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Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir mi?

Yıl 2021, Cilt: 11 Sayı: 1, 10 - 15, 01.04.2021

Öz

Amaç: Önceki çalışmalar oksidatif stresin polikistik over sendromu (PKOS) yanı sıra infertilite ile ilişkili olabileceğini ve antioksidan tedavilerin fertilite oranlarını artırabileceğini göstermiştir. Bu nedenle, infertil polikistik over sendromlu hastalarda total antioksidan seviyelerinin klomifen sitrat (KS) direncini öngörmede faydalı olup olmadığının araştırılması amaçlandı.
Materyal ve Metot: Çalışma kriterlerini karşılayan ve polikistik over sendromu olan yetmiş yedi (77) katılımcının (45 duyarlı ve 32 dirençli), yaşları 20–35 arasındaydı ve partnerlerinin spermiyogramları normaldi. Klomifen sitrat, menstrüel sikluslarının 3–7. günleri arasında, 50 mg/günlük dozla başlanarak, üç siklusa kadar tüm hastalara verildi. Eğer ovulasyon sağlanmadıysa, verilen doz sonraki sikluslarda 100 ve 150 mg’a kadar yükseltildi. Plazma Total antioksidan durumu (TAD) otomatik bir ölçüm yöntemi kullanılarak belirlendi. KS’ye duyarlı grup ile KS’ye dirençli grup, total antioksidan düzeyleri açısından karşılaştırıldı.
Bulgular: Ortalama plazma total antioksidan seviyeleri KS dirençli ve duyarlı gruplarda sırasıyla 1,21±0,42 ve 2,4±0,49 mmolTrolEq/L idi (p=0,001). ROC eğrisi analizinde, total antioksidan durum değeri ≤1,66 mmolTrolEq/L iken direnç gelişimi için %93,75 duyarlılık ve %86,6 özgüllük ile öngörülebilirlik elde edildi.
Sonuç: KS tedavisine dirençli olan infertil polikistik over sendromu hastalarında total antioksidan düzeyi daha düşüktü. Bu nedenle, total antioksidan düzeyleri KS direncinin saptanmasında yararlı bir belirteç olabilir.

Kaynakça

  • 1. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum. Reprod. 2010;25:544-551.
  • 2. Pandey V, Singh A, Krishna A, Pandey U, Tripathi YB. Role of oxidative stress and lowgrade inflammation in letrozole-induced polycystic ovary syndrome in the rat. Reprod Biol 2016;16(1):70-7.
  • 3. Rojas J, Chavez M, Olivar L, Rojas M, Morillo J, Mejias J, et al. Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth. Int J Reprod Med 2014; 2014:719050.
  • 4. Fenkci V, Fenkci S, Yilmazer M, Serteser M. Decreased total antioxidant status and increased oxidative stress in women with polycystic ovary syndrome may contribute to the risk of cardiovascular disease. Fertil Steril 2003;80(1):123-127.
  • 5. Deepika ML, Nalini S, Maruthi G, Ramchander V, Ranjith K, Latha KP, et al. Analysis of oxidative stress status through MN test and serum MDA levels in PCOS women. Pakistan J Biol Sci 2014;17:574.
  • 6. Olusi SO. Obesity is an independent risk factor for plasma lipid peroxidation and depletion of erythrocyte cytoprotectic enzymes in humans. Int J Obes Relat Metab Disord. 2002; 26:1159-1164.
  • 7. Urakawa H, Katsuki A, Sumida Y. Oxidative stress is associated with adiposity and insulin resistance in men. J Clin Endocrinol Metab. 2003;88:4673-4676.
  • 8. Duleba AJ, Dokras A. Is PCOS an inflammatory process? Fertil Steril 2012; 97:7–12.
  • 9. Vincent HK, Taylor AG. Biomarkers and potential mechanisms of obesity-induced oxidant stress in humans. Int J Obes. 2005;30:400-418.
  • 10. Liu S, Navarro G, Mauvais-Jarvis F. Androgen excess produces systemic oxidative stress and predisposes to beta-cell failure in female mice. PLoS One. 2010;5:e11302.
  • 11. Murri M, Luque-Ramirez M, Insenser M, Ojeda-Ojeda M, Escobar-Morreale HF. Circulating markers of oxidative stres and polycystic ovary syndrome (PCOS):a systematic review and meta-analysis. Human Reproduction Update. 2013;19:268-288.
  • 12. Moti M, Amini L, Ardakani SSM, Kamalzadeh S, Masoomikarimi M. Oxidative stress and anti-oxidant defense system in Iranian women with polycystic ovary syndrome. Iran J Reprod Med 2015;13:373-378.
  • 13. Nunez-Calonge R, Cortes S, Gutierrez Gonzalez LM. Oxidative stress in follicular fluid of young women with low response compared with fertile oocyte donors. Reprod Biomed Online 2016;32:446-456.
  • 14. Yilmaz N, Inal HA, Gorkem U, Sargin Oruc A, Yilmaz S, Turkkani A. Follicular fluid total antioxidant capacity levels in PCOS. J Obstet Gynaecol 2016;6:654-657.
  • 15. Turrens JF. Mitochondrial formation of reactive oxygen species. J Physiol. 2003;552:335-344.
  • 16. Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. Reprod Biol Endocrinol. 2005;3:28.
  • 17. Homburg R. Clomiphene citrate- end of era? A mini review. Hum Reprod. 2005;20:2043-2051.
  • 18. Erel O. A Novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem. 2004;37:112-119.
  • 19. Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertility and sterility, 2001;75(2):305-309.
  • 20. Yeon Lee J, Baw CK, Gupta S, Aziz N, Agarwal A. Role of oxidative stress in polycystic ovary syndrome. Curr Women's Health Rev 2010;6:96-107.
  • 21. Jancar N, Kopitar AN, Ihan A, Klun IV, Bokal EV. Effect of apoptosis and reactive oxygen species production in human granulosa cells on oocyte fertilization and blastocyst development. J Assist Reprod Genet. 2007; 24: 91-7.
  • 22. Oyawoye O, Abdel Gadir A, Garner A, Constantinovici N, Perrett C, Hardiman P. Antioxidants and reactive oxygen species in follicular fluid of women undergoing IVF: relationship to outcome. Hum Reprod. 2003;18:2270-2274.
  • 23. Attaran M, Pasqualotto E, Falcone T. The effect of follicular fluid reactive oxygen species on the outcome of in vitro fertilization. Int J Fertil Womens Med 2000;45:314-20.
  • 24. Bedaiwy MA, Falcone T, Mohamed MS. Differential growth of human embryos in vitro: role of reactive oxygen species. Fertil Steril.2004;82:593-600.
  • 25. Lai Q, Xiang W, Li Q. Oxidative stress in granulosa cells contributes to poor oocyte quality and IVF-ET outcomes in women with polycystic ovary syndrome. Frontiers of medicine. 2017;1-7.
  • 26. Verit FF, Erel O, Kocyigit A. Association of increased total antioxidant capacity and anovulation in nonobese infertile patients with clomiphene citrate–resistant polycystic ovary syndrome. Fertility and sterility. 2007;88(2):418-424.
  • 27. Imani B, Eijkemans MJ, te Velde ER, Habbema JDF, Fauser B. CA nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Fertility and sterility.2002;77:91-97.
  • 28. Eijkemans MJ, Habbema JD, Fauser BC. Characteristics of the best prognostic evidence: an example on prediction of outcome after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Semin Reprod Med.2003;21:39-47.
  • 29. Palini S, Benedetti S, Tagliamonte MC. Influence of ovarian stimulation for IVF/ICSI on the antioxidant defence system and relationship to outcome. Reprod Biomed Online 2014; 29:65–71.

Can Total Antioxidant Capacity Predict Clomiphene Citrate Resistance in Polycystic Ovary Syndrome Patients?

Yıl 2021, Cilt: 11 Sayı: 1, 10 - 15, 01.04.2021

Öz

. 2021; 11(1): 10-15 | DOI: 10.5505/kjms.2021.25991

Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir mi?
Hasan Çılgın
Kafkas Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı, Kars, Türkiye
Amaç: Önceki çalışmalar oksidatif stresin polikistik over sendromu (PKOS) yanı sıra infertilite ile ilişkili olabileceğini ve antioksidan tedavilerin fertilite oranlarını artırabileceğini göstermiştir. Bu nedenle, infertil polikistik over sendromlu hastalarda total antioksidan seviyelerinin klomifen sitrat (KS) direncini öngörmede faydalı olup olmadığının araştırılması amaçlandı.
Materyal ve Metot: Çalışma kriterlerini karşılayan ve polikistik over sendromu olan yetmiş yedi (77) katılımcının (45 duyarlı ve 32 dirençli), yaşları 20–35 arasındaydı ve partnerlerinin spermiyogramları normaldi. Klomifen sitrat, menstrüel sikluslarının 3–7. günleri arasında, 50 mg/günlük dozla başlanarak, üç siklusa kadar tüm hastalara verildi. Eğer ovulasyon sağlanmadıysa, verilen doz sonraki sikluslarda 100 ve 150 mg’a kadar yükseltildi. Plazma Total antioksidan durumu (TAD) otomatik bir ölçüm yöntemi kullanılarak belirlendi. KS’ye duyarlı grup ile KS’ye dirençli grup, total antioksidan düzeyleri açısından karşılaştırıldı.
Bulgular: Ortalama plazma total antioksidan seviyeleri KS dirençli ve duyarlı gruplarda sırasıyla 1,21±0,42 ve 2,4±0,49 mmolTrolEq/L idi (p=0,001). ROC eğrisi analizinde, total antioksidan durum değeri ≤1,66 mmolTrolEq/L iken direnç gelişimi için %93,75 duyarlılık ve %86,6 özgüllük ile öngörülebilirlik elde edildi.
Sonuç: KS tedavisine dirençli olan infertil polikistik over sendromu hastalarında total antioksidan düzeyi daha düşüktü. Bu nedenle, total antioksidan düzeyleri KS direncinin saptanmasında yararlı bir belirteç olabilir.

Anahtar Kelimeler: klomifene direnç, ovulasyon indüksiyonu, polikistik over sendromu, reaktif oksijen türleri, total antioksidan durumu

Can Total Antioxidant Capacity Predict Clomiphene Citrate Resistance in Polycystic Ovary Syndrome Patients?
Hasan Çılgın
Department of Obstetrics and Gynecology, Kafkas University Faculty of Medicine, Kars, Turkey
Aim: Previous studies have shown that oxidative stress may be associated with polycystic ovary syndrome (PCOS) as well as infertility and that antioxidant treatments can increase fertility rates. Therefore, it was aimed to investigate whether total antioxidant levels were useful in predicting clomiphene citrate (CC) resistance in infertile polycystic ovary syndrome patients.
Material and Method: Seventy-seven (77) participants (45 sensitive and 32 resistant) with polycystic ovary sendrome who met study criteria were between 20 and 35 years of age and their partners had normal spermiograms. Clomiphene citrate was given to all patients up to three cycles between three and seven days of their menstrual cycle, starting with a 50 mg/daily dose. If ovulation did not provided dose was raised to 100 and 150 mg in subsequent cycles. Plasma Total antioxidant status (TAS) was determined using an automated measurement method. The CC sensitive group was compared with the CC resistant group in terms of total antioxidant levels.
Results: Mean plasma total antioxidant levels were 1.21±0.42 and 2.4±0.49 mmolTrolEq/L in the CC resistant and sensitive groups, respectively (p=0.001). In the receiver operating characteristic (ROC) curve analysis while total antioxidant status value was ≤1.66 mmol Trolox equivalent/L had predictability on resistance development with 93.75% sensitivity and 86.67% specificity.
Conclusion: Total antioxidant level was lower in infertile polycystic ovary syndrome patients who were resistant to CC treatment. Therefore, total antioxidant levels could be a useful marker in establishing CC resistance.

Kaynakça

  • 1. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum. Reprod. 2010;25:544-551.
  • 2. Pandey V, Singh A, Krishna A, Pandey U, Tripathi YB. Role of oxidative stress and lowgrade inflammation in letrozole-induced polycystic ovary syndrome in the rat. Reprod Biol 2016;16(1):70-7.
  • 3. Rojas J, Chavez M, Olivar L, Rojas M, Morillo J, Mejias J, et al. Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth. Int J Reprod Med 2014; 2014:719050.
  • 4. Fenkci V, Fenkci S, Yilmazer M, Serteser M. Decreased total antioxidant status and increased oxidative stress in women with polycystic ovary syndrome may contribute to the risk of cardiovascular disease. Fertil Steril 2003;80(1):123-127.
  • 5. Deepika ML, Nalini S, Maruthi G, Ramchander V, Ranjith K, Latha KP, et al. Analysis of oxidative stress status through MN test and serum MDA levels in PCOS women. Pakistan J Biol Sci 2014;17:574.
  • 6. Olusi SO. Obesity is an independent risk factor for plasma lipid peroxidation and depletion of erythrocyte cytoprotectic enzymes in humans. Int J Obes Relat Metab Disord. 2002; 26:1159-1164.
  • 7. Urakawa H, Katsuki A, Sumida Y. Oxidative stress is associated with adiposity and insulin resistance in men. J Clin Endocrinol Metab. 2003;88:4673-4676.
  • 8. Duleba AJ, Dokras A. Is PCOS an inflammatory process? Fertil Steril 2012; 97:7–12.
  • 9. Vincent HK, Taylor AG. Biomarkers and potential mechanisms of obesity-induced oxidant stress in humans. Int J Obes. 2005;30:400-418.
  • 10. Liu S, Navarro G, Mauvais-Jarvis F. Androgen excess produces systemic oxidative stress and predisposes to beta-cell failure in female mice. PLoS One. 2010;5:e11302.
  • 11. Murri M, Luque-Ramirez M, Insenser M, Ojeda-Ojeda M, Escobar-Morreale HF. Circulating markers of oxidative stres and polycystic ovary syndrome (PCOS):a systematic review and meta-analysis. Human Reproduction Update. 2013;19:268-288.
  • 12. Moti M, Amini L, Ardakani SSM, Kamalzadeh S, Masoomikarimi M. Oxidative stress and anti-oxidant defense system in Iranian women with polycystic ovary syndrome. Iran J Reprod Med 2015;13:373-378.
  • 13. Nunez-Calonge R, Cortes S, Gutierrez Gonzalez LM. Oxidative stress in follicular fluid of young women with low response compared with fertile oocyte donors. Reprod Biomed Online 2016;32:446-456.
  • 14. Yilmaz N, Inal HA, Gorkem U, Sargin Oruc A, Yilmaz S, Turkkani A. Follicular fluid total antioxidant capacity levels in PCOS. J Obstet Gynaecol 2016;6:654-657.
  • 15. Turrens JF. Mitochondrial formation of reactive oxygen species. J Physiol. 2003;552:335-344.
  • 16. Agarwal A, Gupta S, Sharma RK. Role of oxidative stress in female reproduction. Reprod Biol Endocrinol. 2005;3:28.
  • 17. Homburg R. Clomiphene citrate- end of era? A mini review. Hum Reprod. 2005;20:2043-2051.
  • 18. Erel O. A Novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem. 2004;37:112-119.
  • 19. Mitwally MF, Casper RF. Use of an aromatase inhibitor for induction of ovulation in patients with an inadequate response to clomiphene citrate. Fertility and sterility, 2001;75(2):305-309.
  • 20. Yeon Lee J, Baw CK, Gupta S, Aziz N, Agarwal A. Role of oxidative stress in polycystic ovary syndrome. Curr Women's Health Rev 2010;6:96-107.
  • 21. Jancar N, Kopitar AN, Ihan A, Klun IV, Bokal EV. Effect of apoptosis and reactive oxygen species production in human granulosa cells on oocyte fertilization and blastocyst development. J Assist Reprod Genet. 2007; 24: 91-7.
  • 22. Oyawoye O, Abdel Gadir A, Garner A, Constantinovici N, Perrett C, Hardiman P. Antioxidants and reactive oxygen species in follicular fluid of women undergoing IVF: relationship to outcome. Hum Reprod. 2003;18:2270-2274.
  • 23. Attaran M, Pasqualotto E, Falcone T. The effect of follicular fluid reactive oxygen species on the outcome of in vitro fertilization. Int J Fertil Womens Med 2000;45:314-20.
  • 24. Bedaiwy MA, Falcone T, Mohamed MS. Differential growth of human embryos in vitro: role of reactive oxygen species. Fertil Steril.2004;82:593-600.
  • 25. Lai Q, Xiang W, Li Q. Oxidative stress in granulosa cells contributes to poor oocyte quality and IVF-ET outcomes in women with polycystic ovary syndrome. Frontiers of medicine. 2017;1-7.
  • 26. Verit FF, Erel O, Kocyigit A. Association of increased total antioxidant capacity and anovulation in nonobese infertile patients with clomiphene citrate–resistant polycystic ovary syndrome. Fertility and sterility. 2007;88(2):418-424.
  • 27. Imani B, Eijkemans MJ, te Velde ER, Habbema JDF, Fauser B. CA nomogram to predict the probability of live birth after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Fertility and sterility.2002;77:91-97.
  • 28. Eijkemans MJ, Habbema JD, Fauser BC. Characteristics of the best prognostic evidence: an example on prediction of outcome after clomiphene citrate induction of ovulation in normogonadotropic oligoamenorrheic infertility. Semin Reprod Med.2003;21:39-47.
  • 29. Palini S, Benedetti S, Tagliamonte MC. Influence of ovarian stimulation for IVF/ICSI on the antioxidant defence system and relationship to outcome. Reprod Biomed Online 2014; 29:65–71.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Hasan Çılgın Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 11 Sayı: 1

Kaynak Göster

APA Çılgın, H. (2021). Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir mi?. Kafkas Journal of Medical Sciences, 11(1), 10-15.
AMA Çılgın H. Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir mi?. KAFKAS TIP BİL DERG. Nisan 2021;11(1):10-15.
Chicago Çılgın, Hasan. “Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir Mi?”. Kafkas Journal of Medical Sciences 11, sy. 1 (Nisan 2021): 10-15.
EndNote Çılgın H (01 Nisan 2021) Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir mi?. Kafkas Journal of Medical Sciences 11 1 10–15.
IEEE H. Çılgın, “Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir mi?”, KAFKAS TIP BİL DERG, c. 11, sy. 1, ss. 10–15, 2021.
ISNAD Çılgın, Hasan. “Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir Mi?”. Kafkas Journal of Medical Sciences 11/1 (Nisan 2021), 10-15.
JAMA Çılgın H. Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir mi?. KAFKAS TIP BİL DERG. 2021;11:10–15.
MLA Çılgın, Hasan. “Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir Mi?”. Kafkas Journal of Medical Sciences, c. 11, sy. 1, 2021, ss. 10-15.
Vancouver Çılgın H. Polikistik Over Sendromlu Hastalarda Total Antioksidan Düzeyi Klomifen Sitrat Direncini Öngörebilir mi?. KAFKAS TIP BİL DERG. 2021;11(1):10-5.