İnfertil çiftler için tek veya çift intrauterin inseminasyon (IUI): Çift IUI klinik gebelik oranlarını artırır mı?

Öz

ÖZET

Amaç: Bu pilot çalışmada, çoklu foliküler gelişimi olan kontrollü ovarian hiperstimülasyon (KOH) sikluslarında çift intrauterin inseminasyon (IUI)'nin etkinliğini göstermeyi amaçladık.

Yöntemler:

Tersiyer bir merkezde Kadın Hastalıkları ve Doğum Kliniğinde Mart 2017 ile Mart 2018 tarihleri arasında yardımcı üreme teknikleri (YÜT) merkezinde IUI programına alınan 20 ile 35 yaş aralığında  38 hastaya hCG yapılmasından  sonra  18. ve 36. saatte  2 kez IUI  yapılmış ve kontrol grubu olarak 22 ile 35 yaş aralığında  32 hastaya   human chorionic gonadotropin (hCG) yapıldıktan sonra  36. saatte 1 kez  IUI  yapılmıştır. Toplam 70 hastanın mevcut kayıtlardan hasta ile ilgili demografik özellikler; Yaş, kilo, boy, daha önceki  gebelik öyküsü (gravide, parite), öyküsünde sigara alışkanlığı, hastaların  adetin üçüncü gün  hormon düzeyleri [ follicle stimulating hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)],  Prolaktin, Anti-Müllerian hormone (AMH), antral folikül sayısı (AFC), infertilite tipi ve süresi kayıt  edildi.

Bulgular:

Çalışmada, nisan 2017-mayıs 2018 tarihleri arasında toplam 70 infertil hasta dahil edildi.  Bunların 32 (%45.7)’sinin  1 kez IUI yapılmış grubunda iken, 38’i (%54.2) 2 kez IUI yapılmış grubunda olduğu izlendi.İki gruptaki kadınların HCG günü dominant  Follikül sayısı >15mm değerleri  bakımından median değerleri incelendiğinde, çalışma grubundaki 2.0(1-3), kontrol grubundakilerin ise 2.0(1.0-3.0) olarak bulundu (P=0.139).

İki gruptaki kadınların Klinik gebelik oranı(%) değerleri  bakımından değerleri incelendiğinde, çalışma grubundaki %21.05, kontrol grubundakilerin ise %18.75  olarak bulundu (P=0.812).

Sonuç:

Bu çalışmada  KOH ile  ovülasyon indüksiyonu  sonrası  intrauterin  inseminasyon  yapılan olgularda  tek ve çift  IUI  yapılmasının  klinik gebelik oranları arasında anlamlı bir  fark olmadığı gözlenmiştir. Dolayısıyla   intrauterin  inseminasyon  yapılan olgularda maliyet göz önünde tutularak  sonuçları hastayla paylaşmak gerekir.

Anahtar Kelimeler

• Kontrollü ovarian hiperstimulasyon,tek ve çift intra uterin inseminasyon,infertilite,inseminasyon zamanlaması

Single or double intrauterine insemination (IUI) for infertile couples: Does double IUI increases the rate of clinical pregnancy?

Abstract

Abstract

Objective: In this pilot study, it was aimed to demonstrate the efficacy of double intrauterine insemination (IUI) in the controlled ovarian hyperstimulation (COH) cycles with multiple follicular development.

Methods: Thirty-eight patients involved in IUI program, aged 20-35 years, underwent human chorionic gonadotropin (hCG) procedure in assisted reproductive techniques (ART), between March 2017 and March 2018, in the Gynecology and Obstetrics Clinics of a tertiary center. Thereafter, double IUI was performed at 18^th and 36^th hours; thirty-two patients, aged 22-35 years, received hCG, and a single IUI was performed at the 36^th hour. Demographic characteristics of 70 patients were recorded from the hospital records; age, weight, height, previous history of pregnancy (gravida, parity), smoking habits, hormonal levels at the 3^rd day of their menstrual cycle [follicle stimulating hormone (FSH), Luteinizing Hormone (LH), Estradiol (E2)], prolactin, anti-Mullerian hormone (AMH), antral follicle count (AFC), type and duration of infertility.   

Results: A total of 70 infertile patients were included in the study between April 2017 and May 2018. Of those, 32 (45.7%) were in the single IUI group and 38 (54.2%) were in the double IUI group. When the median values of the dominant follicle number> 15 mm on the HCG day of the women in the second group were examined, they were found as 2.0 (1-3) and 2.0 (1.0-3.0) in the study and control group, respectively (p = 0.139).

When the clinical pregnancy rates (%) of the women in the two groups were examined, they were found as 21.05% and 18.75% in the study and control group, respectively  (p = 0.812).

Conclusion: In the present study, it was observed that there was no significant difference between the clinical pregnancy rates of single and double IUI procedure during intrauterine insemination after ovulation induction with COH. Therefore, by considering the treatment costs, it is necessary to share the results with the patient in the cases of intrauterine insemination.

Keywords

• Controlled ovarian hyperstimulation,single and double intrauterine insemination,infertility,insemination timing

Kaynakça

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