Antagonist/Agonist İn Vitro Fertilizasyon Sikluslarında Hcg Günü Serum Progesteron Konsantrasyonu ile Oosit Maturasyonu, Embriyo Kalitesi ve İmplantasyon Başarısı Arasındaki İlişkinin İncelenmesi

Year 2021, Volume: 11 Issue: 3, 516 - 522, 22.09.2021

Özcan Budak , Songül Doğanay , Seda Özkuler , Nermin Akdemir , Nureddin Cengiz Serhan Cevrioğlu

https://doi.org/10.31832/smj.939080

Abstract

ÖZ
Amaç: Kontrollü overyan hiperstimülasyon (KOH) tedavilerinde, Prematür Lüteinizasyon (PL) ve gebelik sonucunu saptamak için net bir progesteron (P) eşik değeri yoktur. Her kliniğin PL için P eşik değeri belirlemesi önerilmektedir. Çalışmamızda kliniğimizdeki PL nedeni olan P eşik değerini elde etmeyi amaçladık.
Gereç ve Yöntemler: Tüp bebek merkezimize in vitro fertilizasyon (IVF) tedavisi için gelen 119 çiftimize ait tedavi protokolleri retrospektif olarak değerlendirildi. Human Koryonik Gonadotropini (HCG) günü serum P seviyelerinin 1,2 ng/mL konsantrasyonların üzerinde ve altındaki değerlerde olmasının IVF- İntrasitoplazmik Sperm Enjeksiyonu (ICSI) siklus parametrelerine etkisi incelendi. Parametre kriterleri olarak toplam oosit sayısı, metafaz II (M II) oosit sayısı, fertilize oosit sayısı, transfer günü grade 1 embriyo sayıları ve transfer sonrası saptanan HCG pozitiflikleri incelendi.
Bulgular: Serum P eşik seviyesi 1,2 ng/mL sınır olarak alındığında PL görülme oranı %28,6 di. Çalışma grubunun genel tedavi çıktıları incelendiğinde agonist (n:42) veya antagonist (n:77) protokolleri arasında, M II oosit sayısı ve endometriyum kalınlığı antagonist grupta agonist gruba kıyasla istatistiksel açıdan anlamlı olarak yüksek bulundu (sırasıyla; p=0.038; p=0,017). Siklus tipi dahil edilmeden P eşik değeri 1,2 ng/mL olarak kabul edildiğinde bu değerin altında(n:85) ve üstünde(n:34) bulunan sikluslar karşılaştırıldı. HCG günü Estardiol (E2) ve P değerleri ile fertilize oosit sayısı, Grade1 embriyo sayıları arasında istatistiksel olarak anlamlı farklar görüldü. (sırasıyla p=0,041; p=0,000; p=0,041 ve p= 0,003).
Sonuç: Serum P eşiği 1,2 ng / mL alındığında, bu değerin altındaki ve üstündeki P değerlerinde gruplar karşılaştırıldığında, Serum P eşiği 1,2 ng / mL altında olan grup lehine fertilize oosit sayısı, transfer günü Grade1 embriyo sayıları ile E2 hormon düzeyleri arasında istatistiksel olarak anlamlı farklar görüldü. Bu bulgulara rağmen iki grubun gebelik oranları yönünden farklılık bulunamadı. Konu hakkında daha etkin sonuçlara ulaşmak için daha fazla hasta sayısıyla yapılan çalışma verilerine ihtiyaç duyulmaktadır.

Keywords

: Progesteron, Prematür Lüteinizasyon, İn vitro fertilizasyon

Supporting Institution

HERHAN GİR DESTEKLEYEN KURUM BUUNMAMAKTADIR

Antagonıst/Agonıst In Vıtro Fertılızatıon Cycles Investıgatıon of The Relatıonshıp Between Hcg Day Serum Progesterone Concentratıon and Oocyte Maturatıon, Embryo Qualıty and Implantatıon Success

Abstract

Objective: There is no clear progesterone (P) threshold value to detect Premature Luteinization (PL) and pregnancy outcome in controlled ovarian hyperstimulation (COH) treatments. Therefore, clinics are advised to set their own P thresholds for PL. In our study, we aimed to obtain the P threshold value, which is the cause of PL in our clinic.

Material and Methods: Treatment protocols of 119 couples who came to our assisted reproductive techniques center for in vitro fertilization (IVF) treatment were evaluated retrospectively. In our study, the effect of serum P levels above and below the 1.2 ng/mL threshold value on the day of Human Chorionic Gonadotropin (HCG) on IVF- Intracytoplasmic Sperm Injection (ICSI) cycle parameters were investigated. During the evaluation, the total number of oocytes, the number of metaphase II (M II) oocytes, the number of fertilized oocytes, the number of grade 1 embryos on the day of transfer and the HCG positivity values detected after the transfer were examined.

Results: In case of serum P threshold value of 1.2 ng/mL, the incidence of PL was found to be 28.6%. When the treatment results of the study group were examined, M II oocyte count and endometrial thickness were found to be statistically significantly higher in the antagonist group in terms of using agonist (n:42) or antagonist (n:77) protocol (respectively; p=0.038; p=0.017). Regardless of the protocol of cycle, patients with a P threshold value (1.2 ng/mL) below (n:85) and above (n:34) were compared. In this evaluation, there were statistically significant differences between Estradiol (E2) and P values on the HCG day, and the number of fertilized oocytes and Grade1 embryos. (p=0.041; p=0.000; p=0.041 and p= 0.003), respectively.

Conclusion: When the serum P threshold value was taken as 1.2 ng / mL, statistically significant differences were observed between the number of fertilized oocytes, the number of Grade1 embryos on the day of transfer and E2 hormone levels in favor of the patient group below this value. However, no difference was found between the two groups in terms of pregnancy rates. In order to reach more effective results on the subject, study data with a larger number of patients is needed.

Keywords

Progesterone, Premature Luteinization, In vitro fertilization

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