Haihuwar mace da shekaru

Girman haihuwa na mata yana shafar Shekaru kuma yana da gudummawa ga haihuwa ga mata. Haihuwar mace ta kasance mai ɗorewa daga ƙarshen matasa zuwa farkon shekaru talatin, kodayake sannu a hankali yana raguwa a tsawon lokaci. Bayan shekaru 35, haihuwa ya fadi da sauri. A lokacin da suke da shekaru 45, mata za su kasa daukar ciki a cikin kashi 50-80 cikin dari na shari'o'in. Menopause, ko dakatar da Lokacin haila, yawanci yana faruwa tsakanin shekaru 45 zuwa 55, yana nuna ƙarshen haihuwa, kodayake rashin haihuwa da ke da alaƙa da shekaru na iya faruwa kafin wannan lokacin. Dangantaka tsakanin shekaru da haihuwa na mata wani lokacin ana kiranta "agogon halitta" na mace.

## Ƙididdigar tasirin

### A lokacin da yake matashi
Matsakaicin shekarun yarinya na farko (menarche) shine 12 zuwa 13 (shekaru 12.5 a Amurka, 12.72 a Kanada, 12.9 a Burtaniya) amma, a cikin 'yan mata na postmenarchal, kusan 80% na sake zagayowar suna da anovulatory a cikin shekara ta farko bayan menarche, wanda ya ragu zuwa 50% a cikin shekara na uku, kuma zuwa 10% a cikin na shida. Ba a san komai game da haihuwa a cikin matasa ba, saboda zubar da ciki na matasa ba a saba gani ba a yawancin al'ummomi.

### Lokacin da suka girma
Yawan haihuwa na mace yawanci yana da girma tsakanin marigayi da marigayi ashirin, bayan haka ya fara raguwa. Koyaya, ainihin ƙididdigar damar da mace ke da ita don ɗaukar ciki bayan wani shekaru ba a bayyane yake ba, kuma suna ƙarƙashin muhawara.

A cewar Cibiyar Kula da Lafiya da Kulawa ta Kasa (NICE) sama da kashi 80% na mata masu shekaru kasa da 40 waɗanda ke da jima'i na yau da kullun ba tare da kariya ba za su yi juna biyu a cikin shekara 1 na gwaji. A shekara ta biyu kashi ya tashi zuwa sama da 90% . 

Wani binciken da Henri Leridon, PhD, masanin cututtukan cututtuka tare da Cibiyar Kiwon Lafiya da Binciken Kiwon Lafiyar Faransa, na mata da ke ƙoƙarin yin ciki, ba tare da amfani da magungunan haihuwa ko in vitro fertilization ba, ya sami sakamako masu zuwa akan ƙimar ciki ta hanyar shekaru:

* A shekara 30 75% za su sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekara guda 91% za su sami ɗauki wanda ya ƙare da haihuwa mai rai cikin shekaru huɗu
** Kashi 75% za su sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekara guda
** Kashi 91% za su sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekaru huɗu
* A lokacin da yake da shekaru 35 66% zai sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekara guda 84% zai sami juna biyu wanda ya ƙare da haihuwa mai rai cikin shekaru huɗu
** Kashi 66% za su sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekara guda
** Kashi 84% za su sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekaru huɗu
* A shekaru 40 44% za su sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekara guda 64% za su sami ɗauki wanda ya ƙare da haihuwa mai rai cikin shekaru huɗu [1]
** 44% za su sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekara guda
** 64% za su sami ciki wanda ya ƙare a cikin haihuwa mai rai a cikin shekaru huɗu 

Dangane da binciken da aka yi akan samfurin ma'aurata 782 masu lafiya na Turai masu shekaru 19-39, haihuwa ya fara raguwa bayan shekaru 27 kuma ya sauka a wani abu mafi girma bayan shekaru 35. Binciken kididdiga ya nuna cewa mata a cikin rukunin shekaru 27-29 suna da ƙarancin damar yin ciki fiye da masu shekaru 19 zuwa 26. Yawan ciki bai canza sosai tsakanin rukunin shekaru 27-29 da rukunin shekaru 30-34, amma ya ragu sosai ga rukunin shekaru 35-39.

Shekarar abokin tarayya na namiji yana da tasiri sosai a kan haihuwa na mata tsakanin matan da suka kai tsakiyar shekaru 30, amma ba tsakanin matasan mata ba. Koyaya, masana sun ce sabon binciken ya yi ƙanƙanta kuma akwai masu canji da yawa waɗanda suke da wuyar warwarewa, don a kammala a bayyane. Wasu masana sun ba da shawarar cewa babban canji a cikin haihuwa a cikin tsofaffin mata shine gaskiyar cewa ya dauki su tsawon lokaci don yin ciki, ba lallai ba ne cewa sun fi dacewa da cin nasara. David Dunson, masanin ilimin halittu a Cibiyar Nazarin Kiwon Lafiya ta Amurka, ya ce: "Ko da yake mun lura da raguwar haihuwa ta mata a ƙarshen 20s, abin da muka samu shine raguwar yiwuwar yin ciki ta hanyar haila, ba a cikin yiwuwar samun ciki ba. "

Wani binciken Faransanci bai sami bambanci tsakanin yawan haihuwa na mata a ƙarƙashin 25 da waɗanda ke da shekaru 26-30, bayan haka haihuwa ta fara raguwa ba. Kimanin "haɗin mace" yana da wahala sosai saboda namiji (ingancin maniyyi). Wannan binciken Faransanci ya kalli mata 2,193 da ke amfani da Insemination na wucin gadi saboda mazajensu suna da azoospermic. Yawan nasarar da aka samu bayan sau 12 na insemination sun kasance 73% ga mata a ƙarƙashin shekaru 25, 74% a cikin mata masu shekaru 26-30, 61% na shekaru 31-35, da 54% a cikin rukunin shekaru 35.

A Hungary, wani binciken da Központi Statisztikai Hivatal (Central Statistics Office) ya yi ya kiyasta cewa kashi 7-12% na matan Hungary da ba su da haihuwa; kashi 13-22% na mata masu shekaru 35 ba su da juna; kuma kashi 24-46% na mata masu shekara 40 ba su da ciki. 

Tebur da ke ƙasa yana dauke da kimantawa na kashi na mata waɗanda, idan sun fara yin ciki a wani shekaru, za su kasa samun haihuwa mai rai. Lura cewa yayin da masu bincike na matasa suka yarda, ga tsofaffi akwai bambanci.

### Tsaro na Ovarian

Dangane da ajiyar ovarian, mace ta al'ada tana da kashi 12% na ajiyarta a lokacin da take da shekaru 30 kuma tana da kashi 3% kawai a lokacin da ta kai 40. 81% na bambancin a cikin ajiyar ovarian ya faru ne saboda shekaru kadai,  yana mai da shekaru mafi mahimmanci a cikin rashin haihuwa na mata.

Hanyoyin da aka fi amfani da su don bincika matsayin ajiyar ovarian shine yin gwajin jini a ranar 3 na sake zagayowar haila don auna matakin Follicle-Stimulating Hormone (FSH), a madadin haka gwajin jini don auna matakan Anti-Müllerian Hormone (AMH) na iya ba da irin wannan bayanin. Hakanan ana iya amfani da ultrasound na transvaginal don "ƙidaya yawan follicles" kuma ana kiran wannan hanyar Antral Follicle Count.

Kwalejin likitocin haihuwa da likitocin mata na Amurka sun ba da shawarar yin gwajin ajiyar ovarian ga mata da suka wuce shekaru 35 waɗanda ba su yi ciki ba bayan watanni 6 na ƙoƙarin yin ciki da mata da ke cikin haɗarin rage ajiyar ovary, kamar waɗanda ke da tarihin ciwon daji da aka yi musu magani da gonadotoxic, radiation na pelvic, ko duka biyun; waɗanda ke da yanayin kiwon lafiya waɗanda aka yi musu maganin gonadoto toxic; ko waɗanda ke da tiyata na ovarian don endometriomas.

Yana da mahimmanci a gane cewa mummunan sakamako daga gwajin ajiyar ovarian ba ya nuna cikakkiyar rashin iya ɗaukar ciki kuma bai kamata ya zama ma'auni ɗaya da aka ɗauka don iyakance ko ƙin damar samun magani na rashin haihuwa ba.

### Bayanan tarihi
Binciken yawan matan Faransa daga 1670 da 1789 ya nuna cewa wadanda suka yi aure a shekaru 20-24 suna da yara 7.0 a matsakaici kuma kashi 3.7% ba su da yara. Mata da suka yi aure a shekaru 25-29 suna da matsakaicin yara 5.7 kuma 5.0% sun kasance ba tare da haihuwa ba. Mata da suka yi aure a shekaru 30-34 suna da matsakaicin yara 4.0 kuma kashi 8.2% sun kasance ba tare da haihuwa ba. Matsakaicin shekarun a lokacin haihuwa na ƙarshe a cikin yawan haihuwa ta halitta wanda aka yi nazari shine kusan 40.

A shekara ta 1957, an yi bincike a kan yawan jama'a (Hutterites na Amurka) waɗanda ba su taɓa amfani da hana haihuwa ba. Masu binciken sun auna dangantakar da ke tsakanin shekarun abokin tarayya da haihuwa.  (An yi imanin cewa yawan rashin haihuwa a yau ya fi girma a cikin yawan jama'a fiye da yawan jama'ar a cikin wannan binciken daga shekarun 1950.) 

Wannan binciken na 1957 ya gano cewa: 

* Lokacin da suka kai shekaru 30, kashi 7% na ma'aurata ba su da haihuwa
* Lokacin da suke da shekaru 35, kashi 11% na ma'aurata ba su da haihuwa
* Lokacin da suke da shekaru 40, kashi 33% na ma'aurata ba su da haihuwa
* A lokacin da yake da shekaru 45, kashi 87% na ma'aurata ba su da haihuwa

## Tasirin

### Shirye-shiryen Iyali
An yi jayayya da alaƙar da ke tsakanin shekaru da haihuwa na mata a rayuwar haihuwa ta baya don motsa tsarin iyali kafin ya kai shekaru 35. Taswirar ajiyar ovarian na mace, motsi na follicular da alamun halittu masu alaƙa na iya ba da hangen nesa game da damar daukar ciki a nan gaba, yana sauƙaƙa zaɓin da ya dace game da lokacin da za a haifi yara. Musamman, matakin mafi girma na hormone na anti-Müllerian lokacin da aka gwada shi a cikin mata a cikin yawan jama'a an gano yana da kyakkyawar alaƙa da haihuwa na halitta a cikin mata masu shekaru 30-44 da nufin yin ciki ba tare da bata lokaci ba, koda bayan daidaitawa don shekaru. Don haka, ma'aunin AMH yana da taimako don tantance wane mata za su iya buƙatar yin ciki a farkon shekarun, kuma wane mata za a iya jira.

### Magungunan haihuwa
An ba da shawarar cewa mata su sami kimantawar rashin haihuwa idan sun wuce shekaru 40, ko kuma idan sun wuce shekara 35 kuma ba su sami ciki ba bayan sun yi ƙoƙari na watanni 6. A lokuta da yawa, ana iya magance rashin haihuwa tare da fasahar haihuwa da yawa, amma nasarar su tana raguwa tare da shekaru. Za'a iya tattauna batutuwan shekaru tare da ƙwararren ƙwararren mai ilimin haihuwa kamar masanin ilimin haihuwa.

 Fertilization (IVF) fasaha ce ta haihuwa da aka yi amfani da ita don magance rashin haihuwa da kuma taimaka wa iyalai samun 'ya'ya. Duk da yake mata da yawa da suka tsufa na iya zaɓar maganin IVF don samun yara, an gano marasa lafiya da ke da shekarun uwa mafi girma (> shekaru 40) suna da mummunar sakamakon IVF da kuma zubar da ciki mafi girma idan aka kwatanta da masu shekaru 20 zuwa 30. Yawancin cibiyoyin IVF za su yi ƙoƙari su yi amfani da ƙwai na mai haƙuri har zuwa kimanin shekaru 43-45,  kuma likitocin endocrinologists na haihuwa suna bin IVF da ƙarfi a cikin mata sama da 35.

Oocyte cryopreservation (tsuntsu)  hanya ce da aka yi don adana ƙwai (oocytes) don a narke ƙwai, a shayar da su, kuma a canja su zuwa cikin mahaifa ta hanyar hanyar IVF. Wannan yana ba mata damar jinkirta ciki da kuma kauce wa yawancin matsalolin rashin haihuwa da ke tasowa daga lalacewar kwayar halitta. Bincike ya nuna cewa haɗarin samun ƙarancin haihuwa ba ya ƙaruwa a cikin jarirai da aka haifa daga ƙwai masu daskarewa da narkewa,  kuma IVF daga ƙwai da aka narke suna da irin wannan nasarar shigarwa idan aka kwatanta da IVF da aka yi da sababbin ƙwai.  Duk da yake ana kauce wa ƙarancin chromosomal tare da daskarewa, ciki a tsufa yana ƙara haɗarin ciwon sukari na ciki, preeclampsia, aiki kafin lokaci, da sashin cesarean ba tare da la'akari da hanyar ciki ba.

Wani bita a cikin 2012 ya zo ga sakamakon cewa tsoma baki na warkewa don dakatar da ko juyar da tsarin tsufa a cikin mata yana da iyaka, duk da rahotanni na baya-bayan nan game da yiwuwar wanzuwar ƙwayoyin halitta wanda za'a iya amfani dashi don dawo da ajiyar ovarian.

### Matsalolin
Idan ya zo ga uwa, bincike da yawa sun nuna cewa mata masu juna biyu sama da shekaru 35 suna cikin haɗarin eclampsia" id="mwAV4" rel="mw:WikiLink" title="Pre-eclampsia">hauhawar jini a lokacin daukar ciki, eclampsia (hawar jini yayin daukar ciki tare da fashewa), da ciwon sukari na ciki. Bugu da ƙari, matan da suka yi juna biyu bayan sun kai shekaru 35 suma suna cikin haɗarin rikitarwa na haihuwa. Wadannan sun hada da haihuwa, zubar da ciki, da rikitarwa da ke haifar da haihuwa ta hanyar Sashe na caesarean.

Matsalolin tayin ga mata masu juna biyu bayan shekaru 35 suma suna da yawa. Ɗaya daga cikin sanannun haɗari shine karuwar haɗarin samun jariri tare da Ciwon Down. A cewar Kwalejin Obstetrics da Gynecology, bincike ya nuna cewa haɗarin ciwon Down yana ƙaruwa daidai da ƙaruwar shekarun uwa.

Halin daukar ciki na yaro tare da ciwon Down bisa ga shekarun uwa ta NDSS: 

* Lokacin da yake da shekaru 20, 1 a cikin 2000
* A shekara 24, 1 a cikin 1300
* A shekara 25, 1 a cikin 1200
* A lokacin da yake da shekaru 29, 1 cikin 950
* Lokacin da yake da shekaru 30, 1 cikin 900
* A lokacin da yake da shekaru 34, 1 cikin 450
* Lokacin da yake da shekaru 35, 1 cikin 350
* A lokacin da yake da shekaru 39, 1 cikin 150
* A shekara 40, 1 cikin 100
* A shekara 44, 1 cikin 40
* A lokacin da yake da shekaru 45, 1 cikin 30
* A lokacin da yake da shekaru 49, 1 cikin 10

Baya ga ciwon Down, mata masu juna biyu sama da 35 suma suna cikin haɗarin ƙarin lahani na haihuwa. Binciken da Gill et al. suka gudanar ya gano haɗin gwiwar shekarun uwa > 40 da lahani na haihuwa kamar matsalolin zuciya, atresia na esophageal, hypospadias, da craniosynostosis. A ƙarshe, binciken ya ba da rahoton cewa mata masu juna biyu sama da 35 suma sun kara haɗarin haihuwa da jarirai masu ƙarancin nauyin haihuwa.

## Tsufa na Ovarian
Shaida mai mahimmanci ta nuna cewa damar gyara DNA ta biyu ta hanyar hanyar gyara da ta shafi BRCA1 (nau'in kamuwa da cutar kansa ta nono na 1) furotin da ATM (ataxia-telangiectasia mutated) serine / threonine kinase ya raunana tare da shekaru a cikin oocytes na nau'o'i da yawa ciki har da mutane. Takamaiman hanyar gyaran DNA da shekaru suka shafa shine hanyar gyaran ADN. Gabaɗaya, mata da ke da maye gurbin BRCA1 suna da ƙananan ajiyar ovarian kuma suna fuskantar farkon hawan jini.

## Dubi kuma

* Tasirin shekarun uba
* Shekarar uwa

## Manazarta