Ukuqonda i-GnRH Agonists ye-IVF, i-Endometriosis, ne-Fibroids
I-Lupron, i-GnRH agonist, ingenye yezokwelapha ezivame kakhulu nokuzondwa kakhulu kwe- IVF yokwelapha izidakamizwa zokuzala . Lokhu ngokuyinhloko ngenxa yemiphumela emibi engathandeki: ukushintsha kwemizwelo, ikhanda nokushisa okushisayo.
Ama-agonists afana ne-lupron asetshenziswa ngokuyinhloko ekwelapheni kwe- endometriosis ne-fibroids. Ngokuvamile, i-agnist ye-GnRH ingasetshenziselwa ukugqugquzela i-ovulation esikhundleni se-hCG trigger shot evamile phakathi nomjikelezo we- IUI .
Ukusebenzisa i-lupron ukuthola imithi yokwelapha efana ne-IVF kubhekwa "ngaphandle kwelebuli." Lokho kusho ukuthi i-lupron iyingxenye yemithi yokwelapha iminyaka eminingi. Igama elithi "off-label" akufanele likukhathazeke.
Esikhathini eside, imiphumela emibi ye-lupron ingaba yingozi. Ukwelashwa kwe-lupron yesikhathi eside kwenzeka nge-endometriosis noma ukwelashwa kwe-fibroid.
Uma isetshenziselwa ukwelashwa kwesibeletho, i-lupron iyisidakamizwa sokusebenzisa isikhathi esifushane.
Yimiphi Imithi Eyi-GnRH Agonists?
I-Lupron ngumkhiqizo owodwa kuphela we-agnoists we-GnRH.
I-acetate ye-leuprolide, edayiswa ngaphansi kwegama lomkhiqizo i-Lupron Depot, ithathwa nge-injection, ngokuvamile iqala emjikelezweni ngaphambi kokuba ukwelashwa kwe-IVF kuqala.
Uma isetshenziselwa i-IVF, i-Lupron inganikezwa njengemjovo eyodwa noma ukujova nsuku zonke.
I-Nafarelin acetate, ethengiswa ngaphansi kwegama elithi Synarel, futhi i-buserelin, edayiswa ngaphansi kwegama elithi Suprecur, yi-GnRH agonists ethathwe nge-spray yesikhumba nsuku zonke.
Zivame futhi ziqale ngenyanga ngaphambi kokuba i-IVF ihlelwe.
I-Goserelin, ethengiswa ngaphansi kwegama elithi Zoladex, i-agnist GnRH ithunyelwa nge-implant encane, engakhiwa yi-biodegradable, injected ngaphansi kwesikhumba.
Ukufakelwa okukodwa kuthatha inyanga eyodwa.
Imiphumela emibi ye-Lupron
I-Lupron ibeka umzimba emzimbeni wesimiso esiphendukayo, sesikhashana samadoda ase-monoopausal. Iningi lemiphumela emibi lifana nalokho abesifazane ababhekana nakho ngesikhathi sokuya esikhathini.
Izindaba ezinhle ukuthi uma sekuqalwa ukwelashwa kwe-gonadotropin , eminingi yemiphumela emibi izokwehliswa. (Nokho, uzobe ususebenzelana nemiphumela emibi ye-gonadotropin nezingozi .)
Qaphela: Zingaki imiphumela emibi oyitholayo izoxhomeka ukuthi kungani futhi uthatha isikhathi esingakanani ukuthatha ama-agonists e-GnRH. Ngenxa yokuthi i-Lupron yi-agonist esebenzisa i-GnRH kakhulu kunazo zonke ngesikhathi sokunakekelwa kwe-fertility, amaphesenti omphumela ohlangothini olungezansi abhekisela ocwaningweni olwenziwe ngokuqondile ku-Lupron uma kuthathwa amasonto ambalwa. Nakuba amaphesenti angase ahluke phakathi kwamafomu ahlukene e-agnist GnRH, uhlu olujwayelekile lwemiphumela emibi lungafana.
Imiphumela emibi evamile yeLupron ihlanganisa:
- Ukukhanya okushisayo (amaphesenti angu-70 kuya kwangu-80)
- Izinwele (amaphesenti angama-25 kuya kwangu-32)
- I-Mood ishintsha futhi ixakeke (amaphesenti angu-10 kuya kwangu-22)
- Ukomiswa kwama-vaginal nokucasula (amaphesenti angu-11 kuya kwangu-28)
- I-Acne (amaphesenti angu-10)
- Ama-aches omzimba jikelele (amaphesenti angu-8 kuya kwangu-19)
- I-nausea (amaphesenti angu-8 kuya kwangu-13)
- Ubuhlungu obuhlangene (amaphesenti angu-7 kuya kwangu-8)
- I-Edema (amaphesenti angu-5 kuya kwangu-7)
- Ukwesaba (amaphesenti angu-4 kuya kwangu-6)
- Isisu esisondelene ngokujwayelekile (amaphesenti amathathu kuya kwangu-7)
- Inzuzo yesisindo (amaphesenti amathathu kuya kwangu-13)
- Kunciphise libido (amaphesenti amabili kuya kwangu-11)
- Ukuzondwa (amaphesenti amabili kuya kwangu-11)
- Ukulinganisa ("izikhonkwane nezinaliti") ezandleni nasezinyaweni (amaphesenti angu-1 kuya kwangu-7)
- Ububele besisu (amaphesenti amabili kuya kwangu-6)
Uma kuthathwa isikhathi eside, njengoba kunjalo lapho ukwelapha i-endometriosis noma i-fibroids, ungase uyeke ukuthola isikhathi sakho.
Lokhu akuwona umphumela ohlangothini oluthile ngoba kuwumphumela ohlosiwe wezidakamizwa (ukuvala ama-hormone abangela ukuhamba).
Uma i-GnRH i-agonists ithathwa nge-injection, ubuhlungu nokubomvu kwisayithi yokujola kungenzeka.
Lapho kuthathwa njengesifutho esiswini, ukucasuka kwezono kungase kwenzeke.
Inothi elibalulekile! Akuwona wonke amathonya afanelekayo kanye nezingozi ezibalwe. Uma unemiphumela emibi kakhulu, izimpawu ezingavamile, noma ukhathazekile nganoma yisiphi isizathu, xhumana nodokotela wakho. Ulwazi olukulesi sihloko aluhambisani nokubonisana nodokotela wezokwelapha.
Yini Abagnist GnRH? Zisetshenziswa Kanjani Phakathi ne-IVF?
Uhlobo lomuthi wokuzala, i-GnRH i-agonists yi-hormone yokukhiqiza efanisa i-hormone yemvelo ye- gonadotropin-ekhulula i-hormone (GnRH).
I-GnRH agonist kuqala iholela ekukhuleni okusheshayo ekukhiqizeni ama-hormone ama-FSH ne- LH . Kodwa-ke, emva kwalokhu kukhula okuncane, i- pituitary gland iyeka ukukhiqiza ama-hormone , ukuvimbela ukuvunguza .
Ukukhushulwa kokuqala ku-FSH no-LH yingakho i-GnRH i-agonists ingase isetshenziswe ngezinye izikhathi ukudala ukuvuthwa kwe-ovulation.
Kungakho futhi, uma isetshenziselwa ukwelapha i-endometriosis, izimpawu zingase zibe nzima nakakhulu ekuqaleni. (Bheka ngezansi ukuze uthole olunye ulwazi ngalokhu.)
Kulashwa kwe- IVF , izidakamizwa ezifana ne-lupron zisetshenziswa kanye ne- gonadotropin . I-agonists ivimbela ukuvuthwa kwemvelo.
Esikhundleni salokho, udokotela wokuzala uzogqugquzela ngokugqugquzela i-ovulation nezinye izidakamizwa zokuzala, ngendlela elawulwayo eyaziwa ngokuthi i- superovulation .
Isidakamizwa siphinde sivimbele ukuqhuma kwe-LH yemvelo. Ukuqhuma kwe-LH yemvelo kungaholela emaqanda ovulating ngaphambi kokuba athole ama-ovari.
(Uma amaqanda avuliwe ngaphambi kokuba abuyele, athola "alahlekile" ngaphakathi kwesikhumba somzimba. Angeke asetshenziselwe ukwelashwa kwe-IVF uma lokhu kwenzeka.)
I-GnRH Agonists Isetshenziswa kanjani Ukwelapha i-Endometriosis Ne-Fibroids?
Uma isetshenziselwa ukwelapha i- endometriosis , i-GnRH i-agonists ithathwa njalo esikhathini esiyizinyanga ezintathu kuya kweziyisithupha. Ngabe uzothola kaningi kangakanani izijovo kanye / noma ukufiphaza komzimba kuncike ekusebenziseni izidakamizwa.
Umgomo ekuphepheni kwe-endometriosis ukuyeka ukukhiqizwa kwe-estrogen, edla amadiphozi e-endometrial. Ngokulamba "lezi zindleko," ubuhlungu buyancipha.
Phakathi namasonto amabili okuqala kuya kwamathathu okuqala ukwelashwa, izimpawu zakho zingase zibe zimbi nakakhulu. Lokhu kwenzeka ngenxa yokukhulisa kokuqala ku-FSH no-LH. Kufanele ukhulume nodokotela wakho uma ukhathazekile.
Ngemva kwamasonto amane kuya kwangu-8, izimpawu zakho ze- endometriosis kufanele zithuthuke.
Uma isetshenziselwa ukwelapha i-fibroids, umgomo uvame ukunciphisa usayizi we-fibroid ngaphambi kokuhlinzwa. Ngokufa "indlala" i-fibroid ye-estrogen, isisindo siyancipha. Ukwelashwa kungase kwenzeke izinyanga ezintathu noma ezine ngaphambi kokuhlinzwa okuhleliwe.
Ngenxa yokuthi lezi zidakamizwa zibangela umbuso wamasosha wesikhashana, kubalulekile ukwazi ukuthi awukwazi ukukhulelwa ngenkathi uthatha i-GnRH agonists ye-endometriosis noma i-fibroids.
Akuzona ukwelashwa kokuzala kwe- endometriosis noma i-fibroids, futhi ngeke kuthuthukise ukuzala kwakho.
Uma ufuna ukukhulelwa, kuzodingeka uyeke ukwelashwa.
Ngokuya ngemithi oyithathayo, kungathatha noma yikuphi amasonto amane kuya kwanguyisithupha (nge-spal agrayists yama-nasal) noma amasonto ayisithupha kuya kweshumi (enezijovo) ukuze ubuyeke.
Inothi elibalulekile : akufanele uthembele ku-GnRH agonists ukuvimbela ngokuphelele ukuvunguza. Uma kuthathwa ngokuqhubekayo, uma ukhulelwa, i-GnRH agonists ingalimaza ingane ekhulayo.
Ngenxa yalesi sizathu, kungase kudingeke usebenzise indlela yokuvimbela ukuvimbela ukubeletha (njengamakhondomu noma i-diaphragm) ukuqinisekisa ukuthi awukholelwa.
Njengoba njalo, khuluma nodokotela wakho.
Izingozi ze-GnRH Agonists
I-FDA ayihambanga ngokusemthethweni i-Lupron namanye ama-agonists ase-GnRH ukuze asetshenziselwe ukwelashwa kokuzala. Ukusetshenziswa kwalo phakathi ne-IVF kuthathwa ngokuthi "off-label". Ngakho-ke, akukwazi ngempela ukuthi yiziphi izingozi ezikhona lapho zisetshenziselwa ukwelashwa kokuzala.
Ngalokho kusho, lezi yizingozi ezaziwa uma zisetshenziselwa ukwelapha i-endometriosis, fibroids, noma umdlavuza wesi-prostate. Izingozi ngesikhathi ukwelashwa kwe-IVF zingase zibe okufanayo.
Ukucindezeleka : Uma unomlando wokucindezeleka , i-GnRH agonists ingabangela ukucindezeleka okukhulu.
Ungakugcini lokhu kudokotela wakho; babatshele ukuthi uhlangabezana nokucindezeleka okubuhlungu noma ukhathazekile ngemiphumela emibi ehlobene nemizwelo.
Ukwehlisa isisindo samathambo : Kwabesifazane abasebenzisa i-Lupron esikhathini esingangezinyanga ezintathu, ukwehla kwamathambo kwehla ngamaphesenti angu-2.7. Ezinyangeni eziyisithupha zilandela ukwelashwa, ukubonakala kwamathambo kubonakala kuthuthuka, kodwa imiphumela yesikhathi eside engaziwa ngempela.
Ayaziwa ukuthi yikuphi ukwehla kwamathambo okwehla okungafinyeleli. Ngenxa yalesi sizathu, ukwelashwa kwezinyanga ezingaphezu kwezintathu kuya kweziyisithupha akukhuthazwa.
I-Lupron ayinconywa ngabesifazane abasengozini yokunciphisa ithambo labantu. Uma unomlando womndeni we-osteoporosis, khuluma lokhu kudokotela wakho.
I-Pituitary apoplexy : Lokhu kungukuthi isifo se-pituitary (ngokuvamile esingakatholakali) siphume. Lokhu kungavamile kakhulu, ngokuvamile kwenzeka emavikini amabili okuqala okwelashwa, futhi ngezinye izikhathi ngaphakathi kwamahora okuqala.
Uma uzwa ikhanda elibuhlungu ngokuzumayo, ukuhlanza, izinguquko ezibukwayo, ukukhubazeka kwemisipha ngaphakathi noma eduze kwamehlo akho, isimo sengqondo esishintshileyo, noma izimpawu zesifo senhliziyo, thola usizo ngokushesha.
Ingozi encane yokwanda kwesifo sikashukela, ukuhlaselwa yinhliziyo, nokushaywa yisisu : Lezi zingozi zitholakala ngokuyinhloko emadodeni athatha i-GnRH agonists ukuphatha umdlavuza wesibeletho. Kungakhathaliseki ukuthi kuyingozi kubantu besifazane ngenkathi ukwelashwa kwe-IVF kungaziwa.
Okunye okunye ku-GnRH Agonists
Kubalulekile ukwazi ukuthi i-GnRH agonist s akuyona inketho kuphela ye-IVF.
Okunye okubandakanya abaphikisi be-GnRH, njengo-Antagon (ganirelix acetate) ne-Cetrotide (cetrorelix).
Ngokungafani nama-agonists aseGnRH, abaphikisi be-GnRH yi-FDA evunyelwe ukusetshenziswa ngesikhathi sokwelashwa kwe-IVF. Wena uthatha nabo isikhathi esifushane. Lokhu kunganciphisa inani noma ubude besikhathi obhekana nemiphumela emibi.
Abaphikisi be-GnRH bangase bavikeleke, ngokwezinye izifundo. Uma isetshenziselwa ukwelashwa kokuzala, abesifazane babe nengozi ephansi yokuthuthukisa i- ovarian hyperstimulation syndrome uma kuqhathaniswa ne-GnRH agonists.
Ukunciphisa okungenzeka ukuthi i-GnRH abaphikisanayo iyabiza kakhulu futhi akubona bonke ochwepheshe bezokuzala abajwayele ukuwasebenzisa.
Imithombo:
Al-Inany HG, Youssef MA, Aboulghar M, Broekmans F, Sterrenburg M, Smit J, Abou-Setta AM. "Ama-GnRH Antagonist Aphephile Kunama-Agonists: Isibuyekezo Sokubuyekeza Kwe-Cochrane. "Ukuvuselela ukuhlaziya kabusha. 2011 Jul-Aug; 17 (4): 435. i-doi: 10.1093 / i-humupd / dmr004.
U-El-Nemr A, uBhide M, Khalifa Y, Al-Mizyen E, Gillott C, AM-Lower, Al-Shawaf, i-Grudzinskas JG. "Ukuhlolwa kwemitholampilo ye-gonadotrophin ehlukene emithathu-ukukhipha i-hormone efana nohlelo lwe-IVF: okuzofundwa. "I- Eur J Obstet Gynecol Biol ephikisayo . 2002 Jul 10; 103 (2): 140-5.
I-FDA Ukuphepha Kokuphepha Kwezidakamizwa: Ukuvuselela Ukubuyekezwa Kokuphepha Okuqhubekayo kwama-GnRH Agonists kanye nokwazisa kwabakhiqizi be-GnRH Agonists ukufaka ulwazi olusha lwezokuphepha ekubhaleni ngokubhekela ingozi yesifo sikashukela kanye nezifo ezithile ze-Cardiovascular Diseases. I-FDA: Ukuphathwa Kwezokudla Nezidakamizwa zase-US.
Lupron Depot (i-leuprolide acetate ye-depot ukumiswa) Injection, Powder, Lyophilized, For Suspension . Abbott Laboratories.
Izinkuni, Ros. GnRH.