Tekrarlayan İmplantasyon Başarısızlığı Olan Açıklanamayan İnfertilite Olgularında Kronik Endometrit Sıklığının Histeroskopik Olarak Değerlendirilmesi: Altı Yıllık Deneyim

Abstract

Amaç: Tekrarlayan implantasyon başarısızlığı (TİB) olan açıklanamayan infertilite olgularında histeroskopik kronik endometrit (KE) insidansının değerlendirilmesi.
Araçlar ve Yöntem: Bu kesitsel retrospektif çalışmaya, Ocak 2014-Ağustos 2020 tarihleri arasında hastanemizin tüp bebek kliniğine başvurmuş olan 529 katılımcı dahil edilmiştir. Katılımcıların yaşları 18-39 aralığında değişmektedir. Katılımcılar, TİB olan açıklanamayan infertil olguları (Grup:1; n:187) ve TİB olmayan açıklanamayan infertil olguları (Grup:2; n:342) olmak üzere iki gruba ayrılmıştır.
Bulgular: Kadınların ortalama yaşı 31.6± 5.1 olup, katılımcılara ait ortalama vücut kitle indeksi (VKİ) 24.6± 2.5 olarak hesaplanmıştır. Histeroskopik bulgular ise şu şekildedir: 14 katılımcıda (%2.6) kronik endometritis, 19 katılımcıda (%3.6) polip bulunurken, katılımcıların 496'sında (%93.8) patolojik bulguya rastlanmamıştır. İki grup arasında yaş, VKİ, AMH seviyesi, toplam gonadotropin dozu, stimülasyon süresi, kazanılan oosit sayısı, MII ve PN bakımından istatiksel olarak anlamlı farklılık bulunmadığı görülmüştür. Yine, iki grup arasında, infertilite tipi (p=0.09) ve sigara kullanımı (p=0.5) bakımından istatistiksel olarak anlamlı bir fark bulunmamaktadır. Ancak test sayısı bakımından iki grup arasında istatistiksel olarak anlamlı bir farklılık (p=0.000) tespit edilmiştir. Ayrıca, iki grup arasında KE (p=0.1) ve polip (p=0.8) bakımından istatistiksel olarak anlamlı farklılık bulunmamış olup, endometriyal patoloji varlığı bakımından iki grup arasında istatistiksel olarak anlamlı farklılık (p<0.001) söz konusudur.
Sonuç: Bu çalışma, TİB olan kadınların daha yüksek KE insidansına sahip olmadığını, fakat bu hasta gruplarında endometriyal patolojilerin sayısının arttığını ortaya koymuştur. Bundan dolayı, açıklanamayan infertilitesi olan TİB hastalarında histeroskopi işleminin yapılması gerekmektedir. 

Keywords

• açıklanamayan infertilite
• histeroskopi
• kronik endometrit
• tekrarlayan implantasyon başarısızlığı

Hysteroscopic Evaluation of Chronic Endometritis Incidence in Unexplained Infertile Women with Recurrent Implantation Failure: Six Years Experience

Abstract

Purpose: To evaluate histeroscopically-proved chronic endometritis (CE) incidence in unexplained infertility cases with recurrent implantation failure (RIF).
Materials and Methods: This cross-sectional retrospective study was done on 529 participants who attended our hospital's infertility clinic from January 2014 to August 2020. The participants were at the age of 18-39 years. We divided the subjects into two groups, i.e., unexplained infertile patients with RIF (Group:1; n:187) and unexplained infertile patients without RIF (Group:2; n:342).
Results: The women had a mean age of 31.6 ±5.1 years. Hysteroscopic findings were as follows:14 (2.6%) had chronic endomet-ritis, 19 (3.6%) had polyps, and 496 (93.8%) had no pathological findings. Age, BMI, AMH level, total dose of gonadotropin, duration of stimulation, number of retrieved oocytes, Metaphase II (MII), and Pronucleus (PN) showed no significant difference between the two groups. Also, infertility type (P=0.09) and smoking(P=0.5) were not statistically different between the two gro-ups. In addition, the two groups showed no statistically significant difference in polyps (p=0.8) and CE (p=0.1), while the two groups showed a statistically significant difference in endometrial pathology (p<0.001).
Conclusion: In this study, it was shown that those with RIF did not show a higher incidence of CE, but endometrial pathologies were increased in this group of patients. So hysteroscopy should be done in RIF patients with unexplained infertility.

Keywords

• chronic endometritis
• hysteroscopy
• recurrent implantation failure
• unexplained infertility

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