Cenk SOYSAL, İbrahim Ferhat ÜRÜNSAK, M.turan ÇETİN

Histeroskopi IVF-ICSI/ET öncesi mi, sonrası mı yapılmalıdır?

Amaç: Çalışmada İn-Vitro Fertilizasyon - İnstrastoplazmik Sperm İnjeksiyonu/Embriyo Transferi (IVF-ICSI/ET) yapılmış ancak başarısız olunmuş ve ilk kez IVF-ICSI/ET planlanmış olan iki ayrı hasta grubuna histeroskopi uygulanarak, intrauterin patolojilerin saptanması, patoloji saptanan grupta cerrahi düzeltme yapılarak, bundan sonraki IVF-ICSI/ET sürecinde canlı doğum oranlarının karşılaştırılması amaçlanmıştır.Gereç ve Yöntem: Prospektif yapılan bu çalışmada, Mayıs 2014 – Ocak 2016 yılları arasında arasında infertilite polikliniğine başvuran, rutin değerlendirme sonucunda, ilk kez kontrollü ovaryan stimülasyon için rekombinant FSH kullanılıp sonrasında IVF-ICSI/ET kararı alınan hastalara, histeroskopi ile intrauterin patolojilerin saptanarak düzeltilmesi halinde gebeliğe olası katkıları hakkında ayrıntılı bilgi verilerek onamı alınan hasta Grup I (n=65) olarak belirlendi. Aynı süreçte daha önce IVF-ICSI/ET uygulanmış olan ancak histeroskopi uygulanmayan hastalar kontrol grubu Grup II (n=133) olarak belirlendi. Ayrıca histeroskopi uygulanan ve normal uterin kavite saptananlar Grup Ia (n=47), intrauterin patoloji saptananlar ise Grup Ib (n=18) olarak ikiye ayrılarak kontrol grubu ile canlı doğum oranları karşılaştırıldıBulgular: Gruplar arasında yaş, infertilite süresi, infertilite etyolojisi, bazal Folikül stimülan hormon (FSH), Lüteinizan hormon (LH), Östradiol (E2) değerleri ve transfer edilen embriyo sayıları açısından istatistiksel olarak anlamlı bir fark saptanmadı. Grup Ia ve Grup Ib canlı doğumlar açısından kıyaslandığında istatistiksel olarak anlamlı fark saptanmadı . Sonuç: IVF-ICSI/ET öncesi yapılan histeroskopi ve aynı seansta histeroskopi ile saptanan patolojilerin düzeltilmesi IVF-ICSI/ET başarısı ve canlı doğumu istatistiksel olarak anlamlı şekilde arttırmadığını belirledik.

Anahtar Kelimeler:

IVF, histeroskopi, infertilite, IVF öncesi histeroskopi

Should hysterescopy be performe before or after in-vitro fertilisation-Intracytoplasmic sperm injection/Embriyo transfer (IVF-ICSI/ET)?

Purpose: This research aims to determine the statistical efficiency of office histeroscopy, that is performed before In-vitro fertilisation-intrastoplasmic sperm injection/embriyo transfer (IVF-ICSI/ET) procedure, on the live birth rate and cost efficiency perspective. Specifically, the effects of detecting intrauterin pathologies and fixing them via operations on office environment are examined.Materials and Methods: During the period of 2014 - 2016, the patients, that are admitted to the infertility clinic and an IVF-ICSI/ET cycles planned after routine checks, are given detailed information on the histeroscopy and its possible effects on increasing the chance of pregnancy. Among these patient are labeled as Group I (n=65) with their consent. During the same process, a control group Group II (n=133) is formed among the patients who get IVF-ICSI/ET tratment without the histeroscopy. Further, the ones that are applied histeroscopy and that are detected to have regular uterus cavity labeled as Group Ia (n=47), whereas the ones diagnosed with intrauterin patalogy formed Group Ib (n=18). This way, these groups are contrasted with the control group on the basis of their live birth rates.Results: There was no statistically significant difference between the groups in terms of age, duration of infertility, etiology of infertility, basal follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and the number of embryos transferred. When Group Ia and Group Ib were compared in terms of live births, there was no statistically significant difference.Conclusion: Hysteroscopy performed before IVF and correction of pathologies detected by hysteroscopy in the same session did not significantly increase IVF success and live birth.

Keywords:

intrauterine pathologies, hysteroscopy, IVF-ICSI/ET prior to hysteroscopy, endometrial injury,

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