Histeroskopi IVF-ICSI/ET öncesi mi, sonrası mı yapılmalıdır?

Yıl 2020, Cilt: 45 Sayı: 1, 324 - 330, 31.03.2020

Cenk Soysal , İbrahim Ürünsak , M.turan Çetin

https://doi.org/10.17826/cumj.657870

Öz

Amaç: Çalışmada İn-Vitro Fertilizasyon - İnstrastoplazmik Sperm İnjeksiyonu/Embriyo Transferi (IVF-ICSI/ET) yapılmış ancak başarısız olunmuş ve ilk kez IVF-ICSI/ET planlanmış olan iki ayrı hasta grubuna histeroskopi uygulanarak, intrauterin patolojilerin saptanması, patoloji saptanan grupta cerrahi düzeltme yapılarak, bundan sonraki IVF-ICSI/ET sürecinde canlı doğum oranlarının karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Prospektif yapılan bu çalışmada, Mayıs 2014 – Ocak 2016 yılları arasında arasında infertilite polikliniğine başvuran, rutin değerlendirme sonucunda, ilk kez kontrollü ovaryan stimülasyon için rekombinant FSH kullanılıp sonrasında IVF-ICSI/ET kararı alınan hastalara, histeroskopi ile intrauterin patolojilerin saptanarak düzeltilmesi halinde gebeliğe olası katkıları hakkında ayrıntılı bilgi verilerek onamı alınan hasta Grup I (n=65) olarak belirlendi. Aynı süreçte daha önce IVF-ICSI/ET uygulanmış olan ancak histeroskopi uygulanmayan hastalar kontrol grubu Grup II (n=133) olarak belirlendi. Ayrıca histeroskopi uygulanan ve normal uterin kavite saptananlar Grup Ia (n=47), intrauterin patoloji saptananlar ise Grup Ib (n=18) olarak ikiye ayrılarak kontrol grubu ile canlı doğum oranları karşılaştırıldı
Bulgular: Gruplar arasında yaş, infertilite süresi, infertilite etyolojisi, bazal Folikül stimülan hormon (FSH), Lüteinizan hormon (LH), Östradiol (E2) değerleri ve transfer edilen embriyo sayıları açısından istatistiksel olarak anlamlı bir fark saptanmadı. Grup Ia ve Grup Ib canlı doğumlar açısından kıyaslandığında istatistiksel olarak anlamlı fark saptanmadı .
Sonuç: IVF-ICSI/ET öncesi yapılan histeroskopi ve aynı seansta histeroskopi ile saptanan patolojilerin düzeltilmesi IVF-ICSI/ET başarısı ve canlı doğumu istatistiksel olarak anlamlı şekilde arttırmadığını belirledik.

Anahtar Kelimeler

IVF, histeroskopi, infertilite, IVF öncesi histeroskopi

Should hysterescopy be performe before or after in-vitro fertilisation-Intracytoplasmic sperm injection/Embriyo transfer (IVF-ICSI/ET)?

Öz

Purpose: This research aims to determine the statistical efficiency of office histeroscopy, that is performed before In-vitro fertilisation-intrastoplasmic sperm injection/embriyo transfer (IVF-ICSI/ET) procedure, on the live birth rate and cost efficiency perspective. Specifically, the effects of detecting intrauterin pathologies and fixing them via operations on office environment are examined.
Materials and Methods: During the period of 2014 - 2016, the patients, that are admitted to the infertility clinic and an IVF-ICSI/ET cycles planned after routine checks, are given detailed information on the histeroscopy and its possible effects on increasing the chance of pregnancy. Among these patient are labeled as Group I (n=65) with their consent. During the same process, a control group Group II (n=133) is formed among the patients who get IVF-ICSI/ET tratment without the histeroscopy. Further, the ones that are applied histeroscopy and that are detected to have regular uterus cavity labeled as Group Ia (n=47), whereas the ones diagnosed with intrauterin patalogy formed Group Ib (n=18). This way, these groups are contrasted with the control group on the basis of their live birth rates.
Results: There was no statistically significant difference between the groups in terms of age, duration of infertility, etiology of infertility, basal follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and the number of embryos transferred. When Group Ia and Group Ib were compared in terms of live births, there was no statistically significant difference.
Conclusion: Hysteroscopy performed before IVF and correction of pathologies detected by hysteroscopy in the same session did not significantly increase IVF success and live birth.

Anahtar Kelimeler

intrauterine pathologies, hysteroscopy, IVF-ICSI/ET prior to hysteroscopy, endometrial injury

Kaynakça

• Referans1. Ferraretti A GV, De Mouzon J, et al.,. Assisted reproductive technology in Europe, 2008: results generated from European registers by ESHRE. Human reproduction. 2012;27.
• Referans2. Vaegter KK, Lakic TG, Olovsson M, Berglund L, Brodin T, Holte J. Which factors are most predictive for live birth after in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) treatments? Analysis of 100 prospectively recorded variables in 8,400 IVF/ICSI single-embryo transfers. Fertility and sterility. 2017;107(3):641-8. e2.
• Referans3. Coughlan C, Walters S, Ledger W, Li TC. A comparison of psychological stress among women with and without reproductive failure. International journal of gynecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2014;124(2):143-7.
• Referans4. Singh M, Chaudhry P, Asselin E. Bridging endometrial receptivity and implantation: network of hormones, cytokines, and growth factors. The Journal of endocrinology. 2011;210(1):5-14.
• Referans5. Macklon NS, Geraedts JP, Fauser BC. Conception to ongoing pregnancy: the ‘black box’of early pregnancy loss. Human reproduction update. 2002;8(4):333-43.
• Referans6. Taylor E, Gomel V. The uterus and fertility. Fertility and sterility. 2008;89(1):1-16.
• Referans7. Kasius J, Broekmans F, Veersema S, Eijkemans M, Van Santbrink E, Devroey P, et al. Observer agreement in the evaluation of the uterine cavity by hysteroscopy prior to in vitro fertilization. Human reproduction. 2011;26(4):801-7.
• Referans8. Pundir J, Pundir V, Omanwa K, Khalaf Y, El-Toukhy T. Hysteroscopy prior to the first IVF cycle: a systematic review and meta-analysis. Reproductive biomedicine online. 2014;28(2):151-61.
• Referans9. El-Toukhy T, Campo R, Khalaf Y, Tabanelli C, Gianaroli L, Gordts SS, et al. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. The Lancet. 2016;387(10038):2614-21.
• Referans10. Smit JG, Kasius JC, Eijkemans MJ, Koks CA, Van Golde R, Nap AW, et al. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. The Lancet. 2016;387(10038):2622-9.
• Referans11. Di Spiezio Sardo A, Calagna G, Laganà AS, Vitale SG, Catena U, Scutiero G, et al. Is hysteroscopy better than ultrasonography for uterine cavity evaluation? An evidence-based and patient-oriented approach. Journal of Endometriosis and Pelvic Pain Disorders. 2016;8(3):87-93.
• Referans12. Fatemi H, Kasius J, Timmermans A, Van Disseldorp J, Fauser B, Devroey P, et al. Prevalence of unsuspected uterine cavity abnormalities diagnosed by office hysteroscopy prior to in vitro fertilization. Human reproduction. 2010;25(8):1959-65.
• Referans13. Bakas P, Hassiakos D, Grigoriadis C, Vlahos N, Liapis A, Gregoriou O. Role of hysteroscopy prior to assisted reproduction techniques. Journal of minimally invasive gynecology. 2014;21(2):233-7.
• Referans14. Pérez-Medina T, Bajo-Arenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Human reproduction. 2005;20(6):1632-5.
• Referans15. Bosteels J, Kasius J, Weyers S, Broekmans FJ, Mol BWJ, D'Hooghe TM. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database of Systematic Reviews. 2015(2).
• Referans16. Goldenberg M, Sivan E, Sharabi Z, Mashiach S, Lipitz S, Seidman D. Reproductive outcome following hysteroscopic management of intrauterine septum and adhesions. Human reproduction. 1995;10(10):2663-5.
• Referans17. Fertility: Assessment and Treatment for People with Fertility Problems. National Institute for Health and Clinical Excellence: Guidance. Investigation of fertility problems and management strategies. Assessing uterine abnormalities [Internet]. 2004.
• Referans18. Yilmaz N, ÖZtÜRk İNal Z, HanÇErlİOĞUllari N, İNal HA. The Usefullness of Office Hysteroscopy in Evaluation of Infertil Women Prior to In Vitro Fertilization Cycles. Turkiye Klinikleri Journal of Gynecology and Obstetrics. 2016;26(1):13-7.
• Referans19. Crosignani P, Rubin B. Optimal use of infertility diagnostic tests and treatments. The ESHRE Capri Workshop Group. Human reproduction (Oxford, England). 2000;15(3):723-32.
• Referans20. Hassa H., Tufan ÖGE, Yunus AYDIN, Engin KORKMAZER, Vehbi Yavuz TOKGÖZ, ARSLAN E. Is Office Hysteroscopy Potentially Beneficial for Infertile Patients Prior to IVF Cycles? Turkiye Klinikleri J Gynecol Obst. 2013;23(3).