Volkan EMİRDAR, Ferruh ACET

Oosit toplama sırasındaki folikül yıkamanın fertilite prezervasyonu siklusları sonuçlarına etkisi, retrospektif çalışma

Amaç: Kanser hastalarının kemoterapi sonrası yumurtalık rezervlerini kaybetme riski altında olduğu göz önüne alındığında, fertilite prezervasyonu (FP) döngülerinde oosit kalitesini en üst düzeye çıkarmak çok önemlidir. Amacımız, FP için letrozol ve gonadotropinler ile oositleri veya embriyoları korumak için kontrollü yumurtalık stimülasyonu uygulanan kadınlarda elde edilen oosit ve embriyo sayısını maksimize etmede foliküler yıkamanın yararlılığını belirlemekti. Gereç ve Yöntem: Fertilite prezervasonu planlanan meme kanserli olgular retrospektif olarak tarandı. Çift lümenli yıkama yaklaşımı (ÇLY) kullanılarak oositlerin aspire edildiği 11 döngü, oositlerin tek lümenli aspirasyon (TLA) yoluyla alındığı yaş uyumlu 31 döngü ile karşılaştırıldı. 10 mm ve üzerinde ölçüm yapılan tüm foliküller aspire edildi. ÇLY grubunda, foliküller 6 defaya veya oosit elde edilene kadar yıkandı. Bulgular: Ortalama yaş ve anti-müllerian hormon (AMH) değerleri ÇLY ve TLA grupları arasında benzerdi (sırasıyla, yaş:39,8 ± 0,48 / 37,9 ± 0,74; p=0,162; AMH: 1,69 ± 0 ,37 / 1,47 ± 0 ,25 ng/mL p=0,635). Pik estradiol seviyeleri ÇLY grubunda anlamlı olarak daha yüksekti (ÇLY / TLA: 1022,66 ± 205,45 / 715,5 ± 33,69 pg/mL, p= 0,026). Toplam gonadotropin dozu ( ÇLY / TLA: 5345 ± 344 / 5017 ± 108 IU, p= 0,236) ve toplam letrozol dozu (ÇLY / TLA: 59,0 ± 2 ,84 / 57,9 ± 1,08 mg, p=0,633) her iki grupta benzerdi. Tetikleme öncesi ultrasonografide 10 mm üzerindeki folikül sayısı temel alındığında benzer sayıda folikül saptandı (16,2 ± 1,2 / 12,5 ± 1,3; p=0,16). Çift lümenli yıkama yaklaşımı ile daha yüksek toplam oosit sayısı (17,4 ± 2 ,3 / 10,9 ± 1,2; p=0,015) ve daha yüksek sayıda olgunlaşmamış oosit elde edildi (8,36 ± 1,12 / 3,53± 0,45; p < 0,001). Ancak dondurularak saklanan embriyoların sayısındaki fark istatistiksel anlamlılığa ulaşmadı (7,2 ± 1,94 / 5,2 ± 0,79; p = 0,279). Sonuçlar: Fertilite prezervasyonu döngülerinde ÇLY kullanımı, küçük foliküllerden elde edilen immatür oosit sayısını arttırabilir. Çift lümenli yıkama yaklaşımının nihai embriyo verimini artırmadaki değeri, FP uygulanan kadınlar arasında daha geniş prospektif çalışmalarda araştırılmalıdır.

The effect of follicle flushing during oocyte retrieval on fertility preservation cycle outcomes, retrospective study

Aim: In oncology cases, chemo-radiotherapy treatments affect the ovarian reserve negatively, and fertility-preserving (FP) approaches are recommended in this patient group. Our purpose was to evaluate the efficacy of follicular flushing to increase oocyte and embryo retrieval in women undergoing controlled ovarian stimulation to preserve oocytes or embryos using gonadotropin in combination with aromatase inhibitors for FP. Materials and Methods: In our study, breast cancer cases were screened retrospectively. Eleven cycles in which oocytes were retrieved using the Double-lumen washing technique (DLF) in the same age group were compared with the cycle in which the oocytes were aspirated by single-lumen aspiration (SLA). All follicles displayed above 10 mm were aspirated. In the DLF group, oocyte was washed up to retrieval or up to 6 times. Results: Mean age and anti-mullerian hormone (AMH) levels were not significantly different in both groups (age: 39.8 ± 0.48 vs. 37.9 ± 0.74 years; p=0.162; AMH: 1.69 ± 0.37 vs. 1.47 ± 0.25 ng/mL; p=0.635, respectively), maximum estradiol levels were significantly higher in the flushing group. (DLF vs SLA: 1022.66 ± 205.45 vs 715.5 ± 33.69 pg/mL; p= 0.026). Total dose of gonadotropins (DLF vs. SLA: 5345 ± 344 vs. 5017 ± 108 IU; p= 0.236) and total dose of aromatase inhibitors (DLF vs. SLA: 59.0 ± 2.84 vs. 57.9 ± 1.08 mg; p=0.633) were not different. According to the number of follicles >10 mm on the trigger day, a similar number of follicles was stated (DLF vs. SLA: 16.2 ± 1.2 vs. 12.5 ± 1.3; p=0.16). The total number of oocytes retrieved in the DLF group (17.4 ± 2.3 vs 10.9 ± 1.2; p=0.015; respectively) and metaphase 1 oocytes (8.36 ± 1.12 vs 3.53 ± 0.45; p < 0.001) were statistically significantly higher. However, the number of cryopreserved embryos was statistically similar in both groups. (DLF vs. SLA: 7.2 ± 1.94 vs. 5.2 ± 0.79; p = 0.279). Conclusions: Administration of DLF in ovarian stimulation cycles in oncology patients may increase the number of immature oocytes retrieved from non-dominant follicles. The value of DLF in increasing the total number of embryos should be investigated in randomized controlled trials in patients undergoing fertility preservation.

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