Dergiler / Türk Fertilite Dergisi / 2005 / Cilt: 13 - Sayı: 3
Art sikluslarında midluteal E2 konsantrasyonlarının gebelik ve implantasyon oranlarına etkisi
- Sayfa
- 257–264
- DOI
- —
Özet
Amaç: Bu çalışmanın amacı, ART sikluslarında midluteal estradiol (E2) konsantrasyonlarındaki değişimlerin gebelik (PR) ve implantasyon oranlarına (IR) olan etkisini araştırmaktır. Çalışmanın Yapıldığı Yer: Dr. Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi Üremeye Yardımcı Tedavi Merkezi (ÜYTEM). Materyal ve Metod: 01.12.2003-01.04.2004 tarihleri arasında IVF programına dahil edilen 228 hasta çalışmaya alındı. Hasta grubunun ilk tedavi siklusları incelendi. Peak estradiol için hCG sonrası 7. gün kan alındı. Gebe kalan ve kalamayan hastalar pik E2 ve midluteal E2 düzeylerine göre karşılaştırıldı. Midluteal E2 konsantrasyonlarına göre oluşturulan 5 grup için gebelik ve implantasyon oranları ayrı ayrı olarak hesaplandı: Grup 1, 2000 pg/ml olarak belirlendi. İstatiksel analizler samples t-test, paired samples t-test, Mann Whitney U test, chi-square test kullanılarak değerlendirildi. P 5.0 iken (n=43), PR % 20.9 IR % 7.9, oran 2.51 - 5.0 iken (n=43), PR % 25.6, IR % 12.2 ve oran 0.4 - 2.5 iken ise (n=142) PR % 31.7, IR % 14.4% olarak saptandı. Tüm bu oranlar arasında da PR ve IR açısından herhangi bir istatiksel farklılık bulunamadı. Sonuçlar:Midluteal estradiol ölçümleri ART sonuçlarını öngörmede değerli bir yöntem olabilir. Bu konuda kesin karar vermek için geniş çaplı prospektif randomize çalışmalara gereksinim vardır.
Abstract
Objective: The aim of this study is to investigate the effect of clianges in midluteal estradiol (E2) concentrations on pregnancy (PR) and implantation rates (IR): Institution: Assisted Reproductive Teenies Clinic of Dr. Zekai Tahir Burak Women's Health Research and Education Hospital. Materials and methods: 228 patients included in IVF program between 01.12.20003 and 01.04.2004 were enrol¬led in the study. First treatment cycles of the patient group whose indications were male factor, lubal factor, endomet-riosis, and unexplained infertility were investigated. For peak estradiol, blood was Withdrawn seven days after hCG. The patients who were able to conceive and those who we¬re not able to so were compared in terms of peak E2 and midluteal E2 levels. For five groups stratified according to midluteal E2 concentrations, pregnancy and implantation rates were calculated separately: Group 1, <200pg/ml; Group 2, 201-500pg/ml; Group 3, 601-1000pg/ml, Group 4, 1001-2000 pg/ml; Group 5, >2000 pg/ml. Statistical analysis was carried out using t-test, paired samples t test, Mann Whitney U test and chi square test. p<0.05 was considered as statistically significant. Results: Overall 65 continuing pregnancy were obtained. (28.5%). In the comparison between groups who we¬re able to conceive and those who were not able to do so, no statistically significant difference was found with regard to age, FSH values on day three, peak E2 values, the number of oocytes harvested; the number of embryos transferred, and mid luteal E2 values. Midluteal E2 values were significantly lower than those on hCG day. (p<0.0001). Although the difference was not statistically significant, when midluteal estradiol concentrations were over 1000 pg/ml, implantation and pregnancy rates were established to be higher When the rates of viable continuing pregnancy and implantation rates were compared between groups, the results obtained were as follows respectively: Group 1, 28.6% and. 13.2 %, Group 2, 24.1% and 11.3%. Group 3, 21.3% and 8.7%, Group 4, 34.8% and 15.9%. Group 5, 37.9% and 15.8%. No statistically significant difference was present between these values. When we calculate PR and IR according to the ratio of peak E2/ midluteal E2, the results were as follows: when the ratio was >5.0 (n=43) PR was 20.9% andIR 7.9%. When the ratio was 2.51-5.0, (n=43), PR was 25.6% and IR 12.2% and when the ratio was 0.4-2.5, (n=142), PR was 31.7% and IR 14.4%. No statistically significant difference was present between PR and IR values. Conclusion: Midluteal estradiol measurements can be a valuable method in predicting ART results. In order to research a definite conclusion, larger prospective randomized studies are required.