Gonadotropin ile oluşturulan kontrollü ovaryan stimulasyon-intrauterin inseminasyon sikluslarında kullanılan progesteron formunun ve tedavi etkinliğinin karşılaştırılması

Amaç: Gonadotropin ile ovulasyon induksiyonu yapılmış olan olgularda lüteal faz desteği için kullanılan progesteron formlarının gebelik başarısı açısından farklılık olup olmadığını karşılaştırmaktır. Gereç ve Yöntem: Bu çalışmaya Zekai Tahir Burak SUAM infertilite polikliniğine Mart 2017-Şubat 2018 tarihleri arasında başvuran Gonadotropin (GND) tedavisi başlanarak kontrollü ovaryan stimulasyon (KOS) ve intrauterin inseminasyon (IUI) uygulanan 315 olgu dahil edildi. Bazal hormon değerleri, infertilite tipi, süresi, GND başlangıç dozu, total kullanılan GND dozu, HCG günü estradiol (E2) düzeyi, HCG günü endometrium kalınlığı, indüksiyon süresi ve gebelik oluşumu gibi demografik ve klinik değişkenleri hastane kayıtları ile hasta dosyalarından kaydedildi. Ultrasonografide en az 1 adet ≥18 mm çaplı dominant folikül elde edilince ovulasyon 250 µg rekombinant hCG ya da 10000 IU üriner hCG ile gercekleştirildi ve 36 saat sonra IUI işlemi uygulandı. Lüteal faz desteği olarak günlük tek doz %8 vaginal jel verilen hastalarla, natürel mikronize progesteron oral kapsül verilen hastalar olarak 2 gruba ayrıldı. Gruplar belirtilen değişkenler açısından istatistiksel olarak karşılaştırıldı. Bulgular: Hastaların ortalama yaşı her iki grupta sırasıyla 28,7±5,0 ve 28,8±5,4 idi (p=0,839). Gruplar arasında yaş, BMI, hormonal parametreler, infertilite süresi, HCG günü bakılan endometrium kalınlığı açısından istatistiksel olarak anlamlı fark yoktu (p>0,05). Klinik gebelik oranlarına bakıldığında; naturel mikronize progesteron kullanılan grupta %14,2 (n=22), %8 vaginal progesteron kullanılan grupta ise %12,5 (n=19 ) idi (p=0,7). Sonuç: Oral progesteron formu kolay uygulanabilirliği, tedavi maliyetinin daha düşük olması nedeniyle vaginal progesteron formu yerine uygun endikasyonlu hastalarda tercih edilebilir.

Comparison of the progesterone form used in gonadotropin induced controlled ovarian stimulation-intrauterine insemination cycles and treatment efficacy

Aim: To compare the progesterone forms used for luteal phase support during gonadotropin-induced ovulation induction in terms of pregnancy success. Materials and Methods: This study included 315 cases of controlled ovulation stimulation and IUI, using from gonadotropin therapy applied to Zekai Tahir Burak SUAM infertility polyclinic between March 2017 and February 2018. Demographic, clinical variables and pregnancy rates were recorded from hospital records and patient files. When at least 1 dominant follicle with ≥18 mm diameter was obtained on ultrasonography, ovulation was performed with 250 µg recombinant hCG or 10000 IU urinary hCG and IUI treatment was performed after 36 hours. Patients were divided into two groups; given 8% vaginal gel or natural oral micronized progesterone capsule as luteal phase support. The groups were statistically compared in terms of the variables mentioned. Results: The mean age of the patients included in the study was 28.7±5.0 and 28.8±5.4 in both groups, respectively (p=0.839). There was no statistically significant difference between groups in terms of age, BMI, hormonal parameters, duration of infertility, endometrium thickness on HCG day (p>0.05). When the clinical pregnancy rates are examined; 14.2% (n=22) in the group with natural micronized progesterone and 12.5% (n=19) in the group using vaginal progesterone (p=0.7). Conclusion: Oral progesterone form may be preferred in patients with appropriate indication instead of vaginal progesterone form because of its easy applicability and lower cost of treatment.

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1. Fatemi HM, Popovic-Todorovic B, Papanikolaou E, Donoso P, Devroey P. An update of luteal phase support in stimulated IVF cycles. Hum Reprod Update 2007;13(6):581-90.
2. Penzıas AS, Alper MM. Luteal support with vaginal micronized progesterone gel in assisted reproduction. Reprod Biomed Online 2003;6(3):287-95.
3. De Ziegler D, Fanchin R. Progesterone and progestins: Applications in gynecology. Steroids 2000;65(10-11):671-9.
4. Levine H. Luteal support in IVF using novel vaginal progesterone gel Crinone 8%: Results of an open-label trial in 1,184 women from 16 U.S. centers. Fertil Steril 2000;74(4):836-7.
5. Freour T, Jean M, Mirallie S, Langlois ML, Dubourdieu S, Barriere P. Predictive value of CASA parameters in IUI with frozen donor sperm. Int J Androl 2009;32(5):498-504.
6. Tavaniotou A, Smitz J, Bourgain C, Devroey P. Comparison between different routes of progesterone administration as luteal phase support in infertility treatments. Hum Reprod Update 2000;6(2):139-48.
7. Keenan JA, Moghissi KS. Luteal phase support with hCG does not improve fecundity rate in human menopausal gonadotropinstimulated cycles. Obstet Gynecol 1992;79(6):983-7.
8. Hamilton CJ, Jaroudi KA, Sieck UV. The value of luteal support with progesterone in gonadotropin-induced cycles. Fertil Steril 1993;60(5):786-90.
9. Karen Peeraer, Thomas D'Hooghe, Pascale Laurent, et al. Impact of luteal phase support with vaginal progesterone on the clinical pregnancy rate in intrauterine insemination cycles stimulated with gonadotropins: A randomized multicenter study. Fertil Steril 2016;106(6):1490-5.
10. Hill MJ, Whitcomb BW, Lewis TD, et al. Progesterone luteal support after ovulation induction and intrauterine insemination: A systematic review and meta-analysis. Fertil Steril 2013;100(5):1373-80.
11. Romero Nieto MI, Gonzalez JL, Arjona-Berral JE, Del Munoz-Villanueva M, Castelo-Branco C. Luteal phase support with progesterone in intrauterine insemination: A prospective randomized study. Gynecol Endocrinol 2014;30(3):197-201.
12. Ganesh A, Chakravorty N, Mukherjee R, Goswami S, Chaudhury K, Chakravarty B. Comparison of oral dydrogestrone with progesterone gel and micronized progesterone for luteal support in 1,373 women undergoing in vitro fertilization: A randomized clinical study. Fertil Steril 2011;95(6):1961-5.
13. Patki A, Pawar VC. Modulating fertility outcome in assisted reproductive technologies by the use of dydrogesterone. Gynecol Endocrinol 2007;23(Suppl 1):68-72.
14. Chakravarty BN, Shirazee HH, Dam P, Goswami SK, Chatterjee R, Ghosh S. Oral dydrogesterone versus intravaginal micronised progesterone as luteal phase support in assisted reproductive technology (ART) cycles: Results of a randomized study. J Steroid Biochem Mol Biol 2005;97(5):416-20.
15. Green KA, Zolton JR, Schermerhorn SMV, et al. Progesterone luteal support after ovulation induction and intrauterine insemination: An updated systematic review and meta-analysis. Fertil Steril 2017;107(4):924-33.