Author/Editor		Meden-Vrtovec, Helena; Virant-Klun, Irma; Drobnič, Sašo
Title		Staranje jajčnikov in zdravljenje neplodnosti
Translated title		Ovarian aging and infertility treatment
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. Suppl 2
Publication year		2003
Volume		str. II-93-6
Language		slo
Abstract		Background. Due to changes in the socio-economic environment the first pregnancy is being more often postponed to advanced age; an increasing number of women seek medical help for infertility in their late thirties. Degenerative processes in the ovary start as early as after 35 years of age. When the woman is over 38, the signs of hormonal changes occur (FSH, inhibin), the menstrual cycle changes, and fertility is being increasingly reduced. Infertility treatment by assisted reproduction technology (ART) has proved less efficient in older than in younger women. Material and methods. In a retrospective analysis we evaluated the success rates achieved with homologous intrauterine insemination (IUI), in vitro fertilization and embryo-transfer (IVF-ET), intracytoplasmic sperm injection (ICSI), and compared them in regard to the women > 38 years vs. < 38 years. Results. After IUI the pregnancy rate in the women over 38 was 3.7% per patient (1.5% per cycle) and 28.0% (9.9%) in the women younger than 38 years. After IVF-ET the pregnancy rate in the over 38 year group was 16% per patient (14% per cycle), and 28% per patient (25% per cycle) in the less than 38 year group. After ICSI, the pregnancy rate in the group over 38 years was 11% per patient (9% per cycle), and 25% perpatient (22% per cycle) in the less than 38 year group. In the analysed population, the spontaneous abortion rate was 26.0% in the group of women aged over 38 years, and 24.0% in the group of women aged less than 38 years. Conclusions. Before introduction of an ART procedure the woman with advanced age should be properly counselled and well informed about poor success of their infertility treatment and high spontaneous abortion rate.
Summary		Izhodišča. Zaradi spremenjenih socialnoekonomskih razmer se starost žensk ob prvi nosečnosti veča. Vse številnejše so ženske, ki iščejo pomoč zaradi neplodnosti v poznih tridesetih letih. Degenerativne spremembe v jajčniku se pričnejo že po 35. letu starosti, po 38. letu pa se pojavljajo še znamenja hormonskih sprememb (FSH, inhibin) in spremembe v menstruacijskem ciklusu. Zato se tudi plodnost bistveno zmanjša. Material in metode. Postopki oploditve z biomedicinsko pomočjo (OBMP) so pri starejših ženskah manj uspešni kot pri mlajših. Primerjali smo uspešnost postopkov OBMP pri ženskah, starejših in mlajših od 38 let, in sicer glede umetne homologne osemenitve (IUI), zunajtelesne oploditve in prenosa zarodka (NF-ET) in neposrednega vnosa semenčice v jajčno celico (ICSI). Rezultati. Pri ženskah, zdravljenih z lUI in starejših od 38 let, smo ugotovili le 3,7% nosečnosti na bolnico in 1,5% na ciklus, pri mlajših od 38 let pa 28% nosečnosti na bolnico in 9,9% na ciklus. S postopkom IVF-ET je bila stopnja nosečnosti pri starejših od 38 let 16% na bolnico in 14% na ciklus, pri mlajših pa 28% na bolnico in 25% na ciklus. V skupini starejših žensk smo registrirali spontane splave v 21%, pri mlajših pa v 13%. Zdravljenih z metodo ICSI je zanosilo 11% žensk, starejših od 38 let (9% na ciklus), pri mlajših pa je bila stopnja nosečnosti na bolnico 25% in na ciklus 22%. V starejši skupini je bilo 26% spontanih splavov, v mlajši 14%. Zaključki. Pred uvedbo postopkov OBMP morajo biti ženske, starejše kot 38 let, natančno obveščene o majhni stopnji uspešnosti zdravljenja in o visokem odstotku spontanih splavov.
Descriptors		INFERTILITY, FEMALE OVARIAN FAILURE, PREMATURE FERTILIZATION IN VITRO MENSTRUAL CYCLE PREGNANCY AGE FACTORS