I-IVF

Ukwelashwa kwe-IVF eHyderabad

I-in vitro fertilization (IVF) iwuhlobo lobuchwepheshe olusizayo lokuzala, olubandakanya uchungechunge lwezinqubo zokusiza ekuvundeni. Phakathi ne-IVF, amaqanda avuthiwe akhishwa (akhishwe) kuma-ovari futhi avundiswa elabhorethri ngesidoda. Umjikelezo wonke we-IVF uthatha cishe amasonto amathathu. Ukwelashwa kungenziwa ngamaqanda kanye nesidoda salowo mbhangqwana. Umthwali wokukhulelwa, noma othile onombungu ofakwe esibelethweni sakhe, angasetshenziswa kwezinye izimo.

I-IVF ingaholela ekukhulelweni kombungu ongaphezu kowodwa uma umbungu ongaphezu kowodwa ufakwa esibelethweni (ukukhulelwa okuningi). 
Udokotela wakho angakuchazela ukuthi i-IVF isebenza kanjani, ubungozi obukhona, nokuthi le nqubo ikufanele yini.

Kwenziwani?

Uma i-IVF isetshenziselwa ukwelapha inzalo, wena nomngane wakho womshado ningakwazi ukuzama izindlela zokwelapha ezingaphazamisi kangako kuqala, njengemithi yenzalo ukuze kuthuthukiswe ukukhiqizwa kweqanda noma ukungena kwe-intrauterine insemination - inqubo lapho isidoda sifakwa khona ngqo esibelethweni eduze nesikhathi sokuphuma kweqanda.

Uma unezinkinga ezithile zezokwelapha, i-IVF nayo ingenziwa. 

• Ukulimala noma ukuvinjelwa kwamashubhu e-fallopian - Ukulimala noma ukuvinjelwa kwamashubhu e-fallopian kwenza kube nzima ukuthi iqanda livundiswe noma umbungu uye esibelethweni.
• Izinkinga ze-ovulation - Uma i-ovulation ingavamile noma ingekho, kukhona amaqanda ambalwa afinyelelekayo ukuze avundise.
• I-Fibroids esibelethweni - Ama-fibroids izimila zesibeletho ezingenawo umdlavuza. Ama-fibroids angavimbela ukufakwa kweqanda elivundisiwe.
• Ukuvalwa noma ukususwa kweshubhu kwangaphambilini - I-Tubal ligation iyindlela yokuvala inzalo lapho amashubhu e-fallopian esikwa noma evalwa ukuze kuvinjelwe ukukhulelwa unomphela. 
• Ukukhiqizwa noma ukusebenza kwesidoda kungasebenzi - Ukugcwala kwesidoda esingaphansi kwesilinganiso, ukunyakaza kwesidoda okuvilaphayo (ukungahambi kahle), noma usayizi wesidoda nokuma okungavamile kungenza kube nzima ngesidoda ukuvundisa iqanda. Uma kutholakala ukungahambi kahle esidodeni, ukuvakashela uchwepheshe wokuzala kungase kudingeke ukuze kunqunywe ukuthi zikhona yini izinkinga ezingalungiseka noma ukukhathazeka zempilo okucashile.
• Ukungasebenzi okungaqondakali 
• Isimo sofuzo - Uma wena noma owakwakho nisengozini yokudlulisela isifo sofuzo enganeni yakho, ungase ube umuntu ozongenela ukuhlolwa kofuzo okusekelwe ku-IVF. Ngemva kokuba amaqanda elandiwe futhi evundisiwe, abhekwa izinkinga zofuzo, nakuba akuzona zonke izinkinga zofuzo ezingabonwa. 
• Uma uzoqala ukwelashwa komdlavuza okungase kuthinte inzalo yakho, njenge-radiation noma i-chemotherapy, i-IVF yokulondoloza inzalo ingase ibe yinto engenzeka. Abesifazane bangakhishwa amaqanda abo kuma-ovaries abo futhi agcinwe esesimweni esingavundile ukuze asetshenziswe esikhathini esizayo. Ngaphandle kwalokho, amaqanda angase avundiswe futhi agcinwe njengemibungu ukuze asetshenziswe kamuva.

Abesifazane abangenaso isibeletho esisebenzayo noma labo ukukhulelwa okubanikeza engcupheni enkulu yezempilo bangase bakhethe i-IVF nomunye umuntu ukuze baphathe umbungu (umthwali wokukhulelwa noma obambele). Amaqanda owesifazane avundiswa isidoda kulesi simo, kodwa imibungu ewumphumela ifakwa esibelethweni somuntu okhulelwe.

Izingozi ze-IVF

Izingozi noma izinkinga ze-IVF zihlanganisa:

• Ukuzalwa ngokuphindaphinda - Uma umbungu ongaphezu kowodwa ufakwa esibelethweni sakho ngesikhathi se-IVF, amathuba okuzala okuningi ayanda. Ukukhulelwa okunezimbungu eziningi kuhlotshaniswa nengozi enkulu yokuzala ngaphambi kwesikhathi kanye nesisindo sokuzalwa esiphansi kunokukhulelwa nombungu owodwa.
• Ukuzalwa ngaphambi kwesikhathi nesisindo sokuzalwa esiphansi.
• I-Ovarian hyperstimulation syndrome - Imithi yokuzala ejovwayo, njenge-chorionic gonadotropin (HCG), ingabangela i-ovarian hyperstimulation syndrome, ebangela ukuthi amaqanda akho akhule futhi angakhululeki.
• Ukungaphatheki kahle kwesisu, ukuqunjelwa, isicanucanu, ukuhlanza, nesifo sohudo kuyizimpawu ezivamile ezihlala isikhathi esingangesonto. Nokho, uma ukhulelwa, izimpawu zakho zingase zihlale amasonto ambalwa. Akuvamile, uhlobo olubi kakhulu lwe-ovarian hyperstimulation syndrome lungenzeka, okubangela ukuzuza kwesisindo esisheshayo kanye nokuphefumula.
• Ukuphuphunyelwa yisisu - Amazinga okuphuphunyelwa yizisu kwabesifazane abasebenzisa i-IVF abanemibungu esanda kuzalwa uma eqhathaniswa nalawo abesifazane abakhulelwa ngokwemvelo cishe alinganiselwa ku-15% kuya ku-25%, kodwa isigameko siyenyuka ngeminyaka yomama.
• Izinkinga ngenqubo yokubuyisa amaqanda - Ukusetshenziswa kwenaliti efisa ukuvuna amaqanda kungase kubangele ukopha, ukutheleleka, noma ukulimala emathunjini, esinyeni, noma imithambo yegazi. I-sedation kanye ne-anesthesia jikelele, uma isetshenziswa, kubangela izingozi ezengeziwe.
• Ukukhulelwa kwe-Ectopic - Ukukhulelwa kwe-ectopic kwenzeka cishe ku-2 kuya ku-5% wabesifazane abathola i-IVF futhi kwenzeka lapho iqanda elivundisiwe lifakwa ngaphandle kwesibeletho, ngokuvamile eshubhu le-fallopian. Iqanda elivundisiwe alikwazi ukuphila ngaphandle kwesibeletho; ngakho, ukukhulelwa akukwazi ukuqhubeka.
• Ukukhubazeka ekuzalweni - Kungakhathaliseki ukuthi ingane ikhulelwa kanjani, iminyaka kamama iyisici esiyingozi kakhulu ekukhuleni kokungajwayelekile kokuzalwa. 
• Umdlavuza - Nakuba ucwaningo lwangaphambili lwembula ubudlelwano phakathi kwemithi ethile esetshenziselwa ukukhulisa ukwakheka kwamaqanda kanye nokuthuthukiswa kohlobo oluthile lwesimila esibelethweni, ucwaningo lwamanje olwengeziwe luyaphikisana nalokhu okutholakele. 
• Ukucindezeleka

Ulungiselela kanjani?

Ngaphambi kokuqala umjikelezo we-IVF, wena nomlingani wakho cishe nizodinga ukuhlolwa okuhlukahlukene, okuhlanganisa:

• Ukuhlolwa kwe-Ovarian Reserve - Udokotela wakho angase ahlole ukugxila kwe-follicle-stimulating hormone (FSH), i-oestradiol (i-oestrogen), ne-anti-Mullerian hormone egazini lakho phakathi nezinsuku ezimbalwa zokuqala zomjikelezo wakho wokuya esikhathini ukuze ahlole inani nekhwalithi yamaqanda akho. Ukutholwa kokuhlolwa, okuvame ukuhlanganiswa ne-ultrasound yamaqanda akho, kungasiza ukulindela ukuthi ama-ovari akho azosabela kanjani emuthini wokuzala.
• Hlaziya isidoda. 
• Ukuhlolelwa izifo ezithathelwanayo. 
• Linga ngokudlulisa (kuhlehlisa) umbungu - Ukudlulisa umbungu mbumbulu kungase kwenziwe udokotela wakho ukuze athole ukujula kwesibeletho sakho kanye nenqubo okungenzeka ukuthi ifake imibungu ngempumelelo esibelethweni sakho.
• Hlola isibeletho - Ngaphambi kokuba uqale i-IVF, udokotela wakho uzohlola ulwelwesi lwesibeletho. I-sono-hysterogram ingase futhi ihlanganise i-hysteroscopy, ehlanganisa ukufaka isibonakude esilula, esiguquguqukayo, esikhanyayo (hysteroscope) ngesitho sakho sangasese sowesifazane kanye nomlomo wesibeletho esibelethweni sakho.

Cabangela imibuzo ebalulekile elandelayo ngaphambi kokuqala umjikelezo we-IVF:

• Mingaki imibungu ezofakwa? Isibalo semibungu etshalwe kabusha ngokuvamile sinqunywa iminyaka yesiguli kanye nenani lamaqanda atholakele. Ngenxa yokuthi abesifazane asebekhulile banezinga eliphansi lokufakelwa, imibungu eminingi ivamise ukutshalwa kabusha - ngaphandle uma besebenzisa amaqanda abanikelayo noma imibungu eqinisekisiwe ngokofuzo.
• Odokotela abaningi banamathela emithethweni eqinile ukuze bagweme ukukhulelwa okuningi okuphakeme, okufana nama-triplets noma ngaphezulu. 
• Uzokwenzani nganoma yimiphi imibungu esele? Lezi zingaqandiswa futhi zilondolozwe njengezinto ezizosetshenziswa esikhathini esizayo iminyaka embalwa.
• Kungenjalo, ungakwazi ukunikela nganoma yimiphi imibungu eqandisiwe komunye umbhangqwana noma isikhungo socwaningo. 
• Uzobhekana kanjani nokukhulelwa okuningana? I-IVF ingaholela ekukhulelweni okuningi uma umbungu ongaphezu kowodwa ufakwa esibelethweni sakho, okuletha ukukhathazeka kwezempilo kuwena nasezinsaneni zakho. Ukwehliswa kwe-fetus kungasetshenziswa kwezinye izimo ukusiza owesifazane azale izingane ezincane ezinezingozi ezimbalwa zempilo. Kodwa-ke, ukuphishekela ukuncishiswa kwengane kuyisinqumo esibucayi esinemiphumela yokuziphatha, imizwa, kanye nengqondo.
• Ingabe uke wacabanga ngezingozi zokusebenzisa amaqanda anikelwe, isidoda, noma imibungu, kanye nesithwali sokukhulelwa? Umeluleki onekhono onolwazi ngezinkinga zomnikeli angakusiza ekuqondeni okukukhathazayo, okuhlanganisa namalungelo omthetho alowo onikelayo. 

Ukuqaliswa kwe-ovulation

Umjikelezo we-IVF uqala ngokusetshenziswa kwamahomoni okwenziwa ukukhuthaza ama-ovari ukuthi akhe amaqanda amaningana kuneqanda elilodwa elivuthwa ngokwemvelo inyanga ngayinye. Ngenxa yokuthi amanye amaqanda angeke avundise noma akhule ngokujwayelekile ukuvundisa okulandelayo, amaqanda amaningi ayadingeka.
Izidakamizwa ezimbalwa zingasetshenziswa, ezihlanganisa:

• Imithi isetshenziselwa ukuvuselela ama-ovari - Ungase unikezwe umuthi omjovo oqukethe i-follicle-stimulating hormone (FSH), i-luteinizing hormone (LH), noma inhlanganisela yakho kokubili ukuze uvule amaqanda akho. 
• Imithi yokuvuthwa kwe-oocyte - Uma ama-follicle esevuthiwe ngokwanele ukuba akhiphe amaqanda, okuvamise ukuthatha izinsuku eziyisishiyagalombili kuya kweziyishumi nane, uzonikezwa i-human chorionic gonadotropin (HCG) noma eminye imithi ukusiza amaqanda asevuthiwe.
• Ukuvimbela i-ovulation kusenesikhathi usebenzisa imithi - Le mithi ivimbela umzimba wakho ekukhipheni amaqanda asakhulayo kusenesikhathi.
• Imithi elungisa ulwelwesi lwesibeletho sakho - Udokotela wakho angase akweluleke ukuthi uqale ukuthatha izithasiselo ze-progesterone ngosuku lokubuyiswa kweqanda noma ngosuku lokudluliselwa kombungu ukuze wenze ulwelwesi lwesibeletho sakho lwamukeleke kakhudlwana ekufakweni.

Izinketho zokunquma ukuthi iqoqo lamaqanda lizodingeka nini:

• I-Vaginal ultrasound isheke lokuthwebula lama-ovari akho elisetshenziselwa ukulandelela ukukhula kwama-follicle, okungamasaka agcwele uketshezi lapho amaqanda evuthwa khona.
• Ukuhlolwa kwegazi kuzokwenziwa ukuhlola impendulo yakho emithini yokuvuselela i-ovarian.

Kwesinye isikhathi imijikelezo ye-IVF kumele iyekwe ngaphambi kokuvunwa kwamaqanda ngesinye sezizathu ezilandelayo:

• Inani elanele lama-follicle akhulayo
• Ukuvuthwa kweqanda kwenzeka ngaphambi kwesikhathi
• Kunama-follicle amaningi kakhulu akhayo, okwandisa ingozi ye-ovarian hyperstimulation syndrome.
• Okunye ukukhathazeka kwezempilo
• Uma umjikelezo wakho ukhanseliwe, udokotela wakho angase akweluleke ukuthi ushintshe izidakamizwa noma imithamo yazo ukuze uthole impendulo engcono phakathi nemijikelezo ye-IVF ezayo. Ungatshelwa futhi ukuthi udinga i-egg donor.

Ukukhishwa kweqanda

Ukubuyiswa kwamaqanda ehhovisi likadokotela wakho kuthatha amahora angu-34 kuya kwangu-36 ngemva komjovo wokugcina nangaphambi kokuvuthwa kweqanda.

• Ku-transvaginal ultrasound aspiration - amaqanda abe esekhishwa ngokufaka inaliti encane kumhlahlandlela we-ultrasound futhi ayidlulise esithweni sangasese nasefollicle.
• Uma ama-ovari akho engenakufinyelelwa nge-ultrasound ye-transvaginal, i-ultrasound yesisu ingase isetshenziselwe ukuqondisa inaliti. Amaqanda akhishwa efollicle kusetshenziswa inaliti exhunywe emishinini yokumunca. Emaminithini angaba ngu-20, amaqanda amaningi angakhishwa.

Nokho, akuwona wonke amaqanda azovundiswa ngempumelelo.

Ukukhishwa kwesidoda

Uma usebenzisa isidoda somlingani wakho, kufanele ulethe isampula lesidoda ehhovisi likadokotela wakho noma emtholampilo ekuseni lapho kutholwa amaqanda. Okunye ukwelapha, okufana ne-testicular aspiration (ukusetshenziswa kwenaliti noma inqubo yokuhlinzwa ukuze kuvunwe isidoda esendeni), kudingekile ngezikhathi ezithile. Isidoda somnikeli singasetshenziswa. 

Umanyolo

Ukuzalanisa kusetshenziswa izindlela zesintu. 

• I-Intracytoplasmic sperm injection (ICSI) - I-ICSI ivamise ukusetshenziswa lapho ikhwalithi yesidoda noma inani liyinkinga, noma lapho imizamo yokuvundisa phakathi nemijikelezo ye-IVF yangaphambili yehlulekile.
• Kwezinye izimo, udokotela wakho angase akweluleke ukuthi wenze ezinye izindlela zokwelapha ngaphambi kokudluliswa kombungu.
• Ukuchamusela ngosizo - Uma ungowesifazane osekhulile noma ube nemizamo eminingana ye-IVF engaphumelelanga, udokotela wakho angase acabangele ukuchanyuselwa okusizwayo, okuyindlela lapho imbobo esikwa khona ku-zona pellucida ngaphambi kokudluliselwa ukuze kusizwe umbungu ukuthi uchanyuselwe futhi ufakwe. Ngenxa yokuthi le ndlela ingajiya i-zona pellucida, ukuchanyuselwa okusizwayo kunenzuzo ikakhulukazi kumaqanda aqandiswe ngaphambilini noma imibungu.
• Ukuhlolwa kofuzo ngaphambi kokufakelwa - Ngemva kwezinsuku ezinhlanu kuya kweziyisithupha zokukhula, imibungu ifakwa ku-incubator futhi iyekwe ukuba ikhule kuze kube yilapho isampula elincane lingathathwa futhi lihlolelwe izifo ezithile zofuzo noma inani elifanele lama-chromosome. Nakuba ukuhlolwa kofuzo ngaphambi kokutshala kunganciphisa amathuba okuthi umzali adlulise udaba lofuzo, akukwazi ukuyisusa ngokuphelele ingozi. Ukuhlolwa ngaphambi kokubeletha kusengalulekwa.

Ukudluliswa kwemibungu

Ukudluliswa kombungu kuvame ukwenziwa ehhovisi likadokotela wakho noma emtholampilo ezinsukwini ezimbili kuya kweziyisihlanu ngemva kokukhishwa kwamaqanda.

• Udokotela uzofaka i-catheter, okuyishubhu elide, elincanyana, eligobekayo, esithweni sakho sangasese, ngomlomo wesibeletho sakho, nasesibelethweni sakho.
• Isipetu esinombungu owodwa noma ngaphezulu ilengiswe enanini elincane loketshezi sixhunywe ekugcineni kwe-catheter.
• Uma konke kuhamba kahle, i-embryo izofakwa olwelweni lwesibeletho sakho emva kwezinsuku eziyisithupha kuya kweziyishumi kulandela ukukhishwa kweqanda.

Ukulandela inqubo

Nokho, ama-ovari akho asengavuvukale. Ukugwema imisebenzi ekhandlayo, engase ibangele ukungakhululeki, kuwumqondo omuhle.

Okulandelayo yimiphumela emibi evamile:

• Ukudlulisa inani elincane loketshezi olucacile noma olunegazi ngokushesha ngemva kokuhlinzwa - ngenxa yokuswayipha komlomo wesibeletho ngaphambi kokudluliselwa kombungu
• Ukungakhululeki kwebele ngenxa yamazinga e-estrogen eqile
• Ukuvimbela
• I-cramping encane 
• ukuqunjelwa

Udokotela uzophinde akuhlolele izinkinga ezinjengokutheleleka, ukuqunjelwa kwesibeletho, kanye nesifo esinzima se-ovarian hyperstimulation.

Imiphumela

• Udokotela wakho uzohlaziya isampula yegazi lakho izinsuku ezingu-12 kuya emasontweni amabili ngemva kokutholwa kweqanda ukuze abone ukuthi ukhulelwe yini.
• Uma ukhulelwe, udokotela wakho uzokutusa kudokotela wezifo zabesifazane noma omunye uchwepheshe wokukhulelwa ukuze uthole ukunakekelwa ngaphambi kokubeletha.
• Uma ufuna ukuzama omunye umjikelezo we-in vitro fertilization (IVF), udokotela wakho angase atuse izinyathelo ongazithatha ukuze wandise amathuba akho okukhulelwa nge-IVF.

Amathuba okuba nomntwana onempilo ngemva kokusebenzisa i-IVF anqunywa izici eziningi, ezihlanganisa:

• Iminyaka kamama - Abesifazane abaneminyaka engaphezu kwengu-41 bavame ukululekwa ukuthi bacabangele ukusebenzisa amaqanda anikelwe ngesikhathi se-IVF ukuze bakhulise amathuba abo okuphumelela.
• Isiteji sombungu - Ukudlulisa imibungu esele ikhulile kuhlobene namazinga okukhulelwa amakhulu kunokudlulisa imibungu engakhulanga kahle (usuku lwesibili noma lwesithathu). Nokho, akuwona wonke ama-embryo asindayo ekukhuleni. 
• Umlando wokukhiqiza kabusha - Abesifazane abake babeletha phambilini banamathuba amaningi okuthi bakhulelwe nge-IVF kunabesifazane abangakaze babelethe. Abesifazane abenze i-IVF izikhathi eziningi kodwa abangakhulelwa baye banciphisa izinga lempumelelo.
• Isizathu sokungazali - Ukuba nokukhiqizwa kwamaqanda okujwayelekile kukhulisa amathuba akho okukhulelwa nge-IVF. Abesifazane abane-endometriosis eqinile mancane amathuba okuthi kunabesifazane abanobunyumba obungachazeki bakwazi ukukhulelwa nge-IVF.
• Izici zendlela yomuntu yokuphila - Abesifazane ababhemayo banamaqanda ambalwa ukuze balulame ngesikhathi se-IVF futhi maningi amathuba okuthi baphuphukele.