19 research outputs found
Fertility in men with spinal cord injury
Young men comprise the overwhelming majority of men with spinal cord injury (SCI), the incidence of which has been growing over the years. Due to advances in physical medicine and rehabilitation, remarkable improvements in survival rates have been reported, leading to life expectancies similar to those of the general population. However, many sexual and reproductive functions may be impaired due to erectile or ejaculatory dysfunction and semen abnormalities, characterised by low-sperm motility or viability in SCI males who have not become parents yet. Nevertheless, fatherhood is still possible through the introduction of specialised medical management, by using various medical, technical and surgical methods for sperm retrieval in combination with assisted reproductive techniques. Erectile dysfunction can be managed by the use of phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be obtained from the vast majority of anejaculatory men by medically assisted ejaculation through the use of penile vibratory stimulation or electroejaculation and via prostate massage or surgical procedures. Despite impaired sperm parameters, reasonable pregnancy rates similar to those in able-bodied subfertile cohorts have been reported. However, future research should focus on the optimisation of semen quality in these men and on improving natural ejaculation
Suvremene prevencijske strategije porasta predovulacijskog progesterona tijekom stimulacije jajnika u postupku izvantjelesne oplodnje
The purpose of this review is to present contemporary measures for preventing the increase in preovulatory progesterone (P) and its adverse effects on ovarian stimulation in in vitro fertilization (IVF). For the last 20 years, the increase of preovulatory P has been a topic of numerous discussions because its role is not fully understood in terms of its impact on pregnancy outcome after IVF. Some studies failed to establish a connection between the preovulatory P increase and successful IVF outcome regardless of the level of P, while, conversely, most other studies have reported on adverse effects of elevated P concentrations. Current strategies to prevent the increase in preovulatory P include an individualized approach with the use of mild stimulation protocols and early application of human chorionic gonadotropin for ovulation induction among good responders, delay in the transfer of fresh embryos from 3rd to 5th day, and cryopreservation of all embryos with the thawed embryo transfer in the natural cycle. Nevertheless, further studies are needed to confirm the current preventive methods or enable the application of new strategies in order to lower or eliminate the detrimental effects of preovulatory P rise during ovarian stimulation in IVF.Svrha ovoga preglednog Älanka je prikazati suvremene mjere za prevenciju porasta predovulacijskog progesterona (P) i njegovih nepovoljnih uÄinaka kod stimulacije jajnika u postupku izvantjelesne oplodnje. Unatrag 20-ak godina porast predovulacijskog P tema je brojnih rasprava, jer njegova uloga nije u potpunosti razjaÅ”njena u pogledu utjecaja na ishod trudnoÄe nakon postupka izvantjelesne oplodnje. Neka istraživanja nisu utvrdila nikakvu povezanost izmeÄu porasta predovulacijskog P u odnosu na uspjeÅ”nost postupka izvantjelesne oplodnje neovisno o razini P, dok nasuprot tome, veÄina drugih istraživanja izvjeÅ”Äuje o nepovoljnim uÄincima poviÅ”ene koncentracije P. Suvremene strategije u prevenciji porasta predovulacijskog P ukljuÄuju individualizirani pristup primjenom blažih stimulacijskih protokola te raniju primjenu humanog korionskog gonadotropina za indukciju ovulacije kod bolesnica koje dobro reagiraju na stimulaciju, odgodu prijenosa svježih zametaka s 3. na
5. dan i krioprezervaciju svih zametaka uz transfer odmrznutih embrija u prirodnom ciklusu. Neophodna su daljnja istraživanja koja Äe potvrditi postojeÄe prevencijske metode ili omoguÄiti primjenu novih strategija, sa svrhom onemoguÄavanja nepovoljnog utjecaja porasta predovulacijskog P na ishod trudnoÄe nakon postupka izvantjelesne oplodnje
Combined ovulation triggering with GnRH agonist and hCG in IVF patients
The aim of the review is to analyse the combination of a gonadotrophin releasing hormone (GnRH) agonist with a human chorionic gonadotrophin (hCG) trigger, for final oocyte maturation in in vitro fertilisation (IVF) cycles. The concept being a ''dual trigger'' combines a single dose of the GnRH agonist with a reduced or standard dosage of hCG at the time of triggering. The use of a GnRH agonist with a reduced dose of hCG in high responders demonstrated luteal phase support with improved pregnancy rates, similar to those after conventional hCG and a low risk of ovarian hyperstimulation syndrome (OHSS). The administration of a GnRH agonist and a standard hCG in normal responders, demonstrated significantly improved live-birth rates and a higher number of embryos of excellent quality, or cryopreserved embryos. The concept of the ''double trigger" represents a combination of a GnRH agonist and a standard hCG, when used 40 and 34āh prior to ovum pick-up, respectively. The use of the ''double trigger" has been successfully offered in the treatment of empty follicle syndrome and in patients with a history of immature oocytes retrieved or with low/poor oocytes yield. Further prospective studies are required to confirm the aforementioned observations prior to clinical implementation
Medikamentna prevencija sindroma hiperstimulacije jajnika
The purpose of this review is to analyze current medical strategies in the prevention of ovarian hyperstimulation syndrome (OHSS) during ovarian stimulation for in vitrofertilization. Owing to contemporary preventive measures of OHSS, the incidence of moderate and severe forms of the syndrome varies between 0.18% and 1.40%. Although none of medical strategies is completely effective, there is high-quality evidence that replacing human chorionic gonadotropin (hCG) by gonadotropin-releasing hormone (GnRH) agonists after GnRH antagonists and moderate-quality evidence that GnRH antagonist protocols, dopamine agonists and mild protocols reduce the occurrence of OHSS. Among various GnRH agonists, buserelin 0.5 mg, triptorelin 0.2 mg and leuprolide acetate (0.5-4 mg) have been mostly utilized. Although GnRH trigger is currently regarded as the best tool for OHSS prevention, intensive luteal support with exogenous administration of estradiol and progesterone or low-dose hCG on the day of oocyte retrieval or on the day of GnRH agonist trigger are required to achieve optimal conception rates due to early luteolysis. Among currently available dopamine agonists, cabergoline, quinagolide and bromocriptine are the most common drugs that should be used for prevention of both early and late OHSS. Mild stimulation protocols offer attractive option in OHSS prevention with satisfactory pregnancy rates.Svrha ovoga rada bila je analizirati danaÅ”nje medikamentne strategije u prevenciji sindroma hiperstimulacije jajnika za vrijeme stimulacije ovulacije u postupku izvantjelesne oplodnje. ZahvaljujuÄi suvremenim metodama prevencije pojavnost sindroma hiperstimulacije se kreÄe od 0,18% do 1,40%. Premda se nijedna prevencijska strategija nije pokazala u potpunosti djelotvornom, postoje Ävrsti dokazi da zamjena humanog korionskog gonadotropina gonadotropnim otpuÅ”tajuÄim hormonom nakon antagonista gonadotropnog otpuÅ”tajuÄeg hormona te umjereni dokazi da protokoli antagonista gonadotropnog otpuÅ”tajuÄeg hormona, agonisti dopamina i blagi protokoli smanjuju pojavnost sindroma hiperstimulacije. IzmeÄu nekoliko agonista gonadotropnog otpuÅ”tajuÄeg hormona najÄeÅ”Äe se koriste buserelin 0,5 mg, triptorelin 0,2 mg i leuprolid (0,5-4 mg). Premda se danas smatra da je gonadotropni otpuÅ”tajuÄi hormon najuspjeÅ”niji u prevenciji sindroma hiperstimulacije jajnika, zbog rane luteolize potrebna je intenzivna potpora žutom tijelu primjenom estradiola i progesterona ili sniženim dozama humanog korionskog gonadotropina na dan aspiracije jajnih stanica da bi se postigle optimalne stope zanoÅ”enja. IzmeÄu danas dostupnih agonista dopamina kabergolin, kinagolid i bromokriptin su lijekovi koji se najÄeÅ”Äe primjenjuju i koje bi trebalo primjenjivati u prevenciji ranog i kasnog oblika sindroma hiperstimulacije. Blagi stimulacijski protokoli predstavljaju privlaÄan izbor u prevenciji sindroma hiperstimulacije sa zadovoljavajuÄim stopama trudnoÄe
Utjecaj muŔke debljine na plodnost
The aim of this review is to analyze current diagnostic approaches to obesity in adult men, the potential mechanisms linking obesity to infertility, and treatment options aimed at improving reproductive health. Obesity has become a worldwide epidemic with the estimated prevalence increasing from 28.8% to 36.9% between 1980 and 2013. In terms of diagnosis, numerous simple techniques have been developed including body mass index, waist to hip ratio, waist circumference, bioelectrical impedance analysis, ultrasound and skinfold measurements. Additionally, several other less available but more accurate techniques have been suggested, such as air displacement plethysmography, dual energy x-ray absorptiometry, computed tomography and magnetic resonance imaging. In addition to cardiovascular and other disorders, male obesity can negatively affect the male reproductive potential through abnormal reproductive hormone levels, reduced semen quality, increased release of adipose-derived hormones and adipokines, as well as thermal, genetic and sexual mechanisms. In the management of obesity related male infertility, natural weight loss is the cornerstone and regular exercise the first-line treatment. Although bariatric surgery results in greater improvements in weight loss outcomes when compared to non-surgical interventions, further research is required to clarify its overall influence on male fertility.Svrha ove studije bila je analizirati danaÅ”nje dijagnostiÄke metode debljine kod odraslih muÅ”karaca, potencijalne mehanizme koji povezuju debljinu s neplodnoÅ”Äu i moguÄnosti lijeÄenja s ciljem poboljÅ”anja reprodukcijskog zdravlja. Debljina je Å”irom svijeta poprimila epidemijski karakter s procijenjenom pojavnoÅ”Äu u porastu od 28,8% do 36,9% izmeÄu 1980. i 2013. godine. U pogledu dijagnoze pretilosti razvijene su brojne jednostavne tehnike ukljuÄujuÄi indeks tjelesne mase, omjer struka i kukova, opseg struka, analiza biolektriÄnog otpora, ultrazvuk i mjerenje kožnih nabora. Uz to, postoji nekoliko drugih rjeÄe dostupnih no preciznijih tehnika kao Å”to su pletizmografija na temelju istiskivanja zraka, apsorciometrija s dva izvora zraÄenja, kompjutorizirana tomografija i magnetska rezonancija. Uz kardiovaskularne i druge bolesti pretilost muÅ”karca može se nepovoljno odražavati na njegovu fertilnu sposobnost poremeÄajem razine reprodukcijskih hormona, smanjenom kvalitetom sjemena, pojaÄanim luÄenjem hormona i masnog tkiva i adipokina, a isto tako kroz toplinske, genetske i spolne mehanizme. Pri voÄenju neplodnosti muÅ”karca povezane s pretiloÅ”Äu odluÄujuÄe je prirodno smanjenje tjelesne težine, a redovite tjelovježbe predstavljaju prvu liniju lijeÄenja. Premda su kirurÅ”ki zahvati na želucu i crijevima znatno uspjeÅ”niji glede ishoda smanjenja tjelesne težine u odnosu na neoperacijske metode, potrebna su daljnja istraživanja za razjaÅ”njenje njihovog utjecaja na plodnost muÅ”karca
Efekti antiagregacijske i antikoagulacijske terapije trombofilija u trudnoÄi
Uvod: Trombofilija poveÄava rizik od ponovnog pobaÄaja i drugih ozbiljnih opstetriÄkih komplikacija
kao Ŕto je preeklampsija, abrupcija posteljice i zastoj u rastu fetusa.
Cilj: istražiti uÄinkovitost antiagregacijske i antikoagulacijske terapije u odnosu na: pojavu i težinu
opstretiÄkih komplikacija i ishod trudnoÄe.
Ispitanice i metode: MulticentriÄna retrospektivno/prospektivna studija. Istraživanje je provedeno u
razdoblju 2018-2021. godine na podruÄiju ZeniÄko-dobojske županije, Federacija Bosne i Hercegovine.
Laboratorijske analize obavljene su u Kantonalnoj bolnici Zenica (GinekoloÅ”ko-akuÅ”erski odjel) i OpÄoj
bolnici TeÅ”anj (GinekoloÅ”ko-akuÅ”erski odjel). U istraživanje je ukljuÄeno 180 ispitanica. Formirane su
dvije osnovne skupine: radna (skupina ispitanica) i kontrolna skupina. Radnu skupinu Äinilo je ukupno 120
ispitanica (N=120). Kontrolnu skupinu Äinilo je ukupno 60 ispitanica (N=60).
Rezultati:Primjena antikoagulacijske terapije u profilaktiÄkim i terapijskim dozama utjecala je na
smanjenje uÄestalosti i težine komplikacija, pozitivan uÄinak u postizanju terminske trudnoÄe, te pozitivan
uÄinak u profilaksi tromboembolijskih bolesti. Primjenom antiagregacijske terapije postignut je pozitivan
uÄinak profilakse tromboze, ali ne i smanjenje broja komplikacija.
ZakljuÄak:UtvrÄen je bolji uÄinak antikoagulacijske u odnosu na antiagregacijsku terapiju u postizanju
terminske trudnoÄe, smanjenja broja komplikacija i tromboze
PoboljÅ”anje spolne i reprodukcijske funkcije u muÅ”karaca s oÅ”teÄenjem kralježniÄne moždine
The aim of the review is to establish sexual and reproductive functions in men with spinal cord lesion (SCL). Many sexual and reproductive dysfunctions may be found in these patients including individualās low self-esteem, delay of orgasm, erectile or ejaculatory disorder and abnormalities of semen, which are characterized by lower sperm motility or viability. Owing to improvements in physical medicine and rehabilitation, the focus has been shifted from keeping patients alive towards ensuring the quality of life and improvements of sexual dysfunctions and later reproduction. Erectile dysfunction can be treated by using phosphodiesterase-5 inhibitors, intracavernosal injections, vacuum devices and penile prostheses. Semen can be retrieved from anejaculatory patients by medically assisted methods utilizing penile vibratory stimulation, electroejaculation, prostate massage, or surgically. Although there is low chance for pregnancy in natural way in most of SCL patients, fatherhood is possible through the introduction of assisted medical management. By use of various medical, technical and surgical procedures for sperm retrieval combined with assisted reproductive methods, high pregnancy rates have been reported comparable to those in able-bodied subfertile patients. Nevertheless, future studies are needed to improve semen quality and methods of assisted ejaculation in patients with SCL.Svrha ovoga preglednog Älanka je analizirati spolne i reprodukcijske funkcije u muÅ”karaca s oÅ”teÄenjem kralježniÄne moždine (OKM). Mnoge spolne i reprodukcijske funkcije u ovih bolesnika mogu biti oÅ”teÄene ukljuÄujuÄi vlastitu podcjenjenost, nedostatak spolnog zadovoljstva, erekcijsku i ejakulacijsku disfunkciju te nepravilnosti spermiograma koje karakteriziraju slabija pokretljivost i vijabilnost. ZahvaljujuÄi napretku u fizikalnoj medicini i rehabilitaciji pomiÄe se glavna usmjerenost na omoguÄavanje preživljenja takvih bolesnika prema osiguranju kvalitete života, poboljÅ”anju spolne disfunkcije i kasnije reprodukcije. Erekcijska disfunkcija može se lijeÄiti primjenom inhibitora fosfodiesteraze-5, intrakavernoznih injekcija, vakumskih ureÄaja i proteza za penis. U veÄine muÅ”karaca s anejakulacijom sjeme se može dobiti postupkom medicinski pomognute ejakulacije primjenom vibracijske stimulacije penisa, elektroejakulacije, masaže prostate ili kirurÅ”kih zahvata. Premda veÄina muÅ”karaca s OKM ne uspijeva postiÄi trudnoÄu na prirodan naÄin, stvaranje potomstva ipak je moguÄe uvoÄenjem specijalistiÄkog medicinskog lijeÄenja. Primjenom raznih medicinskih, tehniÄkih i kirurÅ”kih tehnika za dobivanje spermija u kombinaciji s metodama za pomognutu oplodnju postignute su zavidne stope trudnoÄa sliÄno kao u subfertilnih osoba bez tjelesnih oÅ”teÄenja. Ipak, potrebna su daljnja istraživanja za poboljÅ”anje kvalitete sjemena i metoda za pomognutu ejakulaciju u bolesnika s OKM
Rizik hiperkoagulabilnosti kod sindromahiperstimulacije jajnika
Ovarian hyperstimulation syndrome (OHSS) is a rare and potentially life-threatening complication of infertility treatment occurring during either the luteal phase or early pregnancy. An increasing number of thromboembolic complications associated with the increased use of assisted reproductive techniques have been reported in the literature. Identification of the risk factors is crucial for prevention of thromboembolic events in OHSS patients. Alterations in the hemostatic system cause hypercoagulability in women affected by severe OHSS. Coexistence of inherited hypercoagulable conditions increases the risk of thromboembolism. The role of clinical parameters that can help predict development of thrombosis is controversial. Patients with a personal or family history of thrombosis undergoing infertility treatment should be considered for thrombophilia screening, while routine examination of inherited thrombophilic mutations is not indicated in infertile patients. Antithrombotic primary prevention is not indicated in healthy women undergoing assisted reproductive procedures or in women with thrombophilia. Anticoagulant therapy is indicted if there is clinical evidence of thrombosis or laboratory evidence of hypercoagulability. In this review, the risks of hypercoagulability in the OHSS are discussed.Sindrom hiperstimulacije jajnika je rijetka i za život opasna komplikacija lijeÄenja neplodnosti koja se javlja u lutealnoj fazi menstruacijskog ciklusa ili tijekom rane trudnoÄe. PoveÄanjem zastupljenosti tehnika potpomognute oplodnje poveÄava se broj prijavljenih sluÄajeva tromboembolijskih komplikacija. U prevenciji tromboembolijskih dogaÄaja kod bolesnica sa sindromom hiperstimulacije jajnika kljuÄno je odreÄivanje riziÄnih Äimbenika. Promjene u sustavu hemostaze uzrokuju hipekoagulabilnost, a nasljedne trombofilije dodatno poveÄavaju rizik tromboembolije. Sporna je uloga kliniÄkih parametara koji mogu pomoÄi u predviÄanju razvoja tromboze. Žene podvrgnute lijeÄenju neplodnosti koje su preboljele tromboembolijsku bolest ili u obitelji imaju sluÄajeve tromboembolijske bolesti treba testirati na nasljedne trombofilije, dok se rutinsko testiranje kod neplodnih žena ne provodi. Antitrombotska terapija je indicirana samo ako su prisutni kliniÄki znakovi tromboze ili laboratorijski dokazana hiperkoagulabilnost, a nije indicirana kod žena s nasljednom trombofilijom u postupku medicinski potpomognute oplodnje bez kliniÄkih i/ili laboratorijskih znakova tromboze. U ovom preglednom Älanku opisani su rizici hiperkoagulabilnosti u sindromu hiperstimulacije jajnika
Kisspeptin as a promising oocyte maturation trigger for in vitro fertilisation in humans
The aim of this review is to analyse the effectiveness of exogenous kisspeptin administration as a novel alternative of triggering oocyte maturation, instead of currently used triggers such as human chorionic gonadotropin (hCG) or gonadotropin releasing hormone (GnRH) agonist, in women undergoing in vitro fertilisation (IVF) treatment. Kisspeptin has been considered a master regulator of two modes of GnRH and hence gonadotropin secretion, pulses and surges. Administration of kisspeptin-10 and kisspeptin-54 induces the luteinising hormone (LH) surge required for egg maturation and ovulation in animal investigations and LH release during the preovulatory phase of the menstrual cycle and hypothalamic amenorrhoea in humans. Exogenous kisspeptin-54 has been successfully administered as a promising method of triggering oocyte maturation, following ovarian stimulation with gonadotropins and GnRH antagonists in women undergoing IVF, due to its efficacy considering achieved pregnancy rates compared to hCG and GnRH agonists. Also, its safety in patients at high risk of developing ovarian hyperstimulation syndrome is noteworthy. Nevertheless, further studies would be desirable to establish the optimal trigger of egg maturation and to improve the reproductive outcome for women undergoing IVF treatment
OÄuvanje plodnosti u mladih žena s ranim rakom dojke
Although breast cancer (BC) occurs more often in older women, it is the most commonly diagnosed malignancy in women of childbearing age. Owing to the overall advancement of modern medicine and the growing global trend of delaying childbirth until later age, we find ever more younger women diagnosed and treated for BC who have not yet completed their family. Therefore, fertility preservation has emerged as a very important quality of life issue for young BC survivors. This paper reviews currently available options for fertility preservation in young women with earlystage BC and highlights the importance of a multidisciplinary approach to fertility preservation as a very important quality of life issue for young BC survivors. Pregnancy after BC treatment is considered not to be associated with an increased risk of BC recurrence; therefore, it should not be discouraged for those women who want to achieve pregnancy after oncologic treatment. Currently, it is recommended to delay pregnancy for at least 2 years after BC diagnosis, when the risk of recurrence is highest. However, BC patients of reproductive age should be informed about the potential negative
effects of oncologic therapy on fertility, as well as on the fertility preservation options available, and if interested in fertility preservation, they should be promptly referred to a reproductive specialist. Early
referral to a reproductive specialist is an important factor that increases the likelihood of successful fertility preservation. Embryo and mature oocyte cryopreservation are currently the only established fertility preservation methods but they require ovarian stimulation (OS), which delays initiation of chemotherapy for at least 2 weeks. Controlled OS does not seem to increase the risk of BC recurrence. Other fertility preservation methods (ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists) do not require OS but are still considered to be experimental techniques for fertility preservation.Premda se karcinom dojke ÄeÅ”Äe javlja u starijoj životnoj dobi, to je i najuÄestaliji malignitet u žena reproduktivne dobi. Zbog sveukupnog napretka moderne medicine i rastuÄeg globalnog trenda odgaÄanja raÄanja djece za kasniju dob suoÄavamo se sa sve viÅ”e mladih žena s dijagnosticiranim i lijeÄenim karcinomom dojke koje joÅ” nisu kompletirale obitelj. Stoga je podruÄje oÄuvanja plodnosti postalo jako bitno u oÄuvanju kvalitete života mladih žena koje su preboljele karcinom dojke. Ovaj rad iznosi trenutno dostupne metode za oÄuvanje plodnosti u mladih žena s ranim karcinomom dojke i istiÄe važnost
multidisciplinarnog pristupa u oÄuvanju plodnosti kao bitnog Äimbenika kvalitete života tih žena. Smatra se da trudnoÄa nakon karcinoma dojke nije povezana s poviÅ”enim rizikom od recidiva pa stoga ne treba obeshrabriti žene koje žele ostvariti trudnoÄu nakon provedenog onkoloÅ”kog lijeÄenja. Danas se preporuÄa priÄekati s trudnoÄom barem 2 godine nakon postavljene dijagnoze za vrijeme kada je rizik od povrata bolesti najveÄi. No, isto tako bi bolesnice reproduktivne dobi trebalo obavijestiti o moguÄem negativnom uÄinku onkoloÅ”ke terapije na plodnost te o dostupnim metodama oÄuvanja plodnosti i u sluÄaju zainteresiranosti za oÄuvanje plodnosti bolesnice treba žurno uputiti reproduktivnom specijalistu. Rano upuÄivanje reproduktivnom specijalistu je bitan Äimbenik koji poveÄava izglede za uspjeÅ”no oÄuvanje plodnosti. Krioprezervacija embrija i zrelih oocita su trenutno jedine standardne metode oÄuvanja plodnosti koje zahtijevaju stimulaciju ovarija kojom se odgaÄa poÄetak kemoterapijskog lijeÄenja barem 2 tjedna. Smatra se da kontrolirana stimulacija ovarija ne poveÄava rizik od povrata karcinoma dojke. Druge metode oÄuvanja plodnosti (krioprezervacija tkiva jajnika, krioprezervacija nezrelih oocita,
ovarijska supresija GnRH agonistima) ne zahtijevaju primjenu ovarijske stimulacije, ali se i dalje smatraju eksperimentalnim metodama za oÄuvanje plodnosti