Biljezi ovarijske rezerve

master's thesis

• Title (english): Markers of ovarian reserve
• Author: Lana Mahovlić
• 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

Konačan broj jajnih stanica dostupnih za folikulogenezu tijekom reproduktivnog života čini ovarijsku rezervu koja nam govori o reproduktivnom potencijalu žene, a ta se rezerva s godinama smanjuje. Klinički, smanjenje broja folikula može se uočiti tek u kasnoj fazi kada menstruacije postanu neredovite. Biljezi ovarijske rezerve omogućavaju nam praćenje broja folikula prije pojave kliničkih znakova reproduktivnog starenja. Biljezi ovarijske rezerve su različiti hormonski i ultrazvučni markeri te dinamički testovi kojima se indirektno procjenjuje ovarijska rezerva i predviđa reproduktivni potencijal žene, ali ne i neuspjeh začeća. Ovarijska rezerva procjenjuje se pasivno hormonskim i ultrazvučnim biljezima te aktivno dinamičkim testovima. Hormonski biljezi uključuju mjerenje serumskih koncentracija anti-Müllerovog hormona (AMH), folikulostimulirajućeg hormona (FSH), estradiola i inhibina B. Ultrazvučni markeri uključuju određivanje broja antralnih folikula (AFC), volumen ovarija i njegovu vaskularizaciju. Dinamički testovi su: provokacijski test klomifen citratom (CCCT), egzogeni FSH test (EFORT), provokacijski test gonadotropinima (GAST) te prijašnji odgovor na gonadotropine tijekom IVF postupka. Kao klinički marker gleda se duljina trajanja menstruacijskog ciklusa. Test ovarijske rezerve je i biopsija, ali ona se u kliničkoj praksi ne primjenjuje. Genski biljezi su, zasada, pitanje budućnosti. Iako nijedan test nije idealan i dostatan za samostalnu primjenu, AFC i AMH pokazuju veću specifičnost i osjetljivost te imaju prednost nad ostalim biljezima.

Abstract (english)

The finite number of oocytes available for folliculogenesis during reproductive life is an ovarian reserve that tells us about the reproductive potential of women, and this reserve decreases with age. Clinical reduction of the number of follicles can only be observed in the late phase when menstruations becomes irregular. Ovarian reserve markers allow us to track the number of follicles before the appearance of clinical signs of reproductive aging. Markers of ovarian reserves are various hormonal and ultrasound markers and dynamic tests that indirectly estimate the ovarian reserve and predict the reproductive potential of a woman but not the failure to conceive. The ovarian reserve is evaluated passively by hormone and ultrasound markers and actively by dynamic tests. Hormone markers include measurement of serum levels of anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), oestradiol (E2) and inhibin-B. Ultrasound markers are antral follicle count (AFC), ovarian vascularity and ovarian volume. Dynamic tests are the clomiphene citrate challenge test (CCCT), exogenous FSH ovarian reserve test (EFORT), GnRH-agonist stimulation test (GAST) and the patient’s prior response to gonadotropins. The length of the menstrual cycle is a clinical marker. Ovarian reserve test is also a biopsy, but it is not applied in clinical practice. Genetic markers are still matter of the future. Although no test is ideal and sufficient for stand-alone application, AFC and AMH show greater specificity and sensitivity and have the advantage over other markers.

• Keywords: ovarijska rezerva; biljezi; AMH; AFC
• Keywords (english): ovarian reserve; markers; AMH; AFC
• Language: croatian
• URN:NBN: urn:nbn:hr:105:869350
• 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: 2018-04-03 09:05:54