata durante il prelievo può comportare “depressione respiratoria, confusione mentale, agitazione e disturbi sensoriali”.

 

3) Gravidanze extrauterine

Carlo Flamigni: “Una complicazione molto frequente è anche la gravidanza tubarica” (p. 65).

Frontali e Zucco; “L’aumentata frequenza di gravidanze ectopiche e di aborti [è] ormai ben nota”.

Bulletti: “La percentuale di gravidanze extrauterine con le tecniche di Pma è del 2%-3,5%”.

 

4) Gravidanze multiple e parti gemellari

Flamigni: “Le gravidanze multiple… sono in effetti una complicazione sgradevole e, talora, pericolosa” (p. 65).

Bulletti: “L’incidenza di gravidanze multiple, molto più frequente nelle tecniche minori dove non si effettua l’aspirazione dei follicoli è di circa il 25-30% ed è conseguenza della stimolazione ovarica… Tuttavia nel 17-20% dei casi le gravidanze ottenute mediante tecniche di fecondazione assistita risultano multifetali, con un’incidenza che tende ad aumentare proporzionalmente al numero di embrioni trasferiti. La maggior parte delle gravidanze multifetali risulta bigemellare (85%) mentre nel 13% dei casi risulta trigemina e nell’1 e 0,1% dei casi quadrupla e quintupla”.

Nel suo libro “Procreazione medicalmente assistita”, la psicologa e psicoterapeuta Manuela Cecotti riporta uno schema tratto da alcune indagini italiane a opera di Eurispes (1990), Flamigni (1998), Sismer (1998), in cui risulta che, in seguito a Fiv, i parti gemellari vanno dal 20 al 35% e i parti trigemini dallo 0,5 al 6%[8].

All’inizio era la legge 40 a essere ritenuta responsabile di gravidanze e parti plurimi, per il fatto che prevedesse la produzione di non più di tre embrioni, l’obbligo del loro contemporaneo impianto e il divieto di crioconservazione degli embrioni sovrannumerari. Nel 2009, a Venezia, al Congresso mondiale della “International Academy of Human Riproduction”, il professore Pasquale Patrizio – direttore della divisione di medicina riproduttiva del centro di fertilità di Yale (Usa) – aveva parlato della legge 40 come di “un’anomalia che penalizzava le italiane determinando effetti paradossali quali la crescita incontrollata di parti multipli nelle donne giovani e l’aumento del numero di cicli necessari per ottenere una chance di successo[9]. Ma, sei anni dopo l’abolizione dei suddetti limiti da parte della Corte Costituzionale (sentenza del 1 aprile 2009), il professor Patrizio – e tutti coloro che la pensavano come lui – di fronte all’evidenza dei fatti si è dovuto ricredere.

I fatti hanno infatti dimostrato che, nonostante l’abolizione della normativa, gravidanze e parti plurigemellari non accennano a diminuire. Negli ultimi trent’anni i parti gemellari sono raddoppiati. Secondo l’Istituto superiore di Sanità (Iss), che dal 2000 ha istituito il Registro Nazionale Gemelli, “il trend è diventato un vero e proprio boom, complice l’aumento del ricorso alla procreazione medica assistita e l’età più avanzata delle mamme”. Nei Paesi occidentali i parti gemellari sono aumentati del 47% e quelli plurigemellari del 370%. In Italia, secondo i dati Istat, i parti plurimi erano l’1,4% nel 1982, sono arrivati al 3% del totale nel 2008, quando ancora vigevano i divieti imposti dalla legge 40, ma nel 2014 – cinque anni dopo l’abolizione dei limiti che ne avrebbero dovuto ridurre il numero – hanno superato la quota del 4%, con un boom di gravidanze trigemine.

Appurata la non colpevolezza della legge 40, il professor Patrizio ha trovato altre motivazioni per spiegare l’incremento di questo fenomeno, rinvenendone le cause nell’età avanzata delle madri e nelle tecniche stesse di Pma. In Italia sono in aumento le donne che diventano madri intorno ai quarant’anni e l’età avanzata, come si sa, è una causa naturale che favorisce le gravidanze gemellari: “Quando le donne entrano nella fascia 37-40, aumenta il valore dell’ormone Tsh che stimola l’ovaio a produrre più di un ormone per ciclo, così è più facile concepire i gemelli”.

L’aumento delle gravidanze gemellari è poi attribuito, dal dottor Patrizio, alla tecnica di induzione farmacologica dell’ovulazione: “I maggiori problemi ci sono con le gravidanze indotte, perché non c’è controllo come quando si fa la fecondazione in vitro… L’ovulazione multipla è un effetto collaterale che deve essere monitorato con attenzione, perché genera il boom di gravidanze trigemine con percentuali tra il 40 e 60 per cento, circa una su ottanta”.

In realtà, benché nell’ambito della fecondazione in vitro vi sia un maggior controllo rispetto alle gravidanze indotte, essa non esclude il verificarsi di gravidanze gemellari poiché, anche se non è più obbligatorio impiantare tutti gli embrioni prodotti, i centri di Pma – e le coppie stesse – preferiscono ugualmente trasferire in utero più di un embrione perché così vi sono maggiori possibilità di successo. Tale prassi è stata evidenziata dal dottore Annibale Mazzocco, ginecologo del Dipartimento materno infantile dell’Ospedale San Valentino di Montebelluna (Treviso).

Dopo aver ricordato che tra le cause dell’aumento del trend dei parti gemellari vi è “lo spostamento in avanti dell’età del primo concepimento” che quando supera i “35 anni contribuisce all’incremento del 25-30% delle gravidanze gemellari”, il dottor Mazzocco ha aggiunto: “Non secondario, nell’aumento delle gravidanze gemellari, è l’aumentato ricorso alle tecniche di fecondazione assistita per le quali, quasi sempre, si ricorre all’impianto multiplo. Mediamente la riproduzione assistita contribuisce all’incremento del 26% delle gravidanze gemellari[10].

Le gravidanze multiple sono foriere di molti rischi e complicanze sia a carico della madre che dei nascituri: “Non bisogna dimenticare – afferma il dottor Mazzocco – che esse presentano un aumentato rischio di complicazioni”.

A questo proposito le dottoresse Frontali e Zucco precisano: “Senza contare che le gravidanze multiple comportano di per sé un aumento di stress, morbilità e mortalità anche fra le madri”.

Il Professor Bulletti puntualizza: “Le gravidanze plurigemine sono complicate da una più alta mortalità in utero, da una maggiore incidenza di parti pretermine e di morbilità e mortalità perinatale[11]” e “da un punto di vista materno il rischio di pre-eclampsia, diabete gestazionale ed emorragie vaginali o uterine tende ad aumentare durante una gravidanza multifetale”.

Nel suo libro, a pagina 111, Emanuela Cecotti riporta uno studio di Nicolini e Hall in cui risulta che “la mortalità materna è 3 volte superiore nelle gravidanze multiple rispetto alle gravidanze singole, prevalentemente come conseguenza del maggior rischio di preeclampsia e di emorragia al parto”. Inoltre, dopo aver ricordato i rischi e i  problemi di salute a carico di feti e neonati conseguenti a una nascita prematura tipica delle gravidanze gemellari e trigemellari, la psicologa aggiunge: “L’impatto sulla famiglia è inoltre importante: sono comuni infatti i problemi comportamentali nei fratelli maggiori dei gemelli e la depressione è più frequente nelle madri di gemelli che in quelle di nati singoli”.

Anche Carlo Muzio, neuropsichiatra infantile e professore presso l’Università di Pavia, spiega che le gravidanze gemellari possono aumentare il rischio di depressione post partum[12].

Il neonatologo Carlo Bellieni riporta[13] uno studio pubblicato sul Lancet a luglio 2007, in cui si parla dei maggiori rischi associati alle gravidanze multiple nelle quali “il rischio di aborto è del 20-34% maggiore della popolazione generale” e “il rischio di nascite premature è doppio rispetto alla popolazione normale”. Inoltre risultano a carico del feto un maggior “rischio di malattie da numero alterato dei cromosomi”, un “aumentato rischio di ritardo di crescita”, un maggior rischio di malformazioni pari a “1,3 volte quello della popolazione generale” e “un rischio maggiore di paralisi cerebrale”.

 

5) Aborti spontanei e ripetuti

Tra le altre complicanze che si verificano frequentemente nelle gravidanze ottenute con la pratica della fecondazione in vitro, vi sono gli aborti spontanei e ripetuti. Anche in questo caso – come avviene per l’aumentata incidenza di gravidanze gemellari – tra le cause foriere del fenomeno vi è l’età avanzata della madre.

Riccardo Marana, direttore al Policlinico Gemelli dell’Istituto Scientifico Internazionale Paolo VI di Ricerca sulla Fertilità e Infertilità Umana (Isi), spiega che “andando avanti negli anni diminuisce la riserva ovarica, ma soprattutto vi sono ridotte capacità biologiche dell’ovocita” e “comincia a funzionare di meno quel meccanismo che porta alla corretta separazione dei cromosomi e dei cromatidi nelle ultime fasi della ovogenesi”. Ciò significa che “più si va avanti negli anni più aumentano gli errori, per cui si avranno embrioni con difetti cromosomici, o che non si impiantano, oppure ci saranno principi di aborti, che vanno del 10% quando si ha meno di 30 anni, fino a un 60% dopo i 43 anni[14].

Dallo schema riportato nel suo libro da Emanuela Cecotti, emerge che gli aborti in seguito a Fiv vanno dal 18 al 30%.

Un altro fattore che determina una maggiore possibilità che si verifichi un aborto, è la gravidanza multipla che, come abbiamo visto dai dati riferiti da Bulletti, ha un’incidenza del 25-30% nelle gravidanze indotte e del 17-20% nelle gravidanze da Fiv. Bulletti specifica che “i rischi legati a una gravidanza multipla sono rappresentati soprattutto da un aumento di incidenza di aborti, presentazioni podaliche e parti pretermine”. Secondo lo studio (già citato) riportato dal Lancet, il rischio di aborto in caso di gravidanza multipla è del 20-34% maggiore rispetto alla popolazione generale.

La combinazione di questi due fattori (età avanzata e gravidanza multipla), assai frequente nell’ambito della Fiv, spiega perché è così alto il rischio di aborto spontaneo nelle gravidanze ottenute con questa tecnica.

 

6) Parto pretermine e parto cesareo

Le gravidanze multiple fanno logicamente balzare in alto anche la possibilità che il parto avvenga prima del termine e che si debba ricorrere a un taglio cesareo.

Dalle indagini riportate dalla Cecotti risulta che le prematurità vanno dal 9 al 18%, ma in caso di embrioriduzione – scrive Bulletti – il parto pretermine sale al 75%.

Il professor Ermanno Greco, esperto di fecondazione in vitro, nella sua pubblicazione “Genitori in provetta” (L’Airone Editrice Roma, 2003) scrive: “Logica conseguenza della gravidanza multipla è il parto pretermine che è globalmente del 25% (14% in caso di gravidanza singola, 56% in caso di gravidanza gemellare, 92% in caso di gravidanza trigemellare). Anche in caso di gravidanza singola la percentuale di parto pretermine risulta essere superiore rispetto al concepimento naturale”. Inoltre “nelle pazienti che concepiscono grazie alle tecniche di fecondazione assistita vi è anche una maggiore incidenza di nascite con taglio cesareo (in media 40-50%)” (p. 112).

Il 28 gennaio 2014 è uscito online un articolo pubblicato sul British Medical Journal, in cui un team di luminari in questo campo – quattro esperti dell’Evidence Based IVF Group, impiegati in tre dei più famosi centri universitari internazionali per la riproduzione artificiale, di Amsterdam (Olanda), Aberdeen (Inghilterra) e Adelaide (Australia) – si sono interrogati sugli altissimi rischi della provetta, taciuti alle coppie e del tutto ignorati a livello di ricerche su larga scala. All’articolo in questione era allegata una tabella in cui sono stati confrontati i problemi insorti nelle gravidanze da provetta con quelli delle gravidanze naturali dalla quale risulta che nelle gravidanze da Fiv vi è il 50% in più di rischio di nascita pretermine e il 70% in più di nascita severamente pretermine (prima delle 32 settimane)[15].

 

7) Morte

In un articolo[16] pubblicato il 3 febbraio 2011 su BioEdge, una nota newsletter settimanale che si occupa di bioetica, Jared Yee ha riportato i seguenti dati:

Mentre nel 2007 in Gran Bretagna sono morte solo 2 donne a seguito di aborto volontario, tra il 2003 e il 2005 ne sono morte 7 per motivi direttamente riconducibili alla Fivet, come è stato evidenziato in un recente editoriale del British Medical Journal. Questo è successo nonostante la proporzione tra cicli di Fivet e ricorso all’aborto sia di 1 a 4, secondo quanto osservato dalla dottoressa Susan Bewley, specialista in ostetricia al Guy’s and St Thomas NHS Foundation Trust di Londra. Tra le morti per Fivet avvenute tra il 2003 e il 2005, 4 sono state provocate dalla sindrome da iperstimolazione ovarica e 3 dalle gravidanze multiple.

Uno studio recente condotto in Olanda ha dimostrato che i tassi di mortalità di gravidanza da Fivet erano superiori ai tassi globali di mortalità della popolazione generale olandese. Mentre 6 sono stati i decessi su 100.000 gravidanze generali, 42 sono state le morti su 100.000 gravidanze da Fivet. I dati inglesi hanno confermato questo rapporto.

Il Dottor Bewley e colleghi hanno sottolineato che, nei Paesi in via di sviluppo le donne muoiono a causa di complicazioni per eccesso di fertilità e aborti a rischio, mentre nelle società post-industriali sono i trattamenti per l’infertilità a determinare un rischio più elevato di morte materna”.

La morte, quindi, è un rischio che deve essere messo in conto dalle donne che si sottopongono a fecondazione artificiale. Il decesso può dipendere dalla sindrome da iperstimolazione ovarica o dalle complicazioni derivanti da una gravidanza multipla, ma può anche scaturire – come abbiamo precedentemente visto – dalle complicanze legate alle tecniche di laparoscopia e agoaspirazione ovarica, foriere di lesioni e perforazioni interne, e di eventi avversi per effetto dei farmaci usati o dell’anestesia.

Un evento tragico di questo tipo si è verificato a giugno di quest’anno all’ospedale Jaia di Conversano (Bari) – una struttura di eccellenza nell’ambito della Pma -, con il decesso della 38enne Arianna Acrivoulis, a causa di un arresto cardiocircolatorio durante la procedura di prelievo degli ovociti. Andrea Borini – responsabile scientifico del centro di Pma Tecnobios di Bologna – ha ipotizzato tra le cause della morte “una reazione allergica all’anestesia” oppure “la lesione di un’arteria con conseguente choc emorragico o la complicazione di un’embolia polmonare… A meno che – ha aggiunto – non avesse problemi congeniti, per esempio di cuore, mai diagnosticati[17].

Una sorte analoga era toccata nel 2004 a una casalinga 31enne di Sciacca, Accursia Attardi, morta di embolia polmonare due settimane dopo il trattamento di stimolazione ovarica[18].

 

8) Tumori

Frontali e Zucco scrivono: “Per accertare gli effetti a lungo termine è invece necessario seguire le donne per molti anni dopo il parto… Si sospetta infatti che l’intenso trattamento con ormoni a cui sono sottoposte le donne per il prelievo degli ovociti possa provocare un aumento di tumori del tratto genitale o della mammella”.

Il Prof. Bulletti scrive: “La somministrazione di gonadotropine nell’ambito di tali protocolli [di stimolazione ovarica] è stata da alcuni autori considerata un fattore di rischio per lo sviluppo di patologie neoplastiche sia a livello ovarico che mammario”.

Nel suo libro “La fecondazione proibita” (Feltrinelli), la giornalista Chiara Valentini riporta un aneddoto che spiega come mai i rischi di tumore associati alla Fiv siano tenuti nascosti. A pagina 95 Valentini racconta la storia di Brigitte Fanny Cohen, specialista di medicina del canale Tv France 2, sottopostasi senza successo a stimolazione ovarica per avere un figlio con la fecondazione in vitro. Ebbene, durante una conferenza stampa la Cohen spinge un medico ad ammettere il rischio di tumore connesso a tale pratica, e quando gli domanda perché non avvertono le pazienti di tale rischio, il medico risponde: “Se lo dicessimo nessuna farebbe più la fecondazione artificiale[19].

 

9) Bassissima percentuale di successo

Nel suo “La procreazione assistita”, Carlo Flamigni ammette: “Tutte le tecniche di procreazione assistita si caratterizzano per il fatto di non essere molto generose in materia di risultati” (p. 35)[20].

Frontali e Zucco scrivono: “È raro che il procedimento di Pma riesca al primo tentativo. Molte donne provano più e più volte… Quali sono le cause degli insuccessi? La composizione del medium di coltura potrebbe non essere ancora perfetta e provocare un cambiamento nell’espressione dei geni. Nel caso dell’Icsi, l’inserimento dell’ago di vetro potrebbe provocare un danno meccanico al fuso (una struttura interna alla cellula che si divide). Un’altra ipotesi che va facendosi strada è quella della presenza di difetti ereditari nelle coppie con problemi di sterilità. Gruber e colleghi, esaminando i cariotipi dei pazienti, maschi e femmine, presentatisi in un centro di fertilità per sottoporsi a Pma, hanno scoperto anomalie del numero dei cromosomi nel 10% dei casi, rispetto allo 0,85% della popolazione generale, il che spiegherebbe come mai anche le gravidanze singole da concepimento con Pma hanno un esito perinatale significativamente peggiore di quelle da concepimento naturale”.

L’americana Miriam Zoll, autrice del libro “Cracked open: liberty, fertility and the pursuit of hight-tech babies” (maggio 2013) sul perseguimento del bambino perfetto, in cui racconta la sua personale esperienza con la Fiv, rivelatasi negativa e fallimentare, denuncia: “Parlare dei fallimenti della fecondazione artificiale è diventato tabù. È invece indispensabile sfatare quei miti che circondano l’infertilità e l’abilità della scienza di curarla. Se diamo un’occhiata ai dati europei il 77% dei trattamenti in vitro falliscono. La realtà è che la scienza in questo settore è ancora molto fragile. Si, è vero che cinque milioni di bambini sono nati con questa tecnica ma esistono almeno 10, 15 milioni di coppie che usando l’ivf [In Vitro Fertilization] non sono riuscite a procreare[21].

Riccardo Marana, esaminando la Relazione ministeriale pubblicata a luglio 2014 (dati riferiti al 2012) sull’attività dei Centri italiani di fecondazione artificiale, ha osservato: “La percentuale di gravidanza cumulativa per Fivet e Icsi è pari al 22,1%, e quella di gravidanza a termine è pari al 16,5 per prelievo ovocitario. Inoltre, a fronte di 114.276 embrioni formati ne sono stati trasferiti 91.720 e sono nati 9.814 bambini. Dunque il 91% degli embrioni formati viene ‘perso’[22].

Anche il professor Tommaso Scandroglio, docente di etica e bioetica e filosofia del diritto, ha commentato questi dati, rilevando che solo circa il 17% delle coppie è riuscita nell’intento di avere un figlio con la fecondazione artificiale. A tal proposito Scandroglio ha notato che “il dato di insuccesso non è molto dissimile da quello del 2004-2005, primo anno in cui legalmente si praticava la fecondazione artificiale. E questo nonostante si possano produrre quanti embrioni si vogliono per ciclo e la crioconservazione del figlio non abbia più limiti grazie alla sentenza della Corte Costituzionale del 2009. Ciò a dimostrare che le aperture alla provetta a colpi di sentenza non ha prodotto i risultati sperati”.

Per quanto riguarda i nascituri – prosegue il professore -, “espresso in percentuali, solo il 10% degli embrioni prodotti è nato, contro il 74% dei loro fratelli che è morto e il 16% che è attualmente crioconservato”. Questo significa che con la Fiv “solo un embrione su 10 vedrà la luce”. Per tutti questi motivi – conclude Scandroglio – “il figlio in provetta era e rimane una tecnica assai fallimentare[23].

La Relazione annuale dell’anno prima – luglio 2013 (dati del 2011) – aveva messo in luce un’analoga altissima percentuale di insuccesso. Su 56.092 cicli con embrioni “freschi” si sono avute 10.959 gravidanze (il 19,5%), ma di queste solo 8.734 si sono concluse con la nascita del bambino, cioè appena il 15,6%. Tra le donne rimaste incinte con la provetta, circa il 30% aveva meno di 34 anni, circa il 25% aveva tra i 35 e i 39 anni, il 15% tra i 40 e i 42 anni, e meno del 7% aveva più di 43 anni.

Gli analisti attribuiscono l’alta percentuale di insuccessi al fatto che sia aumentata l’età delle donne che accedono alla provetta. L’età avanzata della madre è infatti un fattore che determina una minore probabilità di rimanere incinta e, se la gravidanza ha inizio, una maggiore probabilità di perdere il bambino. Questa connessione è stata recentemente evidenziata da uno studio scientifico realizzato dall’Università scozzese di Aberdeen – pubblicato sul numero di dicembre 2013 della prestigiosa rivista “Plos One” – che ha preso in esame i dati di 121mila donne che si erano sottoposte a fecondazione in vitro, in Gran Bretagna, tra il 2000 e il 2007. Gli studiosi hanno rilevato che prima dei 37 anni è rimasto incinta il 25% delle donne, mentre nelle donne tra i 45 e i 50 il risultato è crollato al 2%. Inoltre, lo studio ha evidenziato che le aspiranti madri tra i 38 e 39 anni hanno il 43% in più di possibilità di perdere il bambino rispetto a quelle sotto i 34 anni[24].

I dati mostrano, quindi, che la provetta funziona poco e perlopiù su donne giovani. Nonostante questa evidenza, i dati italiani degli ultimi anni hanno evidenziato un fatto inspiegabile: per la prima volta, a partire dal 2011, il numero dei nati vivi da procreazione assistita è sensibilmente calato (meno 5,9% rispetto al 2010), nonostante sia invece aumentato il numero delle coppie che accede alla provetta, il numero di cicli e le gravidanze avviate. Inoltre, fatto altrettanto inspiegabile, la diminuzione delle gravidanze si è registrata soprattutto tra le donne più giovani: la percentuale di gravidanze per le donne di età dai 34 anni in giù, che nel 2010 ammontava al 31%, nel 2011 è scesa al 29,2%. I dati dell’anno successivo hanno mostrato un panorama sostanzialmente invariato, con una leggera flessione dei nati vivi. Il ministro della salute Lorenzin ha definito questi numeri “preoccupanti” e ha manifestato la necessità di “un approfondimento ulteriore per poterne individuare le cause[25].

 

10) Stress fisico e psicologico, delusione, rottura del rapporto di coppia

Carlo Flamigni: la “delusione della coppia [è] un’esperienza altrettanto frequente quanto sgradevole” (p. 62).

La rivista scientifica “HEC Forum” ha condotto una ricerca sui commenti lasciati in forum specializzati da più di un centinaio di donne che si erano sottoposte alla fecondazione artificiale. Queste sono le conclusioni: “La fecondazione in vitro ha strette regole che lasciano le donne fisicamente ed emotivamente esauste. Il procedimento può rapidamente diventare oneroso mentalmente e fisicamente per le donne che lo intraprendono, così come per i loro partner. Il trattamento di Fiv può avere un tremendo impatto sulle donne: è un iter assai impegnativo dal punto di vista fisico, con effetti di vasta portata sul benessere psicologico di una donna […] oltre a causare rotture nel rapporto con il partner e nelle relazioni sociali[26].

Sulla rivista “Bioetica” del 2006, Peris et al. Hanno scritto che tutto l’iter di fecondazione artificiale è così pesante che il 25% delle pazienti rifiuta un secondo tentativo[27].

Claudio Manna, direttore scientifico del centro di fecondazione assistita “Genesis” di Roma, rivela: “La procreazione assistita implica un percorso complesso, soprattutto da un punto di vista psicologico ed emotivo[28].

Susan Bewley, professore di ostetricia al King’s College di Londra, nel 2013 denunciava sul Guardian che nessuno “parla del dolore, della disperazione e del senso di fallimento che i tentativi non riusciti della fecondazione in vitro hanno provocato in milioni di donne”. Theresa Kennedy, una signora inglese di 35 anni, che ha rinunciato al proposito di diventare madre dopo aver vissuto sulla propria pelle tre cicli fallimentari di Fiv, ha dichiarato: “Ho pensato più di una volta di togliermi la vita. La fecondazione in vitro è come la chemioterapia. Con la differenza che per le donne malate di cancro il sistema offre un supporto psicologico mentre per quelle che falliscono di concepire non c’è niente. Sono dimenticate, cancellate. Di loro non si parla più[29].

Miriam Zoll descrive dettagliatamente nel suo libro (precedentemente citato) i traumi emotivi e le crisi attraversate da lei e dal marito quando compresero di non poter avere figli. “La strada verso la genitorialità attraverso mezzi scientifici è costellata di trappole con serpenti e oli combustibili”, ha rimarcato l’autrice dopo che il terzo trattamento di fecondazione in vitro si era concluso con un aborto spontaneo. Dopo il quarto ciclo di Fivet – racconta Zoll -, le delusioni avevano segnato il rapporto con suo marito e la sua intimità personale: “Il sesso per noi era ormai sinonimo di stress. Ciò significa siringhe, laboratori, provette. Il sesso era associato alla delusione, al senso di colpa e al dolore[30].

Zoll ha raccontato la sua esperienza anche in un’intervista di Avvenire: “In cinque anni ho fatto quattro cicli di fertilizzazione in vitro con i miei ovuli e due con ovuli donati. È stato doloroso e traumatico. E inutile. Ho anche scoperto a posteriori che le donatrici da cui avevo ricevuto gli ovuli erano probabilmente diventate sterili come conseguenza dell’eccessiva stimolazione ormonale… Ero come drogata. Ogni fallimento mi portava a fare un altro tentativo. Avevo perso il senso della misura. Non mi accorgevo che stavo usando il corpo di un’altra donna per il mio beneficio personale. Un giorno, durante una profonda depressione in cui mi alzavo a malapena dal letto, mio marito mi ha scoperta al computer a fare una ricerca sulla gravidanza surrogata. E mi ha detto: sei impazzita, io mi fermo qui… Qualche giorno dopo, il mio medico ha chiamato dicendo che l’ultimo ciclo era fallito. Mentre assorbivo la notizia, ha aggiunto: spero che questo non la scoraggi dal provare ancora. Quella mancanza di rispetto per il prezzo emotivo che avevo pagato mi ha aperto gli occhi. Aveva ragione mio marito… Abbiamo fatto domanda di adozione. Un paio d’anni dopo, siamo diventati genitori[31].

 

FIV: RISCHI e COMPLICANZE PER I NASCITURI

nascituro

1) Altissima mortalità embrionale, alta mortalità perinatale e infantile; nascita prematura; sottopeso alla nascita

Come abbiamo visto, la bassissima percentuale di successo va di pari passo con l’altissima mortalità embrionale: con la Fiv riesce a nascere solo un embrione su dieci. Commentando i dati della Relazione ministeriale del 2014, il professor Scandroglio ha evidenziato che solo il 10% degli embrioni è riuscito a nascere, contro il 74% che è morto e il 16% che è stato crioconservato. Questo significa che con la Fiv “solo un embrione su 10 vedrà la luce”.

I medici dell’Associazione ginecologi e ostetrici cattolici (Aigoc), hanno ricordato l’altissimo costo di vite umane innocenti che la fecondazione in vitro comporta: su scala mondiale per 4,5 milioni di bambini nati ce ne sono stati 41,5 milioni scartati ed “esposti volontariamente a morte[32].

Dagli studi italiani sulla Fiv, riportati nel suo libro dalla Cecotti, emerge una prematurità dal 9 al 18%, una mortalità perinatale dal 13 al 17% e un basso peso alla nascita dal 5 al 10%. Questi eventi sono più frequenti in caso di gravidanza multipla: l’epoca gestazionale media risulta di 37 settimane nelle gravidanze bigemellari e 33,5 settimane nelle trigemellari. Ovviamente, un periodo di gestazione inferiore comporta anche un peso alla nascita più basso: la nascita con un peso inferiore a 1,5 Kg è del 10% nelle gravidanze bigemellari, del 25% nelle gravidanze trigemellari e più del 50% per i nati da gravidanze con quattro o più gemelli. Le gravidanze gemellari fanno registrare anche una mortalità perinatale più alta: 4-5 volte superiore nelle gravidanze bigemellari e 9 volte superiore nelle trigemellari. Maggiore è anche la probabilità di morte trascorso il periodo neonatale: 3 volte superiore nei gemelli rispetto ai nati singoli; e la mortalità infantile: 5 volte più elevata. I nati da gravidanze multiple hanno anche un maggior rischio di paralisi cerebrale: 7% per i gemelli e 28% per i trigemelli; e, in seguito, sono comuni in questi bambini i problemi di ritardo del linguaggio e le difficoltà di apprendimento[33].

Lo studio (citato nella prima parte) realizzato dagli esperti dell’Evidence Based IVF Group e pubblicato a gennaio 2014 sul British Medical Journal, ha individuato il 90% in più di morte perinatale nelle gravidanze da provetta rispetto alle gravidanze naturali, il 50% in più di rischio di nascita pretermine e il 70% in più di nascita severamente pretermine (prima delle 32 settimane) nelle prime rispetto alle seconde.

Diversi studi che confermano questi dati sono riportati anche da Carlo Bellieni, alcuni dei quali evidenziano che non sono solo le gravidanze multiple a creare questi problemi, ma le tecniche di Fiv in sé.

Scrive Bellieni: “L’uso di queste tecniche espone le donne e i bambini a rischi maggiori che la popolazione generale. Basta leggere i dati. Ad esempio la rivista Plos One [gennaio 2014] riporta uno studio australiano fatto su oltre 5.000 bambini nati da Fiv, che mostra un rischio di morte neonatale e di peso alla nascita molto basso più che doppio rispetto alla popolazione generale”. Inoltre “in gennaio 2014 la rivista Human reproduction mostrava che peso alla nascita e durata della gravidanza sono influenzati dal tempo trascorso nel terreno di coltura in vitro, e Human reproduction update che ‘ancora si ignora quale sia il mezzo di coltura più efficace per la miglior riuscita della Fiv’[34]. Entra allora in campo l’epigenetica: “la branca della scienza che mostra che l’ambiente modifica il modo in cui si esprime il dna di una cellula. E basta poco perché nel dna si attivino dei geni e si silenzino altri sotto l’influsso dell’ambiente esterno, delle sostanze con cui la cellula viene a contatto, addirittura sotto l’influsso della luce…[35].

E ancora: “Siamo davvero stanchi di veder censurati i dati scientifici sulla fecondazione in vitro […] Il 25 febbraio [2013] la rivista Fertility and sterility pubblica uno studio su quasi 400 bambini nati da donazione di ovociti e vede che in questo gruppo c’è un rischio 3,4 volte maggiore rispetto alla popolazione generale che il bambino nasca prematuro; e nascere prematuri, si sa, è un rischio in sé per la futura salute […] Ma non basta: sulla rivista Urology è apparso uno studio coreano che mostra come i nati da fecondazione in vitro hanno un aumentato rischio di basso peso alla nascita e prematurità”. Inoltre “uno studio finlandese – pubblicato su Human reproduction in marzo [2013] – ha evidenziato che la durata della coltura in vitro dell’embrione influisce sul peso alla nascita[36].

In altro articolo sempre Bellieni scrive: “Il Center for Disease Control and Prevention lo dice chiaramente: il 46% dei neonati americani avuti per fecondazione in vitro non nascono ‘singoli’, ma in coppia, tripletta (o più) di gemelli e il 37% sono prematuri, contro il 3% di gemelli nella popolazione generale e il 12% di prematuri… Nascere gemelli o nascere prematuri sono entrambi eventi che portano un rischio per la salute del bambino”. Tuttavia “alcuni studi mostrano rischi per la salute superiore alla popolazione generale, anche nel caso dell’impianto di un singolo embrione. Basta leggere l’articolo “Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome?’ (‘Perchè i neonati singoli concepiti con FIV hanno conseguenze avverse?’) pubblicato a marzo 2013 nella rivista USA Human Reproduction Update[37].

Una ricerca clinica, pubblicata sulla rivista “Human Reproduction”, condotta da un gruppo di ricercatori inglesi dell’Aberdeen Fertility Centre e del King’s College in collaborazione con ricercatori italiani dell’Università degli studi di Modena e Reggio Emilia, ha scoperto che un’eccessiva stimolazione ormonale sulle donne nell’ambito della Fiv provoca danni al nascituro, determinando “un rischio aumentato del 15-30% di basso peso neonatale e parto prima del termine”. Secondo quanto ipotizzato dai ricercatori questo potrebbe essere dovuto all’alterazione della mucosa uterina dove l’embrione si annida, a causa degli eccessivi valori di estradiolo e progesterone che si determinano quando si sviluppa un numero eccessivo di follicoli nelle ovaie quale conseguenza dell’iperstimolazione ovarica. Lo studio si è basato sui dati di oltre 65mila bambini nati da fecondazione in vitro, contenuti nel database nazionale della Human Fertilisation and Embryology Authority, il registro inglese di Pma più vasto al mondo[38].

I ricercatori dell’Università di Adelaide (Australia), guidati dal professor Michael Davies, hanno pubblicato uno degli studi più completi realizzati sulla Fiv, basato su 300mila casi australiani dal 1986 al 2002, da cui sono stati esclusi i parti gemellari di per sé più complicati. Lo studio ha evidenziato che i bambini nati in provetta hanno un rischio molto maggiore di soffrire di gravi complicanze e di morire, prima o qualche settimana dopo il parto, rispetto a quelli concepiti in modo naturale. I numeri delle gravidanze da riproduzione assistita parlano di una probabilità quasi doppia di parto di feto morto, più che doppia di parto prematuro e quasi tripla che il neonato nasca sottopeso, oltre a un rischio doppio che muoia entro 28 giorni dalla nascita. Questi neonati – ha detto il professor Davies – “pesano in media 250 grammi in meno e hanno un rischio 7 volte maggiore di un raro ma catastrofico evento di parto di feto morto o di morte neonatale”.

Lo studio parla anche dei problemi causati dai medicinali usati per la stimolazione e dagli ormoni assunti dalla donna durante i trattamenti. Davies ha sottolineato che le criticità o le malattie sviluppate dal bambino sono spesso dovute al fatto che il concepimento avviene fuori dall’utero materno, e ha ribadito che i farmaci usati nell’ambito dei trattamenti hanno effetti nocivi sul grembo e sulla placenta della donna[39].

 

2) Anomalie genetiche, malattie degenerative, malformazioni congenite…

Carlo Flamigni: riguardo ai bimbi nati con fecondazione artificiale “resta il dubbio relativo alla possibile comparsa di un’anomalia tardiva”, specie “malattie di tipo degenerativo riguardanti il sistema nervoso e i muscoli” (“La procreazione assistita”, p. 54)[40].

In un articolo del settembre 2004 Repubblica riporta un’amara testimonianza: “Volevano un figlio ad ogni costo, soprattutto sano, perciò avevano scelto la fecondazione in vitro, un centro di Bologna che dava queste garanzie, una clinica privata attrezzata per la diagnosi pre-impianto. La sorte ha riservato loro un destino difficile: il bambino è down, nato peraltro con due gravissime malformazioni allo stomaco e al cuore[41].

Frontali e Zucco scrivono: “Secondo l’indagine effettuata nel 2002 da Strömberg e colleghi in Svezia, dove quasi tutti i bambini con qualche handicap neurologico, sensoriale o mentale frequentano centri di riabilitazione del servizio sanitario nazionale, il rischio di handicap è risultato più alto nei ragazzi nati con Fivet, anche escludendo dall’analisi i gemelli. Oltre a quella di paresi cerebrale, le diagnosi più frequenti comprendevano malformazioni congenite, ritardo mentale, disturbi del comportamento. Questa analisi mostra inoltre che danni a lungo termine possono comparire anche oltre il primo anno di vita, scadenza alla quale di solito si fermano le indagini”.

Inoltre: “In uno studio del 2002, un gruppo di ricercatrici australiane ha analizzato i risultati relativi a più di 1000 bambini nati con Pma in un determinato intervallo di tempo nell’Australia occidentale, scoprendo che circa il 9% di essi soffriva di almeno una malformazione congenita grave rilevabile a un anno di età, a confronto con il 4,5% fra i bambini concepiti normalmente”.

Le autrici aggiungono: “Sulle base delle nuove possibilità di ricerca epidemiologica offerte dai grandi numeri, altri autori hanno rilevato nei nati con fecondazione assistita una prevalenza statisticamente significativa di difetti del tubo neurale, di atresia dell’esofago e di malformazioni cardiache. Sia queste malformazioni sia gli handicap vengono imputati dagli autori delle due ricerche alle gravidanze gemellari o plurime”. Poi continuano: “Le malattie genetiche, dovute cioè a un danno ai cromosomi o più in generale al Dna, sono numerosissime nell’uomo ma per fortuna ognuna di esse è molto rara. Di conseguenza, quando compaiono malattie di questo tipo fra i bambini nati da Pma, il timore è che non si tratti di eventi casuali. Questi dubbi sono sorti a proposito della sindrome di Beckwith-Wiedemann (BWS), detta anche ‘large offspring syndrome’, caratterizzata da sovrappeso pre e postnatale, lingua grossa e difetti della parete addominale anteriore. Una patologia simile è stata descritta nei bovini e può verificarsi quando embrioni di pecora o di topo, sottoposti sperimentalmente a Pma, vengono coltivati in vitro per troppi giorni prima di essere inseriti in utero. Sei casi di questa grave malattia fra i bambini nati con Pma sono stati segnalati al gruppo di genetica medica dell’Università di Birmingham. Dal confronto statistico risulta giustificato il sospetto che la malattia sia più frequente nei bambini nati con Pma”.

Infine: “In Olanda, nel 2001, su 3000 donne che si erano sottoposte a Pma, cinque hanno dato alla luce bambini con reticoloblastoma, un raro tumore infantile della retina di origine genetica. Anche in questa occasione lo studio statistico ha messo in evidenza che l’aumento dei casi rispetto al numero che ci si poteva spettare (al massimo uno), era significativo”.

Manuela Cecotti ricorda che con la Fiv “il rischio di anomalie cromosomiche è aumentato” e che “esiste comunque un eccesso di rischio pari ad un fattore di circa 3 volte per alcune malformazioni: difetti del tubo neurale, occlusioni del tratto gastroenterico, onfalocele ed ipospadia[42].

In un articolo su Avvenire Lorenzo Schoepflin riporta tre ricerche: “La rivista scientifica Fertility and sterility ha recentemente pubblicato un articolo di un gruppo dell’ateneo cinese Nanjing Medical University che mostra come per i concepiti in laboratorio aumenti del 37% la probabilità di difetti alla nascita. Considerazioni analoghe vengono esposte in un lavoro sulla rivista dell’American Heart Association. Secondo l’articolo i nati in provetta mostrano un’inclinazione generalizzata a problemi vascolari proprio a causa dei problemi legati alla tecnica della fecondazione in vitro. Risultati simili risalgono al 2010. Su Pediatrics, la rivista ufficiale dell’accademia americana di pediatria, un articolo parlava di un più alto rischio di sviluppare tumori per i bambini nati da fecondazione[43].

Anche la giornalista Ilaria Nava riferisce di alcune ricerche che hanno messo in luce il “nesso tra fecondazione artificiale e patologie del bambino”. Scrive Nava: “Un gruppo di ricercatori della Nanjing Medical University della Cina ha compiuto una revisione di tutti gli articoli scientifici sul tema fino a settembre 2011, esaminando più di 900 ricerche pubblicate. Dal loro lavoro è emerso che i bambini concepiti in vitro hanno un rischio significativamente aumentato di avere patologie alla nascita rispetto a quelli concepiti naturalmente… I bambini nati attraverso la fecondazione artificiale presentano, secondo la ricerca, maggiori rischi di malattie e malformazioni di arti o organi o problemi che coinvolgono il sistema nevoso, l’apparato digerente e osseo e i genitali”.

Nava prosegue riportando i risultati di una ricerca realizzata con lo scopo di monitorare gli effetti sul lungo periodo nei nati da Pma: “Sulla rivista scientifica Circulation, un gruppo di ricercatori di Berna ha pubblicato i risultati di uno studio su 65 bambini di 12 anni nati con la fecondazione assistita. Gli autori descrivono ‘una significativa disfunzione vascolare’ nonché ‘mutamenti avversi in entrambe le circolazioni, sistemica e polmonare, tra cui alterazioni strutturali e funzionali’. Alcuni di questi sono associati a un maggior rischio di malattie cardiache. ‘Questo problema – affermano i ricercatori – non sembra essere correlato a fattori ereditari, ma alle tecniche stesse’”.

Infine, la giornalista ricorda la pubblicazione nel 2011 – da parte del National Post – di una ricerca condotta da Rosanna Weksberg, genetista dell’Università di Toronto, esposta durante il congresso della Società canadese di fertilità e andrologia. Scrive Nava: “Lo studio ha analizzato il legame tra tecniche di riproduzione assistita e malattie genetiche rare, evidenziando un’incidenza 10 volte superiore rispetto al resto della popolazione. Tra queste, la sindrome di Beckwith-Wiedemann, che causa sintomi come malformazioni agli arti, eccessiva crescita volumetrica della lingua e un elevato rischio di tumori renali. In Canada, ha spiegato la genetista, un bambino su 1.300 tra i nati con la fecondazione in vitro soffre questa condizione, a differenza di uno ogni 13mila nella popolazione generale[44].

Per quanto concerne la fecondazione in vitro, con le sue due principali applicazioni: FIVET (Fecondazione In Vitro e Trasferimento dell’Embrione) e ICSI (Iniezione Intra-Citoplasmatica di uno Spermatozoo) attuata nella sua forma classica con l’impianto di embrioni freschi, Domenico Coviello – direttore della S.C. Laboratorio di Genetica Umana, E.O. Ospedali Galliera di Genova – riferisce[45] che “in diversi studi viene riportata una frequenza aumentata di anomalie congenite in bambini nati da fecondazione assistita con una variabilità dal 5,7% al 7% rispetto ad una frequenza del 2-3% della popolazione di bambini nati naturalmente[46] e “tale rischio aumentato di anomalie congenite non è differente tra FIVET ed ICSI[47]. Coviello precisa che “è importante ricordare che tali dati epidemiologici sono disponibili in quanto il periodo temporale di osservazione dall’inizio della Pma classica è abbastanza lungo”.

Inoltre, per quanto riguarda lo sviluppo da embrione a bambino e le possibili conseguenze sul suo genoma dovute all’intero processo di Pma, Coviello ricorda che è ormai cosa nota il fatto che “oltre alle classiche mutazioni del Dna o dei cromosomi che determinano difetti congeniti, esistono alterazioni non della sequenza del Dna, ma di fattori che regolano i geni stessi, determinandone l’accensione o lo spegnimento”: questi meccanismi fanno parte di una disciplina detta “Epigenetica”. “In quest’ottica – continua il genetista – anche stimoli derivati da variazione della temperatura potrebbero influire su meccanismi epigenetici e potrebbero evidenziare gli effetti solo a distanza di tempo o anche nella generazione successiva”.

Coviello puntualizza inoltre che esistono “regioni del genoma umano che subiscono tale regolazione epigenetica proprio durante la formazione del gamete, per cui alcuni geni sono attivi solo nei gameti maschili ed altri solo nei gameti femminili… Tale fenomeno viene denominato ‘Imprinting’ e può essere paterno o materno”; a tal riguardo – scrive Coviello – “esistono diverse segnalazioni di un aumento di errori dell’imprinting in bambini nati tramite Pma[48]. In particolare “studi recentissimi valutano diversi parametri che caratterizzano lo stato epigenetico dello sperma, quali ritenzione e modificazioni istoniche, modificazioni della cromatina e la metilazione del Dna, portando evidenze del coinvolgimento del gamete maschile non solo quanto tale, ma anche come elemento in grado di determinare vari aspetti dello sviluppo embrionale. Le modificazioni epigenomiche vengono quindi poste alla base di patologie del soggetto anche in età adulta[49].

Di epigenetica e di studi che documentano i problemi di salute sui nati da Pma, parla anche Carlo Bellieni. Scrive il neonatologo: “Uno studio eseguito da ricercatori americani del Centro nazionale su difetti congeniti e disabilità evolutive (Nbdps)” nell’ambito della fecondazione in vitro, pubblicato su “Human Reproduction” (novembre 2008), “riporta che i bimbi nati dopo fecondazione in vitro hanno un rischio di certe malformazioni maggiore degli altri[50]. E ancora: “Uno studio australiano e inglese (“Obstetrics and Gynecology, ottobre 2012) riferisce che, nonostante una diminuzione negli ultimi anni, nei bambini ‘la prevalenza di anomalie alla nascita da Fiv resta maggiore che nelle popolazione generale’, cioè l’8,7% contro il 5,4%, in accordo con recenti analisi sistematiche pubblicate su altre riviste scientifiche[51].

Il 4 marzo 2013 “è stato pubblicato sul ‘Journal of fetal maternal and neonatal medicine’ uno studio israeliano fatto su oltre 9000 bambini concepiti in vitro, che mostra che il rischio di malformazioni sia maggiore in questo gruppo piuttosto che in quello della popolazione generale… Su ‘Fertility and sterility’, il 5 marzo è uscito uno studio neozelandese che mette a confronto i nati dopo impianto di embrioni ‘scongelati’ e di embrioni ‘freschi’, e si vede che questi ultimi hanno una statura media minore dei primi, per una maggior presenza di un fattore di crescita simile all’insulina, anche maggiore dei nati da fecondazione non artificiale. Ma non basta: sulla rivista ‘Urology’ è apparso in marzo uno studio coreano che mostra come i nati da fecondazione in vitro hanno un maggior rischio di criptorchidismo e di ipospadia, due anomalie dei genitali maschili. Il 25 febbraio la rivista ‘Clinical defects part A’ ha pubblicato uno studio cinese che mostra che le malformazioni riscontrate a 3 anni dalla nascita nei nati da Icsi sono l’8,65%, e il 5,21% nei bambini concepiti con Fiv… Per fare una sintesi, sulla rivista ‘Human reproduction update’ del marzo 2013, un gruppo di studiosi svedesi si domanda come mai ‘i bambini non gemelli concepiti con tecniche di riproduzione assistita hanno un outcome peggiore?’ e spiegano che ‘i fattori legati alla stimolazione ormonale e ai metodi di fecondazione possono avere un ruolo in questo problema’, sottolineando dunque che il problema è probabilmente ‘intrinseco’ alla tecnica[52].

E in un altro articolo ancora: “Non si possono trascurare i problemi alla nascita, come insegnano i neonatologi: Annie Janvier sul ‘Journal of pediatrics’ del 2011 chiede una maggior regolazione di queste tecniche dato che nel suo reparto di patologia neonatale il 17% dei ricoveri sono gemelli nati da Fiv (questa percentuale aumenterebbe aggiungendo i nati da Fiv non gemellari)[53].

E riguardo alla questione dell’epigenetica, cioè al “modo in cui l’ambiente influisce del DNA”, Bellieni fa presente che nel 2013 è stato pubblicato sul “Journal of Human Genetics” un riassunto della letteratura scientifica in questo campo, scritto dal genetista giapponese Takashi Kohda. Lo studioso ha ricordato che per i bambini nati da fecondazione in vitro “resta la possibilità di alterazioni epigenetiche indotte da queste tecniche” poiché “il codice epigenetico negli stadi precoci dello sviluppo può essere alterato da stimoli ambientali; perciò gli effetti della manipolazione embrionale e delle tecniche di coltura sull’embrione sono un argomento importante per l’epigenetica”. Bellieni precisa: “L’autore riporta gli studi in cui si mostra un aumento di alcune malattie rare proprio legate all’alterazione dell’imprinting epigenetico nei nati da Fiv, così come mostra che sia il terreno di coltura dell’embrione oppure come il tempo che l’embrione vi trascorre possono esercitare azioni sull’espressione epigenetica del DNA”. Quindi aggiunge: “Lo scorso febbraio [2014] su ‘Human Reproduction’ è stato riportato che il terreno di coltura in cui si fa nascere l’embrione influisce sul peso alla nascita. Ma la rivista ‘Fertility and Sterility’, nel marzo 2013, ha una serie di articoli proprio su epigenetica e Fiv. Gli autori Vermeiden e Bernardus, vi concludono che le malattie legate all’epigenetica sono più frequenti nei nati da Fiv; mentre altri due ricercatori, Haji e Haaf, spiegano che ‘quando si considera la sicurezza della Fiv da un punto di vista epigenetico, la nostra principale preoccupazione non deve essere se aumentano rare malattie dell’imprinting, ma essere consapevoli di un legame tra l’interferenza con la riprogrammazione epigenetica e lo sviluppo di alcune malattie dell’adulto’. Anche sulla rivista ‘Lancet’ e sull’‘American Journal of Human Genetics’ vennero riportati esempi che mostrerebbero il legame tra malattie dell’imprinting genomico e fecondazione in vitro[54].

Bellieni parla anche del “possibile impatto psicologico per il sopravvissuto [all’uccisività delle tecniche e ai fratelli inviati al congelatore] quando saprà di essere il campione di un gruppetto di fratelli-embrioni che invece sono ‘rimasti indietro’, come ben spiega lo psichiatra francese Benoit Bayle nel libro ‘L’embryon sur le divan’[55].

Lo studio realizzato dal team dell’Evidence Based IVF Group (precedentemente citato) pubblicato a gennaio 2014 in un articolo sul British Medical Journal, ha confrontato i problemi di salute insorti nei bebè di gravidanze da provetta con quelli di gravidanze naturali, rilevando che nei primi vi è il 70% di rischio in più di malformazioni genetiche. Le statistiche parlano, inoltre, anche di effetti a lungo termine, con l’insorgere di patologie cerebrali e di problemi vascolari in percentuali ancor più allarmanti[56].

Nell’articolo si legge che diversi studi hanno dimostrato che “bambini sani concepiti grazie alla fecondazione hanno più probabilità rispetto ai bambini concepiti naturalmente di soffrire di pressione alta, obesità, livelli di glucosio anormali e disfunzioni vascolari[57].

Il professor Davies ha parlato dell’urgenza sia di fornire un’informazione più chiara rispetto alle metodiche della provetta sia di analizzare anche le conseguenze di lungo periodo: “Ora è urgente cominciare ad analizzare anche le conseguenze di lungo periodo, che riguardano i bambini nati tramite fecondazione e ormai cresciuti[58].

Il biologo evoluzionista Pascal Gagneux, professore all’Università della California di San Diego, durante il meeting annuale dell’“American Association for the Advancement of Science” (Aaas) a Washington, ha ricordato che i bambini nati da Fiv potrebbero avere una vita più breve e una salute più cagionevole una volta diventati adulti, a causa del fatto che la fecondazione assistita bypassa i processi di selezione naturale tipici della razza umana. Nel concepimento naturale succede infatti che solo lo spermatozoo più forte, fra centinaia di milioni, riesce a percorrere tutta la strada lungo il sistema riproduttivo femminile e a fecondare l’ovocita, mentre nella procreazione in laboratorio questo importante passaggio viene eluso.

Gagneux ha detto di essere “preoccupato per il fatto che il sistema naturale di concepimento con queste tecniche venga del tutto bypassato” in quanto “la scelta dello spermatozoo spesso viene fatta da un tecnico”. “Non escluderei – ha aggiunto l’esperto – che tutto questo possa accorciare la vita di chi nasce ‘in provetta’. Siamo attualmente impegnati in un esperimento evolutivo, ma la riproduzione assistita potrebbe avere una combinazione di conseguenze biologiche e sociali che non è ancora stata sufficientemente presa in considerazione”. Gagneux ha ricordato che Louise Brown, la prima bambina nata in vitro, ha oggi solo 37 anni, quindi non è ancora possibile dimostrare se la procedura possa provocare problemi nella vita adulta.

Un altro rischio della fecondazione artificiale – ha aggiunto il biologo – è rappresentato dal fatto che “coltivare e crescere gli embrioni per 3-5 giorni in una provetta potrebbe danneggiare il loro sviluppo, in una fase delicata in cui si improntano tutti i geni”. Infine Gagneux paragona il potenziale effetto “boomerang” della Pma con quello provocato dal “cibo spazzatura” in America, dove per 50 anni si sono ignorati gli effetti del mangiare in maniera non sana, e ora si fanno i conti con l’obesità dilagante[59].

 

Questi sono gli effetti negativi che le tecniche di fecondazione artificiale hanno sulla salute di donne e nascituri, effetti che vengono per la maggior parte taciuti alle coppie con problemi di fertilità mentre sono orientate, con una fretta e superficialità sospette, ai trattamenti di Pma. Dietro la provetta si muovono infatti interessi economici enormi che rischierebbero un forte ridimensionamento se circolasse una corretta informazione sui risultati fallimentari della fecondazione artificiale e sui problemi per la salute che da essa scaturiscono.

Le coppie infertili o sterili non devono tuttavia rassegnarsi alla loro condizione perché per coronare il desiderio di genitorialità esistono altre strade molto più efficaci della provetta, che non comportano effetti collaterali sulla salute di donne e nascituri, che rispettano la dignità di tutti i soggetti coinvolti e che costano poco o, addirittura, nulla. È la strada dei metodi naturali per la cura dell’infertilità: ne parliamo qui.

 

Note:

[1] Elena Ramilli, “I dati della fecondazione assistita dicono che è una scorciatoia illusoria”, Gente Veneta n. 37, 12 ottobre 2013.

[2] Carlo Bellieni, “Fecondazione, tutto quello che si tace della vera scienza”, Avvenire, 25 luglio 2014.

[3] Emanuela Vinai, “Il ginecologo Boscia. Donne non informate dei rischi che corrono”, Avvenire, 12 giugno 2015.

[4] Emanuela Vinai, “L’infertilità e il falso mito della provetta”, Avvenire, 27 febbraio 2014.

[5] N. Frontali – F. Zucco, “Sterili per legge”, Le Scienze, settembre 2004.

[6] Carlo Flamigni, “La procreazione assistita”, Il Mulino, 2002. Citato da Francesco Agnoli, “Il rischio tumore per le donne che accedono alla fiv”, Libertà e Persona, 19 luglio 2009.

[7] “Le complicanze nel percorso diagnostico e nelle procedure”, www.carlobulletti.com/bulletti/sterilita_pma/pma/complicanze_diagnosi.htm; “Le complicanze dei trattamenti”, www.carlobulletti.com/bulletti/sterilita_pma/pma/complicanze_trattamenti.htm.

[8] Citato da Francesco Agnoli, “È esistito in Italia il far west della provetta? Quali sono i rischi della Pma?”, Libertà e Persona, 9 settembre 2006.

[9] Caterina Minnucci, “Baby 2.0: con la provetta è un’invasione di gemelli”, Il fatto Quotidiano, 31 agosto 2015.

[10] Enzo Favero, “Boom di gemelli. Al San Valentino è più 43 per cento”, La Tribuna di Treviso, 5 aprile 2014.

[11] Il periodo perinatale è il periodo compreso tra la 29a settimana di gestazione e i primi 30 giorni di vita del neonato.

[12] C. Minnucci, art. cit.

[13] Carlo Bellieni, “Nessuna persona è un diritto per un’altra”, L’Osservatore Romano, 10 gennaio 2009.

[14] Graziella Melina, “Figli ‘tardi’, disinformazione e il mito del ‘tutto semplice’”, Avvenire, 29 maggio 2014.

[15] Viviana Daloiso, “Un mondo di figli in provetta. Inutilmente e con tanti rischi”, Avvenire, 25 marzo 2014.

[16] Jared Yee, “IVF more deadly than abortion for women, says BMJ”, BioEdge, 3 febbraio 2011.

[17] Mario Pappagallo, “Prelievo ovociti: a rischio una su mille. Ipotesi della reazione allergica”, Corriere Della Sera, 12 giugno 2015.

[18] E. M., “Muore dopo la fecondazione assistita”, Corriere della Sera, 21 aprile 2004.

[19] Francesco Agnoli, art. cit.

[20] Citato da Francesco Agnoli, “Torna il dibattito sulla procreazione medicalmente assistita. I rischi…”, Libertà e Persona, 3 luglio 2007.

[21] Elisabetta Del Soldato, “Il lato oscuro (e censurato) della provetta che fallisce”, Avvenire, 3 ottobre 2013.

[22] Graziella Melina, “Coppie infertili, illusioni in provetta”, Avvenire, 30 aprile 2015.

[23] Tommaso Scandroglio, “La strage degli embrioni: solo uno su 10 vive”, La nuova Bussola Quotidiana, 15 luglio 2014.

[24] Valentina Fizzotti, “Troppe illusioni in provetta: oltre i 37 anni pochi successi”, Avvenire, 19 dicembre 2013.

[25] Emanuela Vinai, “Fecondazione in vitro per la prima volta nati meno bambini”, Avvenire, 25 luglio 2013.

[26] Tommaso Scandroglio, “I pericoli della provetta che è meglio nascondere”, Avvenire, 14 ottobre 2011.

[27] Citato da T. Scandroglio, art. cit.

[28] G. Melina, art. cit.

[29] E. Del Soldato, art. cit.

[30] John Flynn, “Crolla il mito della fecondazione artificiale”, www.zenit.org, 18 novembre 2013.

[31] Elena Molinari, “La provetta? Mi ha annientata come una droga”, Avvenire, 27 febbraio 2014.

[32]  “Un nobel per 4 milioni di vite. E 41 milioni di morti”, Avvenire, 6 ottobre 2010.

[33] F. Agnoli, art. cit.

[34] Carlo Bellieni, “Bambini in vitro rischiatutto sulla loro pelle”, Avvenire, 16 gennaio 2014.

[35] Carlo Bellieni, “Manipolare la vita: rischio più che reale”, Avvenire, 30 gennaio 2014.

[36] Carlo Bellieni, “Provetta & rischi, spuntano altre prove”, Avvenire, 4 aprile 2013.

[37] Carlo Bellieni, “Embrioni usati. Quando la natura dell’uomo viene calpestata”, Il Sussidiario.net, 8 dicembre 2013.

[38]  “Fecondazione, troppi ormoni fanno danni”, Gazzetta di Modena, 27 agosto 2015.

[39] Benedetta Frigerio, “Australia. Studio su 300mila bambini nati in provetta: quasi doppia la probabilità di morte”, www.tempi.it, 9 gennaio 2014.

[40] F. Agnoli, art. cit.

[41] Giuseppe Filetto, “Hanno scambiato gli embrioni così nostro figlio è nato down”, La Repubblica, 19 settembre 2004.

[42] F. Agnoli, art. cit.

[43] Lorenzo Schoepflin, “I figli perfetti? A rischio malformazioni”, Avvenire, 26 aprile 2012.

[44] Ilaria Nava, “C’è un nesso tra fecondazione artificiale e patologie pediatriche”, Newsletter di Scienza & Vita n. 56 – Edizione aprile 2012.

[45] Domenico Coviello, “Effetti della crioconservazione sul patrimonio genetico degli embrioni”, Newsletter di Scienza & Vita n. 58 – Edizione giugno 2012.

[46] Wen J, et al. Fertil Steril. 2012 Jun;97(6):1331-1337; Sagot P, et al. Hum Reprod. 2012 Mar;27(3):902-9; Ramin Mozafari Kermani, et al. Archives of Iranian Medicine, Volume 15, Number 4, April 2012; Sala P, et al. Minerva Ginecol. 2011 Jun;63(3):227-35); Artini PG, et al. Gynecol Endocrinol. 2011 Jul;27(7):453-7. Citati da D. Coviello, ivi.

[47] Wen J, et al. Fertil Steril. 2012 Jun;97(6):1331-1337. Citato da D. Coviello, ivi.

[48] Emily L. et al. Epigenetics and Assisted Reproductive Technology: A Call for Investigation. Am. J. Hum. Genet. 74:599-609, 2004; Gicquel C. Et al. In Vitro Fertilization May Increase the Risk of Beckwith-Wiedemann Syndrome Related to the Abnormal Imprinting of the KCNQ1OT Gene. Am. J. Hum. Genet. 72:1338-1341, 2003; K. H. Orstavik K.H. et al. Another Case of Imprinting Defect in a Girl with Angelman Syndrome Who Was Conceived by Intracytoplasmic Sperm Injection. Am. J. Hum. Genet. 72:218-219, 2003. Citati da D. Coviello, ivi.

[49] T G Jenkis and D T Carrell. The sperm epigenome and potential implications for the developing embryo. Reproduction. 2012 Jun;143(6):727-34. Citato da D. Coviello, ivi.

[50] C. Bellieni, art. cit.

[51] Carlo Bellieni, “Dove pende la bilancia”, L’Osservatore Romano, 28 novembre 2012.

[52] C. Bellieni, art. cit.

[53] C. Bellieni, art. cit.

[54] C. Bellieni, art. cit.

[55] C. Bellieni, art. cit.

[56] V. Daloiso, art. cit.

[57] Leone Grotti, “Scienziati pro fecondazione assistita lanciano l’allarme: ‘I danni forse sono maggiori dei benefici’”, www.tempi.it, 5 febbraio 2014.

[58] B. Frigerio, art. cit.

[59] “Biologo Usa, bimbi nati in provetta potrebbero vivere meno”, www.online-news.it, 16 febbraio 2016.

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  252. ### Какой парик купить после химиотерапии: Полное руководство

    Химиотерапия — это серьезное испытание, которое оказывает значительное влияние на организм, включая потерю волос. Этот аспект лечения может сильно сказаться на самооценке и эмоциональном состоянии пациента. Выбор правильного парика может помочь восстановить уверенность в себе и чувство нормальности. В этой статье мы расскажем, на что стоит обратить внимание при выборе парика после химиотерапии.

    #### Почему выбор парика важен

    Парик — это не просто аксессуар, а важная часть восстановления после химиотерапии. Правильно подобранный парик помогает:
    – Восстановить внешний вид и самооценку
    – Защитить кожу головы от солнца и холода
    – Обеспечить комфорт и уверенность в общественных местах

    #### Ключевые факторы при выборе парика

    1. **Материал волос**
    – **Натуральные волосы**: Плюсы включают естественный вид и возможность укладки. Однако они требуют более тщательного ухода и стоят дороже.
    – **Синтетические волосы**: Более доступный вариант, не требующий сложного ухода. Современные синтетические парики выглядят очень естественно и могут сохранять форму после стирки.

    2. **Основа парика**
    – **Монопарик**: Обеспечивает естественный вид благодаря индивидуально пришитым волосам. Обычно более дорогие, но и более комфортные и натуральные.
    – **Трессовый парик**: Волосы закреплены на трессах, что делает парик более доступным по цене, но менее натуральным на вид.

    3. **Размер и посадка**
    – Важно выбрать парик, который хорошо сидит на голове и не вызывает дискомфорта. Обратите внимание на регулировочные ремешки и эластичность основы.

    4. **Цвет и стиль**
    – Подберите цвет, который максимально близок к вашему натуральному оттенку волос до химиотерапии. Это поможет вам чувствовать себя более естественно.
    – Обратите внимание на стрижку и укладку парика. Выберите стиль, который вам подходит и не требует сложного ухода.

    5. **Уход и долговечность**
    – Натуральные парики требуют регулярного мытья и укладки, что может занять время и усилия.
    – Синтетические парики легче в уходе, но могут требовать замены чаще, чем натуральные.

    #### Где купить парик

    – **Специализированные магазины**: В таких магазинах можно получить профессиональную консультацию и примерить разные модели.
    – **Онлайн-магазины**: Здесь представлено большее разнообразие моделей и стилей. Важно внимательно изучить отзывы и уточнить возможность возврата.

    #### Советы по ношению парика

    – **Используйте подкладку**: Это поможет предотвратить раздражение кожи головы.
    – **Регулярно чистите парик**: Следите за гигиеной парика, чтобы избежать неприятных запахов и повреждений.
    – **Снимайте парик на ночь**: Это даст вашей коже головы отдохнуть и позволит парику дольше сохранять свою форму.

    #### Поддержка и консультации

    Не стесняйтесь обращаться за советом к специалистам в магазинах или парикмахерских. Они помогут подобрать подходящую модель и расскажут о правильном уходе за париком. Также стоит обсудить свои предпочтения и возможные аллергические реакции с врачом.

    #### Заключение

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  268. Лебедка — это механическое устройство, используемое для подъема, перемещения или удержания груза на месте. Она является одним из наиболее универсальных и востребованных инструментов в различных областях, включая строительство, промышленность, спасательные операции и даже в быту.

    ### Основные типы лебедок

    1. **Ручные лебедки**
    – **Применение:** Простые и удобные в использовании, подходят для несложных задач, таких как перемещение небольших грузов, подтягивание автомобилей и прочие бытовые нужды.
    – **Преимущества:** Легкость и компактность, не требуют источника энергии.

    2. **Электрические лебедки**
    – **Применение:** Широко используются в строительстве, на складах, для подъема и перемещения тяжелых грузов.
    – **Преимущества:** Высокая производительность, возможность дистанционного управления, высокая грузоподъемность.

    3. **Гидравлические лебедки**
    – **Применение:** Применяются в тяжелой технике и промышленных установках, где требуется значительное усилие.
    – **Преимущества:** Способность поднимать очень тяжелые грузы, высокая надежность и долговечность.

    4. **Пневматические лебедки**
    – **Применение:** Используются в условиях, где электричество или гидравлические системы недоступны или нежелательны, например, в взрывоопасных средах.
    – **Преимущества:** Безопасность использования в специфических условиях, надежность.

    ### Применение лебедок

    1. **Строительство**
    – Лебедки используются для подъема строительных материалов, перемещения оборудования и других задач, связанных с возведением зданий и сооружений.
    – Например, при строительстве высотных зданий лебедки играют ключевую роль в подъеме строительных материалов на верхние этажи.

    2. **Промышленность**
    – В промышленных условиях лебедки применяются для перемещения тяжелых станков, оборудования и материалов. Они незаменимы на производственных линиях, в мастерских и на складах.

    3. **Спасательные операции**
    – В спасательных операциях лебедки используются для эвакуации людей и транспортных средств из труднодоступных мест.
    – Например, в горах или лесах, где необходимо поднять или переместить пострадавших, лебедка может быть жизненно важным инструментом.

    4. **Судоходство и морская отрасль**
    – На судах и в портах лебедки применяются для подъема грузов, управления якорями и швартовки судов.

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    ### Преимущества использования лебедок

    1. **Универсальность**
    – Лебедки могут использоваться в самых разнообразных условиях и для выполнения различных задач, от подъема небольших грузов до перемещения многотонных конструкций.

    2. **Повышение эффективности**
    – Использование лебедок позволяет значительно сократить время и усилия, затрачиваемые на перемещение грузов, что повышает общую производительность труда.

    3. **Безопасность**
    – Применение лебедок снижает риск травм и аварий, так как многие модели оснащены механизмами, предотвращающими неожиданный спад или проскальзывание груза.

    4. **Экономичность**
    – Несмотря на первоначальные затраты на приобретение и установку, лебедки способствуют снижению общих затрат за счет уменьшения потребности в ручном труде и ускорения процессов.

    ### Заключение

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