KLOMİFEN SİTRATA REZİSTAN OLAN POLİKİSTİK OVER SENDROMLU OLGULARDA KRONİK DÜŞÜK DOZ GONADOTROPİN VE KONVANSİYONEL DOZ GONADOTROPİN TEDAVİ PROTOKOLLERİNİN KARŞILAŞTIRILMASI

Amaç: Anovulatuar polikistik over sendromlu hastalarda kronik düşük doz ve konvansiyonel doz tedavi rejimlerinin etkinliklerinin karşılaştırılmasıGereç ve yöntemler: Klomifen sitrata rezistan anovulatuar PCOS tanısı almış olan 50 olgu çalışmaya dahiledildi. Olguların 25 tanesine konvansiyonel stepwise protokol uygulandı ve (Grup 1) olarak adlandırıldı. Diğer 25 olgudan oluşan gruba (Grup 2)’ da kronik düşük doz FSH protokol uygulandı. Hastalar seri ultrasonografi ve serum estradiol sevilerine bakılarak monitörize edildi. Folliküler gelişim paterni, toplam kullanılanFSH dozu, serum estradiol konsantrasyonu, siklus fekunditesi, multiple gebelik oranları ve ovarian hiperstimulasyon sendromu açısından iki grup karşılaştırıldı.Bulgular: Her iki grup yaş, infertilite süresi, vücut kitle indeksi ve endokrin parametreler açısından benzerolarak bulundu. Stimulasyon süresi Grup 2 'de anlamlı olarak uzun bulundu (p=0.02). Gruplar, ovulatuarsiklus açısından değerlendirildiğinde düşük doz kullanılan grupta ovulatuar siklus oranı %68 iken konvansiyonel grupta %76 olarak bulundu. Gebelik oranları açısından değerlendirildiğinde düşük doz grupta gebelikoranı %24 iken konvansiyonel grupta %20 olarak bulundu. Düşük doz kullanılan grupta ovulatuar siklus başına gebelik oranı konvansiyonel gruptan daha yüksek (%37 vs %26) idi. Monofolliküler gelişim düşük dozkullanılan grupta %60, konvansiyonel grupta ise %48 olarak bulundu. Düşük doz kullanılan grupta gerekOHSS (p < 0.04) gerekse estradiol (p < 0.008) konsantrasyonları anlamlı olarak düşük bulundu. Her iki gruptada çoğul gebelik izlenmedi.Sonuç: Kronik düşük doz FSH rejimi ; multifolliküler gelişim ve OHSS riskini azaltarak, ovulasyon indüksiyonunun güvenliğini artırmakta ve bunun yanında tatmin edici gebelik sonuçları elde edilmesini sağlayabilmektedir.

Comparison of Chronic Low Dose Gonadotropin and Conventional Dose Gonadotropin Treatment Protocols in Patients Who Had Clomiphene Citrate-Resistant Anovulation Associated With Polycystic Ovarian Syndrome

Objective: To compare efficiency of conventional and chronic low-dose regimens for treatment of anovulation associated with polycystic ovary syndrome (PCOS). Materials and methods: Fifty women, who had clomiphene citrate-resistant anovulation associated with PCOS, participated in the study. The first 25 patients were treated with urinary FSH using a conventional stepwise protocol (Group 1), while the second group had a regimen of chronic low dose FSH (Group 2). Patterns of follicular development, amount of FSH required, serum estradiol concentrations, cycle fecundity, rates of multiple pregnancy and OHSS were compared. Results: The two groups were similar in terms of duration of infertility, age, body mass index and endocrine parameters. The duration of treatment was significantly higher (p = 0.02) in Group 2 . The percentage of ovulatory cycles occurring in low dose and conventional regimens was 68% versus 76% respectively. Pregnancy rate was 20% in conventional stepwise protocol group and 24% in chronic low dose group. The patients in Group 2 had a higher pregnancy rate per ovulatory cycle (37% versus 26%). Monofollicular development was noted in 60% of the Group 2 patients (48% in Group 1, p = 0.03). Treatment with the low-dose protocol resulted in significant reduction in OHSS (p < 0.04) and serum oestradiol concentrations (p < 0.008). No multiple pregnancies occurred in either group. Conclusion: The use of chronic low-dose regimen of FSH permitted induction of ovulation safely by minimizing the risk of multifollicular development and OHSS while maintaining a satisfactory pregnancy

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