İntrasitoplazmik sperm injeksiyonu tedavisine başlanan çiftlerde embriyo transferi öncesi iptal nedenleri: 11 yıllık pratiğin retrospektif analizi

GİRİŞ ve AMAÇ: Özel bir tüp bebek ünitesine başvurarak intrasitoplazmik sperm enjeksiyonu (ICSI) programa alınmış ancak embriyo transferi (ET) yapılamamış çiftlerde siklus iptaline neden olan faktörler incelendi. YÖNTEM ve GEREÇLER: ICSI tedavisine alınan ve ET yapılamayarak siklusu iptal edilen çiftler incelendi. Siklus iptal nedenleri; azospermik hastalarda mikroskobik testiküler sperm ekstraksiyonunda (m-TESE) sperm bulunamaması, kadında ovulasyon indüksiyonuna yanıt alınamaması, oosit aspirasyonunda oosit bulunamaması, fertilizasyon olmaması, embriyo gelişimi olmaması, ovaryan hiperstimulasyon sendromu (OHSS) riski, endometriumun gelişmemesi, servikal stenoz ve sosyal nedenler olarak sınıflandırıldı. BULGULAR: Çalışma grubu, tedavi programına alınan 6623 çiftten oluştu. Siklusu iptal edilen 2014 hastanın %10.8’ inde (n=218) siklus iptal nedeni m-TESE’ de sperm bulunmamasıydı. Azospermi endikasyonuyla programa alınan 586 erkek hastanın 218’ sinde (218/2014, %10.8) sperm bulunamaması nedeniyle siklus iptal edildi. Non-obstrüktif azospermik (NOA) 462 hastanın %47.1’inde (n = 218) ise testiküler sperm elde edilemedi. Ovulasyon indüksiyonuna başlanan kadınların 651’inde ovaryan yanıt alınamadı (%9.8) ve oosit aspirasyonu yapılamadı. Diğer nedenler ise fertilizasyon olmaması 321 (%15.9), embriyo gelişmemesi 232 (% 11.5), OHSS riskinin olması 57 (% 2.8), endometriumun gelişememesi 23 (% 1.1) olarak bulundu. TARTIŞMA ve SONUÇ: ICSI-ET endikasyonu ile tedavi programına alınan erkeklerde en sık siklus iptal nedeni NOA hastalarında m-TESE işleminde testiküler sperm bulunamaması olurken; kadınlarda zayıf over yanıtı nedeniyle ovulasyon indüksiyonuna yanıt alınamaması oldu.

Reasons for cancellation of the cycle before embryo transferr in couples who have received intrastoplasmic sperm injection therapy: retrospective analysis of 11 yearrs practice

INTRODUCTION: Factors leading to cycle cancellation were investigated in couples who have started intracytoplasmic sperm injection (ICSI) treatment but did not embryo transfer (ET) in a special IVF unit. METHODS: The couples who received ICSI treatment but whose cycle was cancelled without ET were evaluated. Reasons for cycle cancellation classified as unable to find sperm in micro-dissection sperm retrieval (m-TESE) procedure in patients with azoospermia, no response to ovulation induction in women, unable to find oocyte in oocyte pick-up (OPU) procedure, lack of fertilization, lack of embryo development, risk of ovarian hyperstimulation syndrome (OHSS), not enough endometrial development, cervical stenosis and social problems. RESULTS: 6623 couples were received ICSI treatment, 30.4% (n=2014) of them cycles were cancelled. The absence of sperm in m-TESE found in 10.8% (n= 218) of cycle canceled patients (n= 2014). Sperm was not detected in 218 of 586 male patients (218/2014, % 10,8) who underwent m-TESE due to azoospermia and then the cycle was cancelled. 47.1% (218/462) of patients with non-obstructive azoospermia (NOA) did not have testicular sperm. In 651 (9.8%) of women who started ovulation induction, the ovarian response was not obtained and oocyte aspiration could not be performed. Lack of fertilization 321 (15.9%), lack of embryo development 232 (11.5%), risk of ovarian hyperstimulation syndrome (OHSS) 57 (2.8%), not enough endometrial development 23 (1.1%) were the other reasons. DISCUSSION and CONCLUSION: The most frequent reasons for cycle cancellation in couples who underwent ICSIET treatment were failures to obtain testicular sperm in the m- TESE procedure in NOA patients and to ovulation induction due to weak ovarian response.

Kaynakça

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