In vitro feteleza (IVF)

In vitro fertilization (IVF) ndikulowa kwa dzira la mkazi ndi umuna wa abambo mchakudya cha labotale. In vitro amatanthauza kunja kwa thupi. Feteleza amatanthauza kuti umuna walumikiza ndikulowa dzira.

Nthawi zambiri, dzira ndi umuna zimakumana ndi umuna m'thupi la mkazi. Dzira la umuna likamangirira m'mbali mwa chiberekero ndikupitirizabe kukula, mwana amabadwa patatha miyezi 9. Izi zimatchedwa kuti lingaliro lachilengedwe kapena losathandizidwa.

IVF ndi njira yothandizira ukadaulo wobereka (ART). Izi zikutanthauza kuti njira zapadera zamankhwala zimagwiritsidwa ntchito kuthandiza mayi kutenga pakati. Amayesedwa nthawi zambiri njira zina, zotsika mtengo zakubereka zalephera.

Pali zinthu zisanu zofunika kuchita ku IVF:

Gawo 1: Kukondoweza, komwe kumatchedwanso super ovulation

• Mankhwala, omwe amatchedwa mankhwala obereketsa, amapatsidwa kwa mayiyo kuti athandize kupanga mazira.
• Nthawi zambiri, mkazi amatulutsa dzira limodzi pamwezi. Mankhwala obereketsa amauza thumba losunga mazira kuti lipange mazira angapo.
• Munthawi imeneyi, mayiyo amakhala ndi ma ultrasound opitilira nthawi yayitali kuti awone thumba losunga mazira ndi kuyezetsa magazi kuti awone kuchuluka kwa mahomoni.

Gawo 2: Kutenga dzira

• Kuchita opaleshoni yaying'ono, yotchedwa follicular aspiration, kumachitika kuti achotse mazira m'thupi la mkazi.
• Opaleshoniyo imachitika muofesi ya dokotala nthawi zambiri. Mayiyo adzapatsidwa mankhwala kotero samva kuwawa panthawiyi. Pogwiritsa ntchito zithunzi za ultrasound monga chitsogozo, wothandizira zaumoyo amalowetsa singano yopyapyala kudzera mu nyini mu ovary ndi matumba (follicles) okhala ndi mazira. Singanoyo imagwirizanitsidwa ndi chida chokoka, chomwe chimakoka mazira ndi madzimadzi kuchokera pakhola lililonse, imodzi.
• Ndondomekoyi imabwerezedwa kwa ena ovary. Pakhoza kukhala kuti pali zovuta zina pambuyo pa ndondomekoyi, koma idzatha tsiku limodzi.
• Nthawi zambiri, pakhosi la m'chiuno lingafunike kuchotsa mazira. Ngati mayi sangabereke kapena sangatenge mazira, angagwiritse ntchito mazira omwe aperekedwa.

Gawo 3: Insemination ndi Feteleza

• Umuna wa bambo umayikidwa limodzi ndi mazira abwino kwambiri. Kusakanikirana kwa umuna ndi dzira kumatchedwa insemination.
• Mazira ndi umuna zimasungidwa m'chipinda choyang'aniridwa bwino. Umuna nthawi zambiri umalowa (kutulutsa feteleza) dzira patangopita maola ochepa kuchokera pamene linayikidwa.
• Ngati dokotalayo akuganiza kuti mwayi wa umuna ndiwochepa, umunawo ungalowemo dzira. Izi zimatchedwa intracytoplasmic sperm injection (ICSI).
• Mapulogalamu ambiri obereketsa amachita ICSI m'mazira ena, ngakhale zinthu zikuwoneka ngati zachilendo.

Gawo 4: Chikhalidwe cha mluza

• Dzira likakumana ndi ubwamuna limasanduka mluza. Ogwira ntchito ku labotale amayang'ana kamwana kameneka kuti atsimikizire kuti ikukula bwino. Pakadutsa masiku asanu, mwana wosabadwayo amakhala ndi maselo angapo omwe akugawana.
• Mabanja omwe ali pachiwopsezo chachikulu chopatsira mwana wawo matenda amtundu wobadwa nawo angaganize kuti matendawa asanabadwenso (PGD). Njirayi imachitika masiku atatu kapena asanu pambuyo pa umuna. Asayansi a labotale amachotsa khungu limodzi kapena khungu m'mimba iliyonse ndikusanthula zinthuzo pazovuta zamtundu winawake.
• Malinga ndi American Society for Reproductive Medicine, PGD imatha kuthandiza makolo kusankha miluza yomwe angaimitse. Izi zimachepetsa mwayi wopatsira mwana matenda. Njirayi ndi yotsutsana ndipo siyiperekedwa konseko konse.

Gawo 5: Kusamutsa mwana m'mimba

• Mazirawo amaikidwa m'mimba mwa mkazi patatha masiku atatu kapena asanu kuchokera pamene mazira amatengedwa ndi umuna.
• Njirayi imachitika kuofesi ya adotolo mkaziyo atadzuka. Dokotala amalowetsa chubu chofewa (catheter) chomwe chili ndi mazirawo mu nyini ya mkaziyo, kudzera pachibelekero, mpaka mmimba. Ngati mluza umakanirira (zopangira) m'mbali mwa chiberekero ndikukula, pamakhala mimba.
• Mimba yopitilira imodzi imatha kuyikidwa m'mimba nthawi yomweyo, zomwe zimatha kubweretsa mapasa, mapasa atatu, kapena kupitilira apo. Chiwerengero chenicheni cha mazira omwe asamutsidwa ndi nkhani yovuta yomwe imadalira pazinthu zambiri, makamaka zaka za mkazi.
• Mazira omwe sanagwiritsidwe ntchito atha kuzizidwa ndikuikidwa kapena kuperekedwa pambuyo pake.

IVF yachitika kuthandiza mayi kutenga pakati. Amagwiritsidwa ntchito kuthana ndi zomwe zimayambitsa kusabereka, kuphatikiza:

• Msinkhu wokalamba wa mkazi (msinkhu wa amayi apakati)
• Machubu owonongeka kapena otsekeka (angayambitsidwe ndi matenda otupa m'chiuno kapena opaleshoni yam'mbuyomu)
• Endometriosis
• Kusabereka kwa amuna, kuphatikiza kuchepa kwa umuna ndi kutsekeka
• Kusabereka kosadziwika

IVF imaphatikizapo mphamvu zambiri zakuthupi, zamaganizidwe, nthawi, komanso ndalama. Mabanja ambiri omwe ali ndi vuto lakusabereka amakhala ndi nkhawa komanso kupsinjika.

Mzimayi amene amamwa mankhwala obereketsa amatha kuphulika, kupweteka m'mimba, kusinthasintha kwamaganizidwe, mutu, ndi zovuta zina. Majakisoni obwerezabwereza a IVF amatha kupweteketsa mtima.

Nthawi zambiri, mankhwala osokoneza bongo amatha kuyambitsa matenda osokoneza bongo (OHSS). Matendawa amadzetsa madzi m'mimba ndi pachifuwa. Zizindikiro zimaphatikizapo kupweteka m'mimba, kuphulika, kunenepa msanga (mapaundi 10 kapena makilogalamu 4.5 mkati mwa masiku 3 mpaka 5), ​​kuchepa pokodza ngakhale mumamwa madzi ambiri, nseru, kusanza, komanso kupuma pang'ono. Matenda ofatsa amatha kuchiritsidwa ndi kupumula kwa kama. Milandu yovuta kwambiri imafuna kukhetsa madzimadzi ndi singano ndipo mwina kuchipatala.

Kafukufuku wamankhwala awonetsa mpaka pano kuti mankhwala obereketsa samalumikizidwa ndi khansa ya m'mimba.

Zowopsa zobwezeretsa dzira zimaphatikizapo kuyanjana ndi anesthesia, magazi, matenda, komanso kuwonongeka kwa nyumba zomwe zimazungulira mazira, monga matumbo ndi chikhodzodzo.

Pali chiopsezo chokhala ndi pakati kangapo m'mimba yopitilira m'mimba. Kunyamula ana opitilira amodzi pa nthawi imodzi kumawonjezera chiopsezo chobadwa msanga komanso kulemera kochepa. (Komabe, ngakhale mwana m'modzi wobadwa pambuyo pa IVF ali pachiwopsezo chachikulu chotenga msinkhu komanso kubadwa pang'ono.)

Sizikudziwika ngati IVF imachulukitsa chiopsezo cha kupunduka kwa kubadwa.

IVF ndi yokwera mtengo kwambiri. Ena, koma osati onse, ali ndi malamulo omwe amati makampani a inshuwaransi yazaumoyo ayenera kupereka mtundu wina wophimba. Koma, mapulani ambiri a inshuwaransi samakhudza chithandizo cha kusabereka. Ndalama zolipirira gawo limodzi la IVF zimaphatikizapo mtengo wamankhwala, opareshoni, ochititsa dzanzi, openda magazi, kuyesa magazi, kukonza mazira ndi umuna, kusungitsa kamwana, komanso kusamutsa mwana wosabadwayo. Ndalama zonse za IVF zimasiyanasiyana, koma zitha kuwononga $ 12,000to $ 17,000.

Pambuyo pobereka mwana, mayiyo angauzidwe kuti apume tsikulo.Kupuma kokwanira sikofunikira, pokhapokha ngati chiwopsezo cha OHSS chiwonjezeke. Amayi ambiri amabwerera kuzinthu zachilendo tsiku lotsatira.

Amayi omwe amalandira IVF amayenera kumwa ziphuphu tsiku ndi tsiku kapena mapiritsi a progesterone yamasabata 8 mpaka 10 pambuyo pobereka. Progesterone ndi timadzi tomwe timapangidwa mwachilengedwe ndi thumba losunga mazira lomwe limakonza chiberekero cha chiberekero (chiberekero) kuti mluza ugwirizane. Progesterone imathandizanso kuti mwana wosakhwima akule ndikukhazikika m'chiberekero. Mzimayi amatha kupitiriza kumwa progesterone kwa milungu 8 mpaka 12 atakhala ndi pakati. Kuchuluka kwa progesterone m'masabata oyambira kutenga mimba kumatha kubweretsa padera.

Pafupifupi masiku 12 mpaka 14 kuchokera pomwe mwana adasamutsidwa, mayiyo abwerera kuchipatala kuti akayezetse ngati ali ndi pakati.

Itanani omwe akukuthandizani nthawi yomweyo mukadakhala ndi IVF ndipo muli:

• Kutentha kwakukulu kuposa 100.5 ° F (38 ° C)
• Kupweteka kwa m'mimba
• Kutaya magazi kwambiri kuchokera kumaliseche
• Magazi mkodzo

Ziwerengero zimasiyanasiyana pachipatala chilichonse ndipo zimayenera kuwunikidwa mosamala. Komabe, anthu odwala ndi osiyana pachipatala chilichonse, motero kuchuluka kwa pakati sikungagwiritsidwe ntchito ngati chisonyezero cholondola cha chipatala chimodzi chopambana kuposa china.

• Mimba yokhudzana ndi mimba ikuwonetsa kuchuluka kwa azimayi omwe adakhala ndi pakati pambuyo pa IVF. Koma si mimba zonse zomwe zimabweretsa kubadwa kwamoyo.
• Ziwerengero zakubadwa zikuwonetsa kuchuluka kwa azimayi omwe amabala mwana wamoyo.

Maonekedwe a kubadwa kwamoyo kumadalira pazinthu zina monga zaka za amayi, kubadwa asanabadwe, komanso kusamutsa mwana m'modzi pa nthawi ya IVF.

Malinga ndi Society of Assisted Reproductive Technologies (SART), mwayi woyerekeza wobereka mwana wamoyo pambuyo pa IVF ndi uwu:

• 47.8% azimayi azaka zosakwana 35
• 38.4% azimayi azaka 35 mpaka 37
• 26% azimayi azaka zapakati pa 38 mpaka 40
• 13.5% azimayi azaka 41 mpaka 42

Njira; Tekinoloje yothandizira kubereka; ART; Ndondomeko yoyeserera mwana; Kusabereka - mu vitro

Catherino WH. Endocrinology yobereka komanso kusabereka. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. 26 wa. Philadelphia, PA: Elsevier; 2020: chap 223.

Choi J, Lobo RA. In vitro umuna. Mu: Lobo RA, Gershenson DM, Lentz GM, Valea FA, olemba. Gynecology Yambiri. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2017: mutu 43.

Komiti Yoyeserera ya American Society for Reproductive Medicine; Komiti Yoyeserera ya Sosaiti Yothandizira Ukadaulo Wobereka. Kuwongolera pamalire a kuchuluka kwa miluza yosamutsa: lingaliro la komiti. Feteleza wosabala. 2017; 107 (4): 901-903. PMID: 28292618 pubed.ncbi.nlm.nih.gov/28292618/.

Tsen LC. Umuna wa vitro ndi ukadaulo wina wothandizira kubereka. Mu: Chestnut DH, Wong CA, Tsen LC, et al, olemba. Obstetrics Obstetrics Anesthesia. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier; 2020: mutu 15.