İntrauterin inseminasyon uygulanan infertil hastalarda spermiogram, hormon profili, endometrial kalınlık ve diğer faktörlerin gebelik oranına etkisi
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Tarih
2015
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Trakya Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada 04 Ocak 2012 – 30 Aralık 2014 tarihleri arası Trakya Üniversitesi Tıp Fakültesi İnfertilite Polikliniği'ne başvuran ve ovulasyonun hormonal stimulasyonu ile birlikte intrauterin inseminasyon yapılan infertil hastalarda spermiogram, hormon profili, antral follikül sayısı, hCG uygulanan gün bakılan folikül (çap>10mm) sayısı ve endometrial kalınlık ölçümü ve diğer faktörlerin klinik gebelik oranına olan etkisini retrospektif olarak araştırmayı amaçladık. Toplam 201 olguya uygulanan 307 ovulasyon indüksiyonu ile birlikte uygulanan intrauterin inseminasyon sonucunda 55 klinik gebelik elde edildi. Olgu başına gebelik oranı % 28 ; siklus başına gebelik oranı % 18,1 olarak izlendi. Bu gebeliklerin 3 tanesi ikiz diğerleri tekil gebeliklerdi. İkiz gebeliklerde kullanılan ovulasyon indüksiyon ajanı gonadotropin olarak izlendi. Toplam 55 klinik gebeliğin 37 tanesinin birinci siklus sonrası, 9 tanesinin ikinci siklus sonrası, 7 tanesinin üçüncü siklus sonrası, kalan iki tanesinin ise 4 ve 5. sikluslarda elde edildiği belirlendi. Hastaların karakteristik özelliklerinden hasta yaşının, vücut kitle indeksinin, infertilite süresinin, infertilite nedeninin, menstrüasyonun üçüncü günü FSH, LH, E2 değerlerinin, toplam antral folikül sayısının, hCG uygulanan gün bakılan endometrial kalınlık değerinin ve Kruger katı ölçümüne göre bakılmış sperm morfolojisinin klinik gebelik elde edilemeyen hastalarla klinik gebelik elde edilen hastalar arasındaki farkları araştırıldı ve bu değerler açısından istatistiksel olarak anlamlı fark saptanmadı. Çalışmamızda gebe kalanlar ile kalamayanlar arasında yalnızca üç parametre anlamlı olarak farklı çıktı. Bunlar hCG uygulandığı gün bakılan folikül (çapı >10mm) sayısı, insemine edilen total motil sperm sayısı ve ovulasyon indüksiyonu protokolüydü (Klomifen sitrata karşı gonadotropin). Bu faktörler ile regresyon analizi yapıldığında anlamlı çıkan üç parametreden iki tanesinin [hCG uygulanan gün bakılan folikül (çap >10mm) sayısı ve insemine edilen total motil sperm sayısı] gebeliği bağımsız olarak belirlediği saptandı (sırasıyla p: <0,001 ve p: 0,01). Sonuç olarak, intrauterin inseminasyon infertilitenin tedavisinde kabul edilebilir başarı oranına sahip uygun olgularda denenmesi gereken bir yöntemdir. Değerlendirdiğimiz olgu sayısının nisbeten düşük olması göz önüne alınarak kesin sonuçlar için daha fazla çalışmaya ihtiyaç olduğunu düşünmekteyiz.
Abstract
The aim of our retrospective study was to evaluate the effect of spermiogram parameters, hormone profile, antral follicle count, follicle (diameter > 10mm) count and endometrial thickness on the day of hCG administration and other factors on pregnancy rates in infertile patients who were referred to Trakya University, Faculty of Medicine Infertility Clinic between 04.01.2012 and 30.12.2014 and underwent intrauterine insemination with ovulation induction. We studied a total of 307 cycles in 201 cases and observed 55 clinical pregnancies. The pregnancy rate per patient and cycle were %28 and %18,1 respectively. Among these clinical pregnancies three of them were twins and it was observed that gonadotropins were used as ovulation induction agent in these patients with multiple pregnancies. Among these 55 clinical pregnancies, 37 of them were obtained after first cycle, 9 of them after second cycle, 7 of them after third cycle and the rest 2 of them were obtained after fourth and fifth cycles. Among patients' characteristic features; patient age, body mass index, duration of infertility, type of infertility, FSH, LH, E2 levels on third day of menstruation, total antral follicle count, endometrial thickness value on the day of hCG administration and sperm morphology value according to Kruger Strict Criteria were evaluated between the patients with and without clinical pregnancy and no significant differences were observed. Between patients with and without clinical pregnancy we observed three factors showing significant difference which were follicle (diameter > 10mm) count on the day of hCG administration, inseminated total motile sperm count and ovulation induction protocol (Clomiphene Citrate vs. Gonadotropins). When regression analyses was done only two of these three factors (follicle (diameter > 10mm) count on the day of hCG administration and inseminated total motile sperm count) were found to have effect on pregnancy rate independently (p:<0,001 and p:0,01 respectively). As a result, intrauterin insemination is a method which should be attempted in appropriate cases that have an acceptable success rate. We suppose that there is a need for more studies to get ultimate results considering the few number of cases we have evaluated.
Abstract
The aim of our retrospective study was to evaluate the effect of spermiogram parameters, hormone profile, antral follicle count, follicle (diameter > 10mm) count and endometrial thickness on the day of hCG administration and other factors on pregnancy rates in infertile patients who were referred to Trakya University, Faculty of Medicine Infertility Clinic between 04.01.2012 and 30.12.2014 and underwent intrauterine insemination with ovulation induction. We studied a total of 307 cycles in 201 cases and observed 55 clinical pregnancies. The pregnancy rate per patient and cycle were %28 and %18,1 respectively. Among these clinical pregnancies three of them were twins and it was observed that gonadotropins were used as ovulation induction agent in these patients with multiple pregnancies. Among these 55 clinical pregnancies, 37 of them were obtained after first cycle, 9 of them after second cycle, 7 of them after third cycle and the rest 2 of them were obtained after fourth and fifth cycles. Among patients' characteristic features; patient age, body mass index, duration of infertility, type of infertility, FSH, LH, E2 levels on third day of menstruation, total antral follicle count, endometrial thickness value on the day of hCG administration and sperm morphology value according to Kruger Strict Criteria were evaluated between the patients with and without clinical pregnancy and no significant differences were observed. Between patients with and without clinical pregnancy we observed three factors showing significant difference which were follicle (diameter > 10mm) count on the day of hCG administration, inseminated total motile sperm count and ovulation induction protocol (Clomiphene Citrate vs. Gonadotropins). When regression analyses was done only two of these three factors (follicle (diameter > 10mm) count on the day of hCG administration and inseminated total motile sperm count) were found to have effect on pregnancy rate independently (p:<0,001 and p:0,01 respectively). As a result, intrauterin insemination is a method which should be attempted in appropriate cases that have an acceptable success rate. We suppose that there is a need for more studies to get ultimate results considering the few number of cases we have evaluated.
Açıklama
Tıpta Uzmanlık Tezi
Anahtar Kelimeler
Ovulasyon İndüksiyonu, Preovulatuar Folikül Sayısı, İntrauterin İnseminasyon, İnsemine Edilen Total Motil Sperm Sayısı, Ovulation Induction, Preovulatuar Follicle Count, Intrauterine Insemination, Inseminated Total Motile Sperm Count
