Metode pripreme endometrija za transfer krioprezerviranih embrija

master's thesis

• Title (english): Methods of endometrial preparation for transfer of cryopreserved embryos
• Author: Petra Nikšić
• Mentor: Ivan Bolanča (mentor)
• Committee member: Marina Šprem-Goldštajn (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Ivan Bolanča (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2024-12-07, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Krioembriotransfer (FET) je danas sve češća metoda medicinski pomognute oplodnje kojom se prethodno kriopohranjen zametak prenosi u maternicu s ciljem liječenja neplodnosti. Za svaki prijenos zamrznutog zametka i postizanje njegove implantacije potrebno je pripremiti endometrij. Uspješnost same metode najviše ovisi o receptivnosti endometrija te o usklađenosti receptivnosti endometrija s fazom razvoja u kojoj je zametak krioprezerviran. Danas postoji nekoliko metoda pripreme endometrija: prirodni ciklus, modificirani prirodni ciklus s hCG primjenom, HRT (umjetni) ciklus te stimulirani ciklus. Prirodni i modificirani prirodni ciklus se provode kod žena s redovitim menstrualnim ciklusom te se transfer zametka odvija u skladu s njim. HRT ciklus koristi egzogenu suplementaciju hormona estrogena i progesterona čime simulira fiziološki ciklus. Za razliku od prirodnog i stimuliranog ciklusa, nedostatak ove metode je izostanak formiranja žutog tijela potrebnog za prilagodbu na kardiovaskularne promjene tijekom rane trudnoće. Zbog navedenog je uočena povećana učestalost hipertenzivnih poremećaja i komplikacija u trudnoći poput preeklampsije i makrosomije. Stimulirani ciklus je metoda izbora kod anovulatornih žena te se za indukciju ovulacije najčešće koriste klomifen citrat, letrozol ili niske doze FSH. Prema dosadašnjim studijama nije dokazana veća učinkovitost određene metode u odnosu na druge po pitanju uspješnosti implantacije zametka i ishoda trudnoće. Ipak, individualizirani pristup u pripremi endometrija omogućava prilagodbu terapije specifičnim potrebama svake pacijentice, uzimajući u obzir njezine jedinstvene karakteristike i čimbenike rizika. Time se povećavaju šanse za uspješan ishod trudnoće, no važno je provesti dodatna istraživanja kako bi se identificirali najbolji protokoli i strategije u ovom procesu.

Abstract (english)

Frozen embryo transfer (FET) is an increasingly common method of medically assisted reproduction in which a previously cryopreserved embryo is transferred to the uterus to treat infertility. Preparing the endometrium is necessary for each frozen embryo transfer and achieving its implantation. The success of this method largely depends on the receptivity of the endometrium and the synchronization of the endometrial receptivity with the developmental stage at which the embryo was cryopreserved. Today, there are several methods for preparing the endometrium: the natural cycle, the modified natural cycle with hCG administration, the HRT (artificial) cycle and the stimulated cycle. The natural and modified natural cycles are carried out in women with regular menstrual cycles, with the embryo transfer taking place in alignment with their cycles. The HRT cycle uses exogenous hormone supplementation of estrogen and progesterone to simulate a physiological cycle. Unlike the natural and stimulated cycles, a disadvantage of this method is the absence of corpus luteum formation, which is necessary for adaptation to cardiovascular changes during early pregnancy. As a result, an increased incidence of hypertensive disorders and pregnancy complications such as preeclampsia and macrosomia has been observed. The stimulated cycle is the method of choice for anovulatory women, and ovulation is most often induced using clomiphene citrate, letrozole, or low doses of FSH. According to current studies, no particular method has proven to be more effective than others regarding embryo implantation success and pregnancy outcomes. However, an individualized approach to endometrial preparation allows for therapy to be personalized to the specific needs of each patient, considering their unique characteristics and risk factors. This increases the chances of a successful pregnancy outcome, still additional research is essential to identify the best protocols and strategies in this process.

• Keywords: FET; priprema endometrija; prirodni i HRT ciklus; hipertenzivni poremećaji
• Keywords (english): FET; endometrial preparation; natural and HRT cycle; hypertensive disorders
• Language: croatian
• URN:NBN: urn:nbn:hr:105:326986
• 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: 2024-07-02 11:45:29