Okufanele Ucabangele
Ukudluliswa kwe-embryo eyodwa (eSET) yilapho unayo embryo engaphezulu kweyodwa emkhatsini wezokwelapha ze- IVF kodwa ukhethe ukudlulisela eyodwa kuphela kwisibeletho. Noma yimiphi imibungu engase isetshenziswe , ingasuswa futhi ihanjiswe emigqeni yokulandelela. Ngeziguli ezinhle zokuhlonza izifo, i-eSET inganciphisa ingozi yokukhulelwa okuphindwe kaningi ngenkathi ingabi kakhulu ekunciphiseni ukwelashwa okuphumelelayo.
Kodwa-ke, ukunquma ngokudluliswa komzimba ongashadile akulula. Imithi ye-IVF iyabiza . Ukudluliswa kwemibungu embalwa kungabangela ukukhathazeka ukuthi umjikelezo awukwazi ukusebenza, okungasho imjikelezo eminingi, isikweletu esengeziwe, nokwesaba okukhulu kokuhluleka. Kungase kube nzima ukuba nethemba lokukhulelwa amawele , mhlawumbe "ukugcwalisa" umndeni wakho kumjikelezo owodwa.
Ukudluliswa kombungu ongashadile akulungile kubo bonke abagulayo. Kulabo abakhethiweyo, kunezizathu ezinhle kakhulu zokuzicabangela ngokungathí sina. I-CDC kanye ne-American Society for Reproductive Medicine (i-ASRM) ithemba ukuthi uzokwenza. Nakhu.
Umbuzo Wama-Embryo Amakhulu Okudluliselwa
Umgomo wokunakekelwa kokuzala yinye ingane enempilo, eyodwa ngesikhathi. Lona ngumphumela omuhle kakhulu kumama nengane. Ungase ucabange ukuthi kusho ukuthi umbungu owodwa kufanele udluliselwe yonke imjikelezo, kungakhathaliseki ukuthi isimo siyini, kodwa akulula. Ngenxa yokuthi une-embryo, lokho akusho ukuthi uzothola ukukhulelwa.
Lokhu kuyiqiniso ikakhulukazi uma imibungu engeyona "ikhwalithi ephezulu" nakwabesifazane abaneminyaka engu-37 noma ngaphezulu .
I- IVF yokuqala eyayikhulelwa umntwana yayingumntwana owodwa wokudluliswa kombungu. Kodwa lokhu kwakungesiyo protocol ejwayelekile phakathi neminyaka yokuqala. Ubuchwepheshe bokuzala bokusiza busebuningi, kanti izinkinga zokuphumelela kokukhulelwa nokudluliswa komzimba oyedwa kwabaphansi kakhulu.
Lokhu kwakusho ukuthi odokotela bavame ukudlulisa imibungu emithathu noma emine ngesikhathi. Ithemba lokuthi umuntu "uzonamathela."
Ngenkathi ukudlulisela inani eliphakeme lemibungu kwaholela ekutheni izinga lokukhulelwa okungcono, liphinde laholela ekukhulelweni okuphindwe kabili futhi okuphakeme kakhulu uma ezinye noma yonke imibungu idluliselwa "ithatha." Njengoba ubuchwepheshe buphuthukisiwe, kwaba lula ukudlulisela "kuphela" imibungu emibili ezigulini ezinhle zokuhlushwa futhi usathola amazinga aphakeme wokukhulelwa. Eyaziwa ngokuthi ukudluliswa kwe-embryo kabili (DET), lokhu kwaba yindlela ejwayelekile kakhulu ekhethwe odokotela neziguli.
Noma kunjalo, ukuhanjiswa kabili kwe-embryo kwakusho ukuthi izinkinga zokukhulelwa amawele zaphezulu, ikakhulu kulabo ababenethuba elihle lokuphumelela. Iziguli ze-IVF ziphindwe izikhathi ezingu-20 zokukhulelwa ngamawele kunabantu abaningi. Kule minyaka eyishumi eyedlule, i-IVF iye yaqhubeka nokuphumelela ekuphumeleleni kwayo kanye nekhono lokukhetha ama-embryo aphezulu. Lokhu kuye kwaholela ekucindezeni ukukhuthaza ukudluliswa kombungu ongashadile.
Kukhona izimo lapho ukudluliswa kwemibungu emibili, emithathu, noma emine kuyisinqumo esinengqondo. Kulabo besifazane abaneminyaka engaphezu kwengu-40 abanamibungu enhle kakhulu, lokhu kuyiqiniso ngokukhethekile. Kodwa lesi sinqumo akufanele senziwe kalula.
Ingabe Ungumkhethi Omuhle we-eSET?
Uma kufanelekile, i-American Society for Medicine Reproductive ikhuthaza odokotela neziguli ukuba bakhethe ukudluliswa kwesisu esisodwa.
Baye bahlakulela iziqondiso ezisekelwe ekucwaningeni ukuze basize ochwepheshe bezokwelapha banqume uma kuyindlela efanele.
Ukudluliswa komuntu oyedwa oyedwa kungaba yisinqumo esifanele uma ...
Umjikelezo wakho uveza embryo engaphezulu kweyodwa . Yiqiniso, uma uthola umbungu owodwa ukudlulisa, ngeke ukhethe ukudluliswa kombungu oyedwa. Uzobe nomunye owokudlulisa.
Kodwa-ke, kulokhu, lokho abakushoyo ukuthi ngaphezu kweyodwa embryo esemqoka eholele ngesikhathi sokukhulelwa kwe-IVF. Ukuthola i-embryo engaphezulu kweyodwa yekhwalithi ephezulu kuyisibonakaliso sokukhulelwa kwakho konke okuhle.
Kusho futhi ukuthi kufanele ube nemibungu eyodwa noma ngaphezulu ukuze ugweme (noma iqhwa).
Lezi zimbungu ezinama-cryopervised zingahlushwa futhi zihanjiswe phakathi nomjikelezo olandelayo, noma lowo olandelayo (uma ukukhulelwa kungenzeki ngalesi sikhathi) noma esikhathini esizayo (uma uzama ingane eyengeziwe).
Uneminyaka engama-35 noma encane . Izinga lokuphumelela kwe-IVF liphakeme kubantu besifazane abaneminyaka engama-35 noma abancane, abakhuluma njalo. Yiqiniso, kuye ngokuthi imbangela yokungasebenzi, lokhu akunjalo njalo. Udokotela wakho angakunika isiqondiso esengeziwe ukuthi ngabe isimo sakho sihlukile yini.
Usebenzisa amaqanda e-donor . I-donor egg IVF inikeza imiphumela engcono kunazo zonke zokubeletha eziphilayo. Lokhu kungenxa yokuthi abanikeli bamaqanda bakhethwe ngokucophelela. I-egg donor IVF inethuba elingcono lokuholela ekukhulelweni kunokuba isifuba esingcono kakhulu se-IVF isiguli esebenzisa amaqanda akhe.
Unemibungu eyodwa noma ngaphezulu, kungakhathaliseki ukuthi uneminyaka emingaki. I-embryy euploid inenani elivamile lama-chromosomes. Iqanda eliphilile ne-sperm enempilo ngayinye lifaka ama-chromosomes angu-23, okwenza kube nama-chromosomes angu-46 (uma ukuhlukaniswa kweseli kuhamba ngokushelela.) Ukutshala nokuphila kwamazinga okubeletha kuphakeme kakhulu kumibungu evulekile.
I-embryo enenani elingavamile lama-chromosomes libizwa nge-aneuploidy. Ukuthatha umhlalaphansi kungase kwenzeke uma umbungu unesi-aneuploidy. I-Downs syndrome ebangelwa inombolo engavamile yama-chromosomes.
Abesifazane abaneminyaka engama-37 abanamathuba okuba baphumelele nge-IVF, kodwa lokhu kubangelwe ikakhulukazi ngenxa yokungahleleki kwe-chromosomal. Kodwa-ke, ngokusebenzisa ukuhlolwa, uma owesifazane oneminyaka engaphezu kwengu-37 etholakala enemibungu e-euploid, ukubikezela impumelelo kuphakeme. Ukudluliswa kombungu ongashadile kuyindlela enhle, nakuba iminyaka yabo ingase ibe yinto engavumelekile.
Ukukhetha i-Embryo Ehamba phambili
Ukudluliswa kombungu ongashadile kukhethwa uma une-embryo engaphezulu kweyodwa. Kodwa udokotela wakho unquma kanjani ukuthi umbungu "ungumgangatho ophezulu?"
Kunezindlela ezimbili eziyinhloko:
- ukubuka i-morphology (noma ukuma) kombungu
- ukwenza i-Screen Comprehensive Chromosome Screening (CCS) ye-embryo
Sekuyisikhathi eside, ukucacisa ukuthi imibungu yayiyikhwalithi ephakeme ngokuyinhloko ngokubheka i-morphology ye-embryo ekhulayo ebhodini. Le ndlela inamaphutha. I-embryo ingabonakala ibe mkhulu ngaphansi kwe-microscope kepha isaba yinto engavamile ngokwakhiwa kwe-chromosom. Kungenzeka futhi ukuba umbungu ubheke "ngaphansi kokuphelela" futhi uhle kahle nge-chromosomally.
Lena namanje indlela eyinhloko yokunquma ukuthi yikuphi imibungu ephakeme kakhulu futhi engekho. Ihlanganiswe ne-IVF yokwelapha eyisisekelo.
Noma kunjalo, indlela enembile kakhulu yokukhetha ama-embryo wekhwalithi eliphezulu i-Comprehensive Chromosome Screening, noma i-CCS. Lona ubuchwepheshe bokuhlola ubuciko obuvumela ukuthi ochwepheshe abhale ama-chromosomes esiphelele (futhi anqume ukuthi ngabe umbungu usebenza kanjani). I-CSS nayo ingakutshela ubulili obufuywayo bombungu. I-CSS ayiyona ephelele njenge-preimplantation ye-genetic diagnosis / screening (PGD / PGS), kodwa ngenxa yalokhu, akudingeki ukuba.
I-CCS ayitholakali emtholampilo wonke wokuzala. Futhi, kusho izindleko ezengeziwe kwizokwelapha zakho ze-IVF. Lokho kusho ukuthi ama-embryo ahlolwe yi-CSS angase aholele ekukhulelweni, okungenakuphela kokuphela kokukhulelwa kwesisu, futhi angakusiza ukhethe ukudluliswa kombungu oyedwa ngokuzethemba okukhulu.
Ukuhlolwa kwe-CSS kunengozi futhi akulungile kuwo wonke umuntu. Lokhu kuyinto yokuxoxa nodokotela wakho.
Ingabe Kungenzeka Kungenzeka Ukuba Ukhulelwe neSET?
Lona umbuzo wezigidigidi. Impendulo ukuthi, kunzima ... kodwa uthembisa.
Uma uqhathanisa umjikelezo owodwa wokukhetha umjikelezo owodwa wokudlulisa embryo ukuya kumjikelezo owodwa wokudlulisa umbungu, amanani okukhulelwa emitholampilo aphakeme kumjikelezo wokudlulisa kabili. Noma kunjalo, kuqhathaniswa okungalungile.
Ukuqhathaniswa okufanele kakhulu ukuqhathanisa amazinga okukhulelwa komjikelezo owodwa wokudlulisa umbungu kuya emijikelezweni emibili yokudlulisa embryo. Ngamanye amazwi, ngomjikelezo owodwa wokudlulisa embryo, omunye uzoba umjikelezo omusha futhi, uma lokho kungazange kubangele ukukhulelwa, i-eSET yesibili izokwenziwa besebenzisa ubungu obomvu obuvela emjikelezweni wangaphambili owedlule.
Lapho izinga lokukhulelwa lifaniswa nalokhu, imiphumela ihluke kakhulu.
Ukuhlaziywa kwemeta yezifundo ezingu-14, ezihlanganisa abesifazane abangaphezu kuka-2 000, abacwaningi bathola ukuthi amazinga okuphumelela kokudluliswa kombungu awazange ahluke kakhulu ekukhethweni kwama-single embryo yokudlulisela uma ubheka imijikelezo emibili noma emithathu engashadile ndawonye. Ucwaningo lubuthole ukuthi uma izimo zokuzalwa eziphilayo ziyizingxenye ezingamaphesenti angu-40 ezinokudluliswa kombungu kabili, kungaba phakathi kwamaphesenti angu-30 no-42 ngokudluliswa okuphindaphindiwe kwe-embryo eyodwa.
Abacwaningi baphinde bathola ukuthi labo ababenokubili ukudluliselwa kombungu babe namaphesenti angu-15 amathuba okukhulelwa okuphindwe kabili, uma kuqhathaniswa namaphesenti angu-1 no-4 okungahambisani nokudluliswa komuntu oyedwa. Kodwa-ke, lezi zifundo zahlulela imibungu esemqoka esekelwe ku-morphology. Kwenzekani uma ukuhlolwa kwe-CSS kwezakhi zofuzo kusetshenziswa? Izinkinga zokuphumelela zibukeka kangcono nakakhulu.
Esifundweni esithile, amazinga okubeletha aphilayo abukwa, eqhathaniswa nokudluliselwa komzimba okukodwa okukodwa (okuhlolwe kusetshenziswa i-CSS) ukukhishwa kwemibuthano yokudlulisa kabili embryo. Ngokungafani nesifundo esingenhla, imijikelezo yayiqhathaniswa ngamunye. (Ngamanye amazwi, umjikelezo owodwa nomjikelezo owodwa wokukhetha umbrebo uma kuqhathaniswa nomjikelezo owodwa wokudluliswa kombungu.)
Bathola ukuthi amazinga okuphumelela awazange ahluke kakhulu. Baphinde bathola ukuthi ingozi yokuzalwa ngokuphindaphindiwe yayiphume kakhulu (amaphesenti angu-0 uma kuqhathaniswa namaphesenti angu-48) ne-CSS ehlolwe ukudluliswa kwe-embryo eyodwa, futhi izingozi zezinkinga ezinjengokulethwa kwezikhathi zangaphambili, ukuzalwa okuphansi, kanye nesikhathi ku-NICU zazihluke kakhulu.
Ukubeletha kwabantwana abangabodwa kwakungaba yingxenye engamatshumi amabili okubeletha kakhulu, umthamo wesithathu wokuba nesisindo sokuzalwa okuphansi, futhi okungaphezulu kwesigamu ukuchitha isikhathi ekamelweni lokunakekelwa okukhulu ngesikhathi sokuzalwa.
Kodwa Ingabe Amawele Angengcono Kakhulu Kunezingane Ezincane Nje?
Uma bebuzwa odokotela babo ukuthi ngabe bayothanda yini ukucubungula ukudluliswa komama oyedwa, ukuze bagweme ukukhulelwa amawele, imibhangqwana eminingi ibuza ukuthi kungani bengathandi ukuthi amawele abe yisisekelo sabo esikhulu. Ngemva kweminyaka yokuzama ukukhulelwa, nomthwalo wezezimali wezokuhlola kanye nokwelashwa, enethemba lokuthola izingane ezimbili kwelinye elilodwa kuzama umsindo.
Kodwa akunjalo. Amawele afika engozini kumama nabantwana abangakazalwa .
Ukukhulelwa kanye nokuzalwa okuyishumi kunamathuba amaningi oku:
- uhlangabezana nokucindezeleka kokukhulelwa
- zizalwe nge-C-isigaba
- uzalwe ngaphambi kwesikhathi
- uzalwe ngesisindo sokuzalwa esincane
- sebenzisa isikhathi ku-NICU, noma i-unit yokunakekelwa okukhulu
Ukukhulisa nokunakekela amawele nakho kungaba nzima. Abazali bamawele bangase:
- ube nobunzima obuningi bokuncelisa
- ubhekene nokukhathala ngokomzimba nangokomzwelo phakathi neminyaka yokuqala
- zinezindleko eziphakeme zokunakekelwa (akusiyo "izinto ezimbili" eyodwa)
Ukuba nomntwana oyedwa ngesikhathi kuyindlela engcono kakhulu.
Kuthiwani Ngezindleko Zokunakekelwa Kwezinzalo?
Esinye isizathu umbhangqwana osebenzelana nokuphelelwa yisifo esingenasifo sangasese singanqikazi ukukhetha ukudluliswa kwesisu esisodwa kungabiza izindleko zokwelapha . Emazweni lapho i-IVF ihlanganiswa khona nomshuwalense wezempilo, izinga lokukhethwa kwe-embryo elilodwa eliphakeme liphakeme kakhulu.
Nazi ezinye izinto okufanele uzikhumbule:
- Izindleko zokudluliswa komuntu oyedwa kanye nomjikelezo wesibili nge-thawed, embryo enamahloni ayifani nemigqa emibili egcwele ye-IVF. Umjikelezo we-embryo-ukudlulisa kuphela uyabiza kakhulu.
- Ngisho noma usindisa imali eminye imijikelezo ye-IVF, amawele angabiza. Awukwazi ukulondoloza imali esikhathini eside.
- Ezinye imitholampilo zinikeza izikhuthazo zezimali ukugqugquzela imibhangqwana ukuba ikhethe ukudluliswa komuntu oyedwa, okufaka izinhlelo zokubuyiselwa imali kanye nezaphulelo. Buza umtholampilo wakho ukuthi bangenzenjani.
- Ukudluliswa kombungu ongashadile kanye nokuhlolwa kwe-CSS kuyinani lemali, kodwa awunamathuba okuba ulahlekelwe amandla futhi kungenzeka ukuthi ukhulelwe nokubeletha okunempilo.
Izwi elivela ku-Verywell
Isinqumo sokukhetha ukwedluliswa kwesisu somuntu oyedwa kufanele senziwe kanye nokufakelwa kukadokotela wakho, futhi ucabangele isimo sakho sezempilo, isimo sezimali kanye nokuzala.
Olunye ulwazi oludingekayo ukunquma ngeke lutholakale kuze kuphele umjikelezo we-IVF, ngemuva kwenqubo yokubuyiswa kwamaqanda nokukhulelwa. Kuze kube umtholampilo wakho uqinisekisile ukuthi unemibungu enempilo efanelekile ukudluliselwa kombungu oyedwa, awukwazi ngempela ukuthi kulungile yini kuwe.
Asikho isinqumo "esingalungile" lapha. Amawele amabili angaba umphumela omuhle. Nakuba kunezingozi, izingozi akuzona isiqinisekiso. Eqinisweni, i-IVF yakhulelwa amawele ayizincishwana ezincane-ezivame ukubhekana nezinkinga kunamawele azalwa ngokwemvelo, mhlawumbe ngenxa yokwelapha okungaphezulu okunikezwa ukukhulelwa kwe-IVF-pregnancy.
Noma kunjalo, ukwenza lesi sinqumo ngokushesha akukhuthazwa. Xoxa ukuthi kungenzeka yini ukhethe ukudluliswa kombungu oyedwa nomlingani wakho nodokotela ngaphambi kokuba ujikeleze i-IVF. Ngale ndlela, ngeke uphoqelelwe ukuba unqume ukuthi ingabe ukucindezeleka kunzima futhi ungaphansi kokucindezeleka kokwelashwa kokuzala .
> Imithombo:
> Ukukhetha Ukudluliswa Kwemibilini Yodwa . IKomiti Yokuzijwayeza YeNhlangano yeKomidi Yokusiza Yokukhiqiza Esizayo kanye neKomiti Yokuzikhandla ye-American Society for Medicine Reproductive.
> Forman, u-Eric J .; UScott Jr., uRichard T. "Ukudluliswa Kwamabhere Omunye Euploid: I-Paradigm Entsha Ye-IVF" I- OB / GYN Yomqulu . Julayi 1, 2014.
> Kuohung, Wendy; Ginsburg, u-Elizabeth S; Racowsky, Catherine. "Amasu okulawula ukulingana okuphezulu kwe-oda eliphezulu. "UptoDate.com.
> Pandian Z1, Marjoribanks J, Ozturk O, Serour G, Bhattacharya S. "Inombolo yemibungu yokudlulisa emva kokufaka umanyolo we-in vitro noma i-intra-cytoplasmic injection yesilisa. "Cochrane Database Syst Rev. 2013 Jul 29; (7): CD003416. i-doi: 10.1002 / 14651858.CD003416.pub4.
Ikomidi Lokuzijwayeza le-American Society for Medicine Reproductive; Ikomidi Lokuzikhandla LeNhlangano Yezobuchwepheshe Ezizosiza Ngokuzala. "Isiqondiso emkhawulweni wenani lemibungu ekudluliseni: umbono wekomidi." UFertil Steril. 2017 Apr; 107 (4): 901-903. doi: 10.1016 / j.fertnstert.2017.02.107. Epub 2017 Mar 11.
> Ukudluliswa kwe-Embryo eyodwa. Ubuchwepheshe bokuzala obusekelwe. Isikhungo Sokulawula Izifo.