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TONTHaONGTAMLY PHU NCf HIEM MUON CON QUA PHAN TICH TRUONG HOP Nghien cCru dtrgc tai trg bdi Quy Phat trien khoa hgc va Cong nghe Quoc gia (NAFOSTED) de tai: Kho khan tam ly cua cac cap va chong hiem muon con; Ma so 501.01-2019,03; Trudng Oai hoc Khoa hgc Xa hgi va Nhan van chij tri; TS Trirang Quang Lam lam chO nhiem Truong Quang Lam Trudng Dgi hgc Khoa hgc Kd hgi vd Nhdn vdn, Dgi hgc Quoc gia Hd Ngi TOM TAT Tinh trang hiem mudn Id mdt thdch thiic ldn cho cdc cdp va chdng vi Idi chinh, sire khoe the chdi vd tinh Ihdn tren hdnh trinh "tim con" Qua viec phdn tich ba Irudng hgp dien hinh cho thdy, cd ba ngudi deu cd nhirng Idn thuang ldm ly nhu: vdn de ve cam xiic lieu cue (lo ldng, sg hai, that vgng ), gap dp lue tir gia dinh vd xd hgi, tu li ve gid Iri bdn Ihdn, dp luc ve tdi chinh Ket qud phdn tich ba trudng hgp phu nQ hiem mudn budc ddu tim hieu tdn thuang tdm ly eua ngudi vd sinh, hiem muon, tren ca sa do, bdi viel cung dua mdt sd bdn ludn cho cdc hudng nghien ciru tiep theo Tir khoa: Vo sinh; Hiem mudn; Tdn thuang tdm ly Ngdy nhdn bdi: 2/2/2020; Ngdy duyet ddng bdi: 25/2/2020 Dat van de Sinh san, nuoi duong va giao due cai la mpt nhiing chuc nang ea ban ciia gia dinh Buae vao cuoc song hon nhan, chao don dua doi la mong uoc cua tat ea eae cap va chong Trong van hoa phuang Dong va Viet Nam, viee dong nhieu chau eo the duge coi la mot nhiJng chuan mue hang dau eua hanh phiic nhieu gia dinh Tuy nhien, dieu luang chiing nhu gian dan lai tra nen het sue kho khan vdi nhirng nguai roi vao tinh trang vo sinh, hiem muon Dieu da lao nhieu ap Iuc lon doi vai cae cap vg chong, dae biel la doi vdi ngirdi phu n\x Ho phai chiu nhung kien nhu "cdy dgc khong trdi, gdi doc khong con" hay ""cdy kho khong co lgc, nguai dgc khong CO con" Ngay ca nguyen nhan hiem muon tii phia nam gidi, thi phu nu van chju ap luc sinh eon, tham chi nhieu gia dinh, ngudi phu nii phai TAP CHI TAM LV HOC, Sd' (252), - 2020 83 CO bang moi each d^ co dugc hanh phiic gia dinh Di6u tao nhieu ton thuong tam ly cho ho tren hanh trinh "tim con" Theo bao cao cua To chiic Y te The gioi (WHO) ve dir lieu Khao sat Nhan khju hoe va Y tl (2004), uoc tinh co hon 186 trieu phu nu da tirng ket hon tuoi sinh san cr cac nuoc dang phat trien dang tri "uoc mo tre em", cii bon cap vg chong thi co mpt cap bi anh huong bcti vo sinh Vo sinh dugc uoc tinh anh hucmg tu 37 den 70 trieu cap vg chong tren toan the gitDfi (Boivin, Buntin, Collins va Nygren, 2007) Trong nam 2010, co khoang 48,5 trieu cap doi tren toan the gioi hi vo sinh (Mascarenhas, Seth, Ties va cong sir, 2012) Nam 2012, WHO da chi rSng, ganh nang tong thi cua vice bi vo sinh, hiem muon o phii ntr tren 190 quoc gia van tuong tu ve muc dp va xu huong nhu tit nhung nam 90 cita tbl ky XX din nam 2010 Vo sinh, hiem muon dugc danh gia la mgt nhiing trai nghiem cuoc song cang thang cua nguoi Ben canh do, qua trinh dieu tri cung gay nhirng khung hoang cuoc song eho cac cap vg chong (Menning, 1980; Dunkel-Schetter, I99I; Lalos, 1999) Tai Viet Nam, nghien ciru tren toan quoc Benh vien Phu san Trung uong va Dai hpc Y Ha Npi (2015) tien hanh tren 14.300 cap vg chong dp tuoi sinh san (tir 15 tuoi den 49 tuoi) cf tinh dai dien cho vimg sinh thai eita Viet Nam cho thay: Ty le vo sinh ciia cac cap vg chong dp tuoi sinh san la 7,7%, vo sinh nguyen phat la 3,9% va vo sinh thir phat la 3,8% (50% so cap vg chong vo sinh duoi 30 tuoi) (dan theo bao dien tir dantri.com) Nhu vay, co the thay, vo sinh, hiem muon dang la ganh nang cho rat nhieu gia dinh, khong eh! ve tai ehinh, ma no la nhOng ap lire tSm ly cho cac vien gia dinh, dac biet la doi voi cac cap vg chong Vo sinh, hiem muon tao nhirng ton thuong tam ly cho nguoi, cting c6 the dan den dau kh6 vil tram cam ciing nhu su ky thi va tay chay (Cui W., 2010; Chachamovich va cpng su, 2010) Nhtrng ton that cang nghiem trpng htm doi vai nguoi phu ntr, boi hp cam thay tuyet vpng, mac cam ve ban than va mkt kien nhSn qua trinh diiu tri hilm muon (Deka, Sarma, 2010) Phu nir vo sinh eo tu bao cao thap hon ve sire khoe tam thiin, boat dpng xa hpi va hanh vi tinh cam (Chachamovich va cpng sit, 2010) Ngoai ra, thoi gian vo sinh, hilm mupn c6 tuong quan nghich vol diem so vl su hai long hon nhan Nhung benh nhan thoi gian dai khong co thucmg co chit lucmg hon nhan kem Thoi gian vo sinh co lien quan viJi nhilu phan iing cam xiic khac (vi du nhu lo au va trim cam) va chat lugng cuoc sing (Reza Omani-Samani, Saman Marouftzadeh va cpng su, 2017) Viet Nam, da co mgt so nghien citu ve anh huong ciia tinh trang vo sinh, hiem mupn doi vol tam ly cua nguoi hilm muon Nghien euu eiia Nguyen Thi Hang Phuong (2011a) da chi ra, nguoi pbii nit hoan canh hilm 84 TAP CHi TAM t y HOC, So (252), - 2020 mupn, vo sinh da phai chiu dimg mgt ap luc kep Do la mong mu6n sinh dugc mgt diia va thai dp xet, ehi trich cua nhirng nguoi xung quanh, tir hang xom, ban be co quan, khu phi din nhiJng ngucri than thupc nhu gia dinh nha ching va ca chpng cua hp Nhifng ap lire tam ly dp da khiln phu nii roi vao trang thai chan nan, nang suat lam viec giam siit Mpt nghien cim khac, tac gia da chi nhung ton thuang ve cam xuc lon nhat ciia phu nil la dau don tam bin (89,6%), chan nan (87,9%), tuyet vpng (87,3%i), cam thiy tui thiin (85,4%) Theo tae gia, mpt nhirng ly din din viee kho hoac cham mang thai hon la vi phu ntr hiem mupn thuong xuyen g trang thai lie che (Nguyen Thi Hang Phuong, 201 lb) Nghien ciru ciia Nguyen Do Hong Nhung, Nguyin D Huong Giang (2017) cho thay, cac bieu hien kho khUn tam ly nguai vo sinh, hiem muon gap phai nhieu nhat la tinh trang lo au cang thang vi khong co con; bi quan, chan chuong vi thcri gian dieu tri keo dai; thit vgng vi chua dupc den dap va mac cam tu ti thua kem Da so nguoi vo sinh mong muon va rat mong muon dugc cham soc sire khoe tam than Nhin chung, cac nghien citu va qua trinh dieu tri cho ngucti vo sinh, hiem muon da dat dugc nhieu tuu lan duoi goc dp Y hpe, nhien, eac nghien ciiu ve ton thuang tam ly ciia nguai vo sinh, hiem muon thuc sir van la mpt khpang chua dugc quan tiim nhieu Nhirng nam gan diiy, cac van de tam ly ciia nguoi vo sinh, hiem muon dugc nhac den nhieu hon tren cac phugng tien truyen thong dai chung Tuy nhien, viec xac djnh nhiing kho khan tam ly ciia ngucri vo sinh, hiem mupn vin can nhieu nghien citu hon nOa Vi vay, muc tieu cua bai viet buijc dau phan tich nhiing ton thuang tam ly o nguiji phu nit hiem mupn qua viee phan tich ba trucmg hgp dien hinh Scr dl chiing toi chgn nghien eiru tren khach tbl la phu nu boi nhieu nghien ciru chi rang ton thuang o phu nil lijn hon so veil nam gicSi (Deka, Sarma, 2010), nhung ap luc tam ly ciia ngucri vp phiii ganh chiu la lon hem, ca nguyen nhan ciia viee khong eo tit phia ngucri chong (Lee va Sun, 2000) va nhttng nguoi phu ntr hilm mupn co chat luong cupe song thap han so vai chong ciia hg (Goker, Yanikkerem, Birge va Kuscu, 2017) Khai niem cc ban 2.1 Vd sinh, hiem muon Theo tac gia Vu Van Du (2017), vo sinh la tinh trang mpt cap vg ching khong tbl CO thai sau mpt nam chung sing, giao hgp binh thudng, khong ap dung bien phap tranh thai Ty le vo sinh a nu chilm khoang 30 - 40% eae truang hgp, vo sinh a nam chilm khoang 30% cac truang hgp, khoang 20% cac trudng hgp la nguyen nhan a ca hai vg ching Ben canh do, co khoiing 10 15% cac cap vg chong khong tim thiy nguyen nhan gay vo sinh TAP CHI TAM Vi HOC, Sfi (252), - 2020 85 Vo sinh CO the duge phan loai: 1/ Vo sinh nguyen phat la trucmg hgp mpt cap vg chong chua timg co thai, mac dii da song vai tren mpt nam va khong diing bien phap tranh thai 2/ Vo sinh thii phat la trucmg hgp cap vg chong da co hoac da co thai, nhung sau khong the co thai lai mac du dang sing vo'i tren mpt nam va khong dung bien phap tranh thai (Bp Y te, 2015) v l khai niem vo sinh, hiem mupn, theo cac tai lieu tieng Anh co nhieu thuat ngu khae Theo Uy ban quoc te giam sat ho trg cong nghe sinh san va T6 chuc Y tl Tbl giai, thuat ngir Infertility dupe dinh nghTa la benh ctia he thing sinh san dupc xac dinh boi su thit bai viec mang thai sau 12 thang hoac hon, viJi tinh trang quan he tinh due khong sti dung biit ky bien phap tranh thai nao (Zegers-Hochsehild va cpng su, 2009; WHO, 2013) Theo Tit diln Y hpc Anh - Viet (2007), tir infertility la tinh trang khong tbl mang thai dupc sau thcri ky 12 thang quan he tinh due binh thuong ma khong diing bien phap tranh thai Mot tit khac la subfertility - dupe hieu la mpt ngudi nao duge mo ta la van co co hgi co thai tot, mac dii co the mat nhieu thdi gian hon nhung ngudi khac (Evers, 2002) Diiu dugc so sanh vdi infertility, la nhOng ngudi can ho trg y tl dl co thai Vdi trudng hgp dae biet khong CO khong c6 kha nang sinh san dugc hieu la vd sinh (sterility) Theo thuai ngil tieng Anh, ea "infertility" va "subferility", cac cap vg chting deu CO ca hgi mang thai dudi sir bo trg cua y hgc Vi vay, chung toi tan vdi thuat ngu "hiem muon" nghien citu ve ton thuong tam ly ciia ngudi dang tren hanh trinh "tim eon", nham giam ap luc tam ly cho cac cap vg chong qua trinh nghien citu 2.2 Tdn thuang tdm ly ffphu nd- hiem mudn Theo dinh nghla thong thudng, ton thuang la su hu hai, mat mat mgt phan nao dd Thit hi ton thuang khong cdn duge nguyen ven nhu trudc nita (Van Tbi Kim Ciic, 2016) Theo Pearlman va Saakvitne (1995), tin thuang tam ly la trai nghiem ea nhan doi vdi mgt sir kien hoac cae sir kien lau dai, bao gom: kha nang tich hgp trai nghiem cam xue ciia ca nhan la qua siic chiu dung hoac nhung trai nghiem chii ijuan ciia ca nhan nhu la mil de dga doi vdi sir sing, tinh toan ven ciia co thi hoac sir tinh tao cila ea nhan (din theo Esther Oilier, 1999) Cdn theo tac gia Huynh Van Son (2019), tin thuong tam ly la trang thai tam ly sau ca nhan trai nghiem nhtrng su kien bit thudng, de dpa sit toan ven, yen In ve tbl chit hoac tinh thin cua hg, cd anh hudng tieu cue din boat dpng song cua ea nhan Cac sir kien gay tin thuong tam ly thudng bao gom lam dung quyen Ittc, phan boi long tin, su mic ket, bit lire, dau dan, sir hoang mang va/hoac mat mat Nhttng diiu lam lin at kha nang duong 86 TAP CHITAM Vi HOC, S6' (252), - 2020 diu ciia ca nhan (Esther Ciller, 1999), la nhirng ylu t l Iam dao dpng, tham ehi dao lgn trang thdi can bang tam ly, thudng tac dpng tieu cite din sir phat triin binh thudng (Van Thi Kim Ciic, 2016) Tren thuc te, ton thuang tam ly cQng phu thupc vao titng ea nhan, timg su kien tac dpng, timg boi canh _ Hai ngudi cd thi trai qua ciing mpt su kien dpe hai va mpt ngudi cd the bi tdn thuang ngudi van cdn tuong dii binh tmh Ngoai ra, cac khia canh cu thi cua mpt su kien gay chin thuong se khac tit ca nhan sang ca nhan khae Dieu dd phu thugc vao van hoa, vao thdi dai, vao kha nang chju dung ciia moi ngudi, vao y nghla cua su kien dii vdi ngudi dd (Esther Oilier, 1999; Van Thi Kim Cue, 2016) Cac nghien ctiu tren da chi ra, vice khong cd cai da tao nhilu ton thucmg cho cac cap vg chong, nhat la doi vdi ngudi phu nil nhu; dau kho (vi khong sinh dugc con), tuyet vpng (vi that bai nd luc diiu tri), mac cam vl ban than Do do, khai niem tdn thuong tam ly d phu ntt hilm mupn dugc hieu Id nhung dp luc vd trdi nghiem cdm xitc qud sire chiu dung, dnh hirdng tieu cue den tdm ly vd the chat ciia ngirdi phu nir tren hdnh trinh "lim " Phiro'ng phap vii dao diic nghien ciru 3.1 Thiet ke nghien ciru Nghien ciru trudng hgp duge ap dung it khai thac dupc chieu sau ve mat tam ly nhiing trai nghiem ciia phu ntr hiem mupn eon 3.2 Mdu nghien cieu Khach the la ba phu nil da dugc tham kham va dugc y hgc ket luan la vo sinh nguyen phat Day la nhiing phu nu chua tirng mang thai, sinh eon, ding thdi hp da co nhOng trai nghiem that bai dieu tri vo sinh, hiem mupn Trong nghien ciru nay, mau nghien ciru dugc chgn ngau nhien, thuan tien, bdi viee lira chpn khach the de nghien ctiu la het site khd khan, tam ly chung eua benh nhan hiem mupn la phdng ve cao, khong sin sang tra ldi Chung toi da lien he vit ed dupc stt dong y ciia mpt phdng kham hiem mudn tren dia ban Ha Npi, dong thdi eung dugc sir dong y cua ba benh nhan nil Thdng tin ve eae trudng hgp cu the nhu sau: Trudng hgp T.: 29 tudi; que quan: Me Linh - Ha Npi Nghe nghiep: Kinh doanh buon ban Ket hon tir nam 2017, thdi gian hiem mupn la nam Tinh trang siic khde: vg bj tic vdi triing, chdng bi tinh triing yeu T da ba lin lam bien phap bam tinh triing vao buing trung (lUI) va mpt lin chuyen phoi bang bien phap thu tinh dng nghiem (IVF) TAP CHI TAM L f HOC, So' (252), - 2020 87 Trudng hap H.: 30 tudi, que quan: NghTa Dan - Nghe An Nghe nghiep; giao vien mam non Thdi gian hiem mupn la nam (kit hdn tit nam 2015, den nam 2017 mdi co ke hoach sinh con) Tinh trang sire khde: vg bi viem 16 tuyen, chu ky kinh khong deu, sue khde eua ching binh thudng H da lam lUI lan (3 lin d benh vien tinh Nghe An va lin d Ha Ngi), du kien se lam IVF vao nam 2020 Trudng hgp M.: 33 tudi, sinh sdng tai Nha Trang, Khanh Hda; Nghe nghiep: ST quan quan dpi Kit hon tit nam 2014, thdi gian hiem mupn eon la nam Tinh trang sire khde: vg bj buong triing da nang, chong bi tinh triing ylu Nam 2017, M da diiu trj bing bien phap IVF benh vien T.D lan Nam 2019, vg chdng M da benh vien B.D d Ha Ngi va diiu trj IVF Ian 3.3 Cdng cu nghien ciiu Bang hdi phi ciu true dugc xay dung dua tren eac nghien cuu tren the gidi va d Viet Nam vl vin de phu nii' hilm mupn de thu thap dQ lieu Qua tritih phdng vin dugc thuc hien linh boat, tiiy titng hoan canh, tinh huong ciia tien trinh phdng vin khach the nham khai thac va lam ro nhiing ndi dau ma hg dii va dang trai qua Vi du mpt so cau hdi nhu: Anh chi mong cd duac bao idu? Khi bdc si kit ludn tinh trang la vd sinh, cdm xuc ctia chi nhu the ndo? Nhirng dp lire ndo md chi da vd dang trdi qua tinh trang hiem mudn? Trong qud trinh chira tri hiem mudn, vg chdng chi gap nhirng khd khan ndo? Cupe phdng van vira dugc ghi am vdi sir dong y cua khach the va vira ghi chep bdi nha nghien ciru 3.4 Phdn tich dd- lieu Phan tieh dir lieu dugc dua tren cac thong tin ma khach thi cung cip Dau tien, cac ban ghi iim dugc danh may lai chinh xac cac cau hdi va tra Idi Sau dd, nha nghien citu dpc kT lai ca ban bang dl tim kilm cac chil dl khac cd lien quan den trai nghiem ton thuong tam ly Sau dd, qua trinh ma hda dugc tien hanh vdi timg doan ctia loan bd ban bang dira tren y nghTa ctia cac cau ed lien quan, phan anh tirng chii dl Qua trinh phan tich se diia tren timg chu de de trich rut dii lieu 3.5 Dgo dire nghien ciru Cac khach the da dugc trao ddi trudc vl noi dung nghien eiiu, dugc giai thich ro ve muc dich nghien eiru, dd la de tim hiiu nhiing kho khan va nhtrng tin thuang ciia ngudi phu nu dang tinh trang hilm mupn eon Cae thdns TAP CHITAM Vi HOC, Sd (252), - 2020 tin ca nhan hoan toan dugc gia bi mat, ten cua hp da dugc vilt tit bai vilt Khach the cung dugc khuyin cao la cd tbl tir chii tham gia nghien ciru bit c i nao hp cam thiy khong phit hgp hoac cd tbl tir chii tra ldi nhttng cau hdi ma hp khdng mudn tra ldi Viec phdng vin sau duge thuc hien khach tbl trang thai khde manh, san sang chia se Cac cudc phdng van sau dugc diin mdi trudng an toan, nlng im, cac khach the san sang chia se Cimg vdi qua trinh thu thap thdng tin, chiing tdi ciing lang nghe va thau cam vdi nhtrng cam xuc am tinh ma cac khach the dang trai qua, Khi cac khach the cd su binh In vl tiim ly, hg cd tbl chia se nhieu hon ve nhiing khd khan dang va sip trai qua Vi vay, nghien cilu khong di sSu phan tich theo hudng phuc trinh ca tham vin, ma muc dich phan tich nhung bilu hien tin thuang tam ly ctia nhttng phu nu da va dang trai qua tinh trang hiem mudn Nhu'ng ton thu'gng tam Iy ciia ba chan dung tam Iy 4.1 Cdm giac tuyet vong Nhttng trai nghiem cam xuc tieu cue la van de ldn nhat ma cii ba ngudi phu nu deu trai qua tir hp mong cd Trudc bet la tam trang met mdi ciia ba trudng hgp thdi gian dai da dieu tri biing thudc ddng y nhung khdng hieu qua Ben canh dd, ve mat tam linh, gia dinh hg cdn di cau eiing, le bai d nhieu noi vdi tam ly la "ai mach gi cung lam, nghe ndi chd nao chua dugc cung tim den" - trudng hgp T Vg chdng hp da tdn rat nhieu tien cau cung, theo nhieu thay ciing bai met mdi ma khdng cd duge eon - trudng hcrp M Khi chuyen sang chtta bang tay y, cam xue dau tien la ca ba trudng hgp deu hi sdc va bj ap luc rat nang nl nhan ket qua la vo sinh nu (dii nguyen nhan la tu phia ngudi chdng nhu trudng hgp T.) Dieu dd lam tang them ap lire va su lo lang cho ngudi phu nu, hp cam thay nang ne, tuyet vpng nghe lit "vd sinh" - Uudng hgp M Dac biet la hp thay ap lire ban vdi gia dinh nha chdng bdi "khi biet benh an nhu vay thi cam giac nhu gia dinh hp khdng cd chau la ldi tai minh chii khdng phai la tai trai hp" - trudng hgp M Chung tdi nhan thiy, nhttng tin thuang vl cam xuc dien nhieu hon d ca ba trudng hgp sudt qua trinh dieu tri bang lay y va sau dieu trj gap thit bai Cu thi: Trudng hap T.: Khi chuyin sang diiu trj tay y, vg chdng T da lan dieu tri hiem mupn bang bien phap lUI, nhung roi ket qua deu that bai Sau mdi lin nhu vay, T lai bj eang thing vl tam ly, sir that vgng va ap luc vi khdng sinh dupe eon lai cang tang len Ndi ve nhttng trai nghiem da qua, T cho bilt dpng lai tam tri la nhttng ky lie budn dau, hy vgng rdi lai that vgng Nhit la qua trinh diiu trj, T cd cam giac don ddc, chan chudng va TAP CHI TAM Lt HOC, S« (252), - 2020 89 khdng biet den nao mdi cd dugc Quiing thdi gian hai nam dieu tri a benh vien, nhung tiem kich trirng la nhttng T khdng the quen T bi am iinh bdi nhung miii tiem va sg doan dudng ma T thucmg di den benh vien de chua benh: "Cdm gidc den benh vien mgt minh de tiem thdy dudng dd ddi ddng ddng, ndng ne vd ddi kinh khung, vi md em phdi cd" - T ndi nude mat Dac biet, ndi dau khd irong T, tang len la ket qua dieu trj bang bien phap IVF gap that bai Cu the, nam 2019, vg chdng T phai chuyin sang bien phap IVF, vdi T., day hy vpng cudi cimg de cd dugc dira nen T da cd gang giu tinh than lac quan de duge ddn tin vui Tuy nhien, ket qua lai khdng dugc nhu mong mudn: chat lugng phdi ciia vg chdng T khdng tdt, phdi khdng phat triin Nhic lai dieu nay, T cam thay dau khd vi tinh cam dd T "mudn khde ma khdng khde dugc" T chia se: "Hdm vg chdng em vdo benh vien chuyen phdi, bdn thdn em dd chudn bi tinh thdn vd cd cd su- hao cho mdt hy vgng mdi, nhirng bdc si gap rieng em vd ndi rdng phdi cita chung em khdng phdt trien vd do khdng chuyen duac Luc cdm gidc moi thii nhu sap lai trudc mat, em lui thiii budc khdi phdng vd khdng biet ndi gi, em dau khd ldm" Ci thdi diem hien tai, T cam thay dau khd, cd dan va hoang mang vi khdng biet sap tdi se nhu the nao Trudng hap H: Trong thdi gian hiem mupn ba nam, chi H cung da trai nghiem nhieu ciim xuc budn dau ddn nen Trong sudt thdi gian mong chd cd ma chua cd dugc va trai qua nhung that bai sau lan dieu trj bang bien phap lUI, H cho biet la da trai qua qua nhieu cay dang vi "vira mdt tien chua tri, vira tdn bao nhieu cdng sire md cuoi ciing kit qud lai vi khong" NghT v^ viee khdng cd dugc con, nhieu dem H lo lang qua muc din din bj mit ngu, tham chi, ndi lo sg khdng sinh dugc edn khien H bj am anh giic mo H ndi: "sau nhirng ldn Ihdi bai em nghi rdt nhiiu, em cdm gidc budt nguc, khd thd md khdng biit ldm the ndo" - H bj roi loan kinh nguyet va cd nhilu lin bi mat kinh, bac sT ket luan nguyen nhan la hi ap luc vl tam ly Vdi H., viec chtta trj dl cd cd nhttng khd khan khac vdi nhilu phu ntt hiem mupn khac bdi khoang each ve dia ly gitta noi chi sinh sing va co sd diiu trj qua xa Viec di lai lu nha benh vien tinh Nghe An lin diiu trj lUI, rli dgt diiu tri thu di tit Nghe An Hii Ndi (chi bit xe di Ha Npi tii hdm trude, chieu hdm sau tit Ha Npi vl Nghe An) khiln chj met mdi vl thi chit va tam trang Ben canh dd, cung giing nhu trudng hpp T., nhttng tiem kieh trimg, theo doi tning chin, mdt minh chj phai tu di (vl ching ban cdng viec) H eOng trai qua tam trang don ddc, cam giac phai tit than mpt minh duong dau vdi hanh trinh "tim con", H chai ly vdi mOi tiem, diiu kien di lai khd khan nen H tu tiem thudc cho minh d nha ma khdng cin din sir hd tro 90 TAP CHi TAM Vi HOC, SS (252), - 2020 Trudng hap M.: Khi dugc hdi vl nhung gl da trai qua thdi gian hilm mupn, M cho biet dd la quang thdi gian nhilu ap lyc va cang thing Nhung mat mat da qua vai chj la "khdng the ndo quen cudc dai" Tir luc nhan kit qua benh an ket luan la vd sinh, chi roi vao tinh trang cang thing, mit ngO va lo sg thdi gian dai "vi vd sinh Id khdng tlie sinh duac con" (cung giong vdi trudng hgp H,) Khac vdi hai trudng hgp tren, M diiu trj bing bien phap IVF sau cd kit qua tham kham cua benh vien Trong suit qua trinh diiu tri, tir thdi dilm tiem kich tning, chpc hut triing, nudi ciy va chuyin phdi dd la tam trang lo lang, hdi hop, hy vpng va rdi lai that vpng Ca hai lan thit bai lan dieu trj IVF da khien M c6 nhilu tin thuong Cd phan may man hon trudng hgp T la ca lan M deu chuyin phdi IVF cdng, dieu dd da tao cho M nhieu hy vgng M c6 cam xuc tit hao va may vi dugc mang bau, dugc lam me Nhung ndi dau ctia M lai la mpt dang khac - dp la ndi dau ctia mot ngudi phu nu mat con, hiit hang va that vgng Mdi lan nhd lai ky ire do, M tiec quang thdi gian mang bau tuoi dep, nhung lai cang thay dau ddn va tu dan vat ban than vi "khdng biit minh cd Idi gi de din mirc phdi bi nhu vdy" Nhung ndi dau khien M, roi vao trang thai tuyet vgng: "nhieu di dudng nght din nhung khodng thdi gian nhu ngudi mdt hdn, cdm gidc nd dau md minh khdng ndi duac lin ldi'\ Sau'nhttng cd gang de cd ma khdng dugc den dap, nghT vl tuong lai, M cam thay hoang mang va cd cam giac can kiet nang Iugng: "Em khdng biit lieu minh chdng dd duoc din bao gid?" - M ndi 4.2 Cdm gidc minh Id ngu-di phu nii- vd gid tri mdt gia dinh va xd hpi Truang hgp T.: Tren hanh trinh "tim con", diiu T cam thiiy may man la cd chdng ding hanh, hiiu va chia se vdi vg vc tinh than cung nhu cac cdng viec cudc sdng Tuy nhien, mdi quan he vdi mpi ngudi xung quanh, nhat la vdi gia dinh nha chdng, T ludn cam thay cd ap lire vd hinh, bdi chdng chj la trai nhit Mac dii, sau dieu trj, sire khde ciia chj da duge kit luan dii diiu kien dl co nhu ngudi binh thudng, nhung chi cho biet: "cdm gidc mdt cua gia dinh nhd chdng, minh Id ngudi vo gid tri, vl khdng biit de" Nhilu lin me ching T khde vl viee chj khdng sinh duge khien chj them eang thing va dau khd, tu din vat ban than, mac dd chdng T cung cd vin dl vl sire khde sinh san Tir nhung ap lire, cang thang ve cam xiic va thit bai diiu trj, T din din it gap gd ban be, it tham gia vao cac cudc di choi cung nhdm ban T sg va chan ghet nhttng ll tit, gid chap gia dinh Nhtrng nghi le nhu mpt cue hinh vdi T bao nhieu nam liii thiii mpt minh, rdi ty co rut lai khdng mudn gap T cho biet "co ngudi tdt thi hdi quan tdm, ngudi dc mieng thi hg hdi ldm minh dau ddn: tit a, khdng de duac TAP CHI TAM LY HOC, Sd (252), - 2020 91 thi sdm mudn nhd nd (nhd chdng) cdng trd vi nai sdn xudt (vi nhd bd me_ de), dn thi khde md khdng di duac d? " Nhttng cau ndi ctia mpi ngudi khien i cam thiy hi xiic pham, dan dan anh huting den hinh anh ban than, chj cam thay "minh khdng cd gid tri" vi khdng sinh dugc Nhung tdn thuang F khdng chia se duge vdi ai, ca vdi bd me de ciia T., vi cd ndi ihi cung chi lam eho hg them lo lang, budn dau Trudng hgp H.: La dau thii gia dinh cd ba anh chj em, vg chdng anh ca da cd hai va mdi day da sinh dua thu ba, dieu khien H cam thiy ap luc, cang thang tir ben Vdi nhung that bai dieu tri, 11 cung xac djnh tam ly la nlu sau nam chiia iri ma khdng eong, H chap nhan ly hdn "cho ching iiy vp khac", mac dit H cam thay dau ndi dieti nhung H cho la diiu cam thiy nen lam Khi biet tin chi dau mang bau H cung mung cho chi iy, nhung H cam thiy ttii than Idng H gap ap lyc vdi su hdi tham ciia mgi ngudi: Mdi cd ngudi than gia dinh den tham chj dau, hp lai chuyin sang cau chuyen "khdng sinh dugc con" cua H Chi cho ring, hg bang ben nha chdng khdng phai cung yeu thuong minh: "Cd ngudi hdi true tiip, cd ngirdi thi hdi qua bd me chdng Hg hiiu hg thirang thi khdng sao, ngudi khdng thuang hg cd cdch nhin dc y, cd ngudi vd tu cudi ndi den mirc vd tdm" II bj tdn thuang nang ne, bj am iinh ca vao giac ngii vi nhung cau ndi nhu: "Idy vi rdi thi de di chir, bung cir xep lep mdi the? " Chi ed cam giac bi quy gan, tham chi bj ky thj vl khdng lam trdn chirc nang: "Em nghe nhung khdng biit trd ldi sao, bdi de duac thi tdi da di rdi, minh cd mudn nhu vdy ddu" Dan dan, chj ban che giao tiep vdi gia dinh nha ehdng, chi cho biet la hang chu ddng di lam tir sdm dt;n tdi mupn, ve nha dpn dep an udng xong la vao phdng di ngu Trong cac cdng vice gia dinh, mgi ngudi nghT la H ranh (khdng bau bi nang nhoc) nen giao nhieu viec cho chi: "em di ldm cd ngdy vi em ciing met ldm, ciing mudn nghi ngai, nhung minh khde manh han, minh khdng bdu bi nin cdc viec gia dinh minh lai phdi ldm" H cho biet ban than chj rat khd chju nhung khdng ndi dugc vdi ai, vi vay phai de nen Trudng hgp M.: Chj cam ihay ap lyc mpi ngudi gia dinh hdi tham, nam ket hdn nhung khdng sinh dugc con, ap lyc ldn nhit cua chj lit vdi chlng._ Cam xuc ciia M la thay thuong minh, thuong ching, cam thiy ed loi vdi chdng vi minh khdng dc dugc cho chdng: "Va chdng ngirdi ta cd cd cdi, mirth cir nhu cdi cdy khdng hoa khdng trdi, cdm thdy tiii Ihdn vd ciing Hai lan dieu tri IVF that bai, M ludn tu day dut, din vat ban than: "Em tu hdi Id minh dd ldm gi, khdng biet minh cd ldi gl md em lai bi rai vdo iinh cdnh nhu vdy Cdi tiec nudi (phdijhai) dy mgt phdn, nhiiu cit day dirt lai Id khdng hiiu minh sai a ddu, M/ d chd ndo di md khde phuc" Ben canh dd, ddng nghiep, ban be hdi han vl chuyen cai M diu ne tranh, chi cho bilt la ban 92 TAP CHi TAM Vi HOC, So (252), - 2020 than cung khdng mudn gap gd nhieu ngudi va cungkhdng muln hdi tham "vi hodn cdnh cita minh nhu the nen de nhay cdm, di tu di hoac budn titi, mdc dii nhiiu mgi ngudi ciing chi hdi thdm vdi j tdt" Chi cho bilt, cam giac khd chju va dau ddn nhit la Jan dieu trj IVF thit bai, chj khdng chia se dugc vdi ai, vi khdng cd thyc sy lang nghe va hieu cho hoan canh ciia chi 4.3 Ap tuc ngng ne ve tdi chinh Trong viec dieu trj hiem mudn, tai chinh la mgt vin dl rit quan trpng cua cac cap vg chdng Tren thuc te, cd nhieu trudng hpp ngudi benh khdng du chi tra chp nhttng lan dieu trj hiem mupn hoac ngudi benh lam cae can thiep y tl phitc tap Chung tdi duge biet chi phi cho I lan diiu trj bing bien phap IVF la rat ldn, dao ddng tit 80 trieu den hon 100 trieu hoac hon tiiy thudc vao tinh trang siic khde va dan thudc, tiiy thudc vao cac dich vu benh vien ma hg lya chpn Tir nhirng thdng tin thu dupe cho thay, ca trudng hpp deu gap khd khan ve tai chinh, phai ddi mat vdi cam giac tieu tdn rat nhieu tien cua gia dinh ma lai khdng ed ket qua, tir dd iinh hucmg gian tiep den vice dieu trj Cu tbl: Trudng hop T.: Hai vg chdng T da tdn rat nhieu tien chtta trj de cd Chdng T lam viec budn ban cho gia dinh bdn npi, dd ngudn thu nhap ciia chdng bj phu thudc vao bd me Them vao dd, viec T nhan tien tu bd me chdng de di chua benh, chi lai ciim thay ap lyc nang nc hon sau mdi lan dieu trj that bai - "cam giac dd tien xudng sdng" Vi vay, de cd the tiep tuc dieu trj, T tam nghi dieu trj mdt thdi gian de chuan bj ve tai chinh cung nhu ve sire khde va tam ly Trudng hgp H.: Vdi cdng vice la giao vien mam non, H vua dieu tri, nhung van phai di lam Viec vira dam bao cdng viec, vira cd thu nhap va vua danh thdi gian dl dieu tri hiem mudn da tao ap luc cho H Chj gap khd khan vice xin nghi phep dl di chtta benh, bdi neu chj nghi day thi se khdng cd luong Vi dieu kien khdng cho phep, chdng H phai lo di lam nen H phai ty di kham chtta mdt minh, nen H cam thay tiii than, don ddc Trudng hgp M.: Viec diiu trj lin d phi ldn (chuyen tir Hd Chi Minh Ha Ndi) khiln vg ching M tin kem nhieu ve tai chinh M da chi nhieu tien cho viec di lai va dieu tri M rai vao ndi dau mat va sau dd la sy nudi tiec cdng sire, tiin bac da bd ma khdng cdng Vdi thu nhap dua vao luong, M cho bilt da danh nhung ddng tiin cudi ciing de chtta trj, dd, neu de tiep tue dieu trj de cd tbl phai lo ve kinh te Cd the thiy, cac chi phi la ganh nang vdi cac gia dinh, nhung cd le ganh nang dd cang nang ban va gay ap lyc cho ngudi phy nu bon hg bj that bai, tien ciia dd xudng sdng xuing be ma khdng dem lai lgi ich gi Dd gidng nhu TAP CHI TAM Vi HOC, So' (252), - 2020 93 that bai kep, tao ap luc tam ly vd cimg nang ne cho ngudi cudc, cam giac nhu ngudi an hai Ban Iuan va ket luan Tu nhung phan tich tren cho thay, diing nhu cac nghien citu da chi phu nu hiem mudn va nhtrng trai nghiem qua trinh dieu trj hiem mudn ed nhieu tdn thuang tam ly Tren thuc te, dieu tri hiem mupn cd nhieu giai doan nhu tham kham, tiem kich trirng, tao phdi, chuyen phdi Do dd, neu ngudi benh gap viin de d giai doan khac thi lai cd nhung trai nghiem dau khd khac Cd ngudi dau khd vi dieu trj lUI khdng cdng (trudng hop H.), cd ngudi dau khd vi chuyen phdi khdng cdng (trudng hi;p T - vi gia nhu dugc mdt lin cd phdi thai dl cdn cd hy vpng), cd ngudi lai dau khd vi phdi thai hinh nhung lai bj hdng (trudng hgp M vdi ndi dau ciia ba me mat con) Do dd, ciing la sy tin thuong ve cam xiic, nhung ndi dau ciia ba ngudi phu ntt la khac Nhung cd le, cd mdt diem ehung cua ba trudng hgp tren la cam giac tuyet vgng: vi hp khdng hieu dugc nguyen nhan, van de ciing nam ngoai tam kiem soat - khdng biet phai cl gang nhu the nao Cii ba ngudi phu ntt deu khdng biet tinh trang dien bao lau, nao se cd dugc - de hg dugc lam me Vdi tiim the eang mong dgi, cang hy vpng, cang nd lyc de cd nhung lai gap that bai, khien cho sy tdn thuong cang tang len nhieu Ca ba trudng hgp deu hp phai chiu nhttng ap luc cua gia dinh va xa hpi dd la ap lyc sinh eon ddi vdi nha chdng (dac biet vdi tnrdng hgp H., sue khde cia chdng binh thudng) va ca nguyen nhan hiem mudn tit phia ngudi chong (trudng hpp T.) Dieu cung cd the ly giai bdi, vdi ngudi Viet Nam, cd cai la mdt dieu bet site quan trpng, nen bd me chdng cua ba ngudi phy ntt cung riit mong mdi va ap luc trai hg lay vg nhieu nam ma chua sinh dupc (til - nam) Vi vay, diiu khdng tranh khdi viec hg bj cang thang va dieu dd dugc thi hien qua anh mit, gigng ndi, ngdn tu giao liep va gian tiep tao ap lyc cho ngudi dSu hilm mudn Vi du nhu vdi trudng hpp chj T., nhieu lin me ching T khde vl viec chj khdng sinh dugc - tam trang cua ba ed thi la thuong cai, nhung cQng ed thi la sy din vat ban than (minh da lam gi dl bi nhu vay!) hoac dd eung cd thi la ba thiy tlii than vi minh chua cd chau Ben canh do, ca ba ngudi phu ntt diu bj tin thuong bdi ldi ndi cua mgi ngudi, ma theo hg dd la tin thuang sau sic vi am anh Viec khat khao cd cho thiy, cai la mdt gia trj ldn dii vdi hp, vi vay ca ba ngudi phu ntt deu nhay cam vdi quan niem "khdng cd la vd gia tri", dieu dd din den viee hg tu ti vl gia trj cua ban than Ngoai ra, khd khan vl tai chinh la mpt ap lyc anh hudng vua true tiip va gian tiip din viec diiu trj hilm mudn, vi tai chinh la vin dl quyit djnh cho cac TAP CHi TAM LV HOC, S6 (252), - 2020 lieu trinh, cac bien phap chtta tri hiem mupn (udng thudc, bien phap lUI hoac IVF, th$m chi la cac diiu tri phitc tap khac ) Anh hudng gian tiip la vi khdng cd diiu kien tai chinh, nen ngudi ching phai lo di kilm tiin, ngudi vg roi vao trang thai buin ba, cd don, khdng dugc chdng ddng hanh nhung lin di diiu tri d day, ca ba ngudi phu nu roi vao trang thai dau khd, tdn tiin vi khdng dat kit qua (cd con), nhung ddng thdi hp cung se phai Ip ling vin dl tai chinh chp kl hoach dieu trj tiep theo Bdi neu ngudi benh khdng cd tiin, qua trinh dieu tri hiem mupn se keo dai them, dd ap lyc khdng ed se tang len Them vao dd, neu keo dai them thdi gian, thi tudi ciia ngudi phu ntt se tang len, dd, van dl tudi tac lai la mpt yeu id anh hudng din kha nang cd Cudi ciing, ba ngudi phy ntt deu roi vao tinh trang la noi dau khdng ndi dugc ra, khdng cd ngudi dl lang nghe, chia se dl vai di nhtrng ap lyc vl tam ly Bdi thii nhat la xung quanh nhttng ngudi phu ntt nay, hp khdng tim dupc ngudi thyc sy hieu de ndi nhttng van de ve sue khde sinh san, nhttng dau khd va that bai eac lan dieu trj hiem mupn Thir hai, ea vdi ngydi cd the chia se nhu vdi bd me de hoac anh chj em rupt, thi lai dieu dd lai cimg lam cho bd me lo lang, thuong (tham chi la cam giac bat luc) Chinh cam xiic dd lai tao them ap lyc cho ngydi phu ntt, vi vay hp khdng the ndi ra, khiln hg bj de nen tam trang Tdm lai, ket qua tren day mdi chi dupc mpt sd tdn thuong dien hinh sd riit nhieu trudng hgp ngudi phu nu hiem mudn d Viet Nam - vdi khat khao dugc lam me Dd la cam giac gin nhu tuyet vpng, cam thay minh vd gia trj mat ngudi khac va ap lyc nang ne vi tieu tdn qua nhieu tien eua ciia gia dinh ma van khong cdng Qua trinh dieu trj hiem mudn, vd sinh la mdt hanh trinh liiu dai, gian nan, gay nhung tdn thucmg vl tam ly va nhttng tdn that ve tai chinh cho cac cap vg chdng Vi vay, tuong lai, chiing tdi se cd nhung nghien ciru dinh lugng, tren nhieu khach the va ca d phu ntt va nam gidi, de danh gia miic tin thuong tam ly ciia nhttng ngudi vd sinh, hiem mudn Ben canh dd, chiing tdi cho rang, ben canh nhttng can thiep, dieu tri ve y hpc, hg cung can sy hd trg ve tam ly dl duong diu tit hon tren hanh irlnh "tim con" Day ciing la nhung ggi md cho chung tdi cho cac nghien ciru ve sau Tai lieu tham khao Bp Y tl (2015) Hudng ddn chdn dodn vd diiu Iri cdc benh sdn phu khoa Ban hanh kem theo Quyit djnh sl 315/QD-BYT 29/01/2015 TAP CHI TAM Vi HOC, Sd (252), - 2020 95 Boivin J., Buntin L., Collins J.A & Nygren K.G (2007) International estimates of infertility prevalence and treatment-seeking: Potential need and demand for Infertility medical care Human Reproduction 22 (6) P 1.506 - 1.512 DOI: 10.1093/humrep/ dem046 Juliana Rigol Chachamovich, Eduardo Chachamovich, Helene Ezer, Marcelo P Fleck, Daniela Knauth & Eduardo P Passos (2010) Investigating quality of life and healthrelated quality of life in infertility: A systematic review Joumal of Psychosomatic Obstetrics & Gynecology 31 (2) P 101 - 110 Van Thj Kim Cue (2016) Ghi nhan vi ldn thuang Idm ly qua thire ti hdnh nghe vd kinh nghiem diiu Iri chiing bdng ldi ndi Ky yeu Hoi thao quoc te "Sang chan tam ly va cac boat dong trg giup" NXB Dai hoc Qu()C gia Ha Npi Tr 39-49 Cui W (2010) Mother or nothing- The agony of infertility Bull World Health Organ 88 (12) 881-2 DOI: I0.247I/BLT.10.011210 Vu Van Du (2017) Hudng ddn chdn dodn vd diiu tri sdn phu khoa NXB Dai hpc Quoc gia Ha Npi Deka P.K., Sarma S (2010) Psychological aspects of infertility British Journal of Medical Practitioners Vol No P 32 - 34 Dunkel-ScheUer C & Lobel M (1991) Psychological reactions lo /«/ertility In A L Stanton & C Dunkel-Schetter (Eds.) The plenum series on stress and coping Infertility: Perspectives from stress and coping research P 29 - 57 New York US: Plenum Press DOI: 10.1007/978-l-4899-0753-0_3 Evers J.L (2002) Female subfertility Lancet Vol 360 P 151 - 159 DOI: 10.1016/ 80140-6736(02)09417-5 10 Esther Giller (1999) The annual conference of the maryland mental hygiene administration Passages to Prevention; Prevention across Life's Spectrum 11 Goker A., Yanikkerem E., Birge O & Kuscu N.K (lOM) Quality of life in Turkish infertile couples and related factors Human Fertility 21 (3) P 195 - 203 DOI: 10.1080/14647273.2017.1322223 12 https://dantri.com.vn/suc-khoe/ti-le-vo-sinh-o-viet-nam-dang-vao-muc-canh-bao20180405120937326.htm Ngay dang 05/04/2018 13 Jafarzadeh-Kenarsari p., Ghahiri A., Zargham-Boroujeni A., Habibi M (2015) Exploration of the counseling needs of infertile couples: A qualitative study Iranian Joumal of Nursing and Midwifery Research 20 (5) P 552 - 559 DOI: 10 4103/ 1735-9066.164506 14 Jones E & Wessely S (2006) Psychological trauma: A historical perspective Psychiatry (7) P 217 - 220 DOI: 10.1053/j.mppsy.2006.04.011 15 Lalos A (1999) Breaking bad news concerning fertility Human Reproduction Vol 14 Iss P 581 - 585 DOI: 10.1093/humrep/14.3.581 96 TAP CHI TAM Lt HOC, SO' (252), - 2020 16 Lee T.Y & Sun G.H (2000) Psychological respones of Chinese infertile husbands andwives Archives of Andrology Vol 45 P 143 - 148 17 Maya N Mascarenhas, Seth R Flaxman, Ties Boerma, Sheryl Vanderpoel, Gretchen A Stevens (2012) National, regional, and global trends in infertility prevalence since 1990: A systematic analysis of 277 health surveys PLOS Medicine Openaccess Vol Iss 12 P - 12 DOI: 10.1371/journal.pmed.l001356 18 Menning B.E (1980) The emotional needs of infertile couples Fertility and Sterility Vol 34 Iss P 313 - 319 DOI: 10.1016/S0015-0282(16)45031-4 19 Nguyen D6 H6ng Nhung, Nguyin Do Huong Giang (2017) Nhu cdu chdm sdc sire khoe ldm than a ngudi vd sinh (Nghien cuu Irudng hgp lgi khoa Hd trg sinh sdn, Benh vien A Thdi Nguyen) Ky yeu Hpi thao Quoc te Tam ly hoc khu vuc Dong Nam A lan thu nhat "'Hanh phuc eon nguoi va su phat trien ben vung" NXB Dai hoc Qu6c gia Ha Noi Tr 70 - 77 20 Nguyen Thi Hang Phuang (2011) Thdi xd hdi vi hiim miidn/vd sinh: Thuc trgng vd cdch irng phd cua ngudi phu nu Ky yeu Hpi ihao Qu6c t£: 20 nam Khoa Xa hoi hpc, Trucmg Dai hoc Khoa hpc Xa hpi va Nhan van NXB Dai hoc Quoc gia Ha Npi Tr 350-358 21 Nguyen Thi Hang Phuong (2011) Thuc trgng Idn thuang Idm ly a phu nif hiem mugn/vd sinh Tap chi Nghien cim Gia dinh va Gioi So Tr 68 - 80 22 Rutstein, Shea O and Iqbal H Shah (2004) Infecundily, infertility, and childlessness in developing countries DHS Comparative Reports No Calverton Maryland, USA: ORG Macro and the World Health Organization 23 Huynh Van Son (2019) Tdn thuang Idm ly ciia Ire em gia dinh khong todn ven Tap chi Tam ly hpc So Tr 29 - 40 24 Tir diin Y hgc Anh - Viel (2007) NXB Tu diSn Bach Khoa Ha Npi 25 Nguyen Due Vy (chu bien, 2006) Bdi gidng sdn phu khoa dung cho sau dgi hgc Bp mon Phu san, Truong Dai hpc Y Ha Npi 26 World Health Organization (2005) Malawi demographic and health survey 2004 Malawi National Statistical Office TAP CHI TAM LV HOC, So' (252), - 2020 97 ... gitDfi (Boivin, Buntin, Collins va Nygren, 2007) Trong nam 2010, co khoang 48,5 trieu cap doi tren toan the gioi hi vo sinh (Mascarenhas, Seth, Ties va cong sir, 2012) Nam 2012, WHO da chi rSng, ganh... vi khdng biet sap tdi se nhu the nao Trudng hap H: Trong thdi gian hiem mupn ba nam, chi H cung da trai nghiem nhieu ciim xuc budn dau ddn nen Trong sudt thdi gian mong chd cd ma chua cd dugc va... sinh Id khdng tlie sinh duac con" (cung giong vdi trudng hgp H,) Khac vdi hai trudng hgp tren, M diiu trj bing bien phap IVF sau cd kit qua tham kham cua benh vien Trong suit qua trinh diiu tri,
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