Clinical Research
BibTex RIS Cite

AÇIKLANAMAYAN İNFERTİLİTEDE iNTRAUTERİN İNSEMİNASYONUN YERİ VE KULLANILAN OVER STİMULASYON PROTOKOLLERİ İLE YAŞIN GEBELİK ORANLARINA ETKİSİ VAR MI?

Year 2024, Volume: 4 Issue: 9, 8 - 14, 07.02.2024
https://doi.org/10.54270/atljm.2024.48

Abstract

Amaç: Bazı ulusal rehberlerde açıklanamayan infertilitede intrauterin inseminasyon önerilmemektedir (Birleşik Krallık, NICE 2013, 2017). Bu çalışmanın asıl amacı, açıklanamayan infertilitede intrauterin inseminasyonun yeri olup olmadığını göstermektir. Birincil olarak başarı oranı, ikincil olarak bu endikasyonda, varsa intrauterin inseminasyonun başarısının yaş ve kullanılan oosit stimülasyon protokolüne bağlı olup olmadığının incelenmesidir.
Materyal-Metot: Retrospektif kohort gözlemsel çalışmamız, 2018-2019 yılları arasında 18-43 yaşlarında açıklanamayan infertil tanısıyla intrauterin inseminasyon yapılan 113 hastayı içermektedir. Klinik gebelik oranları frekans (yüzde) olarak hesaplanmıştır. Kadın yaşının, oosit stimulasyonu için kullanılan ilaçların klinik gebelik oranlarına etkisi Pearson Ki Kare testi ile değerlendirilmiştir.
Bulgular: Açıklanamayan infertilitede intrauterin inseminasyon ile tüm hastalarda klinik gebelik oranı % 14.1 dir. Yaş, gebelik oranını anlamlı derecede etkilemiyor görünmektedir, ancak en fazla gebelik 35 yaş altı grupta elde edilmiştir. Oosit stimulasyonu için gonadotropinlerin kullanıldığı grupta gebelik oranları en yüksektir (%36.4), oral ilaçla birlikte gonadotropinlerin kullanıldığı gruptaki gebelik oranı da dikkat çekici derecede iyidir (%33.3). İlaç ve yaşın kombine etkisi istatistiksel olarak anlamsızdır.
Sonuç: Çalışmamıza göre açıklanamayan infertilitede, İUİ tek denemede bile dikkat çekici başarısıyla denenmeye değer bir yöntemdir. Maliyet etkin, uygulaması kolay, daha az invazif, hasta dostu bu tedavi, iyi seçilmiş hasta grubunda ilk seçenek olarak önerilebilir.

Ethical Statement

Tüm yazarlar çıkar çatışması olmadığını beyan eder

References

  • Infertility workup for the women’s health specialist. ACOG Committee Opinion No:781. American College Obstetricians and Gynecologists. ObstetGynecol 2019; 133: e377-84. (Reaffirmed 2017)
  • Effectiveness and treatment for unexplained infertility. Practise Committee of ASRM. FertilSteril 2006; 86 (suppl 1): S111-4.
  • ASRM Evidence-based treatments for couples with unexplained infertility: a guideline. FertilSteril 2020; 113(2): 305-22
  • Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. FertilSteril 98.3 (2012a): 591-598.
  • Practice Committee of the American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: a committee opinion. FertilSteril 97.4 (2012b): 825-834.
  • National Institute for Health and Care Excellence. Fertility: assessment and treatment for people with fertility problems. London: NICE; 2013. CG156.
  • O'Flynn N. Assessment and treatment for people with fertility problems: NICE guideline. Br J Gen Pract. 2014 Jan;64(618):50-1.
  • Buckett W, Sierra S. The management of unexplained infertility: an evidence-based guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online. 2019;39(4):633-40.
  • Taylor, H.S.; Pal, L.; Seli, E. Speroff’s Clinical Gynecologic Endocrinology and Infertility, 9th ed.; Department of Obstetrics, Gynecology and reproductive Sciences, Yale School of Medicine: New Haven, CT, USA, 2019.
  • Ferraretti AP, Goossens V, de Mouzon J, Bhattacharya S, Castilla JA, Korsak V, Kupka M, Nygren KG, Nyboe Andersen A, European IVF-monitoring. Consortium for European Society of Human Reproduction and Embryology Assisted reproductive technology in Europe, 2008: results generated from European registers by ESHRE. Hum Reprod.2012; 27: 2571–2584.
  • Dinelli L, Courbière B, Achard V, Jouve E, Deveze C, Gnisci A, Grillo JM, Paulmyer-Lacroix O. Prognosis factors of pregnancy after intrauterine insemination with the husband's sperm: conclusions of an analysis of 2,019 cycles. FertilSteril. 2014, 101.4: 994-1000.
  • European IVF-Monitoring Consortium. European Society of Human Reproduction and Embryology. Kupka MS, D'Hooghe T, Ferraretti AP, de Mouzon J, Erb K, Castilla JA, Calhaz-Jorge C, Ch De Geyter, Goossens V. Assisted reproductive technology in Europe, 2011: results generated from European registers by ESHRE. Hum Reprod. 2016; 31: 233–248.
  • Zadehmodarres S, Oladi B, Saeedi S, Jahed F, Ashraf H. Intrauterine insemination with husband semen: an evaluation of pregnancy rate and factors affecting outcome. J Assist Reprod Genet. 2009; 26: 7–11.
  • Honda T, Tsutsumi M, Komoda F, Tatsumi K. Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles. Reprod Med Biol. 2015; 14: 27–32.
  • Sicchieri F, Silva AB, Silva ACJSRE, Navarro PAAS, Ferriani RA, Reis RMD. Prognostic factors in intrauterine insemination cycles. JBRA Assist Reprod. 2018 Mar 1; 22(1): 2-7.
  • Erdem A, Erdem M, Atmaca S, Korucuoglu U, Karabacak O. Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation. Reprod Biomed Online. 2008; 17: 199–206.
  • Ibérico G, Vioque J, Ariza N, Lozano JM, Roca M, Llácer J, Bernabeu R. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. FertilSteril. 2004; 81: 1308–1313.
  • Wu HM, Tzeng CR, Chen CH, Chen PH. Pelvic endometriosis with peritoneal fluid reduces pregnancy rates in women undergoing intrauterine insemination. Taiwan J Obstet Gynecol. 2013; 52: 512–515.
  • Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril. 2010; 93: 79–88.
  • Ashrafi M, Rashidi M, Ghasemi A, Arabipoor A, Daghighi S, Pourasghari P, Zolfaghari Z. The role of infertility etiology in success rate of intrauterine insemination cycles: an evaluation of predictive factors for pregnancy rate. Int J Fertil Steril. 2013; 7: 100–107.
  • Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Ager J, Huang H, Hansen KR, Baker V, Usadi R, Seungdamrong A, Bates GW, Rosen RM, Haisenleder D, Krawetz SA, Barnhart K, Trussell JC, Ohl D, Jin Y, Santoro N, Eisenberg E, Zhang H; NICHD Reproductive Medicine Network. Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility. N Engl J Med. 2015 Sep 24;373(13):1230-40.
  • Malchau SS, Henningsen AA, Loft A, Rasmussen S, Forman J, Nyboe Andersen A, Pinborg A. The long-term prognosis for live birth in couples initiating fertility treatments. Hum Reprod. 2017;32:1439–1449.
Year 2024, Volume: 4 Issue: 9, 8 - 14, 07.02.2024
https://doi.org/10.54270/atljm.2024.48

Abstract

References

  • Infertility workup for the women’s health specialist. ACOG Committee Opinion No:781. American College Obstetricians and Gynecologists. ObstetGynecol 2019; 133: e377-84. (Reaffirmed 2017)
  • Effectiveness and treatment for unexplained infertility. Practise Committee of ASRM. FertilSteril 2006; 86 (suppl 1): S111-4.
  • ASRM Evidence-based treatments for couples with unexplained infertility: a guideline. FertilSteril 2020; 113(2): 305-22
  • Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. FertilSteril 98.3 (2012a): 591-598.
  • Practice Committee of the American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: a committee opinion. FertilSteril 97.4 (2012b): 825-834.
  • National Institute for Health and Care Excellence. Fertility: assessment and treatment for people with fertility problems. London: NICE; 2013. CG156.
  • O'Flynn N. Assessment and treatment for people with fertility problems: NICE guideline. Br J Gen Pract. 2014 Jan;64(618):50-1.
  • Buckett W, Sierra S. The management of unexplained infertility: an evidence-based guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online. 2019;39(4):633-40.
  • Taylor, H.S.; Pal, L.; Seli, E. Speroff’s Clinical Gynecologic Endocrinology and Infertility, 9th ed.; Department of Obstetrics, Gynecology and reproductive Sciences, Yale School of Medicine: New Haven, CT, USA, 2019.
  • Ferraretti AP, Goossens V, de Mouzon J, Bhattacharya S, Castilla JA, Korsak V, Kupka M, Nygren KG, Nyboe Andersen A, European IVF-monitoring. Consortium for European Society of Human Reproduction and Embryology Assisted reproductive technology in Europe, 2008: results generated from European registers by ESHRE. Hum Reprod.2012; 27: 2571–2584.
  • Dinelli L, Courbière B, Achard V, Jouve E, Deveze C, Gnisci A, Grillo JM, Paulmyer-Lacroix O. Prognosis factors of pregnancy after intrauterine insemination with the husband's sperm: conclusions of an analysis of 2,019 cycles. FertilSteril. 2014, 101.4: 994-1000.
  • European IVF-Monitoring Consortium. European Society of Human Reproduction and Embryology. Kupka MS, D'Hooghe T, Ferraretti AP, de Mouzon J, Erb K, Castilla JA, Calhaz-Jorge C, Ch De Geyter, Goossens V. Assisted reproductive technology in Europe, 2011: results generated from European registers by ESHRE. Hum Reprod. 2016; 31: 233–248.
  • Zadehmodarres S, Oladi B, Saeedi S, Jahed F, Ashraf H. Intrauterine insemination with husband semen: an evaluation of pregnancy rate and factors affecting outcome. J Assist Reprod Genet. 2009; 26: 7–11.
  • Honda T, Tsutsumi M, Komoda F, Tatsumi K. Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles. Reprod Med Biol. 2015; 14: 27–32.
  • Sicchieri F, Silva AB, Silva ACJSRE, Navarro PAAS, Ferriani RA, Reis RMD. Prognostic factors in intrauterine insemination cycles. JBRA Assist Reprod. 2018 Mar 1; 22(1): 2-7.
  • Erdem A, Erdem M, Atmaca S, Korucuoglu U, Karabacak O. Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation. Reprod Biomed Online. 2008; 17: 199–206.
  • Ibérico G, Vioque J, Ariza N, Lozano JM, Roca M, Llácer J, Bernabeu R. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. FertilSteril. 2004; 81: 1308–1313.
  • Wu HM, Tzeng CR, Chen CH, Chen PH. Pelvic endometriosis with peritoneal fluid reduces pregnancy rates in women undergoing intrauterine insemination. Taiwan J Obstet Gynecol. 2013; 52: 512–515.
  • Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril. 2010; 93: 79–88.
  • Ashrafi M, Rashidi M, Ghasemi A, Arabipoor A, Daghighi S, Pourasghari P, Zolfaghari Z. The role of infertility etiology in success rate of intrauterine insemination cycles: an evaluation of predictive factors for pregnancy rate. Int J Fertil Steril. 2013; 7: 100–107.
  • Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Ager J, Huang H, Hansen KR, Baker V, Usadi R, Seungdamrong A, Bates GW, Rosen RM, Haisenleder D, Krawetz SA, Barnhart K, Trussell JC, Ohl D, Jin Y, Santoro N, Eisenberg E, Zhang H; NICHD Reproductive Medicine Network. Letrozole, Gonadotropin, or Clomiphene for Unexplained Infertility. N Engl J Med. 2015 Sep 24;373(13):1230-40.
  • Malchau SS, Henningsen AA, Loft A, Rasmussen S, Forman J, Nyboe Andersen A, Pinborg A. The long-term prognosis for live birth in couples initiating fertility treatments. Hum Reprod. 2017;32:1439–1449.
There are 22 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences (Other)
Journal Section Research Articles
Authors

Levent Dikbaş 0000-0002-7730-6898

Bülent Duran 0000-0002-7090-8183

Mustafa Küçük 0000-0002-3883-556X

Early Pub Date January 15, 2024
Publication Date February 7, 2024
Submission Date October 17, 2023
Acceptance Date January 11, 2024
Published in Issue Year 2024 Volume: 4 Issue: 9

Cite

Vancouver Dikbaş L, Duran B, Küçük M. AÇIKLANAMAYAN İNFERTİLİTEDE iNTRAUTERİN İNSEMİNASYONUN YERİ VE KULLANILAN OVER STİMULASYON PROTOKOLLERİ İLE YAŞIN GEBELİK ORANLARINA ETKİSİ VAR MI?. ATLJM. 2024;4(9):8-14.