Yüksek Doz Başlangıç FSH ile Sağlanan Serum FSH Düzeyi Artışı Over Yanıtlarına Göre Farklılık Gösterir mi?

Abstract

Çalışmanın amacı, antagonist kontrollü ovarian simülasyon (KOH) sikluslarında yüksek (300 IU) sabit rFSH dozu ile uyarılan ve farklı yanıtları (zayıf, suboptimal yanıt veya normal yanıt ) olan hastalar arasında, antagonistin başlatıldığı gün serum FSH düzeyleri ve serum FSH düzeylerindeki simülasyon başlangıcına göre artışı retrospektif olarak değerlendirmekti. Çalışmaya toplam 122 kadın dahil edildi; bunların 51'i zayıf yanıtlı, 52'si suboptimal yanıtlı ve 19'u normal yanıtlı hastalar idi. Bazal serum FSH düzeyleri her üç grup arasında anlamlı farklı idi (7[5.2-8.6], 5.7[4.6-7.2], 4.8[4.1- 5,3] sırasıyla zayıf, suboptimal ve normal yanıt grupları; p<0,001). Antagonist başlangıç gününde medyan spot serum FSH seviyeleri, normal yanıt verenlerde zayıf ve suboptimal yanıtlı gruplara göre anlamlı derecede düşüktü (p=0,001 ve p=0,025). Antagonist başlangıç gününe kadar serum FSH düzeyindeki artış miktarı gruplar arasında anlamlı farklılık göstermedi (p=0,39). Normal yanıt veren grupta, zayıf ve suboptimal yanıtlı gruplarla karşılaştırıldığında, KOH' a yanıt oranı anlamlı derecede yüksekti (p<0,001 ve p=0,019). Antagonist başlangıç gününe kadar serum FSH düzeyindeki artış oranı, KOH yanıtı ile pozitif korelasyon gösterdi (r=0,24, p=0,008). Sonuç olarak, serum FSH düzeyinde başlangıçtan itibaren artış oranı gruplar arasında farklılık göstermese de, normal yanıt veren hastaların KOH' a yanıt verme oranı daha yüksekti. Bu bulgular şunu desteklemektedir; zayıf yanıt verenler, daha yüksek başlangıç FSH seviyeleri nedeniyle zaten ilerlemiş olan küçük antral foliküllerden oluşan sınırlı bir havuza sahiptir ve daha yüksek FSH başlangıç dozlarından yararlanamayabilir.

Keywords

• Serum Fsh düzeyleri
• Kontrollü over stimülasyonu
• IVF
• ICSI
• Over rezervi

Does Serum Delta FSH Level Provided with High Starting Dose FSH Differ Among Various Ovarian Responses?

Abstract

The objective of this study is to evaluate whether serum delta FSH levels (the percentage difference of serum FSH between antagonist starting day and basal serum FSH level) differ between patients with different COH responses (poor, suboptimal response and normoresponders) who stimulated with a high (300 IU) fixed recombinant FSH dose during flexible antagonist cycles. This study is a retrospective cross sectional cohort study conducted in a tertiary ART Center. 122 women were evaluated, of which, 51 were poor responders, 52 had suboptimal response and 19 had normal response. The primary outcome is to evaluate the spot serum FSH levels on the first day of GnRH antagonist dose administration and the delta FSH levels between groups. Basal serum FSH levels differed significantly between (7[5.2-8.6], 5.7[4.6-7.2], 4.8[4.1-5.3] poor, suboptimal and normoresponders respectively; p<0.001). Median spot serum FSH level on the antagonist starting day was significantly lower in normoresponders than poor and suboptimal responders (p=0.001 and p=0.025). Delta serum FSH levels did not differ significantly between groups (p=0.39). Rate of response to COH was significantly higher for the normoresponder group compared to poor and suboptimal groups (p<0.001 and p=0.019). Delta serum FSH levels were positively correlated with the response to COH (r=0.24, p=0.008). Although Delta serum FSH percentage did not differ between groups, normoresponder patients had a better response to COH. In conclusion, poor responders are not positively affected by a high dose of FSH exposure due to the fact that poor responders have a limited number of antral follicles that have already been exposed to high levels of FSH.

Keywords

• Serum Fsh levels
• Controlled ovarian hyperstimulation
• IVF
• ICSI
• Ovarian reserve

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