Izidakamizwa Ezivame Ukwelashwa Ngokuvamile + Ezinye Imithi Yokunakekelwa Kwesisu
Ngesikhathi ukwelashwa kwe-fertility , izidakamizwa ongase uthathe ziwele kwesinye sezigaba ezine ezijwayelekile:
- Imithi ehlose ukugqugquzela i- ovulation (imithi yokuzala)
- Imithi ehlose ukuvimbela noma yokulawula umjikelezo wesimiso (esetshenziswa ngesikhathi se-IVF )
- Imithi ehloselwe ukuphatha ezinye izici zokuzala
- Imithi ehlosiwe yokwelapha isimo esingokwempilo esibhedlela esithinta ukuzala kwakho
Imithi yodwa ingasetshenziswa, noma ingasetshenziswa eceleni kwe- intrauterine insemination (i-IUI) , ukwelashwa kwe-IVF, noma ukuhlinzekwa okuhlinzayo.
Ngisho noma ukungabi nabantwana kuthinta amadoda nabesifazane cishe ngokulingana, abesifazane basengaphezu kwamathuba okuthatha izidakamizwa zokwelapha ukwelashwa kunamadoda. Lokhu kungenxa yokuthi izinkinga eziningi zesifo sokubeletha azikwazi ukuphathwa ngemithi. Kodwa-ke, kwezinye izimo, amadoda angathatha ama-hormone noma ezinye izidakamizwa njengengxenye yokwelashwa kokuzala.
Isidakamizwa Esijwayelekile Kunazo zonke: U-Clomid
Kungenzeka ukuthi uzwe ngeComomid ngaphambili. I-Clomid, noma i-clomiphene citrate , ivame ukuqala ukusetshenziswa kwezidakamizwa uma uphatha ukukhubazeka kwama-ovulatory . Kungase futhi kunconywe ezinyathelweni zakuqala zokwelashwa kwemibhangqwana etholakala ngokungenakuchazwa.
I-Clomid ithebhulethi ethathwe ngomlomo. Ngokuvamile, i-Clomid inqunywe yedwa. Kodwa kungenzeka futhi ukuhlanganisa i-Clomid neminye imithi, izidakamizwa zokuzala, noma ukwelashwa kwe-IUI .
Imiphumela emibi kakhulu yilezi zikhanda, ukukhanya okushisayo, nokushintsha kwemizwa . Ezinye izingozi zokwelashwa kwe-Clomid zihlanganisa amawele okukhulelwa noma ukukhulelwa okuphezulu okukhulelwa , i- ovarian hyperstimulation syndrome , nokuphazamiseka kombono.
Imiphumela emibi kanye nezingozi zithobekile uma kuqhathaniswa nezidakamizwa ezinamandla zokuzala.
Nakuba kungavamile, ezinye izimo zesifo esingenasilisa zingasetshenziswa nge-Clomid.
I-Femara (Letrozole): I-Alternative kuya ku-Clomid
I-Femara, noma i-letrozole, yayingahloswe ukuba ibe umuthi wokuzala. Eqinisweni, imithi yomdlavuza webele.
Kodwa-ke, manje isetshenziswe kaningi ngaphandle kwelebuli ukuphatha izinkinga ze-ovulation .
Njenge-Clomid, i-Femara ithathwe ngomlomo. Kungasetshenziswa yodwa, kanye neminye imithi noma imithi yokuzala, noma njengengxenye yezokwelapha ze-IUI.
Ngokomunye ucwaningo, i-Femara ingase iphumelele kakhulu kune-Clomid kulabesifazane abane-PCOS nabesifazane abangenjalo ngokumelene ne-Clomid . (Ukumelana ne-Clomid nje kusho ukuthi i-Clomid ayifuni ukugqugquzela ukuvota njengoba kulindeleke.)
Imiphumela emibi nezingozi zifana kakhulu ne-Clomid.
I-Femara ayiphephile ukusebenzisa ngesikhathi sokukhulelwa. Lokho kusho ukuthi ngenxa yokuthi u-Femara uthathwa ekuqaleni komjikelezo wokuya esikhathini-ngaphambi kokukhipha isisu-odokotela abaningi bacabanga ukuthi kuphephile lapho kusetshenziselwa izinhloso zokuzala.
I-Gonadotropins: Ukuvuthwa kwe-Ovulation nge-Drugs Injectable
I-Gonadotropins yizidakamizwa eziqine kakhulu zokuvuthwa kwe-ovulation. Iqukethe i-biologically efanayo i- follicle stimulation hormone (FSH) , i-hormone i-luteini (LH) noma inhlanganisela yale mibini. Ekukhiqizeni abesifazane, lawa amahomoni avuselela ama-ovari ukuvuna nokukhulula amaqanda.
Lezi zidakamizwa zithathwa nge-injection, ngokuvamile ziyizicubu ezinamafutha (eyaziwa nangokuthi i-injection subcutaneous.) Umtholampilo wakho wokuzala uzokufundisa ngendlela yokuzinikeza lezi zijovo ekhaya.
I-Gonadotropins ingasetshenziswa yedwa noma eceleni kweminye imithi ephethe ubulili obuphelile ngesikhathi. Zivame futhi zisetshenziswe ngesikhathi se-IUI noma i- IVF .
Imiphumela emibi ejwayelekile ye-gonadotropin ihlanganisa ikhanda, isicanucanu, ukubhula, isifuba sebele, ukuguquka kwemizwa, nokucasula endaweni yomjovo.
Ingozi yakho yokukhulelwa amawele, ama-triplets, noma ama-multiples oda ephakeme kakhulu ephakeme nge-gonadotropin kunezidakamizwa zomlomo njenge-Clomid.
Ingozi yakho yokuthuthukisa i-ovarian hyperstimulation syndrome nayo iphezulu kakhulu.
Nakuba i-gonadotropin isetshenziswa ngokuyinhloko kwabesifazane, amadoda ane hypogonadrophic hypogonadism angase abekwe izidakamizwa zokuzala ezingenakulungiswa ukuze kuthuthukiswe amazinga e-testosterone futhi athuthukise impilo yezinsikazi.
I-Gonadotropins udokotela wakho angase ayinikeze ifaka phakathi ...
I-Follistim (follitropin beta) ne-Gonal-F (i-follitropin alpha): lezi zidakamizwa zifanisa i-hormone FSH emzimbeni wakho. Zidalwa ebhodini besebenzisa i-recombinant technology ye-DNA, eyenza ibe yizimo ezifanayo namahomoni akho emvelo.
I-Bravelle, i-Fertinex : Lezi zidakamizwa ze-hormonal fertility nazo ziyi-FSH, ngaphandle kokuthi zenziwe ngobuciko ebhodini, i-hormone ikhishwa futhi ihlanzwa emcimbini wabesifazane besifazane abakwa-post-menopausal.
Lezi zidakamizwa zibhekwa njengento enamandla kakhulu kune-FSH eyenziwe ngokusebenzisa i-recombinant DNA technology, kodwa ayabizi kakhulu.
I-Ovidrel (i-choriogonadotropin alpha), i-Novarel, i-Pregnyl, i-APL: Lezi zidakamizwa zenziwe nge- hCG, i-hormone yokukhulelwa . IHCG ye-hormone ifana ne-LH emzimbeni.
Ungase ukhumbule i- LH yi-hormone edala ukuvuthwa .
I-Novarel, i-Pregnyl, ne-APL ihlanzwa emcimbini wabesifazane abakhulelwe, kanti i-Ovidrel ibhebhu idalwe ngokusebenzisa i-recombinant DNA technology.
I-Luveris (i-lutropin alpha) : Lena i-hormone ye-LH, eyenziwa ebhokisini usebenzisa i-DNA technology ephindaphindiwe.
I-Repronex, i-Menopur, i-Pergonal, i-Humegon : Lezidakamizwa zokuzala zihlanganiswa i-LH ne-FSH, eyaziwa nangokuthi i-gonadotropins yabantu abesilisa (hMG). Ayisebenzisi njalo kepha angasetshenziswa kwezinye izimo ezikhethekile.
Izidakamizwa Okusetshenziselwa Ukulawula Noma Ukuvimbela Ukuvuthwa Phakathi Nokwelapha kwe-IVF
Eminye imithi esetshenziswa ngesikhathi sokunakekelwa kokuzala ikhuphula ukuvuthwa.
Kungani? Izizathu ezimbili ezibalulekile:
- Ngesikhathi ukwelashwa kwe-IVF, ukuvimbela i-ovulation ngaphambi kokuba amaqanda athole ukuhlinzwa. Uma amaqanda avuliwe emzimbeni, ayitholakali noma asetshenziselwe i-IVF.
- Ukuxhumanisa imijikelezo nge-potential donor noma i-surrogate.
Amaphilisi okulawula ukubeletha : Lawa angabekwa enyangeni ngaphambi kokwelashwa kwe-IVF.
Ukulawulwa kokuzalwa kungasetshenziswa futhi ngokwelapha.
Isibonelo, abesifazane abane-PCOS abangaphenduli ku-Clomid bangase babe nempendulo engcono kumuthi uma bephethe amaphilisi okulawula ukubeletha izinyanga ezimbili ngaphambi kokwelashwa.
I-Antagon, Ganirelix, Cetrotide, i- Orgalutran (i- acreate i-acreate ne-cetrorelix acetate): Lezi zidakamizwa zokuzala ziyi-GnRH. Lokhu kusho ukuthi basebenza ngokumelene namahomoni i-LH ne-FSH emzimbeni, ukucindezela ukuvuthwa. Kuthathwa nge-injection.
Imiphumela emibi kakhulu ehlanganisa ukuhlukunyezwa kwesisu, ikhanda lokukhwabanisa, kanye nosizi lwesilonda.
Lupron, Synarel, Suprecur, Zoladex (i-leuprolide acetate, nafarelin acetate, buserelin, goserelin): Le mithi yi- GnRH agonists noma i-gonadotropin-ekhulula ama-hormonone agonists.
I-Lupron ithathwa nge-injection. I-Synarel ne-Suprecur yi-sprays yama-nasal. I-Zoladex ihanjiswa nge-implant encane.
Bangela ukuqala kokuqala kokukhiqiza kwe-FSH ne-LH kodwa kubangele umzimba uyeke ukukhiqiza i-FSH ne-LH. Lokhu kuvimbela i-ovulation futhi kunciphisa inani le-estrogen.
Lezi zidakamizwa zivame ukusetshenziswa ngesikhathi sokunakekelwa kwe-IVF, okuvumela udokotela ukuba alawule i-ovulation nama-gonadotropin. Kungase futhi zisetshenziselwe ukwelapha i- endometriosis noma i-fibroids.
Imiphumela emibi kakhulu evame ukushisa, ukukhanda ikhanda, ukuguquka kwemizwelo, nokumelela kwesisu.
Imithi Yokuphatha Ezinye Izinkinga Zokuzala
Imithi yokwelapha imithi ehlose ukugqugquzela ama-ovari. Kodwa-ke, lena akuyona yodwa imithi udokotela wakho angayibhalela ngesikhathi sokwelashwa kokuzala.
I-aspirin noma i-heparin : Uma uke wabhekana nokukhulelwa kwesisu okuphindaphindiwe, noma uthola ukuthi unesifo se-thrombophilia yegazi (isimo lapho ama-clots amancane angabangela ukukhulelwa), udokotela wakho angase anikeze ingane yansuku zonke aspirin noma imijovo yegazi- ukunciphisa i-heparin yezidakamizwa.
I-progesterone : Udokotela wakho angase anikeze ukuxhaswa kwe-progesterone, njengokungene nge-vaginal suppository noma nge-injection.
Ama-suppository wama-progesterone ase-vaginal angase aphakanyiswe uma ubhekene nesisu sokuphumula okuphindaphindiwe noma ube nesici sokusola kwesigaba sokusola . I-progesterone engenakuthola isetshenziselwa kakhulu ukwelashwa kwe-IVF .
I-Estrogen : Udokotela wakho angase anike izidakamizwa ze-estrogen zangasese uma isilonda sakho se- endometrial sincane kakhulu , uma uzwa ukumelela kwesisu noma ubuhlungu phakathi kocansi , noma ukuthuthukisa ikhwalithi ye-mucus yakho yesibeletho .
Umphumela ongase ube nomphumela wokusetshenziswa kwe-Clomid yinkimbinkimbi ephakeme yomlomo wesibeletho , okungaphazamisa ukukhulelwa. Ukusetshenziswa kwe-Clomid enwetshiwe kungaphinde kuholele ekubhekeni kwe-endometrial encane. I-Estrogen ingasiza ngalezi zinkinga.
Imithi Yokuphatha Izimo Eziphathelene Nezokwelapha
Ngezinye izikhathi, isimo esingokwempilo esibhedlela sinciphisa ukuzala kwakho. Kulezi zimo, leyo nkinga kufanele ilashwe kuqala.
Ukwelapha inkinga ebalulekile kungase kube ngokwanele ukuthuthukisa ukuzala kwakho. Emva kokwelashwa, ungakwazi ukukhulelwa ngokwakho.
Nokho, kwezinye izimo, kuhlanganiswa izixazululo ezidingekayo. Kungase kudingeke ube nokwelashwa kwenkinga yezokwelapha ngaphezu kwemithi yokuzala noma ukungenelela kokuhlinzwa.
I-glucophage (metformin): I- Metformin yisidakamizwa sikashukela, ehloselwe ukuphatha labo abane-insulin ukumelana. Abesifazane abane-PCOS bavame ukutholakala ukuthi banesifo se-insulin.
Olunye ucwaningo luye lwabonisa ukuthi ukwelashwa kwe-metformin kungasiza ukuqala kabusha noma ukulawula ukuvuthwa kwabesifazane nabakwa-PCOS. Ezinye izifundo ziye zathola ukuthi zinganciphisa izinga lokukhulelwa kwesisu futhi zisize ukusebenza kwe-Clomid kwabesifazane abakwazi ukuvotela ku-Clomid kuphela.
Ama-antibiotics : Ukutheleleka kwendlela yokuzala kunganciphisa ukuzala kokubili kokubili amadoda nabesifazane. Kwezinye izimo, ukutheleleka kungaholela ekwehleni. Lokhu kunqanda kungavimbela iqanda nesidoda ekuhlanganisweni.
Uma nje kungenayo inqamuzana, ama-antibiotics kuphela anganele okwenza ngcono ukuzala. Kodwa-ke, uma izilimo eziyizigaxa ezivinjelwe zivinjiwe noma zigcwele uketshezi oluketshezi , ukuhlinzwa noma i-IVF kufanele futhi.
I-Parlodel ne-Dostinex (i-bromocriptine ne-cabergoline): Le mithi i-dopamine agonists. Zingase zibekwe ku-hyperprolactinemia.
I-hyperprolactinemia yisimo lapho ama-hormone ama-prolactin ephakeme ngokungavamile. I-prolactin yi-hormone ephethe ukuthuthukiswa kwesifuba kanye ne-lactation. Amazinga aphezulu e-prolactin angabangela ukuvuthwa okungajwayelekile noma okungekho emkhatsini wabesifazane futhi kubangele ukubalwa kwamademoni okuphansi kwamadoda.
I-Parlodel ne-Dostinex inganciphisa amazinga e-prolactin. Imiphumela emibi engase ibe khona ihlanganisa ikhanda lokukhanda, ukuxubana kwesikhumba, ikhanda lokukhwabanisa, nosizi. Ayikho ingozi eyengeziwe yokukhulelwa amawele ngama-medication ngaphandle kokuthi umuthi wokuzala ofana neClomid usetshenziselwa ukwelashwa.
Ngezinye izikhathi, lokhu kungabuyisa ukuvuthwa noma ukukhiqizwa kwesidoda. Kwezinye izimo, ukuhlinzwa noma ukwelashwa okunye okudingekayo kudingeke.
Imithi yokwelapha ye-thyroid ye-hypothyroidism noma i-hyperthyroidism : I-under-over or over functioning thyroid ingabangela izinkinga zokuzala emadodeni nakwabesifazane.
Abesifazane bangase babe nemijikelezo engavamile, kanti amadoda angase abe nezibalo ezincane zobuningi. Ukunciphisa i-thyroid kungabangela ukukhathala nokuzuza kwesisindo. Ukukhuluphala kungakhuphula umthelela wokuzala.
Imithombo:
U-Elzbieta Krajewska-Kulak1 no-Pallav Sengupta. Umsebenzi we-Thyroid ku-Male Infertility. " Front Endocrinol (Lausanne) yangaphambili . 2013; 4: 174. Ishicilelwe ku-intanethi ngo-2013 Nov. 13: i-10.3389 / fendo.2013.00174 i-PMCID: PMC3826086
UGrene, uRobert A. noTarken, uLaurie. (2008). Ukulinganisela kwamaHhomomu aphelele Ukuzala. I-United States of America: I-Press Rivers Three.
Imithi yokwehlisa i-Ovulation: Umhlahlandlela weziguli. I-American Society of Medicine Yokuzala.
I-Ovarian Hyperstimulation Syndrome. I-Medical Encyclopedia, i-MedlinePlus.
Pratibha Singh, Manish Singh, 1 Goutham Cugati, 2 no-Ajai Kumar Singh. "I-Hyperprolactinemia: Isikhathi Esingekho Esingabanjwanga Sokuhluleka Kwesilisa." J Hum Reprod Sci . 2011 Meyi-Aug; 4 (2): 102-103. doi: 10.4103 / 0974-1208.86094 PMCID: PMC3205532