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Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin ile Birlikte Luteal Uzun-Leuprolid Asetat ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması

Year 2008, Volume: 25 Issue: 4, 131 - 138, 29.12.2009

Abstract

Düşük over yanıtı tüp bebek ve ilgili yardımcı üreme teknolojilerinin en önemli sorunlarından biridir. Günümüzde düşük over yanıtlı olgularda etkinliği kanıtlanmış ve herkes tarafından kabul görmüş bir protokol yada ajan yoktur. Bu araştırmada daha önceden düşük yanıt vermiş olgularda yüksek doz rekombinant folikül stimulan hormonla birlikte gonadotropin analogunun folikuler fazda kesilmesi (stop-leuprolid asetat) ile gonadotropin analoguna ovulasyona kadar devam edilmesi (uzun leuprolid asetat) protokollerinin etkinliğini karşılaştırmayı amaçladık.
Bu çalışmaya daha önce intrastoplazmik sperm enjeksiyonu denemelerine düşük yanıt vermiş 19 hasta kabul edildi. Olgular iki gruba randomize edildi. Birinci gruba (n=8) luteal uzun leuprolid asetat, ikinci gruba (n=11) ise stop-leuprolid asetat protokolu uygulandı. Her iki gruba da yüksek doz (450IU/gün) rekombinant folikül stimulan hormon başlandı ve doz daha sonra azaltılarak ayarlandı.
Over yanıtını etkileyebilecek temel demografik ve endokrin değişkenler her iki grupta da benzerdi. Kullanılan ampül sayısı, stimulasyon süresi, iptal oranları, folikül sayısı, toplanan oosit sayısı ve transfer edilen embriyo sayıları arasında istatistiksel olarak anlamlı farklılık izlenmedi. Stop-leuprolid asetat uygulanan vakaların hiçbirinde erken luteal hormon salınmasına rastlanmadı. Olguların hiçbirinde gebelik izlenmedi.
Kötü over yanıtı olan olgularda stop-leuprolid asetat protokolü ve uzun leuprolid asetat protokolü over yanıtı üzerinde birbirlerine benzer etkileri bulundu. Stop-leuprolid asetat protokolu uygulanan olgularda erken luteal hormon salınması hiçbir olguda izlenmedi.
Anahtar kelimeler: Düşük over yanıtı, stop-leuprolid asetat protokolu, rekombinat gonodotropin


Stop-Leuprolide Acetate Protocol Does Not Yield a Better Ovarian Response Compared to Luteal Long Protocol with Recombinant Gonodotrophin in Patients with Poor Ovarian Response Undergoing Intracytoplasmic Injection
Poor ovarian response is a major factor limiting success in assisted reproduction. There is currently no agent or protocol that has been unequivocally proven to be successful in patients with poor ovarian response. Our objective in this study was to compare stop-leuprolide acetate and luteal long-leuprolide acetate protocols with using high dose recombinant follicule stimulating hormone.
19 patients with previous poor ovarian response during intracytoplasmic sperm injection cycle were included. Patient were randomized with computer produced numbers to luteal long- leuprolide acetate(n=8) and stop-leuprolide acetate (n=11). Recombinant follicule stimulating hormone was started on day three with starting dose of 450IU/day and the dose was induvidualized using step-down regimen. All patients had similar intracytoplasmic sperm injection cycle, embryo transfer and luteal support procedures
Both groups were comparable in terms of body mass index, female age, duration of infertility. All paremeters of ovarian response gonodotrophin dose, time reguired for stimulation, cancellation rate, number of mature oocytes and transfered embrios were comparable between two groups. None of the patients in the stop-leuprolide acetate exhibited a premature LH surge. We could not have any pregnancies in both groups.
We conclude that stop-leuprolide acetate protocol and luteal long- leuprolide acetate protocol have similar effect on ovarian response in poor responders. We did not observe any premature LH surge in the stop-leuprolide acetate group.
Key words: Poor ovarian response, stop-leuprolide acetate protocol, recombinant gonodotrophins

References

  • Keay SD, Liversedge NH, Mathur RS, et al. Assisted conception fallowing poor ovarian response to gonadotropin stimulation. Bri J Obstet Gynecol. 1997; 104: 521–27.
  • Surrey ES, Schoolcraft WB. Evaluating strategies for improving ovarian response of the poor responder. Undergoing assisted reproductive techniques Fertil Steril. 2000; 73: 668–675.
  • Loutradis D, Vomvolaki E, Drakakis P. Poor responder protocols for in-vitro fertilization: options and results. Current Opinion in Obstetrics and Gynecology 2008; 20: 374–378.
  • Tarlatzis BC, Zepiridis L,Grimbizis G,et al. Clinical management of low ovarian response to stimulation for IVF: a systematic review, Human Reproduction Update. 2003; 9(1): 61–76.
  • Surrey ES. Management of the poor responder: the role of GnRH agonists and antagonists. J Assist Reprod Genet 2007; 24: 613–619.
  • Beckers, NGM, Macklon, NS, Eijkemans, MJC and Fauser, BCJM. Women with regular menstrual cycles and a poor response to ovarian hyperstimulation for in vitro fertilization exhibit follicular phase characteristics suggestive of ovarian aging. Fertil. Steril. 2002; 78: 291–297.
  • Garcia JE, Jones CS, Acosta AA,et al. Human menopausal gonodotropin/human chorionic gonadotropin follicular maturation for oosit aspiration. Fertil Steril 1983; 62: 343–346.
  • Nikolaou, D, Lavery, S, Turner, C, et al. Is there a link between an extremely poor response to ovarian hyperstimulation and early ovarian failure? Hum Reprod 2002; 17: 1106–1111.
  • Maclanhan V, Besanco M, O’Shea F. Acontrolled study of luteinizing hormon releasing hormon agonist (buserilin) for the induction of foliculogenesis before in vitro fertilization. N Engl J Med 1989; 320: 1233–1237.
  • Hughes EG, Fedorkow DM, Daya S, et al. A routine use of gonodotropin releasing hormone agonist prior to in vitro fertilization and gamette intra fallopian transfer: a meta analysis of randomized trials. Fertil Steril 1992; 58: 888–896.
  • Droesch K, Muasher SJ, Brzyski RG, et al. Value of suppression with gonodotropin releasing hormone agonist prior to gonodotropin stimulation for in vitro fertilization. Fertil Steril; 1989, 51: 292-297.
  • Diedrich K, Diedrich C, Santos E, et al. Suppression of the endogenous luteinizing hormone surge by the gonadotropin releasing hormone antagonist cetrorelix during ovarian stimulation. Hum Reprod 1994; 9: 788–791.
  • Craft I, Giorgy A, Hill J, et al. Will GnRH antagonists provide new hope for patients considered “difficult responders” to GnRH agonist protocols? Hum Reprod 1999; 14: 2959–2962.
  • BenRafael Z, Lipitz S, Bider D, et al. Ovarian hyporesponsiveness in combined gonadoropin releasing hormon agonist and menotropin therapy is associated with low serum follicle hormon levels. Fertil Steril 1991; 55: 272–275.
  • Hugues JN, Cedrin-Dunerin I. Revisiting gonadotropin releasing hormane agonist protokols and management of poor responses to gonadotropins. Hum Reprod Update 1998; 4: 83–101.
  • Pelcier A, Miro F. Steroidogenesis in in vitro human granulosa cells pretreated in vivo with gonodotropin releasing hormone anologs. Fertil Steril 1990; 50: 590–596.
  • Bourgain C, Smitz J, Camus M, et al. Human endometrial maturation is markedly improved after luteal suplementation of gonodotropin releasing hormone anolog/human menopausal gonodotropin stimulated cycles. Hum Reprod 1994; 9: 32–4068.
  • Feldberg D, Fahri J, Benrafael Z. Minidose gonodotropin releasing hormone agonist is the treatment of choice in poor responders with high high follicle stimulating hormone levels. Fertil Steril 1994; 62: 343–346.
  • Faber BM, Mayer J, Cox B, et al. Cessation of gonodotropin releasing hormone agonist therapy combined with high dose gonodotropin stimulation yields favorable pregnancy results in low responders. Fertil Steril 1998; 69: 826–830.
  • Dirnfeld M, Fluchter O, Yshai D, et al. Cessation of gonadotropin releasing hormone analogue (GnRH-a) upon down regulation versus conventional long GnRH-a protokol in poor responders undergoing in vitro fertilization. Fertil Steril 1999; 72: 406–410.
  • Garcia-Velasco J, Isaza V, et al. High doses of gonadotropins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial. Hum Reprod 2000; 15: 2292–2296.
  • De Placido G, Alviggi C, Mollo A, et al. Recombinant follicle stimulating hormone is effective in poor responders to highly purified follicle stimulating hormone. Hum Reprod 2000; 15: 17- 20.
  • Raga F, Bonilla-Musoles F, et al. Recombinant follicle stimulating hormone stimulation in poor responders with normal basal concentrations of follicle stimulating hormone and oestradiol: improved reproductive outcome. Hum Reprod 1999; 14: 1431–1434.
  • Daya S, Gunby J. Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction. Hum Reprod 1999; 9: 1207–1215.
Year 2008, Volume: 25 Issue: 4, 131 - 138, 29.12.2009

Abstract

References

  • Keay SD, Liversedge NH, Mathur RS, et al. Assisted conception fallowing poor ovarian response to gonadotropin stimulation. Bri J Obstet Gynecol. 1997; 104: 521–27.
  • Surrey ES, Schoolcraft WB. Evaluating strategies for improving ovarian response of the poor responder. Undergoing assisted reproductive techniques Fertil Steril. 2000; 73: 668–675.
  • Loutradis D, Vomvolaki E, Drakakis P. Poor responder protocols for in-vitro fertilization: options and results. Current Opinion in Obstetrics and Gynecology 2008; 20: 374–378.
  • Tarlatzis BC, Zepiridis L,Grimbizis G,et al. Clinical management of low ovarian response to stimulation for IVF: a systematic review, Human Reproduction Update. 2003; 9(1): 61–76.
  • Surrey ES. Management of the poor responder: the role of GnRH agonists and antagonists. J Assist Reprod Genet 2007; 24: 613–619.
  • Beckers, NGM, Macklon, NS, Eijkemans, MJC and Fauser, BCJM. Women with regular menstrual cycles and a poor response to ovarian hyperstimulation for in vitro fertilization exhibit follicular phase characteristics suggestive of ovarian aging. Fertil. Steril. 2002; 78: 291–297.
  • Garcia JE, Jones CS, Acosta AA,et al. Human menopausal gonodotropin/human chorionic gonadotropin follicular maturation for oosit aspiration. Fertil Steril 1983; 62: 343–346.
  • Nikolaou, D, Lavery, S, Turner, C, et al. Is there a link between an extremely poor response to ovarian hyperstimulation and early ovarian failure? Hum Reprod 2002; 17: 1106–1111.
  • Maclanhan V, Besanco M, O’Shea F. Acontrolled study of luteinizing hormon releasing hormon agonist (buserilin) for the induction of foliculogenesis before in vitro fertilization. N Engl J Med 1989; 320: 1233–1237.
  • Hughes EG, Fedorkow DM, Daya S, et al. A routine use of gonodotropin releasing hormone agonist prior to in vitro fertilization and gamette intra fallopian transfer: a meta analysis of randomized trials. Fertil Steril 1992; 58: 888–896.
  • Droesch K, Muasher SJ, Brzyski RG, et al. Value of suppression with gonodotropin releasing hormone agonist prior to gonodotropin stimulation for in vitro fertilization. Fertil Steril; 1989, 51: 292-297.
  • Diedrich K, Diedrich C, Santos E, et al. Suppression of the endogenous luteinizing hormone surge by the gonadotropin releasing hormone antagonist cetrorelix during ovarian stimulation. Hum Reprod 1994; 9: 788–791.
  • Craft I, Giorgy A, Hill J, et al. Will GnRH antagonists provide new hope for patients considered “difficult responders” to GnRH agonist protocols? Hum Reprod 1999; 14: 2959–2962.
  • BenRafael Z, Lipitz S, Bider D, et al. Ovarian hyporesponsiveness in combined gonadoropin releasing hormon agonist and menotropin therapy is associated with low serum follicle hormon levels. Fertil Steril 1991; 55: 272–275.
  • Hugues JN, Cedrin-Dunerin I. Revisiting gonadotropin releasing hormane agonist protokols and management of poor responses to gonadotropins. Hum Reprod Update 1998; 4: 83–101.
  • Pelcier A, Miro F. Steroidogenesis in in vitro human granulosa cells pretreated in vivo with gonodotropin releasing hormone anologs. Fertil Steril 1990; 50: 590–596.
  • Bourgain C, Smitz J, Camus M, et al. Human endometrial maturation is markedly improved after luteal suplementation of gonodotropin releasing hormone anolog/human menopausal gonodotropin stimulated cycles. Hum Reprod 1994; 9: 32–4068.
  • Feldberg D, Fahri J, Benrafael Z. Minidose gonodotropin releasing hormone agonist is the treatment of choice in poor responders with high high follicle stimulating hormone levels. Fertil Steril 1994; 62: 343–346.
  • Faber BM, Mayer J, Cox B, et al. Cessation of gonodotropin releasing hormone agonist therapy combined with high dose gonodotropin stimulation yields favorable pregnancy results in low responders. Fertil Steril 1998; 69: 826–830.
  • Dirnfeld M, Fluchter O, Yshai D, et al. Cessation of gonadotropin releasing hormone analogue (GnRH-a) upon down regulation versus conventional long GnRH-a protokol in poor responders undergoing in vitro fertilization. Fertil Steril 1999; 72: 406–410.
  • Garcia-Velasco J, Isaza V, et al. High doses of gonadotropins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial. Hum Reprod 2000; 15: 2292–2296.
  • De Placido G, Alviggi C, Mollo A, et al. Recombinant follicle stimulating hormone is effective in poor responders to highly purified follicle stimulating hormone. Hum Reprod 2000; 15: 17- 20.
  • Raga F, Bonilla-Musoles F, et al. Recombinant follicle stimulating hormone stimulation in poor responders with normal basal concentrations of follicle stimulating hormone and oestradiol: improved reproductive outcome. Hum Reprod 1999; 14: 1431–1434.
  • Daya S, Gunby J. Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction. Hum Reprod 1999; 9: 1207–1215.
There are 24 citations in total.

Details

Primary Language English
Journal Section Surgery Medical Sciences
Authors

Deniz Karçaaltıncaba This is me

Hakan Yaralı This is me

Publication Date December 29, 2009
Submission Date December 25, 2009
Published in Issue Year 2008 Volume: 25 Issue: 4

Cite

APA Karçaaltıncaba, D., & Yaralı, H. (2009). Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin ile Birlikte Luteal Uzun-Leuprolid Asetat ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması. Journal of Experimental and Clinical Medicine, 25(4), 131-138. https://doi.org/10.5835/jecm.v25i4.1063
AMA Karçaaltıncaba D, Yaralı H. Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin ile Birlikte Luteal Uzun-Leuprolid Asetat ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması. J. Exp. Clin. Med. December 2009;25(4):131-138. doi:10.5835/jecm.v25i4.1063
Chicago Karçaaltıncaba, Deniz, and Hakan Yaralı. “Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin Ile Birlikte Luteal Uzun-Leuprolid Asetat Ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması”. Journal of Experimental and Clinical Medicine 25, no. 4 (December 2009): 131-38. https://doi.org/10.5835/jecm.v25i4.1063.
EndNote Karçaaltıncaba D, Yaralı H (December 1, 2009) Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin ile Birlikte Luteal Uzun-Leuprolid Asetat ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması. Journal of Experimental and Clinical Medicine 25 4 131–138.
IEEE D. Karçaaltıncaba and H. Yaralı, “Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin ile Birlikte Luteal Uzun-Leuprolid Asetat ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması”, J. Exp. Clin. Med., vol. 25, no. 4, pp. 131–138, 2009, doi: 10.5835/jecm.v25i4.1063.
ISNAD Karçaaltıncaba, Deniz - Yaralı, Hakan. “Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin Ile Birlikte Luteal Uzun-Leuprolid Asetat Ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması”. Journal of Experimental and Clinical Medicine 25/4 (December 2009), 131-138. https://doi.org/10.5835/jecm.v25i4.1063.
JAMA Karçaaltıncaba D, Yaralı H. Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin ile Birlikte Luteal Uzun-Leuprolid Asetat ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması. J. Exp. Clin. Med. 2009;25:131–138.
MLA Karçaaltıncaba, Deniz and Hakan Yaralı. “Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin Ile Birlikte Luteal Uzun-Leuprolid Asetat Ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması”. Journal of Experimental and Clinical Medicine, vol. 25, no. 4, 2009, pp. 131-8, doi:10.5835/jecm.v25i4.1063.
Vancouver Karçaaltıncaba D, Yaralı H. Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin ile Birlikte Luteal Uzun-Leuprolid Asetat ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması. J. Exp. Clin. Med. 2009;25(4):131-8.