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Medicina
Croatian Medical Association - Rijeka branch
ISSN: 0025-7729
Vol. 43, No. 4, 2007, pp. 285-289
Bioline Code: me07041
Full paper language: Croatian
Document type: Special Article
Document available free of charge

Medicina, Vol. 43, No. 4, 2007, pp. 285-289

 hr Utjecaj Dobi na Veličinu , Izgled i Prokrvljenost Jajnika i Maternice
Marton, Ulla


Primjena trodimenzionalnog ultrazvuka uz pomoć obojenog i pulsirajućeg doplera omogućuje iscrpni prikaz i procjenu ovarijskog volumena, ocjenu broja antralnih folikula, analizu stromalne vaskularne mreže kao i ocjenu endometrijske receptivnosti u bolesnica uključenih u IVF postupke. Rezultati ove studije ukazuju na to da je najznačajniji prognostički čimbenik u predviđanju uspješnosti ovarijske stimulacije broj antralnih folikula. Drugi čimbenici, poput indeksa protočnosti (FI) i ocjena volumena jajnika tehnikom trodimenzionalnog ultrazvuka, pokazali su se manje osjetljivim parametrima. Uočeno je zamjetno smanjenje volumena jajnika, broja antralnih folikula i indeksa protočnosti (FI) u odnosu na porast starosne dobi bolesnica. Ovi se čimbenici odnose obrnuto proporcionalno u odnosu na stupanj fertilizacije i zanošenja u postupcima medicinske potpomognute oplodnje. Buduća će istraživanja pokazati može li se inicijalnom korekcijom gonadotropinske stimulacije u bolesnica s manjim brojem antralnih folikula, neprimjerenim volumenom jajnika i nižim vrijednostima indeksa protočnosti (FI) unutar strome jajnika postići primjereni odgovor jajnika i pravilno sazrijevanje oocita uz sinkronu maturaciju endometrija. Sastavni dio suvremenog pristupa liječenja neplodnosti i izvođenju postupaka medicinski potpomognute oplodnje podrazumijeva odgađanje postupka embrio transfera u slučajevima neprimjerenog endometrijskog odgovora (debljine, morfologije, volumena i prokrvljenosti), što je omogućeno osuvremenjivanjem metoda kriopohrane zametaka i zamrzavanjem gameta. Naši rezultati ukazuju na mogućnost individualnog pristupa svakoj bolesnici uključenoj u IVF postupak, uvođenjem prilagođenih stimulacijskih protokola. Stoga primjena trodimenzionalnog ultrazvuka može postati nezaobilazno pomoćno sredstvo u ocjeni ovarijskog odgovora i endometrijske receptivnosti bolesnica uključenih u programe potpomognute oplodnje.


uterus, ultrazvuk, potpomognuta oplodnja

 
 en Age Influence on Ovary and Uterus Dimension, Morphology and Vascularisation
Marton, Ulla

Abstract

Three dimensional ultrasonographic measurements and color and pulsed Doppler evaluation allow detailed analysis of the ovarian volume, antral follicle number, assessment of the ovarian stromal vascularity, as well as evaluation of the endometrial receptivity in patients undergoing IVF procedures. Results of our study indicate that the best prognostic parameter in determination of number of the oocytes in ovarian stimulation protocols for IVF/ET treatment is number of antral follicles. Other parameters such as flow index (FI) and ovarian volume assessed by 3D ultrasound are less sensitive. Significant decrease of the ovarian volume, number of antral follicles and flow index was noticed with ageing of the patients. These parameters had shown the opposite trend regarding the fertilization rates in medically assisted reproductive procedures. Patients with small ovarian volume, few antral follicles and poor intraovarian vascularity may benefit from higher dose of gonadotropins and different stimulation protocol. Although the total number of follicles, ovarian volume, and mean ovarian stromal vascularity decrease with age, high pregnancy rates may be achieved even in older patients in whom three dimensional variables are considered normal. In addition to ovarian measurements, endometrial volume measurements and assessment of endometrial perfusion by 3 D power Doppler histogram on the day of embryo transfer could be used for determination of uterine receptivity in deciding how many embryos or blastocysts will be transferred or cryopreserved. Therefore, ovarian and endometrial measurements by tree dimensional ultrasound may become simple additional tests which could predict response to stimulating drugs, degree of endometrial receptivity and outcome of assisted reproductive techniques.

Keywords
uterus, ulrasonography, assisted reproduction

 
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