The Effect of the Gonadotropin Dose Increment During Controlled Ovarian Hyperstimulation on Live Birth Rates of POSEIDON Group 3-4 Patients

Öz

This retrospective study seeks to explore whether modifying the gonadotropin dose in cases of poor ovarian response during controlled ovarian hyperstimulation contributes to improved live birth rates in Poseidon Group 3-4 patients. The study took place at a tertiary level university. The electronic database spanning 2012-2021 was scrutinized to identify patients with diminished ovarian reserve (DOR) who underwent intra-cytoplasmic sperm injection – embryo transfer (ICSI-ET). Diminished ovarian reserve was determined using the POSEIDON criteria. Patients were categorized into two groups based on whether dose adjustment was implemented during the initial ultrasound assessment in controlled ovarian hyperstimulation (COH). There were 188 patients in the dose adjustment (DA) group and 310 patients in the fixed-dose (FD) group. The demographic parameters were similar between the groups. The started gonadotropin dose was similar in both groups (300 IU). The median dose adjustment on the first control was +75 IU in the DA group. The follicle output rates, follicle to oocyte indexes, and the embryology parameters were comparable between the groups. The positive pregnancy rate was 19.7% (36/188) in the DA group vs. 19.1% (61/310) in the FD Group (p=0.4). The primary outcome of the study; live birth rates were 12% in the DA group vs. 9% in the FD group, and the results were statistically similar (p=0.3). Our research revealed that adjusting the gonadotropin dose in cases of inadequate ovarian response during COH results in comparable live birth rates to those observed in the fixed-dose group. For patients exhibiting an inadequate response, dose adjustment may be deemed necessary.

Anahtar Kelimeler

• Poor Ovarian Response
• Diminished Ovarian Reserve
• Gonadotropin Dosage
• in vitro fertilization
• infertility

Kontrollü Ovaryan Hiperstimülasyon Sırasında Gonadotropin Dozunun Artışının POSEİDON Grubu 3-4 Hastalarının Canlı Doğum Oranlarına Etkisi

Öz

Bu retrospektif çalışma, kontrollü ovaryan hiperstimülasyon sırasında düşük over yanıtı gösteren Poseidon Grubu 3-4 hastalarında gonadotropin dozunu değiştirmenin, canlı doğum oranlarını artırıp artırmadığını araştırmayı amaçlamaktadır. Çalışma üçüncü basamak bir üniversite hastanesinde gerçekleştirilmiştir. 2012-2021 yıllarını kapsayan elektronik veritabanı, düşük over rezervi (DOR) olan ve intra-sitoplazmik sperm enjeksiyonu - embriyo transferi (ICSI-ET) geçiren hastaları belirlemek için incelenmiştir. Düşük over rezervi, Poseidon kriterlerine göre belirlenmiştir. Hastalar, kontrollü over hiperstimülasyonu (COH) sırasındaki ilk ultrason değerlendirmesi sırasında doz ayarlamasının uygulanıp uygulanmadığına göre iki gruba ayrılmıştır. Doz ayarlaması (DA) grubunda 188 hasta ve sabit doz (FD) grubunda 310 hasta bulunmaktadır. Demografik parametreler gruplar arasında benzerlik göstermektedir. Başlangıç gonadotropin dozu her iki grupta da benzerdi (300 IU). İlk kontroldeki median doz ayarlaması DA grubunda +75 IU idi. FORT (follicle-output rate) oranları, folikül-oosit indeksleri ve embriyoloji parametreleri gruplar arasında karşılaştırılabilir düzeydeydi. Pozitif gebelik oranı DA grubunda %19,7 (36/188) iken, FD Grubunda %19,1 (61/310) idi (p=0,4). Çalışmanın birincil sonucu; canlı doğum oranları DA grubunda %12 iken, FD grubunda %9 olarak bulundu ve sonuçlar istatistiksel olarak benzerdi (p=0,3). Araştırmamız, kontrollü over hiperstimülasyonu sırasında yetersiz over yanıtı olan vakalarda gonadotropin dozunun ayarlanmasının, sabit doz grubunda gözlenen canlı doğum oranlarına benzer sonuçlar verdiğini ortaya koymuştur. Yetersiz yanıt gösteren hastalar için doz ayarlaması gerekli olabilir.

Anahtar Kelimeler

• Düşük over rezervi
• kötü over yanıtı
• gonadotropin
• in-vitro fertilizasyon
• infertilite

Kaynakça

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