Yeliz Akpınar MAYİR, Lütfiye Eren YAZICI, Neslihan ERKAL, Münire Erman AKAR

Polikistik Over Sendromlu Infertil Hastalarda IUI Sikluslarında Gnrh Antagonisti Kullanımının Etkinliği

GİRİŞ ve AMAÇ: Polikistik over sendromu anovulasyon ile ilişkili olarak infertilite ve menstrüel disfonksiyona yol açan bir hastalıktır. Bu çalışmada polikistik over sendromlu infertil hastalarda intrauterin inseminasyon siklusunda gonadotropin salgılatıcı hormon antagonisti kullanımının folliküler gelişim, tedavi süresi ve gebelik oranları üzerine etkisi araştırılmıştır. YÖNTEM ve GEREÇLER: Çalışmaya 20-35 yaş arası polikistik over sendromu olan infertil 54 hasta dahil edildi. Hastalar iki gruba ayrıldı. İlk gruba düşük doz basamaklı artım rejimi ile rekombinant FSH ve GnRH antagonisti kullanılarak ovulasyon indüksiyonu sonrası human koryonik gonadotropin uygulamasını takiben intrauterin inseminasyon yapılan hastalar dahil edildi Grup 1, n: 27 . Kontrol grubunda aynı protokol ile ovaryan stimülasyon ve inseminasyon yapılan ancak GnRH antagonisti kullanılmayan hastalar dahil edildi Grup 2, n: 27 . BULGULAR: Grup 2’deki iki hastada tedavi sırasında gelişen prematür LH artışı nedeniyle sikluslar iptal edildi ve bu iki hasta çalışma dışı bırakıldı. Grup 1’de hiçbir hastada prematür LH artışı izlenmedi. Tedavi sonunda grup 1’de daha fazla hastada monofoliküler gelişim saptandı. Grup 1’de grup 2’ye göre dominant folikül sayısı ve E2 oranı daha düşük idi. Grup 1’de hastaların % 33’ünde 9/27 , grup 2’de ise % 16’sında 4/25 gebelik tespit edildi. TARTIŞMA ve SONUÇ: İVF sikluslarında kullanımı gün geçtikçe artan GnRH antagonisti sayesinde ovulasyon indüksiyonu sonrası planlanan inseminasyon sikluslarında özellikle PKOS’li hastalarda izlenen ve siklus iptallerine neden olan prematür LH artışının da önüne geçilebilir ve gebelik oranları arttırılabilir.

Anahtar Kelimeler:

Polikistik over sendromu, infertilite, GnRH antagonist

Efficacy of Gnrh Antagonist Usage in Infertility Patients with Policystic Ovary Syndrome during IUI Cycles

INTRODUCTION: Polycystic ovary syndrome goes with menstruel irregularity and infertility due to anovulation. In this study, we investigate usage of gonadotropin releasing hormone antagonist for intrauterine insemination cycles among infertile polycystic ovary syndrome patients and also effect of treatment on follicular growth, treatment duration, pregnancy rates. METHODS: 54 patients with polycystic ovary syndrome were included in study, ages between 20-35 years. Patients were divided into two groups. At first group, intrauterine insemination was applied after hCG injection following ovulation stimulation with low dose step up regimen with recombinant FSH and GnRH antagonist application Group 1, n: 27 . At control group ovulation stimulation with same regimen and insemination applied except for GnRH antagonist usage Group 2, n: 27 .RESULTS: In group 2, two patients were excluded from study because of cancellation of cycle due to premature LH increase. Premature increasement in LH levels wasn’t observed in group 2. Monofollicular growth rate was higher in group 1 at end of treatment. Dominant follicular amount and estradiol levels were lower in group 1. Pregnancy rates were 33% and 16% among group 1 and group 2 respectively. DISCUSSION AND CONCLUSION: Premature increasement of LH levels causes cancellation of ovulation induction cycles especially among patients with polycystic ovary syndrome. Expanding usage of GnRH antagonist among insemination cycles can increase pregnancy rates via reducing prematüre LH increase frequency

Keywords:

Polycystic ovary syndrome, infertility, GnRH antagonist,

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