Ukuqanda kweqanda… Kwabesifazane abathile abaphethwe yizifo ezingamahlalakhona noma ezimbi, le ndlela yokuzala esizwa ngokwezokwelapha kwesinye isikhathi iyona ndlela kuphela yokulondoloza ukuzala kwabo futhi banethemba lokuthi uhlelo lwabo lokuzala izingane luyogcwaliseka ngelinye ilanga. Kodwa i-oocyte cryopreservation nayo inezinye izinkomba ezivame ukungaziwa kakhulu. Uhlolojikelele lwalo mkhuba eFrance.

I-oocyte eqandayo, eyaziwa nangokuthi i-oocyte cryopreservation, iyindlela yokulondoloza inzalo. Kuqukethe ukuthatha ama-oocyte, ngemuva kokuvuselelwa kwe-ovari noma cha, ngaphambi kokuwafaka ku-nitrogen ewuketshezi nokuwagcina ukuze akhulelwe ngokulandelayo.

E-France, i-oocyte cryopreservation ilawulwa ngokomthetho futhi ikakhulukazi i-athikili L-2141-11 Yekhodi Yezempilo, njengazo zonke izindlela zokwelapha zokulondoloza inzalo (ukuqandisa umbungu noma isidoda, ukulondolozwa kwezicubu zesibeletho noma izicubu zamasende). Lo mbhalo ubeka ukuthi “noma imuphi umuntu onakekelwa ngosizo lwezempilo olungalimaza inzalo, noma onobungozi bokuzala bungakhubazeki ngaphambi kwesikhathi, angazuza ekuqoqweni nasekulondolozweni kwamageyimu abo […] ngenhloso yokuhlinzekelwa okulandelayo, ukuze kuzuze yena, kwezokwelapha esiza ekuzaleni, noma ngenhloso yokulondoloza nokubuyisela inzalo yakhe. “

Ngakho-ke lokhu kuyinkomba eyinhloko yokuqandiswa kwe-oocyte: ukuvumela abesifazane ukuthi balondoloze ukuzala kwabo lapho bethatha ukwelashwa okunzima kungalimaza indawo yabo yokugcina ama-ovari. Ngakho-ke i-oocyte cryopreservation ihloselwe kakhulu abesifazane okufanele belashwe ngamakhemikhali (ikakhulukazi lawo ahlotshaniswa nokufakelwa komnkantsha) noma i-radiotherapy, ikakhulukazi esifundeni se-pelvic.

Umbuzo:

• Lezi zindlela zokwelapha zinobuthi obukhulu kuma-ovari (kuthiwa angama-gonadotoxic), amangqamuzana okuqala (ama-oocyte angavuthiwe) kanye nokusebenza kwe-ovarian;
• Ngokuvamile zidinga ukuthi iziguli ziyeke izinhlelo zazo zokubeletha isikhathi eside, ngezinye izikhathi ngeminyaka eminingana, isikhathi sokwenza ukwelashwa kanye nokuqinisekisa ukulandelwa okudingekayo kokukhulelwa.

Kodwa umdlavuza akuzona kuphela izifo okungahlongozwa ukulondoloza inzalo. Ngakho-ke, ukuqandisa i-oocyte kungase kunconywe uma kwenzeka:

• ukuthatha enye imishanguzo ye-gonadotoxic. Lokhu kunjalo, isibonelo, ekulawuleni ukufakelwa kwezitho noma izifo zesimiso somzimba sokuzivikela ezifweni (izidakamizwa ze-immunosuppressive) noma ezifweni ezithile ze-hematological ezifana ne-sickle cell anemia;
• ukuhlinzwa okungathinta inzalo;
• isifo sokuzalwa esibelethweni. Ngokuvamile izakhi zofuzo, lezi zifo, njenge-Turner syndrome, zingaholela ekuhlulekeni kwe-ovarian ngaphambi kwesikhathi.

Qaphela: uma kwenzeka ukugula, ukuqandisa amaqanda kunconyelwa ikakhulukazi kwabesifazane abasebasha, imvamisa abangaphansi kweminyaka engama-37 ubudala. Ngakolunye uhlangothi, uma ukulondolozwa kokuzala kukhonjiswa entombazaneni encane noma ebusheni bangaphambi kokubeletha, indlela yokulondolozwa kwezicubu zama-ovari ingathandwa ngenhloso yokwenza i-autograft yalezi zicubu kamuva.

Kude nalawa macala axhumene ngqo nesifo, kunenye inkomba yokubanda kwama-oocyte: ukuguqulwa kobulili.

Ngempela, phakathi nenqubo yokushintsha ubulili, ukwelashwa okunconyiwe noma ukuhlinzwa kungalimaza nokuzala. Ngakho-ke, uma uqala uhambo lobudoda, ungalulekwa ukuthi ugcine futhi umise ama-oocyte akho. Kusele namuhla okukhulu okungaziwa: ukusetshenziswa kwalawa ma-gamete afriziwe ngaphakathi kohlaka lwe-MAP (ukuzala okusizwa ngemithi), okusanqunyelwe umthetho we-Bioethics osebenza kusukela ngo-2011. kulezi ziguli.

Umbhangqwana osuvele ubhalise esifundweni se-MAP sokuzala ungadinga futhi ukuphendukela ku-oocyte cryopreservation uma:

• ukubhoboza kwenza kube nokwenzeka ukuthola ama-oocyte angaphezu kwezibalo angakwazi ukuvundiswa;
• ukuqoqwa kwesidoda kwehluleka ngosuku lokukhulelwa kwe-in vitro. Inhloso-ke ilula: ukugwema "ukulahlekelwa" ama-gamete asusiwe futhi uwagcine kuze kube umzamo olandelayo we-IVF.

Amazwe amaningi aseYurophu manje agunyaza ukuqaliswa kwama-oocyte okuthiwa “induduzo” ukuze kuvunyelwe abesifazane ukuba bagcine ama-gametes abo ukuze bathole ukukhulelwa ngaphandle kwezinkomba zezokwelapha. Ngakho-ke inhloso iwukuba ukwazi ukubuyisela emuva iminyaka yokuba ngumama ngaphandle kokuhlupheka kokuncipha kokuzala okuhlobene nokukhula.

EFrance, ukubanda kwama-oocyte enduduzo (okubizwa nangokuthi ukugcinwa kwama-oocyte) okwamanje kugunyazwe kuphela esimweni esisodwa: umnikelo we-oocyte. Ekuqaleni ibigcinelwe abesifazane abadala asebenengane kakade, lo mnikelo uye wavela ngomthetho we-Bioethics wangoJulayi 7, 2011. Intsha yalo mbhalo: nulliparas (abesifazane abangakabi nabantwana) manje banelungelo lokunikela ngabantwana babo. ama-oocyte futhi avunyelwe ukugcina amanye awo elindele ukukhulelwa okulandelayo.

Lokhu kubanda kwama-oocyte ngaphandle kwenkomba yezokwelapha kuhlala, nokho, kulinganiselwe kakhulu:

• Umnikeli kufanele aziswe kusengaphambili ngamathuba akhe okukhulelwa avela kuma-oocyte akwazile ukuwagcina;
• Kuthatha ukuthi uhhafu wama-oocyte aqoqiwe uzonikezelwa emnikelweni ngesisekelo sama-oocyte okungenani ama-5 (uma kuthathwa ama-oocyte ama-5 noma ngaphansi, konke kuya emnikelweni futhi akukho ukunqandeka okungenzeka komnikeli);
• Umnikeli angenza iminikelo emibili kuphela.

Iqiniso lihlala liwukuthi ukuguqulwa komnikelo we-oocyte kuvula ilungelo le-de facto lokuzigcina eliqhubeka nokuphikisana: kufanele livulelwe bonke abesifazane ngaphandle komnikelo, uma kubhekwa ukuqhubeka kweminyaka yobudala? Nalapha futhi, ukubuyekezwa komthetho we-Bioethics kunganikeza impendulo engokomthetho kulo mbuzo. Okwamanje, imiphakathi efundile kanye ne-Academy of Medicine ikakhulukazi baye bavuma.

Ukuqhwa kwama-oocyte namuhla kususelwa kunqubo: i-oocyte vitrification. Umgomo ? Ama-oocyte acwiliswa ngqo ku-nitrogen ewuketshezi lapho efriziwe khona ngokushesha okukhulu ekushiseni okungu -196 ° C. Kusebenza kangcono kunendlela yokubanda okuhamba kancane okusetshenziswe ngaphambili, i-vitrification yenza kube lula ukuqinisekisa ukusinda okungcono kwama-oocyte afriziwe, ikakhulukazi ukuvimbela ukwakheka kwamakristalu aguqule ngaphambilini ama-gametes, okwenza angasebenziseki.

Ukuze kwenzeke, ukubanda kwe-oocyte kuyingxenye yenqubo yokwelapha. Lokhu kuyehluka kuye ngokuphuthuma kokwelashwa kanye nesifo okukhulunywa ngaso. Uma ukhathazekile kuzomele, kuzo zonke izimo, ube nokubonisana kokuqala nodokotela wakho ozokuchazela:

• ubuthi bokwelashwa;
• izixazululo zokulondoloza inzalo ezitholakala kuwe;
• amathuba okukhulelwa (okungakaze kuqinisekiswe) kanye nezinye izindlela ezingenzeka;
• ukuvimbela inzalo kuzobekwa ngenkathi kulindwe ukuqala kokwelashwa.

Uzobe esekucela ukuthi wenze isikhathi sokubonisana ngemikhakha eminingi ukuze kugcinwe inzalo, okuzonquma izimo zokwelashwa kwakho. Izinketho ezimbili zingenzeka:

• Uma uneminyaka yobudala, awunakho ukuphikisana nokwelashwa kwama-hormone futhi nokwelashwa kwakho (i-chemotherapy, i-radiotherapy, njll.) akuphuthumi kakhulu, ukwelashwa kwakho kuzoqala ngokuvuselela i-ovarian ukuze kukhuthaze ukufika ekuvuthweni kwenani eliphezulu lama-oocyte. Kulo mongo, uzozuza ekulandeleni "i-classic" ye-in vitro fertilization: ukuvuselela, ukulandelwa kwe-ultrasound kanye ne-biological, ukuvuthwa kwe-ovulation kanye ne-oocyte puncture;
• Uma ungeke ukwazi ukukhuthazwa (ukwelashwa kwakho kuyaphuthuma, unomdlavuza oncike kuhomoni njengomdlavuza webele), udokotela wakho ngokuvamile uzoncoma iphrothokholi ye-vitrification ngaphandle kokukhuthazwa. Ihlanganisani? Ngemva kokubhobozwa kwama-oocyte angavuthiwe, ama-gamete akhuliswa elabhorethri amahora angu-24 kuya kwangu-48 ukuze afinyelele ukuvuthwa. Lokhu kubizwa ngokuthi yi-in vitro maturity (IVM).

Ama-oocyte avuthiwe atholakala ngaleyo ndlela (ngokukhuthazwa noma nge-IVM) abe eseqandiswa ngaphambi kokusetshenziswa kamuva esimweni sokuzala ngosizo lwezokwelapha. Qaphela: kwezinye izimo, udokotela angancoma ukuvundiswa kwe-in vitro ngaphambi kokuqandisa. Unganqikazi ukuxoxa nodokotela wakho ngale ndaba.

Ngenkathi amathuba okukhulelwa ngemuva kokubanda kweqanda enyukile ngenxa yentuthuko yezobuchwepheshe efana ne-vitrification, kubalulekile ukukhumbula ukuthi ukukhulelwa akukaze kuqinisekiswe.

Ezinye izibalo ziyakufakazela lokhu, ezihlanganiswe yi-Academy of Medicine:

• Ngesikhathi senqubo ye-vitrification, phakathi kuka-8 no-13 ama-oocyte aqoqwa ngokwesilinganiso ngomjikelezo ngamunye;
• Ngemva kokuncibilika, ama-85% alawa ma-oocyte afanayo ayasinda;
• Khona-ke, i-IVF nge-ICSI, eyenza kube nokwenzeka ukuvundisa ama-oocyte asele, inezinga lempumelelo lika-70%.

Umphumela: isilinganiso sokukhulelwa jikelele ngokuncibilika kwama-oocyte sishintsha phakathi kuka-4,5 no-12% kuye ngeminyaka yobudala nezimo zempilo. Ngakho-ke kulinganiselwa ukuthi kuyadingeka ukubamba ngempumelelo ama-oocyte aphakathi kuka-15 no-20 ukuze ube nethemba lokuthi uzobeletha. Lokhu ngokuvamile kusho ukuqoqwa okuningana namakhaza amaningi ekugcineni abe nethemba lokuba ngabazali.