Lokho Okufanele Ukwazi Ngokuhlolwa Kwenani Lamaqanda, Ukuhlolwa Kwekhwalithi Yamaqanda, Nokuhlolwa Kwesipele Samaqanda

Ukuzala iyindaba esondelene nenhliziyo kubantu abaningi nasemibhangqwaneni eminingi. Kungaba uhambo olujabulisayo kodwa kwesinye isikhathi lwedida, ikakhulukazi uma uzama ukukhulelwa. Ukuqonda ukuthi umzimba wakho usebenza kanjani nokwazi ukuthi yini engase ithinte amathuba akho okukhulelwa kubaluleke kakhulu. Kwabesifazane, isimo samaqanda abo sidlala indima enkulu ekuzaleni. Izivivinyo ezifana nokuhlolwa kokubalwa kwamaqanda, ukuhlolwa kwekhwalithi yamaqanda, nokuhlolwa kwe-ovarian reserve zonke zakhelwe ukunikeza isithombe esicacile kakhulu sokuthi kwenzekani ngaphakathi kuma-ovary.

Ake sibhekane nakho, i-fertility ayikhulumi nje ngesifiso sokuba nengane—ikhuluma ngesikhathi, ngokwakhiwa komzimba, futhi kwesinye isikhathi nangenhlanhla. Ukuthola ukufinyelela kulezi zivivinyo kungakunikeza umuzwa wokucaca nokuqondiswa, ikakhulukazi kwabesifazane abahlela noma abahlushwa ubunzima bokukhulelwa. Lezi zivivinyo azinazo zonke izimpendulo, kodwa ngokuqinisekile zisiza ekuhlanganiseni lawo mazinga epuzele.

Ukuhlolwa Kokubalwa Kwamaqanda

Ukuhlolwa kokubalwa kwamaqanda cishe yilokho okuzwakala kuyikho—kuhlola ukuthi mingaki imbewu osele nayo kuma-ovary akho. Kodwa ungakhathazeki, akekho oyibala eyodwa ngemuva kwenye! Kwenziwa ngempela ngokuhlolwa kwegazi okunquma into ebizwa nge-Anti-Müllerian Hormone (AMH). Le hormone ikhiqizwa ama-follicle kuma-ovary akho (yilezo zikhwama ezincane ezigcina amaqanda akho). Amazinga e-AMH aphezulu ngokuvamile asho ukuthi usenemibungu eminingi esele, kanti amazinga aphansi angase abonise ukuthi isitokwe sakho sesiya ngokuya siphela [1].

Lolu vivinyo luwusizo kakhulu kwabesifazane abazama ukukhulelwa sebemdala, abanokuya esikhathini okungajwayelekile, noma abavele befuna ukwazi ngezempilo yabo yokuzala. Uma ucabanga ngokubanda/ukugcina amaqanda akho (egg freezing), ukwazi inani lamaqanda onawo kungakusiza ukunquma isikhathi esingcono kakhulu sokukwenza.

Kodwa masikhulume iqiniso, ukuhlolwa kokubalwa kwamaqanda akusona isiporho esikutshela ikusasa. Akuyona into ezokutshela ukuthi uzakhulelwa nini—noma ukuthi uzokhulelwa yini nhlobo. Kuningi okufana nesithombe esisheshayo sokuthi usasebenza nani kulesi sikhathi samanje.

Kuyini Ukuhlolwa kwe-Ovarian Reserve?

I-ovarian reserve iwuhlobo oluhle nje lokusho ukuthi “mingaki imbewu usasele nayo?” Ukuhlolwa kwe-ovarian reserve kujula kancane kunokuvivinywa okuyisisekelo kokubalwa kwamaqanda. Akuqali nje ukukutshela inani; kukunika umqondo wokuthi ama-ovary akho asebenza kanjani ngokujwayelekile.

I-AMH isenendima enkulu kulo luhlolo, kodwa kukhona okunye futhi. Elinye ihomoni elibizwa nge-Follicle-Stimulating Hormone (FSH) lilinganiswa nalo. Le homoni ikhiqizwa yisitho se-pituitary futhi isebenza ukugqugquzela isibeletho sakho ukuze silungise lawo maqanda ekuvuthweni (ovulation). Uma amazinga akho e-FSH ephakeme, kungasho ukuthi isibeletho sakho asisabeli kahle ngokwanele njengoba kufanele [2].

Bese kuba khona i-Estradiol, uhlobo lwe-estrogen. Ilinganiswe kanye ne-FSH ukuze ibanike odokotela umbono ocacile kakhulu. Futhi masingakhohlwa nenani lama-antral follicle (AFC), elenziwa nge-ultrasound ye-transvaginal. Ngesikhathi salolu hlolo, udokotela ubala ama-follicle amancane esibelethweni sakho anamandla okuthuthuka abe amaqanda avuthiwe [3].

Wonke la mahlolo ndawonye akha ukuhlolwa kwesipele samaqanda esibelethweni. Kufana nokuthola ikhadi lombiko eligcwele ngesipele samaqanda akho, elinezigaba zenani nokusebenza kwawo okuphelele.

Uhlolo Lwesipele Samaqanda

Uhlolo lwesipele samaqanda luyithuluzi elibalulekile lokuqonda ukuthi umi kuphi mayelana nokuzala. Lolu hlolo lugxile ikakhulukazi ekutholeni ukuthi usenamaqanda angaki asele. Akuthathi sikhathi eside ukuphelelwa amaqanda—lapho usufika ebuntwaneni obukhulu (puberty), usuvele wehlele cishe ku-300,000 kuya ku-400,000 usuka ezigidi owazalwa nazo. Futhi kusukela lapho, leyonani iyaqhubeka nje kuphela nokwehla.

Lapho usufika eminyakeni ephakathi kwawo-30, inani lamaqanda akho liqala ukwehla ngesivinini esikhulu. Yingakho uhlolo lwesipele samaqanda luwusizo kangaka. Luhlanganisa amazinga e-AMH kanye nenani lama-antral follicle ukuze lunikeze ukulinganisa okunembile ngokuthi mhlawumbe unesikhathi esingakanani esisele sokukhulelwa ngokwemvelo [4].

Kwabesifazane abacabanga ukuwafriza amaqanda abo noma ukwenza ukwelashwa kokungabi nenzalo njengokwelashwa kwe-IVF, lolu hlolo luguqula umdlalo. Lusiza odokotela banqume indlela engcono kakhulu nesikhathi esifanele sokwelashwa.

Kuthiwani Ngohlolo Lwekhwalithi Yamaqanda?

Inani alikho yikho konke. Uhlolo lwekhwalithi yamaqanda lugxile empilweni yamaqanda akho. Noma unamaqanda amaningi asele, kudingeka abe nempilo enhle ukuze kuholele ekukhulelweni okuyimpumelelo.

Manje, nansi ingxenye ekhohlisayo: asikho isindlela eqondile yokuhlola ikhwalithi yamaqanda. Akufani nokuthi odokotela bangahlikihla iso bathi, “Yebo, leli lihle!” Esikhundleni salokho, bathembele ezinkombeni ezingaqondile ezifana nobudala bakho, amazinga amahomoni, nokuthi amaqanda akho asabela kahle kangakanani ekugqugquzeleni ngesikhathi sokwelashwa kokungabi nenzalo.

Njengoba uguga, iphesenti lamaqanda anofuzo ajwayelekile liqala ukwehla. Abesifazane abangaphansi kweminyaka engu-35 bavame ukuba nesabelo esikhulu samaqanda asezingeni eliphezulu, kuyilapho labo abaneminyaka engaphezu kwengu-40 bebhekana nokwehla okusheshayo. Uhlolo lwekhwalithi yamaqanda lusiza ukulinganisa amathuba okuthi amaqanda akho abe nawo amandla okuchumiseka nokuholela ekukhulelweni [5].

Kungani Le Mihloyo Ibalulekile?

I-fertility akuyona into abantu abaningi abayicabangayo kuze kube sebezama ukuchitha umntwana—bese kungazelelwe iba yinto abayicabangayo kuphela. Ukuhlolwa okufana nokuhlolwa kwenani lamaqanda, ukuhlolwa kwekhwalithi yamaqanda, nokuhlolwa kwe-ovarian reserve kuwamathuluzi abalulekile okulawula uhambo lwakho lwe-fertility.

Kwabanye abesifazane, le mihloyo iqinisekisa ukuthi konke kuhamba kahle. Kwabanye, iveza izingqinamba ezingase zibe khona. Noma kunjalo, ukuba nolwazi kusho ukuthi ungathatha izinqumo ezinolwazi mayelana nokuthi wenzeni ngokulandelayo.

Uma isitokwe sakho samaqanda siphakeme futhi ikhwalithi ibukeka kahle, ungase ube nethuba lokulinda kancane ngaphambi kokuzama ukuba nomntwana. Kodwa uma imiphumela ikhombisa ukuthi isikhathi asisekho ohlangothini lwakho, uzokwazi ukuthi kufanele usheshise noma ubheke ezinye izinketho ezifana ne-IVF noma ukugcinwa (freezing) kwamaqanda [6].

Iminyaka Ne-Fertility: Iqiniso Elibuhlungu

Akukho ukusonteka kweqiniso—iminyaka iyona nto enkulu eyodwa ethinta i-fertility. Abesifazane abaseminyakeni yabo yama-20 kuya ekuqaleni kwama-30 ngokuvamile banamathuba angcono kakhulu okukhulelwa. Kodwa uma usufika eminyakeni ephakathi kwama-30, izinto ziqala ukushintsha.

Inani lamaqanda nekhwalithi yawo kokubili kwehla kakhulu njengoba uguga. Uma usufinyelela kwema-40, ukukhulelwa ngokwemvelo kuba nzima kakhulu, bese nobungozi be-miscarriage buyanda. Yingakho ukuhlolwa okufana nokuhlolwa kwenani lamaqanda nokuhlolwa kwekhwalithi yamaqanda kubaluleke kangaka kwabesifazane abaneminyaka engaphezu kwengu-35.

Nokho, iminyaka ayiyona yodwa into ebalulekile. Izindlela zokuphila, umlando wezifo, kanye nempilo yakho iyonke nakho kudlala indima [7].

Ingabe Ungathuthukisa Ikhwalithi Yamaqanda?

Nansi izindaba ezinhle: yize ungeke ukwazi ukukhulisa inani lamaqanda onalo, ungathatha izinyathelo zokuthuthukisa ikhwalithi yawo. Ama-antioxidant afana ne-CoQ10 angasiza ukuvikela amaqanda akho ekulimaleni. Amavithamini afana ne-folic acid kanye ne-vitamin E nawo aziwa ngokusekela impilo yokuzala.

Ukudla okulinganiselayo, ukuzivocavoca njalo, nokugwema imikhuba emibi njengokubhema nokuphuza utshwala ngokweqile kungakwazi ukuletha umehluko omkhulu futhi. Ukulawula i-stress nakho kuyingxenye ebalulekile yephazili. I-stress engapheli ingaphazamisa amahormone akho futhi iphazamise i-cycle yakho [8].

Uma uqaphela izimpawu ezingajwayelekile ngesikhathi sokuvuthwa (ovulation), njengoshintsho emucus wesibeletho noma ukuqunjelwa okujulile, kungenzeka ukuthi uba ne-izimpawu zokukhishwa kwamaqanda amabili, okungathinta ukuzala kwakho.

Indlela Ukuhlolwa Kokuzala Okusiza Ngayo Ukwelashwa

Uma ucabangela ubuchwepheshe bokuzala obusizwa njenge-IVF, lawa mihlolo ayabalulekile. Uhlolo lokubala amaqanda, uhlolo lwekhwalithi yamaqanda, nokuhlolwa kwesitokwe samaqanda kusiza odokotela bakhe izinhlelo zokwelapha ezenzelwe wena uqobo.

Kwabesifazane abanesitokwe esiphezulu samaqanda, izinhlelo ezijwayelekile zokushukumisela amaqanda zingase zisebenze kahle. Kodwa kulabo abanamaqanda ambalwa noma ikhwalithi ephansi, ezinye izindlela njengemithi enomthamo ophezulu noma amaqanda anikelwe zinganconywa [9].

Ukwazi imiphumela yokuhlolwa kwakho kusiza wena nodokotela wakho ninqume isinyathelo esingcono kakhulu okufanele nithathe.

Okufanele Ukukhunjulwe

Ukuzala uhambo, futhi awekho amabili amahlandla afana. Uhlolo lokubala amaqanda, uhlolo lwekhwalithi yamaqanda, nokuhlolwa kwesitokwe samaqanda kungakunikeza imininingwane ebalulekile mayelana nempilo yakho yokuzala, kukusize wenze izinqumo ezinolwazi ngekusasa lakho.

Noma usaqala ukucabanga ngokuba nezingane noma usuzame isikhathi esithile, lawa mihlolo ingaba ithuluzi elinamandla lokukuqondisa ngezinketho onazo. Awazukunikeza zonke izimpendulo, kodwa ngokuqinisekile azokukhombisa indlela okufanele uthathe.

Futhi khumbula, noma imiphi imiphumela ephumayo, usenazo izinketho. Ochwepheshe bokuzala bakhona ukuze bakusize, kanti izindlela zesimanje zokwelapha zingenza ubuzali bube nokwenzeka kubantu abaningi ababecabanga ukuthi kwakungafinyeleleki. Ngakho ungapheli ithemba—uhambo lwakho lusaqala.

Imibuzo evame ukubuzwa

Uyini uhlolo lokubala amaqanda?

Uhlolo lokubala amaqanda lukala ukuthi usasele namangaki amaqanda ngokubheka amazinga akho e-AMH. Lunikeza ukulinganiselwa kwesitokwe samaqanda akho kodwa alubikezeli ukuthi uzokhulelwa nini noma ukuthi uzokhulelwa yini.

Ukuhlolwa kwesitokwe samaqanda kusebenza kanjani?

Ukuhlolwa kwesitokwe samaqanda kuhlanganisa ukukala amazinga e-AMH, FSH, ne-estradiol, kanye nokubala ama-antral follicle kusetshenziswa i-ultrasound. Kunikeza ukubuka ngokuningiliziwe ngesitokwe samaqanda akho.

Uyini umehluko phakathi kwesitoko samaqanda nekhwalithi yamaqanda?

Isitoko samaqanda sibhekisela enanini lamaqanda onawo, kanti ikhwalithi yamaqanda imayelana nokuthi lawo maqanda anempilo kangakanani. Kokubili kubalulekile ekuzaleni.

Ngingazicabangela nini lezi zivivinyo?

Uma uneminyaka engaphezu kwengu-35, unomjikelezo wokuya esikhathini ongajwayelekile, noma usuhozama ukukhulelwa izinyanga eziyisithupha ungaphumeleli, kuwumqondo omuhle ukucabangela lezi zivivinyo.

Ingabe ukuguqula indlela yokuphila kungayithuthukisa ngempela inzalo?

Yebo, ukudla kahle, ukuzivocavoca, nokuphatha kahle ingcindezi kungasiza ukuthuthukisa ikhwalithi yamaqanda kanye nempilo yokuzala iyonke.

Izinkomba

1. La Marca, A., & Sunkara, S. K. (2014). Ukwenza kube ngokomuntu siqu ukuvuselelwa kwama-ovari okulawulwayo ku-IVF kusetshenziswa izinkomba zesitoko samaqanda: kusukela ethiyori kuya ekusebenzeni. Human reproduction update. Available at: https://pubmed.ncbi.nlm.nih.gov/24077980/
2. Practice Committee of the American Society for Reproductive Medicine (2015). Ukuhlola nokuchaza izilinganiso zesitoko sama-ovari: umbono wekomidi. Fertility and sterility. Available at: https://pubmed.ncbi.nlm.nih.gov/25585505/
3. Dewailly, D., Andersen, C. Y., Balen, A., Broekmans, F., Dilaver, N., Fanchin, R., Griesinger, G., Kelsey, T. W., La Marca, A., Lambalk, C., Mason, H., Nelson, S. M., Visser, J. A., Wallace, W. H., & Anderson, R. A. (2014). I-physiology nokusetshenziswa emtholampilo kwe-anti-Mullerian hormone kwabesifazane. Human reproduction update. Available at: https://pubmed.ncbi.nlm.nih.gov/24430863/
4. Wallace, W. H., & Kelsey, T. W. (2010). Isitoko sama-ovari somuntu kusukela ekukhulelweni kuya esikhathini sokuyeka ukuya esikhathini. PloS one. Available at: https://pubmed.ncbi.nlm.nih.gov/20111701/
5. Dai, X., Wang, Y., Yang, H., Gao, T., Yu, C., Cao, F., Xia, X., Wu, J., Zhou, X., & Chen, L. (2020). I-AMH ayinendima ekubikezelweni kwekhwalithi yamaqanda kwabesifazane abadala kakhulu abenza i-IVF/ICSI cycles. Scientific reports. Available at: https://pubmed.ncbi.nlm.nih.gov/33184364/
6. Broekmans, F. J., Soules, M. R., & Fauser, B. C. (2009). Ukuguga kwama-ovari: indlela okwenzeka ngayo nemiphumela emtholampilo. Endocrine reviews. Available at: https://pubmed.ncbi.nlm.nih.gov/19589949/
7. van der Steeg, J. W., Steures, P., Eijkemans, M. J., Habbema, J. D., Hompes, P. G., Broekmans, F. J., Bouckaert, P. X., Bossuyt, P. M., van der Veen, F., & Mol, B. W. (2007). Inani lokubikezela nomthelela emtholampilo we-basal follicle-stimulating hormone kwabesifazane abangazali ngokuphelele kodwa abakhishwa iqanda kahle. The Journal of clinical endocrinology and metabolism. Available at: https://pubmed.ncbi.nlm.nih.gov/17405849/
8. Chiu, Y. H., Chavarro, J. E., & Souter, I. (2018). Ukudla nokuzala kowesifazane: dokotela, kufanele ngidle ini?. Fertility and sterility. Available at: https://pubmed.ncbi.nlm.nih.gov/30196938/
9. La Marca, A., & Sunkara, S. K. (2014). Ukwenza kube ngokomuntu siqu ukuvuselelwa kwama-ovari okulawulwayo ku-IVF kusetshenziswa izinkomba zesitoko samaqanda: kusukela ethiyori kuya ekusebenzeni. Human reproduction update. Available at: https://pubmed.ncbi.nlm.nih.gov/24077980/