No ka mea, he mea hoihoi ka māhoe, no kekahi mau kāne, me nā māhoe he moeʻuhane. Akā, hiki anei ke hoʻololi i ke ʻano a hoʻonui i kou manawa e loaʻa ai ka ʻōpū māhoe?

Pono mākou e hoʻokaʻawale i ʻelua ʻano o ka hāpai ʻana i nā māhoe ʻelua, e pili ana i ʻelua mau hanana olaola like ʻole:

• māhoe like a i ʻole māhoe monozygotic mai hoʻokahi hua (mono ke ʻano "hoʻokahi", zyogote "hua"). ʻO ka hua manu i hoʻomoʻa ʻia e ka sperm e hānau i ka hua. Eia naʻe, e māhele ʻia kēia hua manu, no nā kumu i ʻike ʻole ʻia, ma hope o ka hoʻoulu ʻana. A laila e ulu ana ʻelua mau hua, e hāʻawi ana i ʻelua mau fetuses e lawe ana i ka hoʻohālikelike genetic like. He kāne like nā pēpē a he ʻano like ke ʻano o nā pēpē, no laila ka huaʻōlelo "māhoe maoli". Me nā ʻokoʻa liʻiliʻi liʻiliʻi ma muli o ka mea i kapa ʻia e nā ʻepekema ʻo phenotypic mismatch; ʻo ia ka hopena o ka epigenetics, ʻo ia hoʻi ke ʻano o ke kaiapuni i ka hoʻohālikelike ʻana i nā genes;
• māhoe fraternal a i ʻole māhoe dizygotic mai ʻelua hua like ʻole. I loko o ka pōʻai hoʻokahi, ua hoʻopuka ʻia nā hua ʻelua (e kūʻē i ka mea maʻamau) a ua hoʻomomona ʻia kēlā me kēia mau hua i ka manawa like e kahi sperm ʻokoʻa. ʻO ka hopena o ka hoʻomomona ʻana o ʻelua mau hua like ʻole a me ʻelua spermatozoa ʻokoʻa, ʻaʻole like ka hoʻoilina genetic o nā hua. Hiki i nā pēpē ke kāne like a ʻokoʻa paha, a like ke ʻano like me nā keiki mai nā kaikunāne like.

Ma kahi o 1% o nā hānau hānau maoli he mau hāpai māhoe (1). Hiki i kekahi mau mea ke hoʻololi i kēia kiʻi, akā, pono e hoʻokaʻawale i waena o ka hāpai monozygous a me ka hāpai dizygotic.

He kakaikahi ka hapai monozygous: pili ia i ka 3,5 a i ka 4,5 no 1000 hānau, me ka nānā ʻole i ka makahiki o ka makuahine, ke kauoha hānau a i ʻole ke kumu ʻāina. Ma ke kumu o keia hapai ana, aia ka nawaliwali o ka hua e puunaue ana mahope o ka fertilization. Hiki ke hoʻopili ʻia kēia hanana i ka ʻelemakule o ka ovum (akā, ʻaʻohe pili i ka makahiki makuahine). ʻIke ʻia ia ma nā pōʻai lōʻihi, me ka ovulation hope (2). No laila hiki ʻole ke pāʻani i kēia kumu.

ʻO ka mea like ʻole, pili nā kumu like ʻole i ka loaʻa ʻana o kahi hāpai dizygotic:

• ʻO ka makahiki makuahine: piʻi mau ka hapa o nā hāpai māhoe dizygotic a hiki i ka makahiki 36 a i ʻole 37 ke hiki i ka nui. E emi koke ana a hiki i ka menopause. ʻO kēia ma muli o ke kiʻekiʻe o ka hormone FSH (follicle stimulating hormone), ke kiʻekiʻe o ka piʻi mau ʻana a hiki i 36-37 mau makahiki, e hoʻonui ana i ka nui o ka ovulation (3);
• kauoha hānau: i ka makahiki like, piʻi ka helu o nā māhoe fraternal me ka helu o nā hāpai mua (4). ʻAʻole koʻikoʻi kēia ʻano hoʻololi ma mua o ka mea pili i ka makahiki makuahine;
• genetis predisposition: aia kekahi mau ʻohana kahi pinepine ka māhoe, a ʻoi aku ka māhoe o nā māhoe ma mua o nā wahine i ka heluna lehulehu;
• lāhui: ʻelua ʻoi aku ka kiʻekiʻe o ka māhoe dizygotic ma ʻApelika ma ka hema o Sahara ma mua o ʻEulopa, a ʻehā a ʻelima mau manawa kiʻekiʻe ma mua o Kina a i Iapana (5).

Me ka piʻi ʻana o ka ART, ua hoʻonui ʻia ka nui o nā hāpai māhoe ma 70% mai ka hoʻomaka ʻana o nā makahiki 1970. ʻO ʻelua hapakolu o kēia piʻi ʻana ma muli o ka mālama ʻana i ka infertility a ʻo ke koena ʻekolu i ka emi ʻana o ka hāpai ʻana. makahiki o ka hānau mua (6).

Ma waena o nā ʻenehana o ART, hoʻonui ka nui i ka hiki ke loaʻa i kahi hāpai māhoe ma o nā ʻano hana like ʻole:

IVF ʻO ka hoʻoili ʻana i nā embryo he nui i ka manawa like e hoʻonui ai i ka nui o ka hāpai ʻana. I mea e hōʻemi ai i kēia pilikia, ua ʻike ʻia ka emi ʻana o ka nui o nā embryos i hoʻoili ʻia e ka hoʻoili ʻana no kekahi mau makahiki. I kēia lā, ʻo ka ʻae ʻana e hoʻoili i ka nui o ʻelua embryos - ʻaʻole ʻekolu i ka wā o ka hāʻule ʻole. No laila, mai 34% i ka 2012, ua piʻi ka nui o ka hoʻololi mono-embryonic ma hope o IVF a i ʻole ICSI i 42,3% ma 2015. Eia naʻe, ʻoi aku ka kiʻekiʻe o ka māhoe male ma hope o IVF ma hope o ka hāpai ʻana. kūlohelohe: ma 2015, 13,8% o ka hāpai ʻana ma hope o IVF i alakaʻi i ka hānau ʻana o nā māhoe fraternal (7).

L'induction d'ovulation (ʻaʻole i hāʻule maoli ma lalo o ka AMP) ʻO ka induction ovarian maʻalahi i kuhikuhi ʻia i kekahi mau maʻi ovulation e manaʻo e loaʻa kahi ovulation maikaʻi aʻe. I kekahi mau wahine, hiki ke alakaʻi i ka hoʻokuʻu ʻana i ʻelua mau hua i ka wā o ka ovulation, a alakaʻi i ka hāpai ʻana i ka māhoe inā hoʻomomona ʻia nā hua ʻelua e hoʻokahi sperm.

Hoʻoulu hānai (a i ʻole intrauterine insemination IUI) ʻO kēia ʻano hana ka waiho ʻana i ka sperm momona loa (mai ka hoa a i ʻole ka mea hāʻawi) i loko o ka ʻōpū i ka manawa o ka ovulation. Hiki ke hana ia ma ka pōʻaiapuni maoli a i ʻole ma ka pōʻai hoʻoulu ʻia me ka hoʻoulu ʻana o ka ovarian, hiki ke alakaʻi i ka ovulation lehulehu. I ka makahiki 2015, 10% o nā hāpai ʻana ma hope o ka UTI i alakaʻi i ka hānau ʻana o nā māhoe fraternal (8).

Ka hoʻoili ʻana o ka embryo maloʻo (TEC) E like me IVF, ua ʻike ʻia ka emi ʻana o ka nui o nā embryos i hoʻoili ʻia no kekahi mau makahiki. Ma 2015, 63,6% o TECs i hana me ka embryo hoʻokahi, 35,2% me ʻelua embryos a me 1% wale nō me 3. 8,4% o nā hāpai ma hope o TEC alakaʻi i ka hānau ʻana o nā māhoe (9).

ʻO nā māhoe ma muli o ka hāpai ʻana ma hope o nā ʻenehana ART he mau māhoe fraternal. Eia nō naʻe, aia nā hihia o nā māhoe like ma muli o ka māhele ʻana o kahi hua. I ka hihia o IVF-ICSI, ʻike ʻia ʻoi aku ka kiʻekiʻe o ka hāpai ʻana o ka monozygous ma mua o ka hānau ʻana. ʻO nā hoʻololi ma muli o ka hoʻoulu ʻana o ka ovarian, nā kūlana moʻomeheu in vitro a me ka lawelawe ʻana i ka zona pellucida hiki ke wehewehe i kēia ʻano. Ua ʻike pū kekahi haʻawina ma IVF-ICSI, ʻoi aku ka kiʻekiʻe o ka nui o ka hāpai ʻana o ka monozygous me nā embryos i hoʻoili ʻia i ka pae blastocyst, ma hope o ka moʻomeheu lōʻihi (10).

• E ʻai i nā hua waiu Ua hōʻike ʻia kahi noiʻi ʻAmelika e pili ana i ka hānau ʻana o nā māhoe māhoe i nā wahine vegan i nā wahine e ʻai ana i nā huahana waiu, ʻoi aku ka nui o nā bipi i loaʻa i nā injections hormone ulu, ʻoi aku ka nui o nā māhoe ma mua o nā wahine. wahine meaʻai meaʻai (5). ʻO ka ʻai ʻana i nā huahana waiu e hoʻonui i ka huna ʻana o IGF (Insulin-Like Growyh Factor) e hoʻoikaika ai i nā ovulations lehulehu. Loaʻa i ka ʻuala a me ka ʻuala kēia hopena, hiki ke wehewehe i ka hapa kiʻekiʻe o nā hāpai māhoe ma waena o nā wahine ʻApelika.
• E lawe i ka mea hoʻohui huaʻai B9 (a i ʻole folic acid) ʻōlelo ʻia kēia huaora i ka wā ma mua o ka hāpai ʻana a me ka hāpai mua ʻana e pale i ka spina bifida hiki ke hoʻonui i ka manawa o ka loaʻa ʻana o nā māhoe. Manaʻo ʻia kēia e kahi noiʻi Australia i ʻike i ka piʻi ʻana o 4,6% o ka nui o ka hāpai ʻana i ka māhoe i nā wahine i lawe i ka hoʻohui ʻana i ka vitamina B9 (12).