GONADOTROPİNLERLE OVULASYON İNDÜKSİYONU VE İNTRAUTERİN İNSEMİNASYON YAPILAN AÇIKLANMAYAN İNFERTİL ÇİFTLERDE HCG GÜNÜ ENDOMETRİAL KALINLIK VE PATERNİNİN TEDAVİ BAŞARISINA ETKİSİ

Öz

Amaç: Kontrollü ovulasyon indüksiyonu ve intrauterin inseminasyon (OI-IUI) tüm dünyada infertil çiftlerde ilk basamak tedavi olarak kullanılmaktadır. Bu çalışmada OI-IUI yapılan nedeni belirlenemeyen infertilite olgularında Hcg günü değerlendirilen endometrial kalınlık ve paternin tedavi başarısına etkisini inceledik.

Materyel-metod: Bu çalışmada Şubat 2013-Eylül 2013 tarihleri arasında nedeni belirlenemeyen infertilite tanısı alan 101 çift ve132 IUI siklusu prospektif olarak incelendi.

Bulgular: 132 siklusta 22 gebelik elde edildi ve siklus başına gebelik oranı %16.6 hasta başına gebelik oranı %21.7 olarak hesaplandı. Gebelik pozitif ve negatif olan grupta kullanılan FSH dozu, stimülasyon süresi, bazal FSH, bazal E2, TPMSS, IUI siklus sayısı, folikül çapı arasında anlamlı farklılık saptanmadı. Gebelik pozitif olan grupta infertilite süresi 2.1±1.4 yıl gebelik negatif olan grupta 4.1±2.3 yıldı ve bu fark anlamlı olarak daha kısaydı (p < 0,05). Gebelik pozitif olan grupta antral folikül sayısı  ve hCG günü folikül sayısı gebelik negatif olan gruptan anlamlı (p < 0.05) olarak daha yüksekti. Hcg günü yapılan endometrial değerlendirmede gebelik elde edilen grupta 9.8±1.1 mm, gebelik elde edilemeyen grupta ise 9.6±3.5 mm ölçüldü ve endometrial kalınlığın veya endometrium paterninin her iki grup arasında anlamlı farklılık göstermediği görüldü.

Sonuç: İnfertilite tedavisinde OI-IUI uygulanan hastalarda hCG günü ölçülen endometrial kalınlık ve endometrial paternin gebelik oranlarını etkilemediği görüldü.

 

Anahtar Kelimeler

• infertilite,ovulasyon indüksiyonu,endometriyum

THE EFFECT OF THICKNESS AND PATTERN OF ENDOMETRIUM ON SUCCESS RATE ON HCG DAY IN INFERTILE COUPLES TREATED WITH OVULATION INDUCTION VIA GONADOTROPINS AND INTRAUTERINE INSEMINATION

Abstract

Aim: Ovulation induction and intrauterine insemination is the first line therapy chosen for infertile couples. In this study, we investigated the effect of endometrial thickness and endometrial pattern; examined on HCG day,  on the success rate of OI-IUI performed in unexplained infertility cases on the day of HCG.

Material and Method: In this study 101 couples and 132 IUI cycle who were diagnoses unexplained infertility were examined  prospectively.

Results: 22 successful pregnancy was achieved in 132 cycles, the rate of pregnancy was calculated as %16.6 per cycle and %21.7 per patient. There was no significant difference between clinically proved pregnancy-positive and negative outcome groups regarding FSH dosage, duration of stimulation, basal FSH level, basal E2, TPMSS, number of IUI cycle, follicle diameter. Infertility period was calculated as 2.1 ± 1.4 years, and 4.1 ± 2.3 years positive and negative outcome groups respectively.  The difference was statistically significant (p < 0.05). The number of an antral follicle and follicle count on HCG day was significantly different on pregnancy positive group compared to pregnancy negative group (p< 0.05).  Endometrial thickness was measured as 9.8±1.1 mm and 9.6±3.5 mm in groups with positive and negative outcomes respectively. There was no significant difference regarding endometrial thickness and endometrial pattern.

Result: There was no significant difference between pregnancy clinically proven and unproven groups in terms of endometrial thickness and endometrial pattern on the day HCG performed.

Keywords

• infertility,ovulation induction,endometrium

Kaynakça

1. 1. Moghissi KS, Wallach EE. Unexplained infertility. Fertil Steril. 1983; 39(1):5-21.
2. 2. Guzick DS, Grefenstette I, Baffone K, Berga SL, Krasnow JS, Stovall DW, Naus GJ. Infertility evaluation in fertile women: a model for assessing the efficacy of infertility testing. Hum Reprod. 1994; 9(12):2306-10
3. 3. Collins JA, Crosignani PG. Unexplained infertility: a review of diagnosis, prognosis, treatment efficacy and management. Int J Gynaecol Obstet 1992; 39:267.
4. 4. Templeton AA, Penney GC. The incidence, characteristics, and prognosis of patients whose infertility is unexplained. Fertil Steril 1982; 37:175
5. 5.Practice Committee of American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril 2012; 97:825.
6. 6. Reindollar RH, Regan MM, Neumann PJ, et al. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril 2010; 94:888.
7. 7. Esmailzadeh S, Faramarzi M. Endometrial thickness and pregnancy outcome after intrauterine insemination. Fertil Steril. 2007; 88(2):432-437.
8. 8. Noyes N, Liu HC, Sultan K, Schattman G, Rosen Waks Z. Endometrial thickness appears to be a significant factor in embryo implantation inin-vitro fertilization. Hum Reprod 1995;10:919–922.

9. 9. Weissman A, Gotleib L, Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rated and outcome in an in vitro fertilization program. Fertil Steril 1999;71:81–83.
10. 10. Kolibianakis EM, Zikopoulos KA, Fatemi HM, Osmanagaoglu K, Evenpoel J, Van Steirtghem A, et al. Endometrial thickness can not predict ongoing pregnancy achievement in cycles stimulated with clomiphene citrate for intrauterine insemination. Repro Biomed Online 2004;8:115–8.
11. 11. Coulam CB, Bustillo M, Soenksen DM, Britten S. Ultrasonographic predictors of implantation after assited reproduction. Fertil Steril 1994; 62:1004-1010
12. 12. Schild RL, Knobloch C, Dorn C, Fimmers R, Vander Ven H, Hansman M. Endometrial receptivity in an in vitro fertilization as assessed by spiral artery blood flow, endometrial thickness, endometrial volume, and artery blood flow. Fertil Steril 2001;75:361–6.
13. 13. Kupesic S, Bekavac I, Bjelos D, Kurjak A. Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients undergoing in vitro fertilization procedures. J Ultrasound Med. 2001; 20(2):125-34.
14. 14. Reuter KL, Cohen S, Furey L, Baker S. Sonographic appearance of the endometrium and ovaries during cycles stimulated with human menopausal gonadotropin. J Reprod Med. 1996;41(7):509-14
15. 15. Tsai HD, Chang CC, Hsieh YY, Lee CC, Lo HY. Artificial insemination,role of endometrial thickness and pattern, of vascular impedance of the spiral and uterine arteries and of the dominant follicle. J Reprod Med 2000;45:195–200.
16. 16. Dickey RP, Olar TT, Curole DN, Taylor SN, Rye PH. Endometrial pattern and thickness associated with pregnancy outcome after assisted reproduction technologies. Hum Reprod. 1992; 7(3):418-21
17. 17. Check, J.H., Nowroozi, K., Choe, J. and Dietterich. Influence of endometrial thickness and echo patterns on pregnancy rates during in vitrofertilization. Fertil. Steril. 1991; 56: 1173-1175
18. 18. Ibérico G, Vioque J, Ariza N, Lozano JM, Roca M, Llácer J, Bernabeu R. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertil Steril. 2004; 81(5):1308-13.
19. 19. Bancsi LF, Broekmans FJ, Eijkemans MJ, de Jong, FH, Habbema Jd, et al. Predictors of poor ovarian response in in vitro fertilization: aprospective study comparing basal markers of ovarian reserve. Fertil Steril. 2002;77:328-36.
20. 20. Frattarelli JL, Lauria-Costab F, Miller BT, Bergh A, Scott RT. Basal antral follicle number and mean ovarian diameter predict cycle cancellation and ovarian responsiveness in assisted reproductive technology cycles. Fertil Steril 2000;74(3):512-7
21. 21. Stone A, Vargyas JM, Ringler GE, Stein AL, Marrs RP. Determinants of the outcome of intrauterine insemination: analysis of outcomes of 9963 consecutive cycles. Am J Obstet Gynecol 1999;180:1522-34.
22. 22. Plosker SM, Jacobson W, Amato P. Predicting and optimizing success in an intra-uterine insemination programme. Hum Reprod. 1994; 9(11):2014-21.
23. 23. Soria M, Pradillo G, García J, et al. Pregnancy Predictors after Intrauterine Insemination: Analysis of 3012 Cycles in 1201 Couples. Journal of Reproduction & Infertility. 2012;13(3):158-166.
24. 24. McKnight KK, Nodler JL, Cooper JJ Jr, Chapman VR, Cliver SP, Bates GW Jr. Body mass index-associated differences in response to ovulation induction with letrozole. Fertil Steril. 2011; 96(5):1206-8.
25. 25. Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: the effect of body mass index on the outcome of superovulation/intrauterine insemination cycles. Fertil Steril. 2011;95(3):1042-7.