Gürkan YAZICI, HÜSEYİN DURUKAN, Aysun SAVAŞ

Role of Dominant Follicle Count in Controlled Ovarian Stimulation with Intrauterine Insemination Cycles in Patients with Unexplained Infertility

Amaç: Bu çalışmanın amacı açıklanmayan infertilite nedeniyle kontrollü overyan hiperstimülasyon (KOH) ve intrauterin inseminasyon (IUI) yapılan kadınlarda dominant folikül sayısının gebelik başarısı ve çoğul gebelik oranları üzerine etkilerini değerlendirmektir. Gereç ve Yöntemler: Prospektif ve non-randomize olarak planlanan ve Mersin Üniversitesi Kadın Hastalıkları ve Doğum Ana Bilim Dalında yapılan bu çalışmaya Mayıs 2008 ile Eylül 2010 tarihleri arasında açıklanamayan infertilite tanısı ile KOH-IUI uygulanan 214 kadın dahil edildi. Bulgular: KOH başlanan 532 siklustan 513ü tamamlanarak IUI yapılmış ve 62 klinik gebelik elde edilmiştir (siklus başına klinik gebelik oranı %12,1). Bu gebeliklerden 9unda çoğul gebelik (%14,5) gelişirken 7si (%11,3) ise abortusla sonuçlanmıştır. hCG günü tek, iki ve üç dominant folikül (>16 mm) gelişen sikluslardaki klinik gebelik oranları sırasıyla %8,3, %14,7 ve %27,1 olarak saptanmıştır. Klinik gebelik oranı bir ve iki dominant folikül gelişen olgularda benzerken (p>0,05), üç dominant folikül gelişen olgularda bir ve iki dominant folikül gelişenlere kıyasla daha yüksek bulunmuştur (p değerleri sırası ile 0,001 ve 0,044). Bir, iki ve üç folikül gelişen olguların çoğul gebelik oranları ise sırasıyla %7,4, %15,8 ve %25 olarak saptanmıştır. Çoğul gebelik oranları bir ve iki dominant folikül gelişen olgularda benzerken (p>0,05), üç dominant folikül gelişen olgularda bir ve iki dominant folikül gelişenlere kıyasla istatistiksel anlamlı olarak daha yüksek bulunmuş- tur (p=0,004). Sonuç: Açıklanamayan infertilite nedeniyle KOH-IUI yapılan kadınlarda hCG günü üç folikül gelişimi artmış gebelik oranı ile ilişkilidir. Ancak, üç folikül gelişimi artmış çoğul gebelik oranına da sahiptir.

Açıklanamayan İnfertiliteli Hastalarda Kontrollü Overyan Hiperstimulasyon ve İntrauterin İnseminasyon Sikluslarında Dominant Folikül Sayısının Rolü

Objective: The aim of the present study was to determine the predictive value of dominant follicle count as a marker for pregnancy and multiple pregnancy rate in controlled ovarian hyperstimulation (COH) with intrauterine insemination (IUI) cycles in couples with unexplained subfertility. Material and Methods: The study was designed as a prospective non-randomized trial and involving 214 women with unexplained infertility was underwent COH-IUI at a University of Mersin School of Medicine, Obstetric and Gynecology department between May 2008 and September 2010. Results: Of 532 COH cycles started, 513 were completed and resulted in 62 clinical pregnancies (12.1% per completed cycle). There were 9 (14.5%) multiple pregnancies and 7 (11.3%) miscarriages. In cycles with a single, two and three dominant follicles (>16 mm) on the day of hCG the clinical pregnancy rate were 8.3%, 14.7% and 27.1% respectively. Three dominant follicles (>16 mm) count have increased pregnancy rate more than the 1 or 2 (p value 0.001 and 0.044 respectively). In addition cycles with a single, two and three dominant follicles the multiple pregnancy rate were 7.4%, 15.8% and 25% respectively. The multiple pregnancy rate was similar in cycles with 1 and 2 dominant follicles and lower than three (p:0.004). Conclusion: Three follicular growths are associated with increased pregnancy rates in COH-IUI women with unexplained subfertility. In cycles with one or two follicles, the multiple pregnancy rates are not significantly different however 3 dominant follicles associated with increased multiple pregnancy rates.

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