Namık Kemal DURU, İbrahim ALANBAY, Murat MUHCU, Uğur KESKİN, Vedat ATAY

Ektopik gebelik tedavileri (laparoskopik salpingostomi ve sistemik methotrexate) sonrasında intrauterin inseminasyon başarısı

Amaç: Bizim çalışmamızın amacı, laparoskopik salpingostomi ve sistemik tek doz Methotrexate uygulanan hastalarda intrauterin inseminasyon başarıları arasında fark olup olmadığını araştırmaktır. Gereç ve Yöntem: Çalışmaya ektopik gebelik tanısı ile laparoskopik salpingostomi uygulanan 25 hasta ve 50 mg/m2, sistemik, tek doz Methotrexate uygulanan 12 hastayı kapsamaktadır. Bu grup hastalarda intrauterin inseminasyon sonrası gebelik başarısı araştırıldı. İntrauterin inseminasyon protokolü içerisinde tüm hastalara gonadotropin ile ovulasyon indüksiyonu planlandı. İstatistiksel analiz için, SPSS for Windows 13.0 paket programı kullanıldı. Bulgular: Laparoskopik salpingostomi uygulanan grupta spontan konsepsiyon oranı % 48 idi (12/25). Spontan siklusta gebelik oluşmayan ve sonrasında intrauterin inseminasyon uygulanan hastalarda gebelik oranı ise % 15,3 (2/13) idi. 12 hastanın 5 inde spontan konsepsiyon ile gebelik elde edilirken (% 41,6), spontan konsepsiyonda gebelik elde edilemeyen ve intrauterin inseminasyon uygulanan 7 hastadan sadece 1 inde gebelik elde edildi (% 14,2). Her iki grup arasında spontan gebelik başarısı ve intrauterin inseminasyon sonrası gebelik başarısı arasında anlamlı fark saptanmamıştır (p=0,94)(p=0,71). Sonuç: Bu çalışmada en az 1 yıl süre sonrasında spontan gebelik başarısı, her iki grupta eşit olarak saptanmıştır. Çalışmamız her 2 grup tedavi sonrası intrauterin inseminasyon başarılarının birbirleri üzerine üstünlükleri olmadığını ortaya koymuştur. Sonuç olarak tedavi sonrası spontan siklusta gebelik elde edilmeyen ve tubalpatens izlenen hastalarda intrauterin inseminasyon uygulanmasını önermekteyiz.

Anahtar Kelimeler:

Gebelik, ektopik, Laparoskopi, Methotreksat, Dölleme, Gebelik oranı, Salpingostomi

The results of intrauterine insemination after ectopic pregnancy treatment (laparoscopic salpingostomy and systemic methotrexate

Aim: To evaluate the results of Intrauterine Insemination in patients with ectopic pregnancy treated by laparoscopic salpingostomy and systemic single dose methotreaxate. Materials and Methods: This study was included 25 patients with ectopic pregnancy treated by laparoscopic salpingostomy and 12 patients with ectopic pregnancy treated by 50 mg/m2 single dose methotrexate. All patients were traeted with gonadothropins for ovulation induction. SPSS for Windows 13.0 was used for statistical analysis. Results: Spontaneus pregnancy occured 48 % of the patients (12/25) treated by laparoscopy. The remairiings were treated by intrauterine insemination and the pregnancy rate was 15.3% (2/13) in this group. In methotreaxate group, spontaneus pregnancy occured 41.6 % of the patients (5/12) treated by methotreaxate. The remainings were treated by intrauterine insemination and the pregnancy rate was 14.2% (1/7) in this group. There were no statistically significant differences in both groups in terms of spontaneus pregnancy and pregnancy resulted by intrauterine insemination (p=0,94) (p=0,71). Conclusion: Our results showed that spontaneus pregnancy rate was similar in both groups one year following treatment. The pregnancy rate was similar in both groups treated by intrauterine insemination. We recommend intrauterine insemination in patients with tubal patency, who fail to concive spontaneusly.

Keywords:

Pregnancy, Ectopic, Laparoscopy, Methotrexate, Insemination, Pregnancy Rate, Salpingostomy,

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