Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı

Namık Kemal Duru; İbrahim Alanbay; Murat Muhcu; Uğur Keskin; Vedat Atay

doi:10.16948/zktb.60911

The results of intrauterine insemination after ectopic pregnancy treatment (laparoscopic salpingostomy and systemic methotrexate

Year 2007, Volume: 38 Issue: 3, 89 - 92, 01.04.2007

Namık Kemal Duru İbrahim Alanbay Murat Muhcu Uğur Keskin Vedat Atay

Abstract

Aim: To evaluate the results of Intrauterine Insemination in patients with ectopic pregnancy treated by laparoscopic salpingostomy and systemic single dose methotreaxate. Materials and Methods: This study was included 25 patients with ectopic pregnancy treated by laparoscopic salpingostomy and 12 patients with ectopic pregnancy treated by 50 mg/m2 single dose methotrexate. All patients were traeted with gonadothropins for ovulation induction. SPSS for Windows 13.0 was used for statistical analysis. Results: Spontaneus pregnancy occured 48 % of the patients (12/25) treated by laparoscopy. The remairiings were treated by intrauterine insemination and the pregnancy rate was 15.3% (2/13) in this group. In methotreaxate group, spontaneus pregnancy occured 41.6 % of the patients (5/12) treated by methotreaxate. The remainings were treated by intrauterine insemination and the pregnancy rate was 14.2% (1/7) in this group. There were no statistically significant differences in both groups in terms of spontaneus pregnancy and pregnancy resulted by intrauterine insemination (p=0,94) (p=0,71). Conclusion: Our results showed that spontaneus pregnancy rate was similar in both groups one year following treatment. The pregnancy rate was similar in both groups treated by intrauterine insemination. We recommend intrauterine insemination in patients with tubal patency, who fail to concive spontaneusly.

Keywords

Pregnancy, Ectopic, Laparoscopy, Methotrexate, Insemination, Pregnancy Rate, Salpingostomy

References

1. Ego, A., Subtil, D., Cosson, M., Legoueff, F.O., Houfflin-Debarge, V.R., Querleu,D., Survival analysis of fertility after ectopic Pregnancy, Fertility and Sterility, 75 (3), 2001
2. Sultana, C.J., and Easley KCRL, Outcome of laparoscopic versus traditional surgery for ectopic pregnancies, Fertil Steril, 57, 285- 289,1992
3. Lindblom, B., Hahlin, M., Lundorff P. et all, Treatment of tubalpregnancy by laparoscope guided injection of prostoglandine F2 alpha, Fertil Steril, 54, 404- 408, 1990
4. Tomâs, C, Nuojua-Huttunen, S. and Martikainen, H., Pretreatment transvaginal ultrasound examination predicts ovarian responsiveness to gonadotrophins in in-vitro fertilization, Hum Reprod, 12, 220-223, 1997
5. Chang, M.Y., Chiang, C.H., Hsieh, T.T., Soong, Y.K., Hsu, K.H, Use of the antral follicle count to predict the outcome of assisted reproductive Technologies, Fertil Steril, 69, 505-510, 1998
6. Nahum, R., Shifren, J.L., Chang, Y.C., Leykin, L., Isaacson, K. and Toth, T, Antral follicle assessment as a tool for predicting outcome in ÎVFis it a beter predictor than age andFSH?, J Assist Reprod Genet, 18, 151-155, 2001
7. Bancsi, L.F., Broekmans, F.J., Eijkemans, M.J., De Jong, F.H., Habbema, J.D. and te Velde, E.R., Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve, Fertil Steril, 77, 328-336, 2002
8. Syrop, C.H., Willhoite, A. and Van Voorhis, B.J., Ovarian volume: a novel outcome predictor for assisted reproduction, Fertil Steril, 64, 1167—1171, 1995
9. Lass, A., Skull, J., McVeigh, E., Margara, R. and Winston, R.M., Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotrophin for in-vitro fertilization can predict poor response, Hum Reprod, 12, 294-297, 1997
10. Kupesic, S., Kurjak, A., Bjelos, D. and Vujisic, S., Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age, Fertil Steril, 79, 190-197, 2003
11. Popovic-Todorovic, B., Loft, A., Lindhard, A., Bangsboll, S., Andersson, A.M. and Andersen, A.N., A prospective study of predictive factors of ovarian response in 'standard'IVF/ICSIpatients treated with recombinant FSH. A suggestion for a recombinant FSH dosage normogram, Hum Reprod, 18, 781-787, 2003
12. Sharara, F.I., Scott, R.T. andSeifer, D.B., The detection of diminished ovarian reserve in infertile women, Am J Obstet Gynecol, 179, 804-812, 1998
13. Dzik, A., Lambert-Messerlian, G., Izzo, V.M., Soares, J.B., Pinotti, J.A. and Seifer, D., Inhibin B response to EFORT is associated with the outcome of oocyte retrieval in the subsequent in vitro fertilization cycle, Fertil Steril, 74, 1114-1117, 2000
14. Fanchin, R., Schonâuer, L.M., Righini, C, Guibourdenche, J., Frydman, R. and Taieb, J., Serum anti-Müllerian hormone is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3, Hum Reprod, 18, 323-327,2003
15. Centers for Disease Control and Prevention, Ectopic pregnancy United States, 1990- 1992, MMWRMorb. Mortal. WklyRep., 44, 46-48, 1995
16. Gervaise, A., Mass on, L., de Tayrac, R., fraydman, R., Fernandez, H, Reproductive Outcome after methotrexate treatment of tubal pregnancies, Fertil Steril, 82(2), 304-308, 2004.

Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı

Year 2007, Volume: 38 Issue: 3, 89 - 92, 01.04.2007

Namık Kemal Duru İbrahim Alanbay Murat Muhcu Uğur Keskin Vedat Atay

Abstract

Amaç: Bizim çalışmamızın amacı, laparoskopik salpingostomi ve sistemik tek doz Methotrexate uygulanan hastalarda intrauterin inseminasyon başarıları arasında fark olup olmadığını araştırmaktır. Gereç ve Yöntem: Çalışmaya ektopik gebelik tanısı ile laparoskopik salpingostomi uygulanan 25 hasta ve 50 mg/m2, sistemik, tek doz Methotrexate uygulanan 12 hastayı kapsamaktadır. Bu grup hastalarda intrauterin inseminasyon sonrası gebelik başarısı araştırıldı. İntrauterin inseminasyon protokolü içerisinde tüm hastalara gonadotropin ile ovulasyon indüksiyonu planlandı. İstatistiksel analiz için, SPSS for Windows 13.0 paket programı kullanıldı. Bulgular: Laparoskopik salpingostomi uygulanan grupta spontan konsepsiyon oranı % 48 idi (12/25). Spontan siklusta gebelik oluşmayan ve sonrasında intrauterin inseminasyon uygulanan hastalarda gebelik oranı ise % 15,3 (2/13) idi. 12 hastanın 5 inde spontan konsepsiyon ile gebelik elde edilirken (% 41,6), spontan konsepsiyonda gebelik elde edilemeyen ve intrauterin inseminasyon uygulanan 7 hastadan sadece 1 inde gebelik elde edildi (% 14,2). Her iki grup arasında spontan gebelik başarısı ve intrauterin inseminasyon sonrası gebelik başarısı arasında anlamlı fark saptanmamıştır (p=0,94)(p=0,71). Sonuç: Bu çalışmada en az 1 yıl süre sonrasında spontan gebelik başarısı, her iki grupta eşit olarak saptanmıştır. Çalışmamız her 2 grup tedavi sonrası intrauterin inseminasyon başarılarının birbirleri üzerine üstünlükleri olmadığını ortaya koymuştur. Sonuç olarak tedavi sonrası spontan siklusta gebelik elde edilmeyen ve tubalpatens izlenen hastalarda intrauterin inseminasyon uygulanmasını önermekteyiz.

Keywords

Gebelik, ektopik, Laparoskopi, Methotreksat, Dölleme, Gebelik oranı, Salpingostomi

References

1. Ego, A., Subtil, D., Cosson, M., Legoueff, F.O., Houfflin-Debarge, V.R., Querleu,D., Survival analysis of fertility after ectopic Pregnancy, Fertility and Sterility, 75 (3), 2001
2. Sultana, C.J., and Easley KCRL, Outcome of laparoscopic versus traditional surgery for ectopic pregnancies, Fertil Steril, 57, 285- 289,1992
3. Lindblom, B., Hahlin, M., Lundorff P. et all, Treatment of tubalpregnancy by laparoscope guided injection of prostoglandine F2 alpha, Fertil Steril, 54, 404- 408, 1990
4. Tomâs, C, Nuojua-Huttunen, S. and Martikainen, H., Pretreatment transvaginal ultrasound examination predicts ovarian responsiveness to gonadotrophins in in-vitro fertilization, Hum Reprod, 12, 220-223, 1997
5. Chang, M.Y., Chiang, C.H., Hsieh, T.T., Soong, Y.K., Hsu, K.H, Use of the antral follicle count to predict the outcome of assisted reproductive Technologies, Fertil Steril, 69, 505-510, 1998
6. Nahum, R., Shifren, J.L., Chang, Y.C., Leykin, L., Isaacson, K. and Toth, T, Antral follicle assessment as a tool for predicting outcome in ÎVFis it a beter predictor than age andFSH?, J Assist Reprod Genet, 18, 151-155, 2001
7. Bancsi, L.F., Broekmans, F.J., Eijkemans, M.J., De Jong, F.H., Habbema, J.D. and te Velde, E.R., Predictors of poor ovarian response in in vitro fertilization: a prospective study comparing basal markers of ovarian reserve, Fertil Steril, 77, 328-336, 2002
8. Syrop, C.H., Willhoite, A. and Van Voorhis, B.J., Ovarian volume: a novel outcome predictor for assisted reproduction, Fertil Steril, 64, 1167—1171, 1995
9. Lass, A., Skull, J., McVeigh, E., Margara, R. and Winston, R.M., Measurement of ovarian volume by transvaginal sonography before ovulation induction with human menopausal gonadotrophin for in-vitro fertilization can predict poor response, Hum Reprod, 12, 294-297, 1997
10. Kupesic, S., Kurjak, A., Bjelos, D. and Vujisic, S., Three-dimensional ultrasonographic ovarian measurements and in vitro fertilization outcome are related to age, Fertil Steril, 79, 190-197, 2003
11. Popovic-Todorovic, B., Loft, A., Lindhard, A., Bangsboll, S., Andersson, A.M. and Andersen, A.N., A prospective study of predictive factors of ovarian response in 'standard'IVF/ICSIpatients treated with recombinant FSH. A suggestion for a recombinant FSH dosage normogram, Hum Reprod, 18, 781-787, 2003
12. Sharara, F.I., Scott, R.T. andSeifer, D.B., The detection of diminished ovarian reserve in infertile women, Am J Obstet Gynecol, 179, 804-812, 1998
13. Dzik, A., Lambert-Messerlian, G., Izzo, V.M., Soares, J.B., Pinotti, J.A. and Seifer, D., Inhibin B response to EFORT is associated with the outcome of oocyte retrieval in the subsequent in vitro fertilization cycle, Fertil Steril, 74, 1114-1117, 2000
14. Fanchin, R., Schonâuer, L.M., Righini, C, Guibourdenche, J., Frydman, R. and Taieb, J., Serum anti-Müllerian hormone is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3, Hum Reprod, 18, 323-327,2003
15. Centers for Disease Control and Prevention, Ectopic pregnancy United States, 1990- 1992, MMWRMorb. Mortal. WklyRep., 44, 46-48, 1995
16. Gervaise, A., Mass on, L., de Tayrac, R., fraydman, R., Fernandez, H, Reproductive Outcome after methotrexate treatment of tubal pregnancies, Fertil Steril, 82(2), 304-308, 2004.

There are 16 citations in total.

Details

Primary Language	Turkish
Journal Section	Articles
Authors	Namık Kemal Duru This is me İbrahim Alanbay This is me Murat Muhcu This is me Uğur Keskin This is me Vedat Atay This is me
Publication Date	April 1, 2007
Published in Issue	Year 2007 Volume: 38 Issue: 3

Cite

APA	Duru, N. K., Alanbay, İ., Muhcu, M., Keskin, U., et al. (2007). Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı. Zeynep Kamil Tıp Bülteni, 38(3), 89-92. https://doi.org/10.16948/zktb.60911
AMA	Duru NK, Alanbay İ, Muhcu M, Keskin U, Atay V. Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı. Zeynep Kamil Tıp Bülteni. April 2007;38(3):89-92. doi:10.16948/zktb.60911
Chicago	Duru, Namık Kemal, İbrahim Alanbay, Murat Muhcu, Uğur Keskin, and Vedat Atay. “Ektopik Gebelik Tedavileri (laparoskopik Salpingostomi Ve Sistemik Methotrexate) sonrasında Intrauterin Inseminasyon başarısı”. Zeynep Kamil Tıp Bülteni 38, no. 3 (April 2007): 89-92. https://doi.org/10.16948/zktb.60911.
EndNote	Duru NK, Alanbay İ, Muhcu M, Keskin U, Atay V (April 1, 2007) Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı. Zeynep Kamil Tıp Bülteni 38 3 89–92.
IEEE	N. K. Duru, İ. Alanbay, M. Muhcu, U. Keskin, and V. Atay, “Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı”, Zeynep Kamil Tıp Bülteni, vol. 38, no. 3, pp. 89–92, 2007, doi: 10.16948/zktb.60911.
ISNAD	Duru, Namık Kemal et al. “Ektopik Gebelik Tedavileri (laparoskopik Salpingostomi Ve Sistemik Methotrexate) sonrasında Intrauterin Inseminasyon başarısı”. Zeynep Kamil Tıp Bülteni 38/3 (April 2007), 89-92. https://doi.org/10.16948/zktb.60911.
JAMA	Duru NK, Alanbay İ, Muhcu M, Keskin U, Atay V. Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı. Zeynep Kamil Tıp Bülteni. 2007;38:89–92.
MLA	Duru, Namık Kemal et al. “Ektopik Gebelik Tedavileri (laparoskopik Salpingostomi Ve Sistemik Methotrexate) sonrasında Intrauterin Inseminasyon başarısı”. Zeynep Kamil Tıp Bülteni, vol. 38, no. 3, 2007, pp. 89-92, doi:10.16948/zktb.60911.
Vancouver	Duru NK, Alanbay İ, Muhcu M, Keskin U, Atay V. Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı. Zeynep Kamil Tıp Bülteni. 2007;38(3):89-92.