OOSİT ÇIKIŞININ ÖNGÖRÜLMESİ : Kontrollü Ovaryan Hiperstimulasyon sikluslarında foliküllerden çıkan oosit sayısını nasıl maksimize edebiliriz?

Abstract

Öz Amaç: Üremeye Yardımcı Tekniklerin uygulamalarında oosit outputunu öngörerek, daha çok oosit toplamak ve IVF başarısını arttırmak için hangi değişkenleri kullanmamız gerektiğini incelemek amacıyla çalışmamızı design ettik. Gereç ve Yöntemler: 2016-2018arasında tersiyer bir üniversitenin IVF merkezine başvuran 412 infertil hasta retrospektif olarak değerlendirildi. KOH sonucu elde edilen foliküllerden OPU ile çıkan oosit sayıları yüzdelik dilimlere ayrılarak gruplandırıldı. Gruplarda oosit outputuna etkili değişkenler analiz edilerek, maximum sayıda oosit eldesini predikte edecek testleri tespit etmeye çalıştık. Bulgular: Hastaları oosit/≥14mm folikül oranlarına göre incelediğimizde, %10,2’sinin ≤%30, %4,1’inin %31-40, %6,6’sının %41-50, %2,9’unun %51-60, %5,6’sının %61-70, %8’inin %71-80, %4,9’unun %81-90 ve %57,8’inin %91-100 grubunda olduğu tespit edilmiştir. Çalışmamıza göre, oosit/≥14mm folikül oranına etkili değişkenler kadının yaşı, basal FSH (cut off 9,5mIU/mL, sensitivite 0,706 spesifite 0,621, p=0,001) ,basal LH (cutoff5,5mIU/mL, sensitivite0,640 spesifite0,690, p<0,001), AMH (cutoff 0,280ng/mL, sensitivite 0,748 spesifite 0,684, p<0,001), trigger günü E2 (cutoff388,50pg/mL, sensitivite 0,774spesifite 0,774, p<0,001)ve trigger günü ≥17 mm folikül sayısıdır.AMH için AUC 0,734 ve trigger günü E2 için AUC 0,768,basal LH için AUC 0,721 ile iyi derecede; basal E2 AUC 0,623, basal FSH 0,685ise düşük (poor) derecede prediktiftir. Sonuç: Oosit outputuna etkili değişkenler day2-4 FSH-LH, AMH, trigger günü E2, ve trigger günü ≥17mm folikül sayısıdır. AMH, basal LH ve trigger günü E2 oosit outputu için iyi derecede prediktiftir. Anahtar Kelimeler: Oosit output, Yardımcı Üreme Teknikleri, Oosit pick up

Keywords

• Oosit output
• Yardımcı Üreme Teknikleri
• Oosit pick up

PREDICTION OF OOCYTE OUTPUT: How can we maximize the oocyte retrieving from follicles in Controlled Ovarian Hyperstimulation cycles?

Abstract

PREDICTION OF OOCYTE OUTPUT: How can we maximize the oocyte retrieving from follicles in Controlled Ovarian Hyperstimulation cycles? Abstract Aim: We designed our study with the purpose of determining which variables should be used to predict oocyte output, to increase the number of collected oocytes and the success rate of IVF. Materials and Method: A total of 412 infertile patients admitted to the IVF center of a tertiary university hospital between the years 2016 and 2018 were evaluated retrospectively. The number of oocytes obtained by OPU from the follicles as the result of COH was grouped in percentiles. The variables effective on oocyte output were analyzed in the groups, and tests to predict acquisition of the maximal number of oocytes were tried to be determined. Results: When we investigated according to the oocyte/≥ 14 mm follicle ratios, we determined that 10.2% of the patients were in the ≤ 30% group, whereas 4.1% of them were in the group of 31-40 %. 6.6% of the patients were in the group of 41-50 %, 2.9% in the group of 51-60%, 5.6% in the group of 61-70 %, 8% in the group of 71-80%, 4.9% in the group of 81-90 %, and 57.8% in the group of 91-100 %. According to the results of our study, the variables effective on the oocyte/≥14 mm follicle ratio were the patient’s age, basal FSH value (cutoff 9.5mIU/mL, sensitivity 0.706, specificity 0.621, p=0.001), basal LH (cutoff 5.5mIU/mL, sensitivity 0.640 specificity 0.690, p<0.001), AMH (cutoff 0.280ng/mL, sensitivity 0.748 specificity 0.684, p<0.001), trigger day E2 (cutoff 388.50pg/mL, sensitivity 0.774, specificity 0.774, p<0.001) and the number of ≥17 mm follicles on the trigger day. The area under the curve (AUC) was 0.734for AMH, 0.768 for trigger day E2, and 0.721 for basal LH, having a good predictivity. The AUC was 0.623 for basal E2, and 0.685 for basal FSH value, having poor predictivity. Conclusion: The variables effective on oocyte output were the basal (day 2-4) FSH, LH, and AMH values, together with trigger day E2 value and the number of ≥17 mm follicles on the trigger day. AMH, basal LH, and trigger day E2 have good predictivity regarding oocyte output. Keywords: Oocyte output, Assisted Reproductive Technologies, Oocyte pick-up

Keywords

• Oocyte output
• Assisted Reproductive Technologies
• Oocyte pick-up

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