Ali Sami GÜRBÜZ, Necati ÖZÇİMEN, Emel Ebru ÖZÇİMEN

İntrauterin HCG Enjeksiyonu IVF' te Hangi Hastalara Uygulanmalıdır?

Amaç: İn vitro fertilizasyon IVF tedavisinde embryo transferinden önce yapılan intrauterin human chorionic gonadothropin enjeksiyonlarının etkisinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Yüz atmış sekiz hasta çalışma grubuna alındı. 274 hasta ise kontrol grubuna dahil edildi. Hasta grupları kendi içinde de ikiye ayrıldı.Grup 1: Birinci ve ikinci IVF denemesi olan çalışma grubu hastaları N:126 Grup 2: Birinci ve ikinci IVF denemesi olan control grubu hastaları N:189 Grup 3: Üç veya daha fazla IVF denemesi olan çalışma grubu hastaları N:42 Grup 4: Üç veya daha fazla IVF denemesi olan control grubu hastaları. N:85 .Tüm hastalara taze embryo transferi ET yapıldı. Çalışma grubuna ET öncesi intrauterine hcg enjeksiyonu uygulandı.Bulgular: Üç veya daha fazla sayıda IVF uygulaması yapılmış hastalarda gebelik, klinik gebelik ve implantasyon oranları intrauterine hCG enjekte edilenlerde belirgin düzeyde yüksek çıkmıştır. p=0,03, p=0,02, p=0,02 sırasıyla Sonuç: Intrauterin hCG enjeksiyonu tekrarlayan IVF başarısızlığı olan hastalarda gebelik oranlarını iyileştirmektedir.

Anahtar Kelimeler:

Intrauterin hCG, infertilite, tekrarlayan IVF başarısızlığı, hCG

To Which Patients Should Intrauterine HCG Injection Be Applied In In Vitro Fertilization?

Aim: To investigate the impact of the intrauterine injection of hCG before embryo transfer in in vitro fertilization IVF according to number of transfer.Material And Methods: One hundred and sixty-eight 168 patients were included to the study group; 274 patients were included to the control group. The patients were divided into 2 study and 2 control groups.Group 1: Study group patients in the first and the second IVF cycles. N=126 Group 2: Control group patients in the first and the second IVF cycles. N=189 Group 3: Study group patients in the third or more IVF cycles. N=42 Group 4: Control group patients in the third or more IVF cycles. N=85 Fresh IVF-embryo transfer ET was performed to all patients. Intrauterine hCG injection was performed before ET in the study groups.Results: The pregnancy, clinical pregnancy and implantation rates were significantly increased in the intrauterine hCG injected patients with third or more IVF cycles p= 0.03, p= 0.02, p= 0.02 respectively.Conclusion: The intrauterine hCG injection improved the pregnancy rates in the patient with recurrent IVF failures.

Keywords:

Intrauterine hCG infertility, IVF, recurrent IVF failures, hCG,

PDF

___

TeVelde ER, Eijkemans R, Habbema HD. Variation in couple fecundity and time to pregnancy, an essential concept in human reproduction. Lancet 2000; 355: 1928-1929.
Psychoyos A. Uterine receptivity for nidation. Ann NY Acad Sci 1986; 476:36-42.
Teles A, Zenclussen AC. How Cells of the Immune System Prepare the Endometrium for Implantation. Semin Reprod Med 2014;32(5)358-64
Irwin JC, Kirk D, King RJ, Quigley MM, Gwatkin RB. Hormonal regulation of human endometrial stromal cells in culture: an in vitro model for deci- dualization. Fertil Steril 1989; 52(5): 761-768.
Huang JR, Tseng L, Bischof P, Janne OA. Regulation of prolactin producti- on by progestin, estrogen and relaxin in human endometrial stromal cells. Endocrinology 1987; 121(6): 2011-2017.
Tang B, Gurpide E. Direct effect of gonadotropins on decidualization of human endometrial stromal cells. J Steroid Biochem Mol Biol 1993; 47(1-6):115-21.
Tang B, Guller S, Gurpide E. Cyclic adenosine 3‘, 5‘-monophosphate in- duces prolactin expression in stromal cells isolated from human prolife- rative endometrium. Endoc 1993; 133(5): 2197-2203.
Kasahara K, Takakura K , Takebayashi K, Kimura F, Nakanishi K, Noda Y. The role of human chorionic gonadotropin on decidualization of endomet- rial stromal cells in vitro. J Clin Endoc Metab 2001; 86(3):1281-1286.
Licht P, Fluhr H, Neuwinger J, Wallwiener D, Wildt L. Is human chorionic gonadotropin directly involved in the regulation of human implantation? Mol Cell Endoc 2007; 269(1-2): 85-92.
Tsampalas M, Gridelet V, Berndt S, et al. Human chorionic gonadotropin: a hormone with immunological and angiogenic properties. J Reprod ım- munol 2010; 85: 93-98.
Bonduelle ML, Dodd R, Liebaers I, Van Steirteghem A, williamson R, Akhurst R. Chorionic gonadotropin-beta mRNA, a trophoblast marker, is expressed in human 8-cell embryos derived from tripronucleate zygotes. Hum Reprod 1988; 3: 909-914.
Lopata A, Hay DL. The potential of early human embryos to form blas- tocysts, hatch from their zona and secrete hCG in culture. Hum Reprod 1989; 4 (8 Suppl): 87-94.
Fazleabas AT, Donnelly KM, Srinivasan S, Fortman JD, Miller JB. Modula- tion oft he baboon uterine endometrium by chorionic gonadotropin during the period of uterine receptivity. Proc Natl Acad Sci 1999; 96: 2543-2548.
Akoum A, Metz CN, Morin M. Marked increase in macrophage migration inhibitory factor synthesis and secretion in human endometrial cells in response to human chorionic gonadotropin hormone. J Clin Endoc Metab 2005; 90: 2904-2910.
Licht P, Russu V, Wildt L. On the role of human chorionic gonadotropin (hCG) in the embryo endometrial microenvironment: implications for dif- ferentiation and implantation. Semin Reprod Med 2001; 19: 37-47.
Fluhr H, Bischof-Islami D, Krenzer S, Licht P, Bischof P, Zygmunt M. Hu- man chorionic gonadotropin stimulates matrix metalloproteinases 2 and 9 in cytotrophoblastic cells and decreases tissue inhibitor of metalloprotei- nases-1, -2, and -3 in decidualized endometrial stromal cells. Fertil Steril 2008; 90( 4 Suppl ): 1390-1395.
Sherwin JR, Sharkey AM, Cameo P, et al. Identification of novel genes regulated by chorionic gonadotropin in baboon endometrium during the window of implantation. Endoc 2007; 148: 618-626.
Fogle RH, Li A, Paulson RJ. Modulation of HOXA 10 and other markers of endometrial receptivity by age and human chorionic gonadotropin in an endometrial explant model. Fertil steril 2010; 93: 1255-1259.
Reinisch N, Sitte BA, Kahler CM, Wiedermann CJ. Human chorionic gona- dotropin: a chemoattractant for human blood monocytes, neutrophils and lymphocytes. J Endocrinol 1994; 142: 167-170.
Mansour R, Tawab N, Kamal O, et al. Intrauterine injection of human cho- rionic gonadotropin before embryo transfer significantly improves the implantation and pregnancy rates in in vitro fertilization/ intracytoplasmic sperm injection: a prospective randomized study. Fertil Steril 2011; 96 (6): 1370-1374.
Santibañez A, Garcia J, Pashkova O, et al. Effect of intrauterine injection of human chorionic gonadotropin before embryo transfer on clinical preg- nancy rates from in vitro fertilisation cycles: a prospective study. Repro- ductive Biology and Endocrinology 2014 12:9.
Zarei A, Parsanezhad ME, Younesi M, Alborzi S, Zolghadri J, Samsami A, Amooee S, Aramesh S. Intrauterine administration of recombinant human chorionic gonadotropin before embryo transfer on outcome of in vitro fertilization/ intracytoplasmic sperm injection: a randomized clinical trial. Iran J Reprod Med 2014;12:1–6.
Hong KH, Forman EJ, Werner MD, Hart CL, Winslow AD, Scott RT, Up- ham KM, Gumeny CL, Winslow AD, Kim TJ et al. Endometrial infusion of human chorionic gonadotropin at the time of blastocyst embryo transfer does not impact clinical outcomes: a randomized, double-blind, place- bo-controlled trial. Fertil Steril 2014;102:1591–1595.
Wirleitner B, Schuff M, Vanderzwalmen P, Stecher A, Okhowat J, Hrade- cky L, Kohoutek T, Kralickova M, Spitzer D, Zech NH. Intrauterine admi- nistration of human chorionic gonadotropin does not improve pregnancy and life birth rates independently of blastocyst quality: a randomised prospective study. Reprod Biol Endocrinol 2015;13:10
Sugihara K, Kabir-Salmani M, Byrne J, et al. Induction of trophinin in hu- man endometrial surface epithelia by CGß and IL-1ß. FEBS Lett 2008; 582: 197-202.
Környei JL, Lei ZM, Rao CV. Human myometrial smooth muscle cells are novel targets of direct regulation by human chorionic gonadotropin. Biol Reprod 1993; 49: 1149-1157.
Lee TK, Kim DI, Song YL, Lee YC, Kim HM, Kim CH. Differential inhibition of Scutellaria barbata D. Don (Lamiaceae) on hCG-promoted proliferation of cultured uterine leiomyomal and myometrial smooth muscle cells. Im- munopharmacol Immunotoxicol 2004; 26: 329-342.
Kane N, Kelly R, Saunders PT, Critchley HO. Proliferation of uterine natural killer cells is induced by human chorionic gonadotropin and mediated via the mannose receptor. Endoc 2009; 150: 2882-2888.
Ritschel S, Zambon Bertoja A, Fest S, et al. Regulatory t cells induce a privileged tolerant microenvironment at the fetal- maternal interface. Eur J Immunol 2006; 36: 82-94.
Langwisch S, Dolaptchieva M, Sohr S, et al. Human chorionic gonadotro- pin attracts regulatory T cells into the fetal-maternal interface during early human pregnancy. J Immunol 2009; 182: 5488-5497.
Licht P, Lösch A, Dittrich R, Neuwinger J, Siebzehnrübl E, Wildt L. No- vel insights into human endometrial paracrinology and embryo-maternal communication by intrauterine microdialysis. Hum reprod Update 1998; 4: 532-538.
Banerjee P, Fazleabas AT. Endometrial responses to embryonic signals in the primate. Int J Dev Biol 2010; 54: 295-302.
Navali N, Gassemzadeh A, Farzadi L, Abdollahi S, Nouri M, Hamdi K, Mallah F, Jalilvand F.Intrauterine administration of hCG immediately after oocyte retrieval and the outcome of ICSI: a randomized controlled trial. Hum Reprod. 2016 Nov;31(11):2520-2526.
Potdar N, Gelbaya T, Nardo LG. Endometrial injury to overcome recur- rent embryo implantation failure: a systematic review and meta-analysis. Reprod Biomedicine Online 2012 Dec; 25(6): 561-71.