Anti-Müllerov hormon i broj antralnih folikula kao biljezi ovarijske rezerve i uspješnosti metoda pomognute oplodnje

master's thesis

• Title (english): Anti-Müllerian hormone and antral follicle count as markers of ovarian reserve and the success of assisted reproduction methods
• Author: Barbara Valinčić
• Mentor: Tatjana Pavelić Turudić (mentor)
• Committee member: Ivanka Bekavac Vlatković (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (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: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Sve češći uzrok neplodnosti žena u današnjem modernom svijetu čine promjena stila života i odgoda rađanja. Žene se rađaju s konačnim brojem primordijalnih folikula dostupnih za folikulogenezu te se oni smanjuju sa životnom dobi, a tako se smanjuje i ženin reproduktivni potencijal. Taj broj konačnih folikula predstavlja ženinu ovarijsku rezervu. Smanjenje ovarijske rezerve klinički se ne očituje simptomima te se nažalost uočava prekasno, stoga je određivanje ovarijske rezerve dio rutinske pretrage u žena kod obrade neplodnosti. Značajan rizik smanjenja ovarijske rezerve imaju žene starije od 35 godina, žene koje su primale kemoterapiju i/ili radioterapiju te one žene koje su imale ginekološke operacije.

Izravan način mjerenja ovarijske rezerve još uvijek ne postoji pa se zbog toga koristimo biljezima ovarijske rezerve za neizravnu procjenu. U biljege ovarijske rezerve ubrajamo hormonske markere, ultrazvučne markere i dinamičke testove koji nam daju uvid u ženino stanje. Hormonski biljezi podrazumijevaju anti-Müllerov hormon (AMH), folikulostimulirajući hormon (FSH), estradiol (E2) i inhibin B. Ultrazvučni markeri uključuju mjerenje broja antralnih folikula (AFC) te mjerenje volumena jajnika. Najčešće upotrebljavan dinamički test je klomifen-citrat dinamički test (CCCT).

AMH i AFC danas se smatraju najboljim biljezima ovarijske rezerve, a njihovim mjerenjem dobivamo najbolji uvid u stvarno stanje preostalih folikula. Ove testove je lako provesti, štoviše, AMH I AFC proporcionalno se smanjuju s godinama, a njihova mala varijabilnost unutar ciklusa čini ih boljim od drugih markera.

Unatoč tome što su trenutno najbolji markeri ovarijske rezerve, AMH i AFC još uvijek ne mogu predvidjeti ishode IVF-a, kao ni trudnoću.

Abstract (english)

Modern world lifestyle changes and delaying childbirth are an increasing cause of infertility among women. Women are born with a finite number of primordial follicles available for folliculogensis and they are decreasing with age, and thus reducing a woman's reproductive potential. This number of finite follicles represents woman's ovarian reserve. Decreased ovarian reserve is not clinically manifested by symptoms and is unfortunately noticed too late. Because of that, testing a woman's ovarian reserve is a routine examination in women during infertility treatment. Women over the age of 35, women who have received chemotherapy and/or radiotherapy and women who had gynecological surgeries have a significant risk of diminished ovarian reserve.

A direct method of determining ovarian reserve still does not exist so we use ovarian reserve markers for indirect assessment. Ovarian reserve markers include hormonal markers, ultrasound markers and dynamic tests that gives us insight in woman's condition. Hormonal markers are anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2) and inhibin B. The antral follicle count (AFC) and measurement of ovarian volume are considered to be ultrasound markers. The most commonly used dynamic test is the clomiphene-citrate dynamic test (CCCT).

Today, AMH and AFC are considered the best ovarian reserve markers and by measuring them we acquire the best insight of remaining follicles. These test are easy to perform as AMH and AFC decrease proportionally with age and their small intracycle variability makes them better than other markers.

Despite currently being the best ovarian reserve markers, AHM and AFC still cannot predict IVF outcomes nor pregnancy.

• Keywords: ovarijska rezerva; biljezi; AMH; AFC; ishodi MPO
• Keywords (english): ovarian reserve; marker; AMH; AFC; IVF outcome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:825769
• 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: 2023-11-02 11:33:35