Očuvanje plodnosti u žena

master's thesis

• Title (english): Fertility preservation in women
• Author: Lucija Pukec
• Mentor: Hrvoje Vrčić (mentor)
• Committee member: Marina Šprem Goldštajn (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Hrvoje Vrčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Očuvanje plodnosti u žena odnosi se na metode i postupke kojima je cilj očuvati potencijal biološkog majčinstva u djevojčica i žena kojima bolest ili gonadotoksična terapija prijete prijevremenom insuficijencijom jajnika. Metode očuvanja plodnosti u žena koje se danas smatraju standardnima jesu transpozicija jajnika izvan polja zračenja prije početka radioterapije, zaštita jajnika olovnim štitnicima tijekom radioterapije, krioprezervacija oocita i krioprezervacija embrija. Kontrolirana stimulacija jajnika prema različitim, individualno prilagođenim protokolima preduvjet je krioprezervacije oocita i embrija, dvaju najčešće korištenih metoda očuvanja plodnosti. Tehnika vitrifikacije pokazuje se uspješnijom i sve više zamjenjuje sporo zamrzavanje oocita i embrija. Primjena agonista hormona koji oslobađa gonadotropine (GnRHa) nema jednoznačne rezultate u očuvanju plodnosti, no kada druge metode nisu izvedive, i kod mladih žena s rakom dojke, preporučuje se primjena GnRHa s ciljem smanjenja rizika kemoterapijom inducirane ovarijske insufucijencije. U prepubertalnih djevojčica jedina izvediva metoda je krioprezervacija tkiva jajnika (OTC) – u većini zemalja i dalje smatrana eksperimentalnom. Temeljem dosadašnjih rezultata mnogi stručnjaci smatraju da je vrijeme da se OTC proglasi valjanom i uspješnom metodom. In vitro maturacija (IVM) nezrelih oocita novija je istraživana mogućnost, no potrebno je još istraživanja i unaprjeđenja te metode da bi se primjenjivala u očuvanju plodnosti djece i žena. Indikacije za očuvanje plodnosti dijele se na medicinske (maligne bolesti i nemaligne bolesti/stanja koja zahtijevaju gonadotoksičnu terapiju) te nemedicinske, tj. socijalne (vitrifikacija oocita zbog očekivanog smanjenja plodnosti s dobi). Pacijentice kojima prijeti POI važno je pravovremeno informirati o dugoročnim posljedicama bolesti i liječenja na plodnost te, one zainteresirane za očuvanje plodnosti, uputiti specijalistima reproduktivne medicine.

Abstract (english)

Fertility preservation in women consists of methods and procedures aiming to save the potential of biological motherhood in girls and women in which disease itself or its treatment causes premature ovarian insufficiency (POI). For women, standard methods in fertility preservation include ovarian transposition away from the radiation field before its start, pelvic shielding during radiation therapy, cryopreservation and banking of oocytes or embryos. Controlled ovarian stimulation using different, individualized protocols precedes cryopreservation of oocytes and embryos - two most commonly used methods of fertility preservation. Compared to slow freezing, vitrification seems to be superior freezing technique for both embryos and oocytes. There is conflicting evidence to recommend agonists of gonadotropin-releasing hormone (GnRHa) for fertility preservation, but when proven methods are not feasible, and in the setting of young women with breast cancer, GnRHa may be offered to reduce the likelihood of chemotherapy induced ovarian insufficiency. For prepubertal girls, ovarian tissue cryopreservation (OTC), in most countries an experimental method, is the only option for fertility preservation. However, many experts believe that there is now enough evidence to support the use of OTC as a valid and effective method. In vitro maturation (IVM) of immature oocytes is a recently investigated method, but more research and improvements of the technique are needed so that it could be used in the setting of fertility preservation for girls and some women. Indications for fertility preservation are divided into medical (malignant and non-malignant disease/conditions treated with gonadotoxic agents) and nonmedical, i.e social (oocyte vitrification for anticipated age-related fertility decline). It is very important to timely inform patients with a risk of POI about the long-term effects of the disease and its treatment on fertility and to refer those interested in fertility preservation to reproductive specialists.

• Keywords: plodnost; prijevremena insuficijencija jajnika; krioprezervacija oocita; krioprezervacija embrija; krioprezervacija tkiva jajnika
• Keywords (english): fertility; premature ovarian insufficiency; oocyte cryopreservation; embryo cryopreservation; ovarian tissue cryopreservation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:475592
• 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: 2020-02-04 07:45:05