Nurcan ALTAŞ, Hilal USLU TOYGAR, Ülkem CİLASUN, Banu KUMBAK AYGÜN, Becem DEMİR

ERİODONTAL SAĞLIĞIN İN VİTRO FERTİLİZASYON SONUÇLARI ÜZERİNE ETKİSİNİN DEĞERLENDİRİLMESİ

AMAÇ: Bu çalışmanın amacı sistemik sağlık üzerinde et-kisi kanıtlanmış olan periodontal durumun infertil kadın-larda uygulanan in vitro fertilizasyon tedavisi sonuçları üzerindeki etkisini değerlendirmektir. GEREÇ VE YÖNTEM: İnfertilite tanısı konmuş kadın has-talardan sosyodemografik veriler bir anket yardımıyla toplanmıştır. Kan testi gününde plak indeksi, gingival indeks, cep derinliği, sondalamada kanama indeksi öl-çümleri yapılmıştır. Buna göre; sağlıklı, gingivitisli ve pe-riodontitisli olarak sınıflandırılan hastalar ile kullanılan human chorionic hormon gonadotropin (hCG) dozu, öst-radiol ve progesteron seviyeleri, transfer edilen embriyo sayıları, oosit sayıları ve gebelik sonuçları karşılaştırılmış-tır. Çalışmada, tek yönlü ANOVA, Tukey HDS, Tampane’s T2, Kruskal-Wallis, Mann-Whitney U ve ki-kare testleri kullanılmıştır. BULGULAR: Gruplar arasında oosit sayıları, transfer edi-len embriyo sayıları ve gebelik sonuçları açısından bir farklılık gözlenmemiştir. Gruplar arasında hCG günü öst-radiol seviyesi açısından bir farklılık gözlenmemesine karşın hCG günü progesteron seviyesi periodontitis gru-bunda sağlıklı ve gingivitisli gruba göre anlamlı şekilde yüksek bulunmuştur. SONUÇ:Periodontitis grubunda gözlenen progesteron seviyesindeki yükselme IVF sonucunu etkileyebilecek olan eşik değerin altındadır. Periodontal durumun inferti-lite tedavisi üzerindeki etki mekanizmasının belirlenmesi için geniş ölçekli ve uzun vadeli çalışmalara ihtiyaç duyul-maktadır

EVALUATING THE EFFECTS OF PERIODONTAL HEALTH ON IN VITRO FERTILIZATION OUTCOMES

BJECTIVE: This study aims to evaluate the effect of pe-riodontal status, which has been proven to have effects on systemic health, on the outcomes of in vitro fertiliza-tion (IVF) treatment which is applied to infertile women. MATERIAL AND METHODS: Sociodemographic data have been collected from female patients diagnosed with infertility through a questionnaire. On the day of the blood test, plaque index, gingival index, probing depth and bleeding index on probing were measured. Recruited patients were classified into the healthy, gin-givitis, and periodontitis groups according to the afore-mentioned criteria. These groups were compared with respect to human chorionic gonadotropin (hCG) dosage, estradiol and progesterone levels, the number of oocy-te and embryos transferred, and pregnancy outcomes. One-way ANOVA, Tukey HDS, Tampane’s T2, Kruskal-Wal-lis, Mann-Whitney U, and chi-square tests were used in this study. RESULTS: The three groups were statistically similar in the aspect of retrieved oocytes, transferred embryos and pregnancy outcomes. Although three groups had statistically similar in terms of estradiol levels on the day of hCG administration, progesterone levels were signifi-cantly higher in the periodontitis group compared to he-althy and gingivitis groups.CONCLUSIONS: This elevation in progesterone levels ob-served in the periodontitis group is below the threshold level which could affect the IVF outcomes. Large scale and long-term studies are needed to clarify the effects of periodontal status on IVF outcomes.

PDF

___

1. Mariotti A. Dental plaque-induced gingival disease. Ann Periodontol 1999; 4:7-19.

2. Klokkevold PR, Mealey BL. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA, ed. Carranza’s Clinical Perio-dontology. 11th ed. Elsevier-Saunders; St. Louis, Missou-iri: 2012: 304-19.

3. Collins JG, Windley HW, Arnold RR, Offenbacher S. Ef-fects of a Porphyromonas gingivalis infection on inflam-matory mediator response and pregnancy outcome in hamsters. Infect Immun 1994; 62(10): 4356-61.

4. Temoin S, Chakaki A, Askari A, et al. Identification of oral bacterial DNA in synovial fluid of patients with arth-ritis with native and failed prosthetic joints. J Clin Rheu-matol 2012; 18: 117–21.

5. Han YW, Ikegami A, Bissada NF, Herbst M, Redline RW, Ashmead GG. Transmission of an uncultivated Bergeyella strain from the oral cavity to amniotic fluid in a case of preterm birth. J Clin Microbiol 2006; 44: 1475–83

6.. Goepfert AR, Jeffcoat MK, Andrews WW, et al. Perio-dontal disease and upper genital tract inflammation in early spontaneous preterm birth. Obstet Gynecol 2004; 104(4): 777-83.

7. Han YW, Fardini Y, Chen C, et al. Term stillbirth caused by oral Fusobacterium nucleatum. Obstet Gynecol 2010; 115: 442–5.

8. Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol 2015; 15(1): 30-44.

9. Kumar A, Basra M, Begum N, et al. Association of mater-nal periodontal health with adverse pregnancy outcome. J Obstet Gynaecol Res 2013; 39(1): 40-5.

10. Forner L, Larsen T, Kilian M, Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Perio-dontol 2006; 33: 401–7.

11. Practice Committee of the American Society for Reproductive Medicine, Definitions of infertility and re-current pregnancy loss. Fertil Steril 2008; 90(3): 60.

12. Talbert LM, Hammond MG, Shabanowitz R, Bailey LE. Assisted reproductive technologies at the UNC Hospitals. An update. NC Med J 1990; 51: 201.

13. Pavlatou A, Tsami A, Vlahos N, Mantzavinos T, Vrotsos I. The effect of in vitro fertilization on gingival inflamma-tion according to women's periodontal status: clinical data. J Int Acad Periodontol 2013; 15(2): 36-42.

14. Silness J, Löe H. Periodontal disease in pregnancy. II. correletion between oral hygiene and periodontal condi-tion. Acta Odontol Scand 1964; 22: 121-35.

15. Löe H, Silness J. Periodontal disease in pregnancy I.prevelance and severity. Acta Odontol Scand 1963; 21: 531-51.

16. Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975; 25(4): 229-35.

17. Gibbons RV, Germs DR. Billings, and the theory of fo-cal infection. Clin Infect Dis 1998;27(3):627-633.

18. Billings F. Focal Infection as the Cause of General Dise-ase. Bull N Y Acad Med 1930;6(12):759-773.

19. Schelegel PN, Girardi SK. In Vitro Fertilization for Male Factor Infertility. J Clin Endocrinol Metab. 1997;82(3): 709-716.

20. Kondapalli LA, Molinaro TA, Sammel MD, Dokras A. A decrease in serum estradiol levels after human chori-onic gonadotrophin administration predicts significantly lower clinical pregnancy and live birth rates in in vitro fer-tilization cycles. Hum Reprod 2012;27(9):2690-2697.

21. Sharma V, Allgar V, Rajkhowa M. Factors influencing the cumulative conception rate and discontinuation of in vitro fertilization treatment for infertility. Fertil Steril 2002;78(1):40-46.

22. Nelson SM, Lawlor DA. Predicting live birth, preterm delivery, and low birth weight in infants born from in vit-ro fertilisation: a prospective study of 144,018 treatment cycles. PLoS Med 2011;8(1): e1000386.

23. Bu Z, Zhao F, Wang K, et al. Serum progesterone ele-vation adversely affects cumulative live birth rate in dif-ferent ovarian responders during in vitro fertilization and embryo transfer: a large retrospective study. PLoS One 2014;9(6):e100011.

24. Li R, Qiao J, Wang L, Zhen X, Lu Y. Serum progesterone concentration on day of HCG administration and IVF out-come. Reprod Biomed Online 2008;16(5): 627-631.

25. Kobayashi T, Okada M, Ito S, et al. Assessment of inter-leukin-6 receptor inhibition therapy on periodontal con-dition in patients with rheumatoid arthritis and chronic periodontitis. J Periodontol 2014;85(1):57-67.

26. Zhu Y, Wu M, Wu CY, Xia GQ. Role of progestero-ne in TLR4-MyD88-dependent signaling pathway in pre-eclampsia. J Huazhong Univ Sci Technolog Med Sci 2013;33(5):730-734.