Ukukhishwa kweqanda kusenesikhathi nokukhulelwa: Ukuqonda imiphumela yokukhishwa kweqanda kusenesikhathi

Uhambo ngalunye lokuya ekukhulelweni luwukuhlangana okuyinkimbinkimbi kwesayensi yomzimba nesikhathi. Ngenkathi abantu abaningi bezwa ngokuvuthwa kwamaqanda okwakufundiswa ezincwadini okwenzeka cishe ngosuku lwe-14 lomjikelezo wokuya esikhathini ojwayelekile wezinsuku ezingu-28, iqiniso linezinhlangothi eziningi. Amahomoni, indlela yokuphila, nokwehluka komzimba komuntu ngamunye kungashintsha isikhathi sokukhishwa kweqanda. Kwezinye izimo, ukuvuthwa kungase kwenzeke kusenesikhathi kunalokho obukulindelekile, okushiya abantu bezibuza, kungenzeka yini ukuvuthwa kusenesikhathi bese usakhulelwa? Impendulo emfushane ithi yebo: kungenzeka, futhi kungaholela nasekukhiqizeni ukukhulelwa okuqhubeka kahle, njengasesimweni lapho umuntu evuthwa kusenesikhathi bese ekhulelwa.

Ukuqaphela ukuthi umzimba awulandeliseli njalo ikhalenda eliqinile kubalulekile. Izinto ezifana nengcindezi, ukudla, ukungalingani kwamahomoni, nezakhi zofuzo zingathinta usuku lapho ukuvuthwa kwenzeka ngalo. Ukuqonda ukuthi ukuvuthwa kusenesikhathi kuwumcimbi wempela kubeka isisekelo sokuhlola indlela ongathinta ngayo iwindi lokuzala, imiphumela yokukhulelwa, nezinketho mayelana nempilo yomuntu. Ezindimeni ezilandelayo, sihlolela ngokujulile isayensi esemuva kwesikhathi sokuvuthwa, izimbangela ezingaba khona zokushintsha, nezindaba zalabo ababa ngabazali ngokukhulelwa kusenesikhathi kunalokho ababekulindele [1].

Izisekelo Zokuvuthwa Kwamaqanda

Ngaphambi kokukhuluma ngokukhishwa kweqanda okusheshisiwe, kuyasiza ukubuyekeza ukuthi ukuvuthwa kuyini. Umjikelezo ojwayelekile wokuya esikhathini ungaba phakathi kwezinsuku eziyi-21 kuya kweziyi-35, nakuba abantu abaningi benomfutho ojwayelekile wezinsuku ezingaba ngu-28. Ngaphansi kwezimo ezijwayelekile, i-hypothalamus ebuchosheni ivusa isibindi se-pituitary ukuthi sikhulule i-follicle-stimulating hormone (FSH), esheshisa ukukhula kwama-follicle emaqandeni. Njengoba lama-follicle ekhula, amazinga e-estrogen ayakhuphuka, ekugcineni ekhuthaza ukwanda kwe-luteinizing hormone (LH). Lokhu kukhuphuka kwenza i-follicle ehamba phambili ikhiphe iqanda elivuthiwe—ukuvuthwa.

Ngemva kokukhishwa, iqanda lidlula eshubhini le-fallopian, lapho lingachanyuselwa khona uma isidoda sikhona. Uma ukungachanyuselwa kwenzeka, ugqinsi lwesibeletho luyachitheka ngesikhathi sokuya esikhathini, umjikelezo uqale phansi futhi. Emjikelezweni wezinsuku ezingama-28, usuku lokuqala luwusuku lokuqala lokopha kokuya esikhathini, futhi ukuvuthwa kuvame ukwenzeka cishe maphakathi nomjikelezo. Nokho, leli phuzu elisemaphakathi lingashintsha ngoba umzimba uthonywa izinto eziningi, okuhlanganisa amazinga amahomoni nesimo sempilo iyonke [2].

Umehluko Wesikhathi Emjikelezweni Wokuya Esikhathini

Kukhona umbono ovamile wokuthi ukuvuthwa kumele kuhlale kwenzeka ngosuku olungama-14 ngaphambi kokuthi uqale umjikelezo olandelayo wokuya esikhathini. Nakuba lesi sikhathi singase sibe yinto ejwayelekile, umzimba womuntu awufani nhlobo. Umjikelezo ngamunye ungafiphala kancane kumuntu oyedwa inyanga nenyanga. Ngenxa yalokho, labo abavuthwe ngosuku lwe-11 komunye umjikelezo bangase bavuthwe ngosuku lwe-13 noma lwe-14 enyangeni elandelayo, kuye ngezimo zengcindezi, ukushintsha kwesisindo, noma ezinye izinto zomzimba.

Ngakho-ke, yini ebhekwa njengokuvuthwa kusenesikhathi? Ngokuvamile, noma yikuphi ukukhishwa kweqanda okwenzeka ngaphambi kakhulu kwalapho maphakathi nobude bomjikelezo ojwayelekile womuntu okhona kungabizwa ngokuthi “ukuvuthwa kusenesikhathi.” Kulowo onomjikelezo wezinsuku ezingama-28, lokhu kungasho ukuvuthwa phakathi kwezinsuku ezisi-8 kuya kwezi-12. Imingcele ethile incike kumaphethini omjikelezo ajwayelekile womuntu. Okubalulekile okumele kukhunjulwe ukuthi imijikelezo yokuya esikhathini ayimi ndawonye, futhi ukuguquguquka okuncane ebhalansi yamahomoni kungaholela ekushintsheni kwezinsuku zokukhishwa kweqanda.

Izizathu Ezingaba Khona Zewindi Lokuzala Elisuke Phambili

Izizathu eziningi ezingaphakathi zingaholela ekutheni umuntu avuthwe ngokushesha ngemva kokuya esikhathini noma kusenesikhathi kunokulindelwe. Ingcindezi ikuquluza phezulu, njengoba amazinga e-cortisol akhuphukile engaphazamisa amahomoni okuzala. Izinguquko ezinkulu zempilo, njengohlelo lomsebenzi olunzima noma ukucindezeleka ngokomzwelo, zingase ziphoqe umzimba ukuthi ushintshe iwindi lawo lokuzala ngendlela engalindelekile. Ukwehla okukhulu noma ukwenyuka kwesisindo nakho kungaguqula umjikelezo, ikakhulukazi uma kuphazamisa ukukhiqizwa okuvamile kwamahomoni.

Isifo sama-ovari anezinhlamvu eziningi (PCOS) nokungalingani kwama-thyroid zimele ezinye zezimbangela ezihambisana nempilo ezivamile. Zombili lezi zimo zingaholela ekushintsheni kwesikhathi, kuthinte ukuthi ukuvuthwa kwenzeka kusenesikhathi—noma kwesinye isikhathi kungaveli nhlobo. Ngaphezu kwalokho, abanye abantu ngokwemvelo banemijikelezo emifushane noma ukuthuthuka kwe-follicle okushesha kakhulu, okwenza bakhiphe iqanda ngaphambi kosuku lwama-14 oluvame ukufundiswa. Ukukhomba laba baqalayo bokushintsha kungaba kubalulekile ekubikezeleni amaphethini okuvuthwa nasekuthuthukiseni ukuqaphela iwindi lokuzala. Ukuqonda imbangela yesikhathi esingajwayelekile kwenza abantu bakwazi ukwenza izinqumo ezinolwazi mayelana nokuhlela umndeni noma ukucela olunye usizo lwezokwelapha uma kudingeka [3].

Ukuqaphela Izimpawu

Izinkomba zomzimba zingasiza ekuboneni ukuvuthwa kusenesikhathi kudala ngaphambi kokuba ukuhlolwa kokukhulelwa kube usizo. Omunye umkhondo ocacile ukuhambisana koketshezi lwesibeletho (cervical mucus). Njengoba ubulili bokuzala busondela, imfihlo yesibeletho ngokuvamile iba sobala, iyeluleke, iphinde ibe yiningi, ifane namazolo eqanda aluhlaza. Uma umuntu eqaphela lolu shintsho ngokushesha nje ngemva kokuphela kokuya esikhathini, lokho kungase kubonise ukuthi uyavuthwa ngosuku lwe-11 noma ngaphambi kwalokho.

Enye indlela evamile wukulinganisa izinga lokushisa komzimba eliyisisekelo (BBT). Ngokubhala izinga lokushisa kusenesikhathi ekuseni, amaphethini avame ukuvela. Ukukhuphuka okuncane—cishe ngo-0.4°F kuya ku-0.8°F—kubonisa ukwanda kwe-progesterone ngemva kokuvuthwa. Uma leli zinga lokushisa likhuphuka ngaphambi kwesikhathi obukulindele, kusikisela ukuthi ukukhishwa kweqanda kwenzeke kusenesikhathi kunendawo emaphakathi yomjikelezo.

Amakhithi okuqagula ukuvuthwa (OPKs) alinganisa ukwanda kwe-luteinizing hormone. Uma esetshenziswa njalo, anikeza isexwayiso esicacile sokuthi umzimba ungena ewindi lawo eliphezulu lokuzala. Ukuthola ukwanda kwe-LH kusenesikhathi kunalokho obukulindele kunganikeza ulwazi ngokushesha kulabo abafuna ukukhulelwa. Nakuba amakhithi okuqagula ukuvuthwa engasiza ekulandeleni amafasitela okuzala, kubalulekile futhi ukuba uqaphele amathuba e-test yokuvuthwa enikeza umphumela omuhle ongamanga, engesinye isikhathi engaholela ekudidekeni lapho uzama ukubona isikhathi esifanele sokukhulelwa.

Imibono Engalungile Ngokuthi Ukukhulelwa Nokuvuthwa Kusenesikhathi

Noma kunezinkomba ezicacile zomzimba, kusakhona imibono engalungile ngokuthi ingabe ungavuthwa kusenesikhathi kodwa usakhulelwa yini. Abanye bakholwa ukuthi uma ukuvuthwa kwenzeka masinyane kakhulu emjikelezweni, ugqinsi lwesibeletho lungase lungabi selulungile ukwamukela inhlanyelo. Yize kukho iqiniso elincane embonweni wokuthi i-endometrium idinga i-estrogen ne-progesterone eyanele ukuze yamukele iqanda, ukukhulelwa okuningi okuyimpumelelo kuqala ngeqanda elikhishwe kusenesikhathi kunendawo emaphakathi ecabangwayo.

Omunye umbono ongafanele wukuthi ukukhishwa kweqanda kusenesikhathi kusho ukwehla kokuzala ngokuzenzakalelayo. Eqinisweni, umjikelezo ngamunye unewindi lokuzala, futhi inqobo nje uma iqanda nesidoda kuhlangana endaweni efanele, ukuchanyuselwa kungenzeka ngokuphelele. Kwezinye izimo, isikhathi singahambisana ngisho kangcono kunalokho obekulindelekile, okushaqa abashadile bebengakulindele ukukhulelwa. Ngakho-ke, labo abakhathazeka ngokuthi kungenzeka yini ukuvuthwa kusenesikhathi futhi lokho kwehlise amathuba okukhulelwa bangathola induduzo yokuthi lezi zinguquko azisho ngokwemvelo ukwehla kwamathuba omphumela omuhle wokukhulelwa [4].

Umbono Wezokwelapha Nokuhlolwa

Ochwepheshe bezempilo ngokuvamile bachaza “ukuvuthwa okuvamile” njengokwenzeka phakathi kosuku lwe-11 nolwe-21 lomjikelezo, nakuba bebheka namaphethini omuntu edlule. Uma iziguli zibika njalo ukuvuthwa ngosuku lwe-11 noma ngaphambili, odokotela bangase bahlolisise izinto ezingaphansi zempilo. Ukuhlolwa kwegazi kungabheka amazinga amahomoni, okuhlanganisa i-follicle-stimulating hormone, i-luteinizing hormone, i-progesterone, namahomoni e-thyroid. Ukuhlolwa kwe-ultrasound kungakhombisa ukuthuthuka kwama-follicle futhi kuqinisekise isikhathi esiqondile sokukhishwa kweqanda.

Uma umjikelezo ufushane njalo kunalokho okulindelekile noma uholela ekubeni nzima ukukhulelwa, odokotela bokuzala bangase batusa ukwelashwa okufana ne-Clomid (clomiphene citrate) noma i-letrozole, okusiza ukulungisa ukuvuthwa. Bangabuye batusa nezinguquko endleleni yokuphila—ezinjengamasu okunciphisa ingcindezi, ukulungisa izinhlelo zokuzivocavoca, noma ukubhekana nezinkinga zesisindo—ukuze kuzinziswe amazinga amahomoni. Umqondo ojwayelekile wezokwelapha ukuthi nakuba ukuvuthwa kusenesikhathi kungaletha izinto ezithile okufanele zicatshangelwe, iziguli eziningi ziyazala ngokujwayelekile uma imbangela esezansi isiqondwe, futhi uma kudingeka, ilawulwe.

Okuhlangenwe Nakho Kwabantu Bempela

Ngemva kokuvuthwa, ukulinda ukuqinisekiswa kokukhulelwa kungazwakala kukade, okwenza abaningi bazibuze izinsuku ezingaki ngemva kokuvuthwa uqala ukukhulelwa nokuthi yisiphi isikhathi esingcono kakhulu sokwenza ukuhlolwa kokukhulelwa. Abantu abaningi bathola ukuthi bavuthwa ngokushesha ngemva kokuya esikhathini noma ngosuku lokuvuthwa lwe-11 kuphela ngemva kokulandela imijikelezo yabo ngokucophelela. Isimo esivamile singesokuthi umuntu alindele iwindi lokuzala elizobuya sekuhambe izinsuku eziningi, agcine esethola ukuthi ukhulelwe engakakulindele. Bangase babe becabanga ukuthi banazo “izinsuku eziphephile” ngokushesha nje ngemva kokuya esikhathini, bengazi ukuthi isidoda singahlala siqhubeka emgudwini wokuzala kuze kube izinsuku ezinhlanu. Uma iqanda likhishwa ngaphakathi kwalesi sikhathi, ukuchanyuselwa kungenzeka.

Kwezinye izimo, abantu bahlela ucansi ngokusekelwe ekutheni bacabanga ukuthi iwindi lokuzala lizoba maphakathi nomjikelezo, bese bethola imiphumela emibi yokuhlolwa kokukhulelwa, bengazi ukuthi iwindi labo eliphezulu lokuzala selidlulile kusenesikhathi enyangeni. Uma sebeqaphele la maphethini—imvamisa ngosizo lwamashadi ezinga lokushisa eliyisisekelo noma amakhithi okuqagula ukuvuthwa—bakwazi ukulungisa isu labo lokuhlela umndeni kahle. Kulezi zibonelo zomhlaba wangempela lapho umbuzo othi “ungavuthwa kusenesikhathi kodwa usakhulelwa?” uphendulwa ngempela ngo-yebo eliqinile.

Okokugcina

Kwabafuna ukuba ngabazali, ukulandela amaphethini omjikelezo wokuya esikhathini kuyisinyathelo esibalulekile. Uma leso sikhathi siholela ekukhulelweni ongakulindele, khumbula ukuthi awuwedwa. Abantu abaningi bavuthwe kusenesikhathi futhi bakhulelwa ngokuphelele, bekhombisa ukuthi indlela ngayinye eya ekukhulelweni ingavuleka ngendlela yayo eyingqayizivele.

Uma usola ukuthi uvuthwa ngosuku lwe-11 noma ngaphambili kaningi kunokujwayelekile, ukulandela umjikelezo wakho kungakunikeza ukuqonda okubalulekile. Amathuluzi afana namashadi ezinga lokushisa eliyisisekelo, amakhithi okuqagula ukuvuthwa, nokubheka uketshezi lwesibeletho anikeza imikhondo ebalulekile mayelana nokuthi iwindi lakho lokuzala livuleka nini. Uma lokho kuhlanganiswa nosizo lochwepheshe bezempilo abangahlola amahomoni noma benze i-ultrasound, ungasivumbulula ukuthi ngabe kukhona yini isimo sezokwelapha esithinta isikhathi sakho sokuvuthwa. Kuye ngemiphumela, izindlela zokungenelela ezifana nemithi yezinkinga ze-thyroid, i-PCOS, noma amasu okulawula ingcindezi zingasiza ukwenza umjikelezo wakho usebenze kangcono.

Ekugcineni, ubufakazi bezindaba zabantu kanye nedatha yesayensi kuqinisekisa ukuthi abantu abaningi abavuthwa ngokushesha ngemva kokuya esikhathini noma ngaphambi kwalokho abalindele kungenzeka bakhulelwe ngempumelelo. Isidoda singahlala sisebenza emgudwini wokuzala izinsuku eziningana, futhi uma iqanda selikhishiwe, ukuchanyuselwa kungenzeka uma kunezimo ezifanele. Akukho sikhathi esisodwa esilungele wonke umuntu sokuzala, futhi ukunaka izimpawu zomzimba wakho kungukhiye. Ukuqonda, ukulandela, nokuzivumelanisa nemijikelezo yakho eyingqayizivele kukusiza ukuba ulungele kangcono ukubhekana newindi lokuzala—noma nini lapho livela khona.

Izithenjwa

1. Fukuda M, Fukuda K, Andersen CY, Byskov AG. Izici zokuvuthwa komuntu emijikelezweni yemvelo ehlotshaniswa nobudala nokuthola ukukhulelwa. Hum Reprod. 2001 Dec;16(12):2501-7. doi: 10.1093/humrep/16.12.2501. PMID: 11726566.
2. Wilcox AJ, Dunson D, Baird DD. Isikhathi se-"windi lokuzala" emjikelezweni wokuya esikhathini: ukulinganiselwa kosuku olukhethekile ocwaningweni olungaphambili. BMJ. 2000 Nov 18;321(7271):1259-62. doi: 10.1136/bmj.321.7271.1259. PMID: 11082086; PMCID: PMC27529.
3. Reed BG, Carr BR. Umjikelezo Ojwayelekile Wokuya Esikhathini Nokulawulwa Kokuvuthwa. [Updated 2018 Aug 5]. Ku: Feingold KR, Anawalt B, Blackman MR, et al., abahleli. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Kutholakala ku: https://www.ncbi.nlm.nih.gov/books/NBK279054/
4. Kaya HD, Yılmaz T, Günaydın S, Çalımlı EN, Sadeghi E. Imibono engalungile ngokobulili ngesikhathi sokukhulelwa: ucwaningo lokuqhathanisa. J Obstet Gynaecol. 2022 May;42(4):587-593. doi: 10.1080/01443615.2021.1931826. Epub 2021 Aug 12. PMID: 34382486.