Hipogonadotropik Hipogonadizmli Kadınlarda İn Vitro Fertilizasyon Sonuçlarının Değerlendirilmesi

Yıl 2023, Cilt: 25 Sayı: 1, 21 - 26, 30.04.2023

Kübra Dilbaz Oya Aldemir Serdar Dilbaz Berna Dilbaz Runa Özelçi Yaprak Ustun

https://doi.org/10.18678/dtfd.1164685

Öz

Amaç: Hipogonadotropik hipogonadizm (HH), düşük hipofizer gonadotropin düzeylerine bağlı gonadal yetmezlikten kaynaklanan nadir bir klinik durumdur. Bu hastalarda ovulasyon nadiren gerçekleştiği için spontan gebelik olasılığı çok düşüktür. Bu çalışmanın amacı, HH hastalarında in vitro fertilizasyon (IVF) tedavi sonuçlarını değerlendirmek ve bu sonuçları açıklanamayan infertilitesi (Aİ) olan ve IVF tedavisi uygulanan hastalarla karşılaştırmaktır.
Gereç ve Yöntemler: Bu çalışmaya IVF tedavisi uygulanan 28 HH hastasının 36 siklusu ve Aİ nedeniyle IVF tedavisi uygulanan 68 hastanın 72 siklusu dahil edildi. Demografik veriler, ovaryan hiperstimülasyon ve siklus sonuçları, klinik gebelik oranları ve klinik gebelik için prediktif faktörler geriye dönük olarak değerlendirildi ve iki grup karşılaştırıldı.
Bulgular: IVF sonrası siklus başına klinik gebelik ve canlı doğum oranları Aİ grubu ile karşılaştırıldığında HH grubunda anlamlı derecede daha yüksekti (sırasıyla, n=16, %44,4'e karşı n=17, %23,6; p=0,027 ve n=14, %38,9'a karşı n=14, %19,4; p=0,030). Antral folikül sayısı (p=0,001) ve toplanan oosit sayısı (p=0,042) Aİ grubunda anlamlı olarak daha yüksek olmasına rağmen, matür oosit ve grade I-II embriyo sayısı HH ve Aİ gruplarında benzerdi. HH grubunda kullanılan toplam gonadotropin dozu ve stimülasyon süresi Aİ grubuna göre anlamlı derecede daha yüksekti (her iki p=0,001).
Sonuç: HH hastaları, IVF tedavisine iyi yanıt verdiler ve Aİ nedeniyle IVF uygulanan kadınlara oranla IVF sonuçları daha iyi oldu. HH hastalarında gebelik başarısını etkileyen herhangi bir prognostik faktör saptanmadı.

Anahtar Kelimeler

Hipogonadotropik hipogonadizm, IVF sonuçları, açıklanamayan infertilite

Evaluation of In Vitro Fertilization Outcomes in Women with Hypogonadotropic Hypogonadism

Öz

Aim: Hypogonadotropic hypogonadism (HH) is a rare clinical condition resulting from gonadal insufficiency due to low pituitary gonadotropin levels. Since ovulation occurs rarely in these patients, the probability of spontaneous pregnancy is very low. The study aimed to evaluate the in vitro fertilization (IVF) treatment outcomes in patients with HH and to compare these results with that of patients with unexplained infertility (UI) who underwent IVF treatment.
Material and Methods: In this study, 36 cycles of 28 HH patients who underwent IVF treatment and 72 cycles of 68 patients who underwent IVF treatment for UI were included. Demographic data, ovarian hyperstimulation and cycle outcomes, clinical pregnancy rates, and predictive factors for clinical pregnancy were evaluated retrospectively, and the two groups were compared.
Results: In the HH group, clinical pregnancy, and live birth rates per cycle after IVF were significantly higher compared with the UI group (n=16, 44.4% vs. n=17, 23.6%, p=0.027; and n=14, 38.9% vs. n=14, 19.4%; p=0.030, respectively). Although the number of antral follicles (p=0.001) and retrieved oocytes (p=0.042) were significantly higher in the UI group, the number of mature oocytes and grade I-II embryos were similar in the HH and UI groups. The total gonadotropin dose used and duration of stimulation in the HH group were significantly higher than in the UI group (both p=0.001).
Conclusion: HH patients responded well to IVF treatment and had better IVF outcomes compared to women who underwent IVF for UI. No prognostic factor that affected pregnancy success in HH patients was detected.

Anahtar Kelimeler

Hypogonadotropic hypogonadism, IVF outcomes, unexplained infertility

Kaynakça

• Silveira LF, MacColl GS, Bouloux PM. Hypogonadotropic hypogonadism. Semin Reprod Med. 2002;20(4):327-38.
• Yilmaz S, Ozgu-Erdinc AS, Yumusak O, Kahyaoglu S, Seckin B, Yilmaz N. The reproductive outcome of women with hypogonadotropic hypogonadism undergoing in vitro fertilization. Syst Biol Reprod Med. 2015;61(4):228-32.
• Unuane D, Tournaye H, Velkeniers B, Poppe K. Endocrine disorders & female infertility. Best Pract Res Clin Endocrinol Metab. 2011;25(6):861-73.
• Eser A, Bostancı Ergen E. Infertility treatment results in hypogonadotropic hypogonadism cases. J Gynecol Obstet Neonatol Med. 2016;13(4):160-3. Turkish.
• Ulug U, Ben-Shlomo I, Tosun S, Erden HF, Akman MA, Bahceci M. The reproductive performance of women with hypogonadotropic hypogonadism in an in vitro fertilization and embryo transfer program. J Assist Reprod Genet. 2005;22(4):167-71.
• Lewit N, Kol S. The low responder female IVF patient with hypogonadotropic hypogonadism: do not give up! Fertil Steril. 2000;74(2):401-2.
• Kumbak B, Kahraman S. Women with hypogonadotropic hypogonadism: cycle characteristics and results of assisted reproductive techniques. Acta Obstet Gynecol Scand. 2006;85(12):1453-7.
• Yildirim G, Ficicioglu C, Attar R, Akcin O, Tecellioglu N. Comparision of reproductive outcome of the women with hypogonadotropic hypogonadism and tubal factor infertility. Clin Exp Obstet Gynecol. 2010;37(2):120-2.
• Baczkowski T, Kurzawa R, Głabowski W. Methods of embryo scoring in in vitro fertilization. Reprod Biol. 2004;4(1):5-22.
• Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73(6):1155-8.
• Liu S, Feng HL, Marchesi D, Chen ZJ, Hershlag A. Dose-dependent effects of gonadotropin on oocyte developmental competence and apoptosis. Reprod Fertil Dev. 2011;23(8):990-6.
• Edgar DH, Whalley KM, Mills JA. Effects of high-dose and multiple-dose gonadotropin stimulation on mouse oocyte quality as assessed by preimplantation development following in vitro fertilization. J In Vitro Fert Embryo Transf. 1987;4(5):273-6.
• Ghaffari F, Arabipoor A, Lankarani NB, Etminan Z, Tehraninejad ES. Assisted reproductive technique outcomes in hypogonadotropic hypogonadism women. Ann Saudi Med. 2013;33(3):235-40.
• Zhang CM, Zhang H, Yang R, Chen LX, Liu P, Li R, et al. The reproductive outcome of women with hypogonadotropic hypogonadism in IVF. Front Endocrinol (Lausanne). 2022;13:850126.
• Guzick DS, Sullivan MW, Adamson GD, Cedars MI, Falk RJ, Peterson EP, et al. Efficacy of treatment for unexplained infertility. Fertil Steril. 1998;70(2):207-13.
• Reindollar RH, Regan MM, Neumann PJ, Levine BS, Thornton KL, Alper MM, et al. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril. 2010;94(3):888-99.
• Kansal-Kalra S, Milad MP, Grobman WA. In vitro fertilization (IVF) versus gonadotropins followed by IVF as treatment for primary infertility: a cost-based decision analysis. Fertil Steril. 2005;84(3):600-4.
• Eroglu M, Helvacioglu C, Eser AÇ, Sayıcı D, Arınkan A, Şahin S. What are the factors affecting IVF success in women with hypogonadotropic hypogonadism? Eur Rev Med Pharmacol Sci. 2021;25(24):7750-3.