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

Yıl 2021, Cilt: 18 Sayı: 3, 973 - 979, 25.09.2021
https://doi.org/10.38136/jgon.987790

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.

Kaynakça

  • D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003 May;21(2):243-54.
  • Ozkan S, Murk W, Arici A. Endometriosis and infertility: epidemiology and evidence-based treatments. Ann N Y Acad Sci. 2008 Apr;1127:92-100.
  • Gupta S, Agarwal A, Agarwal R, Loret de Mola JR. Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online. 2006 Sep;13(3):349-60.
  • Young VJ, Brown JK, Saunders PT, Horne AW. The role of the peritoneum in the pathogenesis of endometriosis. Hum Reprod Update. 2013 Sep-Oct;19(5):558-69
  • Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand. 2017 Jun;96(6):633-643.
  • Mahutte NG, Arici A. New advances in the understanding of endometriosis related infertility. J Reprod Immunol. 2002 May-Jun;55(1-2):73-83.
  • Al-Azemi M, Bernal AL, Steele J, Gramsbergen I, Barlow D, Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod. 2000 Jan;15(1):72-5.
  • Kitajima M, Dolmans MM, Donnez O, Masuzaki H, Soares M, Donnez J. Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas. Fertil Steril. 2014 Apr;101(4):1031-7.
  • Donnez J, Binda MM, Donnez O, Dolmans MM. Oxidative stress in the pelvic cavity and its role in the pathogenesis of endometriosis. Fertil Steril. 2016 Oct;106(5):1011-1017.
  • Sanchez AM, Viganò P, Somigliana E, Panina-Bordignon P, Vercellini P, Candiani M. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update. 2014 Mar-Apr;20(2):217-30.
  • Hsieh CL, Shiau CS, Lo LM, Hsieh TT, Chang MY. Effectiveness of ultrasound-guided aspiration and sclerotherapy with 95% ethanol for treatment of recurrent ovarian endometriomas. Fertil Steril. 2009 Jun;91(6):2709-13.
  • Wong BC, Gillman NC, Oehninger S, Gibbons WE, Stadtmauer LA. Results of in vitro fertilization in patients with endometriomas: is surgical removal beneficial? Am J Obstet Gynecol. 2004 Aug;191(2):597-606; discussion 606-7.
  • Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Crosignani PG. Surgery for endometriosis-associated infertility: a pragmatic approach. Hum Reprod. 2009 Feb;24(2):254-69.
  • Garcia-Velasco JA, Mahutte NG, Corona J, Zúñiga V, Gilés J, Arici A, Pellicer A. Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. Fertil Steril. 2004 May;81(5):1194-7.
  • Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril. 2012 Dec;98(6):1531-8.
  • Muzii L, Di Tucci C, Di Feliciantonio M, Marchetti C, Perniola G, Panici PB. The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod. 2014 Oct 10;29(10):2190-8.
  • Hamdan M, Dunselman G, Li TC, Cheong Y. The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis. Hum Reprod Update. 2015 Nov-Dec;21(6):809-25.
  • Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar;29(3):400-12.
  • Mesogitis S, Daskalakis G, Pilalis A, Papantoniou N, Thomakos N, Dessipris N, Koutra P, Antsaklis A. Management of ovarian cysts with aspiration and methotrexate injection. Radiology. 2005 May;235(2):668-73.
  • Castellarnau Visus M, Ponce Sebastia J, Carreras Collado R, Cayuela Font E, Garcia Tejedor A. Preliminary results: ethanol sclerotherapy after ultrasound-guided fine needle aspiration without anesthesia in the management of simple ovarian cysts. J Minim Invasive Gynecol. 2015 Mar-Apr;22(3):475-82.
  • Gatta G, Parlato V, Di Grezia G, Porto A, Cappabianca S, Grassi R, Rotondo A. Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts. Radiol Med. 2010 Dec;115(8):1330-9. English, Italian.
  • Albanese G, Kondo KL. Pharmacology of sclerotherapy. Semin Intervent Radiol. 2010 Dec;27(4):391-9.
  • García-Tejedor A, Castellarnau M, Ponce J, Fernández ME, Burdio F. Ethanol sclerotherapy of ovarian en dometrioma: a safe and effective minimal invasive procedure. Preliminary results. Eur J Obstet Gynecol Reprod Biol. 2015 Apr;187:25-9.
  • Yazbeck C, Madelenat P, Ayel JP, Jacquesson L, Bontoux LM, Solal P, Hazout A. Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation. Reprod Biomed Online. 2009 Jul;19(1):121-5.
  • Fisch JD, Sher G. Sclerotherapy with 5% tetracycline is a simple alternative to potentially complex surgical treatment of ovarian endometriomas before in vitro fertilization. Fertil Steril. 2004 Aug;82(2):437-41.
  • Agostini A, De Lapparent T, Collette E, Capelle M, Cravello L, Blanc B. In situ methotrexate injection for treatment of recurrent endometriotic cysts. Eur J Obstet Gynecol Reprod Biol. 2007 Jan;130(1):129-31.
  • Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011 Jun;26(6):1270-83.
  • Gardner, D. & Schoolcraft, W. (1999). In vitro culture of human blastocysts. Towards reproductive Certainty, Sydney, Australia, Sydney, Australia, pp. 378-388.
  • Cohen A, Almog B, Tulandi T. Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril. 2017 Jul;108(1):117-124.e5.
  • Aflatoonian A, Rahmani E, Rahsepar M. Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: A randomized clinical trial. Iran J Reprod Med. 2013 Mar;11(3):179-84.
  • Guo YH, Lu N, Zhang Y, Su YC, Wang Y, Zhang YL, Sun YP. Comparative study on the pregnancy outcomes of in vitro fertilization-embryo transfer between long-acting gonadotropin-releasing hormone agonist combined with transvaginal ultrasound-guided cyst aspiration and long-acting gonadotropin-releasing hormone agonist alone. Contemp Clin Trials. 2012 Nov;33(6):1206-10.
  • Miquel L, Preaubert L, Gnisci A, Resseguier N, Pivano A, Perrin J, Courbiere B. Endometrioma ethanol sclerotherapy could increase IVF live birth rate in women with moderate-severe endometriosis. PLoS One. 2020 Sep 28;15(9):e0239846.

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

Yıl 2021, Cilt: 18 Sayı: 3, 973 - 979, 25.09.2021
https://doi.org/10.38136/jgon.987790

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.

Kaynakça

  • D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003 May;21(2):243-54.
  • Ozkan S, Murk W, Arici A. Endometriosis and infertility: epidemiology and evidence-based treatments. Ann N Y Acad Sci. 2008 Apr;1127:92-100.
  • Gupta S, Agarwal A, Agarwal R, Loret de Mola JR. Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online. 2006 Sep;13(3):349-60.
  • Young VJ, Brown JK, Saunders PT, Horne AW. The role of the peritoneum in the pathogenesis of endometriosis. Hum Reprod Update. 2013 Sep-Oct;19(5):558-69
  • Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand. 2017 Jun;96(6):633-643.
  • Mahutte NG, Arici A. New advances in the understanding of endometriosis related infertility. J Reprod Immunol. 2002 May-Jun;55(1-2):73-83.
  • Al-Azemi M, Bernal AL, Steele J, Gramsbergen I, Barlow D, Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod. 2000 Jan;15(1):72-5.
  • Kitajima M, Dolmans MM, Donnez O, Masuzaki H, Soares M, Donnez J. Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas. Fertil Steril. 2014 Apr;101(4):1031-7.
  • Donnez J, Binda MM, Donnez O, Dolmans MM. Oxidative stress in the pelvic cavity and its role in the pathogenesis of endometriosis. Fertil Steril. 2016 Oct;106(5):1011-1017.
  • Sanchez AM, Viganò P, Somigliana E, Panina-Bordignon P, Vercellini P, Candiani M. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update. 2014 Mar-Apr;20(2):217-30.
  • Hsieh CL, Shiau CS, Lo LM, Hsieh TT, Chang MY. Effectiveness of ultrasound-guided aspiration and sclerotherapy with 95% ethanol for treatment of recurrent ovarian endometriomas. Fertil Steril. 2009 Jun;91(6):2709-13.
  • Wong BC, Gillman NC, Oehninger S, Gibbons WE, Stadtmauer LA. Results of in vitro fertilization in patients with endometriomas: is surgical removal beneficial? Am J Obstet Gynecol. 2004 Aug;191(2):597-606; discussion 606-7.
  • Vercellini P, Somigliana E, Viganò P, Abbiati A, Barbara G, Crosignani PG. Surgery for endometriosis-associated infertility: a pragmatic approach. Hum Reprod. 2009 Feb;24(2):254-69.
  • Garcia-Velasco JA, Mahutte NG, Corona J, Zúñiga V, Gilés J, Arici A, Pellicer A. Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. Fertil Steril. 2004 May;81(5):1194-7.
  • Somigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. Fertil Steril. 2012 Dec;98(6):1531-8.
  • Muzii L, Di Tucci C, Di Feliciantonio M, Marchetti C, Perniola G, Panici PB. The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod. 2014 Oct 10;29(10):2190-8.
  • Hamdan M, Dunselman G, Li TC, Cheong Y. The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis. Hum Reprod Update. 2015 Nov-Dec;21(6):809-25.
  • Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W; European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar;29(3):400-12.
  • Mesogitis S, Daskalakis G, Pilalis A, Papantoniou N, Thomakos N, Dessipris N, Koutra P, Antsaklis A. Management of ovarian cysts with aspiration and methotrexate injection. Radiology. 2005 May;235(2):668-73.
  • Castellarnau Visus M, Ponce Sebastia J, Carreras Collado R, Cayuela Font E, Garcia Tejedor A. Preliminary results: ethanol sclerotherapy after ultrasound-guided fine needle aspiration without anesthesia in the management of simple ovarian cysts. J Minim Invasive Gynecol. 2015 Mar-Apr;22(3):475-82.
  • Gatta G, Parlato V, Di Grezia G, Porto A, Cappabianca S, Grassi R, Rotondo A. Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts. Radiol Med. 2010 Dec;115(8):1330-9. English, Italian.
  • Albanese G, Kondo KL. Pharmacology of sclerotherapy. Semin Intervent Radiol. 2010 Dec;27(4):391-9.
  • García-Tejedor A, Castellarnau M, Ponce J, Fernández ME, Burdio F. Ethanol sclerotherapy of ovarian en dometrioma: a safe and effective minimal invasive procedure. Preliminary results. Eur J Obstet Gynecol Reprod Biol. 2015 Apr;187:25-9.
  • Yazbeck C, Madelenat P, Ayel JP, Jacquesson L, Bontoux LM, Solal P, Hazout A. Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation. Reprod Biomed Online. 2009 Jul;19(1):121-5.
  • Fisch JD, Sher G. Sclerotherapy with 5% tetracycline is a simple alternative to potentially complex surgical treatment of ovarian endometriomas before in vitro fertilization. Fertil Steril. 2004 Aug;82(2):437-41.
  • Agostini A, De Lapparent T, Collette E, Capelle M, Cravello L, Blanc B. In situ methotrexate injection for treatment of recurrent endometriotic cysts. Eur J Obstet Gynecol Reprod Biol. 2007 Jan;130(1):129-31.
  • Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011 Jun;26(6):1270-83.
  • Gardner, D. & Schoolcraft, W. (1999). In vitro culture of human blastocysts. Towards reproductive Certainty, Sydney, Australia, Sydney, Australia, pp. 378-388.
  • Cohen A, Almog B, Tulandi T. Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril. 2017 Jul;108(1):117-124.e5.
  • Aflatoonian A, Rahmani E, Rahsepar M. Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: A randomized clinical trial. Iran J Reprod Med. 2013 Mar;11(3):179-84.
  • Guo YH, Lu N, Zhang Y, Su YC, Wang Y, Zhang YL, Sun YP. Comparative study on the pregnancy outcomes of in vitro fertilization-embryo transfer between long-acting gonadotropin-releasing hormone agonist combined with transvaginal ultrasound-guided cyst aspiration and long-acting gonadotropin-releasing hormone agonist alone. Contemp Clin Trials. 2012 Nov;33(6):1206-10.
  • Miquel L, Preaubert L, Gnisci A, Resseguier N, Pivano A, Perrin J, Courbiere B. Endometrioma ethanol sclerotherapy could increase IVF live birth rate in women with moderate-severe endometriosis. PLoS One. 2020 Sep 28;15(9):e0239846.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kadın Hastalıkları ve Doğum
Bölüm Araştırma Makaleleri
Yazarlar

Lale Susan Karakış 0000-0003-1870-5415

Sabri Cavkaytar 0000-0003-1584-8568

Güvenç Karlikaya 0000-0002-0366-1037

Mustafa Bahceci 0000-0002-5626-3251

Yayımlanma Tarihi 25 Eylül 2021
Gönderilme Tarihi 27 Ağustos 2021
Kabul Tarihi 13 Eylül 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 18 Sayı: 3

Kaynak Göster

Vancouver Karakış LS, Cavkaytar S, Karlikaya G, Bahceci M. The Impact of Ethanol Sclerotherapy on ICSI Outcomes in Infertile Patients with Endometriomas Undergoing Controlled Ovarian Stimulation. JGON. 2021;18(3):973-9.