{"id":465,"date":"2022-12-27T23:33:37","date_gmt":"2022-12-27T22:33:37","guid":{"rendered":"https:\/\/antikoncepcia.org\/?p=465"},"modified":"2022-12-29T10:51:52","modified_gmt":"2022-12-29T09:51:52","slug":"navrat-plodnosti-po-odstraneni-lng-iud","status":"publish","type":"post","link":"https:\/\/antikoncepcia.org\/?p=465","title":{"rendered":"N\u00e1vrat plodnosti po odstr\u00e1nen\u00ed LNG-IUD"},"content":{"rendered":"

V dostupnej literat\u00fare je st\u00e1le nedostatok \u00fadajov o dlhodobej bezpe\u010dnosti pou\u017e\u00edvania IUD-LNG <\/span>(vn\u00fatromaternicov\u00e9 teliesko uvo\u013e\u0148uj\u00face levonorgestrel\u00a0 (LNG)), a to najm\u00e4 v s\u00favislosti s n\u00e1vratom plodnosti u \u017eien, ktor\u00e9 za\u010dali pou\u017e\u00edva\u0165 LNG-IUD u\u017e po\u010das dospievania.i<\/sup><\/a> \u0160t\u00fadie, ktor\u00e9 hodnotia n\u00e1vrat plodnosti po ukon\u010den\u00ed pou\u017e\u00edvania LNG-IUD zah\u0155\u0148aj\u00fa do \u0161t\u00fadie len ve\u013emi m\u00e1lo mlad\u00fdch \u017eien, ktor\u00e9 e\u0161te nerodili a prim\u00e1rne sa zameriavaj\u00fa na n\u00e1vrat k plodnosti po krat\u0161om trvan\u00ed pou\u017e\u00edvania LNG-IUD (v priemere krat\u0161ie ako 5 rokov). V\u00a0\u0161t\u00fadii, ktor\u00fa vykonali Gemzell-Danielsson a\u00a0kol.<\/i> (2017), miera po\u010datia po ukon\u010den\u00ed pou\u017e\u00edvania LNG-IUD 12 (uvo\u013e\u0148uj\u00face 12 \u03bcg levonorgestrelu\/hod) bola 71.2% do 12 mesiacov. Vek \u017eien zahrnut\u00fdch do \u0161t\u00fadie bol <\/span>18 \u2013 35 rokov (priemern\u00fd vek <\/span>27.1 rokov). Podiel \u017eien, ktor\u00e9 e\u0161te nerodili bol <\/span>39.5%.ii<\/sup><\/a> Perriera a\u00a0kol.<\/i> (2016) zistili n\u00e1vrat men\u0161tru\u00e1cie do troch mesiacov po odstr\u00e1nen\u00ed LNG-IUD (52 mg) u\u00a099,7 % \u017eien. U \u017eien vo veku 16 \u2013 35 rokov bola stredn\u00e1 hodnota pou\u017e\u00edvania LNG-IUD 26 mesiacov. Do 6 mesiacov od ukon\u010denia pou\u017e\u00edvania LNG-IUD otehotnelo 70% \u017eien.iii<\/sup><\/a> V Eur\u00f3pskej randomizovanej multicentrickej \u0161t\u00fadi\u00ed vykonanej v\u00a05 krajin\u00e1ch (Andersson a\u00a0kol., 1992<\/i>), hrub\u00e1 kumulat\u00edvna miera po\u010datia po ukon\u010den\u00ed pou\u017e\u00edvania LNG-IUD bola 79.1% do 12 mesiacoch a\u00a086.6% do 24 mesiacoch. Vek \u017eien zahrnut\u00fdch do \u0161t\u00fadie bol <\/span>18 \u2013 36 rokov (priemern\u00fd vek <\/span>27.0 rokov). <\/span>Priemern\u00e1 d\u013a\u017eka pou\u017e\u00edvania LNG-IUD bola 19 mesiacov.iv<\/sup><\/a><\/span><\/span><\/p>\n

Jedn\u00fdm z\u00a0mechanizmov, ktor\u00fdm LNG-IUD m\u00f4\u017ee negat\u00edvne ovplyvni\u0165 n\u00e1vrat plodnosti, s\u00fa v\u00fdrazne morfologick\u00e9 zmeny na sliznici maternice. Ke\u010f\u017ee levonorgestrel (LNG) je z\u00a0vn\u00fatromaternicov\u00e9ho telieska uvo\u013enen\u00fd priamo do sliznice maternice, dosahuje v\u00a0nej ve\u013emi vysok\u00e9 koncentr\u00e1cie, ktor\u00e9 s\u00fa mnohon\u00e1sobne vy\u0161\u0161ie ako tie, ktor\u00e9 dosahuje v\u00a0sliznici maternice, ke\u010f sa pou\u017e\u00edva vo forme tabliet.v<\/sup><\/a> <\/b>Vysok\u00e9 koncentr\u00e1cie LNG sp\u00f4sobuj\u00fa v\u00a0sliznici maternice v\u00fdznamn\u00e9 \u00a0morfologick\u00e9, histologick\u00e9 a\u00a0biochemick\u00e9 zmeny.vi<\/sup><\/a> vii<\/sup><\/a> V\u00a0\u0161t\u00fadii, ktor\u00fa vykonali Hejmadi <\/a>a kol.<\/i> (2007), zmeny na sliznici maternice zahr\u0148ovali najm\u00e4 pseudodecidualiz\u00e1ciu (bola pozorovan\u00e1 u\u00a098% pr\u00edpadov; pseudodecidualiz\u00e1cia je komplex morfologick\u00fdch a\u00a0funk\u010dn\u00fdch zmien na sliznici maternice, ktor\u00e9 s\u00fa podobn\u00e9 t\u00fdm, ktor\u00e9 sa vyskytuj\u00fa v skor\u00fdch \u0161t\u00e1di\u00e1ch tehotenstva), mucin\u00f3zne zmeny (55,7%), zvredovatenie (41.5%), zv\u00e1penatenie (10.4%), nepravideln\u00e9 bunkov\u00e9 jadr\u00e1 (18.6%) a lo\u017eiskov\u00fa \u017e\u013eazov\u00fa metapl\u00e1ziu (53.9%).viii<\/sup><\/a><\/span><\/p>\n

\u0160t\u00fadie, ktor\u00e9 sledovali expresiu g\u00e9nov v\u00a0sliznici maternice po zaveden\u00ed LNG-IUD preuk\u00e1zali zv\u00fd\u0161en\u00fa expresiu IGFBP1 (Insulin-like Growth Factor Binding Protein 1) a\u00a0prolakt\u00ednu, ktor\u00e9 sa pova\u017euj\u00fa za ukazovatele pseudodecidualiz\u00e1cie a\u00a0atrofie (zmen\u0161enia) sliznice maternice.ix<\/sup><\/a> x<\/sup><\/a> xi<\/sup><\/a> \u010eal\u0161\u00edm mechanizmom oddia\u013euj\u00facim n\u00e1vrat plodnosti u pou\u017e\u00edvateliek LNG-IUD je zn\u00ed\u017een\u00e1 expresia estrog\u00e9nov\u00fdch aj progester\u00f3nov\u00fdch receptorov v\u00a0sliznici maternice po jeho zaveden\u00ed, hoci expresia sa postupne vracia na v\u00fdchodiskov\u00fa hodnotu po 6 a\u017e 12 mesiacoch.xii<\/sup><\/a> xiii<\/sup><\/a> xiv<\/sup><\/a> V\u00a0\u0161t\u00fadii, ktor\u00fa vykonali Smith-McCune<\/i> a\u00a0kol.<\/i> (2020), mali pou\u017e\u00edvate\u013eky LNG-IUD v\u00a0sliznici maternice v\u00a0porovnan\u00ed so \u017eenami, ktor\u00e9 ho nepou\u017e\u00edvali, odli\u0161ne exprimovan\u00fdch a\u017e 2 509 g\u00e9nov reguluj\u00facich predov\u0161etk\u00fdm imunitn\u00e9 a z\u00e1palov\u00e9 dr\u00e1hy.xv<\/sup><\/a> Je pravdepodobn\u00e9, \u017ee u niektor\u00fdch \u017eien m\u00f4\u017ee<\/span> dlhodob\u00e9 pou\u017e\u00edvanie LNG-IUD vies\u0165 k pretrv\u00e1vaj\u00facemu naru\u0161eniu hr\u00fabky a\u00a0funkcie sliznice maternice, \u010di u\u017e z d\u00f4vodu<\/span> zn\u00ed\u017eenej odpovede na stimul\u00e1ciu estradiolom (stav sp\u00f4soben\u00fd chronick\u00fdm zn\u00ed\u017een\u00edm estrog\u00e9nov\u00fdch receptorov), alebo dokonca z\u00a0d\u00f4vodu<\/span> rezistencie na progester\u00f3n.xvi<\/sup><\/a><\/span><\/p>\n

Vn\u00fatromaternicov\u00e9 telieska m\u00f4\u017eu sp\u00f4sobi\u0165 neplodnos\u0165 taktie\u017e sekund\u00e1rne v\u00a0d\u00f4sledku z\u00e1palov\u00fdch ochoren\u00ed panvy (PID).xvii<\/sup><\/a> <\/b>Pokia\u013e je n\u00e1m zn\u00e1me, nie s\u00fa k\u00a0dispoz\u00edcii \u0161t\u00fadie, ktor\u00e9 by sk\u00famali, ako vpl\u00fdva pou\u017e\u00edvanie LNG-IUD po\u010das adolescencie na tzv. TRGs (Tumor Related Genes) hypotalamick\u00fa sie\u0165, ktor\u00e1 v\u00a0spolupr\u00e1ci s\u00a0\u010fal\u0161\u00edmi g\u00e9nmi hr\u00e1 v\u00fdznamn\u00fa \u00falohu nielen v\u00a0\u0161tarte puberty a regul\u00e1cii reproduk\u010dn\u00e9ho v\u00fdvinu, ale aj pri tvorbe alebo potl\u00e1\u010dan\u00ed n\u00e1dorov.xviii<\/sup><\/a> xix<\/sup><\/a><\/span><\/p>\n

Aktu\u00e1lna literat\u00fara o n\u00e1vrate k plodnosti po pou\u017eit\u00ed LNG-IUD ukazuje, \u017ee do 1 roka od jeho odstr\u00e1nenia otehotnie pribli\u017ene 70 \u2013 75% \u017eien. To ale nazna\u010duje, \u017ee miera neplodnosti po odstr\u00e1nen\u00ed LNG-IUD m\u00f4\u017ee by\u0165 dvojn\u00e1sobn\u00e1 oproti be\u017ene uv\u00e1dzanej miere neplodnosti vo v\u0161eobecnej popul\u00e1cii, ktor\u00e1 je pribli\u017ene 15%.xx<\/sup><\/a> Navy\u0161e, ch\u00fdbaj\u00fa pozorovacie a randomizovan\u00e9 kontrolovan\u00e9 \u0161t\u00fadie, ktor\u00e9 by preuk\u00e1zali, \u017ee zavedenie LNG-IUD u\u017e po\u010das adolescencie a\u00a0jeho dlhodob\u00e9 pou\u017e\u00edvanie neovplyv\u0148uje n\u00e1sledn\u00fa plodnos\u0165.<\/span><\/p>\n

Odborn\u00e9 pramene<\/strong><\/em><\/div>\n

i<\/a> Zgliczynska M, Kocaj K, Szymusik I, et al. Levonorgestrel-Releasing Intrauterine System as a Contraceptive Method in Nulliparous Women: A Systematic Review. Journal of Clinical Medicine.2020;9(7):2101.<\/span><\/p>\n

ii<\/a> Gemzell-Danielsson K, Apter D, Dermout S, et al. Evaluation of a new, low-dose levonorgestrel intrauterine contraceptive system over 5 years of use. <\/span>European Journal of Obstetrics, Gynecology, and Reproductive Biology.<\/span> 2017 Mar;210:22-28.<\/span><\/p>\n

iii<\/a> Perriera LK, Blumenthal PD, Stuart GS, et al. \u00a0Return of Spontaneous Menses and Fertility After Removal of the Liletta Levonorgestrel Intrauterine System [4O]. <\/i>Obstetrics & Gynecology. 2016 May;127:123S\u2013124S.<\/span><\/p>\n

iv<\/a> Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception. 1992 Dec;46(6):575-84.<\/span><\/p>\n

v<\/a> Nilsson CG<\/a>, Haukkamaa M<\/a>, Vierola H<\/a>, et al. Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD. Clinical Endocrinology. 1982 Dec;17(6):529-36.<\/span><\/p>\n

vi<\/a> Chai M, Su S, Dong B. Morphological and Ultrastructural Changes in Human Endometrium Following Low-Dose Levonorgestrel Contraceptive Intrauterine Systems (LNG-IUS-12) 13.5\u00a0mg. Journal of Obstetrics and Gynaecology of India.2015;65(5):323-327. <\/span><\/p>\n

vii<\/a> Sitruk-Ware R<\/a>, Inki P<\/a>. The levonorgestrel intrauterine system: long-term contraception and therapeutic effects. Women’s Health. 2005 Sep;1(2):171-82.<\/span><\/p>\n

viii<\/a> Hejmadi RK<\/a>, Chaudhri S<\/a>, Ganesan R<\/a>, Rollason TP<\/a>. Morphologic changes in the endometrium associated with the use of the mirena coil: a retrospective study of 106 cases. International Journal of Surgical Pathology. 2007 Apr;15(2):148-54. <\/span><\/p>\n

ix<\/a> Goldfien GA, Barragan F, Chen J, et al. Progestin-Containing Contraceptives Alter Expression of Host Defense-Related Genes of the Endometrium and Cervix. Reproductive Sciences. 2015;22(7):814-828. <\/span><\/p>\n

x<\/a> Jones RL, Critchley HO. Morphological and functional changes in human endometrium following intrauterine levonorgestrel delivery. Human Reproduction. 2000 Aug;15 Suppl 3:162-72. <\/span><\/p>\n

xi<\/a> Rutanen EM. Insulin-like growth factors and insulin-like growth factor binding proteins in the endometrium. Effect of intrauterine levonorgestrel delivery. Human Reproduction. 2000 Aug;15 Suppl 3:173-81.<\/span><\/span><\/p>\n

xii<\/a> Rutanen EM. Insulin-like growth factors and insulin-like growth factor binding proteins in the endometrium. Effect of intrauterine levonorgestrel delivery. Human Reproduction. 2000 Aug;15 Suppl 3:173-81<\/span><\/span><\/p>\n

xiii<\/a> Engemise SL<\/a>, Willets JM<\/a>, Taylor AH<\/a>, et al. Changes in glandular and stromal estrogen and progesterone receptor isoform expression in eutopic and ectopic endometrium following treatment with the levonorgestrel-releasing intrauterine system. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2011 Jul;157(1):101-6.<\/span><\/p>\n

xiv<\/a> Vereide AB<\/a>, Kaino T<\/a>, Sager G<\/a>, et al. Effect of levonorgestrel IUD and oral medroxyprogesterone acetate on glandular and stromal progesterone receptors (PRA and PRB), and estrogen receptors (ER-alpha and ER-beta) in human endometrial hyperplasia. Gynecologic Oncology. 2006 May;101(2):214-23. <\/span><\/p>\n

xv<\/a> Smith-McCune K, Thomas R, Averbach S, et al. Differential Effects of the Hormonal and Copper Intrauterine Device on the Endometrial Transcriptome. Scientific Reports. <\/i>2020;10(1):6888. <\/span><\/p>\n

xvi<\/a> Dinehart E, Lathi RB, Aghajanova L. Levonorgestrel IUD: is there a long-lasting effect on return to fertility?. Journal of Assisted Reproduction and Genetics. 2020;37(1):45-52. <\/span><\/p>\n

xvii<\/a> Girum T, Wasie A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. <\/span>Contraception and Reproductive Medicine. 2018 Jul 23;3:9. <\/span><\/span><\/p>\n

xviii<\/a> Toro CA, Aylwin CF, Lomniczi A. Hypothalamic epigenetics driving female puberty. Journal of Neuroendocrinology.2018;30(7):e12589. <\/span><\/p>\n

xix<\/a> Lomniczi A<\/a>, Wright H<\/a>, Ojeda SR<\/a>, et al. Epigenetic regulation of female puberty. Frontiers in Neuroendocrinology. 2015 Jan;36:90-107.<\/span><\/p>\n

xx<\/a> Dinehart E, Lathi RB, Aghajanova L. Levonorgestrel IUD: is there a long-lasting effect on return to fertility?. Journal of Assisted Reproduction and Genetics.<\/span> 2020;37(1):45-52.<\/span> <\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

V dostupnej literat\u00fare je st\u00e1le nedostatok \u00fadajov o dlhodobej bezpe\u010dnosti … <\/p>\n","protected":false},"author":1,"featured_media":466,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[155,42,57,43],"tags":[356,188,189,354,357,355,359,360,187,358,44],"class_list":["post-465","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clanky","category-neplodnost","category-zdravie","category-zmeny-na-sliznici-maternice","tag-igfbp1","tag-iud","tag-lng","tag-navrat-plodnosti","tag-prolaktin","tag-pseudodecidualizacia","tag-trgs","tag-tumor-related-genes","tag-vnutromaternicove-teliesko","tag-zapalove-ochorenia-panvy","tag-zmeny-na-sliznici-maternice"],"_links":{"self":[{"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/posts\/465","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=465"}],"version-history":[{"count":1,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/posts\/465\/revisions"}],"predecessor-version":[{"id":467,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/posts\/465\/revisions\/467"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/media\/466"}],"wp:attachment":[{"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=465"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=465"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=465"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}