Polikistik over sendromunda Clomiphene sitrat tedavisine eklenen E vitamini takviyelerinin fertilite üzerine etkisi

Yıl 2021, Cilt: 8 Sayı: 3, 443 - 448, 30.09.2021

Derya Kanza Gül Ayça Şolt

https://doi.org/10.34087/cbusbed.843323

Öz

Giriş ve Amaç: Bu çalışma, infertil Polikistik Over Sendromu (PKOS) olan kadınlarda klomifen sitrat (KS) ile ovulasyon indüksiyonunda sikluslar sırasında E vitamini desteğinin ovülasyon defekti, endometrium kalınlığı, klinik ve devam eden gebelik artışı üzerindeki rolünü araştırmak için tasarlanmıştır.
Gereç ve Yöntemler: Bu retrospektif vaka kontrol çalışmasında, 1 Ocak 2015 ile 1 Ekim 2020 tarihleri arasında Yenibosna Özel Nisa Hastanesi Kadın Hastalıkları Kliniğine infertilite tedavisi için başvuran PKOS hastaları değerlendirildi. KS ve vitamin E tedavisi alan (Vitamin E grubu) PKOS'lu 139 hasta ve sadece KS tedavisi alan 167 PKOS hastası (Kontrol grubu) olmak üzere toplam 306 hasta değerlendirildi. Birincil sonuç, kümülatif yumurtlama oranının (yani, tüm takip süresi boyunca yumurtlamanın meydana geldiği döngülerin oranı), ikincil sonucun dominant folikül sayısı, HCG'ye uygulama gününde endometriyal kalınlık ve klinik ve devam eden gebelik oranlarıdır.
Bulgular: İki grup arasında dominant folikül sayıları, ovulasyon oranları, klinik ve devam eden gebelik oranları açısından istatistiksel fark saptanmadı (p>0.05). E vitamini grubu ile kontrol grubu karşılaştırıldığında endometrial kalınlık açısından gruplar arasında istatistiksel olarak anlamlı fark olduğu belirlendi (p <0.000).
Sonuç: Sikluslar sırasında verilen E vitamini desteğinin PKOS'lu infertil kadınlarda dominant folikül sayısını, ovulasyon oranlarını ve klinik ve devam eden gebelik oranlarını artırmada etkili olmadığı, ancak endometrial kalınlık artışına neden olduğu bulundu.

Anahtar Kelimeler

E vitamin, kısırlık, polikistik over sendromu, klomifen sitrat

Destekleyen Kurum

bulunmamaktadır

Proje Numarası

Reference number: 10840098-772.02-E.61617

The effect of vitamin E supplements added to Clomiphene citrate treatment on fertility in polycystic ovary syndrome

Öz

Objective: This study was designed to investigate the role of vitamin E supplementation during cycles in ovulation induction with clomiphene citrate (CC) in women with infertile Polycystic Ovary Syndrome (PCOS) on ovulation defect, endometrium thickness, clinical and ongoing pregnancy increase.
Materials and Methods: In this retrospective case control study, PCOS patients admitting to Yenibosna Private Nisa Hospital Obstetrics Clinic between January 1st 2015 and October 1st 2020 for infertility treatment were evaluated. A total of 306 patients were evaluated, including 139 Patients with PCOS receiving CC and vitamin E treatment (Vitamin E group), and 167 patients with PCOS who received CC treatment only (Clomiphene group). The primary result was that the cumulative ovulation rate (i.e. the rate of the cycles in which ovulation occurs during the entire follow-up period), the secondary result was the number of dominant follicles, the endometrial thickness on the day of HCG admission, and the clinical and ongoing pregnancy rates.
Results: No statistical differences were detected between the two groups in terms of dominant follicle counts, ovulation rates, and clinical and ongoing pregnancy rates (p>0.05). When the vitamin E group and control group were compared it was determined that there was a statistically significant difference between the groups in terms of endometrial thickness (p<0.000).
Conclusion: It was found that vitamin E supplementation given during the cycles was not effective in increasing the number of dominant follicles, ovulation rates, and clinical and ongoing pregnancy rates in infertile women with PCOS, but increased endometrial thickness.

Anahtar Kelimeler

Vitamin E, infertility, polycystic ovary syndrome, clomiphene citrate

Proje Numarası

Reference number: 10840098-772.02-E.61617

Kaynakça

• Goodarzi, M.O, Dumestic, D.A, Chazenbalk, G, Azziz, R, Polycystic ovary syndrome; etiology, pathogenesis and diagnosis, Nature Reviews Endocrinology, 2011, 7, 219-31.
• Joham, A.E, Teede, H.J, Ronasinha, S, Zanges, S, Boyle, J, Prevalence of infertility and use of fertility treatment in women with polycystic ovary syndrome; data from a large community based study, Journal of Women Health, 2015, 24(4), 299-307.
• Kurdoglu, Z, Ozkol, H, Tuluce, Y, Koyuncu, I, Oxidative status and its relation with insulin resistance in young non-obese women with polycystic ovary syndrome, Journal of Endocrinoogy Investigation, 2012, 35(3), 317–21.
• Victor, V.M, Rucha, M, Banuls, C, Alvarez, A, De- Pablo, C, Sachez-Ssrrano, M, et al., Induction of oxidative stress and human leukocyte/endothelial cell interactions in polycystic ovary syndrome patients with insulin resistance, Journal of Clinical Endocrinology and Metabolism, 2011, 96(10), 3115-22.
• Muni, M, Luque-Mirez, M, Insenser, M, Ojede-Ojede, M, Escobar-Morreds, H.F, Circulating markers of oxidative stress and polycystic ovary syndrome; a systemic review and meta-analysis, Human Reproduction Update, 2013, 19(3), 268-88.
• Miyamoto, K, Sato, E.F, Kasahare, E, Jikumaru, M, Hiramoto, K, Tabate, H, et al., Effect of oxidative stress during repeated ovulation on the structure and function of the ovary, oocyte and the mitochondria, Free Radical Biology and Medicine, 2010, 49(4), 674-81.
• Evans, H.M, Bishop, K.S, On the existence of a hitherto unrecognized dietary factor essential for reproduction, Science, 1922, 56(1458), 650–1.
• Traber, M.G, Atkinson, J, Vitamin E, antioxidant and nothing more, Free Radical Biology and Medicine, 2007, 43, 4–15.
• Wahid, S, Khan, R.A, Feroz, Z, Reduction in mortality and teratogenicity following simultaneous administration of folic acid and vitamin E with antiepileptic, antihypertensive and anti-allergic drugs, Journal of Pharmacy Bioallied Science, 2014, 6(3), 185–91.
• Hubalek, M, Buchner, H, Mortl, M.G, Schlembach, D, Huppertz, B, Firulovic, B, Kohler, W, Hafner, E, Dieplinger, B, Wildt, L, et al., The vitamin E-binding protein afamin increases in maternal serum during pregnancy, Clinica Chimica Acta, 2014, 434, 41–7.
• Tarin, J.J, Perez-Albala, S, Cano, A, Oral antioxidants counteract the negative effects of female aging on oocyte quantity and quality in the Mouse, Moleculer Reproduction and Development, 2002, 61(3), 385–97.
• Farzollahi, M, Tayefi-Nasrabadi, H, Mohammadnejad, D, Abedelahi, A, Supplementation of culture media with vitamin E improves mouse antral follicle maturation and embryo development from vitrified ovarian tissue, Journal of Obstetrics Gynaecology Research, 2016, 42(5), 526–35.
• Fatemi, F, Mohammadzadeh, A, Sadeghi, M.R, Akhondi, M.M, Mohammadmoradi, S, Kamali, K, Lackpour, N, Jouhari, S, Zafadoust, S, Mokhtar, S, et al., Role of vitamin E and D3 supplementation in intra-cytoplasmic sperm injection outcomes of women with polycystic ovarian syndrome: a double blinded randomized placebo-controlled trial, Clinical Nutrution ESPEN, 2017, 18, 23–30.
• Bjelica, A, Trninić-Pjević, A, Mladenović-Segedi, L, Cetković, N, Petrović, D Comparison of the efficiency of clomiphene citrate and letrozole in combination with metformin in moderately obese clomiphene citrate-resistant polycystic ovarian syndrome patients, Srpski Arhiv Za Celokupno Lekarstvo, 2016, 144(3-4), 146-50.
• Gerli, S, Gholami, H, Manna, C, Di Frega, A.S, Vitiello, C, Unfer, V, Use of ethinyl estradiol to reverse the antiestrogenic effects of clomiphene citrate in patients undergoing intrauterine insemination: A comparative, randomized study, Fertility and Sterility, 2000, 73, 85–89.
• Rotterdam ESHRE/ASRM-sponsored PCOS consensus workshop group. Revised 2003, Consensus on diagnostic criteria and long-term health risk related to polycystic ovary syndrome (PCOS), Human Reproduction, 2004, 19(1), 41-7.
• Rosselli, M, Keller, R, Dubey, R.K. Role of nitric oxide in the biology, physiology and pathophysiology of reproduction, Human Reprod uction Update, 1998, 4, 3–24.
• Sadeghi, F, Alavi-Naeini, A, Mardanian, F, Ghazvini, M.R, Mahaki B, Omega-3 and vitamin E co-supplementation can improve antioxidant markers in obese/overweight women with polycystic ovary syndrome, International Journal for Vitamin and Nutrition Research, 2020, 90(5-6), 477-483.
• Izadi, A, Ebrahimi, S, Shirazi, S, Taghizadeh, S, Parizad, M, Farzadi, L, Gargari, BP, Hormonal and Metabolic Effects of Coenzyme Q10 and/or Vitamin E in Patients With Polycystic Ovary Syndrome..Journal of Clinical Endocrinology Metabolism, 2019, 104(2), 319-327.
• Izadi, A, Shirazi, S, Taghizadeh, S, Gargari, B.P, Independent and Additive Effects of Coenzyme Q10 and Vitamin E on Cardiometabolic Outcomes and Visceral Adiposity in Women With Polycystic Ovary Syndrome, Archives of Medical Research, 2019, 50(2), 1-10.
• Shokrpour, M, Asemi, Z, The Effects of Magnesium and Vitamin E Co Supplementation on Hormonal Status and Biomarkers of Inflammation and Oxidative Stress in Women with Polycystic Ovary Syndrome, Biological Trace Element Research, 2019, 191(1), 54-60.
• Panti, A, Shehu, C, Saidu, Y, Tunau, K, Nwobodo, E, Jimoh, et al., Oxidative stress and outcome of antioxidant supplementation in patients with polycystic ovarian syndrome (PCOS) International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018, 7(5), 1667-1672.
• Showell, M.G, Mackenzie-Proctor, R, Jordan, V, Hart, R.J, Antioxidants for female subfertility, Cochrane Database Systemical Review, 2017, 7, CD007807.
• Chen J, Guo Q, Pei Y, Ren Q, Chi L, Hu R and Tan Y Effect of a short-term vitamin E supplementation on oxidative stress in infertile PCOS women under ovulation induction: a retrospective cohort study BMC Women's Health. 2020,20:69,1-9.
• Morsy, A, Sabri, N, Mourad, A, Mojahed, E, and Shawki, M, Randomized controlled open-label study of the effect of vitamin E supplementation on fertility in clomiphene citrate-resistant polycystic ovary syndrome, Journal of Obstetrics and Gynaecology Research, 2020, 1-8.
• Cicek, N, Eryilmaz, O.G, Sarikaya, E, Gulerman, C, Genc, Y, Vitamin E effect on controlled ovarian stimulation of unexplained infertile women, The Journal of Assisted Reproduction and Genetics, 2012, 29(4), 325–8.
• Hashemi, ZSN, Khani, B, The effects of vitamin E supplementation on endometrial thickness, and gene expression of vascular endothelial growth factor and inflammatory cytokines among women with implantation failure, Journal of Maternal Fetal Neonatal Medine, 2017, 32(3), 1–19.