Евалуација на хормоните на хипофизо-гонадна и хипофизо-адренална оска како предиктори за појава на постпартална депресија при ин витро фертилизација

Abstract

Introduction: The most important life event for a married couple is the formation of their own family, usually planned as precisely as their education, career, finances, etc. That is why infertility, in one or in both partners, is a painful and devastating experience and is often a secret life crisis that couples experience in isolation. The development of reproductive medicine supported insemination techniques give hope to partners facing the problem of infertility. Prevention and protection of the mental health of women involved in the procedure with biologically supported fertilization is a current problem that is not sufficiently researched. The protection of the mental health of the future mother due to the wide reflection of postpartum psychological problems, especially postpartum depression is the main motive of the research. Objective: The general goal of the research is to evaluate the hormonal changes at the level of the pituitary-gonadal and pituitary-adrenal axis as potential predictors of postpartum depression in interaction with the psychological state of candidates for IVF treatment in women with spontaneous pregnancy. The research is also aimed at evaluating the impact of psychological counseling on the prevention of postpartum depression in women who have undergone IVF treatment. Material and method: The research is designed as a prospective study, which includes 90 respondents divided into two groups: • I Exam group consisting of 60 respondents involved in in vitro fertilization with long "Lupron" ovarian stimulation protocol; and • II control group consisting of 30 respondents with spontaneous pregnancy. Regarding the studies on the impact of psychological counseling on stress and anxiety in women during IVF treatment, the examined group is divided into two subgroups: I examined subgroup consisting of 30 respondents (with in vitro fertilization), included at random without psychological counseling and II examined subgroup consisting of 30 respondents (with in vitro fertilization) with psychological counseling. The included respondents meet the set inclusive research criteria. The basic method of research is the analytical-comparative procedure. Evaluation of hormonal fluctuations is performed by measuring the hormonal status of FSH, LH, Estradiol and serum Cortizol concentration before IVF treatment and 48 hours postpartum for the study group and immediately after conception and 48 hours postpartum for the control group. The psychological state is monitored by using psychological measuring instruments: Depression, Anxiety and Stress Scale (DAS scale) and Edinburgh Postpartum Depression Scale (EDPS). The DAS scale will be given in two phases at the beginning of IVF treatment and after delivery for the examined group, while the control group will be given for the first gynecological examination when pregnancy is determined and in the second phase after delivery. EDPS will be given after delivery. Results: The results of this study showed that hormonal fluctuations in pituitary-gonadal and pituitary-adrenal hormones are partly predictors of the risk of postpartum depression in IVF stimulated cycles with a long "Lupron" protocol. Also, that psychological counseling affects the reduction of stress and anxiety during IVF treatment and has a preventive effect on reducing the risk of postpartum depression in respondents treated with in vitro fertilization involved in psychological counseling.