OOSİT ÇIKIŞININ ÖNGÖRÜLMESİ : Kontrollü Ovaryan Hiperstimulasyon sikluslarında foliküllerden çıkan oosit sayısını nasıl maksimize edebiliriz?

Öz

Öz Amaç: Üremeye Yardımcı Tekniklerin uygulamalarında oosit outputunu öngörerek, daha çok oosit toplamak ve IVF başarısını arttırmak için hangi değişkenleri kullanmamız gerektiğini incelemek amacıyla çalışmamızı design ettik. Gereç ve Yöntemler: 2016-2018arasında tersiyer bir üniversitenin IVF merkezine başvuran 412 infertil hasta retrospektif olarak değerlendirildi. KOH sonucu elde edilen foliküllerden OPU ile çıkan oosit sayıları yüzdelik dilimlere ayrılarak gruplandırıldı. Gruplarda oosit outputuna etkili değişkenler analiz edilerek, maximum sayıda oosit eldesini predikte edecek testleri tespit etmeye çalıştık. Bulgular: Hastaları oosit/≥14mm folikül oranlarına göre incelediğimizde, %10,2’sinin ≤%30, %4,1’inin %31-40, %6,6’sının %41-50, %2,9’unun %51-60, %5,6’sının %61-70, %8’inin %71-80, %4,9’unun %81-90 ve %57,8’inin %91-100 grubunda olduğu tespit edilmiştir. Çalışmamıza göre, oosit/≥14mm folikül oranına etkili değişkenler kadının yaşı, basal FSH (cut off 9,5mIU/mL, sensitivite 0,706 spesifite 0,621, p=0,001) ,basal LH (cutoff5,5mIU/mL, sensitivite0,640 spesifite0,690, p<0,001), AMH (cutoff 0,280ng/mL, sensitivite 0,748 spesifite 0,684, p<0,001), trigger günü E2 (cutoff388,50pg/mL, sensitivite 0,774spesifite 0,774, p<0,001)ve trigger günü ≥17 mm folikül sayısıdır.AMH için AUC 0,734 ve trigger günü E2 için AUC 0,768,basal LH için AUC 0,721 ile iyi derecede; basal E2 AUC 0,623, basal FSH 0,685ise düşük (poor) derecede prediktiftir. Sonuç: Oosit outputuna etkili değişkenler day2-4 FSH-LH, AMH, trigger günü E2, ve trigger günü ≥17mm folikül sayısıdır. AMH, basal LH ve trigger günü E2 oosit outputu için iyi derecede prediktiftir. Anahtar Kelimeler: Oosit output, Yardımcı Üreme Teknikleri, Oosit pick up

Anahtar Kelimeler

• Oosit output
• Yardımcı Üreme Teknikleri
• Oosit pick up

PREDICTION OF OOCYTE OUTPUT: How can we maximize the oocyte retrieving from follicles in Controlled Ovarian Hyperstimulation cycles?

Öz

PREDICTION OF OOCYTE OUTPUT: How can we maximize the oocyte retrieving from follicles in Controlled Ovarian Hyperstimulation cycles? Abstract Aim: We designed our study with the purpose of determining which variables should be used to predict oocyte output, to increase the number of collected oocytes and the success rate of IVF. Materials and Method: A total of 412 infertile patients admitted to the IVF center of a tertiary university hospital between the years 2016 and 2018 were evaluated retrospectively. The number of oocytes obtained by OPU from the follicles as the result of COH was grouped in percentiles. The variables effective on oocyte output were analyzed in the groups, and tests to predict acquisition of the maximal number of oocytes were tried to be determined. Results: When we investigated according to the oocyte/≥ 14 mm follicle ratios, we determined that 10.2% of the patients were in the ≤ 30% group, whereas 4.1% of them were in the group of 31-40 %. 6.6% of the patients were in the group of 41-50 %, 2.9% in the group of 51-60%, 5.6% in the group of 61-70 %, 8% in the group of 71-80%, 4.9% in the group of 81-90 %, and 57.8% in the group of 91-100 %. According to the results of our study, the variables effective on the oocyte/≥14 mm follicle ratio were the patient’s age, basal FSH value (cutoff 9.5mIU/mL, sensitivity 0.706, specificity 0.621, p=0.001), basal LH (cutoff 5.5mIU/mL, sensitivity 0.640 specificity 0.690, p<0.001), AMH (cutoff 0.280ng/mL, sensitivity 0.748 specificity 0.684, p<0.001), trigger day E2 (cutoff 388.50pg/mL, sensitivity 0.774, specificity 0.774, p<0.001) and the number of ≥17 mm follicles on the trigger day. The area under the curve (AUC) was 0.734for AMH, 0.768 for trigger day E2, and 0.721 for basal LH, having a good predictivity. The AUC was 0.623 for basal E2, and 0.685 for basal FSH value, having poor predictivity. Conclusion: The variables effective on oocyte output were the basal (day 2-4) FSH, LH, and AMH values, together with trigger day E2 value and the number of ≥17 mm follicles on the trigger day. AMH, basal LH, and trigger day E2 have good predictivity regarding oocyte output. Keywords: Oocyte output, Assisted Reproductive Technologies, Oocyte pick-up

Anahtar Kelimeler

• Oocyte output
• Assisted Reproductive Technologies
• Oocyte pick-up

Kaynakça

1. 1. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in ivf treatment: an analysis of 400 135 treatment cycles. Hum Reprod 2011; 26: 1768-74.
2. 2. Hasegawa A, Takahashi T, Igarashi H, Amita M, Matsukawa J, Nagase S. Predictive factors for oocyte retrieval failure in controlled ovarian hyperstimulation protocols: A Retrospective Observational Cohort Study. Reprod Biol Endocrinol 2015; 13: 53.
3. 3. Mesen TB, Yu B, Richter KS, Widra E, DeCherney A H, Segars JH. The prevalence of genuine empty follicle syndrome. Fertil Steril 2011; 96: 1375-77.
4. 4. Abbara A, Vuong LN, HoVNA , Clarke SA, Jeffers L, Comninos AN, et al. Follicle size on day of trigger most likely to yield a mature oocyte. Front Endocrinol 2018; 9: 193.
5. 5. Lensen SF, Wilkinson J, Leijdekkers JA, La Marca A, Mol BWJ, Marjoribanks J, et al. Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmicsperm injection (ivf/icsi). Cochrane Database Syst Rev 2018;(2), CD012693.
6. 6. Youssef MA, Abou-Setta AM, Lam WS. Recombinant versus urinary human chorionic gonadotrophin for final oocyte maturation triggering in ivf and icsi cycles. Cochrane Database Syst Rev 2016;(4), CD003719.
7. 7. Healey MW, Hill MJ, Levens ED. Optimal oocyte retrieval and embryo transfer techniques: where are we and how we got here. Semin Reprod Med 2015; 33: 83-91.
8. 8. Levy G, Hill MJ, Ramirez C I, Correa L, Ryan ME, De Cherney AH, et al. The use of follicle flushing during oocyte retrieval in assisted reproductive technologies: a systematic review and meta-analysis. Hum Reprod 2012; 27: 2373–79.

9. 9. Souza AL, Sampaio M, Noronha GB, Coster LG, de Oliveira RS, Geber S. Effect of follicular flushing on reproductive outcomes in patients with poor ovarian response undergoing assisted reproductive technology. J Assist Reprod Genet 2017; 34: 1353-57.
10. 10. Su YT, Lin PY, Huang FJ, Kung FT, Lin YJ, Tsai YR, et al. Age is a major prognosticator in extremely low oocyte retrieval cycles. Taiwan J Obstet Gynecol 2017; 56: 175–80.
11. 11. Timeva T, Milachich T, Antonova I, Arabaji T, Shterev A, Omar HA. Correlation between number of retrieved oocytes and pregnancy rate after in vitro fertilization/intracytoplasmic sperm infection. Scientific World Journal 2006; 6: 686-90.
12. 12. van der Gaast MH, Eijkemans MJ, van der Net JB, de Boer EJ, Burger CW, van Leeuwen FE, et al. Optimum number of oocytes for a successful first ivf treatment cycle. Reprod Biomed Online 2006; 13: 476-80.
13. 13. Revelli A, Martiny G, Delle Piane L, Benedetto C, Rinaudo P, Tur-Kaspa, I. A critical review of bi-dimensional and three-dimensional ultrasound techniques to monitor follicle growth: do they help improving ivf outcome? Reprod Biol Endocrinol 2014; 12: 107.
14. 14. Rosen MP, Shen S, Dobson AT, Rinaudo PF, McCulloch CE, Cedars MIA. Quantitative assessment of follicle size on oocyte developmental competence. Fertil Steril 2008; 90: 684-90.
15. 15. Dubey AK, Wang HA, Duffy P, Penzias AS. The correlation between follicular measurements, oocyte morphology, and fertilization rates in an in vitro fertilization program. Fertil Steril 1995; 64: 787-90. 16. Jayasena CN, Abbara A, Comninos AN, Nijher GMK, Christopoulos G, Narayanaswamy S, et al. Kisspeptin-54 triggers egg maturation in women undergoing in vitro fertilization. J Clin Invest 2014; 124: 3667–77.
16. 17. Humaidan P, Bredkjaer HE, Bungum L, Bungum M, Grondahl ML, Westergaard L, et al. Gnrh agonist (buserelin) or hcg for ovulation induction in gnrh antagonist ivf/icsi cycles: a prospective randomized study. Hum Reprod 2005; 20: 1213-20.
17. 18. Oktay K, Turkcuoglu I, Rodriguez-Wallberg K A. Gnrh agonist trigger for women with breast cancer undergoing fertility preservation by aromatase inhibitor/fsh stimulation. Reprod Biomed Online 2010; 20: 783-88.