कोविड -19 महामारी:उम्र के जरिये बांझपन – और कैसे आईवीएफ ने हमारे सोचने के तरीके को बदल दिया
कोविड -19 महामारी से दुनिया भर में तबाही के साथ, मानव प्रजनन के पूरे परिदृश्य में एक बड़ा बदलाव आया है। विडंबना यह है कि यह कई जोड़ों के लिए एक वरदान साबित हुआ है, जो पहले अपने कठिन काम के कारण एक-दूसरे के लिए समय नहीं रखते थे।
कोविड -19 महामारी से दुनिया भर में तबाही के साथ, मानव प्रजनन के पूरे परिदृश्य में एक बड़ा बदलाव आया है। विडंबना यह है कि यह कई जोड़ों के लिए एक वरदान साबित हुआ है, जो पहले अपने कठिन काम के कारण एक-दूसरे के लिए समय नहीं रखते थे। लॉकडाउन लागू होने के साथ, यह देखा गया है कि व्यक्ति परिवार शुरू करने के बारे में सोचने के लिए अधिक इच्छुक हैं। इसने लॉकडाउन के दौरान नए वर्क-फ्रॉम-होम रूल या फरलो के साथ युगल अंतरंगता के अवसरों को बढ़ाया है।
हरियाणा कर्मचारी महासंघ:यूनियन के मांग पत्र पर सकारात्मक रवैये को लेकर महाप्रबंधक का जताया आभार; रोडवेज कर्मचारी यूनियन की हांसी उपकेंद्र की मीटिंग का आयोजन
हालाँकि, अनैच्छिक संतानहीनता के विभिन्न मनोवैज्ञानिक और मनोदैहिक प्रभाव होते हैं, विशेषकर महिलाओं में। सबसे आम हैं संकट, अवसाद, चिंता, कम आत्मसम्मान, दैहिक शिकायतें, कम कामेच्छा और दोष की भावना और साथ ही अपराधबोध। बांझपन उपचार शुरू करने में देरी के कारण कोविड -19 संकट ने महिलाओं के मानसिक स्वास्थ्य के लिए एक गंभीर चुनौती पेश की है।
महामारी ने बांझपन के उपचार, विशेष रूप से आईवीएफ को बड़े पैमाने पर रद्द कर दिया। 25 जुलाई को मनाया जाने वाला विश्व इन विट्रो फर्टिलाइजेशन (आईवीएफ) दिवस, बांझपन उपचार में इस तकनीक के सार और महत्व का प्रतीक है। 1978 में अपनी स्थापना के बाद से, IVF को हमेशा प्रजनन उपचार के अंतिम उपाय में से एक माना गया है। निराशाजनक रूप से कम परिणाम दिखाने वाले उपलब्धि चार्ट के साथ यह श्रमसाध्य, महंगा और समय लेने वाला था। प्रारंभिक वर्षों में, यह बांझपन के बहुत उन्नत मामलों में किया गया था और दुनिया भर में केवल कुछ ही केंद्रों में इसका अभ्यास किया गया था।
दशकों में, क्रांतिकारी परिवर्तन हुए हैं, जिससे यह दुनिया भर में व्यापक रूप से उपलब्ध हो गया है। न केवल उपचार को सरल बनाया गया है, बल्कि इसकी पिछली लागत के केवल एक-तिहाई पर सुलभ होकर सस्ती भी है। बांझपन उपचार की आधुनिक अवधारणा को लोकप्रिय रूप से सक्रिय प्रबंधन के रूप में जाना जाता है। कोशिश करने के एक साल के भीतर गर्भ धारण करने में असमर्थ जोड़े को आगे की जांच के लिए किसी विशेषज्ञ के पास जाना चाहिए। यह अंतराल कम हो सकता है यदि उनके पास अन्य प्रजनन समस्याएं हैं या महिला साथी की आयु 35 वर्ष से अधिक है। जांच की बैटरी के बजाय अब मुट्ठी भर परीक्षण किए जाते हैं, जो पहले आदर्श हुआ करते थे। इन परीक्षणों के साथ, बांझपन के कारण का पता लगाया जाता है और बाद की उपचार योजना पर निर्णय लिया जाता है।
बहुसंख्यकों के लिए बांझपन के उपचार का प्रारंभिक चरण शुरुआती छह महीनों में ओव्यूलेशन इंडक्शन (अंडे को छोड़ना) के लिए दवाओं के साथ है। यदि यह काम नहीं करता है, तो अगला कदम ओव्यूलेशन को प्रेरित करने के लिए गोनैडोट्रॉफ़िन इंजेक्शन का उपयोग करना होगा, सीरियल अल्ट्रासोनोग्राफी द्वारा उपचार की निगरानी करना होगा और जोड़े को ओव्यूलेशन के समय सलाह दी जाती है, जब उन्हें सेक्स करना चाहिए।
अगली प्रक्रिया अंतर्गर्भाशयी गर्भाधान (आईयूआई) है, जहां ओवुलेशन के दिन पुरुष से सबसे अच्छी गुणवत्ता वाले शुक्राणु को अलग किया जाता है और उसके साथी के गर्भाशय में डाला जाता है। गोनैडोट्रॉफिन और आईयूआई के साथ ओव्यूलेशन इंडक्शन में छह महीने और लगेंगे। इस प्रकार, एक वर्ष बीत जाने के साथ, शेष छह से 12 महीने सहायक गर्भाधान के लिए छोड़ दिए जाते हैं, या जिसे आमतौर पर आईवीएफ के रूप में जाना जाता है। इस प्रक्रिया में, अंडे को एक महिला के शरीर के बाहर एकत्र किया जाता है और एक प्रयोगशाला में शुक्राणु के साथ मिला दिया जाता है। इन विट्रो का मतलब शरीर के बाहर, टेस्ट ट्यूब या डिश में होता है। एक बार निषेचन होने के बाद, भ्रूण को गर्भ में प्रत्यारोपित किया जाता है। सफलता, यानी ओव्यूलेशन प्रेरण के साथ गर्भावस्था दर, 10-15 प्रतिशत है, आईयूआई के साथ 15-20 प्रतिशत है, जबकि आईवीएफ के साथ यह क्रमशः 40-60 प्रतिशत प्रति प्रयास है।
इस प्रकार, उपचार का कोई भी विकल्प हो, इसे अधिकतम दो वर्षों की अवधि के भीतर पूरा किया जा सकता है। वे दिन गए जब एक जोड़े के इलाज में अंतहीन इंतजार, विभिन्न क्लीनिकों का दौरा और परीक्षणों की एक श्रृंखला शामिल थी। आधुनिक समय के समाधान में अब पेट को खोले बिना समस्या की पहचान करने के लिए लैप्रोस्कोपिक या हिस्टेरोस्कोपिक सर्जरी शामिल है। ये प्रक्रियाएं एक दूरबीन के माध्यम से की जाती हैं और उनमें से अधिकांश डे-केयर के आधार पर होती हैं।
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वर्तमान महामारी के परिदृश्य पर वापस आते हुए, यहां तक कि लॉकडाउन में चरणों में ढील दिए जाने के बावजूद, अभी भी यात्रा प्रतिबंध, सार्वजनिक परिवहन की अनुपस्थिति और कुछ स्थानों पर विस्तारित लॉकडाउन है। इसके परिणामस्वरूप कई मामलों में उपचार रद्द कर दिया गया है या इसे बंद कर दिया गया है। दूसरी लहर की शुरुआत के साथ ही विभिन्न शहरों और कस्बों में काम करने वाले कई लोग आर्थिक गतिविधियां बंद होने के कारण अपने घरों के लिए रवाना हो गए हैं। इसके अतिरिक्त, इसने आर्थिक गतिविधियों में किसी भी सुधार की उम्मीदों को भी धराशायी कर दिया है क्योंकि स्कूल और कॉलेज बंद हैं और व्यवसायों ने नौकरियों में कटौती की है।
समग्र स्थिति ने लोगों के जीवन के मूल पहलुओं को एक अनोखे और जटिल तरीके से बदल दिया है क्योंकि आर्थिक मंदी जन्म दर को प्रभावित करने के लिए एक प्रमुख नियामक है। कई लोगों को संक्रमित होने के डर से इलाज के लिए अपनी योजनाओं को छोड़ने के लिए भी मजबूर होना पड़ा है।
चूंकि आईवीएफ एक समय-संवेदी उपचार है, इस प्रक्रिया के माध्यम से माता-पिता बनने के इच्छुक जोड़ों के लिए हर गुजरते हफ्ता महत्वपूर्ण होता है। उपचार कार्यक्रम में बदलाव या स्थगित किया जाना भारी भावनात्मक असंतोष और अनिश्चितता का कारण बनता है। कई लोगों को कुछ अपरिवर्तनीय समस्याएं होती हैं जैसे खराब शुक्राणु गुणवत्ता, अवरुद्ध फैलोपियन ट्यूब, एंडोमेट्रियोसिस, फाइब्रॉएड या पॉलीसिस्टिक अंडाशय। इसके लिए चिकित्सकीय हस्तक्षेप की आवश्यकता होती है जिसके बिना ये जोड़े अपने आप गर्भ धारण नहीं कर सकते, भले ही वे घर पर रहे और समय पर संभोग किया हो।
आईवीएफ चक्र कुछ महीनों में एक नियोजित तैयारी है। इस प्रकार, वर्तमान परिदृश्य में, कई बांझ जोड़े इलाज शुरू नहीं कर सकते हैं और यह अनिश्चित है कि उन्हें कितना इंतजार करना होगा। एक महिला के लिए यह जानना जरूरी है कि उसकी प्रजनन क्षमता 35 साल की उम्र से कम होने लगती है। इस प्रकार, अंडों की घटती संख्या उनकी घटती गुणवत्ता के बराबर है। जबकि पुरुष नए शुक्राणुओं का उत्पादन जारी रखते हैं, उनके शुक्राणुओं में जीन की गुणवत्ता भी बढ़ती उम्र के साथ बिगड़ती जाती है।
सबसे महत्वपूर्ण प्रश्न जिसका उत्तर अब मिलना बाकी है: क्या कोविड -19 किसी के प्रजनन कार्य को खराब कर सकता है? इसका उत्तर सीधा नहीं है। महामारी के पिछले 18 महीनों के दौरान यह साबित हो चुका है कि यह संक्रमण, कण्ठमाला जैसे अन्य वायरस के विपरीत, वृषण या डिम्बग्रंथि समारोह पर कोई प्रभाव नहीं डालता है। न तो स्पर्म काउंट कम होता है और न ही ओवेरियन फंक्शन दब जाता है।
हालांकि यह सच है कि कोविड -19 वायरस व्यक्ति को थका हुआ और सुस्त महसूस कराता है, जिसके परिणामस्वरूप पुरुषों की यौन शक्ति से समझौता किया जा सकता है। पुरुष अंग के भीतर, रक्त की आपूर्ति इरेक्शन में मदद करती है। इसलिए, यदि कोविड -19 संक्रमण के साथ कुछ सूक्ष्म थक्के बनते हैं, तो इससे इरेक्टाइल डिसफंक्शन हो सकता है। यह बदले में, प्राकृतिक गर्भाधान की संभावना को कम करता है।
कई लोगों के बीच एक आम गलत धारणा है कि कोविड -19 वैक्सीन मानव प्रजनन को प्रभावित कर सकता है। सच्चाई यह है कि कोई भी टीका प्रजनन क्षमता को प्रभावित नहीं करता है। बल्कि, वे शरीर को कोरोनावायरस की सतह पर पाए जाने वाले स्पाइक प्रोटीन की प्रतियां बनाने के लिए प्रोत्साहित करते हैं। यह शरीर की प्रतिरक्षा प्रणाली को उस वायरस से लड़ने के लिए सिखाता है जिसमें विशिष्ट स्पाइक प्रोटीन होता है।
डराना-धमकाना ऐसी गलत व्याख्याओं का एक निश्चित कारण है। जहां तक टीकाकरण के बाद बांझपन का इलाज शुरू करने के लिए उपयुक्त समय की बात है, तो जैब के बाद कम से कम तीन दिन इंतजार करने का आदर्श समय होगा। इसका कारण यह है कि टीकाकरण के बाद बहुत से लोग अस्वस्थता या बुखार से पीड़ित होते हैं। इसलिए, यदि वे उसी समय के बारे में अपना इलाज शुरू करते हैं जब वे टीका लगाते हैं, तो वे जो लक्षण अनुभव करते हैं, उन्हें गलत तरीके से उनके उपचार के दुष्प्रभाव के रूप में लिया जा सकता है, न कि टीकाकरण का। इसे टीकाकरण से पहले, कभी भी उनकी दो खुराक के बीच में या उनके जाब के तीन दिन बाद भी शुरू किया जा सकता है।
वर्तमान वैज्ञानिक प्रगति ने हमारे लिए बांझपन वाले जोड़ों के एक बड़े प्रतिशत में परिणाम देना संभव बना दिया है, बशर्ते वे समय पर आकर मदद मांगें। यह एक तेजी से विकसित होने वाला क्षेत्र है और नई तकनीकें हमें बांझपन के कारणों में गहरी अंतर्दृष्टि प्रदान करती हैं और इन कारणों का अधिक प्रभावी ढंग से इलाज करती हैं। इसके सक्रिय प्रबंधन में विश्वास रखने की जरूरत है और एक सही समय की उम्मीद में आने वाले वर्षों के लिए इसे लंबा करने के बजाय 18-24 महीनों के भीतर अपना इलाज पूरा करना होगा। इलाज के लिए आने वाले इन जोड़ों में से अधिकांश वास्तव में सफल होंगे।
दुर्भाग्य से, ऐसे जोड़ों का एक छोटा अनुपात होगा जो चिकित्सा में तकनीकी प्रगति के बावजूद गर्भ धारण करने में सक्षम नहीं हो सकते हैं। जब वे अभी भी छोटे हैं तो उन्हें इस जानकारी में शामिल करना अनिवार्य है ताकि उन्हें गोद लेने पर विचार करने के लिए पर्याप्त समय दिया जा सके, अगर वे इसे चाहते हैं।
जैसे-जैसे चिकित्सा विज्ञान का विकास जारी है, यह उपचार अगले दशक और उसके बाद भी बेहतर, सस्ता और अधिक व्यापक होने की उम्मीद है। शब्द ‘बांझपन’ धीरे-धीरे एक बड़ा कहर पैदा करने वाला मामला नहीं रह जाएगा जो अत्यधिक सामाजिक, मानसिक और भावनात्मक उथल-पुथल लाएगा।
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