Hoʻomaʻemaʻe hua manu ... No kekahi mau wahine e ʻehaʻeha nei i nā maʻi maʻi a koʻikoʻi paha, ʻo kēia ʻano hana o ke kōkua ʻana i nā lāʻau lapaʻau kekahi manawa ʻo ia wale nō ke ala e mālama ai i kā lākou momona a lana ka manaʻo e ʻike i kā lākou hoʻolālā hānau keiki i kekahi lā i kaʻoiaʻiʻo. Akā he mau hōʻailona ʻē aʻe kekahi o ka oocyte cryopreservation i ʻike pinepine ʻole ʻia. Overview o kēia hana ma Palani.

ʻO ka hau hau ʻa hau, a i kapa ʻia hoʻi me ka cryopreservation oocyte, kahi hana e mālama ai i ka momona. Aia ia i ka lawe ʻana i nā oxytes, ma hope o ka hoʻoulu ʻana o ovarian a i ʻole ʻole, ma mua o ka hoʻopaʻa ʻana iā lākou i ka nitrogen wai a mālama iā lākou no ka hāpai ʻana ma hope.

I Palani, hoʻoponopono ʻia ka oocyte cryopreservation e ke kānāwai a me ka ʻatikala L-2141-11 ʻē aʻe o ke Code Health, e like me nā mālama mālama mālama ʻana (embryonic or sperm freezing, mālama o nā kiko ovarian a i ʻole nā ​​kiko testicular). Kuhi ʻia kēia ʻōlelo "kēlā me kēia kanaka nāna ka lawelawe olakino e hōʻino paha i ka momona, a i ʻole nā ​​pilikia o ka hānau mua ʻana e hōʻino ʻia, hiki ke loaʻa iā ia ka pōmaikaʻi mai ka hōʻiliʻili a me ka mālama ʻana o kā lākou gametes [...] me ka manaʻo no ka hoʻolako hou aku, no kona pono, no ka lāʻau. kōkua i ka hānau ʻana, a i ʻole me ka manaʻo e mālama a hoʻihoʻi i kāna momona. “

No laila ʻo kēia ka hōʻailona mua no ka paʻa ʻana o ka oosit: e ʻae i nā wahine e mālama i ko lākou momona ke lawe i kahi lāʻau koʻikoʻi hiki ke hōʻino i kā lākou waihona ovarian. No laila ke manaʻo nui ʻia nei ʻo Oositte cryopreservation no nā wahine e pono ke hana i ka chemotherapy (ʻo ia hoʻi nā mea e pili ana i ka iwi iwi) a i ʻole radiotherapy, ʻo ia hoʻi ma ka pelvic.

I ka nīnau:

• Kūpilikiʻi nui kēia mau ʻano lāʻau i nā ovaries (ʻōlelo ʻia he gonadotoxic), nā hunaola primitive (nā oositita immature) a me ka hana ovarian;
• Koi pū lākou i nā mea maʻi e waiho i kā lākou hoʻolālā hānau keiki no kahi manawa lōʻihi, i kekahi manawa e kekahi mau makahiki, ka manawa e hoʻokō ai i ka lāʻau a hōʻoia i ka ukali kūpono no ka hana.

Akā ʻaʻole ʻo ka maʻi ʻaʻai nā maʻi wale nō e hiki ai ke noi ʻia ka mālama ʻana i ka momona. No laila, e paipai ʻia ka hau no ka oocyte i ka hanana o:

• lawe i kahi lāʻau gonadotoxic hou. ʻO kēia ka hihia, no ka laʻana, i ka mālama ʻana i nā transplants ʻākena a i ʻole nā ​​maʻi o ka ʻōnaehana pale (nā lāʻau immunosuppressive) a i ʻole kekahi mau maʻi hematological e like me ka anemia maʻi maʻi.
• ʻoki hiki ke hoʻohuli i ka momona;
• maʻi ovarian congenital. ʻO ka genetical pinepine, ʻo kēia mau maʻi, e like me Turner Syndrome, hiki ke alakaʻi i ka maikaʻi ʻole o ka ovarian.

Kaha: i ka hanana o ka maʻi, koi ʻia ka hoʻomoʻa ʻana i nā hua manu i nā wahine pubescent, ma lalo o 37 mau makahiki. Ma ka ʻaoʻao ʻē aʻe, inā hōʻike ʻia ka mālama ʻana o ka momona i kahi kaikamahine a i ʻole ʻōpio ʻōpio, e ʻoluʻolu paha i ka mālama ʻana i nāʻiʻo ovarian me ka manaʻo e hana i kahi autograft o kēia mau mea ma hope.

Ma kahi mamao loa mai kēia mau hihia e pili pono ana i kahi maʻi, aia kahi hōʻike ʻē aʻe no ka paʻa ʻana o nā oosit: ka hoʻololi hoʻololi kāne.

ʻOiaʻiʻo, i ke kaʻina hoʻololi o ke kāne, hiki i nā lāʻau lapaʻau i ʻōlelo ʻia a lāʻau lapaʻau paha ke hōʻino i ka momona. No laila, inā ʻoe e hoʻomaka nei i kahi huakaʻi masculinizing, e aʻo ʻia paha ʻoe e mālama a no laila hoʻopaʻa i kāu mau oosit. Ke koe nei i kēia lā kahi ʻike nui ʻole: ʻo ka hoʻohana ʻana o kēia mau gametes paʻahau i loko o ke kumumanaʻo o kahi MAP (hānau kōkua kōkua ʻia), i kaupalena ʻia e ke kānāwai o Bioethics i ka ikaika mai ka makahiki 2011. Akā hiki i ka ulu ʻana o ke kānāwai ke kōkua i ke komo i ka makua no kēia mau mea maʻi.

Ua kākau inoa ʻia kahi kāne i kahi papa MAP no ka infertility a i ʻole e ʻae i ka cryopreservation oocyte inā:

• hiki i ka puncture ke kiʻi i nā oocytes supernumerary e hiki ʻole ke hoʻouluulu ʻia;
• kūleʻa ka hōʻiliʻili sperm i ka lā o ka hoʻouluulu in vitro. A laila maʻalahi ka pahuhopu: e hōʻalo i ka "nalo ʻana" i nā gametes i hoʻoneʻe ʻia a mālama iā lākou a hiki i ka hoʻāʻo hou ʻana ma IVF.

Ua ʻae nā ʻāina he nui o ʻEulopa i kēia manawa i ka paʻahau ʻana o nā oosit i kapa ʻia ʻo "hōʻoluʻolu" i mea e ʻae ai i nā wahine e mālama i kā lākou gametes no kahi hāpai ma hope me ka ʻole o ka hōʻailona olakino. No laila hiki i ka pahuhopu ke hoʻokuʻu i ka makahiki o ka makuahine me ka ʻole o ka hōʻemi ʻana i ka momona i pili i ka makahiki e neʻe nei.

I Palani, ke kūpuna wale ʻana o nā oxytes hōʻoluʻolu (i kapa ʻia hoʻi ka mālama ʻana iā ia iho o nā oosit) i kēia manawa wale nō i ʻae ʻia i hoʻokahi hihia: ka hāʻawi ʻana i nā oosit. Ua mālama mua ʻia no nā wahine makua i loaʻa kahi keiki, ua ulu kēia makana me ke kānāwai Bioethics o Iulai 7, 2011. ʻO ka mea hou o kēia ʻōlelo: nulliparas (nā wahine i loaʻa ʻole nā ​​keiki) i kēia manawa ke kuleana e hāʻawi manawaleʻa i kā lākou keiki. oocytes a ʻae ʻia e mālama i kekahi o lākou i ke kakali ʻana o kahi hāpai hope.

Ke waiho nei kēia paʻa ʻana o nā oosit a me nā ʻole o nā lāʻau lapaʻau, eia nō naʻe, kaupalena ʻia.

• Pono e hoʻomaopopo mua ka mea hāʻawi i kāna manawa hope o ka hāpai ʻana mai nā oosit a hiki iā ia ke mālama;
• Mālama ʻia e hoʻolaʻa ʻia ka hapalua o nā oxytes i ka manawaleʻa ma ke kumu o 5 liʻi liʻiliʻi (inā lawe ʻia he 5 oosit a ʻoi aku paha, hele nā ​​mea āpau i ka manawaleʻa a ʻaʻohe hiki ke kūpona no ka mea hāʻawi);
• Hiki i ka mea hāʻawi ke hana i ʻelua mau makana wale nō.

ʻO ka ʻoiaʻiʻo ka wehe ʻana o ka hāʻawi ʻana o ka oocyte i kahi kuleana kūpono i ka mālama pilikino ʻana e hoʻomau nei i ka hoʻopaʻapaʻa: pono e wehe ʻia i nā wahine āpau ma waho o ka manawaleʻa, hāʻawi i ka holomua o ka makahiki hānau? Eia hou, hiki i ka hoʻoponopono hou ʻana o ke kānāwai Bioethics ke hāʻawi koke i kahi pane kū kānāwai i kēia nīnau. I kēia manawa, ua ʻae ʻia nā kaiāulu aʻo a me ka Academy of Medicine.

Hoʻokumu ʻia ka paʻa ʻana o ka oosit i kēia lā ma kahi ʻano: oitrte vitrification. Ke kumu? Hoʻopomo pololei ʻia nā oxytes i loko o ka nitrogen wai kahi i paʻa ai lākou i ka wela o -196 ° C. ʻOi aku ka maikaʻi ma mua o ke kiʻina hana o ka paʻahau lohi i hoʻohana mua ʻia, hiki i ka vitrification ke hōʻoia i ke ola maikaʻi o nā oxytes paʻahau, e ka ke pale nei i ke kūkulu ʻana o nā aniani i hoʻololi mua i nā gametes, e hoʻohana pono ʻole ana iā lākou.

I hiki ai, ʻo ke kūpona o ka oocyte kahi ʻāpana o kahi kauka lāʻau lapaʻau. Hoʻololi kēia i ka hilinaʻi o ka lāʻau a me ka maʻi i nīnau ʻia. Inā hopohopo ʻoe, ma nā hihia āpau, pono ʻoe e nīnau me kāu kauka e wehewehe iā ʻoe:

• ka ʻawahia o ka lāʻau;
• nā hopena mālama mālama momona i loaʻa iā ʻoe;
• nā manawa o ka hāpai keiki (ʻaʻole i hoʻohiki ʻia) a me nā koho ʻē aʻe hiki;
• e hoʻokau i ka pale i ka wā e kali ana no ka hoʻomaka ʻana o ka lāʻau.

A laila e noi ʻo ia iā ʻoe e hana i kahi manawa no kahi kūkā kamaʻilio multidisciplinary e mālama ai i ka momona, kahi e hoʻoholo ai i nā kūlana no kāu mālama ʻana. Hiki ke koho ʻia ʻelua mau koho:

• Inā ʻoe he makahiki hānau keiki, ʻaʻohe contraindication i ka hoʻomaʻamaʻa ʻana i ka hormonal a me kāu lāʻau lapaʻau (chemotherapy, radiotherapy, a me nā mea ʻē aʻe) ʻaʻole wikiwiki, e hoʻomaka kāu lapaʻau me ka ovarian stimulate e hoʻolauna i ka hōʻea ʻana i ke oʻo ʻana o ka nui o nā oosit. I kēia pōʻaiapili, e pōmaikaʻi ʻoe i ka hāhai ʻana o ka "classic" o ka fertilization in vitro: stimulate, ultrasound and biological follow-up, triggering of ovulation and oocyte puncture;
• Inā ʻaʻole hiki iā ʻoe ke hoʻonāukiuki (koi koke kāu lāʻau, loaʻa ʻoe i ka maʻi ʻaʻai kūpaʻa e like me ka maʻi ʻaʻai), e ʻōlelo pinepine kāu kauka i kahi protocol vitrification me ka ʻole stimulate. He aha ke ʻano o ia? Ma hope o ka puncture o nā ʻōpio kō ʻole, hana ʻia nā gametes i ka hale hana no 24 a 48 mau hola e hiki ai i ke oʻo. Kāhea ʻia kēia i ka vitro maturity (IVM).

Loaʻa nā oocytes makua i loaʻa (e ka stimulate a i ʻole IVM) a paʻa i mua o ka hoʻohana ʻia ʻana i loko o ka pōʻaiapili o ka hānau kōkua kōkua. Kaha: i kekahi mau hihia, hiki i ka mea hoʻomaʻamaʻa ke koi aku i ka vitro fertilization ma mua o ka paʻa ʻana. Mai kānalua i ke kūkākūkā ʻana me kāu kauka.

ʻOiai ʻo ka manawa o ka hāpai ʻana ma hope o ka hoʻomoʻa ʻana o ka hua manu ua hoʻonui i ka mahalo i ka holomua ʻenehana e like me ka vitrification, he mea nui e hoʻomanaʻo i ka hāpai ʻole ʻia.

Hōʻike kekahi mau kiʻi i kēia, i hōʻuluʻulu ʻia e ka Academy of Medicine:

• Ma ke kaʻina hana vitrification, ma waena o 8 a me 13 oocytes e ʻohiʻohi ʻia ma ka awelika o ke kaapuni;
• Ma hope o ka hoʻoheheʻe ʻana, ola ka 85% o kēia mau oocytes like;
• A laila, ʻo IVF e ICSI, kahi e hiki ai ke hoʻomomona i nā oosit i koe, he 70% ka helu o ke kūleʻa.

Hualoaʻa: ʻo ka nui o ka nui o ka hāpai hāpai ʻana me ka hoʻoheheʻe ʻana o nā oxytes e loli ma waena o 4,5 a me 12% e pili ana i ka makahiki a me nā kūlana olakino. No laila ua koho ʻia he mea pono e hoʻopaʻa kūleʻa ma waena o 15 a 20 mau oxytes e lana ai ka hānau. Hōʻike kēia i nā hōʻiliʻili he nui a me nā hau paʻa e lana ai ka manaʻo e lilo i mau mākua.