ART sikluslarında stimulasyona başlamadan önce uzamış ovaryen süpresyonun gebelik oranlarına etkisi

Amaç: Stimulasyona başlamadan önce ovaryen süpresyonun uzamasının gebelik oranlarına etkisini araştırmak Hastalar ve Yöntem: Üniversite affiliye hastanede yardımcı üreme tetkikleri (assisted reproductive technologies (ART)) tedavileri yapılan 565 hasta retrospektif olarak incelendi. Kadınlar gonadotropin salgılayan hormon (gonadotropin releasing hormone (GnRH)) analogu ile ovaryen süpresyon süresine göre gruplandırıldı. GnRH analog kullanım süresine göre grup A alt 25 persentil içinde, grup B de üst 25 persentil içindeki hastalardan oluşmaktaydı. İmplantasyon ve klinik gebelik oranları karşılaştırıldı. Bulgular: Grup A’da ortalama aspire edilen ve insemine edilen oosit sayısı grup B’dekinden fazla idi. İmplantasyon oranları benzer idi. Klinik gebelik oranları benzer idi. Sonuçlar: Ovaryen süpresyon için geçen zamanın uzaması ART sikluslarında klinik gebelik oranlarını olumsuz etkilemez.

Anahtar Kelimeler:

GnRH, ART, Ovaryen süpresyon, Gebelik, Uzun protokol

-

Objective: To determine if the prolonged time for achieving ovarian suppression before starting stimulation affected the pregnancy rates.Patients and Methods: Retrospective cohort analysis was performed on 565 women undergoing first assisted reproductive technologies (ART) treatment in a University-affiliated Hospital. The women were grouped according to the duration of downregulation by gonadotropin-releasing hormone (GnRH) analogue. Group A consisted of women in the lower 25th percentile, group B consisted of women in the upper 25th percentile, according to the duration of GnRH analogue use. The implantation and clinical pregnancy rates were compared. Results: Mean number of aspirated and inseminated oocytes were more in group A than in group B. Implantation rates were similar. Clinical pregnancy rates were alike. Conclusion: Prolonged time for achieving ovarian supression does not compromise clinical pregnancy rates in ART cycles

Keywords:

GnRHa, ART, Ovarian suppression, Pregnancy, Extended protocol,

PDF

___

1. Jennings J C, Moreland K, Peterson CM. In vitro fertilisation. A review of drug therapy and clinical management. Drugs 1996; 52: 313–43.
2. Balasch J, Gomez F, Casamitjana R, et al. Pituitary–ovarian suppression by the standard and half-doses of D-Trp-6-luteinizing hormone-releasing hormone depot. Hum Reprod 1992; 7:1230–4.
3. Simon A, Benshushan A, Shushan A, et al. A comparison between a standard and reduced dose of D-Trp-6-luteinizing hormonereleasing hormone administered after pituitary suppression for in-vitro fertilization. Hum Reprod 1994; 9:1813–7.
4. Scott R T, Neal G S, Illions E H, et al. The duration of leuprolide acetate administration prior to ovulation induction does not impact ovarian responsiveness to exogenous gonadotropins. Fertil Steril 1993; 60: 247–53.
5. Edwards R G, Morcos S, Macnamee M, et al. High fecundity of amenorrhoeic women in embryo transfer programmes. Lancet 1990; 338: 292–4. doi: 10.1016/0140-6736(91)90427-Q
6. Hugues JN, Cedrin D. Revisiting gonadotrophin releasing hormone agonist protocols and management of poor ovarian responses to gonadotrophins. Hum Reprod Update 1998; 4: 83–101. doi: 10.1093/ humupd/4.1.83
7. Hugues J N, Bidart J M, Robert P, Cédrin-Durnerin I. Differential pattern of hLH and alpha subunit secretion during short and ultra-short administration of GnRH agonist in IVF protocol. 13th Annual Meeting of the European Society of Human Reproduction and Embryology. Edinburgh. Hum Reprod 1997; 12: (Abstract Bk.1) Abstr. 203.
8. Meldrum D R, Wisot A, Hamilton F, et al. Routine pituitary suppression with leuprolide before ovarian stimulation for oocyte retrieval. Fertil Steril 1989; 51: 455–9.
9. Matikainen T, Ding YQ, Vergara M, et al. Differing responses of plasma bioactive and immunoreactive FSH and LH to gonadotropin-releasing hormone antagonist and agonist treatments in postmenopausal women. J Clin Endocrinol Metab 1992; 75: 820–5. doi: 10.1210/jc.75.3.820
10. Broekmans F J, Bernadus R E, Broeders A, et al. Pituitary responsiveness after administration of a GnRH agonist depot formulation: Decapeptyl CR. Clin Endocrinol 1993; 38: 579–87. doi: 10.1111/j.1365-2265.1993.tb02138.x
11. Broekmans F J, Hompes P G A, Lambalk C B, et al. Short term pituitary desensitization: effects of different doses of the gonadotrophinreleasing hormone agonist triptorelin. Hum Reprod 1996; 11: 55–60.
12. Albuquerque LE, Saconato H, Maciel MC. Depot versus daily administration of gonadotrophin releasing hormone agonist protocols for pituitary desensitization in assisted reproduction cycles. Cochrane Database of Syst Rev 2005; Jan 25: CD002808. doi: 10.1002/14651858. CD002808.pub2
13. Kolibianakis EM, Collins J, Tarlatzis BC, Devroey P, Diedrich K, Griesinger G. Among patients treated for IVF with gonadotrophins and GnRH analogues, is the probability of live birth dependent on the type of analogue used? A systematic review and meta-analysis. Hum Reprod Update 2006; 12: 651–71. doi: 10.1093/humupd/dml038
14. Hayden C. GnRH analogues: applications in assisted reproductiv techniques. Eur J Endocrin 2008; 159:17–25. doi: 10.1530/EJE-08- 0354
15. Daya S. Maheshwari A, Siristatidis CS, Bhattacharya S, Gibreel AF. Gonadotropin releasing hormone agonist protocols for pituitary desensitization in in vitro fertilization and gamete intrafallopian transfer cycles. Cochrane Database of Syst Rev 2000; 1 : CD001299. doi: 10.1002/14651858.CD001299
16. CoomarasamyA,AfnanM, Cheema D, van der Veen F, Bossuyt PM, van Wely M. Urinary hMG versus recombinant FSH for controlled ovarian hyperstimulation following an agonist long downregulation protocol in IVF or ICSI treatment: a systematic review and meta-analysis. Hum Reprod 2008; 23: 310-5. doi: 10.1093/humrep/dem305
17. van Loenen AC, Huirne JA, Schats R, Hompes PG, Lambalk CB. GnRH agonists, antagonists, and assisted conception. Semin Reprod Med 2002; 20: 349–64. doi: 10.1055/s-2002-36713
18. Testart J, Lefevre B, Gongeon A. Effects of gonadotrophin releasing hormone agonists on follicle and oocyte quality. Hum Reprod 1993; 8: 511–8.
19. Agrawal R, Holmes J, Jacobs HS. Follicle-stimulating hormone or human menopausal gonadotropin for ovarian stimulation in in vitro fertilization cycles: a meta-analysis. Fertil Steril 2000;73: 338–43. doi: 10.1016/S0015-0282(99)00519-1
20. Kerin J F. The advantages of a gonadotrophin releasing hormone agonist (leuprolide acetate) in conjunction with gonadotrophins for controlled ovarian hyperstimulation in IVF and GIFT cycles. Arch Gynecol Obstet 1989; 246: S45–52.
21. Tarlatzis B C, Grimbizis G, Pournaropoulos F, et al. Evaluation of two gonadotrophin-releasing hormones (GnRHa) analogues (leuprolide and buserelin) in short and long protocols for assisted reproduction techniques. J Assist Reprod Genet 1994; 11: 85–91.
22. Tan S L. Gonadotrophin-releasing hormone agonists in assisted reproductive therapy. Hum Reprod 1996; 11 (Suppl. 4): 137–42.
23. Rutherford A J, Subak-Sharpe R J, Dawson K J, et al. Improvement of in vitro fertilization after treatment with buserelin, an agonist of luteinising releasing hormone. Br Med J 1988; 296: 1765–8. doi: http://dx.doi.org/10.1136/bmj.296.6639.1765
24. Han S W, Lei Z M, Rao Ch V. Up-regulation of cyclooxygenase-2 gene expression by chorionic gonadotropin during the differentiation of human endometrial stromal cells into decidua. Endocrinology 1996; 137: 1791–7. doi: 10.1210/en.137.5.1791
25. Toth P, Li X, Rao Ch V. Expression of human chorionic gonadotropin (hCG)/ luteinizing hormone receptors and regulation of cyclooxygenase-1 gene by exogenous hCG in human fetal membranes. J Clin Endocrinol Metab 1996; 81: 1283–8.
26. Schwartz M, Jewelewicz R, Dyrenfurth I. The use of human menopausal and chorionic gonadotropin for induction of ovulation. Sixteen years’ experience at the Sloane Hospital for women. Am J Obstet Gynecol 1980; 138: 801–7.