Značenje otežanog embriotransfera za ishod medicinski pomognute oplodnje

master's thesis

• Title (english): Difficult embryo transfer and assisted reproductive technology outcome
• Author: Dina Gržan
• Mentor: Maja Banović (mentor)
• Committee member: Držislav Kalafatić (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Maja Banović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Metode medicinski pomognute oplodnje (MPO) su skup kliničkih i laboratorijskih postupaka kojima se liječi neplodnost. Embriotransfer (ET) je posljednji korak u metodama izvantjelesne oplodnje kojim se embrij smješta u šupljinu maternice sa svrhom implantacije.
Otežani embriotransfer (OT) podrazumijeva otežani prolazak kateterom za prijenos embrija kroz cervikalni kanal, a događa se u 7 do čak 32% slučaja. Najčešći uzrok OT-a su anatomske karakteristike pacijentice poput cervikalne stenoze, cervikalnih kripta, vijugavosti cervikalnog kanala te iznimne anteverzije maternice. Veliki problem predstavlja neusuglašenost oko kriterija za definiranje OT-a. Ipak, dosadašnja istraživanja pokazuju kako OT-i dovode do smanjenja stope kliničkih trudnoća i živorođene djece nakon MPO za čak 30%. Pretpostavlja se kako traumatski dodir cerviksa ili endometrija dovodi do povećanih kontrakcija maternice koje ometaju implantaciju. Kao posebne komplikacije ET-a izdvajaju se ponovljeni embriotransfer i prisutnost krvi u kateteru koje vjerojatno nisu povezane s negativnim ishodima MPO. Utjecaj boli tijekom ET-a na ishode MPO još je nedovoljno istražen. Dodatni problem predstavlja nedostatak preporuka o intervencijama u slučaju OT-a. Prije samog ET-a moguće je pristupiti probnom ET-u ili cervikalnoj dilataciji. U slučaju OT-a, moguće je odustati od prijenosa te zamrznuti embrije. Primjena antagonista oksitocina još je nedovoljno istražena no mogla bi biti korisna.
S obzirom na to da je OT uzrok gubitka održivih embrija u čak jedne od četiri žena u postupcima MPO, nužno je postići konsenzus oko definicije OT-a kako bi se kroz multicentrične studije istražile intervencije kojima bi se umanjili ovi značajni gubitci.

Abstract (english)

Assisted reproductive technology (ART) is a set of procedures used to treat infertility. Embryo transfer (ET) is a procedure in which the embryo is placed in the uterine cavity for implantation.
Difficult embryo transfer (DT) involves difficult passage of the catheter through the cervical canal and occurs in 7 to 32% of cases. The most common causes of DT are the patient's anatomical characteristics, such as cervical stenosis, tortuosity of the cervical canal, and anteversion of the uterus. Inconsistency regarding the criteria for defining DT poses a major problem. Nevertheless, research shows that DTs reduce the rate of clinical pregnancies and live births after ART by as much as 30%. It is assumed that traumatic contact with the cervix or endometrium leads to increased contractions of the uterus, which interfere with implantation. Repeated embryo transfer and the presence of blood in the catheter are probably not related to the negative outcomes of ART. The impact of pain during ET on ART outcomes is still insufficiently investigated. Before the actual ET, it is possible to access a trial ET or cervical dilatation. In the case of DT, it is possible to abandon the transfer and freeze the embryos. The use of oxytocin antagonists is still insufficiently researched but could be useful.
Given that DTs are the cause of the loss of viable embryos in as many as one in four women in ART procedures, it is necessary to reach a consensus on the definition of DT. This would enable the investigation of interventions through multicenter studies to reduce these significant losses.

• Keywords: embriotransfer; ishod trudnoće; medicinski pomognuta oplodnja; otežani embriotransfer; ponovljeni embriotransfer
• Keywords (english): assisted reproductive technology; difficult embryo transfer; embryo transfer; pregnancy outcome; repeated embryo transfer
• Language: croatian
• URN:NBN: urn:nbn:hr:105:839514
• 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: 2024-06-20 12:27:46