| Abstract | Cilj: Analizirati uzroke neplodnosti i uspješnost postupaka medicinski potpomognute oplodnje u Centru za medicinski potpomognutu oplodnju u Klinici za ženske bolesti i porode u KBC-u Split, u razdoblju od 1. siječnja 2016. do 31. prosinca 2016. godine.
Pacijenti i metode: U studiju su uključeni svi parovi koji su se liječili metodama medicinski potpomognute oplodnje u razdoblju od 1. siječnja 2016. do 31. prosinca 2016. godine. Na temelju podataka dobivenih iz povijesti bolesti Klinike za ženske bolesti i porode KBC Split, analizirana je: prosječna dob žene i partnera, prosječno trajanje neplodnosti, uzrok neplodnosti, nalaz spermiograma muškarca, učestalost pojedinog uzroka ženske neplodnosti. Zatim, gledale su se vrste postupaka MPO-a, vrste protokola stimulacije ovulacije, broj jajnih stanica, zametaka i embriotransfera te negativnih aspiracija. Gledao se ukupan broj trudnoća, broj trudnoća iz pojedine metode MPO i ovisno o protokolu SO, te broj trudnoća ovisno o dobi žene. Urađene su korelacije: dob žene i broj jajnih stanica, dob žene i broj zametaka, dob žene i trudnoća, vrsta protokola SO i broj jajnih stanica, vrsta protokola SO i broj zametaka te vrsta protokola i trudnoće.
Rezultati: Ukupno je liječeno 336 parova. Prosječna dob žene je bila 34,8, a partnera 37,7 godina. Prosječno trajanje neplodnosti je bilo 4,8 godina. Uzrok neplodnosti je u 24,8% bio ženski faktor, u 30,7% muški, a u 18,1% obostrani. O idiopatskoj neplodnosti bilo je riječ u 26,4% slučajeva. Od 264 muškarca sa patološkim spermiogramoma, njih 11,4% imalo je oligozoospermiju, 40,5% astenozoospermiju, 1,9% teratozoospermiju, 26,5% oligoastenozoospermiju, 0,8% astenozoospermiju, 13,6% OAT te 0,4% azoospermiju. Anovulacija bila uzrok neplodnosti u 32,78% slučajeva. Tubarna neplodnost bila je prisutna u 30,7% slučajeva, endometrioza kao uzrok neplodnosti u 19,1% slučajeva, a miom u 3,9%. U 21,7% slučajeva uzroci neplodnosti, koji su svrstani svi u jednu skupinu, bili su trombofilije, polipi endometrija i cerviksa, operacijski zahvat u maloj zdjelici, hiperprolaktinemija, prekomjerna masa i dob iznad 40 godina. Primjenjeno je 29,9% AIH-a te 65,8% IVF-ova dok je u 4,3% došlo do odustajanje od postupka. Razdvajajući postupke izvantjelesne oplodnje na IVF i ICSI, primjenjeno je 37,1% IVF-ova i 62,9% ICSI-a. Bilo je ukupno 274 embriotransfera. 27,8% su bili SET-ovi, 64,1% DET-ovi, a 8,1% trostruki ET-ovi. Od ukupno 541 postupka, 14,6% bili su u prirodnom ciklusu, 24,4% u prirodnom modificiranom, 9,1% u stimuliranom agonističkom, a 50,9% u stimuliranom antagonističkom. 9,3% AIH-a je rezultiralo trudnoćom. 27,8% od ukupnog broja IVF-ova i ICSI-a rezultiralo kliničkom trudnoćom, odnosno 36,1% IVF-ova i ICSI-a po embriotransferu. Gledajući broj trudnoća ostvarenih na ukupan broj žena u pojedinoj dobnoj skupini dobili smo sljedeće rezultate: 28,3% žena mlađih od 30 godina je postiglo trudnoću, 21,9% dobi od 30-34 godine, 25% dobi 35-37, 14,1% dobi 38-39 i 14,5% starijih od 40 godina. Također, dokazane su statistički značajne razlike između dobi žene i broja jajnih stanica (r=-0,308, P<0,01), kao i između dobi žene i broja zametaka (r=-0,112, P<0,05). Pokazano kako postoji statistički značajna povezanost između dobi žene i trudnoća, t=2,470, P<0,05. Dokazana je statistički značajna povezanost primjenjenog protokola stimulacije ovulacije i broja jajnih stanica te broja zametaka (P<0,05). Žene koje su primale stimulirani protokol SO (agonistički ili antagonstički) imale su veći broj jajnih stanica i zametaka od žena koje su imale prirodni ciklus ili su primale prirodni modificirani protokol. Statistički značajne razlike nisu zabilježene između prirodnog i prirodnog modificiranog protokola (P˃0,05), kao ni između stimuliranog agonističkog i stimuliranog antagonističkog protokola (P˃0,05).
Zaključak: Prosječna dob žene je 34,8 godina što govori da se žene javljaju liječniku u još uvijek povoljnom razdoblju, s obzirom da nagli pad plodnost nastupa nakon 38. godine. Statistički je dokazana povezanost trudnoće i dobi žene. Prosječno trajanje neplodnosti je 4,8 godina, što je dvostruko dulje nego što se navodi u litertauri. To rezultira smanjenjem vjerojatnosti postizanja trudnoće. Obradu i liječenje neplodnih parova treba započeti znatno ranije unutar najkasnije 2 godine trajanja neplodnosti. Dokazano je kako je muški faktor sve češći uzrok neplodnosti para. Najčešći uzroci ženske neplodnosti jesu anovulacija, tube, endometrioza i miom, jednako kao i u dostupnoj literaturi. Primjenjeno je 29,9% AIH-a te 65,8% IVF-ova. Dokazano je da postoje statistički značajne razlike između dobi žene i broja jajnih stanica, kao i između dobi žene i broja zametaka. Dokazano je da su žene koje su primale stimulirani agonistički ili stimulirani antagonistički protokol imale statistički značajno veći broj jajnih stanica i zametaka u odnosu na žene koje su imale prirodni cikuls ili su primale prirodni modificirani protokol. Uspjeh u postizanju kliničkih trudnoća iz AIH-a je 13,2% iz IVF-a i ICSI-a 86,8% i jednak je uspjehu hrvatskih i europskih MPO centara. |
| Abstract (english) | Objective: In this research, we analyzed the causes of infertility and the success of assisted reproductive technology (ART) procedures in couples undergoing the process of medical assisted reproduction at the Center for medically assisted reproduction in Clinical Hospital Center Split between January 1, 2016 and December 31, 2016.
Design: Retrospective study
Patients and methods: Couples who were undergoing the process of medical assisted reproduction at the Center for medically assisted reproduction in the period mentioned above, were included in this study. We analyzed: the average age of women and their partners, the average duration of infertility, the causes of infertility, spermiograms, the frequency of individual causes of female infertility. Also, the types of ART procedures, ovulation stimulation protocols, number of aspirated oocytes, number of embryos and embryo transfers, and number of negative aspirations were analyzed. The total number of pregnancies, the number of pregnancies for each ART method depending on the SO protocol, and the number of pregnancies depending on the woman's age were observed. Correlations were made: age and number of oocytes, age and number of embryos, age and pregnancy, ART procedure and pregnancy, type of SO protocol and number of occytes, type of SO protocol and number of embryos, protocol SO and pregnancy.
Results: 336 couples were included in this study. The average women´s age was 34,8 years, and the partner´s 37,7 years. The average duration of infertility was 4,8 years. The cause of infertility in 24,8% cases was due to female factor, 30,7% male factor and 18,1% male and female factor. In 26,4% of cases it was idiopathic infertility. 264 men were assessed as infertile. 11,4% had oligozoospermia, 40,5% asthenozoospermia, 1,9% teratozoospermia, 26,5% oligoastenozoospermia, 0,8% asthenozoospermia, 13,6% OAT and 0,4% azoospermia. Anovulation was the cause of infertility in 32,8% cases. Tubal infertility was present in 30,7% of cases, endometriosis as a cause of infertility in 19,1% cases, and myoma uteri in 3,9%. In 21,7% of cases, the causes of infertility, all of them in one group, were thrombophilia, endometrial and cervix polyps, pelvic surgery, hyperprolactinemia, overweight and age over 40 years. There was 29,9% AIH and 65,8% IVF/ICSI, while in 4,3% cases the procedure of ART has been abandoned. When we look at the invididual numbers of IVF and ICSI, there were 37,1% IVFs and 62,9% ICSIs. There were a total of 274 embryo transfers. 27,8% were SETs, 64,1% DETs, and 8,1% triple ETs. Of the 541 cases of ARTs, 14,6% were in the natural cycle, 24,4% natural modified, 9,1% stimulated agonistic, and 50,9% stimulated antagonistic cycle. 9,3% AIHs resulted in clinical pregnancy. 27,8% of the total number of IVFs and ICSIs resulted in clinical pregnancy, and 36,1% IVFs and ICSIs by embryo transfer. Considering the number of pregnancies achieved in the total number of women in each age group we obtained the following results: 28,3% of women under the age of 30 years have reached pregnancy, 21,9% age 30-34, 25% age 35-37, 14,1% age 38-39 and 14,5% older than 40 years. Also, we proved statistically significant differences between women´s age and number of oocytes (r=-0.308, P<0.01), as well as between women´s age and number of embryos (r=-0.112, P<0.05). T test showed that there is a statistically significant association between women´s age and pregnancy, t=2,470, P<0,05. ANOVA test proved a statistically significant correlation between the applied ovulation stimulation protocol and the number of oocytes and the number of embryos (P<0.05). Women who received the stimulated (agonistic or antagonistic) protocol had a higher number of oocytes and number of embryos than women who had a natural cycle or received a naturally modified protocol. Statistically significant differences were not observed between the natural and the naturally modified protocol (P˃0.05), nor between the stimulated agonistic and the stimulated antagonistic protocol (P˃0.05).
Conclusion: The average women´s age is 34,8 years, meaning that women seek help from a doctor in a still favorable period, since a sudden decline in fertility occurs after the age of 38. There is a statistically proven correlation between pregnancy and woman's age (t=2,470, P<0,05). The average duration of infertility is 4,8 years, which is twice as long comparing to other studies. This results in a reduction in probability of achieving pregnancy. The treatment of infertile couples should start much earlier within a maximum of 2 years of infertility. It has been shown that the male factor is ever more common cause of infertility. The most common causes of female infertility are anovulation, uterine tubes, endometriosis and myoma, just as in available literature. 29,9% AIH and 65,8% IVFs were performed. There are statistically significant differences between women´s age and number of oocytes, as well as between women´s age and number of embryos. It has been shown that women who received stimulated agonistic or stimulated antagonistic protocols had statistically significantly higher number of ovarian cells and number of embryos than women who had natural cycles or received a naturally modified protocol. Success in achieving clinical pregnancy by AIH is 13,2% IVF and 86,84% ICSI and is equivalent to the success of Croatian and European centers. |
