Kadın İnfertilitesi
Özet
Kadın infertilitesinin organ kaynaklı nedenlerini, gelişimsel anomalilerini ve histopatolojik faktörlerini kapsamlı bir şekilde inceleyen yazı, over, fallop tüpü, uterus, serviks ve vajen kaynaklı patolojileri ele almaktadır. Over kaynaklı nedenler arasında Turner ve Swyer sendromları gibi genetik faktörler, polikistik over sendromu (PCOS), over rezerv azlığı ve prematür over yetmezliği (POF) öne çıkmaktadır. Yaşlanmayla artan reaktif oksijen türleri (ROS) ve mitokondriyal hasar oosit kalitesini düşürmektedir. İnfertil kadınların yaklaşık %30'unda görülen fallop tüpü patolojilerinde ise aksesuar tüp, Kartagener sendromu, sigara kullanımı, endometriozis ve N. Gonorrhoeae veya Chlamydia trachomatis gibi enfeksiyonlar siliyer aktiviteyi bozarak oosit transportunu engellemektedir. Uterus kaynaklı faktörlerde septat ve unikornuat gibi Müllerian anomalileri, endometriyal desidualizasyon eksiklikleri ve implantasyon penceresindeki uyumsuzluklar gebeliğin oluşmasını veya devamını engellemektedir. Ayrıca servikal mukustaki antisperm antikorları ve vajinal/uterin mikrobiyata çeşitliliğindeki değişimler de infertilite ile yakından ilişkilidir. Başarılı bir tedavi için tüm bu çevresel, genetik ve hormonal etkenlerin ve ailesel hikayenin analiz edilmesi gerekmektedir.
Providing a comprehensive examination of the organ-based causes, developmental anomalies, and histopathological factors of female infertility, the text details ovarian, fallopian tube, uterine, cervical, and vaginal pathologies. Ovarian causes prominently include genetic factors such as Turner and Swyer syndromes, polycystic ovary syndrome (PCOS), diminished ovarian reserve, and premature ovarian failure (POF). Increased reactive oxygen species (ROS) and mitochondrial damage associated with aging reduce oocyte quality. In fallopian tube pathologies, which affect approximately 30% of infertile women, accessory tubes, Kartagener syndrome, smoking, endometriosis, and infections like N. Gonorrhoeae or Chlamydia trachomatis impair ciliary activity, thereby obstructing oocyte transport. Regarding uterine factors, Müllerian anomalies such as septate and unicornuate uterus, deficiencies in endometrial decidualization, and mismatches in the implantation window prevent the establishment or continuation of pregnancy. Furthermore, antisperm antibodies in cervical mucus and alterations in vaginal/uterine microbiota diversity are closely linked to infertility. For a successful treatment, all these environmental, genetic, and hormonal factors, along with family history, must be analyzed.
Referanslar
Zegers-Hochschild F, Adamson GD, Dyer S, et al. The international glossary on infertility and fertility care. Fertility and Sterility. 2017;108 (3)393–406. doi: 10.1016/j.fertnstert.2017.06.005
Budak Ö. Sperm parametreleri ile sperm DNA fragmantasyonu ve kromozom anomalilerinin karşılaştırılması. Kocaeli Üniversitesi Sağlık Bilimleri Enstitüsü, Histoloji ve Embriyoloji Anabilim Dalı, Doktora Tezi, Kocaeli, 2014 (Tez Danışmanı: Prof. Dr. Melda Yardımoğlu Yılmaz).
Hatiboğlu Y. Toluidin mavisi, anilin mavisi ve sperm kromatin dispersiyon testleri ile sperm DNA hasar oranlarının kıyaslanması. İstanbul Bilim Üniversitesi, Tıp Fakültesi, Histoloji ve Embriyoloji Anabilim Dalı, Yüksek Lisans Tezi, İstanbul, 2014 (Tez Danışmanı: Prof. Dr. Vildan Karpuz).
Hart RJ. Physiological aspects of female fertility: role of the environment, modern lifestyle, and genetics. Physiological Reviews. 2016;96 (3): 873–909. doı: 10.1152/physrev.00023.2015
Agarwal A, Mulgund A, Hamada A, et al. A unique view on male infertility around the globe. Reproductive biology and endocrinology. (2015); 13:37. doi: 10.1186/s12958-015-0032-1
DiGeorge AM, Hermaphroditism. In Behrman RE, Kliegman RM, Arvin AM (ed) Nelson Textbook of Pediatrics, 15th ed. Philadelphia, WB Saunders, 1996.
Moore LK, Persaud TVN, Torchia MG, Klinik yönleriyle insan embriyolojisi (Hakkı Dalçık Çev. Ed.) Ankara: Nobel Kitabevi; 2016
Kierszenbaum AL, Histoloji ve hücre biyolojisi patolojiye giriş (Ramazan Demir Çev. Ed.) Ankara: Palme Yayıncılık; 2006
Ross MH, Pawlina W, Histoloji konu anlatımı ve atlas ( Barış Baykal Çev. Ed.) Ankara: Palme Yayıncılık;2014
Wolff DJ, Van Dyke DL, Powell CM. Laboratory guideline for Turner synd¬rome. Genetics in Medicine; 2010;12(1):52-55. doi: 10.1097/GIM.0b013e3181c684b2.
Morgan T. Turner Syndrome: Diagnosis and Management. American Family Phy-sician; 2007;76(3):405-10.
Gravholt CH, Anderson NH, Conway GS et al. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting. European Journal of Endocrinology; 2017; 177(3): G1-G70. doi: 10.1530/EJE-17-0430.
Pasquino AM, Passeri F, Pucarelli I, et al. Spontaneous pubertal development in Turner's syndrome. Italian Study Group for Turner's Syndrome. The journal of clinical endocrinology and metbolism; 1997;82(6)1810-3. doi: 10.1210/jcem.82.6.3970.
Kaneko N, Kawagoe S, Hiroi M. Turner's syndrome--review of the literature with reference to a successful pregnancy outcome. Gynecologic Obstetric investigation; 1990; 29(2):81-7. doi: 10.1159/000293307
Bryman I, Sylven L, Berntorp K, et al. Pregnancy rate and outcome in Swedish women with Turner syndrome. Fertility and sterility; 2011;95(8): 2507-10. doi: 10.1016/j.fertnstert.2010.12.039
Gonzalez L, Witchel SF. The patient with Turner syndrome: puberty and medical management concerns. Fertility and sterility; 2012;98(4):780-6. doi: 10.1016/j.fertnstert.2012.07.1104
Chrysostomou A. Swyer Syndrome in a Woman with Pure 46, XY Gonadal Dysgenesis, A Rare Disorder, Late Presentation: Case Report. Women’s Health & Gynecology; 2017;3(3)
DeFrias DVS, Okonkwo AM, Keh PC, et al. Cytopathology of the ovary. Cancer Treatment and Research; 2002;107:185-211. doi: 10.1007/978-1-4757-3587-1_8.
Kovanci E, Buster JE. Polycystic ovary syndrome. Bieber E (ed.) Clinical Gynecology içinde Cambridge: ebook; 2015. Second Edition.1024
Liu AL, Xie HJ, Xie HY, et al. Association between fat mass and obesity associated (FTO) gene rs9939609 A/T polymorphism and polycystic ovary syndrome: a systematic review and meta-analysis. BMC Medical Genetics; 2017;18:89 doi:10.1186/s12881-017-0452-1
Melo AS, Dias SV, Cavalli RC, et al. Pathogenesis of polycystic ovary syndrome: multifactorial assessment from the foetal stage to menopause. Reproduction; 2015; 150(1):R11-24. doi: 10.1530/REP-14-0499
Ajmal N, Khan SZ, Shaikh R. Polycystic ovary syndrome (PCOS) and genetic predisposition: A review article. European journal of obstetrics and reproductive biology; 2019; 3:100060 doi: 10.1016/j.eurox.2019.100060
Santoro N. Mechanisms of premature ovarian failure. Annales d’endocrinologie; 2003;64(2):87-92.
Goswami D, Conway GS. Premature ovarian failure. Human Reproduction Update; 2005;11(4):391–410 doi: 10.1093/humupd/dmi012
Kumar M, Pathak D, Kriplani A, et al. Nucleotide variations in mitochondrial DNA and supra-physiological ROS levels in cytogenetically normal cases of premature ovarian insufficiency. Archives of Gynecology and Obstetrics; 2010;282(6):695–705 doi:10.1007/s00404-010-1623-x.
Sousa M, Teixeira da Silva J, Silva J, et al. Embryological, clinical and ultrastructural study of human oocytes presenting indented zona pellucida. Zygote; 2015;23(1):145–157. doi: 10.1017/S0967199413000403.
Titus S, Li F, Stobezki R, et al. Impairment of BRCA1-related DNA double-strand break repair leads to ovarian aging in mice and humans. Science Translational Medicine; 2013;13;5(172): 172ra21. doi: 10.1126/scitranslmed.3004925
McTavish KJ, Jimenez M, Walters KA, et al. Rising follicle-stimulating hormone levels with age accelerate female reproductive failure. Endocrinology; 2007;148(9):4432–4439. doi: 10.1210/en.2007-0046
Ge ZJ, Schatten H, Zhang CL, et al. Oocyte ageing and epigenetics. Reproduction; 2015;149(3):R103–R114. doi: 10.1530/REP-14-0242
Briceag I, Costache A, Purcarea VL, et al. Fallopian tubes – literature review of anatomy and etiology in female infertility. Journal of medicine and life; 2015; 8(2): 129–131.
Rezvani M, Shaaban AM. Fallopian tube disease in the non pregnant patient. Radiographics; 2011;31(2):527–48 doi: 10.1148/rg.312105090.
Rapisarda G, Pappalardo EM, Arancio A, et al. Unilateral ovarian and fallopian tube agenesis. Archives of Gynecology and Obstetrics; 2009;280(5):849–850 doi: 10.1007/s00404-009-1018-z
Halbert SA, Patton DL, Zarutskie PW, et al. Function and structure of cilia in the fallopian tube of an infertile woman with Kartagener's syndrome. Human reproduction; 1997;12(1):55-8. doi: 10.1093/humrep/12.1.55
Pulkkinen MO, Jaakkola UM. Low serum progesterone levels and tubal dysfunction—A possible cause of ectopic pregnancy. American Journal of Obstetrics and Gynecology; 1989;161(4):934–937. doi:10.1016/0002-9378(89)90756-4
Lyons RA, Saridogan E, Djahanbakhch O. The reproductive significance of human Fallopian tube cilia. Human Reproduction Update; 2006;12(4):363–372. doi: 10.1093/humupd/dmI012.
Mitchell JA, Hammer RE. Effects of nicotine on oviductal blood flow and embryo development in the rat. Journal of Reproduction and Fertility;1985;74(1):71-76. doi: 10.1530/jrf.0.0740071.
Bouyer J, Coste J, Shojaei T, et all. Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. American Journal of Epidemiology; 2003;157(3),185–194. doi: 10.1093/aje/kwf190.
Knoll M, Talbot P. Cigarette smoke inhibits oocyte cumulus complex pick-up by the oviduct in vitro independent of ciliary beat frequency. Reproductive Toxicology; 1998; 12(1),57–68. doi:10.1016/s0890-6238(97)00100-7.
Matthews SJ, Shires S, Picton HM, et al. Pre- and post-natal tobacco exposure and tubal disease. Human Reproduction 17,Abstract Book; 2002; 1,80.
Lyons RA, Djahanbakhch O, Saridogan E, et al. Peritoneal fluid, endometriosis, and ciliary beat frequency in the human fallopian tube. Lancet; 2002;360(9341),1221–1222. doi:10.1016/S0140-6736(02)11247-5
Reeve L, Ledger WL, Pacey AA. Does the Arg-Gly-Asp (RGD) adhesion sequence play a role in mediating sperm interaction with the human endosalpinx? Human Reproduction; 2003;18(7),1461–1468 doi: 10.1093/humrep/deg296.
McGee ZA, Johnson AP, Taylor-Robinson D. Pathogenic mechanisms of Neisseria gonorrhoeae: observations on damage to human fallopian tubes in organ culture by gonococci of colony type 1 or type 4. The Journal of Infectious Diseases; 1981;143(3),413–422. doi:10.1093/infdis/143.3.413
Cooper MD, Rapp J, Jeffery-Wiseman C, et al. Chlamydia trachomatis infection of human fallopian tube organ cultures. Journal of General Microbiology; 1990; 136(6):1109–1115. doi: 10.1099/00221287-136-6-1109
Wiesenfeld HC, Hillier SL, Krohn MA, et al. Lower genital tract infection and endometritis: insight into subclinical pelvic inflammatory disease. Obstetrics and Gynecology; 2002;100(3),456–463. doi: 10.1016/s0029-7844(02)02118-x
Pıng WW. Sperm antıbody actıvıty ın human fallopıan tube fluıd. Fertility and Sterility; 1979;32(6):681-4. doi: 10.1016/s0015-0282(16)44419-5.
Gardner DK, Lane M, Calderon I, et al. Environment of the preimplantation human embryo in vivo: metabolite analysis of oviduct and uterine fluids and metabolism of cumulus cells. Fertility and Sterility; 1996;65(2):349–53 doi: 10.1016/s0015-0282(16)58097-2.
Hammoud AO, Gibson M, Peterson CM,et all. Quantification of the familial contribution to Mullerian anomalies. Obstetrics and Gynecology; 2008; 111, 378–384
Hassan MM, Lavery SA, Trew GH. Congenital uterine anomalies and their impact on fertility. Women's Health; 2010; 6(3), 443–461 doi: 10.2217/whe.10.19.
Brosens I, Pijnenborg R, Vercruysse L, et al. The “Great Obstetrical Syndromes” are associated with disorders of deep placentation. American Journal of Obstetrics and Gynecology; 2011;204(3):193–201. doi: 10.1016/j.ajog.2010.08.009.
Jarrell J. The significance and evolution of menstruation. Best Practice & Research. Clinical Obstetrics & Gynaecology; 2018;50:18–26.doi: 10.1016/j.bpobgyn.2018.01.007.
Shu-Wing Ng, Norwitz GA, Pavlicev M, et al. Endometrial Decidualization: The Primary Driver of Pregnancy Health. İnternational journal of molecular sciences; 2020;21(11): 4092. doi: 10.3390/ijms21114092
Kin K, Maziarz J, Chavan AR, et al. The transcriptomic evolution of mammalian pregnancy: Gene expression innovations in endometrial stromal fibroblasts. Genome Biology and Evolution; 2016;8(8):2459–2473. doi: 10.1093/gbe/evw168.
Bulletti C, Coccia ME, Battistoni S, et al. Endometriosis and infertility. Journal of Assisted Reproduction and Genetics.; 2010; 27(8): 441–447. doi: 10.1007/s10815-010-9436-1
Daunter B, Khoo SK. Role of cervical mucus in human infertility. The Australian & New Zealand journal of Obstetrics & Gynaecology;1984;24(4):271-5. doi: 10.1111/j.1479-828x.1984.tb01509.x.
Campisciano G, Florian F, D'Eustacchio A, et al. Subclinical alteration of the cervical–vaginal microbiome in women with idiopathic infertility. Journal of Cellular Physiology; 232(7), 1681–1688. doi:10.1002/jcp.25806
Riganelli L, Iebba V, Piccioni M, et al. Structural Variations of Vaginal and Endometrial Microbiota: Hints on Female Infertility. Frontiers in Cellular and Infection Microbiology; 2020; 10:350. doi: 10.3389/fcimb.2020.00350.
