Uspješnost kliničkih trudnoća u KB Sveti Duh od 2015. do 2020 vraćanjem prethodno zamrznutih zametaka u prirodnim i umjetnim ciklusima

master's thesis

• Title (english): Success after returning previously frozen embryos in natural and artificial cycles at the University Hospital "Sveti Duh" in the period 2015-2020
• Author: Ivan Perković
• Mentor: Tatjana Pavelić Turudić (mentor)
• Committee member: Ivanka Bekavac Vlatković (predsjednik povjerenstva)
• Committee member: Željko Duić (član povjerenstva)
• Committee member: Tatjana Pavelić Turudić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

UVOD: Postoje dva osnovna protokola pripreme endometrija prilikom vraćanja prethodno zamrznutih zametaka. Priprema endometrija u prirodnom ciklusu odvija se bez ili uz minimalnu hormonsku terapiju, dok se u umjetnim ciklusima endometrij priprema isključivo uz nadomjesnu hormonsku farmakoterapiju. ----- CILJEVI: Cilj ovog rada je usporediti stope kliničkih trudnoća kod prijenosa prethodno zamrznutih zametaka u prirodnim i umjetnim ciklusima. Također, cilj je i prikazati stope kliničkih trudnoća ovisno o dobi pacijentica, stadiju i broju prenesenih zametaka te primarnom i sekundarnom sterilitetu pacijentica. ----- MATERIJALI I METODE: Ovo istraživanje obuhvaća prijenose prethodno zamrznutih zametaka u Kliničkoj bolnici "Sveti Duh" u petogodišnjem razdoblju. Obuhvaćeno je ukupno 369 prijenosa i 323 pacijentice koji zadovoljavaju kriterije uključenja. Ishod je određen kao stopa kliničkih trudnoća. Stope su uspoređene ovisno o protokolu pripreme endometrija, dobi pacijentica, stadiju i broju prenesenih zametaka te sterilitetu pacijentica. ----- REZULTATI: Utvrđena je klinička stopa trudnoća od 32,1 % (79/246) u prirodnim i 31,0 % (38/123) u umjetnim ciklusima pripreme, p=0,812. Zapažena je povećana kumulativna stopa kliničkih trudnoća kod prijenosa zametaka u stadiju blastociste, 36,7 % (104/283) naspram ranijih razvojnih stadija (brazdanje i kompaktacija) 15,1 % (13/86), p<0,001. Povećana je i kumulativna stopa pri prijenosu dva zametka 38,8 % (45/116) naspram jednog zametka 28,5 % (72/253), p=0,048. ----- ZAKLJUČAK: Oba protokola pripreme pokazala su usporedivo jednake stope kliničkih trudnoća. S obzirom na moguće nuspojave hormonske terapije kod umjetnih ciklusa, kod pacijentica sa regularnim menstrualnim ciklusom prednost treba dati prirodnom protokolu. Stopa kliničkih trudnoća biti će veća pri prijenosu zametaka u stadiju blastociste naspram ranijih razvojnih stadija. Također, stopa će biti veća i pri prijenosu dva zametka, ali postoji povećana mogućnost višeplodne trudnoće.

Abstract (english)

BACKGROUND: There are two main endometrial preparation techniques in frozen embryo transfers. The natural cycle protocol implies using none or minimal hormone agents, whereas artificial cycles are dependent on using adjuvant hormone therapy. ----- OBJECTIVES: The purpose of this study is to compare clinical pregnancy rates following frozen embryo transfers (FET) in natural and artificial cycles. Also, the goal is to analyse clinical pregnancy rates depending on the age of the participants, stages and number of transferred embryos and types of patient infertility. ----- MATERIALS AND METHODS: This paper includes frozen embryo transfers at University hospital “Sveti Duh” in the five year period. Three hundred sixty-nine transfers and three hundred twenty-three patients who met inclusion criteria were included. The main outcome is presented as a clinical pregnancy rate. The rates are compared depending on the endometrial preparation protocol, the age of the patients, stages and number of transferred embryos and type of patient infertility. ----- RESULTS: The study showed clinical pregnancy rates of 32.1% (79/246) in natural and 31.0% (38/123) in artificial cycles, p=0.812. Increased cumulative clinical pregnancy rate was observed in transfers of blastocyst stage embryos, 36.7% (104/283) compared to cleavage stage embryos 15.1% (13/86), p<0.001. In addition, increased cumulative clinical pregnancy rate was observed in transfers of two embryos, 38.8% (45/116) compared to single embryo transfer 28.5% (72/253), p=0.048. ----- CONCLUSION: There was no significant difference found between natural and artificial cycles in frozen embryo transfers. Due to the possible side effects of artificial cycle protocols, in patients with regular menstrual cycles the advantage is to be given to the natural cycle endometrium preparation. Clinical pregnancy rate is to be higher when transferring blastocyst stage embryos compared to cleavage stage. Also, clinical pregnancy rate will be higher when transferring two embryos, but there is an increased risk of multiple pregnancy.

• Keywords: pomognuta oplodnja; protokol pripreme; umjetni ciklus; prirodni ciklus; zamrznuti zametci
• Keywords (english): in vitro fertilization; frozen embryo transfer; artificial cycle; natural cycle; clinical pregnancy rate
• Language: croatian
• URN:NBN: urn:nbn:hr:105:601328
• 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: 2022-03-25 12:41:41