In vitro fertilization (IVF)

ʻO ka hoʻouluulu in vitro (IVF) ka hui ʻana o ka hua manu a ka wahine a me ka sperm a ke kāne i loko o kahi pā hale hana. ʻO ka in vitro ma waho o ke kino. Hoʻomaʻamaʻa ka manaʻo o ka sperm i hoʻopili ʻia a komo i ka hua manu.

ʻO ka maʻamau, hua ʻia kahi hua manu a me ka sperm ma loko o ke kino o ka wahine. Inā hoʻopili ka hua manu momona i ka uhi o ka ʻōpū a hoʻomau i ka ulu ʻana, hānau ʻia kahi pēpē ma kahi o 9 mau mahina ma hope. Kapa ʻia kēia hana he hāpai kūlohelohe a kōkua ʻole paha.

ʻO IVF kahi ʻano o ka ʻenehana hoʻohua kōkua i kōkua ʻia (ART). Hoʻohana kēia i nā hana lapaʻau kūikawā e kōkua i ka wahine e hāpai. Hoʻomaʻo pinepine ʻia ia inā ʻaʻole i kūleʻa nā ʻenehana momona hou aʻe.

Aia ʻelima mau ala maʻamau i IVF:

KaʻAnuʻu 1: Stimulation, i kapa ʻia ʻo super ovulation

• Hāʻawi ʻia nā lāʻau, i kapa ʻia nā lāʻau hoʻohua, i ka wahine e hoʻonui i ka hana hua.
• ʻO ka maʻamau, hana ka wahine i hoʻokahi hua manu i kēlā me kēia mahina. Hōʻike nā lāʻau lapaʻau momona i nā ovaries e hana i kekahi mau hua.
• Ma kēia kaʻina, e loaʻa i ka wahine nā ultrasound transvaginal maʻamau e nānā i nā ovaries a me nā hoʻāʻo ʻana i ke koko e nānā i nā pae hormonone.

KaʻAnuʻu 2: Ke kiʻi hou ʻana i nā hua

• Hana ʻia kahi ʻoki liʻiliʻi, i kapa ʻia ka follicular aspiration, e wehe i nā hua mai ke kino o ka wahine.
• Hana ʻia ke kīʻaha ma ke keʻena o ke kauka i ka hapanui o ka manawa. Hāʻawi ʻia ka wahine i nā lāʻau no laila ʻaʻole ia e ʻeha i ka wā o ke kaʻina hana. Ke hoʻohana nei i nā kiʻi ultrasound ma ke ʻano he alakaʻi, hoʻokomo ka mea mālama olakino i kahi nila keleawe ma o ka ʻōpū i loko o ka ovary a me nā ʻeke (follicle) i loaʻa nā hua. Pili ka nila i kahi hāmeʻa, e huki i nā hua a me ka wai o kēlā me kēia follicle, i kēlā me kēia manawa.
• Hoʻopiʻi hou ʻia ke kaʻina hana no ka ovary ʻē aʻe. Aia paha kekahi cramping ma hope o ke kaʻina hana, akā e hala ia i loko o kahi lā.
• I nā hihia kakaʻikahi, pono ʻia kahi pelvic laparoscopy e hemo i nā hua. Inā ʻaʻole hana a ʻaʻole hiki i ka wahine ke hua i kekahi hua, hiki ke hoʻohana ʻia nā hua i manawaleʻa ʻia.

KaʻAnuʻu Hana 3: Insemination a me ka Hoʻoulu

• Hoʻokomo ʻia ka sperm a ke kāne me nā hua hua maikaʻi loa. ʻO ka hoʻohuihui ʻana o ka sperm a me ka hua manu i kapa ʻia he insemination.
• Mālama ʻia nā hua moa a me ka sperm i loko o kahi keʻena mālama kaiapuni. Komo pinepine ka sperm (fertilizing) i kahi hua manu i kekahi mau hola ma hope o ka insemination.
• Inā manaʻo ke kauka he haʻahaʻa ka manawa kūpono o ka momona, hiki ke hoʻopili pono ʻia ka sperm i ka hua manu. Kāhea ʻia kēia ka intracytoplasmic sperm injection (ICSI).
• Hana pinepine nā papahana momona i ka ICSI ma kekahi o nā hua, ʻoiai inā he maʻamau nā mea.

KaʻAnuʻu 4: moʻomeheu Embryo

• Ke hoʻokaʻawale ka hua manu momona, lilo ia i embryo. Nānā pinepine nā limahana Laboratory i ka embryo e hōʻoia e ulu pono ana. Ma waena o 5 mau lā, aia kekahi embryo maʻamau i kekahi mau pūnaewele e ʻāpana like.
• ʻO nā kāne i loaʻa i ka makaʻu nui i ka hele ʻana i kahi maʻi genetical (hereditary) i kahi keiki e noʻonoʻo paha i ka diagnostic genetic pre-implantation (PGD). Hana pinepine ʻia ke kaʻina hana 3 a 5 mau lā ma hope o ka momona. Wehe nā ʻepekema Laboratory i hoʻokahi hunaola a i ʻole nā ​​pūnaewele mai kēlā me kēia embryo a hoʻopaʻa i nā mea no nā maʻi kūlohelohe.
• Wahi a ka American Society for Reproductive Medicine, hiki i ka PGD ke kōkua i nā mākua e hoʻoholo i nā embryos e hoʻokomo. Hoʻemi kēia i ka manawa o ka hele ʻana i kahi maʻi i kahi keiki. Kūleʻa ke ʻano hana a hāʻawi ʻole ʻia ma nā kikowaena āpau.

KaʻAnuʻu Hana 5: Embryo hoʻoili

• Hoʻokomo ʻia ʻo Embryos i loko o ka ʻōpū o ka wahine 3 a 5 mau lā ma hope o ka loaʻa ʻana o ka hua manu a me ka momona.
• Hana ʻia ke kaʻina hana i ke keʻena o ke kauka ʻoiai e ala ana ka wahine. Hoʻokomo ke kauka i kahi paipu lahilahi (catheter) i loaʻa nā embryos i loko o ka wahine wahine, ma o ka cervix, a piʻi i loko o ka ʻōpū. Inā pili ka embryo i (implants) i ka uhi o ka ʻōpū a ulu, hopena nā hāpai.
• Hiki ke hoʻokomo ʻia ma mua o hoʻokahi embryo i loko o ka ʻōpū i ka manawa like, hiki ke alakaʻi i nā māhoe, ʻekolu, a ʻoi aku paha. ʻO ka helu kikoʻī o nā embryos i hoʻoili ʻia he pilikia paʻakikī e pili ana i nā kumu he nui, keu hoʻi ka makahiki o ka wahine.
• Hoʻopaʻa ʻia nā embryo i hoʻohana ʻole ʻia a hāʻawi ʻia a hāʻawi ʻia i kahi lā ma hope.

Hana ʻia ʻo IVF e kōkua i ka wahine e hāpai. Hoʻohana ʻia ia e mālama i nā kumu he nui o ka infertility, me:

• Makahiki holomua o ka wahine (age maternal age)
• Ua hōʻino ʻia a pale ʻia nā paipu Fallopian (hiki i ka maʻi pelvic inflammatory a i ʻole ke ʻoki hānau mua).
• Endometriosis
• ʻO ka infertility kāne, me ka hoʻemi ʻana i ka helu sperm a me ka blockage
• Infertility wehewehe ʻole ʻia

Hoʻopili ʻo IVF i ka nui o ka ikaika o ke kino a me ka naʻau, ka manawa, a me ke kālā. He nui nā kāne e pili ana i ka infertility i ka ʻeha a me ke kaumaha.

ʻO ka wahine e lawe nei i nā lāʻau lapaʻau momona i loaʻa i ka bloating, ka ʻeha o ka ʻōpū, nā loli o ka naʻau, nā maʻi poʻo, a me nā hopena ʻē aʻe. Hiki i nā inikua IVF ke hana hou i ka palapū.

I nā hihia maʻamau, hiki i nā lāʻau lapaʻau ke hoʻohua i ka maʻi hyperstimulation ovarian (OHSS). ʻO kēia kumu ke kumu o ka hoʻonui ʻia o ka wai i loko o ka ʻōpū a me ka umauma. Pākuʻi ʻia nā ʻōuli me ka ʻeha o ka ʻōpū, ka pehu ʻana, ka loaʻa wikiwiki ʻana (10 paona a i ʻole 4.5 kilokilo ma waena o 3 a 5 mau lā), hoʻemi i ka urination me ka inu nui ʻana i nā wai, kahe, ka luaʻi, a me ka hanu ʻole. Hiki ke mālama ʻia nā hihia akahai me ka hoʻomaha hoʻomaha. ʻO nā hihia ʻoi aku ka nui e koi i ka ninini ʻana o ka wai me ka nila a hiki paha i ka haukapila.

Ua hōʻike ʻia nā noiʻi lāʻau lapaʻau i kēia manawa ʻaʻole pili nā lāʻau lapaʻau hoʻohua i ka maʻi ʻaʻai ovarian.

ʻO nā pōʻino o ka loaʻa ʻana o ka hua manu me nā hopena o ka anesthesia, ke kahe ʻana o ke koko, ka maʻi, a me ka hōʻino ʻana i nā hale e pili ana i nā ovaries, e like me ka ʻōpū a me ka pūpū.

Aia kekahi pilikia o nā hāpai keiki ke kau ʻia ma mua o hoʻokahi embryo i loko o ka ʻōpū. Lawe i ka ʻoi aku ma mua o hoʻokahi pēpē i ka manawa hoʻonui i ka makaʻu no ka hānau mua a me ke kaupaona hānau haʻahaʻa. (Eia nō naʻe, ʻo ka pēpē hoʻokahi i hānau ma hope o ka IVF ʻoi aku ka nui o ka makaʻu no ka wā ʻōpio a me ke kaupaona hānau haʻahaʻa.)

ʻAʻole maopopo inā hoʻonui ka IVF i ka makaʻu no ka hānau hānau.

He kumu kūʻai nui ʻo IVF. ʻO kekahi, akā ʻaʻole nā ​​mokuʻāina āpau i loaʻa nā kānāwai e ʻōlelo nei e pono nā ʻoihana ʻinikua olakino e hāʻawi i kekahi ʻano o ka uhi ʻana. Akā, nui nā hoʻolālā ʻinikua ʻaʻole e uhi i ka mālama infertility. ʻO nā uku no ke kaʻapuni IVF hoʻokahi e pili ana i nā kumukūʻai no nā lāʻau, ke ʻoki, anesthesia, nā ultrasounds, nā hoʻokolohua koko, ka hana ʻana i nā hua a me ka sperm, ka mālama ʻana i ka embryo, a me ka lawe ʻana i ka embryo. ʻOkoʻa ka huina kikoʻī o hoʻokahi pōʻaiapuni IVF, akā ʻoi aku paha ke kumukūʻai ma mua o $ 12,000 i $ 17,000.

Ma hope o ka hoʻohuli embryo, haʻi ʻia ka wahine e hoʻomaha no ke koena o ka lā.ʻAʻole pono ka hoʻomaha hoʻomaha piha, ke ʻole ka piʻi nui o ka pilikia no ka OHSS. Hoʻi ka hapa nui o nā wahine i nā hana maʻamau i ka lā aʻe.

Pono nā wahine e hele i ka IVF i kēlā me kēia lā a i ʻole nā ​​paila o ka hormone progesterone no 8 a 10 mau pule ma hope o ka hoʻololi ʻana o ka embryo. ʻO Progesterone kahi homone i hana kūlohelohe ʻia e nā ovaries i hoʻomākaukau i ka uhi o ka uterus (ʻōpū) i hiki i kahi embryo ke hoʻopili. Kōkua pū ʻo Progesterone i kahi embryo i kanu ʻia e ulu a lilo i hoʻokumu ʻia i loko o ka kōpū. E hoʻomau ka wahine i ka lawe progesterone no 8 a 12 mau pule ma hope o ka hāpai ʻana. ʻO ka progesterone liʻiliʻi loa i nā hebedoma mua o ka hāpai ʻana e alakaʻi i ka hāpai keiki ʻole.

Ma kahi o 12 a 14 mau lā ma hope o ka lawe ʻana o ka embryo, e hoʻi ka wahine i ka haukapila i hiki ai ke hoʻokolohua hāpai keiki.

Kāhea koke i kāu mea hāʻawi inā loaʻa iā IVF a loaʻa iā:

• Ke kuni ma kahi o 100.5 ° F (38 ° C)
• ʻEha pelvis
• Kaumaha kahe mai ka ʻōpū
• Koko i ka mimi

Hoʻololi nā helu helu i kēlā me kēia keʻena maʻi i kekahi a pono e nānā pono. Eia nō naʻe, ʻokoʻa nā heluna hoʻomanawanui i kēlā me kēia keʻena lapaʻau, no laila ʻaʻole hiki ke hoʻohana ʻia nā helu hāpai ma ke ʻano he hōʻailona kūpono o kahi keʻena i ʻoi aku ka maikaʻi ma mua o kekahi.

• Hōʻike nā helu hāpai i ka helu o nā wahine i hāpai ma hope o IVF. Akā ʻaʻole nā ​​hapai a pau nā hopena i kahi hānau hānau.
• Hōʻike ka helu hānau ola i ka helu o nā wahine hānau hānau keiki.

Aia ka ʻike o nā helu hānau ola i kekahi mau mea e like me ka makahiki makuahine, ka hānau mua ma mua, a me ka hoʻololi embryo hoʻokahi i ka manawa o IVF.

Wahi a ka Society of assisted Reproductive Technologies (SART), ʻo ka manawa kokoke e hānau i kahi pēpē ola ma hope o IVF penei:

• 47.8% no nā wahine ma lalo o 35 mau makahiki
• 38.4% no nā makahiki wahine 35 a 37
• 26% no nā wahine mai 38 a 40 mau makahiki
• 13.5% no nā makahiki wahine 41 a 42

IVF; Kōkua ʻenehana hānau hou; ART; Ke kaʻina hana pēpē paipu hoʻāʻo; Hoʻokomo - ma vitro

ʻO Catherino WH. Reproductive endocrinology a me ka infertility. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 223.

Choi J, Lobo RA. I ka hoʻouluulu vitro. I: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Gynecology Comprehensive. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 43.

Komite Hoʻomaʻamaʻa o ka ʻAmelika Hui Pū ʻIa no ka Laʻi Hana Hou; Kōmike Hoʻomaʻamaʻa o ka ʻAhahui no ka ʻenehana Reproductive Kōkua. Ke alakaʻi e pili ana i nā palena i ka helu o nā embryos e hoʻololi: he manaʻo kōmike. Fertil Steril. 2017; 107 (4): 901-903. PMID: 28292618 pubmed.ncbi.nlm.nih.gov/28292618/.

ʻO Tsen LC. ʻO ka fertilization in vitro a me nā ʻenehana hoʻoulu hou i kōkua ʻia. I: Chestnut DH, Wong CA, Tsen LC, et al, eds. ʻO Chestnut's Obstetrics Anesthesia. ʻElua huaʻōlelo Piladelapia, PA: Elsevier; 2020: chap 15.