Komplikacije postupaka izvantjelesne oplodnje

master's thesis

• Title (english): Complications of in vitro fertilization procedures
• Author: Iva Matotek
• Mentor: Marina Šprem Goldštajn (mentor)
• Committee member: Lana Škrgatić (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: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Liječenje izvantjelesnom oplodnjom primjenjuje se u gotovo 70% svih uzroka bračne neplodnosti. Komplikacije su moguće prilikom aspiracije jajnih stanica, embriotransfera i stimulacije ovulacije.
Najčešća komplikacija aspiracije jajnih stanica jest manje vaginalno krvarenje, koje prestaje spontano ili uz kratkotrajnu kompresiju. Ostale komplikacije poput opsežnijeg krvarenja iz jajnika, ozljede i krvarenja iz zdjeličnih organa te upale i apscesa puno su rjeđe. Atraumatski i lagan embriotransfer važan je preduvjet uspjeha izvantjelesne oplodnje. Otežan embriotransfer često zahtjeva uporabu tvrdih katetera i dodatnih instrumenata, povećavajući time vjerojatnost ozljede endometrija i indukcije materničnih kontrakcija. Najozbiljnija posljedica stimulacije ovulacije gonadotropinima je OHSS. Koncept segmentacije ciklusa, koji obuhvaća odabir optimalnog protokola uz GnRH agonist za završno sazrijevanje jajne stanice, kriopohranu zametka ili jajne stanice i naknadni transfer u sekundarnom, nestimuliranom ciklusu smanjuje rizik za OHSS i pridonosi boljem kliničkom ishodu. U trudnoći nakon IVF-a veća je incidencija heterotopične i ektopične trudnoće te spontanih pobačaja. Smatra se da su uzroci tome s jedne strane maternalne karakteristike i subfertilitet, a s druge strane jatrogeni rizici IVF postupaka. Djeca iz IVF ciklusa, a posebice iz višeplodne trudnoće, imaju lošiji perinatalni ishod u odnosu na spontano začetu djecu. Provođenje strategije elektivnog transfera jednog zametka (eSET) pridonosi značajnom smanjenju incidencije višeplodnih trudnoća.

Abstract (english)

IVF procedure accounts for almost 70 % of all couple infertility treatments. Complications are possible during oocyte retrieval, embryotransfer and controlled ovarian stimulation.
The most common complication of oocyte retrieval procedure is minor vaginal bleeding, which generally stops spontaneously or can be controlled with local compression. Severe intra-abdominal or vascular complications, as well as infection or injury of pelvic structures are possible, but rare. The performance of an atraumatic ET is essential to IVF success. Difficult transfers are time consuming, require a firmer catheter, cause discomfort, or involve additional instrumentation. They are associated with decreased pregnancy rate through the stimulation of uterine contractions, induced by cervical manipulation or fundal contact. OHSS is a serious iatrogenic complication of controlled ovarian stimulation treatment. The strategy for minimizing the risk for OHSS is closely related to the segmentation concept. It consists of optimization of the ovarian stimulation, including GnRH agonist triggering in a GnRH antagonist cycle, optimum cryopreservation methods for oocyte or embryo vitrification and embryotransfer in a natural cycle. The rate of ectopic and heterotopic pregnancy, as well as spontanious abortion, is higher in pregnancies resulting from IVF than in spontaneous pregnancies, probably due to subfertility and specific factors related to IVF techniques. Pregnancies concieved after IVF face increased risk of many important perinatal outcomes, with a majority of them arising as a result of multiple pregnancies. The practice of eSET has reduced multiple pregnancy rates and improved perinatal outcomes.

• Keywords: IVF; komplikacije; aspiracija jajnih stanica; embriotransfer; OHSS
• Keywords (english): IVF; complications; oocyte retrieval; embryotransfer; OHSS
• Language: croatian
• URN:NBN: urn:nbn:hr:105:748743
• 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: 2019-12-18 14:43:25