Kutanga chirongwa chekurapa kwaIVF kunogona kuva chiitiko chinonakidza uye chengwaru. Kazhinji, IVF inoshandiswa mushure mokunge mamwe marapirwo ekuberekwa akundikana. Iwe unogona kunge wakanga uchiedza kubata pamuviri kwemwedzi kana, zvichiwedzerwa, kwemakore nemakore.
Asi izvi hazvisi nguva dzose. Dzimwe nguva, IVF ndiyo yekutanga kurapwa kwakaedzwa.
Somuenzaniso, IVF inogona kuva yekutanga kana ...
- dhi donor iri kushandiswa
- mumwe anodiwa anoda
- muzviitiko zvakakomba zvekushaya mwana
- kana mudzimai wemadzimai asina maturo akavharwa
Kunyange zvakadaro, kunyange mumatambudziko aya, IVF inogona kuuya shure kwemakore ekuedza kutora pamuviri uye kuongororwa kwakawanda kwekuberekwa .
Heino mashoko akanaka: IVF yakaisvonaka yakabudirira. Maererano nekutsvakurudza kwevakadzi vanenge 156 000, muvharo wekuberekwa kwekurarama kwekutanga kwaiva 29.5 muzana. Izvi zvakaenzana nekubudirira kwehutano hwemhuka yakasikwa muhukama nehutano hwakanaka .
Nzira dzako dzakanakisisa dzekubudirira dzinogona kuuya kubva pakudzokorora maitiro ekurapa. Chidzidzo ichocho chakawana kuti mushure memaawa matanhatu eVF, kuwedzera kwekuberekwa kwekuberekwa kwakange kuri 65.3 muzana. Izvi zviyero zvitanhatu zvinowanzoitika makore maviri.
Zera rinotamba basa rinokosha mukubudirira kwako, sezvinoita chikonzero chekushaya kwako. Kushandisa mazai evha kuchachinjawo kubudirira kwako. Kana uri kunzwa uchinetseka, iwe hausi woga. Kuvhiringidzwa kweVIV kunoshungurudza.
Kungotarisa pamusoro penhepfenyuro ye-ultrasound, basa reropa, majekiseni, nezvimwe zvinogona kuita kuti iwe unzwe usina kusimba. (Uye izvi zvisati zvamboitika mishonga inogona kusvibisa nemafungiro ako!) Wedzera kune izvozvo mari yeVF , kunyanya kana uri kubhadhara kunze kwehomwe, uye hazvishamisi iwe unonetseka.
Izvozvo zvakati, kana iwe unowedzera kunzwisisa chii chiri kuuya chinotevera, kunyanya mukubata iwe uchanzwa. Iwe unogona kunge uchishamisika kuti zvinhu zvose zvichaungana sei. Kunyange zvazvo chirongwa chekliniki yose ichave yakasiyana zvakasiyana uye mishonga inogadziriswa nokuda kwechido chomunhu mumwe nomumwe, heino nhanho-nhanho kuputsika kwezvinhu zvinowanzoitika panguva in vitro fertilization.
Iro Rokutanga Kusati Kurapa
Kutenderera mberi kwehutano hwako hweVIV isarongedzerwa, iwe unogona kuiswa pamapiritsi ekuberekwa nekuberekwa. Izvi zvingaita sechekare-hausi iwe unoedza kutora pamuviri?
Kushandisa mapiritsi ekuberekwa kusati kwaitwa kurapwa kwave kuchiratidzwa kuti inogona kuvandudza mararamiro ako ekubudirira. Uyewo, inogona kuderedza ngozi yako ye ovarian hyperstimulation syndrome uye ovarian cysts.
Asi kwete chiremba wega wega anoshandisa kuberekwa kupirisa mapiritsi. Chimwe chiitiko ndechokuti chiremba wako achakukumbira kuti ucherechere ovulation mhirizhonga kare. Zvingangodaro, iye achakurudzira kushandisa chirongwa chekuvhara ropa . Zvisinei, anogonawo kuratidza kutengesa kwemuviri wechando , kunyanya kana iwe uine ruzivo rwekutora maitiro ako.
Zvadaro, iwe unoda kurega chiremba wako achiziva pakarepo paunoona ovulation.
Pane imwe nguva mushure mekuvhura, kliniki yekubereka ingadaro iwe unotanga kutora mutsigiri weGnRH (saGanirelix) kana kuti GnRH agonist (saLupron) . Izvi zvinodhaka mishonga, asi zvimwe zvinowanikwa sepine spray kana kuiswa.
Iyi mishonga inobvumira chiremba wako kuti ave nechidzora chakakwana pamusoro pekuvhara ropa kana chirwere chako chinotanga.
Kana iwe usingagoni kuwana maitiro ako pachako, chiremba wako angatorazve imwe nzira. Muchiitiko ichi, anogona kupa chirongwa cheprogesterone nenzira yaProvera. Izvi zvingaunza panguva yako.
Muchiitiko ichi, chiremba wako angangokumbira kuti utange kutora GnRH agonist kana kupikisa kwemazuva matanhatu kana kupfuura mushure mekutanga kwePill pill.
Zvakare, zvakare, izvi zvinogona kusiyana. Nguva dzose tevera mirayiridzo yechiremba wako.
Paunowana Period yako
Zuva rekutanga rehurumende rekushanda kwako ndiro zuva raunowana nguva yako. (Kunyange zvazvo zvinogona kunzwa sokunge watotanga nemishonga yawakatanga kare muchikamu chimwe.)
Pazuva rechipiri remakore ako, chiremba wako angangoita basa reropa uye an ultrasound.
Ichi chichava shanduko ye ultrasound . An ultrasound panguva yako haisi yakanaka chaizvo, asi edza kuyeuka izvi zvakafanana kune mukadzi wese anopfuura neAVF.
Aya mazuva ekutanga anowedzera uye basa reropa anonzi inoshanda yako yeropa rekutanga uye yako yekutanga inonzi ultrasound. Muropa rako rekushanda, chiremba wako achatarisa maestrogen eesrogen yako, kunyanya yako E2 kana estradiol. Izvi zvinoita kuti uone kuti mavha mavari ari "kurara." Ndiyo mhinduro yakagadzirirwa yeRupup shots kana kuti GnRH anopikisana.
Iyo ultrasound ndeyekutarisa hukuru hweiyo mavari. Chiremba wako achatarisawo mavari cysts. Kana pane ma-cysts, chiremba wako achasarudza nzira yekugadzirisa nayo. Dzimwe nguva chiremba wako achangononoka kurapwa kwevhiki. Mazhinji cysts anosarudza ivo pachavo nenguva. Mune zvimwe zviitiko, chiremba wako anogona kutsvaga cyst (inwa mvura yakachena) ine sindano.
Kazhinji, miedzo iyi ichava yakanaka. Kana zvose zvichitarisa zvakanaka, kurapa kunofamba.
Ovarian Stimulation and Monitoring
Ovarian stimulation nemishonga inobereka ishato inotevera.
Zvichienderana nehutano hweprototi yako, izvi zvinogona kureva kupi zvako kubva kune rimwe kusvika kune rimwe shotsana zuva rega rega kwemavhiki kusvika kune gumi. (Ouch!)
Iwe unogona kunge uri puro-self-injection ikozvino, sezvo Lupron nemamwe GnRH agonist zvakare injectable. Kliniki yako inofanira kukudzidzisa kuti iwe ungazvipa sei majekiseni usati watanga utano. Mamwe makiriniki anopa zvidzidzo nemazano uye murayiridzo.
Usanetseke. Havazongokupikii sirindi uye tariro yezvakanakisisa!
Iwe unogona kuverenga zvakawanda pamusoro pemiti inobereka inogona kutora panguva yeVIV pano:
- Zvose NeGonadotropins
- Gonadotropin Side Effects
- GnRH Agonist (Lupron) Nhengo Dzakashata
- GnRH Antagonists (Antagon, Ganirelix, Orgalutran, uye Cetrotide) Maitiro Okupedzisira
- Kazhinji Inorongwa Zvirwere Zvinodhaka
Munguva yekukurudzira maitiro, chiremba wako achacherechedza kukura uye kukura kwe follicles .
Pakutanga, izvi zvinogona kusanganisira kushanda kweropa uye kukura kwemazuva mashomanana. Chiremba wako achange achitarisa mazinga eestradiol yako. Munguva yekudhinda, chiremba wako achaona kuwanda kweiyoiyo . (Oocytes ndiyo mazai mumapapiro enyu.)
Kuongorora kutenderera kwakakosha zvikuru. Iyi ndiyo nzira iyo chiremba wako achasarudza kuti ingashandura sei mishonga yako. Iwe unogona kuwedzera kuwedzera kana kuderedza masero. Kana imwe nguva follicle yako yakakura iri 16 kusvika 18 mm muhukuru, kliniki yako inoda kukuona iwe zuva nezuva.
Kupedzisira Kukura kweOocyte
Nhanho inotevera muhutano hwako hweVIV inotora maoocytes kuti apinde nepakati yekupedzisira yekusimwa. Mazai aya anofanira kupedzisa kukura kwavo uye kubudirira vasati vadzorerwa.
Uku kukura kwekupedzisira kunokonzerwa nevanhu chorionic gonadotropin (hCG). Mazita emagetsi ezvo anosanganisira Ovidrel, Novarel, uye Pregnyl.
Nguva iyo pfuti iyi inokosha. Kana ikapiwa kare kare, mazai haazokura zvakakwana. Kana ikapiwa zvakanyanyisa, mazai angave "akwegura" uye haazodiri zvakanaka.
Zuva rezuva rekupedzisira pamagumo echitsiko chekupedzisira zvinoreva kuti nguva iyi inotamba ichitsvaga zvakanaka.
Kazhinji, chirwere cheHCG chinopiwa apo mana kana kupfuura follicles yakakura kuva 18 kusvika 20 mm muhukuru uye mazinga eestradiol akakura kupfuura 2,000 pg / ML.
Iyi pfuti inowanzo mujoyi wekanguva imwe. Chiremba wako angangokupa nguva chaiyo yekuita pfuti iyi. Iva nechokwadi chekutevera mirayiridzo iyi!
IVM vs. IVF
Penguva yakawanda IVF, mazai anofanira kupedza kubudirira kwavo nekukura vasati vadzorerwa.
IVM kurapa yakasiyana zvakasiyana. IVM inomiririra muhuro hwekutsvaira. Ndiyo teknolojia inoshandiswa yakafanana neyeVF asi inonyanya kusiyanisa panguva ino mukugadzirisa.
Munguva ye IVM, mazai anodzorerwa vasati vasvika mumatanho ose ekukura. Iwe hauzove ne "chinotyisa" munguva yeVMM. Mazai aya anodzingwa achakwiridzirwa mubasa rerairi. Imwe mazai paanenge akura, mamwe masitepi anotevera nzira ye IVF.
Zvakadini Kana Zvinyorwa Zvisingaendi
Takatarisa kune pfungwa iyi kuti mishonga yekukurudzira ovarian yakashanda zvakanaka. Asi iyo haisi nguva dzose iyo inoenda sei. Dzimwe nguva follicles haiti kukura. Chiremba wako anogona kuwedzera mishonga, asi kana mavhai ako asati achipindura, chirongwa chacho chinogona kubviswa .
Izvi hazvirevi kuti kumwe kumwe kutenderera hakuzoshandi. Iwe unogona kungoda mishonga yakasiyana. Zvisinei, kana izvi zvichiitika kakawanda, chiremba wako angaratidza kushandisa dhi kana mubereki wemukomana. Iwe unogona kuda kuwana pfungwa yechipiri usati waenderera mberi pane ino.
Zvakadini Kana Uri Pangozi yeHSSSS
Chimwe chinetso chinokonzerwa nemapapiro ako anopindura zvakanaka. Kana chiremba wako achifunga kuti uri pangozi yekukurira zvakanyanya ovarian hyperstimulation syndrome (OHSS) , kutora kwako kupfura kuchabviswa uye kupoteredza kuchagadzirirwa panguva ino.
Chimwe chiitiko ndechokuti chiremba wako achadzorera mazai, oashambisa, asi anonoka kutengesa embryo. Izvi ndezvekuti kuberekwa kunogona kuwedzera uye kuwedzera kupora kubva kuHSSSS.
Kamwe kana muviri wako uchidzoka, unogona kuedza kubvisa mazai embryo .
Munguva yako inotevera, chiremba wako angaratidza maitiro mashoma emishonga, edza mishonga yakasiyana iwe usati watanga, kana kuratidza IVM pane IVF (yakatsanangurwa pamusoro apa.)
Zvakadini Kana Uchivhara Pamberi
Kunyange zvazvo isingazivikanwi, denderedzwa inogonawo kubviswa kana kuvhara kunowanikwa kusati kwaitika kunogona kuitika. Kana kamwe mazai akazvimirira oga, haagoni kutorazve. Chiremba wako angangokuudza kuti urege kuita zvepabonde.
Zvakakosha iwe kutevera mirairo iyi! Zvingaita kuti iwe wakavhura kusvika mazai gumi nemaviri. Zvichida zvakare. Kune ngozi kune vose amai nevana kana iwe uine pamuviri zvakasununguka nehafu yeavo mazai.
Nzira Dzakawanda Sei Zvinyorwa zveVIV Zvabudiswa?
Kuchenesa kunoitika mu10 kusvika ku20 muzana yeVVF mishonga yekurapa.
Mukana wekuregererwa unomuka nezera, nevaya vakwegura vanopfuura makore makumi matatu akawanda vanogona kurapwa kurapwa.
Egg Retrieval
Munenge maawa 34 kusvika ku 36 mushure mekunge mawana hCG kupfura, mazai ekudzoka achaitika. Zvakajairika kuva nekutya pamusoro pekugadzirisa, asi vazhinji vakadzi vanofamba nayo pasina njodzi yakawanda kana kurwadziwa.
Pamberi pekudzorera, anesthesiologist achakupa mimwe mishonga mukati mekubatsira kuti unzwe wakasununguka uye usina kurwadziwa. Kazhinji, kushandiswa kwechiedza kunoshandiswa, izvo zvichaita kuti iwe "uvete" kuburikidza nenzira iyi. Izvo hazvisi zvakafanana neyese anesthesia, inoshandiswa panguva yekuvhiyiwa. Migumisiro yechirwere uye zvinetso hazvisi zvishoma.
Kana kamese mishonga inotora, chiremba wako achashandisa ultrasound transvaginal kuti atungamirire nheyo kuburikidza nemadziro emashure emudzimai wako, kusvika kune mavha mavari. Iye achashandisa nenyuchi kuti afirate follicle, kana kunyatsonyorova mvura yakasviba uye oocyte kubva muhutano kusvika mundiro. Pane imwe oocyte per follicle. Aya maoocyte achaendeswa ku laboratory embryology yekudyara.
Nhamba yeoocytes yakabviswa inowanzosiyana asi inowanzofungidzirwa isati yawanazve kuburikidza ne ultrasound. Ivhareji yenhamba yeoocyte iri 8 kusvika ku15, uye inopfuura 95 muzana yevarwere vane imwe oocyte imwe yakadzorerwa.
Mushure mekutora nzira, iwe uchachengetwa kwemaawa mashomanana kuti uone kuti zvose zvakanaka. Chiedza chekujeka chinowanzoonekwa, pamwe nechepamusoro pamadziro ekudzivirira, asi vazhinji vanonzwa vari nani pane rimwe zuva kana kuti mushure memutambo. Iwe uchataurirwawo kuti utarise zviratidzo zve ovarian hyperstimulation syndrome , imwe yechiratidzo kubva kubindu rekushandisa zvinodhaka munguva yekurapa kweVIV mu 10 muzana yevarwere.
Egg Fertilization
Paunenge uri pamba uchidzikinura kubva pakuwana, mhando dzakatsvakwa dzichatsvaga maoocyte, kana mazai. Haisi mapuropi ega ega ane oocyte.
Kana kamwe maoocyte awanikwa, achaongororwa ne embryologist. Kana mazai akanyanya kukura, kubereka kungasabudirira. Kana vasina kuve vakakwana zvakakwana, laboratory embryology inogona kukwanisa kuvakurudzira kusvika pakunamata mubazi.
Mafuta eOocytes anofanira kuitika maawa 12 kusvika ku24. Mumwe wako angangodaro anopa saridzi yemasikati mambakwedza iwe unowana kuwanikwa. Kushushikana kwezuva kunogona kuita kuti zvive zvakaoma kune vamwe, uye saka kana zvakadaro, wako wega angapa saridzi yemasvomere yekuchengetedza mberi kwekufamba, iyo inogona kuoma kusvika zuva rekuwana.
Kana imwe saridzi yega yega yakagadzirwa, ichaiswa nenzira yakashambidzwa yekugeza, inoparadzanisa hura kubva pane zvimwe zvinhu zvinowanikwa mumuna. Imbryologist ichasarudza "chirume chinotarisa," ichiisa mbeu inodarika 10 000 mumudziro wega wega wehutori neoocyte. Zvokudya zvekudya zvinochengeterwa mune imwe yekushambadzira inokosha, uye shure kwemaawa 12 kusvika ku24, vanoongororwa nokuda kwezviratidzo zvehutano.
Kunze kwekushaya simba kwechikadzi, 70 muzana yeoocyte ichave yakagadzirwa.
Muchiitiko chechiremera chekushaya mwana, ICSI (inonzi ick-kuona) inogona kushandiswa kudiridza mazai, pane kungovaisa mumutambo wekudya. Ne ICSI, embryologist ichasarudza hutano hunotarisa utano uye hunoisa maoocyte nemumvuri uchishanda nenyuchi inokosha.
Embryo Kudzingisa
Mazuva anenge matatu kusvika mashanu mushure mekudzorerwa, muchechi wemumoto achaona maitiro anopa utano hwakanaka. Izvi zvinowanzoitwa pachena (ne microscope), asi mune dzimwe nguva, kuongorora mazita ekuberekwa kunoitwa. Izvi zvinozivikanwa sekuti preimplantation genetic diagnosis (PGD) kana kuti preimplantation genetic screening (PGS.)
Dzimwe nguva, nePGD / PGS, mazai aya anonzi cryopreserved uye kutengesa kunonoka kusvika panguva inotevera. Kana zvisina kudaro, kutora "kutsva" kunoitika
Nzira yekutengesa embryo yakangofanana neIUI kurapa . Iwe hauchazodi anesthesia.
Munguva yekutengesa embryo, bhute rakapetwa, kana catheter, richapfuura nepamuviri wako. Iwe unogona kuva nechiedza chakanaka kupera asi hapana chimwe chinopfuura icho. Kuburikidza ne catheter, ivo vachabvisa mazamu, pamwe chete nehuwandu hwemvura.
Nhamba yemambrus akaendeswa ichaenderana nehutano hwema embryos uye kukurukurirana kwakapfuura nachiremba wako. Zvichienderana nezera rako, chero ipi zvayo kubva kumadziro maviri kusvika mashanu anogona kuendeswa. Zvidzidzo zvenguva pfupi zvakaratidza kubudirira nemukomana mumwe chete akatamiswa. Taura nachiremba wako kuti uone kana izvi zvingashanda kwauri.
Mushure mokutengeswa, iwe ucharara pasi pasi kwemaawa mashoma (uuye nebhuku) uye udzokere kumba.
Kana pane "yepamusoro" embryo yakakwirira yakasara, unogona kukonzera. Izvi zvinonzi embryo cryopreservation. Inogona kushandiswa gare gare kana izvi zvichitadza hazvibudiriri muchando chisina kuvharwa , kana kuti chinogona kupiwa.
Progesterone Support uye Mavhiki maviri Ari kumirira
Zuva kana kuti mushure mezuva rekudzoka kwako, uye musati maenda kuberekwa, unotanga kupa zvipembenene zveprogesterone. Kazhinji, progesterone munguva yehutano hweVIV inopiwa sechirwere chekuzvidzivirira seprogesterone mumafuta. (Dzimwe shots!) Dzimwe nguva, kunyange zvakadaro, progesterone supplementation inogona kutorwa sepiritsi, gel yemukadzi, kana vaginal suppository.
Kunze kweprogesterone, pane chaizvoizvo hazvisi kuitika kwevhiki mbiri dzinotevera. Mune dzimwe nzira, mavhiki maviri mushure mekutengeswa kunogona kunge kwakaoma mupfungwa kupfuura mavhiki maviri ekurapa. Pakati pezviito zvekare, iwe uchave wakashanyira chiremba wako zvichida rimwe zuva rimwe nerimwe. Iye zvino, mushure mokunge vatapwa, pachava nekukanganisika kwebasa mumabasa.
Iwe unogona kuva nemibvunzo yakawanda pamusoro pevhiki mbiri waitarisira. Unogona kuita zvepabonde here? Zvakadini kana iwe uine makumbo? Zvechokwadi, chiremba wako ndiyo nhamba imwechete yezvimwe zvekunetseka kwako.
Zvose zvaunogona kuita ndezvokumirira vhiki mbiri uye kuona kana pamuviri uchiitika. Inogona kubatsira kuti urambe wakabatikana nehupenyu hwako munguva iyi yekumirira uye usadzikama kugara uye kufunga nezvekuti kana kwete kurapwa kuchabudirira. Ndinoziva, zviri nyore chaizvo kutaura pane kuzviita.
Kuberekwa Muedzo uye Kuitevera
Panenge mazuva mapfumbamwe kusvika ku12 mushure mekutengesa embryo, kuve nekudzivirira pamuviri kunorayirwa. Izvi zvinowanzova chirwere chekudzivirira pamuviri weSeumum (mamwe mabasa eropa) uyewo inosanganisira maitiro eprogesterone kuongororwa. Muedzo unogona kudzokororwa mazuva ose mashoma.
Kana muedzo uri wakanaka (hongu!), Iwe unogona kuramba uchitora progesterone supplementation kune imwe mavhiki mashomanana. Chiremba wako achazotevera zvakare pamwe chete nebasa reropa uye anowedzera kuti aone kutora pamuviri uye kutarisa kusakanganiswa kana ectopic pregnancy.
Munguva yekurapa kweVIV, kupererwa kwepamuviri kunowanikwa kusvika 15 muzana yenguva muvakadzi vari pasi pemakore makumi matatu, 25 muzana yevakadzi vane makore makumi mana nekukwirira uye 35 muzana yenguva mushure memakore makumi mana nemaviri.
Chiremba wako achacherechedza kana kana kwete here kurapwa kwakatungamirira kuve nepamuviri yakawanda. Kana iri mimba yepamusoro-yakakura (4 kana kupfuura), chiremba wako angakurukura sarudzo yekuderedza nhamba yevana vekuberekwa nenzira inonzi "multifetal pregnancy reduction". Izvi pane dzimwe nguva zvinowedzera kuwedzera mikana yekuve nemuviri wakanaka uye kubudirira.
Apo IVF Treatment inokundikana
Kana kuve nekuita pamuviri kuchiri kwemazuva gumi nemaviri kusvika kwemashure gumi nemasere mushure-kutumira, chiremba wako anokukumbira kuti urege kutora progesterone. Ipapo, iwe unotarisira nguva yako kutanga.
Nhanho inotevera ichagadziriswa newe, shamwari yako, uye chiremba wako. Kana iyi yaiva yekutanga yako, imwe shanduro inogona kukurudzirwa. Yeuka kuti mikana yako yakanakisisa yekubudirira ndeyekuita maitiro akawanda.
Kuva nemishonga yekurapa kunokundikana hazvirevi nyore. Zvinoshungurudza. Zvakakosha, zvisinei, kuramba uchifunga kuti kuva nechikwata chimwe chete kukundikana hazvirevi kuti hauzobudiriri kana ukaedza zvakare.
Sources:
> Debbie A. Lawlor, Ph.D. et al. "Kurarama-Kuberekwa Kwekuzvarwa Kunobatanidza Kudzokorora In Vitro Fertilization Kuchengetedzwa Kwemaitiro. " JAMA , December 2015.
> ART: Nhanho-Nhanho Nhungamiro. Society for Assisted Reproductive Technology. http://www.sart.org/Guide_ARTStepByStepGuide.html
> Kubatsiridza Kuberekwa Kwekwenyanzvi: Inotungamirirwa Nevarwere. American Society of Reproductive Medicine.