www.ksmf.org/arhimed   arhimed@ksmf.org   [5/10/2025 4:07:49 PM] http://www.ksmf.org/arhimed/poglej.asp?id=46 Vpliv prekomerne telesne mase na uspešnost postopka zunajtelesne oploditve Avtor: Lina Virnik Mentor: doc.dr. Andrej Vogler, dr.med Izhodišca. V postopku zunajtelesne oploditve je med prognosticnimi dejavniki uspešnosti postopka indukcija ovulacije ena glavnih determinant, ki lahko vpliva na število oocitov, vitalnost zarodkov, funkcionalnost endometrija in rumenega telesca. Približno 10 do 15% bolnic v postopku IVF se na eksogeno stimulacijo ovulacije z gonadotropini ne odzove z zadostno velikostjo in številcnostjo foliklov oziroma oocitov. Med znanimi vzroki za slabo stimulacijo ovulacije maloštevilne študije omenjajo med drugim tudi prekomerno telesno maso. Fiziološka izhodišca za to trditev še niso povsem razjasnena. Debelost naj bi bila povezana s spremenjenim hipofiznim odgovorom na endogeni sprošcevalec lutenizirajocega hormona iz hipotalamusa. Namen raziskave. V raziskavi smo želeli ugotoviti, ali prekomerna telesna masa vpliva na uspešnost postopka zunajtelesne oploditve v smislu slabše stimulacije ovulacije in manjše zmožnosti zanositve. Preiskovanke in metode dela. Študija je potekala prospektivno. Vanjo smo vkljucili 134 nakljucno izbranih bolnic, ki smo jih glede na njihov indeks telesne mase (BMI), razdelili na dve skupini. V prvi so bile bolnice z BMI do 25 kg/m2 (normalna telesna te?a), v drugi pa tiste z BMI nad 25 kg/m2 (debelost). Stimulacijo ovulacije smo ocenili z odmerki gonadotropinov, potrebnih za uspešno stimulacijo, koncentracijo estradiola ob koncani stimulaciji in številom pridobljenih oocitov. Uspešnost IVF postopka smo ocenili s številom prenesenih embrijev in stopnjo zanositve v posamezni skupini bolnic. Rezultati. Dokazali smo pozitivno korelacijo med BMI in dozami gonadotropinov ter negativno korelacijo s koncentracijo estradiola. Tudi korelacije z indeksom ucinkovitosti (EI), številom pridobljenih oocitov in številom embrijev so bile negativne, medtem ko je bila stopnja zanositve rahlo pozitivna. Signifikantni sta bili korelaciji med BMI in EI (p = 0.02) ter BMI in številom embrijev (p = 0.04). Zakljucki. Dokazali smo, da so za stimulacijo ovulacije pri ženskah s povecano telesno maso potrebne vecje doze gonadotropinov kot pri normalnih. Postopek je uspešnejši do stopnje pridobitve embrijev pri ženskah z normalno telesno težo, na samo uspešnost zanositve pa vpliva povecanega BMI nismo uspeli dokazati «» [Abstract / English version] Influence of body mass on the success of in vitro fertilization in women without polycystic ovarian syndrome Author: Lina Virnik Mentor: doc.dr. Andrej Vogler, dr.med Background. Ovulation induction is one of the major prognostic factors that determines the number of retrieved oocytes, quality and viability of embryos. About 10 to 15 % of patients in IVF treatment do not respond to ovarian stimulation by exogenous gonadotropin administration with adequate number of mature follicles and oocytes. One of the established causes for low ovarian response could also be increased body weight. The physiological bases to prove this theory are not completely clear yet. Obesity is supposed to be connected with a changed hipophysical response to the endogenous lutenizing hormone releasing hormone of the hipothalamus. Aim. To evaluate the effect of increased body mass on IVF procedure in the sense of weaker stimulation of ovulation and lowered pregnancy rate. Patients and methods. The study was prospective. We included 134 randomly selected patients who were divided in two groups according to their body mass index (BMI). In the first group (group "A" ) there were women with BMI lower than 25 kg/m2 (normal body weight) and in the second group (group "B") women with BMI higher than 25 kg/m2 (obesity). Stimulation of ovulation was assesed by the quantity of gonadotropins necessary for successful stimulation, by the concentration of E2 at the end of stimulation and by the number of obtained oocytes. The efficiency of the IVF method was assessed by the number of transferred embryos and the pregnancy rate in the particular group of patients. Results. A positive correlation was proved between BMI and gonadotrophin doses and a negative correlation with E2 concentration. The correlation with efficiency index (EI), number of oocytes and number of embryos was negative, the pregnancy rate was slightly positive. There were two statistically significant correlation: the first between BMI and EI (p = 0.02) and the second between BMI and number of embryos (p = 0.04). Conclusion. The results proved that women with increased body mass need higher doses of gonadotropins for stimulation of ovulation than normal women. In the case of patients with normal body mass the procedure was more succesful to the point of embryo acquisition. The influence of increased BMI on pregnancy rate was not proved.