Okwenza Ungadinga i-FET, Okumele Ukulindele, Izingozi Nezindleko
Ukudluliswa kwe-embryo efriziwe, noma i-FET, kuyindlela yokwelashwa kwe- IVF lapho umbungu ophethwe yi-cryopreserved owadalwa umjikelezo ogcwele we- IVF ususwe futhi udluliselwe kwisibeletho sowesifazane. I-embryprubbed e-cryopreserved ingase isuke kumjikelezo we-IVF wesifazane odlule, noma kungaba umbungu wesibindi. Uma umbungu wesibindi usetshenziswa, umbungu awuhlosiwe ngokoqobo ngokobulili kumlingani wakhe noma kumlingani wakhe.
Esikhathini esiningi, ukudluliswa kwe-embriyo efriziwe kwenzeka lapho kunezibungu "ezingaphezulu" emva komjikelezo we-IVF ojwayelekile. Ukudluliswa "okusha" kuvame ukukhethwa. Kodwa-ke, odokotela abathile bayancoma ukudluliselwa kwe-embryo efriziwe-okubizwa nangokuthi "kufinyelela konke" indlela-lapho ukudluliswa okusha kungalingi khona. Kulesi simo, wonke ama-embrypreserved futhi adluliselwa emjikelezweni we-FET ngenyanga ezayo noma kunjalo.
Konke okudingeka ukwazi ngokuba nomjikelezo we-FET-IVF ungaphansi.
Izizathu Ongase Ube Ne-FET-IVF Cycle
Ungakhetha ukuthi ube nomjikelezo we-FET-IVF uma ...
Ukudluliswa okusha kwe-IVF kwehluleka futhi unemibungu ephihliwe .
Ngesikhathi ukwelashwa kwe-IVF, eyodwa noma emibungu eminingi ingabangela. Kuphephile kuphela, kodwa, ukudlulisa oyedwa noma umbhangqwana ngesikhathi. Ukudlulisa ama-embryo amaningi kunandisa amathuba okukhulelwa okuphezulu (okufana no-triplets noma ama-quadruplets.) Eqinisweni, ukuze uthuthukise le ngozi, abanye odokotela batusa "ukukhetha" ukudluliswa kombungu oyedwa, noma iSET , kuziguli ezinezifo ezinhle.
Ngezinye izikhathi, kunezimbungu "ezengeziwe" ngemva kokujikeleza kwe-IVF. Iningi labantu likhetha ukukhipha ama-embryos awo ngaphezulu noma ukugcoba. Isibonelo, asho ukuthi uthola imibungu emihlanu. Ake sithi udokotela wakho uncoma ukwedluliselwa komzimba ongakodwa. Lokhu kusho ukuthi umbungu owodwa uzodluliselwa, kanti amanye amane azogcinwa.
Ake sithi enye imbryo idluliselwe ayiphumeli ukukhulelwa okuphumelelayo. Kulesi simo, unezinketho ezimbili: Ungenza olunye umjikelezo we-IVF ogcwele, ogcwele noma ungadlulisela emibungu yakho eyodwa noma emibili ngaphambili. Okukhethwa kukho okungabiza kakhulu kungaba ukudlulisela eminye imibungu yakho yangaphambili efriziwe. Yilokho abashadile abaningi abangakhetha ukukwenza.
Ufuna ukunikeza ingane yakho i-IVF-ukhulelwe ingane yakini .
Esikhathini sethu esingenhla, ukuhanjiswa okusha kwembungu akuzange kubangele ukukhulelwa. Ake sithi it. Khona-ke, unemibungu emibili isalinde ekunyameni kwe-cryopreservation. Ama-embryp cruspervised angahlala eqhwa kuze kube phakade.
Esikhathini esizayo, ungase uthathe isinqumo sokwenza umjikelezo we-FET-IVF ukuze unike ingane yakho ingane. (Okunye okukhethwa kukho kuzokwenza ukwenziwa komunye umjikelezo omusha futhi ungasebenzisi imibukiso yakho ekhishwe, kodwa njengoba kushiwo ngaphambili, lena yindlela ebiza kakhulu.)
Imibungu isetshenziselwa izakhi zofuzo .
Ukuxilongwa kwe-pre-plantation diagnosis (PGD) kanye nokuhlolwa kwe-genetic pre-plantation (PGS) basizwa ubuchwepheshe bokuzala okuvumela imibungu ukuba ihlolwe isifo sofuzo ezithile noma iziphambeko. Lokhu kwenziwa ngokuphikisana nombungu ngosuku noma emithathu emva kokukhulelwa, ukubuyiswa kweqanda ngemuva.
Ngesinye isikhathi, imiphumela ibuyela emuva ngesikhathi sokudlulisa embryo. Kodwa-ke, uma usuku oluyisihlanu lwe-biopsy lwenziwa, noma ukuhlolwa kofuzo kuyinkimbinkimbi futhi kudinga isikhathi esengeziwe, yonke imithi ebizwa nge-biopsied i-cryopreserved. Uma imiphumela ibuyele emuva, izinqumo zingenziwa lapho imibungu ihambisa khona. Lokhu kuzoba yi-FET-IVF imijikelezo.
Unesidluliswa sokudluliswa kombungu olukhethiwe, ngaphandle noma ngaphandle kwe-PGD / PGS.
Eyaziwa nangokuthi "i-frozen all" protocol, lokhu kungukuthi ukudluliswa okusha kwe-embryo akuyona ingxenye yecebo nhlobo. Lokhu kungase kwenzeke nge-PGD / PGS, kodwa futhi kungenziwa ngaphandle kokuhlolwa kwezinto zofuzo.
Kukhona inkolelo yokuthi izidakamizwa zokuzala ezikhuthaza ama-ovari amahle kakhulu akudingeki ukuthi zidale izimo ezihle zokufaka izibeletho esibelethweni.
Lokhu kusho ukuthi ukudluliswa okusha kungase kube ncane amathuba okuholela ekukhulelweni okunempilo nokuqhubekayo.
Ukuze ugweme le nkinga, izinsuku ezintathu ukuya kwezinhlanu emva kokuqanda amaqanda, yonke imibungu iyagcinwa. Ngenyanga ezayo noma ngenyanga elandelayo, lapho i-endometrium inethuba lokwenza ngaphandle kwethonya lemithi evuselela ama-ovari, ukudluliselwa kwe-embryo efriziwe kungenzeka.
Phakathi naleso sigaba se-FET, udokotela wakho angase anikeze imishanguzo ye-hormonal ukuthuthukisa ukwamukelwa kwe-endometrium. Lokhu kuyiqiniso ikakhulukazi uma ungazitholi uqobo. Noma, udokotela wakho angenza i-FET njengomjikelezo "wemvelo," nemithi ye-hormone esetshenzisiwe. (Okuningi ngalokhu ngezansi.)
Ingozi yakho ye-OHSS yayiphezulu, futhi ukudluliswa okusha kukhanseliwe.
I-Ovarian hyperstimulation syndrome (i-OHSS) ingozi yemithi yokuzala engahlala emacaleni amakhulu (kodwa angavamile) aholela ekulahlekelweni kokuzala ngisho nokufa. Uma ingozi yakho ye-OHSS ivela phezulu ngaphambi kokuthi ukudluliswa okusha kwe-embrying kungenzeke, kungase kukhanselwe futhi wonke ama-embrypreserved . Lokhu kungenxa yokuthi ukukhulelwa kungadambisa i-OHSS. Kungathatha isikhathi eside ukubuyela ku-OHSS uma ukhulelwe. Uma usuvele uphinde usuka eHSSSS, umjikelezo wokudlulisa umbungu onqamule ungahlelwa.
Ukudluliswa okusha kwembungu kukhanseliwe ngenxa yezizathu ngaphandle kwe-OHSS.
I-OHSS yisona sizathu esivame kakhulu sokudluliswa kombungu omusha ukukhanselwa, kodwa kunamanye amathuba. Ukudluliswa kwakho okusha kungadinga ukukhanselwa uma uthola umkhuhlane noma esinye isifo ngemuva kokuthola iqanda kodwa ngaphambi kokudluliswa. Futhi, uma izimo ze-endometrili zingabonakali kahle ku-ultrasound, udokotela wakho angase ancoma ukuthi i-cryopreserving yonke imibungu. Ngosuku oluthile, ungakwazi ukuhlela i-FET-IVF.
Usebenzisa umnikeli wombungu.
Eminye imibhangqwana ikhetha ukunikela ngemibungu yabo engasetshenziselwa komunye umbhangqwana ongenasifo. Uma unquma ukusebenzisa umnikezeli wombungu, umjikelezo wakho uzoba ukudluliswa kwebridi efriziwe.
Ukudluliselwa okufriziwe ngokusuka ku-Fresh: Yikuphi Okuhle Kakhulu?
Ezinye izifundo zithole ukuthi izinga lokukhulelwa lingcono ngokudluliselwa kwama-embryo amaqanda kunokudluliselwa okusha kwe-embryon. Ucwaningo luye lwathola ukuthi ukukhulelwa okukhulelwe emva kokudluliswa kombungu okubandayo kungaba nemiphumela engcono yengane.
Eziningi zalezi zifundo zenzelwe abesifazane abancane abanesifiso esihle, ngakho-ke akucaci ukuthi kuzosho ukuthini kulabo abangaphezu kweminyaka yobudala engama-35 noma ukuhlushwa okubi. Ucwaningo olungaphezulu kufanele lwenziwe.
Kodwa-ke, uma kubonakala kuyiqiniso ukuthi i-FET-IVF inamathuba amaningi okuholela ekuzalweni okuphilayo kunokudluliselwa okusha, yini okungaba isizathu?
Njengoba kushiwo ngaphambili, enye inkolelo yokuthi kungenzeka ukuthi imithi yokuzala evumelana nokugqugquzela ama-ovarian ayifanele ukubunjwa kwe-endometrium. Lokhu kusho ukuthi ukugqugquzela ama-ovari emjikelezweni owodwa-necebo lokudlulisa imibungu ngesikhathi sokujikeleza okungenzi-ukuvuselela-kungcono kube ngcono ukufakelwa.
Isizathu sesibili kungenzeka ukuthi imibungu eyosinda cryopreservation inamandla. Imibungu ebuthakathaka ingase ingasaphila isikhathi esiningi ebhodini kanye nenqubo yokuqhafaza. Lokhu kungenye yezingozi ozithathayo uma ukhetha ukudluliswa kwebridi efriziwe. Imibungu ethile ingase ingenzi. Kodwa-ke, abanye odokotela bathi lezi mbungu ezingenamandla-ke ngeke ziholele ekukhulelweni okunempilo kunoma yikuphi.
Qaphela: Kungenzeka ukuthi ufunde ngezifundo zangaphambilini, eziqhathaniswa nokudluliswa kwamaqanda amasha. Eziningi zalezi zifundo zakudala zaphetha ngokuthi imijikelezo emisha yokudluliswa kombungu yayinamazinga okukhulelwa okungcono kunokudluliswa kwama-embryo. Kodwa-ke, lolo cwaningo alukwazi ukusetshenziselwa umjikelezo "wonke umgodi". Izifundo zakudala zazibandakanya ukuthatha imibungu engaphansi-engcono kakhulu, ukuyiqhwaza, nokudlulisa imibungu emihle kakhulu ngokushesha. Kunengqondo ukuthi imibungu engaphansi-engcono kakhulu ingaba namazinga aphansi okuphumelela kunabantu ababukeka kahle abadluliselwa emjikelezweni omusha.
Inqubo ye-FET-IVF: Yini Okumele Yilindele Ngesikhathi Sezinyathelo Zokunakekelwa
Kunezinhlobo ezimbili eziyisisekelo zezinhlelo ze-FET-IVF: imijikelezo ye-hormone ukwesekwa kanye nemijikelezo "yemvelo". Umjikelezo owenziwa kakhulu nge-FET-IVF umjikelezo wesimo se-hormonally. Lokhu kungukuthi usuku lokudlulisa kulula ukulawula (okwenza kube lula kumtholampilo wokuzala kanye nelebhu), futhi ngoba ukusekelwa kwe-hormonal kuyadingeka uma kunezinkinga zezinkinga zesifazane.
I-FET ne-Hormonal Support
Umjikelezo we-FET-IVF wokuxhaswa kwama-hormones uqala ekupheleni komjikelezo wangaphambi kokuya esikhathini, kufana nomjikelezo we-IVF ojwayelekile. Izilonda zesidakamizwa okuhloswe ukulawula nokuvala umjikelezo wokuzala zinikezwa. Ngokujwayelekile, i -GnRH agonist i-Lupron isetshenziselwa, kodwa ezinye izidakamizwa zokucindezela i-pituitary zingase zikhethwe esikhundleni.
Uma usuthole isikhathi sakho, umsebenzi wokuqala we- ultrasound kanye negazi uyalwe. Uma konke kubukeka kuhle, isandiso se-estrogen siqalisiwe. Lokhu ukusiza ukuqinisekisa ukukhanya kwe-endometrial enempilo. I-Estrogen supplementation iqhutshwa cishe amasonto amabili. Omunye umsebenzi we-ultrasound nokuningi wegazi uyalwe. Ukuqapha ngesikhathi somjikelezo we-FET-IVF kuncane kakhulu kunesikhathi sokujikeleza kwe-IVF.
Emva kwamasonto amabili okusekelwa kwe-estrogen, ukwesekwa kwe-progesterone kuyongezwa. Lokhu kungase kube nge-progesterone emajenini amafutha noma mhlawumbe nge- suppositories yama-vaginal . Ukudluliswa kombungu kuhlelwe ngokusekelwe ku-a) lapho kuqaliswa ukuxhaswa kwe-progesterone, futhi b) ngisiphi isigaba umbungu owawusindiswa.
Isibonelo, uma umbungu usubhalwe phansi ngosuku lwe-Day 5 emva kokubuyiswa kwamaqanda, ukuhanjiswa kwe-embryo efriziwe kuzokwenziwa isikhathi seSuku 6 ngemuva kokuqala kokuxhaswa kwe-progesterone.
I-FET yemvelo
Ngomjikelezo wemvelo we-FET, imishanguzo ayisetshenziselwa ukucindezela noma ukulawula i-ovulation. Esikhundleni salokho, ukudluliselwa kombungu kuhlelwe ngokusekelwe lapho i-ovulation ivela ngokwemvelo.
Isikhathi sokudluliselwa kombungu kubalulekile. Kumele kwenzeke inombolo ethile yezinsuku emva kokuvuthwa. (Njengoba kushiwo ngenhla, lolo suku luzoxhomekeka ukuthi ngabe imbungu yayinomswakama ngosuku lweSuku 3 noma ngo-Usuku 5 lokubuyiswa kweqanda.)
Ngenxa yokuthi isikhathi siyadingeka, umjikelezo uhlolwe ngokucophelela ekhaya noma ukuhlolwa kwe-ovulation predictor noma emtholampilo wokuzala ene-ultrasound nomsebenzi wegazi. Njengoba izitshalo zokuhlelwa kwe-ovulation akulula ngaso sonke isikhathi ukuhumusha, odokotela abaningi basencike ekusebenzeni kwe-ultrasound kanye negazi kuze kube yisikhathi ukudluliselwa.
Uma kutholakala i-ovulation, i-progesterone supplementation iqalwa, futhi usuku lokudlulisa umbungu luhlelelwe.
Yiziphi Izingozi ze-FET-IVF?
Umjikelezo wokudlulisa embramu obandisiwe unobungozi obuncane kunomjikelezo ogcwele we-IVF. Enye yezingozi eziyinhloko ze-IVF (kanye nemithi yokuzala) i-ovarian hyperstimulation syndrome (OHSS). Kodwa-ke, akudingeki ukhathazeke nge-OHSS kumjikelezo we-FET kusukela izidakamizwa ezivuselela ama-ovarien azisebenzisi.
Kuncike ekutheni imibungu eminingi idluliselwa kanjani, kunengozi yokukhulelwa okuningi. Ngisho nokukhulelwa kwamawele kuhamba nenengozi enkulu kumama nezingane . Ukudluliswa kombungu kulandela ingozi ekhulayo yokukhulelwa kwe-ectopic . Kukhona ingozi encane kakhulu yokutheleleka.
Nge-cryopreservation, amanye ama-embryo angase aphile inqubo yefriji neyomnquma. Ngokudluliswa kombungu okwakhiwe ngamaqanda, lokhu kusho ukuthi ungase ulahlekelwe imibungu eyobe isitholakale uma usuyenzile ukudluliswa okusha.
Ingabe i-cryopreservation ilimaza ingane? Ukuhlaziywa kwe-meta kutholakale ukuthi ukukhulelwa kanye nezinsana kusuka ekudlulisweni kwe-embryo efriziwe, empeleni, kungaba nenempilo kunalabo abavela ekudlulisweni okusha kwe-embryo.
Izinsana zokudlulisa umbungu ezinamafutha zikhona ...
- Ingozi engezansi yokubeletha
- Ingozi encane yokuzalwa kwangaphambi kokuzalwa
- Ingozi engezansi yokulinganisa okuphansi
Ucwaningo olulodwa lwaqhathanisa izingozi zenye uhlobo lokukhubazeka kokuzalwa ekudlulisweni okusha kwe-IVF, ukudluliswa kwama-embryo amaqanda, kanye nezingane ezingokwemvelo ezikhulelwe. Ucwaningo lwathola ukuthi izingane ziphindwe kabili amathuba okuba nesifo sokuzalwa ne-IVF esanda kuqhathaniswa uma kuqhathaniswa nezingane ezivela emvelo. Kodwa-ke, leyo ngozi eyengeziwe yayingabonakali ngokudluliswa kwama-embryo efriziwe. (Qaphela ukuthi ingozi enkulu yokuzalwa kwesici yayisencane kakhulu.)
Kukhona ingozi ekhuphukayo yokuzalwa kwezinsana ezizalwa "ezinkulu ngenxa yobudala bokubeletha" kusukela ekudlulisweni kwama-embryo amaqanda.
Ngakanani Imali ye-FET?
Izindleko ezilinganiselwe zokudluliswa kombungu okhukhulayo ziphakathi kuka- $ 3,000 no-5,000. Lokhu kuhlanganisa ukuqapha, noma yikuphi ukwesekwa kwama-hormonal, kanye nenqubo yokudlulisa ngokwayo. Umjikelezo wemvelo ungadla kancane kancane, ukhiphe izindleko zemithi yokuzala.
Nokho, le ntengo ayihlanganisi izindleko ezivela ekwelapheni kokuqala kwe-IVF , noma ukuguqulwa kokuqala kwemibungu noma izimali zokugcina.
Uma ukhuluma nodokotela wakho mayelana nezindleko, qinisekisa ukuthi intengo abayicaphuna ifaka konke ukuze ukwazi ukuhlela ibhajethi yakho ngokufanele.
> Imithombo:
> Evans J1, Hannan NJ2, Edgell TA3, Vollenhoven BJ4, uLutjen PJ5, Osianlis T4, Salamonsen LA6, Rombauts LJ4. "Ukudluliswa okusha kwe-embryo okufakwe ngokusindile: ukusekela izinqumo zemitholampilo ngobufakazi besayensi nobuchopho." Ukuvuselelwa kwe-Hum Reprod. 2014 Nov-Dec; 20 (6): 808-21. i-doi: 10.1093 / i-humupd / i-dmu027. Epub 2014 Jun 10.
> Maheshwari A1, Pandey S, Shetty A, Hamilton M, Bhattacharya S. "Imiphumela engavamile kanye neyokuphela komzimba ekukhulelweni kwe-singleton okubangelwa ukudluliselwa kwamaqanda amasha afakwe amaqanda amasha okukhiqizwa ngokufaka umanyolo: ukuhlolwa okuhlelekile nokuhlaziywa kwemeta. "Fertil Steril. 2012 Aug; 98 (2): 368-77.e1-9. doi: 10.1016 / j.fertnstert.2012.05.019. Epub 2012 Jun 13.
> Pinborg A1, Henningsen AA, Loft A, Malchau SS, Forman J, Andersen AN. "I-baby syndrome enkulu kuma-singletons azalwe ngemuva kokudluliswa kwe-embryo efriziwe (i-FET): ingabe kungenxa yezici zomama noma i-cryotechnique? "Uhlehlisiwe. 2014 Mar; 29 (3): 618-27. i-doi: 10.1093 / i-humrep / i-det440. Epub 2014 Jan 9.