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Kötü Over Yanıtı Olan Olgularda Rekombinant Gonodotropin ile Birlikte Luteal Uzun-Leuprolid Asetat ve Stop-Leuprolid Asetat Protokollerinin Karşılaştırılması

Düşük over yanıtı tüp bebek ve ilgili yardımcı üreme teknolojilerinin en önemli sorunlarından biridir. Günümüzde düşük over yanıtlı olgularda etkinliği kanıtlanmış ve herkes tarafından kabul görmüş bir protokol yada ajan yoktur. Bu araştırmada daha önceden düşük yanıt vermiş olgularda yüksek doz rekombinant folikül stimulan hormonla birlikte gonadotropin analogunun folikuler fazda kesilmesi (stop-leuprolid asetat) ile gonadotropin analoguna ovulasyona kadar devam edilmesi (uzun leuprolid asetat) protokollerinin etkinliğini karşılaştırmayı amaçladık. Bu çalışmaya daha önce intrastoplazmik sperm enjeksiyonu denemelerine düşük yanıt vermiş 19 hasta kabul edildi. Olgular iki gruba randomize edildi. Birinci gruba (n=8) luteal uzun leuprolid asetat, ikinci gruba (n=11) ise stop-leuprolid asetat protokolu uygulandı. Her iki gruba da yüksek doz (450IU/gün) rekombinant folikül stimulan hormon başlandı ve doz daha sonra azaltılarak ayarlandı. Over yanıtını etkileyebilecek temel demografik ve endokrin değişkenler her iki grupta da benzerdi. Kullanılan ampül sayısı, stimulasyon süresi, iptal oranları, folikül sayısı, toplanan oosit sayısı ve transfer edilen embriyo sayıları arasında istatistiksel olarak anlamlı farklılık izlenmedi. Stop-leuprolid asetat uygulanan vakaların hiçbirinde erken luteal hormon salınmasına rastlanmadı. Olguların hiçbirinde gebelik izlenmedi. Kötü over yanıtı olan olgularda stop-leuprolid asetat protokolü ve uzun leuprolid asetat protokolü over yanıtı üzerinde birbirlerine benzer etkileri bulundu. Stop-leuprolid asetat protokolu uygulanan olgularda erken luteal hormon salınması hiçbir olguda izlenmedi. Anahtar kelimeler: Düşük over yanıtı, stop-leuprolid asetat protokolu, rekombinat gonodotropin Stop-Leuprolide Acetate Protocol Does Not Yield a Better Ovarian Response Compared to Luteal Long Protocol with Recombinant Gonodotrophin in Patients with Poor Ovarian Response Undergoing Intracytoplasmic Injection Poor ovarian response is a major factor limiting success in assisted reproduction. There is currently no agent or protocol that has been unequivocally proven to be successful in patients with poor ovarian response. Our objective in this study was to compare stop-leuprolide acetate and luteal long-leuprolide acetate protocols with using high dose recombinant follicule stimulating hormone. 19 patients with previous poor ovarian response during intracytoplasmic sperm injection cycle were included. Patient were randomized with computer produced numbers to luteal long- leuprolide acetate(n=8) and stop-leuprolide acetate (n=11). Recombinant follicule stimulating hormone was started on day three with starting dose of 450IU/day and the dose was induvidualized using step-down regimen. All patients had similar intracytoplasmic sperm injection cycle, embryo transfer and luteal support procedures Both groups were comparable in terms of body mass index, female age, duration of infertility. All paremeters of ovarian response gonodotrophin dose, time reguired for stimulation, cancellation rate, number of mature oocytes and transfered embrios were comparable between two groups. None of the patients in the stop-leuprolide acetate exhibited a premature LH surge. We could not have any pregnancies in both groups. We conclude that stop-leuprolide acetate protocol and luteal long- leuprolide acetate protocol have similar effect on ovarian response in poor responders. We did not observe any premature LH surge in the stop-leuprolide acetate group. Key words: Poor ovarian response, stop-leuprolide acetate protocol, recombinant gonodotrophins

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