GnRH Antagonist Protokolü ile Kontrollü Overyen Hiperstimulasyon Öncesi Endometrioma Aspirasyonu ve Etanol Skleroterapisinin İntrasitoplazmik Sperm Enjeksiyonu Sonuçlarına Etkisi

Öz

Amaç: Bu çalışmanın amacı endometrioması olan infertil hastalarda kontrollü overyen hiperstimülasyon öncesi endometrioma aspirasyonu ve etanol ile skleroterapi işleminin ICSI sonuçlarına olumlu etkisi olup olmadığını araştırmaktır. Gereçler ve Yöntem: GnRH antagonist protokolü ile kontrollü overyen stimulasyon tedavisi öncesi endometrioma aspirasyonu yapılan 103 hasta ile endometrioma aspirasyonu yapılmayan 405 hastanın siklus özellikleri ve gebelik sonuçları retrospektif olarak karşılaştırıldı. Bulgular: İki grup arasında toplanan oosit sayisi, metafaz II oosit sayisi, fertilizasyon oranları ve iyi kaliteli embriyo oranlarında istatistiksel olarak anlamlı bir fark saptanmadı. Klinik gebelik oranları, implantasyon oranları ve canlı doğum oranlarında da iki grup arasında anlamlı bir fark bulunmadı. Skleroterapi uygulanan grupta intraperitoneal kanama, peritonit, overyen abse veya intestinal perforasyon gibi majör herhangi bir komplikasyon izlenmedi. Sonuç: Bu çalışmada GnRH antogonist protokolü ile kontrollü overyen stimulasyondan hemen önce yapılan endometrioma aspirasyonu ve etanol ile skleroterapi işleminin ICSI sonuçlarına olumlu bir etkisi saptanamamıştır. Bunun yanında literatürde etanol skleroterapisinin GnRH agonist protokolleri ile uygulandığı taktirde daha olumlu sonuçlar verebileceğine dair yayınlar mevcuttur. Kolay uygulanabilen ve komplikasyon oranı düşük olan bu prosedürün yumurta toplama işlemini zorlaştıracak büyüklükte endometrioması olan veya şiddetli ağrı şikayeti olan hastalarda cerrahiye alternatif olarak kullanılması önerilebilir.

Anahtar Kelimeler

• endometrioma
• aspirasyon
• etanol
• skleroterapi

The Impact of Ethanol Sclerotherapy on ICSI Outcomes in Infertile Patients with Endometriomas Undergoing Controlled Ovarian Stimulation

Öz

Objective: the aim of the study was to determine whether endometrioma aspiration and alcohol sclerotherapy performed prior to controlled ovarian stimulation has any beneficial effects on ICSI outcomes in patients with endometriomas. Methods: The cycle characteristics and pregnancy outcomes of 103 patients with endometriomas who underwent ethanol sclerotherapy on day 2 of the controlled ovarian stimulation with a gonadotropin antagonist protocol were retrospectively compared with the cycle characteristics of 405 patients with endometriomas who did not receive scleroterapy before stimulation. Results: No statistically significant difference was observed in the number of retrieved oocytes, metaphase II oocytes, fertilization and good quality embryo rates between the two groups. The clinical pregnancy rate, implantation rate and live birth rates were similar among the two groups. No major complications including intraperitoneal haemorrhage, peritonitis, ovarian abscess or intestinal perforation were recorded. Conclusion: The results of the present study indicate that ethanol sclerotherapy does not improve ICSI outcomes when performed right before ovarian stimulation and without concomittant GnRH analogue administration. Since it is a simple outpatient procedure without significant complications, ethanol sclerotherapy may be performed prior to IVF as an alternative to surgery to improve the accessibility of follicles and monitoring of follicle growth in patients with large endometriomas and for those patients with intractable pain symptoms, without decreasing the ovarian reserve.

Anahtar Kelimeler

• endometrioma
• aspiration
• sclerotherapy
• infertility

Kaynakça

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