In vitro fertilization (IVF)

In vitro fertilization (IVF) ukuhlanganiswa kweqanda lowesifazane kanye nesidoda sowesilisa esitsheni se-laboratory. I-in vitro isho ngaphandle komzimba. Ukukhulelwa kusho ukuthi isidoda sinamathisele futhi sangena eqandeni.

Imvamisa, iqanda nesidoda kufakwa ngaphakathi komzimba wowesifazane. Uma iqanda elikhulelisiwe linamathela ulwelwesi lwesibeletho futhi liqhubeka nokukhula, kuzalwa ingane cishe ezinyangeni eziyi-9 kamuva. Le nqubo ibizwa ngokuthi ngumqondo wemvelo noma ongasiziwe.

IVF luhlobo lobuchwepheshe obusizwayo bokuzala (i-ART). Lokhu kusho ukuthi amasu akhethekile ezokwelapha asetshenziselwa ukusiza owesifazane ukuthi akhulelwe. Kuvame ukuzama lapho ezinye izindlela ezingabizi kakhulu zokuzala zihlulekile.

Kunezinyathelo ezinhlanu eziyisisekelo ze-IVF:

Isinyathelo 1: Ukukhuthazeka, okubizwa nangokuthi i-super ovulation

• Imithi, ebizwa ngemithi yokuzala, inikezwa owesifazane ukukhulisa ukukhiqizwa kwamaqanda.
• Ngokuvamile, owesifazane ukhiqiza iqanda elilodwa ngenyanga. Izidakamizwa zokuzala zitshela amaqanda ukuthi akhiqize amaqanda amaningi.
• Ngalesi sinyathelo, owesifazane uzoba nama-ultrasound ajwayelekile we-transvaginal ukuhlola ama-ovari nokuhlolwa kwegazi ukuhlola amazinga ama-hormone.

Isinyathelo 2: Ukubuyisa amaqanda

• Ukuhlinzwa okuncane, okubizwa ngokuthi yi-follicular aspiration, kwenziwa ukuze kususwe amaqanda emzimbeni wowesifazane.
• Ukuhlinzwa kwenziwa ehhovisi likadokotela isikhathi esiningi. Owesifazane uzonikezwa imishanguzo ngakho akazizwa izinhlungu ngesikhathi senqubo. Usebenzisa izithombe ze-ultrasound njengomhlahlandlela, umhlinzeki wezokunakekelwa kwezempilo ufaka inaliti ezacile ngomzimba wesitho sangasese esibelethweni nasemasakeni (follicles) aqukethe amaqanda. Inaliti ixhunywe entweni yokudonsa, edonsa amaqanda noketshezi kulowo nalowo follicle, eyodwa ngasikhathi.
• Inqubo iyaphindwa kwenye i-ovary. Kungaba nokushaywa okuthile ngemuva kwenqubo, kepha kuzophela kungakapheli usuku.
• Ezimweni ezingavamile, i-laparoscopy ye-pelvic ingadingeka ukuze ususe amaqanda. Uma owesifazane engakhiphi noma engakwazi ukukhiqiza noma yimaphi amaqanda, amaqanda anikelwe angasetshenziswa.

Isinyathelo 3: Ukusatshalaliswa kanye Nokuvundiswa

• Isidoda sendoda sibekwa ndawonye namaqanda asezingeni eliphakeme. Ukuxutshwa kwesidoda neqanda kubizwa ngokuthi yi-insemination.
• Amaqanda nesidoda bese kugcinwa ekamelweni elilawulwa imvelo. Isidoda sivamise ukungena (ukuvundisa) iqanda emahoreni ambalwa ngemuva kokumithiswa.
• Uma udokotela ecabanga ukuthi ithuba lokukhulelwa liphansi, isidoda singafakwa ngqo eqandeni. Lokhu kubizwa ngokuthi yi-intracytoplasmic sperm injection (ICSI).
• Izinhlelo eziningi zokuzala zivame ukwenza i-ICSI kwamanye amaqanda, noma ngabe izinto zibonakala zijwayelekile.

Isinyathelo 4: Isiko lombungu

• Lapho iqanda elikhulelisiwe lihlukana, liba umbungu. Abasebenzi baselabhorathri bazohlola umbungu njalo ukuqinisekisa ukuthi ukhula kahle. Ezinsukwini ezingaba ngu-5, umbungu ojwayelekile unamaseli amaningana ahlukaniswa ngamandla.
• Imibhangqwana enobungozi obukhulu bokudlulisela ukuphazamiseka kofuzo (engokofuzo) enganeni ingabheka ukuxilongwa kwezakhi zofuzo ngaphambi kokufakwa. Inqubo ivame ukwenziwa ezinsukwini ezi-3 ukuya kwezi-5 ngemuva kokukhulelwa. Ososayensi baselebhu basusa ingqamuzana elilodwa noma amaseli embungu ngamunye bese babheka okubhaliwe ngezifo ezithile zofuzo.
• Ngokwe-American Society for Reproductive Medicine, i-PGD ingasiza abazali ukuthi banqume ukuthi imiphi imibungu abazoyifaka. Lokhu kunciphisa ithuba lokudlulisela ukuphazamiseka enganeni. Le ndlela inempikiswano futhi ayinikezwa nhlobo ezikhungweni.

Isinyathelo 5: Ukudluliswa kombungu

• Imibungu ibekwa esibelethweni sowesifazane ezinsukwini ezi-3 kuya kwezi-5 ngemuva kokubuyiswa kwamaqanda nokukhulelwa.
• Inqubo yenziwa ehhovisi likadokotela ngenkathi owesifazane ephapheme. Udokotela ufaka ithubhu elincane (ipayipi) eliqukethe imibungu esithweni sangasese sowesifazane, ngomlomo wesibeletho, kuze kufike nasesibelethweni. Uma umbungu unamathela (okufakelwa) emgqeni wesibeletho futhi ukhule, kuba nemiphumela yokukhulelwa.
• Umbungu ongaphezu koyedwa ungafakwa esibelethweni ngasikhathi sinye, okungaholela kumawele, kathathu, noma ngaphezulu. Isibalo esiqondile semibungu esidlulisiwe yinkinga eyinkimbinkimbi encike ezintweni eziningi, ikakhulukazi iminyaka yowesifazane.
• Imibungu engasetshenziswanga ingahle iqandiswe bese ifakwa noma inikelwe ngelinye ilanga.

IVF yenziwa ukusiza owesifazane ukuthi akhulelwe. Isetshenziselwa ukwelapha izimbangela eziningi zokuzala, kufaka phakathi:

• Iminyaka ephakeme yowesifazane (iminyaka yobudala yomama)
• Amashubhu e-Fallopian alimele noma avinjelwe (angadalwa yisifo sokuvuvukala okhalweni noma ukuhlinzwa ngaphambi kokuzala)
• I-Endometriosis
• Ukungabi nenzalo kwabesilisa, kufaka phakathi ukubala kwesidoda nokuvaleka
• Ukungazali okungachazeki

IVF ifaka amandla amakhulu ngokomzimba nangokomzwelo, isikhathi nemali. Imibhangqwana eminingi ebhekene nokungazali iyacindezeleka.

Owesifazane othatha imithi yokuzala angaba nokuqunjelwa, ubuhlungu besisu, ukushintsha kwemizwelo, ikhanda elibuhlungu, neminye imiphumela emibi. Imijovo ephindaphindwayo ye-IVF ingadala ukulimala.

Ezimweni ezingavamile, izidakamizwa zokuzala zingadala i-ovarian hyperstimulation syndrome (OHSS). Lesi simo sidala uketshezi esiswini nasesifubeni. Izimpawu zifaka phakathi ubuhlungu besisu, ukuqunjelwa, ukukhuluphala ngokushesha (amakhilogremu ayi-10 noma ama-4.5 kilograms zingakapheli izinsuku ezi-3 kuye kwezi-5), ukwehla kokuchama yize uphuza uketshezi oluningi, isicanucanu, ukuhlanza, nokuphefumula okuncane. Amacala amancane angalashwa ngokuphumula kombhede. Amacala abucayi kakhulu adinga ukukhishwa kuketshezi ngenaliti futhi mhlawumbe nokulaliswa esibhedlela.

Ucwaningo lwezokwelapha lukhombisile kuze kube manje ukuthi izidakamizwa zokuzala azixhunyanisiwe nomdlavuza we-ovari.

Izingozi zokubuyiswa kwamaqanda kufaka phakathi ukusabela ku-anesthesia, ukopha, ukutheleleka, nokulimala ezakhiweni ezizungeze ama-ovari, njengamathumbu nesinye.

Kukhona ingozi yokukhulelwa kaningi lapho kufakwa ngaphezu kombungu owodwa esibelethweni. Ukuthwala izingane ezingaphezu kwesisodwa ngasikhathi kukhulisa ubungozi bokuzalwa ngaphambi kwesikhathi kanye nesisindo sokuzalwa esiphansi. (Kodwa-ke, ngisho nengane eyodwa ezelwe ngemuva kwe-IVF isengozini enkulu yokukhulelwa ngaphambi kwesikhathi kanye nesisindo sokuzalwa esiphansi.)

Akucaci ukuthi ngabe i-IVF iyayandisa ingozi yokukhubazeka kokuzalwa.

IVF ibiza kakhulu. Ezinye, kepha hhayi zonke, zithi zinemithetho ethi izinkampani zomshuwalense wezempilo kumele zinikeze uhlobo oluthile lokumbozwa. Kepha, izinhlelo eziningi zomshuwalense azibandakanyi ukwelashwa kokuzala. Imali ekhokhelwa umjikelezo owodwa we-IVF ifaka phakathi izindleko zemithi, ukuhlinzwa, i-anesthesia, i-ultrasound, ukuhlolwa kwegazi, ukucubungula amaqanda nesidoda, ukugcinwa kombungu nokudluliswa kombungu. Inani eliqondile lomjikelezo owodwa we-IVF liyahlukahluka, kepha lingabiza ngaphezu kwe- $ 12,000to $ 17,000.

Ngemuva kokudluliswa kombungu, owesifazane angatshelwa ukuthi aphumule ingxenye esele yosuku.Ukuphumula kombhede ngokuphelele akudingekile, ngaphandle kwalapho kunengozi eyengeziwe ye-OHSS. Iningi labesifazane libuyela emisebenzini ejwayelekile ngakusasa.

Abesifazane abathola i-IVF kumele bathathe isibhamu noma amaphilisi nsuku zonke we-hormone progesterone amasonto ayi-8 kuya kwayi-10 ngemuva kokudluliswa kombungu. I-Progesterone iyi-hormone ekhiqizwa ngokwemvelo ngama-ovari elungisa ulwelwesi lwesibeletho (isibeletho) ukuze umbungu ukwazi ukunamathisela. Iprogesterone ibuye isize umbungu ofakiwe ukuba ukhule futhi uqine esibelethweni. Owesifazane angaqhubeka nokuthatha i-progesterone amasonto ayi-8 kuya kwayi-12 ngemuva kokukhulelwa. I-progesterone encane kakhulu phakathi namasonto okuqala okukhulelwa ingaholela ekukhulelweni kwesisu.

Cishe ezinsukwini eziyi-12 kuya kwezingu-14 ngemuva kokudluliswa kombungu, owesifazane uzobuyela emtholampilo ukuze kwenziwe ukuhlolwa kokukhulelwa.

Shayela umhlinzeki wakho ngokushesha uma ngabe une-IVF futhi une:

• Umkhuhlane ongaphezu kuka-100.5 ° F (38 ° C)
• Ubuhlungu be-pelvic
• Ukopha okunzima okuphuma esithweni sangasese
• Igazi emchameni

Izibalo ziyahlukahluka kuye ngomtholampilo ngamunye kuya kwesinye futhi kufanele zibhekwe ngokucophelela. Kodwa-ke, inani leziguli lihlukile emtholampilo ngamunye, ngakho-ke amazinga okukhulelwa abikiwe awakwazi ukusetshenziswa njengesibonakaliso esinembile somtholampilo owodwa onconyelwa komunye.

• Izinga lokukhulelwa likhombisa inani labesifazane abakhulelwa ngemuva kwe-IVF. Kepha akukhona konke ukukhulelwa okuholela ekuzalweni okuphilayo.
• Izinga lokuzalwa elibukhoma likhombisa inani labesifazane abazala ingane ephilayo.

Umbono wamazinga wokuzalwa bukhoma uncike ezintweni ezithile ezifana nobudala bomama, ukuzalwa kwangaphambi kokuzalwa, kanye nokudluliswa kombungu okukodwa ngesikhathi se-IVF.

Ngokwe-Society of Assisted Reproductive Technologies (SART), ithuba elilinganiselwe lokuzala umntwana ophilayo ngemuva kwe-IVF limi ngale ndlela elandelayo:

• U-47.8% wabesifazane abangaphansi kweminyaka engama-35
• U-38.4% wabesifazane abaneminyaka engama-35 kuya kwengama-37
• Amaphesenti angama-26 kwabesifazane abaneminyaka engama-38 kuya kwengama-40
• U-13.5% wabesifazane abaneminyaka engama-41 kuya kwengama-42

IVF; Ubuchwepheshe bokuzala obusizwayo; UBuciko Inqubo yengane yokuhlola; Ukuzala - in vitro

UCatherino WH. I-endocrinology yokuzala nokungazali. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 223.

UChoi J, uLobo RA. Ukukhulelwa kwe-in vitro. Ku: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. I-Gynecology ephelele. Umhla wesi-7. IPhiladelphia, PA: Elsevier; I-2017: isahluko 43.

Ikomidi Lokuzivocavoca le-American Society for Reproductive Medicine; Ikomidi Lokuzilolonga leNhlangano Yezobuchwepheshe Bokuzala Obusizwayo. Isiqondiso semikhawulo enanini lemibungu okufanele idluliswe: umbono wekomidi. Umanyolo Oyinyumba. 2017; 107 (4): 901-903. I-PMID: 28292618 pubmed.ncbi.nlm.nih.gov/28292618/.

I-Tsen LC. In vitro fertilization kanye nobunye ubuchwepheshe bokusiza bokuzala. Ku: Chestnut DH, Wong CA, Tsen LC, et al, ama-eds. I-Chestnut's Obstetrics Anesthesia. Umhlaka 6. IPhiladelphia, PA: Elsevier; 2020: isahluko 15.