Publication: İn Vitro Fertilizasyon hastalarında insan menopozal gonadotropinin foliküler sıvı endokrin değerlerine ve embriyo kalitesine etkisi
Abstract
AMAÇ: IVF hastalarında insan menopozal gonadotropinin foliküler sıvı endokrin profiline ve embriyo kalitesine etkisini araştırmak. METOD: Marmara Üniversitesi Hastanesi İnfertilite Kliniği'ne başvuran 25- 35 yaş arası IVF tedavisi planlanan toplam 70 kadın hasta çalışmaya dahil edilerek 3 grup prospektif olarak randomize edildi. Uzun protokole uygun olarak, önceki siklusun 21.günü löprolid asetat ve tüm gruplara siklusun 3.günü r FSH başlandı. 2. grupta HMG (n=23) 3.günden itibaren eklenirken, 3.grupta (n=24) 10 mmlik folikül elde edildiğinde eklendi. İlk gruptaki hastalara (n=23) HMG eklenmedi. Oosit toplama işlemi sırasında 16mm ve üzerindeki çapta oosit içeren foliküllerden foliküler sıvı aspire edildi ve hormon analizi için -20 °C 'de saklandı. 3. gün embriyo kalitesi değerlendirilmesi yapıldı. BULGULAR: Her üç grup hasta yaşları, vücut kitle indeksi, infertilite süreleri, bazal antral folikül sayısı, FSH ve östradiol seviyeleri açısından benzerdir. Toplanan ortalama oosit sayısı, ortalama MII oosit sayısı ve 3.gün ortalama embriyo sayıları açısından gruplar arası istatiksel olarak anlamlı fark saptanmamıştır. Foliküler sıvıdaki FSH, androstenedion seviyeleri; östradiol/ progesteron, östradiol / testesteron oranları ve ortalama grade 1 embriyo sayıları 2. grupta daha yüksek saptanırken (p<0,05); grade 2 ve grade 3 ortalama embriyo sayısı ve 3. gün 5 ve daha az hücre içeren ortalama embriyo sayısı 1. grupta daha yüksek saptanmıştır ((p<0,05). 2. grupta foliküler sıvıda östradiol seviyeleri ve 3. gün 8 ve daha fazla hücre içeren ortalama embriyo sayısı daha yüksek saptanmıştır ancak fark istatistiksel olarak anlamlılığa ulaşamamıştır. SONUÇ: Sonuçlarımız HMG'nin kontrollü ovaryen stimulasyon protokollerinde stimulasyonun başından itibaren eklenmesinin daha iyi kalitede embriyolarla birlikte foliküler sıvıda östrojen seviyelerini ve östrojen/ testesteron oranını arttırarak foliküler östrojenik mikroçevrede pozitif etkisi olduğunu düşündürmektedir. HMG, rekombinant FSH, embriyo kalitesi, foliküler sıvı, IVF.
OBJECTIVE: To investigate the effects of human menopausal gonadotropin on the endocrine profile in follicular fluid and the embryo quality in IVF patients. METHODS: Seventy patients, aged 20- 35 that admitted to Marmara University Hospital infertility clinic for IVF treatment have been recruited and prospectively randomized into three groups. According to the rules of the long protocol, leuprolide acetate was started on the 21st day of the preceding cycle. For all groups rFSH was started on the 3rd day of the cycle. HMG was added on the 3rd day of the cycle for group 2 (n=23) and when the leading follicle reached 10mm in size, for group 3 (n=24). Patients in group 1 were not given any HMG (n=23). During ovum pick-up, follicular fluid was aspirated from the follicles that were more than 16 mm in size from which an oocyte was retrieved and was stored at -20°C until assayed for hormon profile. The embryo quality was assessed on day 3. RESULTS: Three groups were similar in age, body mass index, duration of infertility period, basal antral follicle number and basal levels of FSH and E2. The mean number of total oocytes retrieved, the mean number of MII oocytes and the mean number of embryo on day 3 were not significantly different between the groups. The mean number of grade 1 embryos and follicular fluid levels of FSH, androstenedion and ratios of estradiol/ progesterone, estradiol/ testesterone were higher (p<0,05) in group 2, whereas the mean number of grade 2 and grade 3 embryos and the mean number of embryos with ≤ 5 cells were higher (p<0,05) in group 1. In group 2 folliculer fluid levels of östradiol and mean number of embryos with ≥ 8 cells on day 3 were higher than the other two groups however the differences could not reach statistical significance. CONCLUSION: We can conclude from our results that the addition of HMG to COH protocols from the begining of stimulation and onwards seems to have a positive effect on the estrogenic microenvironment of the follicule, increasing the estrogen level and the E2/ testosterone ratio in the follicular fluid with a better embryo quality. HMG, recombinant FSH, embryo quality, follicular fluid, IVF.
OBJECTIVE: To investigate the effects of human menopausal gonadotropin on the endocrine profile in follicular fluid and the embryo quality in IVF patients. METHODS: Seventy patients, aged 20- 35 that admitted to Marmara University Hospital infertility clinic for IVF treatment have been recruited and prospectively randomized into three groups. According to the rules of the long protocol, leuprolide acetate was started on the 21st day of the preceding cycle. For all groups rFSH was started on the 3rd day of the cycle. HMG was added on the 3rd day of the cycle for group 2 (n=23) and when the leading follicle reached 10mm in size, for group 3 (n=24). Patients in group 1 were not given any HMG (n=23). During ovum pick-up, follicular fluid was aspirated from the follicles that were more than 16 mm in size from which an oocyte was retrieved and was stored at -20°C until assayed for hormon profile. The embryo quality was assessed on day 3. RESULTS: Three groups were similar in age, body mass index, duration of infertility period, basal antral follicle number and basal levels of FSH and E2. The mean number of total oocytes retrieved, the mean number of MII oocytes and the mean number of embryo on day 3 were not significantly different between the groups. The mean number of grade 1 embryos and follicular fluid levels of FSH, androstenedion and ratios of estradiol/ progesterone, estradiol/ testesterone were higher (p<0,05) in group 2, whereas the mean number of grade 2 and grade 3 embryos and the mean number of embryos with ≤ 5 cells were higher (p<0,05) in group 1. In group 2 folliculer fluid levels of östradiol and mean number of embryos with ≥ 8 cells on day 3 were higher than the other two groups however the differences could not reach statistical significance. CONCLUSION: We can conclude from our results that the addition of HMG to COH protocols from the begining of stimulation and onwards seems to have a positive effect on the estrogenic microenvironment of the follicule, increasing the estrogen level and the E2/ testosterone ratio in the follicular fluid with a better embryo quality. HMG, recombinant FSH, embryo quality, follicular fluid, IVF.