Ranan Gülhan AKTAŞ, Muhammed Emin ALTUNKAYNAK, Gülden TUNALI, Naciye ARAT, Kenan SOFUOĞLU, Ebru ÇÖĞENDEZ, Tayfun KUTLU, Belgin DEVRANOGLU, Handan ANKARALI

BAŞARISIZ İMPLANTASYON ÖYKÜSÜ OLAN HASTALARDA LAZERLE ZONA İNCELTME YÖNTEMİNİN GEBELİK ORANLARINA ETKİSİ

Amaç Embriyo transferlerinin başarısını arttırmak için uygulanan zona pellusidanın inceltilme işlemi olan “assisted hatching” in başarısı halen tartışmalıdır. Bu çalışmada; daha önce başarısız embriyo transferi öyküsü olan hastalarda ikinci kez taze embriyo transfer edilmeden önce zona tabakasının inceltilmesinin gebelik oranları üzerine değişiminin incelenmesi amaçlanmıştır. Çalışmada; aynı hastanın, aynı klinikte ve aynı koşullar altında yapılan ard arda iki tedavisinin sonuçları karşılaştırılmıştır. Gereç ve Yöntem: Kliniğe en az iki kez başvuran 188 çifte ait toplam 376 siklusun gebelik sonuçları değerlendirilmiştir. Hastalar aşağıdaki kriterlere göre gruplandırılmıştır: 1. Grup: 35 yaş ve üzeri, 2. Grup : Zona pellusidası kalın embriyolara sahip hastalar, 3. Grup: Birden fazla IVF-embriyo transfer denemesi olan ve başarısızlığın nedeni saptanamamış hastalar. Tüm bu hastaların embiryolarına ilk denemelerinde lazer uygulaması yapılmamış, ancak ikinci denemelerinde embriyoların zona pellusidaları lazer ile inceltilmiştir. Tüm laboratuvar olanakları, kullanılan medyumlar, hasta ile ilgilenen klinisyen ve embriyologların bu birbirini takip eden iki tedavide aynı olmasına dikkat edilmiştir. 2. Ya da 3. Gün transfer uygulanan hastalar değerlendirmeye alınmıştır. Gebelik oranları transfer gününe göre istatistiksel olarak karşılaştırılmıştır. Sonuçlar: İleri yaş hastaları içeren grupta gerek 2. gerekse 3. Gün transfer yapılan hastalarda klinik gebelik oranları belirgin şekilde artmıştır. Zona pellusidası kalın embriyoya sahip çiftlerde ve neden saptanamamış hastalarda ise 3. gün transferlerinin ardından gebelik oranlarında belirgin artış görülmüştür. İstatistiksel sonuçlar; ardarda gelen iki siklus karşılaştırıldığında zona inceltme işleminin gebelik oranının arttırdığını göstermektedir. Bu sonuçlara göre; başarısız implantasyon öyküsü olan hastalarda embriyoların lazerle zona pellusidasının inceltilmesi mutlaka düşünülmesi gereken bir yöntem olmalıdır.

Anahtar Kelimeler:

İnfertilite, Embriyo, Lazer, Hatching, Gebelik

EFFECTS OF LASER ZONA THINNING ON PREGNANCY RATES IN PATIENTS WITH IMPLANTATION FAILURE

The effectiveness of assisted hatching to improve embryo transfer outcome remains controversial. The current study analyses the impact of zona thinning by laser on pregnancy rates after a failed, fresh, nondonor cycle. The study presents the comparative results of two consecutive treatments of the same patients, which were treated under same conditions in same clinic. Materials and Methods: Pregnancy results of 188 couples 376 cycles were examined. These patients met one of the following criteria: 1st group: ≥35 years of age, 2nd group: Thick zona pellucida of the embryo, 3rd group: More than one IVF-embryo transfer attempts with no clear reason. Embryos of these patients did not have laser treatment during their first trial, while the zona of the embryos of the same patients were thinned by laser during their second try. All laboratory conditions, mediums as well as clinicians and embryologists were the same for the subsequ ent therapies. The pregnancy rates of each attempt were statistically examined according to the day of the transfer. Results: Clinical pregnancy rates increased significantly after hatching both on 2nd and 3rd day transfers on the group with advanced age. The rates were obviously higher after 3rd day transfers on the patients who had embryos with thick zona as well as at the patients who had several attempts before with no clarified reason. Conclusions: Statistical results show that zona thinning causes improved pregnancy rates in subsequent cycles. Laser treatment of embryos should definitely be considered for the patients with at least one prior implantation failure.

Keywords:

Infertility, Embryo, Laser, Hatching, Pregnancy,

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