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

Yıl 2018, Cilt: 49 Sayı: 4, 0 - 0, 15.12.2018

Mert Ulaş Barut Sibel Sak Özcan Budak Hakim Çelik Elif Ağaçayak Muhammet Erdal Sak

https://doi.org/10.16948/zktipb.434522

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?

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• Referans1.Testart J, Frydman R. Minimum time lapse between luteinizing hormone surge or human chorionic gonadotropin administration and follicular rupture. Fertil Steril. 1982;37:50-3.
• Referans2.Verhulst SM, Cohlen BJ, Hughes E, Te Velde E, Heineman MJ. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev. 2006;18(4):CD001838.
• Referans3.Duran HE, Morshedi M, Kruger T, Oehninger S. Intrauterine insemination: a systematic review on determinants of success. Hum Reprod Update. 2002; 8:373-84.
• Referans4.Steures P, van der Steeg JW, Hompes PG, Bossuyt PM, Habbema JD, Eijkemans MJ, Schöls WA, Burggraaff JM, van der Veen F, Mol BW. CECERM (Collaborative Effort for Clinical Evaluation in Reproductive Medicine)Effectiveness of intrauterine insemination in subfertile couples with an isolated cervical factor: a randomized clinical trial. Fertil Steril. 2007;88:1692-6.
• Referans5.Guven S, Gunalp GS, Tekin Y. Factors influencing pregnancy rates in intrauterine insemination cycles. J Reprod Med. 2008;53:257-65.
• Referans6.Ghosh C, Buck G, Priore R, Wacktawski-Wende J, Severino M. Follicular response and pregnancy among infertile women undergoing ovulation induction and intrauterine insemination. Fertil Steril. 2003;80:328-35.
• Referans7.Järvelä IY, Tapanainen JS, Martikainen H. Improved pregnancy rate with administration of hCG after intrauterine insemination: a pilot study. Reprod Biol Endocrinol. 2010;8:18.
• Referans8.Aydin Y, Hassa H, Oge T, Tokgoz VY. A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):444-8.
• Referans9.Aboulghar M, Baird DT, Collins J, Evers JL, Fauser BC, Lambalk CB, Somigliana E, Sunde A, Crosignani PG, Devroey P, Diczfalusy E, Diedrich K, Fraser L, Geraedts JP, Gianaroli L, Glasier A, Van Steirteghem A, Collins J, Crosignani PG. Intrauterine insemination. Hum Reprod Update. 2009;15(3):265–77.
• Referans10.Robb PA, Robins JC, Thomas MA. Timing of hCG administration does not affect pregnancy rates in couples undergoing intrauterine insemination using clomiphene citrate. J Natl Med Assoc. 2004;96(11):1431–3.
• Referans11.Ransom MX, Blotner MB, Bohrer M, et al. Does increasing frequency of intrauterine insemination improve pregnancy rates significantly during superovulation cycles? Fertil Steril. 1994, 61, 303-7.
• Referans12.Ragni G, Maggioni P, Guermandi E, Testa A, et al. Efficacy of double intrauterine insemination in controlled ovarian hyperstimulation cycles. Fertil Steril. 1999; 72: 619- -22.
• Referans13.Anonymous. Temporal relationships between ovulation and defined changes in the concentration of plasma estradiol-17 beta, luteinizing hormone, follicle-stimulating hormone, and progesterone. I. probit analysis. world health organization, task force on methods for the determination of the fertile period, special programme of research, development and research training in human reproduction. Am J Obstet Gynecol. 1980;138(4):383–90.
• Referans14.Ripps BA, Mihnas BS, Carson SA, Buster JE. Intrauterine insemination in fertile women delivers larger numbers of sperm to the peritoneal fluid than intracervical insemination. Fertil Steril. 1994; 61:398–400. Referans15.Osuna C, Matorras R, Pijoan JI, Rodríguez–Escudero FJ. One versus two inseminations per cycle in intrauterine insemination with sperm from patients’ husbands: a systematic review of the literature. Fertil Steril. 2004; 82(1): 17 – 24.
• Referans16.Alborzi S, Motazedian S, Parsanezhad ME, Jannati S. Comparison of the effectiveness of single intrauterine insemination (IUI) versus double IUI per cycle in infertile patients. Fertil Steril. 2003; 80(3): 595 – 9.
• Referans17.Tonguc E, Var T, Onalan G, Altinbas S, Tokmak A, DUDNDú N, et al. Comparison of the effectiveness of single versus double intrauterine insemination with three different timing regimens. Fertil Steril. 2010; 94(4): 1267 –70.
• Referans18.Rahman SM, Malhotra N, Kumar S, Roy KK, Agarwal A. A randomized controlled trial comparing the effectiveness of single versus double intrauterine insemination in unexplained infertility. Fertil Steril. 2010; 94(7): 2913 – 5.
• Referans19.Ghanem ME, Bakre NI, Emam MA, Al Boghdady LA, Helal AS, Elmetwally AG, Hassan M, Albahlol IA, Elzayat MM. The effects of timing of intrauterine insemination in relation to ovulation and the number of inseminations on cycle pregnancy rate in common infertility etiologies. Hum Reprod. 2011;26(3):576-83.
• Referans20.Sorouri ZZ, Shomali RR, Pourmarzi D. Single versus Double Intrauterine Insemination in Controlled Ovarian Hyperstimulation Cycles: A Randomized Trial. Arch Iran Med. 2016; 19(7): 465 –9.
• Referans21.Randall GW, Gantt PA. Double vs. single intrauterine insemination per cycle: use in gonadotropin cycles and in diagnostic categories of ovulatory dysfunction and male factor infertility. J Reprod Med. 2008; 53(3): 196 – 202.