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Klomifen Sitrat Sikluslarında Periovulatuvar Endometrial Kalınlık Ve Endometrial Ekojenite Paterninin Gebelik Sonuçları Üzerine Etkisi

Amaç: Endometrial kalınlık ve endometrial ekojenite paterninin klomifen sikluslarında gebelik sonuçları üzerine etkisini incelemeyi hedef aldık.Gereçler ve Yöntem: Çalışma Temmuz 2011-Aralık 2011 tarihleri arasında hastanemiz infertilite polikliniğine çocuk istemi ile başvuran toplam 102 hasta ile yapıldı. Çalışmaya dahil edilen hastalar için kabul edilme kriterleri olarak; 20-35 yaşları arasında olmak, primer ya da sekonder infertil olmak ve daha önceden hastanemizde ya da dış merkezde gonadotropin veya IVF tedavisi almamış olmak şeklinde tanımlandı. Hastalara menstruasyonun 2. , 3. veya 4. gününde bazal hormon tetkikleri, transvajinal ultrasound yapıldı ve eş zamanlı olarak hastaların eşlerinden 3 günlük cinsel perhiz sonrası spermiogram bakıldı. Hastalar bir sonraki menstruasyonun bazal döneminde tekrar çağrıldı. Hormonal tetkikler tekrarlandı ve bazal folikülometri yapıldı. Folikülometri esnasında eş zamanlı endometrial kalınlık ve endometrial ekojenite paternine bakıldı. Ardından hastalara menstruasyonun 5 ile 9. günleri arasında kullanmak üzere 100 mg klomifen sitrat tedavisi uygulandı. Hastalara aynı gün hCG enjeksiyonu yapıldı, 36 saat sonrasında intrauterin inseminasyon IUI uygulandı ve bu hastaların gebelik sonuçları takip edildi. Gebelik sonuçları değerlendirilirken β-hCG pozitifliği esas alındı. Gebelik devamı ve progresi açısından ek takip uygulanmadı. İstatistiksel analizler için SPSS Statistical Package for Social Sciences for Windows 15.0 programı kullanıldı. Tanımlayıcı istatistiksel metodların ortalama, standart sapma, medyan yanı sıra ölçümlerle elde edilen verilerin karşılaştırılmasında ortalama değerler için Mann-Whitney U testi, Chi-Square testi ve ROC eğrisi kullanıldı. % 95'lik güven aralığında, p

Anahtar Kelimeler:

Ovülasyon indüksiyonu, klomifen sitrat, endometrial kalınlık, ekojenite şekli

Effect Of Preovulatory Endometrial Thıckness And Endometrial Echogenity Pattern On Pregnancy Outcome In Clomiphene Citrate Treated Cycles

Aim: We examined the effect of endometrial thickness and the pattern of echogenity on pregnancy rate in clomiphen treated cycles.Materials and Method: This prospective study included 102 women with the diagnosis of primary/secondary infertility who were evaluated at Zekai Tahir Burak Women Health Education and Research Hospital between July 2011& December 2011. Patients age ranged from 20 to 35. The inclusion criteria were as follows: Regular marital life for at least one year, diagnosis of unexplained infertility, receiving no other ovulation induction agents except clomiphen citrate . All women had patent fallopian tubes proved with HSG and normal semen analysis for their partners. Patients received 100 mg of clomiphene citrate daily starting on the day 5.until the 9th day of the menses. Ultrasonographic examination was performed before initiation of treatment, and one day 12 and as required until dominant follicle reached 15 mm and upper. At the same time, by using transvaginal ultrasound, endometrial thickness and echogenic pattern were evaluated. hCG 10 000 IU IM was given when at least one follicle measured 15 mm and upper. IUI was performed 36 h after hCG administration.Serum oestradiol and progesterone were measured on the day of hCG injection. Serum β-hCG concentration was determined 14 days after hCG injection if menses had not yet occured. Pregnancy was defined as an increase in the serum β-HCG concentration on serial determinations at least 2 days apart. Biochemical pregnancy was defined as falling β-hCG concentration on serial determination.Results: All the patients had normal basal hormone concentrations,had no ovarian cysts in the ultrasonographic examination and had patent fallopian tubes. Semen analysis results for there partners were:sperm concentration>5 million,sperm A+B>%25 and sperm Kruger value between %4-14. Of 102 patients with unexplained infertility 18 patients achieved clinical pregnancy %17,65 , 84 patients did not achieve pregnancy %82,35 . Conception and non-conception cycles were compared. There was no difference in the endometrial thickness between the pregnant and nonpregnant patients p>0,05 .Patients achieving pregnancy showed significantly more triple layer endometria and nonsignificant trend for less homogenous endometrium than patients failing to get pregnant p

Keywords:

Ovulation induction, clomiphene citrate, endometrial thickness, endometrial echogenic pattern,

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