Abaphenduli Abangalungile, Ukubuyiswa Kwamaqanda Akhanseliwe, Nokudluliswa Kwemibhozo Emisiwe
Ukukhansela kwe- IVF ukuvame ukubhekisela lapho inombolo ephansi ye-follicles ithuthuka kuma-ovari ngesikhathi sokuvuselela ukwelashwa, futhi ukubuyiselwa kwamaqanda kukhanseliwe. Abesifazane abanamaqanda abakhiqizi amaqanda okwanele (noma follicles) ngesikhathi sokwelashwa kuthiwa "abaphenduli abampofu." Phakathi kwamaphesenti angu-5 no-35 abesifazane basabela kahle .
Ngenkathi ukwehluleka ukuhlakulela amapollicle okwanele afaneleka ukuthola amaqanda kuyisinye sezizathu zokujikeleza kwe-IVF, umjikelezo wakho unganciphisa, ulibale, noma awukwazi ukugcwaliswa kwezinye izizathu.
Ezinye izibonelo zibandakanya ukuba amaqanda ambalwa angabikho, ukuhluleka kwamaqanda ukutshala, ukwehluleka kwemibungu ukuthuthukisa evamile, noma ingozi yokuthuthukisa i-ovarian hyperstimulation syndrome . (Izizathu ezengeziwe zokukhipha umjikelezo we-IVF noma ukulibaziseka zibalwe ngezansi.)
Ukuba nomjikelezo wakho we-IVF ukhanseliwe noma ukubambezeleka kungabangela ubuhlungu. Ngalesi sikhathi, usuchithe isikhathi, amandla angokomzwelo, kanye nezimali ezibalulekile. Ukungena esiteji sokudlulisa embryo kungaba buhlungu.
Lokho kusho ukuthi, umjikelezo owodwa okhanseliwe noma obambezelekile akusho ukuthi umjikelezo wakho olandelayo uhloselwe ukuphela okufanayo okusosizi. Futhi, ngezinye izikhathi, ungase ukwazi ukuhamba nomjikelezo naphezu kwezincomo zokukhansela noma izinkomba zokuchazwa kabi.
Nakhu okudingeka ukwazi ukuthi uqondise ukukhansela kwe-IVF nokwenza izinqumo ezinolwazi.
Kungani Umjikelezo Wakho We-IVF Ungase Ukhanseliwe, Usheshe noma Uhluleke Ukuqedela
Cishe wonke umuntu oqala umjikelezo we-IVF uyazi ukuthi ukukhulelwa nokuzalwa okuphilayo akuqinisekisiwe.
Kodwa abaningi bayamangala uma bengenzi ukudlulisela embryo.
Nazi ezinye izizathu ezingenzeka ukuthi umjikelezo wakho we-IVF ungabambezeleka, ukhanseliwe, noma uhluleke ukufinyelela ekudlulisweni kombungu.
Isisekelo se-ultrasound noma i-blood work problem : Ekuqaleni komjikelezo we-IVF (noma noma yimuphi umjikelezo wezokwelapha we- fertility ), umsebenzi wokuqala we- ultrasound kanye negazi uyalwe.
Lokhu kwenziwa ngokuyinhloko ukuqinisekisa ukuthi ayikho ama-cysts kuma-ovari. Uma kutholakala i-cyst, ukwelashwa kungadinga ukubambezeleka.
La ma-cysts ajwayelekile futhi ahamba ngaphandle kokungenelela okungeziwe. Uma sekuxazululwe, ungase ukwazi ukuqala umjikelezo we-IVF ngemuva kokulibaziseka okufutshane, noma kungadluliselwa kwenye inyanga.
Akuyona follicle eyaneleyo ethuthukayo : Okushiwo ekuqaleni, yilokho ama-ovarie awaphenduli kanye nokulindeleke emithini yokuzala . Zingaki izintambo "ezinganele"? Incazelo "ephansi kakhulu" ihluka phakathi kodokotela, kodwa ngokuvamile, izintambo ezintathu noma ezimbalwa zizoholela ekukhanselweni. Abanye odokotela bazokhansela umjikelezo uma kunezintambo ezingaphansi kwamahlanu.
Uma ungenayo i-follicle eyanele, ukubuyisa amaqanda kungakhanselwa umtholampilo wakho, noma udokotela wakho angancoma ukukhansela kodwa akuvumele ukuthi wenze ucingo lokugcina ukuthi ungaqhubeka kanjani. Udokotela wakho futhi uzocoma ukuthi uhlele ukuqokwa kokubonisana okulandelayo okumele ucabange ngomjikelezo wezokwelapha wesikhathi esizayo.
(Lokhu konke, endleleni, kuthatha ukuthi unomuthi wokwelapha we-IVF. Uma unomjikelezo "wezemvelo" we-IVF, noma umjikelezo "we-mini-IVF" , uthola eyodwa noma ambalwa follicle kulindeleke futhi ungaphakathi empeleni umgomo.)
Amazinga e-estrogen aphansi : Uma amazinga e-estrogen ephansi kunalindelekile ngesikhathi se-ovulatory stimulation ingxenye yomjikelezo wakho, lokhu kungabonisa izinkinga ngokuthuthukiswa kwe-follicle.
Umjikelezo awunqatshelwe ukukhansela kuphela ngenxa yamazinga e-estrogen aphansi-ayifunayo-ngokuvamile, kuyisinqumo esenziwe ngokusekelwe kulokhu nokuthi zingaki izinhlobo zezintambo.
Amazinga e-Estrogen aphezulu kakhulu : Njengokuba kungenzeka ukuthi angaphathi kahle izidakamizwa zokuzala, kungenzeka futhi ukucasula. Lokhu kungaholela e- ovarian hyperstimulation syndrome (OHSS) , isimo sokuthi uma kushiywa kungalashwa kungaba yingozi. Ezimweni ezimbi, ezingavamile, kungabangela ukulahlekelwa kokuzala ngisho nokufa.
Uma amazinga e-estrogen akho ephakeme kakhulu, umjikelezo wakho ungakhanselwa. Lokhu kungase kwenzeke ngaphambi kokuba i-trigger idutshule, ngaphambi kokubuyiselwa kweqanda, noma ngemva kokuqanda amaqanda. Uma ukukhansela kwenzeka ngemva kokuqanda amaqanda, futhi amanye ama-embri enempilo athola lebhu, leyo mibungu ingase ibe yinkimbinkimbi. Zingakhanjiswa kamuva bese zidluliselwa ngomjikelezo wokudlulisa embryo, noma i-FET.
Kungaba yingozi ukudlulisa imibungu uma uhlakulela icala elibi le-OHSS. Ukukhulelwa kungenza kube nzima ukululama kusuka ku-OHSS. Kungcono ukulinda omunye umjikelezo bese wenza i-FET.
Esikhathini esizayo, udokotela wakho angakwazi ukusebenzisa imithi ephansi yezidakamizwa zokuzala noma isenzo esilandelayo sokugwema enye impendulo ye-ovarian hyperstimulation response.
Izilinganiso ezingalindelekile zehlisa ama-estrogen : Amanye ama-protocol ama-IVF anqatshelwe ukwehla kwi-estrogen ngaphambi kwesigaba sokubuyiselwa amaqanda. Lokhu akuyona inkinga, ngokusho kocwaningo.
Nokho, uma amazinga e-estrogen ewa ngokungalindelekile ngaphambi kokubuyiswa kwamaqanda, lokhu kungase kube uphawu olubi. Udokotela wakho angancoma ukuthi ukhansele ukubuyiswa kwamaqanda, ukugcina imali namandla angokomzwelo ekuqhubekeleni umjikelezo okungenakwenzeka ukuphumelela.
Ukungathathi i-hCG / trigger ngesikhathi esifanele : Umuthi we-fertility hCG uthathwa ngomjovo cishe amahora angu-36 ngaphambi kokubuyiswa kweqanda. Isikhathi salo mjovo sibalulekile. Uma kuthathwa ngesikhathi esingalungile, amaqanda angase avuthe ngaphambi kwenqubo yakho. Uma amaqanda ekhishwa emgodini wezintambo, angeke athole i-IVF.
Udokotela wakho uzokunika isikhathi esiqondile sokuzinikela lo mjovo. (Ezinye imitholampilo izoba neziguli zabo zingene emtholampilo ukuthola isibhamu ngoba isikhathi sibaluleke kakhulu.) Uma usithatha ngesikhathi esingalungile, noma kunjalo, umjikelezo wakho ungadinga ukukhanselwa.
Awekho amaqanda abuyiselwe : Ukuthi, zonke izintambo kufanele zibe neqanda. Kodwa akusebenzi kanje. Ngezinye izikhathi, i-follicles ayinalutho. Ungaba nenani elihle lezintambo, kodwa ungatholi noma yikuphi amaqanda avela kubo.
Uma kungekho amaqanda, ukukhulelwa ngeke kwenzeke. Umjikelezo uzophela lapha.
Amazinga e-progesterone aphakeme kakhulu : I-Progesterone iyi-hormone ephakama ngemva kokuvuthwa. Kusiza ukulungisa ubuningi be-endometrial , lapho umbungu uzomisa khona ithemba, futhi kusiza ukugcina ukukhulelwa. I-progesterone akufanele iqale ukuvuka kuze kube ngemva kokuqanda amaqanda (noma ukuvuthwa).
Kodwa-ke, abanye besifazane bayothola amazinga e-progesterone ekhulayo ngosuku lokuqanda amaqanda. Ucwaningo oluthile luye lwathola ukuthi ukudluliswa kombungu phakathi nale mijikelezo kungenakwenzeka ukuholela ekuphumeleleni kokukhulelwa.
Uma lokhu kwenzeka kuwe, udokotela wakho angase ancoma ukuthi i-cryopreservation yanoma imuphi imibungu futhi ihlele ngosuku oluthile ukudluliselwa kwebridi efriziwe. Ukulinda kungaba nzima, kodwa kungase kuthuthukise izinkinga zokuphumelela kokwelapha.
Ayikho imibungu yokudlulisa : Ngezinye izikhathi, ngisho nangemva kokuba inqwaba yamaqanda ibuyiselwe, ukukhulelwa akukwenzeka. Lokhu kusho ukuthi ngeke kube nemibungu yokudlulisa.
Futhi, ngezinye izikhathi amaqanda ahluma kodwa imibungu ewumphumela ayimpofu empilweni noma "ukuboshwa" ekuthuthukiseni ngaphambi kokuba idluliselwe. Esinye isizathu kungenzeka ukuthi awunayo imibungu yokudlulisa uma imiphumela ye-PGS / PGD yokuhlola i-genetic ibonisa ukuthi imibungu inezinkinga zofuzo noma ze-chromosomal.
Ukubonisa izimpawu ze-OHSS engozini : Njengoba kushiwo ngenhla, i-ovarian hyperstimulation syndrome ingaba yingozi kakhulu uma ingashiywanga ingalashwa. Uma izimpawu zakho, i-ultrasound, noma umsebenzi wegazi kubonisa ingozi ephezulu ye-OHSS, umjikelezo wakho ungakhanselwa noma uhlehliswe.
Lokhu kungase kwenzeke ngaphambi kokubuyiswa kwamaqanda noma ngemuva kokubuyiselwa kodwa ngaphambi kokudluliswa kombungu.
Ukugula okungahambisani ne-IVF : Uma ngabe omunye umlingani ewela ngesifo esibi phakathi kokuphathwa, umjikelezo ungakhanselwa noma ubambezeleke. Umkhuhlane omkhulu ungathinta kabi izibalo zesilisa.
Qiniseka nodokotela wakho uma unomkhuhlane ophezulu noma wehla ngezinye izinto phakathi nenyanga yakho yokwelapha. Kungadumaza ukuthi udinga ukukhansela noma ukubambezela ukwelashwa, kodwa ezinye izifo zinganciphisa izinkinga zakho zokuphumelela futhi zingafaka impilo yakho yonke engozini uma ihlangene nokucindezeleka ngokomzimba kokwelashwa.
Ungakwazi Yini Ukubhekana Ne-Egg Retrieval Ngisho Namaqanda Ambalwa / Amafolda?
Umntwana wokuqala we-IVF wakhulelwa ngeqanda elilodwa elifisa. Ezokwelapha zemvelo kanye ne-mini-IVF, eyodwa noma nje follicles ezimbalwa kuyadingeka. Ngakho-ke, kungani ungahambi nje nokubuyiswa kwamaqanda phakathi ne-IVF evamile ngisho noma unezintambo ezimbalwa ezikhulayo?
Lokhu kuyinkinga ephikisanayo. Kunabanye odokotela abazimisele futhi bangakukhuthaza nokuba uqhubeke nokuqanda amaqanda. Kwezinye izimo, lokhu kuyimeko enhle kakhulu yowesifazane othile. Uma uye wehlisa ama-ovarian reserves futhi akafuni ukusebenzisa umxhasi weqanda , ehamba nomjikelezo ngisho nangenkinga encane yokuphumelela kungenzeka ukuthi abe namathuba akhe amnandi okukhulelwa.
Noma kunjalo, kubalulekile ukwazi ukuthi impendulo embi emithini yokuzala ayiyona into efanayo nomuntu oye wakhuthazwa kuphela ekuthuthukiseni amaqanda ambalwa noma okumbalwa wokuthola. Ukuthi ama-hormone aphezulu akwanele ukuvuselela kakhulu ama-ovari angase akhombise ukuthi izinga leqanda libi.
Akuwona wonke udokotela oyokunika ithuba lokuqhubeka nokubuyiswa kweqanda uma izinombolo zakho ze-follicle ziphansi kakhulu. Abanye bayokunika umbono wabo ngalokho okufanele ukwenze kodwa ushiye isinqumo sokugcina ezandleni zakho.
Nazi ezinye izibalo ukukusiza ukuthi wenze ukukhetha:
- Ngokwezifundo ezihlukahlukene, "abaphenduli abampofu" ababhekana nokuqanda amaqanda banamathuba angama-7.6 kuya ku-17.5 wamaphesenti okuthola ukukhulelwa (uma kuqhathaniswa namaphesenti angu-25,9 kuya ku-36.7 amathuba kulabo abasabela ngokujwayelekile).
- Uma ucubungula yonke idatha, abaphendulayo abampofu banesigamu ithuba lokukhulelwa uma behamba ngokuqanda amaqanda.
- Imicimbi yobudala. Abaphenduli abampofu abaneminyaka engu-36 noma encane babe namanani okukhulelwa phakathi kwamaphesenti angu-13 no-35. Abaphenduli abampofu abaneminyaka yobudala engama-37 nangaphezulu babenezinga eliphezulu lokuphumelela : phakathi kuka-1.5 no-12.7 wamaphesenti.
- Izindaba zesisindo. Abesifazane abakwa- BMI abangaphezu kuka-30 babengenakuthola kakhulu ukukhulelwa uma kuqhathaniswa nabaphenduli abampofu ngesisindo esivamile.
- Abesifazane ababephakanyisile amazinga e-FSH babengenakudlula kakhulu ukukhulelwa emva kokuphendula okungalungile, uma kuqhathaniswa nabaphenduli abampofu abanezinga elijwayelekile le-FSH. (Amaphesenti aphezulu e-FSH abe nezinga elingama-4 kuphela lokukhulelwa, uma kuqhathaniswa namaphesenti angu-14.8 kulabo abanamazinga ajwayelekile we-FSH kepha impendulo embi.)
Inani langempela lamaqanda libuyisa izindaba, ngamaqanda ambalwa aholela ekutheni izinga lokukhulelwa eliphansi. Ucwaningo lwesithathu lwalubuka izinga lokukhulelwa ngokusekelwe kwinani lama-oocyte.
- Abesifazane abathola iqanda elilodwa baphinde bathuthukiswe izinga lokukhulelwa phakathi kwama-0 no-2.3%.
- Labo abathola amaqanda amabili athole amazinga angama-4.3 no-15.2%.
- Ucwaningo olulodwa lwathola ukuthi abesifazane ababenama-oocyte amahlanu atholakala ukuthi babe nokukhulelwa ngamaphesenti angu-22.
Ukushintsha kusuka ku-IVF kuya ku-IUI Mid-Cycle
Enye indlela udokotela wakho anganikeza ngayo ukuguqula umjikelezo wakho kusuka ku-IVF kuya kumjikelezo we- IUI . Lokhu, kungaba njalo, uma ama-ovari akho engaphenduli ngendlela efanele. Ngeke uthande ukushintshela kumjikelezo we-IUI uma ama-ovari akho aphenduliwe kahle.
Kungakhathaliseki ukuthi lokhu kuyisinqumo esihle ukuthi uzothola izindleko, izizathu zakho zokungakhulelwa, nokuthi yiziphi izinkinga zesilisa ezisekudlaleni.
Isibonelo, uma uvimbele amashubhu we-fallopian , i-IUI ngeke ibe inketho. Uma izibalo zesilisa zomlingani zakho ziphansi kakhulu , noma i- IVF ne-ICSI iyadingeka, ukushintshela kumjikelezo we-IUI kungenzeka ukuthi akunakwenzeka.
Ngezinye izikhathi, kunezintambo ezimbalwa kakhulu ze-IVF kodwa namanje ziningi kakhulu ze-IUI. Ukuba ne-follicle emithathu kuya kwemihlanu kusho, nge-IUI, usengozini yokukhulelwa ngamathathu, ama-quadruplets, noma ngisho nama-quintuplets . Lokhu kungabeka impilo yakho kanye nanoma yikuphi abantwana abathandekayo bezempilo besengozini.
Yini Okulandelayo? Kufanele Uzame Futhi Ngemva Kokukhishwa kwe-IVF?
Ngemva kokulindela okukhulu nokutshalwa kwezimali ngokwezimali , ukuba umjikelezo wakho ukhanseliwe kungakushiya uzibuze-uma uzama futhi?
Lo mbuzo akulula ukuphendula futhi kuncike esimweni sakho esithile. Ezimweni eziningi, yebo, uma unezindleko zezimali, kufanelekile ukuzama futhi. Udokotela wakho angafunda ukuthi angaphatha kanjani kangcono umjikelezo wakho olandelayo ngokuya kokungahambanga kahle okokuqala.
Isibonelo, uma usuphelile-uphendule emithini yemithi yokuzala, udokotela wakho anganciphisa ama-dosage noma asebenzise iphrothotho ehlukile esikhathini esizayo. Uma kungekho maqanda azaliswe, udokotela wakho angazama i-IVF nge-ICSI ngesikhathi esizayo. Ngisho nasempikweni embi, kungase kube neprotocol ehlukile engasiza.
Ucwaningo olulodwa lwathola ukuthi amaphesenti angu-54 abesifazane abesabela kahle emjikelezweni owodwa we-IVF baqhubeka ngokujwayelekile ngokulandelayo. (Kubalulekile, noma kunjalo, ukukhombisa ukuthi izinga lokuphumelela lokukhulelwa lisekhona ohlangothini oluphansi kulolu cwaningo: kuphela izinga lokukhulelwa kwe-10.1 emjikelezweni ovamile ophendulayo.)
Kwezinye izimo, umjikelezo okhanseliwe ungumkhuhlane. Ngezinye izikhathi ukuhlolwa kokuzala kubikezela impendulo embi . Ngezinye izikhathi zonke izivivinyo zibukeka kahle futhi izinto azihambi nje njengoba kulindelwe.
Kulezi zimo ikakhulukazi, elinye i-try lingase lizuze. Ucwaningo luye lwabona ukuthi abaphendulayo abampofu abangalindelekile banomphumela wokukhulelwa okukhushulayo wamaphesenti angu-25 kuya ku-47 uma bebuka izinkinga ezingaphezu kwemijikelezo emithathu ye-IVF.
Nokho, kunezikhathi lapho impendulo empofu, ehlangene nezinye izici, kuyisibonakaliso okufanele uqhubeke nayo. Kuye ngenkinga, lokhu kungase kusho ukushukumisela kwi- IVF ngamaqanda omnikelo , i-IVF ne-sperm donor, noma ukucabangela ukutholwa noma impilo engenasibindi .
Izwi elivela ku-Verywell
Akekho ongena emjikelezweni we-IVF ongakwenzanga ukudlulisa embryo. Kuvamile ukuzwa ukudabuka, ukudumala, ngisho nokuthukuthela. Lokhu kuyiqiniso ikakhulukazi uma uthola imali kuphela ukuze uzame kanye.
Qinisekisa ukuthi ngisho nomjikelezo okhanseliwe akuyona imfucuza. Udokotela wakho ngokuqinisekile uzokwazi ukusebenzisa idatha eqoqwe ukusiza ukwenza umjikelezo olandelayo noma isakhiwo somndeni uthathe kangcono. Ngisho noma umjikelezo okhanseliwe ungenzi lutho ngaphandle kokuthi uqinisekise ukuthi kufanele ucabange nge-IVF nge-egg donor, noma uqhubeke ngaphandle kwemithi yokwelapha , lolu lwazi olungenalo ngaphambili.
Khumbula ukuthi umjikelezo wakho wokuqala awuwona uphawu lokuthi olandelayo uzohamba kanjani, futhi ungathola njalo umbono wesibili.
Finyelela ukuthola usizo kusuka kubangani nomndeni . Xoxa nodokotela wakho ngomjikelezo okhanseliwe, ulalele izincomo zakhe, bese unquma-ngemuva kokuba unezikhathi zokucubungula emoyeni isipiliyoni-ukuthi izinyathelo zakho ezilandelayo zizoba yini.
> Imithombo:
> Al-Azemi M1, Kyrou D, Kolibianakis EM, Humaidan P, Van Vaerenbergh I, Devroey P, Fatemi HM. "I-progesterone ephakanyisiwe ngesikhathi sokugqugquzela i-ovarian ye-IVF. "Ukuhlambalazwa Okunezintambo Oku-inthanethi. 2012 Apr; 24 (4): 381-8. doi: 10.1016 / j.rbmo.2012.01.010. Epub 2012 Jan 24.
> Fisher S1, Grin A, Paltoo A, Shapiro HM. "Amazinga we- falling estradiol ngenxa ye- > ngenhloso > ukunciphisa umthamo we-gonadotrophin ayihlotshaniswa nemiphumela emibi ye-IVF, kuyilapho ngokuzenzekelayo kuwela amazinga e-estradiol kubangelwa amazinga aphansi okukhulelwa komtholampilo. "Uhlehlisiwe. 2005 Jan; 20 (1): 84-8. Epub 2004 Oct 15.
> Oudendijk JF1, Yarde F, Eijkemans MJ, Broekmans FJ, Broer SL. "Umphenduli ompofu ku-IVF: ingabe ukubikezelwa kwesimo sezulu kuhlale kuhlupheka?: Ukubuyekezwa okuhlelekile. "Ukuvuselela ukuhlaziya kabusha. 2012 Jan-Feb; 18 (1): 1-11. i-doi: 10.1093 / i-humupd / dmr037. Epub 2011 Okthoba 10.