ROLE OF DOMINANT FOLLICLE COUNT IN CONTROLLED OVARIAN STIMULATION WITH INTRAUTERINE INSEMINATION CYCLES IN PATIENTS WITH UNEXPLAINED INFERTILITY

Yıl 2014, Cilt: 45 Sayı: 3, 151 - 155, 06.08.2014

Gürkan Yazıcı Hüseyin Durukan Aysun Savaş

Öz

Objective: The aim of the present study was to determine the predictive value of dominant follicle count as a marker for pregnancy and multiple pregnancy rate in controlled ovarian hyperstimulation (COH) with intrauterine insemination (IUI) cycles in couples with unexplained subfertility.

Material and Methods: The study was designed as a prospective non-randomized trial and  involving 214 women with unexplained infertility was underwent COH-IUI at a University of Mersin School of Medicine, Obstetric and Gynecology department between May 2008 and September 2010.

Results: Of 532 COH cycles started, 513 were completed and resulted in 62 clinical pregnancies (12.1% per completed cycle). There were 9 (14.5%) multiple pregnancies and 7 (11.3%) miscarriages. In cycles with a single, two and three dominant follicles (>16 mm) on the day of hCG the clinical pregnancy rate were 8.3%, 14.7% and 27.1% respectively. Three dominant follicles (>16 mm) count have increased pregnancy rate more than the 1 or 2 (p value 0.001 and 0.044 respectively). In addition cycles with a single, two and three dominant follicles the multiple pregnancy rate were 7.4%, 15.8% and 25% respectively. The multiple pregnancy rate was similar in cycles with 1 and 2 dominant follicles and lower than three (p:0.004).

Conclusion: Three follicular growth is associated with increased pregnancy rates in COH-IUI women with unexplained subfertility. In cycles with one or two follicles, the multiple pregnancy rates are not significantly different however 3 dominant follicles associated with increased multiple pregnancy rate.

 

(Açıklanamayan İnfertiliteli Hastalarda Kontrollü Overyan Hiperstimulasyon ve İntrauterin İnseminasyon Sikluslarında Dominant Folikül Sayısının Rolü)

Amaç: Bu çalışmanın amacı açıklanmayan infertilite nedeniyle kontrollü overyan hiperstimülasyon (KOH) ve intrauterin inseminasyon (IUI) yapılan kadınlarda dominant folikül sayısının gebelik başarısı ve çoğul gebelik oranları üzerine etkilerini değerlendirmektir.

Gereç ve Yöntemler: Prospektif ve non-randomize olarak planlanan ve Mersin Üniversitesi Kadın Hastalıkları ve Doğum Ana Bilim Dalı’nda yapılan bu çalışmaya Mayıs 2008 ile Eylül 2010 tarihleri arasında açıklanamayan infertilite tanısı ile KOH-IUI uygulanan 214 kadın dahil edildi.

Bulgular: KOH başlanan 532 siklustan 513’ü tamamlanarak IUI yapılmış ve 62 klinik gebelik elde edilmiştir (siklus başına klinik gebelik oranı %12,1). Bu gebeliklerden 9’unda çoğul gebelik (%14,5) gelişirken 7’si (%11,3) ise abortusla sonuçlanmıştır. hCG günü tek, iki ve üç dominant folikül (>16 mm) gelişen sikluslardaki klinik gebelik oranları sırasıyla %8,3, %14,7 ve %27,1 olarak saptanmıştır. Klinik gebelik oranı bir ve iki dominant folikül gelişen olgularda benzerken (p>0,05), üç dominant folikül gelişen olgularda bir ve iki dominant folikül gelişenlere kıyasla daha yüksek bulunmuştur (p değerleri sırası ile 0,001 ve 0,044). Bir, iki ve üç folikül gelişen olguların çoğul gebelik oranları ise sırasıyla %7,4, %15,8 ve %25 olarak saptanmıştır. Çoğul gebelik oranları bir ve iki dominant folikül gelişen olgularda benzerken (p>0,05), üç dominant folikül gelişen olgularda bir ve iki dominant folikül gelişenlere kıyasla istatistiksel anlamlı olarak daha yüksek bulunmuştur (p=0,004).

Sonuç: Açıklanamayan infertilite nedeniyle KOH-IUI yapılan kadınlarda hCG günü üç folikül gelişimi artmış gebelik oranı ile ilişkilidir. Ancak, üç folikül gelişimi artmış çoğul gebelik oranına da sahiptir.

Anahtar kelimeler: İnfertilite, inseminasyon, overyan folikül, ovülasyon indüksiyonu

Anahtar Kelimeler

insemination, ovarian follicle, ovulation induction, infertility

Kaynakça

• Abdelkader AM, Yeh J. The potential use of intrauterine insemination as a basic option for infertility: a review for technology-limited medical settings. Obstet Gynecol Int 2009;2009:584837.
• Duran HE, Morshedi M, Kruger T, Oehninger S. Intrauterine insemination: a systemic review on determinants of success. Hum Reprod 2002;8:373-84.
• Verhulst SM, Cohlen BJ, Hughes E, Te Velde E, Heineman MJ. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev 2006;18:CD001838.
• Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikaninen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod 1999;14:698-703.
• Guven S, Gunalp GS, Tekin Y. Factors influencing pregnancy rates in intrauterine insemination cycles. J Reprod Med 2008;53:257-65.
• Erdem M, Erdem A, Guler I, Atmaca S. Role of antral follicle count in controlled ovarian hyperstimulation and intrauterine insemination cycles in patients with unexplained subfertility. Fertil Steril 2008;90:360-6.
• World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucous interaction, 4th ed. Cambridge: Cambridge University Press;1999.
• Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, et al. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. National Cooperative Reproductive Medicine Network. New Engl J Med 1999;340:177–83.
• van Rumste MM, den Hartog JE, Dumoulin JC, Evers JL, Land JA. Is controlled ovarian stimulation in intrauterine insemination an acceptable therapy in couples with unexplained non-conception in the perspective of multiple pregnancies? Hum Reprod 2006;21:701-4.
• Steures P, van der Steeg JW, Hompes PG, Habbema JD, Eijkemans MJ, Broekmans FJ, et al. Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. Lancet 2006;368:216-21.
• 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;81:1308-13.
• van Rumste MM, Custers IM, van der Veen F, van Wely M, Evers JL, Mol BW. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Hum Reprod 2008;14:563-70.
• Fauser BC, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet 2005;365:1807-16.