Infertilidade, procriação medicamente assistida e epigenética: espessura endometrial como fator preditivo de gravidez levada a termo
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2019-01-26
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A infertilidade é uma patologia complexa que pode apresentar causa conhecida ou ser idiopática. Já existem diversas técnicas que visam o seu tratamento, porém podem de alguma forma induzir algumas consequências no embrião. Na verdade, diversos fatores podem levar a alterações no sucesso dos ciclos de procriação medicamente assistida (PMA), e há uma grande necessidade de os entender, de forma a conseguir ultrapassá-los e alcançar o melhor proveito das técnicas disponíveis. O endométrio fino é uma das características da mulher que pode causar um impedimento para o sucesso dos ciclos de PMA. Também, a epigenética tem suscitado um grande interesse nos últimos anos, dado todas as suas implicações, quer no sucesso das técnicas, quer diretamente no desenvolvimento do embrião, quer nos potenciais efeitos transgeracionais. O presente estudo tem como principal objetivo perceber de que forma o endométrio fino está relacionado com os outcomes de ciclos de PMA e, através de pesquisa bibliográfica, elucidar sobre a relação das alterações epigenéticas e a infertilidade, e o desenvolvimento embrionário, tentando propor uma relação entre a epigenética e o endométrio fino. Pretendeu-se efetuar uma análise retrospetiva para investigar associações das alterações da espessura endometrial com variações nas taxas de gravidez e aborto, averiguando 1543 mulheres, que recorreram a ciclos de PMA entre 2015 e 2017. Dentro destas, 680 foram selecionadas e segmentadas pela presença de endométrio fino (≤7mm) ou endométrio normal (>7mm). Foi calculado um odds ratio como medida de associação entre a espessura endometrial e o sucesso das técnicas. Verificou-se que o endométrio fino é um fator de risco para o insucesso. Além das associações com o sucesso em geral, é importante entender concretamente a forma como a condição influencia os resultados e qual a fase em que é mais crítica. Foi clara a importância da epigenética no desenvolvimento embrionário e no sucesso das técnicas. Foi ainda estabelecida uma primeira abordagem da relação que as alterações epigenéticas podem ter no crescimento do endométrio e consequentemente na sua espessura. Assim, o presente estudo confirma o interesse do endométrio fino e realça a importância de novos estudos para compreender detalhadamente a origem desta condição, e a epigenética como uma causa para o seu desenvolvimento. Neste sentido, será vantajoso integrar este conhecimento de forma a contribuir para elucidar a causa do problema, aumentando a eficácia do tratamento clínico e o sucesso das técnicas de reprodução assistida.
Infertility is a complex pathology that can exhibit a known cause or be idiopathic. There are multiple techniques that aim its treatment, although they may induce consequences in the embryo. In fact, many factors may prompt variations in the success of the medically assisted procreation, and there is a big need to understand them, to overcome and achieve the most of the available techniques. Thin endometrium is one of woman characteristics that can cause an impediment on the success of the PMA cycles. Also, epigenetics has attracted a big interest over the years, given all its implications, whether in the success of the techniques, directly on the development of the embryo, or with the potential transgenerational effects. The present study has as main objective understand how the thin endometrium is related to the outcomes of PMA cycles and, through bibliographic research, elucidate about the relation of the epigenetic alterations and infertility, and embryo development, trying to propose a correlation between epigenetics and thin endometrium. It was intended to do a retrospective analysis to investigate associations between endometrial thickness and variations in pregnancy and abortion rate, 1543 women were included, which resorted to PMA cycles between 2015 and 2017. Among them, 680 were selected and segmented by the presence of a thin endometrium (≤7mm) ou normal endometrium (>7mm). An odds ratio was calculated as an association measure between endometrial thickness and the techniques success. It has been found that thin endometrium is a risk factor for pregnancy success. Besides to understand the associations with the success in general, it is important to comprehend concretely the way thin endometrium influences the results and in which phase is more critical. The importance of the epigenetics in the embryo development and in the techniques success was clear. It was yet established a first approach of the relation that the epigenetic alterations could have in the development of the endometrium thickness. Thus, the present study confirms the importance of thin endometrium and highlights the need of new studies to realise in detail the origin of this condition, and epigenetics as a cause to its development. This way, it would be useful to integrate this knowledge in order to contribute to elucidate the cause of the problem, arising the efficiency of the clinical treatment and the success of assisted reproduction techniques.
Infertility is a complex pathology that can exhibit a known cause or be idiopathic. There are multiple techniques that aim its treatment, although they may induce consequences in the embryo. In fact, many factors may prompt variations in the success of the medically assisted procreation, and there is a big need to understand them, to overcome and achieve the most of the available techniques. Thin endometrium is one of woman characteristics that can cause an impediment on the success of the PMA cycles. Also, epigenetics has attracted a big interest over the years, given all its implications, whether in the success of the techniques, directly on the development of the embryo, or with the potential transgenerational effects. The present study has as main objective understand how the thin endometrium is related to the outcomes of PMA cycles and, through bibliographic research, elucidate about the relation of the epigenetic alterations and infertility, and embryo development, trying to propose a correlation between epigenetics and thin endometrium. It was intended to do a retrospective analysis to investigate associations between endometrial thickness and variations in pregnancy and abortion rate, 1543 women were included, which resorted to PMA cycles between 2015 and 2017. Among them, 680 were selected and segmented by the presence of a thin endometrium (≤7mm) ou normal endometrium (>7mm). An odds ratio was calculated as an association measure between endometrial thickness and the techniques success. It has been found that thin endometrium is a risk factor for pregnancy success. Besides to understand the associations with the success in general, it is important to comprehend concretely the way thin endometrium influences the results and in which phase is more critical. The importance of the epigenetics in the embryo development and in the techniques success was clear. It was yet established a first approach of the relation that the epigenetic alterations could have in the development of the endometrium thickness. Thus, the present study confirms the importance of thin endometrium and highlights the need of new studies to realise in detail the origin of this condition, and epigenetics as a cause to its development. This way, it would be useful to integrate this knowledge in order to contribute to elucidate the cause of the problem, arising the efficiency of the clinical treatment and the success of assisted reproduction techniques.
Descrição
Dissertação de Mestrado em Biotecnologia para as Ciências da Saúde
Palavras-chave
Infertilidade , Técnicas de reprodução assistida , Endométrio , Epigenética