Endometriomalı Hastalarda Kist Çapı ile Over Rezervi Arasındaki İlişkinin Değerlendirilmesi

Amaç Endometriozis, infertil popülasyonda yüksek prevalansa sahip bir jinekolojik hastalıktır.Özellikle infertilite problemi olan hastalarda cerrahi esnasında endometrioma kisti karşımızaçıktığında daha da önem kazanmaktadır. Bu çalışmada, bazal hormon seviyeleri ve klomifensitrat testi ile endometrioma hastalarının over rezervini değerlendirmeyi, sonuçları kontrol grubuile karşılaştırmayı ve kist çapı ile over rezervi arasında muhtemel bir ilişkiyi anlamlılıkderecesinde araştırmayı planladık.Metod Endometrioma tanısı alan 35 hasta çalışmaya dahil edildi. Benzer demografik özelliklere sahipve sınırda erkek faktör infertilitesi olan 35 kontrol hastası aynı hastanenin İnfertilitePolikliniğinden seçildi.BulgularGrupların yaş ortalamaları arasında anlamlı bir fark yoktu. Endometrioma grubunda kistortalaması 33,65 ± 17,08 idi. Üçüncü gün FSH, estradiol ve klomifen sitrat sonrası 10.gün FSHdeğerlerinde anlamlı fark tespit edilmedi. Hormon değerleri normal ve anormal olaraksınıflandırıldığında da anlamlı fark tespit edilmedi.Sonuç İstatistiksel olarak anlamlılık tespit edilemese de; klomifen sitrat testi sonrasında 10. gün FSHdeğerinde sınırda bir anlamlılık tespit edilmesi ve kontrol grubuna nazaran endometriomagrubunda yüksek (anormal) hormon değerleri elde edilmesinden dolayı; büyük gruplarda dahaanlamlı sonuçlar elde edilebileceği yorumu yapılabilir

Anahtar Kelimeler:

endometriozis, infertilite, klomifen sitrat testi

Evaluation of the Relation Between Ovarian Reserve and Cyst Dimension in Patients with Endometrioma

ObjectivesEndometriosis is a gynecologic disease which has high prevalence among infertile population.It has increasing importance particularly for the patients with determined endometrioma cystwhen there is an infertility problem during the surgery. In this study, we aimed to evaluate theovarian reserve with basal hormone values and clomiphene citrate challenge test in patients withendometrioma, to compare results with control group and to determine a possible relationshipbetween the cyst diameter and the ovarian reserve in condition of getting significant results.MethodsThirty-five patients who had diagnosis of endometrioma were included in the study. As thecontrol group, 35 patients with borderline male infertility and similar demographiccharacteristics were selected from Infertility Clinic of the same hospital.ResultsThere was no significant distinction between mean age values of groups. Mean cyst diameterwas 33.65 ± 17.08 mm in the endometrioma group. No significant difference was determinedbetween day 3 FSH, day 3 estradiol and day 10 FSH value after clomiphene citrate challengetest. There was also no significant distinction when the hormone values were categorized asnormal and abnormal.ConclusionAlthough being statistically insignificant, due to the detection of a borderline significance inthe 10th day FSH values after clomiphene citrate test and obtaining elevated hormone levels inthe endometrioma group, we can conclude that it is probable to obtain siginificant results in alarger population

Keywords:

endometriosis, infertility, clomiphene citrate challenge test,

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American Fertility Society classification of endometriosis. Fertil Steril 43:351-2, 1975.

Liu DT, Hitchcock A. Endometriosis: its association with retrograde menstruation, dysmenorrhoea and tubal pathology. Br J Obstet Gynaecol 93:859-62, 1986.

Moen MH. Endometriosis in women at interval sterilization. Acta Obstet Gynecol Scand 66:451-4, 1987.

Mahmood TA, Templeton A. Prevalence and genesis of endometriosis. Hum Reprod 6:544-9, 1991.

Bancroft K, Vaughan Williams CA, Elstein M. Pituitary- ovarian function in women with minimal or mild endometriosis and otherwise unexplained infertility. Clin Endocrinol 36:177-81, 1992.

Matorras R, Rodriguez F, Perez C, Pijoan JI, Neyro JL, Rodriguez-Escudero FJ. Infertile women with and without endometriosis: a case control study of luteal phase and other infertility conditions. Acta Obstet Gynecol Scand 75:826-31 1996.

Pittaway DE, Maxson W, Daniell J, Herbert C, Wentz AC. Luteal phase defects in infertility patients with endometriosis. Fertil Steril 39:712-3, 1983.

Hirschowitz JS, Soler NG, Wortsman J. The galactorrhoea- endometriosis syndrome. Lancet 80:896-8, 1978.

Mio Y, Toda T, Harada T, Terakawa N. Luteinized unruptured follicle in the early stages of endometriosis as a cause of unexplained infertility. Am J Obstet Gynecol 167:271-3, 1992.

Wheeler JM, Johnston BM, Malinak LR. The relationship of endometriosis to spontaneous abortion. Fertil Steril 39:656- 60, 1983.

Scott RT, Opsahl MS, Leonardi MR, Neall GS, Illions EH, Navot D. Life table analysis of pregnancy rates in a general infertility population relative to ovarian reserve and patient age. Hum Reprod. 10:1706-10, 1995.

Toner JP, Philput CB, Jones GS, Muasher SJ. Basal follicle- stimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril. 55:784-91, 1991.

Bukman A, Heineman MJ. Ovarian reserve testing and the use of prognostic models in patients with subfertility. Hum Reprod Update 7:581-90, 2001.

Buyalos RP, Daneshmand S, Brzechffa PR. Basal estradiol and follicle-stimulating hormone predict fecundity in women of advanced reproductive age undergoing ovulation induction therapy. Fertil Steril 68:272-7, 1997.

Scott RT, Opsahl MS, Leonardi MR, Neall GS, Illions EH, Navot D. Life table analysis of pregnancy rates in a general infertility population relative to ovarian reserve and patient age. Hum Reprod.10:1706-10, 1995.

Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 70:1176-80, 1998.

Wood C, Maher P, Hill D. Diagnosis and surgical management of endometriomas. Aust N Z J Obstet Gynaecol 32:161-3, 1992.

Marcoux S, Maheux R, Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 337:217-22, 1997.

Tulandi T, Al-Took S. Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation. Fertil Steril 69:229-31, 1998.

Ho HY, Lee RK, Hwu YM, Lin MH, Su JT, Tsai YC. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet 11:507-11, 2002.

Smotritch DB, Widra EA, Gindoff PR, Levy MJ, Hall JL, Stillman RJ. Prognostic value of day 3 estradiol on in vitro fertilization outcome. Fertil Steril 64:1136-40, 1995.

Navot D, Rosenwaks Z, Margalioth EJ. Prognostic assessment of female fecundity. Lancet 2:645-7, 1987.

Kahraman S, Vicdan K, Isyk A, Ozgun O, Alaybeyoglu L, Polat G, et al. Clomiphene citrate challenge test in the assessment of ovarian reserve before controlled ovarian hyperstimulation for intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol 73:177-82, 1997.