Gülşen DOĞAN DURDAĞ, Hakan SATIROĞLU, Batuhan ÖZMEN, Ruşen AYTAÇ, Cem ATABEKOĞLU, Bülent BERKER, Murat SÖNMEZER

Serumda ve Foliküler Sıvıdaki Gebelikle İlişkili Plazma Protein-A (PAPP-A) Değerlerinin Embriyo Gelişimi ve Erken Gebelik Sonuçları ile İlişkisi

Bu çalışmada, oosit toplanması sırasında elde edilen folikül sıvısında ve serumda Gebelikle İlişkili Plazma Protein-A (PAPP-A) bakılması, bunun oosit maturasyonu, embriyo gelişimi ve erken gebelik sonuçları ile ilişkisinin değerlendirilmesi amaçlanmıştır. Tek merkezde yürütülmüş olan bu prospektif kohort çalışmasına, intrasitoplazmik sperm enjeksiyonu (ICSI) ve embriyo transferi (ET) uygulanan 55 hasta dâhil edilmiştir. Tüm hastalara uzun agonist protokol kullanılarak ovulasyon indüksiyonu yapılmıştır. Her hastanın iki ayrı folikülünden elde edilen folikül sıvılarından ve oosit toplanması sırasında alınan kanlarından Floresan immunoassay (FIA) yöntemi ile PAPP-A seviyeleri ölçülmüştür. Bu foliküllerden elde edilen işaretli oositlerin matürasyon ve fertilizasyonları değerlendirilmiş ve bunlardan oluşan embriyoların gelişimi takip edilmiştir. PAPP-A düzeylerinin embriyo kaliteleri ve gebelik oranları ile ilişkisi değerlendirilmiştir. Folikül sıvılarında bakılan PAPP-A değerleri ile aynı foliküllerden elde edilen embriyo kaliteleri arasında anlamlı bir ilişki saptanmamıştır. Embriyolar kalitelerine göre ayrıldığında, elde edildikleri foliküllerin PAPP-A değerleri arasındaki fark da anlamlı bulunmamıştır. Ancak, gebelik oluşan hastalarda oosit toplanması sırasında serumda bakılan PAPP-A değerleri gebelik oluşmayan hastalardakine göre anlamlı olarak düşük saptanmıştır (p<0.05). Folikül sıvısındaki PAPP-A seviyeleri embriyo kalitesi ve gebelik oranları ile anlamlı olarak ilişkili bulunmadı. Serum PAPP-A değerleri ise gebelik oluşan ve oluşmayan hastalar arasında anlamlı olarak farklı bulundu. Ancak, daha geniş hasta popülasyonu ile çalışmalar yapılmalıdır.

Anahtar Kelimeler:

Embriyo Kalitesi, Folikül Sıvısı, Oosit Maturasyonu, PAPP-A

Relation of Pregnancy Associated Plasma Protein-A (PAPP-A) Levels in Serum and Follicular Fluid with Embryo Development and Early Pregnancy Results

The objective of this study is to measure Pregnancy Associated Plasma Protein-A (PAPP-A) in serum and follicular fluid during oocyte retrieval, and to investigate the association of PAPP-A with oocyte maturation, embryo development and early pregnancy results. This prospective cohort study was conducted in single center including fifty-five patients to whom intracytoplasmic sperm injection (ICSI) and embryo transfer (ET) were applied. Long agonist protocol was applied for ovarian stimulation. Follicular fluid was aspirated from two separate follicules of each patient for oocyte retrieval and PAPP-A levels of follicular fluids and serum were measured via Fluorescence immunoassay (FIA). Marked oocytes from these follicles were evaluated for their maturation and fertilization and embryo development were followed. Association of PAPP-A levels with embryo quality and pregnancy rates were assessed. There was not statistically significant association between the follicular fluid PAPP-A levels and the embryo qualities obtained from the oocyte of the same follicle. Also, PAPP-A levels from follicles were not significantly different when compared between high and low quality embryos. In contrast, serum PAPP-A levels at the time of oocyte retrieval were significantly lower in patients who achieved pregnancy when compared to the patients at whom pregnancy was not achieved (p<0.05). PAPP-A level in follicular fluid was not significantly related to embryo quality and pregnancy rates while serum PAPP-A values were significantly different between patients who achieved pregnancy and the patients who could not achieve pregnancy. However, further studies with large number of patients are needed.

Keywords:

Embryo Quality, Follicular Fluid, Oocyte Maturation, PAPP-A,

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