Erken Yumurtalık Yetersizliğinde Kadın İnfertilitesinin Optimizasyonu

Erken yumurtalık yetmezliği, az bilinen etiyolojisi ile neden olduğu yumurtalık hormonlarının azalmasıyla saptanan, kadınlarda birçok sistemi etkileyen patolojilere yol açar. Etiyolojisini belirlemeye yönelik çalışmalarda pek çok hastanın açıklanamayan grupta olduğu görülmektedir. Diğer yandan genetik yatkınlık ve otoimmün nedenli erken yumurtalık yetersizliği (premature ovarian insufficiency, POI) bilinen en sık etiyolojik nedenlerdir. Temelde östrojen eksikliği ile ilgili semptomların önlenmesi amacı ile erken tanı ve tedavi önemlidir. Hormon replasman tedavisinin bir an önce başlanması, kadınlarda menopozal semptomların önlenmesini ve uzun dönemli komplikasyonların azalmasını sağlayacaktır. Bu hastalarda diğer önemli sorun ise over yetmezliği ile ortaya çıkan infertilitedir. Aslında adet düzensizliği ortaya çıkmadan önce azalmaya başlayan fertilite, ilerleyen dönemde folikül sayısının daha hızlı azalması ile ciddi bir infertilite sorunu haline gelmektedir. Burada özellikle risk altındaki hastaların tespiti ile uygun zamanda fertilite koruyucu tedaviler (oosit, embryo veya over dokusunun dondurulması gibi) ve yardımla üreme teknikleri önerilebilir. Bununla birlikte, infertilite yakınması olan POI tanısı alan hastalarda; kök hücre tedavisi, trombositten zengin plazma (platelet-rich plasma, PRP) ve over dokusuna in vitro aktivasyon gibi uygulamalar yeni ve deneysel aşamada olsa da gelecekte umut verici olabilir. Sunulan bu derlemede erken yumurtalık yetmezliğinin güncel patofizyolojisi ve tedavi seçenekleri tartışılmıştır.

Anahtar Kelimeler:

Erken yumurtalık yetersizliği, infertilite, tanı, tedavi

Optimizing Female Infertility in Premature Ovarian Insufficiency

Premature ovarian failure is a complex pathology with numerous etiologies and multiple system sequelae resulting for early deprivation of ovarian sex hormones. In the studies to determine the etiology, it is seen that many patients are in the unexplained group. On the other hand, genetic predisposition and autoimmune cause of premature ovarian insufficiency (POI) are the most common known etiologic causes. Early diagnosis and energetic treatment are important in order to prevent symptoms related to estrogen deficiency. Initiating hormone replacement therapy as soon as possible will prevent menopausal symptoms and reduce long-term complications in women. Another important problem in these patients is infertility, which occurs due to ovarian failure. In fact, fertility, which begins to decrease before menstrual irregularity, turns into infertility with a rapid decline in the number of follicles in the following period. Here, the detection of patients at risk and appropriately timed fertility preservation treatments (such as freezing of oocyte, embryo, or ovarian tissue) or assisted reproductive techniques can be offered. Besides this, studies like stem cell therapy, platelet-rich plasma (PRP), and in vitro activation of ovarian tissue in patients with POI are recent and still investigational but may be promising in the future. In the present review, the current pathophysiology and treatment options of premature ovarian failure were discussed.

Keywords:

Premature ovarian insufficiency, infertility, diagnosis, treatment,

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