Açıklanamayan infertilide endometriyal kalınlık ve canlı doğum

Yıl 2019, Cilt: 50 Sayı: 3, 142 - 145, 15.09.2019

Ali Ovayolu , İsmet Gün , Dilek Benk Şilfeler , Tayfun Kutlu

https://doi.org/10.16948/zktipb.550114

Cited By: 1

Öz

Amaç: Açıklanmayan infertilide
human
koryonik gonadotropin (hCG) günü ölçülen endometriyal kalınlık ile canlı doğum oranları
arasında ilişki olup, olmadığını araştırmaktır.

Gereç
ve Yöntemler: Bu araştırma 2005-2013 yılları arasında Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve
Araştırma hastanesinde tüp bebek tedavisi uygulanmış hastalarda yapılan
retrospektif bir çalışmadır. Çalışmaya 23-39 yaş aralığında, vücut kitle
indeksi 30 kg/m² altında olan ve embriyoda herhangi bir işlemin
yapılmadığı ve taze embriyo transferi yapılmış kadınlar dahil edildi. Hastalar
canlı doğum yapıp (grup 1), yapmamalarına (grup 2) göre 2 gruba ayrıldı. hCG
günü 2-boyutlu ultrason ile midsagittal planda ölçülen endometriyal doku
kalınlığı, siklus tedavi karakterleri ve hastaya ait demografik karakterler gruplar
arasında karşılaştırıldı. Ayrıca hCG günü ölçülen endometriyal doku kalınlığına
göre; 7 mm ve altı, 8 mm, 9 mm, 10 mm, 11 mm, 12 mm, 13 mm ve 14 mm ve üstü
olan subgruplar oluşturuldu. Bu subgruplar arasında canlı doğum yüzdeleri
açısından karşılaştırmalar yapıldı. İstatistiksel karşılaştırmada devamlı
veriler için student t-testi ve kategorik değerler için ki-kare testi
kullanıldı.

Bulgular: Çalışmaya
359 hasta dahil edildi, 104 hasta grup 1 ve 255 hasta grup 2. Gruplar arasında hCG
günü ölçülen estradiol seviyeleri (pg/ml) dışında fark yoktu (2517.2±1106.0 ve
2210.8±991.7, sırasıyla; p=0.011). Her bir endometriyal doku kalınlığından
oluşturulan subgruplar arasında en yüksek canlı doğum oranı 13 mm de %36.8 iken,
en düşük canlı doğum oranı 12 mm de %23.9 idi. Fakat subgruplar arasında canlı
doğum oranları açısından istatistiksel olarak bir fark bulunamadı.

Sonuç:  Açıklanamayan infertilitede canlı
doğum oranları hCG günü ölçülen endometriyal doku kalınlığından bağımsızdır. 

Anahtar Kelimeler

açıklanamayan infertilite; tüp bebek; endometriyal kalınlık; canlı doğum oranı

Live Birth and Endometrial Thickness in Unexplained Infertility

Öz

Objective: We aimed to demonstrate any possible relationship
between endometrial thickness on the day of hCG trigger and live birth rates
(LBRs) among women with unexplained infertility who underwent IVF/ICSI-ET cycles.

Materials and Methods: We
retrospectively collected data from Zeynep Kamil Women's and Children's Disease
Training and Research Hospital, IVF Center archive. Cases between
2005 and 2013 were collected. Women aged between 23-39 years with a
BMI <30 kg/m² with fresh embryo transfers were included. Patients
were divided into two groups based on their livebirth status (live birth: group
1, no live birth: group 2). Demographic characteristics, treatment regimens,
and endometrial thickness on the day of hCG trigger were compared between the two
groups. In addition, patients were divided into subgroups according to the
endometrial thickness on the day of hCG trigger (≤7 mm, 8 mm, 9 mm, 10 mm, 11 mm,
12 mm, 13 mm, and ≥14 mm, respectively). LBRs were compared between these
subgroups.

Results:  Three hundred fifty-nine cycles (group 1: n=104, group 2: n=255) were included for
statistical analysis. Other than estradiol level (pg/mL) on the day of hCG
trigger (2517.2±1106.0,
2210.8±991.7, respectively; p=0.011), there were no statistically significant differences between the two
groups. Among the subgroups based on endometrial thickness, the highest LBR was
detected in the 13 mm subgroup (36.8%) and lowest LBR was detected in 12 mm
subgroup (23.9%). However, LBRs were not statistically significant between the
subgroups.

Conclusion: LBRs
do not seem to be affected by endometrial thickness on the day of hCG trigger
among couples with unexplained infertility. 

Anahtar Kelimeler

unexplained infertility; in-vitro fertilization; endometrial thickness; live birth pregnancy rate

Kaynakça

• 1. Rinaldi L, Lisi F, Floccari A, Lisi R, Pepe G, Fishel S. Endometrial thickness as a predictor of pregnancy after in-vitro fertilization but not after intracytoplasmic sperm injection. Human reproduction (Oxford, England). 1996;11(7):1538-41.
• 2. Richter KS, Bugge KR, Bromer JG, Levy MJ. Relationship between endometrial thickness and embryo implantation, based on 1,294 cycles of in vitro fertilization with transfer of two blastocyst-stage embryos. Fertil Steril. 2007;87(1):53-9.
• 3. Lamanna G, Scioscia M, Lorusso F, Serrati G, Selvaggi LE, Depalo R. Parabolic trend in endometrial thickness at embryo transfer in in vitro fertilization/intracytoplasmic sperm injection cases with clinical pregnancy evidence. Fertil Steril. 2008;90(4):1272-4.
• 4. Sharma R, Rao K, Srinivas M, Jones TJIJoI, Medicine F. Is endometrial thickness on the day of ET really predictive of IVF outcome? 2012;3(2):40-7.
• 5. Zhang X, Chen CH, Confino E, Barnes R, Milad M, Kazer RR. Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2005;83(2):336-40.
• 6. Yakin K, Akarsu C, Kahraman S. Cycle lumping or--sampling a witches' brew? Fertil Steril. 2000;73(1):175.
• 7. Weissman A, Gotlieb L, Casper RF. The detrimental effect of increased endometrial thickness on implantation and pregnancy rates and outcome in an in vitro fertilization program. Fertil Steril. 1999;71(1):147-9.
• 8. Dietterich C, Check JH, Choe JK, Nazari A, Lurie D. Increased endometrial thickness on the day of human chorionic gonadotropin injection does not adversely affect pregnancy or implantation rates following in vitro fertilization-embryo transfer. Fertil Steril. 2002;77(4):781-6.
• 9. Al-Ghamdi A, Coskun S, Al-Hassan S, Al-Rejjal R, Awartani K. The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET) outcome. Reproductive biology and endocrinology : RB&E. 2008;6:37.
• 10. Pandian Z, Gibreel A, Bhattacharya S. In vitro fertilisation for unexplained subfertility. The Cochrane database of systematic reviews. 2012(4):Cd003357.
• 11. Friedler S, Schenker JG, Herman A, Lewin A. The role of ultrasonography in the evaluation of endometrial receptivity following assisted reproductive treatments: a critical review. Human reproduction update. 1996;2(4):323-35.
• 12. Chan JM, Sukumar AI, Ramalingam M, Ranbir Singh SS, Abdullah MF. The impact of endometrial thickness (EMT) on the day of human chorionic gonadotropin (hCG) administration on pregnancy outcomes: a 5-year retrospective cohort analysis in Malaysia. Fertility research and practice. 2018;4:5.
• 13. Racowsky C, Vernon M, Mayer J, Ball GD, Behr B, Pomeroy KO, et al. Standardization of grading embryo morphology. Fertil Steril. 2010;94(3):1152-3.
• 14. Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: an analysis of over 40 000 embryo transfers. Human reproduction (Oxford, England). 2018;33(10):1883-8.
• 15. De Geyter C, Schmitter M, De Geyter M, Nieschlag E, Holzgreve W, Schneider HP. Prospective evaluation of the ultrasound appearance of the endometrium in a cohort of 1,186 infertile women. Fertil Steril. 2000;73(1):106-13.
• 16. Noyes N, Liu HC, Sultan K, Schattman G, Rosenwaks Z. Endometrial thickness appears to be a significant factor in embryo implantation in in-vitro fertilization. Human reproduction (Oxford, England). 1995;10(4):919-22.
• 17. Gordts S, Van Turnhout C, Campo R, Puttemans P, Valkenburg M, Gordts S. A prospective randomised study comparing a GnRH-antagonist versus a GnRH-agonist short protocol for ovarian stimulation in patients referred for IVF. Facts, views & vision in ObGyn. 2012;4(2):82-7.
• 18. Martins WP, Nastri CO, Rienzi L, van der Poel SZ, Gracia C, Racowsky C. Blastocyst vs cleavage-stage embryo transfer: systematic review and meta-analysis of reproductive outcomes. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2017;49(5):583-91.
• 19. Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. The Cochrane database of systematic reviews. 2016(6):Cd002118.