Onkofertilitetni postupci

master's thesis

• Title (english): Oncofertility procedures
• Author: Ana Pongrac
• Mentor: Marina Šprem Goldštajn (mentor)
• Committee member: Miro Kasum (predsjednik povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Committee member: Marina Šprem Goldštajn (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Maligne bolesti su drugi po učestalosti uzrok smrti u razvijenim zemljama. Zahvaljujući napretku medicine, preživljenje pacijenata je poraslo u usporedbi s prijašnjim godinama te se javila potreba za poboljšanjem dugoročne skrbi ovih pacijenata. Iz tog razloga razvija se nova disciplina medicine, onkofertilitetna medicina koja omogućuje očuvanje fertiliteta pacijentima oboljelim od malignih bolesti. Kemoterapija i/ili radioterapija dovode do smanjenja ovarijske rezerve u žena te u muškaraca smanjuju kvalitetu sjemena. Postoji nekoliko načina očuvanja fertiliteta u žena. To su krioprezervacija embrija i oocita, krioprezervacija tkiva jajnika, primjena agonista gonadotropin-oslobađajućeg hormona i transpozicija jajnika. Pri odabiru metode očuvanja fertiliteta veoma je bitan individualni pristup. Koja će se metoda odabrati ovisi o dobi žene, o protokolu terapije i vremenu preostalom do početka terapije maligne bolesti te o postojanju partnera u vrijeme provođenja postupka očuvanja fertiliteta. Krioprezervacija embrija i oocita standarne su metode kojima je zajednički korak provođenje procesa stimulacije jajnika. Razvijeni su različiti protokoli stimulacije s ciljem povećanja sigurnosti njihovog provođenja. Krioprezervacija tkiva jajnika je eksperimentalna metoda koja je jedina opcija za očuvanje fertiliteta u djevojčica prije puberteta. Kontinuirana primjena agonista gonadotropin-oslobađajućeg hormona preporučuje se kod premenopauzalnih žena s tumorom dojke. Za zaštitu fertiliteta kod primjene radioterapije koristi se transpozicija jajnika. Standardna metoda očuvanja fertiliteta kod dječaka nakon puberteta i odraslih muškaraca je krioprezervacija sjemena. Primjena hormonske terapije, odnosno agonista gonadotropin-oslobađajućeg hormona nije efikasna metoda. Prepubertetalnim dječacima može biti preporučena krioprezervacija tkiva tetisa, ali je važno napomenuti da je to još uvijek eksperimentalna metoda.

Abstract (english)

Malignant diseases are the second most common cause of death in developed countries. Thanks to the advancement of medicine, patient survival has increased over the years and subsequently the need to improve the long-term care of these patients has emerged. As a result, a new area of medicine, named oncofertility, has started to develop. It enables the preservation of fertility in patients with malignant diseases. Chemotherapy and/or radiotherapy lead to decreased ovarian reserve in women and reduced quality of semen in men. There are several ways to preserve fertility in women. Currently used are cryopreservation of embryos and oocytes, cryopreservation of ovarian tissue, application of gonadotrophin-releasing hormone agonists and ovarian transposition. When choosing fertility methods, it is very important to have an individual approach. The chosen method depends on the age of the woman, therapy protocol and time remaining until the start of therapy and the existence of a partner at the time of the fertility preservation process. Cryopreservation of embryos and oocytes are standard methods and have a common step of ovarian stimulation. Various stimulation protocols have been developed to increase the safety of their implementation. The cryopreservation of ovarian tissue is an experimental method that is the only option to preserve fertility in girls before puberty. Continuous administration of gonadotrophin-releasing hormone agonists is recommended in premenopausal women with breast cancer. Ovarian transposition is used to protect fertility when using radiotherapy. The standard method of preserving fertility in boys after puberty and in adult men is cryopreservation of semen. The use of hormone therapy or gonadotropin-releasing hormone agonists is not an effective method. Testicular tissue cryopreservation may be recommended to prepubescent boys, but it is important to note that this is still an experimental method.

• Keywords: onkofertilitetni postupci; gonadotoksičnost; kemoterapija; radioterapija; krioprezervacija; transpozicija jajnika; fertilitet
• Keywords (english): oncofertility procedures; gonadotoxicity; chemotherapy; radiotherapy; cryopreservation; ovarian transposition; fertility
• Language: croatian
• URN:NBN: urn:nbn:hr:105:404893
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-10-25 07:41:00