Klomifen sitrat ile over stimülasyonu yapılan yüksek kilolu polikistik over sendromlu hastalarda myo-inositol kombinasyonu gebelik sonuçlarını iyileştirir mi?

Amaç: Güncel kanıtlar, B vitamini ailesine ait bir besin maddesi olan miyoinositolün (MI), muhtemelen önceden var olan insülin direncinin iyileştirilmesi yoluyla hormon profilini ve polikistik over sendromuna (PKOS) eşlik eden metabolik bozuklukları düzenleyebileceği gösterilmiştir. Bu çalışmada klomifensitrat (CC) ile CC ve MI kombinasyonunun infertil obez PKOS’lu kadınlarda ovülasyon ve gebelik sonuçları üzerine etkisinin karşılaştırılması amaçlandı. Yöntemler: Obez ve infertil 80 PCOS hastası kadın dijital veri tabanı aracılığıyla çalışmaya alındı. Kontrollü over stimülasyonu (OS), CC (100 mg) veya CC (100mg) + MI (4 g) kullanılarak yapıldı. Bu çalışmanın birincil sonuç ölçütü, ovülasyondaki fark ve overstimülasyonu için CC (CC grubu) veya CC + MI (kombinasyon grubu) alan kadınların gebelik oranları olarak alındı. Her bir grupta 40’ar hasta bulunmaktaydı. Bulgular: Kombinasyon grubunda endometriyal kalınlığın (8,4 (1,1) mm ve 7,7 ( 1,2) mm, P=0,006) ve 17 mm’den büyük folikül sayısının (1,6 (0,5) vs. 1.4 (0,5), P=0,036) CC grubundan anlamlı olarak daha yüksek olduğu görüldü. Bununla birlikte, OS'yi takiben yumurtlama oranı [37 (%92) vs. 37 (%92), P=1,000] ve hamilelik oranı [6 (%15) vs. 11 (%27.5), sırasıyla P=0,172] açısından CC ve kombinasyon grupları benzerdi.Sonuç: Sadece CC ile overstimülasyonu ile karşılaştırıldığında, CC + MI kombinasyonunun endometriyal kalınlık ve olgun folikül sayısı üzerinde olumlu etkileri olduğu görüldü. Ancak, yumurtlama oranları her iki rejimde birbirine benzerdi. İstatistiksel olarak anlamlı olmamakla birlikte, CC + MI kombinasyonunda sadece CC ile karşılaştırıldığında daha yüksek gebelik oranları yönünde bir eğilim vardı. İnfertilitesi olan PKOS'lu kadınların yönetiminde MI'nın rolünü açıkça ele almak için ileriye dönük ve randomize çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Polikistik over sendromu, Over stimülasyonu, Klomifensitrat, Miyoinositol

Does the combination of myo-inositol improve pregnancy outcomes in obese polycystic ovary syndrome women undergoing ovarian stimulation with clomiphene citrate?

Aim: Recent evidence has shown that Myoinositol (MI), a nutrient belonging to vitamin B family, may improve hormone profile, and the metabolic disorders accompanying polycystic ovary syndrome (PCOS), probably through the amelioration of preexisting insulin resistance. This study aimed to compare the ovulation and pregnancy outcomes of clomiphene citrate (CC) and its combination with MI in obese PCOS women with infertility. Methods: Data concerning 80 obese, PCOS women with infertility who had undergone ovarian induction were retrieved from the institutional digital database. Controlled ovarian stimulation (OS) was performed using CC 100 mg or CC (100mg) + MI (4 g). The primary outcome measure of this study was the difference in the ovulation and the pregnancy rates of the women receiving CC (CC group) or CC+MI (combination group) for ovarian stimulation. There were 40 patients in each group. Results: Endometrial thickness was significantly higher in the combination group than in the CC group (8.4 (1.1) mm vs. 7.7 (1.2) mm, P=0.006) and the number of the follicles>17 mm following OS was significantly higher in the combination group compared to that of the CC group (1.6 (0.5) vs. 1.4 (0.5), P=0.036). However, the rate of ovulation following OS [37 (92%) vs. 37 (92%), P=1.000] and the rate of the pregnancy were similar in CC and combination groups [6 (15%) vs. 11 (27.5%), P=0.172, respectively].Conclusions: Compared to ovarian stimulation with CC alone, the combination provides a beneficial effect on endometrial thickness and the number of mature follicles. However, ovulation rates are similar with the two regimens. Although not statistically significant, there was a trend towards higher rates of pregnancy on CC+MI combination compared to CC alone. Further prospective and randomized trials are required to clearly address the role of the MI in management of the PCOS women with infertility.

Keywords:

Polycystic ovary syndrome, Ovarian stimulation, Clomiphene citrate, Myo-inositol,

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