Title Homoinseminacija i in vitro fertilizacija u liječenju muške neplodnosti
Title (english) Intrauterine insemination and in vitro fertilization for treatment of male subfertility
Author Dora Malić
Mentor Miro Kasum (mentor)
Committee member Hrvoje Vrčić (predsjednik povjerenstva)
Committee member Dinka Pavičić Baldani (član povjerenstva)
Committee member Miro Kasum (član povjerenstva)
Granter University of Zagreb School of Medicine (Department of Gynecology and Obstetrics) Zagreb
Defense date and country 2018-07-13, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Gynecology and Obstetrics
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Urology
Abstract Neplodnost je nemogućnost zanošenja muškarca i žene koji imaju redovite spolne odnose u trajanju od godine dana te može nastati zbog muških ili ženskih faktora. Uzroci muške neplodnosti mogu se podijeliti na pretestikularne, testikularne, postetsikularne i neplodnost nepoznatog uzroka, pri čemu su najčešći testikularni uzroci neplodnosti. Najvažniji postupci u procesu evaluacije uzroka muške neplodnosti su anamneza, fizikalni pregled i analiza ejakulata. Osim toga, važni su endokrina evaluacija, post ejakulatorna analiza urina, ultrazvuk, genetska analiza i drugi specijalizirani testovi. Različiti lijekovi i kirurški zahvati mogu se koristiti za liječenje određenih uzroka muške neplodnosti. Muška neplodnost najčešće se liječi metodama potpomognute oplodnje. Intrauterina inseminacija najčešće je indicirana kao prva metoda liječenja muške neplodnosti kada postoji barem 2-5 milijuna pokretnih spermija u ejakulatu. Intrauterina inseminacija u pravilu je jednako uspješna ili nešto malo manje uspješna od in vitro fertilizacije u liječenju muške neplodnosti te je praćena značajno manjim troškovima i manjim rizicima. Vremensko usklađivanje inseminacije s ovulacijom može se postići praćenjem vrijednosti LH u krvi i urinu u prirodnim ciklusima te izazivanjem ovulacije primjenom gonadotropina u stimuliranim ciklusima. Nema jasno dokazane razlike u uspješnosti između ove dvije metode. Najvažniji čimbenici koji utječu na uspješnost intrauterine inseminacije su ukupan broj pokretnih spermija u ejakulatu, udio morfološki urednih spermija te dob majke. In vitro fertilizacija se preporuča za liječenje blažih oblika muške neplodnosti i za liječenje neplodnosti nepoznatog uzroka nakon neuspjeha intrauterine inseminacije. Uspješnost in vitro
fertilizacije ovisi o velikom broju ženskih parametara kao što su ženina životna dob, prethodne trudnoće i broj ovulacijom oslobođenih jajnih stanica. Od muških faktora na uspješnost postupka utječu pokretljivost i morfologija spermija. In vitro fertilizacija povezana je s određenim rizicima kao što su pojava ovarijskog hiperstimulacijskog sindroma, povećani broj spontanih pobačaja, višeplodnih trudnoća i prijevremenih poroda te povećani rizik za nastanak kongentinalnih malformacija.
Abstract (english) Infertility is defined as the failure to achieve clinical pregnancy after 12 months of unprotected sexual intercourse and it can be caused by male and female factors. Causes of male infertility are divided in pretesticular, testicular, posttesticular and infertility of an unknown cause. The most important procedures in diagnosing male infertility are medical history, physical examination, and semen analysis. Endocrine evaluation, post-ejaculatory urinalysis, ultrasonography, genetic analysis and other specific tests can be used as well. Some causes of male infertility can be treated with medications and surgical procedures. Assisted reproductive techniques are most commonly used for treatment of male infertility. Intrauterine insemination is used as the first line treatment for male infertility when there are at least 2-5 million mobile spermatozoa in the semen. Intrauterine insemination is almost as effective or as effective as in vitro fertilization in the treatment of male infertility and it is associated with less risk and reduced cost. The optimal time of insemination can be determined by measuring serum and urine LH levels in natural cycles and by stimulating ovulation with gonadotropins in stimulated cycles. These two methods result in similar effectiveness. The total number of motile spermatozoa in semen, the percentage of morphologically normal spermatozoa and the woman’s age are the most important factors which affect the outcome of intrauterine insemination. In vitro fertilization is used for treatment of mild male factor infertility after failure of
intrauterine insemination. The outcome of in vitro fertilization is determined by the number of female-related factors such as the woman’s age, previous pregnancies, and number of oocytes collected during the procedure. Male factors which are important for the outcome are motility and morphology of the spermatozoa. In vitro fertilization is associated with risks such as ovarian hyperstimulation syndrome, increased numbers of miscarriages, multiple pregnancies, preterm labor, and increased risk of congenital malformations.
Keywords
muška neplodnost
uzroci neplodnosti
intrauterine inseminacija
in vitro fertilizacija
Keywords (english)
male infertility
intrauterine insemination
causes of infertility
in vitro fertilization
Language croatian
URN:NBN urn:nbn:hr:105:131787
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
Terms of use
Created on 2019-03-15 09:32:07