Uzroci ponavljanog neuspjeha implantacije zametka poslije izvantjelesne oplodnje

master's thesis

• Title (english): Causes of repeated implantation failure after in vitro fertilization
• Author: Petra Vuković
• Mentor: Branko Radaković (mentor)
• Committee member: Miro Kasum (predsjednik povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Committee member: Branko Radaković (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Ponavljanim implantacijskim neuspjehom se smatra neuspjeh implantacije u barem tri pokušaja in vitro fertilizacije u kojem su u svakom ciklusu preneseni u maternicu jedan ili dva visokokvalitetna embrija. Procjenjuje se da će oko 10 % žena koje idu u postupak IVF doživjeti ponavljani neuspjeh implantacije. Neuspjela implantacija može biti zbog embrionalnih čimbenika, ali i majčinskih i/ili očinskih čimbenika.
Uzrok neuspjelih implantacija, prema današnjim procjenama, je u 1/3 slučajeva u samom zametku, a u 2/3 slučajeva u slabijoj receptivnosti endometrija.
Potrebno je provesti temeljitu kliničku dijagnostičku obradu kako bi se utvrdio uzrok koji dovodi do ponavljanog neuspjeha implantacije. Potrebno je procijeniti funkciju jajnika mjerenjem ovarijske rezerve, razine FSH i anti- Müllerskog hormona,ali i napraviti spermiogram partnera. Ultrazvukom i histeroskopijom treba isključiti razna patološka stanja maternice uključujući miome, polipe endometrija, prirođene anomalije maternice, intrauterine priraslice, ali i postojanje endometrioze, adenomioze i hidrosalpinksa. Histeroskopija i/ili biopsija endometrija u ciklusu koji prethodi stimulaciji jajnika bi mogla postati standard za pacijentice s ponavljanim neuspjehom implantacije. U prisutnosti normalne anatomije maternice promjene u endokrinom profilu te medicinska stanja majke poput trombofilije i imunoloških poremećaja mogu rezultirati nereceptivnim endometrijem. Stoga pacijentice s ponavljanim implantacijskim neuspjehom treba testirati na nasljedne i stečene trombofilije i imunološke poremećaje. Liječenje ponavljanog neuspjeha implantacije treba biti zasnovano na dokazima, s ciljem poboljšanja kvalitete zametaka, ali i receptivnosti endometrija.

Abstract (english)

Repeated implantation failure is considered to be a failure of implantation in at least three attempts of invitro fertilization in which in every cycle one or two high-quality embryos were transferred. It is estimated that approximately 10% of women going through IVF treatment will experience repeated implantation failure. Failed implantation may be due to embryonic factors, and maternal and/or paternal factors. The cause of failed implantation, according to present estimates, in 1/3 of cases is in the embrio, and in 2/3 of cases is decreased endometrial receptivity.
Thorough clinical diagnostic evaluation should be conducted to determine the cause that leads to the repeated failure of implantation. Ovarian function should be evaluated by measurement of ovarian reserve, FSH levels and anti-Müllerian hormone, but spermiogram of the partner as well. Various uterine pathology including fibroids, endometrial polyps, congenital anomalies, intrauterine adhesions, hydrosalpinx, endometriosis and adenomyosis should be excluded by ultrasonography and hysteroscopy.
Hysteroscopy and/or endometrial biopsy in the cycle preceding ovarian stimulation could become a standard for patients with recurrent implantation failure. In the presence of normal uterine anatomy, changes in endocrine profile and the medical conditions of the mother such as thrombophilia and abnormal immunological response could result in non receptive endometrium.
Patients with recurrent implantation failures should be tested for inherited and acquired thrombophilias and immune disorders. Treatment of repeated implantation failure should be based on evidence, with the aim of improving the quality of embryos and endometrial receptivity.

• Keywords: neuspjeh; implantacija; IVF; endometrij; trombofilija; embrij
• Keywords (english): failure; implantation; IVF; endometrium; thrombophilia; embryo
• Language: croatian
• URN:NBN: urn:nbn:hr:105:486861
• 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: 2015-10-26 12:44:49