In vitro fertilization (IVF)

In vitro fertilization (IVF) kukudibana kweqanda lomfazi kunye nesidoda sendoda kwisitya selebhu. In vitro kuthetha ngaphandle komzimba. Ukuchumisa kuthetha ukuba isidoda sinamathele kwaye sangena kwiqanda.

Ngokwesiqhelo, iqanda kunye nedlozi lidityaniswa emzimbeni womfazi. Ukuba iqanda elichumileyo linamathela kumaleko esibelekweni kwaye liyaqhubeka nokukhula, umntwana uzalwa malunga neenyanga ezili-9 kamva. Le nkqubo ibizwa ngokuba yingqondo yendalo okanye engancediswanga.

IVF luhlobo lwetekhnoloji encedisayo yokuzala (i-ART). Oku kuthetha ukuba iindlela ezizodwa zonyango zisetyenziselwa ukunceda umfazi ukuba akhulelwe. Ihlala izanywa xa ezinye iindlela ezingabizi kakhulu zokuchuma zisilele.

Kukho amanyathelo amahlanu asisiseko kwi-IVF:

Inyathelo 1: Ukhuthazo, ekwabizwa ngokuba yi-ovulation ephezulu

• Amayeza, abizwa ngokuba ngamachiza okuzala, anikwa owasetyhini ukukhulisa imveliso yeqanda.
• Ngokwesiqhelo, umfazi uvelisa iqanda elinye ngenyanga. Amachiza okuchuma axelela amaqanda ukuba avelise amaqanda aliqela.
• Ngeli nqanaba, owasetyhini uya kuba ne-ultrasounds rhoqo yokujonga ama-ovari kunye novavanyo lwegazi ukujonga amanqanaba ehomoni.

Inyathelo 2: Ukubuyisa amaqanda

• Utyando oluncinci, olubizwa ngokuba ngumnqweno wokulandelwa, lwenziwa ukususa amaqanda emzimbeni womfazi.
• Utyando lwenziwa kwiofisi kagqirha amaxesha amaninzi. Umfazi uya kunikwa amayeza ukuze angaziva iintlungu ngexesha lenkqubo. Sebenzisa imifanekiso ye-ultrasound njengesikhokelo, umboneleli wezempilo ufaka inaliti ebhityileyo kwilungu lobufazi kwi-ovary nakwiisaka (iifollic) ezinamaqanda. Inaliti iqhagamshelwe kwisixhobo sokutsala, etsala amaqanda kunye nolwelo kwistollicle ngasinye, ibe nye ngexesha.
• Inkqubo iphindaphindwe kwenye i-ovary. Kunokubakho ukunyanzelwa emva kwenkqubo, kodwa iyakuhamba kungaphelanga usuku.
• Kwiimeko ezinqabileyo, kunokufuneka i-laparoscopy ye-pelvic ukususa amaqanda. Ukuba umfazi akenzi okanye akakwazi ukuvelisa amaqanda, amaqanda anikezelweyo anokusetyenziswa.

Inyathelo 3: Ukungenisa amadlozi nokuchumisa

• Isidoda sendoda sibekwa kunye namaqanda akumgangatho ophezulu. Ukuxutywa kwesidoda kunye neqanda kuthiwa kukudibana.
• Amaqanda kunye nesidoda emva koko zigcinwa kwigumbi elilawulwa ngokusingqongileyo. Isidoda sihlala singena (sichumisa) iqanda kwiiyure ezimbalwa emva kokudibana.
• Ukuba ugqirha ucinga ukuba ithuba lokuchumisa liphantsi, isidoda sinokufakwa ngqo kwiqanda. Oku kubizwa ngokuba yi-intracytoplasmic sperm injection (ICSI).
• Iinkqubo ezininzi zokuchuma zihlala zenza i-ICSI kwamanye amaqanda, nokuba izinto zibonakala ziqhelekile.

Inyathelo 4: Inkcubeko yesibeleko

• Xa iqanda elidityanisiweyo lahlulahlulwayo, iba yimbumba. Abasebenzi baselebhu baya kuyijonga rhoqo imibungu ukuqinisekisa ukuba ikhula kakuhle. Kwiintsuku ezintlanu, umbungu oqhelekileyo uneeseli ezininzi ezahlulahlulahlula.
• Abantu abatshatileyo abanomngcipheko ophezulu wokudlulisa isifo semfuza (kumafa) kumntwana angajonga ukumiliselwa kwemfuza ngaphambi kokumiliselwa (i-PGD). Inkqubo ihlala isenziwa kwiintsuku ezi-3 ukuya kwezi-5 emva kokuchumisa. Iinzululwazi zaselebhu zisusa iseli enye okanye iiseli kwimveku nganye kwaye zihlolisise izinto ezithile kwizifo ezithile.
• NgokukaMbutho waseMelika woNyango lokuZala, i-PGD inokunceda abazali bathathe isigqibo sokuba yeyiphi imibungu eza kufakwa. Oku kunciphisa ithuba lokudlulisela isifo emntwaneni. Obu buchule bunempikiswano kwaye abufundiswanga kuwo onke amaziko.

Inyathelo 5: Ukudluliselwa kombungu

• Iimbumba zifakwa kwisibeleko sowasetyhini kwiintsuku ezi-3 ukuya kwezi-5 emva kokufunyanwa kweqanda kunye nokuchumisa.
• Inkqubo yenziwa kwiofisi kagqirha ngelixa umfazi evukile. Ugqirha ufaka ityhubhu ecekethekileyo (i-catheter) eneeembriyo kwilungu lobufazi lobufazi, ngomlomo wesibeleko, kwaye inyukele kwisibeleko. Ukuba umbungu unamathela (kufakelo) kuludwe lwesibeleko kwaye ukhule, iziphumo zokukhulelwa ziyavela.
• Ngaphezu kombungu omnye unokufakwa esibelekweni ngaxeshanye, oko kunokukhokelela kumawele, kathathu, okanye nangaphezulu. Inani elichanekileyo leembumba ezihanjisiweyo ngumcimbi onzima oxhomekeke kwizinto ezininzi, ngakumbi iminyaka yomfazi.
• Iimbumba ezingasetyenziswanga zinokufakwa emkhenkceni kwaye zifakwe okanye zinikelwe ngelinye ixesha.

IVF yenziwe ukunceda umfazi ukuba akhulelwe. Isetyenziselwa ukuphatha uninzi lwezizathu zokungachumi, kubandakanya:

• Iminyaka yobudala yomfazi (iminyaka yobudala yoomama)
• Ukonakala okanye ukuvalwa kweetyhubhu ze-Fallopian (kunokubangelwa sisifo sokudumba kwepelevic okanye utyando lwangaphambi kokuzala)
• Endometriosis
• Ukungachumi kwento yendoda, kubandakanya ukunciphisa ukubala kwesidoda kunye nokuvaleka
• Ukungachumi okungachazwanga

IVF ibandakanya isixa esikhulu samandla omzimba kunye neemvakalelo, ixesha kunye nemali. Izibini ezininzi ezijongana nokungachumi zinexinzelelo kunye noxinzelelo.

Umfazi othatha amayeza okuzala unokuba nokuqunjelwa, iintlungu esiswini, ukutshintsha kwemozulu, iintloko kunye nezinye iziphumo ebezingalindelekanga. Ukuphindaphindwa kwenaliti ye-IVF kunokubangela ukugruzuka.

Kwiimeko ezinqabileyo, iziyobisi zokuchuma zinokubangela i-ovarian hyperstimulation syndrome (OHSS). Le meko ibangela ukwanda kolwelo esiswini nasesifubeni. Iimpawu zibandakanya iintlungu zesisu, ukuqunjelwa, ukukhawuleza ukutyeba (i-10 yeepawundi okanye i-4.5 kilograms ngaphakathi kweentsuku ezi-3 ukuya kwezi-5), ukunciphisa ukuchama ngaphandle kokusela amanzi amaninzi, isicaphucaphu, ukugabha nokuphefumla kancinci. Amatyala amancinci anokunyangwa ngokuphumla ebhedini. Iimeko ezinzima kakhulu zifuna ukukhutshwa kwamanzi ngenaliti kwaye mhlawumbi kulaliswe esibhedlele.

Izifundo zonyango zibonise ukuza kuthi ga ngoku ukuba iziyobisi zokuchuma azidibananga nomhlaza we-ovari.

Umngcipheko wokufunyanwa kweqanda kubandakanya ukusabela kwi-anesthesia, ukopha, usulelo, kunye nomonakalo kulwakhiwo olujikeleze ii-ovari, ezinjengezilonda kunye nesinyi.

Kukho umngcipheko wokukhulelwa okuninzi xa kufakwa ngaphezu kombungu omnye kwisibeleko. Ukuthwala ngaphezulu komntwana omnye ngexesha kwandisa umngcipheko wokuzalwa ngaphambi kwexesha kunye nesisindo sokuzalwa esisezantsi. (Nangona kunjalo, nosana olunye oluzelwe emva kwe-IVF lusemngciphekweni omkhulu wokungakhuli komzimba kunye nobunzima bokuzalwa.

Akucaci nokuba i-IVF iyawonyusa na umngcipheko weziphene zokuzalwa.

IVF ibiza kakhulu. Ezinye, kodwa ayizizo zonke, ezinemithetho ethi iinkampani zeinshurensi yezempilo kufuneka zinikeze uhlobo oluthile lokugubungela. Kodwa, izicwangciso ezininzi zeinshurensi azigubungeli unyango lokungachumi. Imirhumo yomjikelo omnye we-IVF ibandakanya iindleko zamayeza, utyando, i-anesthesia, i-ultrasound, uvavanyo lwegazi, ukuqhubekeka kwamaqanda kunye nesidoda, ukugcinwa kwembungu, kunye nokudluliselwa kombungu. Inani elipheleleyo lomjikelo we-IVF liyahluka, kodwa linokubiza ngaphezulu kwe- $ 12,000to $ 17,000.

Emva kokudluliselwa kwembungu, umfazi unokuxelelwa ukuba aphumle okuseleyo kosuku.Ukuphumla kokulala akukho mfuneko, ngaphandle kokuba kukho umngcipheko owandisiweyo we-OHSS. Uninzi lwabasetyhini lubuyela kwimisebenzi yesiqhelo ngosuku olulandelayo.

Abasetyhini abangena kwi-IVF kufuneka bathathe yonke imihla okanye iipilisi zehomoni progesterone kangangeeveki ezisi-8 ukuya kwezi-10 emva kokudluliswa kombungu. Iprogesterone yihomoni eveliswa ngokwendalo zii-ovari ezilungiselela umda wesibeleko (isibeleko) ukuze umbungu unamathele. Iprogesterone ikwanceda ukuba umbungu ofakelweyo ukhule kwaye uzinze esibelekweni. Umfazi unokuqhubeka nokuthatha iprogesterone kangangeeveki ezisi-8 ukuya kwezi-12 emva kokukhulelwa. I-progesterone encinci kakhulu kwiiveki zokuqala zokukhulelwa ingakhokelela ekuphumuleni komzimba.

Malunga neentsuku ezili-12 ukuya kwezili-14 emva kokudluliswa kombungu, owasetyhini uya kubuyela ekliniki ukuze kwenziwe uvavanyo lokukhulelwa.

Fowunela umboneleli wakho ngoko nangoko ukuba ubune-IVF kwaye une:

• Umkhuhlane ongaphezu kwe-100.5 ° F (38 ° C)
• Intlungu yePelvic
• Ukopha ngamandla kwilungu lobufazi
• Igazi kumchamo

Izibalo ziyahluka ukusuka kwiklinikhi ukuya kwenye kwaye kufuneka zijongwe ngononophelo. Nangona kunjalo, inani lezigulana lahlukile kwiklinikhi nganye, ngoko ke ingxelo yokukhulelwa exeliweyo ayinakusetyenziswa njengophawu oluchanekileyo lokuba iklinikhi enye iyathandwa kwenye.

• Amanani okukhulelwa abonisa inani labasetyhini abakhulelweyo emva kwe-IVF. Kodwa ayisiyiyo yonke into yokukhulelwa ekhokelela ekuzalweni okuphilayo.
• Amanqanaba okuzalwa aphilayo abonisa inani labasetyhini abazala umntwana ophilayo.

Umbono wamazinga okuzalwa aphilayo axhomekeke kwizinto ezithile ezinje ngobudala bukamama, ukuzalwa kwangaphambili kokuzalwa, kunye nokudluliselwa kombungu omnye ngexesha le-IVF.

Ngokwe-Society of Assisted Reproductive Technologies (SART), ithuba elimalunga nokuzala umntwana ophilayo emva kwe-IVF ngolu hlobo lulandelayo:

• I-47.8% yabasetyhini abangaphantsi kweminyaka engama-35
• I-38.4% yabasetyhini abaneminyaka engama-35 ukuya kuma-37
• Iipesenti ezingama-26 kubafazi abaneminyaka engama-38 ukuya kuma-40
• I-13.5% yabasetyhini abaneminyaka engama-41 ukuya kuma-42

IVF; Uncediso lwetekhnoloji yokuzala; UBUGCISA; Inkqubo yovavanyo lwetyhubhu yomntwana; Ukungachumi - kwi vitro

UCatherino WH. Ukuzala i-endocrinology kunye nokungachumi. Ku: IGoldman L, iSchafer AI, ii-eds. Amayeza eGoldman-Cecil. Ngomhla wama-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 223.

Choi J, Lobo RA. In vitro isichumiso. Ku: Lobo RA, Gershenson DM, Lentz GM, Valea FA, ii-eds. Gynecology egqibeleleyo. Umhla wesi-7. IPhiladelphia, PA: Elsevier; Ngo-2017: isahluko 43.

Ikomiti yokuziqhelanisa noMbutho waseMelika woNyango lokuZala; Ikomiti yokuziqhelanisa noMbutho weTekhnoloji yoNzala yokuNzala. Isikhokelo kwimida yenani leembumba zokuhambisa: uluvo lwekomiti. Ukuchuma okuchumileyo. Ngo-2017; 107 (4): 901-903. IINKCUKACHA: 28292618 pubmed.ncbi.nlm.nih.gov/28292618/.

I-Tsen LC. In vitro fertilization kunye nenye itekhnoloji yokunceda. Ku: Chestnut DH, Wong CA, Tsen LC, et al, ii-eds. I-Chestnut's Obstetrics Anesthesia. Umhla wesi-6. IPhiladelphia, PA: Elsevier; 2020: isahl. 15.