Ovarijska rezerva prije i nakon operacije endometrioma

master's thesis

• Title (english): Ovarian reserve before and after endometrioma surgery
• Author: Matea Crnković
• Mentor: Tomislav Čanić (mentor)
• Committee member: Slavko Orešković (predsjednik povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Committee member: Tomislav Čanić (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

Ovarijska rezerva je konačan broj jajnih stanica prisutnih u ovariju koje su dostupne za folikulogenezu. Procjena ovarijske rezerve bitna je u evaluaciji i liječenju neplodnosti, te u predviđanju ishoda metoda medicinske oplodnje. Kako nijedan test danas dostupan ne mjeri direktno ukupan broj oocita, procjena se vrši posredno mjerenjem ovarijskih hormona i poznavanjem fiziološke osnove reprodukcije. Testove za mjerenje ovarijske rezerve možemo podijeliti na pasivne i dinamičke. Pasivni uključuju mjerenje serumskih koncentracija FSH, estradiola, AMH, inhibina-B, mjerenje broja antralnih folikula, te određivanje volumena i vaskularizacije ovarija. U dinamičke testove ubrajamo provokacijski test klomifen citratom, egzogeni FSH test te provokacijski test gonadotropinima. Kako niti jedna od ovih metoda nije idealna, najbolji uvid u ovarijsku rezervu dobivamo kombinacijom nekoliko njih. Endometriom je benigna, o estrogenu ovisna ovarijska cista, koja je usko povezana s neplodnošću i sa smanjenom ovarijskom rezervom. Pretpostavljenih mehanizama te povezanosti ima nekoliko među kojima su najznačajniji oštećenje jajnika samom prisutnošću endometrioma i smanjenje ovarijske rezerve tijekom operacije uslijed uklanjanja zdravog tkiva ovarija koje se nalazi u okolini ciste. Mnogo je dijagnostičkih metoda pomoću kojih možemo utvrditi prisutnost endometrioma s velikom vjerojatno, ali jedina sigurna dijagnoza je patohistološki nalaz. Nema konsenzusa po pitanju načina liječenja endometrioma, iako se danas u pravilu najčešće pristupa laparoskopskoj operaciji. Mnoge studije su pokazale kako je ovarijska rezerva neupitno smanjena nakon operacije endometrioma iako prema dosadašnjim saznanjima to ne utječe drastično na stopu zanošenja pošto funkcija kontralateralnog jajnika ostaje normalna.

Abstract (english)

Ovarian reserve is defined as the number of oocytes in the ovary that are available for folliculogenesis. Determining ovarian reserve is important in evaluating and treating infertility, as well as in predicting the outcomes of assisting reproduction methods. There is no test available today that could directly measure number of oocytes. Therefore, in order to estimate the ovarian reserve different tests are being used, including measuring levels of hormones and knowing the physiological grounds for reproduction. Test used in determining the ovarian reserve can be divided in two groups, passive and dynamic. Passive tests include measuring serume levels of FSH, oestradiol, AMH, inhibin-B as well as measuring AFC, ovarian volume and ovarian vascularisation. Dynamic tests are clomiphene citrate challenge test, egsogeneous FSH test and gonadotrophins challenge test. As neither one of this methods is considered to be ideal, the best way to determine ovarian reserve is to combine them. Endometrioma is a benigb, oestrogen dependant cyst, which is strongly related to infertility and to diminished ovarian reserve. There are several suggested mechanisms to explain that correlation, the most significant being damage of the ovary caused by the presence of the endometrioma itself and removal of healthy ovarian tissue during surgery. Many diagnostic methods are being used to determine the presence of endomerioma, but the only confirmation is the pathohistological one. No consensus has been reached regarding endometrioma treatment. However, laparoscopic surgery is the most common way to treat endometiroma. Many studies have shown that the ovarian reserve is undoubtedly diminished following endometrioma surgery. However, studies have also shown that pregnancy rates in such patients do not seem to be significantly lower which is mostly atributed to the normal fucntion of the contralateral ovary.

• Keywords: ovarijska rezerva; endometriom; AMH; neplodnost
• Keywords (english): ovarian reserve; endometrioma; AMH; infertility
• Language: croatian
• URN:NBN: urn:nbn:hr:105:452099
• 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: 2015-09-28 09:18:35