Author/Editor		Gačić, Marija; Vlaisavljević, Veljko; Meden-Vrtovec, Helena
Title		Indukcija ovulacije v postopkih oploditve z biomedicinsko pomočjo
Translated title		Ovulation induction in assisted reproduction technologies
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 49, št. 2
Publication year		2010
Volume		str. 145-56
Language		slo
Abstract		More than 50 years have passed from the developmental phase of ovulation induction. During this period, new medications have been introduced and new protocols and dosages have been established, but a regimen that would suit all women has not yet been found. The success of ovulation induction in assisted reproduction technologies (ART) does not depend only on the medications used, but is also influenced by contributing key factors, such as the woman's age and the characteristics of her menstrual cycle, as well as her body mass index, ovarian reserve and concomitant diseases. The first successful pregnancy followed natural cycle ART without medications. Because of a relatively low success rate, natural cycle was replaced in 1970's with protocols that included clomiphene citrate or gonadotropins. The introduction of gonadoliberin agonists represented the greatest advantage in this field. The use of human menopausal gonadotropins and the recombinants, namely recombinant FSH, recombinant LH and recombinant HCG in combination with GnRH agonists, has resulted in significantly higher pregnancy rates (cumulative up to 65%), but also in higher multiple pregnancy rates and ovarian hyperstimulation rates. This is why the use of cheaper, less complicated and more patient friendly principles has been renewed, including natural cycle, aswell as methods for minimal and mild ovarian stimulation (use of clomiphene citrate, letrozole and small doses of human menopasual gonadotropin HMG or rFSH) that enable ovulation induction and pregnancy in about 30 % of treated women. After half a century of developing sophisticated protocols of ovarian stimulation, modern European recommendations now favour the use of less aggressive and cheaper, as well as more effective and patient friendly methods of ovulation induction in ART.
Summary		Od prve faze razvoja zdravil za indukcijo ovulacije je minilo že več kot 50 let. V tem času so se razvili novi pripravki, uporabljeni v različnih protokolih in različnih odmerkih, toda doslej še ni bil oblikovan protokol, ki bi bil ustrezen za vse ženske. Uspešnost indukcije ovulacije v postopkih oploditve z biomedicinsko pomočjo namreč ni odvisna le od pripravkov, temveč tudi od ključnih dejavnikov, kot so: starost ženske, značilnosti menstrualnega ciklusa, indeks telesne teže, rezerva jajčnikov in pridružene bolezni. Prva uspešna nosečnost v postopku oploditve z biomedicinsko pomočjo je bila rezultat zunajtelesne oploditve v naravnem ciklusu brez uporabe zdravil. Zaradi sorazmerno majhne stopnje uspešnosti so pri teh postopkih naravni ciklus že v sedemdesetih letih nadomestili protokoli z uporabo klomifen citrata ali gonadotropinov. Največji napredek na tem področju je bilo uvajanje agonistov gonadoliberilina. Uporaba humanih menopavznih gonadotropinov in rekombinantnih oblik (rekombinantni FSH, rekombinantni LH, rekombinantni HCG) v kombinaciji z agonisti GnRH je privedla do večje stopnje nosečnosti (20-60 %) pa tudi do večjega odstotka večplodnih nosečnosti in ovarijske hiperstimulacije. Zato so se ponovno začeli uveljavljati principi, po katerih se uvajajo cenejši, manj zapleteni in prijaznejši protokoli, ki ob naravnem ciklusu, minimalni in blagi ovarijski stimulaciji (uporaba klomifencitrata in letrozola ter majhnih odmerkov humanega menopavznega gonadotropina (HMG) ali rFSH) omogočajo uspešno indukcijo ovulacije in nosečnost pri približno 30 % zdravljenih žensk. Po pol stoletja razvijanja sofisticiranih protokolov ovarijske stimulacije so sodobna evropska priporočila usmerjena v manj agresivne, cenejše, dovolj učinkovite in prijaznejše metode spodbujanja ovulacije v postopkih oploditve z biomedicinsko pomočjo.
Descriptors		OVULATION INDUCTION INFERTILITY, FEMALE MENSTRUAL CYCLE FERTILIZATION IN VITRO CLOMIPHENE AROMATASE OVARIAN HYPERSTIMULATION SYNDROME GONADORELIN GONADOTROPINS