Indukcija ovulacije u žena sa smanjenom ovarijskom rezervom

master's thesis

• Title (english): Ovulation induction in women with diminished ovarian reserve
• Author: Dora Jelinek
• 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: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Smanjena ovarijska rezerva se definira kao smanjenje kvalitete oocita, broja oocita ili pad reprodukcijskog potencijala. Koristi se za opis žena reproduktivne dobi čiji je odgovor na stimulaciju ili fekundabilnost manja u odnosu na žene jednake dobi. Povezuje se sa suboptimalnim odgovorom na stimulaciju ovarija, nižim stopama začeća i višim stopama neuspjeha tijekom IVF postupka. Testovi ovarijske rezerve se ne bi trebali koristiti kao samostalan kriterij na temelju kojeg se odbija provođenje metoda potpomognute oplodnje (ART) ili drugih terapijskih mogućnosti. Ako testovi ukazuju na smanjenu ovarijsku rezervu, trudnoća je manje vjerojatna, ali nije nemoguća. Osmišljeni su različiti terapijski protokoli za žene koje imaju DOR i uključuju visoke doze gonadotropina, prirodne i modificirane prirodne cikluse, estrogen ''priming'', dodavanje LH, lutealni antagonisti i letrozol ''co-treatment'', uporabu adjuvanta kao što su androgeni, hormon rasta, melatonin, aspirin te donacija oocita i potpomognuti ''hatching''. Noviji pristupi u žena koje su PR uključuju transplantaciju jajnika, prijenos mitohondrija i neo-oogenezu iz matičnih stanica, no potrebna su daljnja istraživanja da bi se utvrdila uloga ovih pristupa. Međutim, stope začeća su niske i često je potrebna donacija oocita. Sigurno je da je promjena ireverzibilna i da takve žene imaju veći rizik za suboptimalni odgovor na ovarijsku stimulaciju u ART. Jedan je od vodećih uzroka neplodnosti među ženama danas. Međutim, veliki udio žena koje imaju DOR mogu začeti sa svojim oocitama pod uvjetom da im je bila dostupna individualizirana terapija.

Abstract (english)

Diminished ovarian reserve (DOR) is defined as a decrease in the number, quality, and quantity of oocytes. It is used to describe women of reproductive age whose response to stimulation or fecundity is reduced compared to women of comparable age. It is associated with poor ovarian response to ovarian stimulation, higher cycle cancellation rates, and lower pregnancy rates during IVF. The ovarian reserve tests (ORTs) should not be used as a sole criterion to deny Assisted Reproductive Technology (ART) or other treatments to any patients. If ORTs indicate a diminshed ovarian reserve, it means that pregnancy is less likely but not impossible. Various treatment regimens have been designed to manage the patients with DOR and include high dose of gonadotropins, natural and modified natural cycles, estrogen priming, supplementation with LH, luteal antagonist and letrozole co-treatment, use of adjuncts like androgens, growth hormone, melatonin, and aspirin, as well as oocyte donation and assisted hatching. The newer approaches in poor responders include ovarian transplantation, mitochondrial transfer and stem cell based neo-oogenesis, but more research is needed to establish the role of these approaches. Pregnancy rates are, however, poor and often these patients require oocyte donation. The one thing certain about DOR is that it is irreversible and that these women are at risk of poor ovarian response to ovarian stimulation in ART. It is one of the leading causes of infertility in women today. However, many women with DOR may conceive with their own oocytes, if they are given individualized treatment that is tailored for their profile.

• Keywords: smanjena ovarijska rezerva; indukcija ovulacije; poor responders; AMH; IVF
• Keywords (english): diminished ovarian reserve; ovulation induction; poor responders; AMH; IVF
• Language: croatian
• URN:NBN: urn:nbn:hr:105:377673
• 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: 2018-12-19 11:07:57