IVF/ICSI YAPILAN HASTALARDA GEBELİK VE YENİDOĞAN SONUÇLARININ ÖNGÖRÜLMESİNDE HCG TETİKLEME GÜNÜNDEKİ ESTRADİOL'ÜN DEĞERLENDİRİLMESİ: RETROSPEKTİF KOHORT ÇALIŞMASI

Abstract

Amaç: Bu çalışmadaki amacımız, insan koryonik gonadotropin (hCG) tetikleme günündeki serum estradiolün (E2) gebelik (canlı doğum ile sonuçlanan gebelik, düşük, iu ex, kimyasal gebelik) sonuçlarını ve yenidoğan doğum ağırlığını tahmin etmedeki rolünü araştırmaktır. Gereç ve yöntemler: Bu retrospektif çalışma iki gruptan oluşturuldu: Grup 1: 22. gebelik haftasından sonra canlı doğum yapan kadınlardan (n= 417) ve grup 2: Klinik gebelik tanısı konulan kadınlardan (intrauterin ex, abortus, biyokimyasal ve anembriyonik gebelik) (n=260) oluşmaktadır. Demografik özellikler (anne ve baba yaşı, vücut kitle indeksi (VKİ), gravidite, düşük ve yaşayan çocuk) kaydedildi. Klinik endikasyonlar (erkek faktörü, azalmış over rezervi..), ovulasyon stimülasyon süresi, 3. gün (D3) E2, folikül uyarıcı hormon ve luteinize edici hormon düzeyleri, antral folikül sayısı, stimüle edici ajanların toplam dozları, tetikleme gününde progesteron ve estradiol düzeyleri , toplanan oosit sayısı, matür oosit sayısı, tetikleme ve oosit toplama gününde endometrial kalınlık iki grup arasında karşılaştırıldı. Canlı doğum ile sonuçlanamama riskine etki eden faktörleri belirlemek için Binary Logistic Regresyon, (Backward LR modeli) kullanıldı. Bulgular: Toplam 677 gebe çalışmaya dahil edildi. Tetikleme gününde E2 düzeyi yüksek olan gebelerde canlı doğum oranı daha yüksek bulundu. Tetikleme günündeki E2 düzeyi ile yenidoğan doğum ağırlığı arasında istatistiksel olarak anlamlı bir ilişki izlendi. (p=0,005). Erkek faktörü ve kadın yaşının canlı doğum ile sonuçlanamama durumunu etkileyen en önemli parametreler olduğu görüldü (p<0.05). Kadın yaşının 1 birim artması ile canlı doğum ile sonuçlanamama riskinin %5 artacağı bulundu. Sonuç: Tetikleme gününde E2 düzeyi arttıkça, canlı doğum oranı artarken yenidoğan doğum ağırlığı azalmıştır. Erkek faktörü ve kadın yaşının canlı doğum ile sonuçlanamama durumunu etkileyen önemli parametreler olduğu görülmüştür.

Keywords

• Estradiol
• in vitro fertilizasyon
• gebelik sonuçları
• doğum ağırlığı

EVALUATION OF ESTRADIOL ON THE HCG TRIGGER DAY IN PREDICTING PREGNANCY AND NEONATAL OUTCOMES OF PATIENTS UNDERGOING IVF/ICSI: A RETROSPECTIVE COHORT STUDY

Abstract

Aim: Our aim was to investigate the value of serum estradiol (E2) on human chorionic gonadotrophin (hCG) trigger day in predicting pregnancy (ongoing pregnancy with live birth, abortion, iu ex, chemical pregnancy) outcomes and neonatal birth weight. Material-Methods: This retrospective study consisted of two groups: Group 1: Women who had live birth, labor after 22 gestational week (n= 417). Group 2: Women with clinical pregnancy: intrauterine ex, abortus, biochemical and anembryonic pregnancy (n=260). Demographic characteristics (maternal and paternal ages, body mass index (BMI), gravidity, abortion, and living child) were recorded. Clinical indications (male factor, diminished ovarian reserve...), duration of ovulation stimulation, day 3 (D3) E2, follicle stimulating hormone and luteinizing hormone levels, antral follicle count, total doses of stimulating agents, progesteron and estradiol levels on trigger day, number of oocytes retrieved, number of mature oocytes, endometrial thickness on trigger and oocyte pick-up day were compared between the two groups. Binary Logistic Regression, (Backward LR model) was used to determine the factors affecting the risk of not having a live birth. Results: Totally 677 pregnant women were included in the study. We found increased live birth rate in pregnant whom E2 level was higher on the trigger day. There was a statistically significant relation between E2 level on trigger day and newborn weight in live birth (p=0.005) It was determined that the male factor and age of the women are an important parameter that affect not having a live birth (p<0.05). When the age of the woman increases by 1 unit, the risk of not having a live birth will increase by 5%. Conclusion: The E2 level on hCG trigger day increased, the live birth rate increased while the newborn birth weight decreased. It was also determined that the male factor and age of the women are an important parameter that affect not having a live birth.

Keywords

• Estradiol
• in vitro fertilization
• pregnancy outcomes
• birth weight

References

1. Referans1 Tarlatzi T, Venetis C, Sassi A, Devreker F, Englert Y, Delbaere A. Higher estradiol levels are associated with lower neonatal birthweight after fresh and frozen embryo transfers. A cohort study of 3631 singleton IVF pregnancies. Gynecological Endocrinology 2021;37(7):618-23.
2. Referans2 Qin JB, Sheng XQ, Wang H, Chen GC, Yang J, Yu H, et al. Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births: a systematic review and meta-analysis based on cohort studies. Archives of Gynecology and Obstetrics 2017;295(3):577-97.
3. Referans3 Imudia AN, Awonuga AO, Doyle JO, Kaimal AJ, Wright DL, Toth TL, et al. Peak serum estradiol level during controlled ovarian hyperstimulation is associated with increased risk of small for gestational age and preeclampsia in singleton pregnancies after in vitro fertilization. Fertility and Sterility 2012;97(6):1374-9.
4. Referans4 Pereira N, Elias RT, Christos PJ, Petrini AC, Hancock K, Lekovich JP, et al. Supraphysiologic estradiol is an independent predictor of low birth weight in full-term singletons born after fresh embryo transfer. Human Reproduction 2017;32(7):1410-7.
5. Referans5 Liu S, Kuang Y, Wu Y, Feng Y, Lyu Q, Wang L, et al. High oestradiol concentration after ovarian stimulation is associated with lower maternal serum beta-HCG concentration and neonatal birth weight. Reproductive Biomedicine Online 2017;35(2):189-96.
6. Referan6 Royster GDt, Krishnamoorthy K, Csokmay JM, Yauger BJ, Chason RJ, DeCherney AH, et al. Are intracytoplasmic sperm injection and high serum estradiol compounding risk factors for adverse obstetric outcomes in assisted reproductive technology? Fertility and Sterility 2016;106(2):363-70.e3.
7. Referans7 Khoueiry R, Ibala-Rhomdane S, Méry L, Blachère T, Guérin JF, Lornage J, et al. Dynamic CpG methylation of the KCNQ1OT1 gene during maturation of human oocytes. Journal of Medical Genetics 2008;45(9):583-8.
8. Referans8 Market-Velker BA, Zhang L, Magri LS, Bonvissuto AC, Mann MR. Dual effects of superovulation: loss of maternal and paternal imprinted methylation in a dose-dependent manner. Human Molecular Genetics 2010;19(1):36-51.

9. Referans9 Morita K, Ono Y, Takeshita T, Sugi T, Fujii T, Yamada H, et al. Risk Factors and Outcomes of Recurrent Pregnancy Loss in Japan. The Journal of Obstetrics and Gynaecology Research 2019;45(10):1997-2006.
10. Referans10 Sugiura-Ogasawara M, Ozaki Y, Kitaori T, Suzumori N, Obayashi S, Suzuki S. Live birth rate according to maternal age and previous number of recurrent miscarriages. American Journal of Reproductive Immunology 2009;62(5):314-9.
11. Referans11 Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertility and Sterility 2014;101(3):656-63.e1.
12. Referans12 Ata B, Kaplan B, Danzer H, Glassner M, Opsahl M, Tan SL, et al. Array CGH analysis shows that aneuploidy is not related to the number of embryos generated. Reproductive Biomedicine Online 2012;24(6):614-20.
13. Referans13 Luke B, Brown MB, Wantman E, Forestieri NE, Browne ML, Fisher SC, et al. The risk of birth defects with conception by ART. Human Reproduction 2021;36 (1):116-29.
14. Referans14 Broekmans FJ, Knauff EA, te Velde ER, Macklon NS, Fauser BC. Female reproductive ageing: current knowledge and future trends. Trends in Endocrinology and Metabolism 2007;18(2):58-65.
15. Referans15 Ghuman NK, Mair E, Pearce K, Choudhary M. Does age of the sperm donor influence live birth outcome in assisted reproduction? Human Reproduction 2016;31(3):582-90.
16. Referans16 Meng F, Goldsammler M, Buyuk E, Jindal SK. Live birth rate from euploid blastocysts is not associated with infertility etiology or oocyte source following frozen-thawed embryo transfer (FET): analysis of 4148 cycles reported to SART CORS. Journal of Assisted Reproduction and Genetics 2021;38(1):185-92.
17. Referans17 Van Loendersloot LL, Van Wely M, Limpens J, Bossuyt PM, Repping S, Van der Veen F. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Human Reproduction Update 2010;16(6):577-89.
18. Referans18 Smith A, Tilling K, Nelson SM, Lawlor DA. Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles. JAMA 2015;314(24):2654-62.
19. Referans19 Pereira N, Rosenwaks Z. A fresh(er) perspective on frozen embryo transfers. Fertility and Sterility 2016;106(2):257-8.
20. Referans20 Ishihara O, Araki R, Kuwahara A, Itakura A, Saito H, Adamson GD. Impact of frozen-thawed single-blastocyst transfer on maternal and neonatal outcome: an analysis of 277,042 single-embryo transfer cycles from 2008 to 2010 in Japan. Fertility and Sterility 2014;101(1):128-33.
21. Referans21 Mainigi M, Rosenzweig JM, Lei J, Mensah V, Thomaier L, Talbot CC, Jr., et al. Peri-Implantation Hormonal Milieu: Elucidating Mechanisms of Adverse Neurodevelopmental Outcomes. Reproductive Sciences 2016;23(6):785-94.
22. Referans22 Lee B, Kroener LL, Xu N, Wang ET, Banks A, Williams III J, et al. Function and Hormonal Regulation of GATA3 in Human First Trimester Placentation. Biology of Reproduction 2016;95(5):113.
23. Referans23 Pereira N, Petrini AC, Lekovich JP, Schattman GL, Rosenwaks Z. Comparison of perinatal outcomes following fresh and frozen-thawed blastocyst transfer. International Journal of Gynaecology and Obstetrics 2016;135(1):96-100.
24. Referans24 Simón C, Cano F, Valbuena D, Remohí J, Pellicer A. Clinical evidence for a detrimental effect on uterine receptivity of high serum oestradiol concentrations in high and normal responder patients. Human Reproduction 1995;10(9):2432-7.