Kontrollü Overyan Stimülasyon Protokollerinde rLH Tedaviye Eklenmeli mi?

Abstract

ÖZ Amaç: Kontrollü overyan hiper stimülasyon (KOH), in vitro fertilizasyon (IVF) tedavilerinin temeli durumundadır. Folükül stimüle edici hormon (FSH), antral folliküllerin büyümesinin temel düzenleyicisi iken, lüteinleştirici hormon (LH) da steroidogenezin desteklenmesinde etkindir. LH overyan stimülasyonda etkili olmasına rağmen, literatürde KOH’ a LH takviyesi eklenmesi hakkında net bir görüş birliği bulunmamaktadır. Bizde çalışmamızda kendi kliniğimizdeki olgularda;İn vitro fertilizasyon/intrasitoplazmik sperm enjeksiyonu (IVF/ICSI) uygulanan kadınlarda ,over stimülasyonu için, rekombinant luteinize edici hormonun (rLH) ve rekombinant folikül uyarıcı hormon (rFSH) ile tek başına rFSH kullanımının etkinliğini ve güvenliğini retrospektif olarak karşılaştırmayı amaçladık. Materyal Metod: Çalışmamıza Sakarya Üniversitesi Eğitim ve Araştırma Hastanesi Tüp Bebek Merkezinde 2019-2020 yılları arasında tedavi gören 89 infertil çift dahil edildi. IVF tedavisine alınan normal over fonksiyonuna sahip hastaların verileri incelendi. KOH için; yalnızca, rFSH(Gonal-F ) kullanan ve rFSH (Gonal-F ) ve r-LH (Luveris ) ‘ı birlikte kullanılan hastaların sonuçları retrospektif olarak karşılaştırıldı. Ayrıca 35 yaş üstü ve 35 yaş altı hasta grupları için rFSH, rFSH+rLH stimülasyon sonuçları alt grup olarak değerlendirildi. Çalışmamızda toplam oosit sayısı, toplam metafaz II(MII) sayıları ve gebelik oranları da karşılaştırıldı. Bulgular: Çalışmaya dahil olan seksen dokuz hastanın, 40’ ı rFSH (Grup 1) ve 49 da rFSH + rLH (Grup 2) grubundaydı. Tüm yaş grupları içinde değerlendirildiğinde, gruplar arasında total gonadotropin miktarı ve stimülasyon gün sayısı dışında istatistiksel fark görülen başka bir parametre izlenmedi.35 yaş üstü ve 35 yaş altı hastalar ayrı ayrı değerlendirildiğinde; oosit sayısı,toplam MII oositler, Grade I embriyo sayısı ve gebelik oranları bakımından, her iki grup arasında istatistiksel olarak anlamlı farklılık izlenmedi. Sonuç: 35 yaş ve üstü over reservi normal hasta grubunda r-LH ilave edilen ve edilmeyen stimülasyon protokolleri arasında, sonuçlar r-LH grubunda daha olumlu görülse de, istatistiksel olarak anlamlı fark görülmedi. Çalışmamızda, IVF_ICSI uygulamalarında kullanılan KOH protokollerine, r-LH ilavesinin tüm yaş gruplarında tedavi başarısı üzerinde etkinliğinin bulunmadığı görüldü. Bununla birlikte, hasta sayısının daha fazla olduğu çalışmaların yapılması gerektiğini kanaatindeyiz.

Keywords

• rLH
• İn Vitro Fertilizasyon
• Kontrollü Overyan Hiperstimülasyon

Should rLH Be Added to the Treatment in Controlled Ovarian Stimulation Protocols?

Abstract

ABSTRACT Background: Controlled ovarian hyperstimulation (KOH) is the basis of in vitro fertilization (IVF) treatments. At the same time, follicle-stimulating hormone (FSH) is the primary regulator of the growth of antral follicles. Luteinizing hormone (LH) is also effective in supporting steroidogenesis. Although LH is effective in ovarian stimulation, there is no clear consensus in the literature about adding LH supplementation to KOH. In our study, We aimed to compare to retrospectively analyzed the efficacy and safety of using recombinant luteinizing hormone (rLH) and recombinant follicle-stimulating hormone (rFSH) and rFSH alone for ovarian stimulation in women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in cases in our clinic. Materials and Methods: 89 infertile couples treated at Sakarya University Training and Research Hospital IVF Center between 2019-2020 included in our study. The data of patients with a normal ovarian function who treated with IVF were analyzed. For KOH, the results of patients who used rFSH (Gonal-F) alone and rFSH (Gonal-F) and r-LH (Luveris ) together were compared retrospectively. In addition, rFSH, rFSH+rLH stimulation results were evaluated as a subgroup for the patient groups over 35 years old and under 35 years old. Our study also compared the total number of oocytes, total metaphase II (MII) numbers, and pregnancy rates. Results: Of the 89 patients included in the study, 40 were in the rFSH group (Group 1), and 49 were in the rFSH + rLH (Group 2) group. No statistical difference was observed between the groups except the total gonadotropin amount and stimulation days When evaluated within all age groups. When the patients over 35 years old and under 35 years old assessed separately; There was no statistically significant difference between the two groups in terms of oocytes count, total MII oocytes, Grade I embryo count and clinical pregnancy rates. Conclusions: Although the results were more positive in the r-LH group, we could not detect a statistically significant difference between the stimulation protocols with and without r-LH in the 35-40 age range, a regular patient population with ovarian reserve. As in our study, we were adding r-LH to the controlled ovarian stimulation protocols used in IVF_ICSI applications does not seem to affect treatment success in women of all age groups. However, we believe that studies with a more significant number of patients should be conducted.

Keywords

• rLH
• İN VİTRO FERTİLİZATİON
• CONTROLLED OVARİAN HYPERSTİMULATİON

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