Ngoba amawele ayathandeka, kweminye imibhangqwana, ngamawele kuyiphupho. Kodwa kungenzeka yini ukuthonya imvelo futhi ukwandise amathuba akho okukhulelwa kwamawele?

Kufanele sihlukanise izinhlobo ezimbili zokukhulelwa okungamawele, ezihambisana nezimo ezimbili ezihlukene zebhayoloji:

• amawele afanayo noma amawele e-monozygotic zivela eqandeni elilodwa (i-mono esho ukuthi "eyodwa", i-zyogote "iqanda"). Iqanda elikhulelwe isidoda lizala iqanda. Kodwa-ke, leli qanda, ngezizathu ezingakaziwa, lizohlukana kabili ngemuva kokukhulelwa. Khona-ke amaqanda amabili azokhula, anikeze imibungu emibili ephethe ufuzo olufanayo. Izingane zizoba zobulili obufanayo futhi zizobukeka zifana ncamashi, yingakho igama elithi "amawele angempela". Ngokuhluka okumbalwa okuncane ngenxa yalokho ososayensi abakubiza ngokuthi yi-phenotypic mismatch; uqobo lwayo kungumphumela we-epigenetics, okungukuthi indlela indawo ethonya ngayo ukubonakaliswa kofuzo;
• amawele omndeni noma amawele e-dizygotic zivela emaqandeni amabili ahlukene. Phakathi nomjikelezo ofanayo, kukhishwe amaqanda amabili (ngokuqhathaniswa nelinye ngokujwayelekile) futhi ngalinye lala maqanda lifakwa ngesikhathi esisodwa ngesidoda esihlukile. Njengomphumela wokukhulelwa kwamaqanda amabili ahlukene kanye ne-spermatozoa ehlukene, amaqanda awanalo ifa elifanayo lofuzo. Izingane zingaba ubulili obufanayo noma obuhlukile, futhi zibukeke zifana njengezingane ezivela kubazalwane abafanayo.

Cishe i-1% yokukhulelwa kwemvelo ukukhulelwa okungamawele (1). Izici ezithile zingadala ukuthi lesi sibalo sehluke, kepha futhi, kuyadingeka ukuhlukanisa phakathi kokukhulelwa kwe-monozygous nokukhulelwa kwe-dizygotic.

Ukukhulelwa kwe-monozygous akuvamile: kuthinta ama-3,5 kuya ku-4,5 ngokuzalwa okungu-1000, kungakhathalekile ubudala bomama, uhlelo lokuzalwa noma imvelaphi yendawo. Lapho kuvela khona lokhu kukhulelwa kunentekenteke yeqanda elizohlukana ngemuva kokukhulelwa. Lesi simo singaxhunyaniswa nokuguga kweqanda (okungukuthi, kodwa, elingenakho ukuxhumana nobudala bomama). Kuyabonakala emijikelezweni emide, nge-ovulation sekwephuzile (2). Ngakho-ke akunakwenzeka ukudlala kulokhu.

Ngakolunye uhlangothi, izici ezihlukene zithinta amathuba okuba nokukhulelwa kwe-dizygotic:

• Iminyaka kamama: ingxenye yokukhulelwa kwamawele e-dizygotic ikhula kancane kancane kuze kube yiminyaka engu-36 noma engu-37 lapho ifinyelela isilinganiso esiphezulu. Bese yehla ngokushesha kuze kube sekunqamukeni kokuya esikhathini. Lokhu kungenxa yezinga le-hormone FSH (follicle stimulating hormone), izinga elikhula ngokuqinile kuze kube yiminyaka engama-36-37, okwandisa amathuba okuvuthwa okuningi (3);
• uhlelo lokuzalwa: ngesikhathi esifanayo, izinga lamawele omndeni liyakhula ngenani lokukhulelwa kwangaphambilini (4). Lokhu kwehlukahluka kodwa kubaluleke kangako kunalokho okuxhunyaniswe nobudala bomama;
• ukuthambekela kofuzo: kukhona imindeni lapho amawele ejwayeleke kakhulu, futhi amawele enamawele amaningi kunabesifazane emphakathini jikelele;
• ubuzwe: izinga lokuhlangana kwe-dizygotic liphakeme ngokuphindwe kabili e-Afrika eningizimu ye-Sahara kunaseYurophu, futhi liphindwe kane kuya kahlanu kunaseShayina noma eJapane (5).

Ngokwanda kwe-ART, inani lamawele akhulelwe lenyuke ngama-70% kusukela ekuqaleni kwawo-1970. Izingxenye ezimbili kwezintathu zalokhu kwanda kungenxa yokwelashwa okunqanda inzalo futhi ingxenye yesithathu esele ibangelwa ukwehla kokukhulelwa. iminyaka yokuqala yokubeletha (6).

Phakathi kwamasu we-ART, eziningana zandisa amathuba okuthola ukukhulelwa amawele ngezindlela ezahlukahlukene:

I-IVF Ukudlulisa imibungu eminingi ngasikhathi sinye kwandisa amathuba okukhulelwa kaninginingi. Ukuze kuncishiswe le ngozi, ukwehla kwenani lemibungu edluliswa ngokudluliswa kuye kwabonwa iminyaka eminingana. Namuhla, ukuvumelana ukudlulisa ubuningi bemibungu emibili - akuvamile ukuba ibe mithathu uma kwenzeka ukwehluleka okuphindaphindiwe. Ngakho, kusukela ku-34% ku-2012, izinga lokudluliselwa kwe-mono-embryonic ngemva kwe-IVF noma i-ICSI likhuphuke laya ku-42,3% ngo-2015. Kodwa-ke, izinga lokukhulelwa kwamawele ngemva kwe-IVF lihlala liphakeme kunangemva kokukhulelwa. okwemvelo: ku-2015, i-13,8% yokukhulelwa elandela i-IVF iholele ekuzalweni kwamawele omndeni (7).

I-induction d'ovulation (okungaweli ngaphansi kwe-AMP) Ukwenziwa kwe-ovarian okulula okunqunywe ezinkingeni ezithile ze-ovulation kuhlose ukuthola i-ovulation esezingeni eliphakeme. Kwabanye besifazane, kungaholela ekukhishweni kwamaqanda amabili ngesikhathi sokuvuthwa, futhi kuholele ekukhulelweni okungamawele uma womabili amaqanda efakwe isidoda esisodwa.

Ukukhulelwa okungekhona okwangempela (noma i-intrauterine insemination IUI) Le nqubo ihlanganisa ukufaka isidoda esivunde kakhulu (kusuka kumlingani noma kumnikeli) esibelethweni ngesikhathi sokuvuthwa. Kungenziwa kumjikelezo wemvelo noma kumjikelezo ovuselelwe ngokugqugquzela ama-ovari, okungaholela ekuvuthweni okuningi. Ngo-2015, u-10% wokukhulelwa kulandela i-UTI kwaholela ekuzalweni kwamawele omndeni (8).

Ukudluliswa kombungu okufriziwe (TEC) Njenge-IVF, ukwehla kwenani lemibungu edluliswayo kuye kwabonwa iminyaka eminingana. Ngo-2015, ama-TEC angu-63,6% enziwa ngombungu owodwa, u-35,2% unemibungu emibili kanye no-1% kuphela no-3. 8,4% wokukhulelwa okulandela i-TEC okuholele ekuzalweni kwamawele (9).

Amawele abangelwa ukukhulelwa kulandela amasu e-ART angamawele omndeni. Kodwa-ke, kunamacala amawele afanayo avela ekuhlukanisweni kweqanda. Endabeni ye-IVF-ICSI, kubukeka sengathi izinga lokukhulelwa kwe-monozygous liphakeme kunokukhiqiza okuzenzakalelayo. Ukuguqulwa ngenxa yokugqugquzela i-ovari, izimo zesiko le-in vitro nokusingathwa kwe-zona pellucida kungachaza le nto. Ucwaningo luphinde lwathola ukuthi ku-IVF-ICSI, izinga lokukhulelwa kwe-monozygous laliphezulu ngemibungu edluliselwe esigabeni se-blastocyst, ngemuva kwesiko elide (10).

• Yidla imikhiqizo yobisi Ucwaningo lwaseMelika mayelana namathuba okukhulelwa kwamawele kwabesifazane be-vegan lubonise ukuthi abesifazane abasebenzisa imikhiqizo yobisi, ikakhulukazi izinkomo ezithole imijovo ye-hormone yokukhula, babenethuba eliphindwe ka-5 lokuba namawele kunabesifazane. abesifazane abadla imifino (11). Ukusetshenziswa kwemikhiqizo yobisi kungakhuphula ukukhiqizwa kwe-IGF (Insulin-Like Growyh Factor) engakhuthaza ukuvuthwa kwamaqanda amaningi. I-Yam kanye nobhatata nakho kungaba nalo mphumela, okungase kuchaze ngokwengxenye inani eliphezulu lokukhulelwa kwamawele kwabesifazane base-Afrika.
• Thatha isithasiselo sevithamini B9 (noma i-folic acid) Le vithamini enconyelwe ekukhulelweni kwangaphambi kokukhulelwa nokukhulelwa kwangaphambi kwesikhathi ukuvimbela i-spina bifida nayo ingakhuphula amathuba okuba namawele. Lokhu kuphakanyiswa wucwaningo lwase-Australia olubuke ukwanda okungu-4,6% kwamazinga amawele okukhulelwa kwabesifazane abathathe ukwesekwa kukavithamini B9 (12).