Kuzizira kwa dzira… Kwa azimayi ena omwe ali ndi matenda osachiritsika kapena matenda aakulu, njira iyi yothandizira kubereka nthawi zina ndiyo njira yokhayo yosungira chonde chawo ndikuyembekeza kuwona njira yawo yoberekera tsiku lina itakwaniritsidwa. Koma kusungidwa kwa oocyte kumakhalanso ndi zisonyezo zina zomwe nthawi zambiri sizidziwika bwino. Chidule cha mchitidwewu ku France.

Ma oocyte ozizira, omwe amadziwikanso kuti oocyte cryopreservation, ndi njira yosungira chonde. Zimaphatikizapo kutenga ma oocyte, pambuyo pa kukondoweza kwa ovari kapena ayi, musanawaziziritse mu nayitrogeni wamadzi ndikuwasungira kuti akhale ndi pakati pambuyo pake.

Ku France, kusungunuka kwa oocyte kumayendetsedwa ndi lamulo makamaka nkhani L-2141-11 ya Health Code, monga mankhwala onse oteteza kubereka (kuzizira kwa umuna kapena umuna, kuteteza minofu yamchiberekero kapena minyewa ya testicular). Lembali likunena kuti "munthu aliyense amene chithandizo chamankhwala chingasokoneze chonde, kapena chiwopsezo chake chokhudzana ndi chonde chikalephereka msanga, atha kupindula ndi kusonkhanitsa ndikusunga magemu awo […] ndi cholinga chotsatira, kuti amuthandize, zamankhwala adathandizira kubereka, kapena ndi cholinga chosunga ndi kubwezeretsa chonde chake. "

Ichi ndiye chisonyezero choyambirira cha kuzizira kwa oocyte: kulola azimayi kuti asunge chonde chawo akamamwa mankhwala oopsa atha kuwononga malo awo ovundikira. Oocyte cryopreservation ndiye kuti makamaka amafunikira azimayi kuti azilandira mankhwala a chemotherapy (makamaka omwe amaphatikizidwa ndimafupa) kapena radiotherapy, makamaka m'chiuno.

Mu funso:

• Mankhwalawa ndi owopsa kwambiri m'mimba (amatchedwa gonadotoxic), maselo akale (ma oocyte osakhwima) ndi ntchito yamchiberekero;
• Amafunikiranso kuti odwala alepheretse kulera kwawo kwa nthawi yayitali, nthawi zina ndi zaka zingapo, nthawi yothandizira ndi kuwonetsetsa kuti pakufunika njira yoti abereke.

Koma khansa si matenda okhawo omwe angafunikire kuteteza chonde. Chifukwa chake, kuzizira kwa oocyte kungalimbikitsidwe ngati:

• kumwa mankhwala ena a gonadotoxic. Izi zili choncho, mwachitsanzo, pakuwongolera ziwalo kapena matenda amthupi (mankhwala osokoneza bongo) kapena matenda ena a hematological monga sickle cell anemia;
• opaleshoni yomwe ingakhudze chonde;
• matenda obadwa nawo m'mimba. Nthawi zambiri majini, matendawa, monga Turner syndrome, amatha kubweretsa kulephera kwa mazira msanga.

Chidziwitso: pakagwa matenda, kuzizira mazira kumalimbikitsidwa makamaka mwa amayi omwe ali ndiubwino, makamaka osakwanitsa zaka 37. Kumbali inayi, ngati kuteteza chonde kumawonetsedwa mwa msungwana kapena msinkhu wobereka, njira yothandizira kuteteza thumba la ovari itha kuvomerezedwa ndi cholinga chodziwikiratu patapita nthawi.

Kutali ndimilandu iyi yolumikizidwa makamaka ndi matenda, pali chisonyezero china cha kuzizira kwa ma oocyte: kusintha kwa jenda.

Zowonadi, pakusintha kwa jenda, chithandizo chamankhwala cholimbikitsidwa kapena zochiritsira zitha kuwononganso chonde. Chifukwa chake, ngati mukuyamba ulendo wamisala, mutha kulangizidwa kuti musunge ndikuwumitsa ma oocyte anu. Patsala lero chosadziwika kwambiri: kugwiritsa ntchito ma gametes achisanu mkati mwa MAP (kubereka mothandizidwa ndi zamankhwala), zomwe zikadali zochepa ndi lamulo la Bioethics lomwe lakhala likugwira kuyambira 2011. Kusintha kwa lamuloli kungathandizire kufikira mwayi wokhala kholo kwa odwalawa.

Awiri omwe adalembetsa kale maphunziro a MAP osabereka angafunikenso kupita ku oocyte cryopreservation ngati:

• kubooleza kumapangitsa kukhala kotheka kupeza ma oocyte ambiri omwe sangakhale ndi umuna;
• Kutenga kwa umuna kumalephera patsiku la vitro umuna. Cholinga chake ndikosavuta: kupewa "kutaya" ma gametes kuchotsedwa ndikuwasunga mpaka kuyesanso kwa IVF.

Mayiko ambiri ku Europe tsopano avomereza kuzizidwa kwa ma oocyte otchedwa "comfort" kuti alole azimayi kuti azisunga ma gametes awo pathupi lotsatira popanda chisonyezo chachipatala. Cholinga chake ndichakuti athe kubweza zaka zakubadwa amayi osadwala chifukwa cha kuchepa kwa chonde komwe kumalumikizidwa ndi ukalamba.

Ku France, kuzizidwa kwa ma oocyte otakasuka (omwe amatchedwanso kuti kuteteza ma oocyte) pakadali pano kumangovomerezedwa pamlandu umodzi: zopereka za oocyte. Poyamba zimasungidwa azimayi achikulire omwe anali kale ndi mwana, choperekachi chasintha ndi lamulo la Bioethics la Julayi 7, 2011. Zachilendo pamutuwu: nulliparas (amayi omwe alibe ana) tsopano ali ndi ufulu wopereka ana awo. ma oocyte ndipo amaloledwa kusunga ena mwa iwo poyembekezera kutenga pakati.

Kuzizira kwa ma oocyte popanda chisonyezo cha zamankhwala kumatsalira, komabe, kuli kochepa:

• Woperekayo ayenera kudziwitsidwa pasadakhale za mwayi wake wotsatira woyembekezera kuchokera kuma oocyte omwe wakwanitsa kuwasunga;
• Amanena kuti theka la ma oocyte omwe asonkhanitsidwa adzaperekedwa kwa zopereka pamaziko a ma oocyte osachepera 5 (ngati ma oocyte 5 kapena ochepera amatengedwa, onse amapita kukapereka ndipo palibe kuzizira kotheka kwa woperekayo);
• Woperekayo atha kupereka ndalama ziwiri zokha.

Chowonadi ndichakuti kusintha kwa zopereka za oocyte kumatsegulira ufulu wazodzisungira womwe ukupitilizabe kutsutsana: kodi ziyenera kutsegulidwa kwa amayi onse omwe alibe zopereka, atapitirira msinkhu wa umayi? Apanso, kuwunikanso lamulo la Bioethics posachedwa kungapereke yankho lalamulo pamafunso awa. Pakadali pano, mabungwe ophunzira komanso Academy of Medicine makamaka ayamba kutsatira.

Kuzizira kwa ma oocyte lero kumadalira njira: oocyte vitrification. Mfundo yake? Ma oocyte amamizidwa m'madzi a nayitrogeni pomwe amawundana mwachangu kutentha kwa -196 ° C. Chothandiza kwambiri kuposa njira yozizira pang'ono yozizira yomwe idagwiritsidwapo ntchito, vitrification imapangitsa kuti zitheke kupulumuka kwa ma oocyte achisanu, makamaka ndi kulepheretsa kupangidwa kwa makhiristo omwe kale adasintha ma gametes, kuwapangitsa kukhala osagwiritsidwa ntchito.

Kuti zitheke, kuzizira kwa oocyte ndi gawo la njira yothandizira. Izi zimasiyanasiyana kutengera kufulumira kwa chithandizo ndi matenda omwe akukambidwa. Ngati mukuda nkhawa, nthawi zonse, muyenera kukambirana ndi dokotala yemwe angakufotokozereni:

• kawopsedwe mankhwala;
• njira zotetezera chonde zomwe mungapeze;
• mwayi wokhala ndi pakati (zomwe sizotsimikizika) ndi njira zina zotheka;
• njira zolerera ziyenera kukhazikitsidwa podikirira kuyamba kwa mankhwala.

Adzakufunsani kuti mupange msonkhano wokambirana ndi anthu osiyanasiyana kuti musunge chonde, chomwe chidzatsimikizire zomwe mungalandire. Zosankha ziwiri ndizotheka:

• Ngati muli ndi zaka zakubala, musakhale ndi zotsutsana ndi mankhwala am'thupi komanso chithandizo chanu (chemotherapy, radiotherapy, ndi zina zambiri) sichofunika kwambiri, chithandizo chanu chidzayamba ndikulimbikitsa kwamchiberekero kuti mulimbikitse kufikira kwa ma oocyte ambiri. Poterepa, mupindula ndi "zakumapeto" za vitro feteleza: kukondoweza, kutsata kwa ultrasound ndikutsata kwachilengedwenso, kuyambitsa mazira ndi kuphulika kwa oocyte;
• Ngati simungathe kukondoweza (chithandizo chanu ndichachangu, muli ndi khansa yodalira mahomoni monga khansa ya m'mawere), dokotala wanu nthawi zambiri amalangiza za vitrification protocol osalimbikitsa. Kodi zimakhala ndi chiyani? Pambuyo pobowola ma oocyte osakhwima, ma gametes amakula mu labotale kwa maola 24 mpaka 48 kuti afike pokhwima. Izi zimatchedwa in vitro maturation (IVM).

Ma oocyte okhwima omwe amapezeka (mwa kukondoweza kapena IVM) amawundana asanagwiritsidwe ntchito potengera kubereka komwe kumathandizidwa ndi zamankhwala. Chidziwitso: nthawi zina, adokotala amalimbikitsa umuna wa vitro asanaundane. Musazengereze kukambirana nkhaniyi ndi dokotala wanu.

Ngakhale mwayi wokhala ndi pakati pambuyo pa kuzizira kwa dzira kwawonjezeka chifukwa cha kupita patsogolo kwaukadaulo monga vitrification, ndikofunikira kukumbukira kuti kutenga mimba sikutsimikiziridwa konse.

Ziwerengero zina zimatsimikizira izi, zopangidwa ndi Academy of Medicine:

• Pakukwaniritsa mavitamini, ma oocyte pakati pa 8 ndi 13 amasonkhanitsidwa pafupipafupi;
• Pambuyo pogwedezeka, 85% mwa ma oocyte omwewo amapulumuka;
• Kenako, IVF yolembedwa ndi ICSI, yomwe imapangitsa kuti mavitamini otsalawo akhale ndi feteleza, ali ndi mwayi wopambana 70%.

Zotsatira: kuchuluka kwa pakati pathupi ndikuchepetsa ma oocyte kumasintha pakati pa 4,5 ndi 12% kutengera msinkhu ndi thanzi. Chifukwa chake akuti ndikofunikira kuti ziziziritsa bwino pakati pa ma oocyte pakati pa 15 ndi 20 kuti ziyembekezere kubereka. Izi nthawi zambiri zimatanthawuza kutolera kangapo ndi kuziziritsa kuti chiyembekezo chokhala makolo.