Abaphikisi be-GnRH bangemithi ejoqayo esetshenziselwa ukwelashwa kwe-IVF . Bavimbela i-ovulation ngaphambi kwesikhathi, ngakho udokotela wakho uzokwazi ukuthola amaqanda avela kuma-ovari ngaphambi kokuba akhululwe futhi "alahleke."
Ungangqubuzani nama- agonists aseGnRH - njengoLupron - nabaphikisi be-GnRH. I-GnRH i-agonists ibangele ukuthi i-hormone yokuzala ivuke futhi emva kwezinsuku ezimbalwa, ivale lawo mahomoni.
Lapho lisetshenziselwa ukwelashwa kwe-IVF, kudingeka ukuthi iqalwe okungenani amasonto ambalwa ngaphambi kokuba umjikelezo wezokwelapha we-IVF uqale.
Abaphikisi be-GnRH abenzi ukuqala kokuqala kwama-hormone. Iqala emva kokuba umjikelezo we-IVF uqalile futhi ungathathwa kanye noma nsuku zonke izinsuku ezimbalwa. Ngenxa yokuthi zithathwa isikhathi esifushane, zibangela imiphumela emibi kakhulu, isikhathi esifushane.
Inothi elibalulekile! Akuzona zonke imiphumela emibi kanye nezingozi ezibalwe ngezansi. Uma unemiphumela emibi kakhulu, izimpawu ezingavamile, noma ukhathazekile nganoma yisiphi isizathu, xhumana nodokotela wakho. Ulwazi olukulesi sihloko aluhambisani nokubonisana nodokotela wezokwelapha.
Yimiphi Imithi Eyi-Antagonists?
Kunezimbangi ezimbili eziyisisekelo ze-GnRH emakethe: i-acreate i-anirelix ne-acroate e-cetrorelix.
Amagama ebhrenti ye-acetate ye-ganirelix afaka u-Antagon, Ganirelix, no-Orgalutran.
I-Cetrotide yigama legama le-acetate le-cetrorelix.
Le mithi ithathwa nge-injection. Ukwelashwa kungabandakanya umjovo owodwa, ukujova nsuku zonke izinsuku eziningana, noma ukujova okukodwa okwenziwe izinsuku ezimbalwa ngaphandle. Konke kuxhomeke ohlelweni lwakho lwezokwelapha lwe-IVF.
Abaphikisi be-GnRH bayabiza kakhulu kunama-agonists e-GnRH, kodwa izindleko ezengeziwe angeke zenze umthelela omkhulu kusukela abaphikisi bethathwa isikhathi esifushane.
Futhi, abanye besifazane bakholelwa ukuthi imiphumela emibi yilezi zindleko ezengeziwe.
Ngenkathi odokotela abathile bezobeletha bakhetha i-GnRH agonists ngoba bebelokhu behlala isikhathi eside, ucwaninga alutholanga umehluko ekukhuleni kwezinga lokukhulelwa phakathi kwama-agonists nabaphikisi. Khuluma nodokotela wakho uma ungathanda ukucabangela abaphikisi be-GnRH esikhundleni se-GnRH agonist.
Imiphumela emibi ye-GnRH Antagonists
Kokubili umsebenzi we-acroate acetate and ganirelix acetate ngokuvala ikhono le-pituitary gland lokukhiqiza nokukhulula i-FSH ne- LH . Lokhu kubangelwa ukuyeka esikhathini sokugcina, okuholela emiphumeleni emibi. Zingaki imiphumela emibi ongayithola kuncike ukuthi uthatha imithi isikhathi esingakanani.
Imiphumela emibi evamile ye-acroate i-cetrorelix (Cetrotide) ihlanganisa:
- Ubuhlungu besisu nangesisa (4.4% uma kuthathwa nsuku zonke, 2.1% uma kuthathwa njengesilinganiso esisodwa)
- Izinwele (1.3% nge dose yansuku zonke, 0% uma kuthathwa njengesilinganiso esisodwa)
- I-nausea (1.3% ngesilinganiso samalanga onke, 1.1% ngesilinganiso esisodwa)
Imiphumela emibi evamile ye-acetate ye-anirelix (i-Antagon, Ganirelix, i-Orgalutran) ifaka:
- Ukwehlisa isisu ngamanyosi (4.8%)
- Izinwele (3%)
- Ukusuka kwamagciwane (1.8%)
- Ukulimala kwesayithi noma ukulimala (1.1%)
- I-nausea (1.1%)
- Isisu sesisu (1%)
Izingozi ze-GnRH Antagonists
Ukufa kwe-Fetal : Phakathi nezifundo zomtholampilo, u-3.7% wokukhulelwa wakhulelwa ngenkathi ethatha i-acreate i-anirelix iphelile ekufeni kwe-fetus, noma namanje ukuzalwa.
Kungakhathaliseki ukuthi lokhu kuxhunyaniswe nabaphikisi be-GnRH ngokuqondile, noma kwezinye izidakamizwa ze-IVF, i-IVF ngokwayo, noma ukungabi nabantwana, aziwa.
Ukukhubazeka kokuzalwa : Ucwaningo luye lwathola ingozi ekhudlwana yokukhubazeka kokubeletha ekukhulelwe okwakhiwa ngenkathi ithatha i-acetate ye-ganirelix. Kungakhathaliseki ukuthi lokhu kuxhunywe kule mithi ethile, ezinye izidakamizwa ze-IVF, izinqubo ze-IVF ngokwazo, noma ukungazalwa kahle aziwa.
I-Ovarian hyperstimulation syndrome (OHSS) : Kwatholakala kuma-2.4% wabesifazane abaphathwa nge-acreate i-anirelix. I-OHSS ayibangelwa ngempela abaphikisi be-GnRH, kodwa yi-gonadotropins ethathwe ngesikhathi esifanayo.
Ucwaningo luye lwabona ukuthi ingozi yokuthuthukisa i-OHSS iyancipha kakhulu nabathintekayo be-GnRN uma kuqhathaniswa nokwelashwa nama-agonists aseGnRH.
I-OHSS enamandla ikhona ezingaphansi kwezingu-1% zeziguli. Xhumana nodokotela wakho masinyane uma uzwa ukuhlanza, ubuhlungu obukhulu besisu noma isisu, ukutholakala kwesisindo ngokuzumayo, noma ukuqhuma okukhulu.
> Imithombo:
I-CETROTIDE cetrorelix (njenge-acetate). Ishadi Ledatha Yezidakamizwa. Kufinyelelwe ngo-Februwari 4, 2014. http://www.medsafe.govt.nz/profs/datasheet/c/Cetrotideinj.pdf
EYurophu naseMpumalanga Ephakathi Orgalutran Study Group. "Umphumela wokuthoma komtholampilo usebenzisa i-anti-antiagonist ganirelix noma i-protocole ende ye-GnRH i-triptorelin yokuvimbela ukungena kwe-LH ngaphambi kwesikhathi kwabesifazane abakhuthazayo." U- Hum Reprod . 2001 Apr; 16 (4): 644-51. http://humrep.oxfordjournals.org/content/16/4/644.full?sid=3335d39c-68fd-455f-b948-e4ffa2a70b66
Ganirelix Acetate Injection. Idokhumenti yolwazi lokudakwa. I-Merk. Kufinyelelwe ngo-Februwari 4, 2014. http://www.merck.com/product/usa/pi_circulars/g/ganirelix/ganirelix_pi.pdf
I-Ragni G, i-Vegetti W, i- Riccaboni A, i-Engl B, i-Brigante C, i-Crosignani PG. "Ukuqhathaniswa kwama-GnRH agonists nabaphikisi ekusizeni imijikelezo yokukhiqiza iziguli ezisengozini enkulu ye-ovarian hyperstimulation syndrome." U- Hum Reprod . 2005 Sep; 20 (9): 2421-5. I-Epub 2005 Meyi 12. http://www.ncbi.nlm.nih.gov/pubmed/15890731