Hafif ovaryan stimulasyonun invitrofertilizasyon hastalarında uygulanması
Mild stimulation for IVF
Yazar: CENAN ŞİMŞEK
Danışman: DOÇ. DR. NAMIK KEMAL DURU
GATA / Tıp Fakültesi / Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2010
Konu: Kadın Hastalıkları ve Doğum = Obstetrics and Gynecology
Dizin: Embriyo nakli = Embryo transfer ; Fertilizasyon = Fertilization ; Fertilizasyon-in vitro = Fertilization-in vitro ; Kadın ürogenital hastalıkları = Female urogenital diseases ; Kısırlık = Infertility ; Kısırlık-kadın = Infertility-female ; Oositler = Oocytes ; Over = Ovary ; Üreme teknikleri = Reproduction techniques

Özet:
Giriş: Mild (hafif) ovaryan stimulasyon son birkaç yılda normal yanıt ve rezervli olgularda daha az oosit, ancak daha az aneuploidili embryo ve daha düşük harcama ve daha düşük OHSS riski nedeni ile hasta dostu tedaviler grubunda yer almaktadır.Amaç : Sunulan çalışma mild (hafif) ovaryan stimülasyonun altında yatan mantığı ve KOH protokollerinin etkisini ve üstünlüklerini tartışmayı amaçlamakta sonuç ve tedavi riski arasındaki dengeyi optimize eden cost-effective, hastaya yararlı rejimlere ulaşmayı hedeflemektedir.Materyal Metod : 01.01.2008-01.01.2010 tarihleri arasında GATA IVF Ünitesine başvuran infertilite endikasyonu ile KOH programına alınan ve çalışmaya dahil edilme kriterlerini taşıyan 97 hastanın verileri kullanılmıştır. Belirlenen kriterlere göre seçilen, KOH için uzun agonist protokol, antagonist protokol ve mild stimulasyon uygulanmış ; ICSI yöntemi ile ovum fertilizasyonu sağlanmış ve elde edilen embriolarla transfer uygulanmış hastalarda uygulanmış protokollerinretrospektif olarak etkinlik ve komplikasyonlarının karşılaştırmasının yapılması amaçlanmıştır.Bulgular : Antagonist grubunda ortalama 1,90±0,84 ve agonist grubunda 2,00±0,40 ve mild grupta 2,00±0,36 embriyo transferi gerçekleşmiştir.(p=0,172).Benzer gebelik oranları elde edilmesi ( uzun agonist grupta %41,9 ; antagonist grupta %30, mild grupta %40 ) mild stimulasyon grubunda yeterli sayı ve kalitede oosit oluşumu elde edilebilmiş olduğunu göstermektedir.Devam eden gebelik oranları açısından mild protokol diğer konvansiyonel yöntemlere eşdeğerdir.Sonuç: Mild stimulasyon, sonuç ve tedavi riski arasındaki dengeyi optimize eden cost-effective, hastaya yararlı bir IVF rejimidir.Anahtar Kelimeler : Kontrollü Ovaryan Hiperstimulasyon , Hafif Stimulasyon, OHSS

Abstract:
Introduction: In last few years mild ovarian stimulation has been a patient-friendly treatment in cases with normal response and reserve due to collecting less oocytes, but lower rates of embryos with aneuploidi, cost and risk of OHSS.Objective: Our study purposed to discuss the logic underlying mild ovarian stimulation, and effects and advantages of KOH protocols and to achieve cost-effective, patient-friendly regimens that optimize balance between result and treatment risk.Material and Method: ın this study data was obtained from 97 patients, who applied to GATA (GMMA) IVF unit for infertility between 01.01.2008-01.01.2010 and included to KOH program and met the study criteria. It was purposed to compare retrospectly complications and efficacy of protocols , which were performed to the patients, who were chosen according to criterias, received long agonist protocol, antagonsit protocol and mild stimulation for KOH; achieved ovum fertilization with ICSI method and transfer was provided with obtained embryos.Findings: In antagonsit group mean embryo transfer rates were 1,90±0,84, while were 2,00±0,40 in agonist group and 2.00±0.36 in mild group (p=0,172). Similar pregnancy rates (long antagonist group %41,9; antagonist group %30, mild group %40) show that it is likely to obtain oocytes with sufficient numbers and competent quality in mild stimulation group. Mild protocol has identical ongoing pregnancy rates with other conventional methods.Conclusion: Mild stimulation is a cost effective and patient-friendly regimen, that optimizes balance between result and risk of treatment.Introduction: In last few years mild ovarian stimulation has been a patient-friendly treatment in cases with normal response and reserve due to collecting less oocytes, but lower rates of embryos with aneuploidi, cost and risk of OHSS.Objective: Our study purposed to discuss the logic underlying mild ovarian stimulation, and effects and advantages of KOH protocols and to achieve cost-effective, patient-friendly regimens that optimize balance between result and treatment risk.Material and Method: ın this study data was obtained from 97 patients, who applied to GATA (GMMA) IVF unit for infertility between 01.01.2008-01.01.2010 and included to KOH program and met the study criteria. It was purposed to compare retrospectly complications and efficacy of protocols , which were performed to the patients, who were chosen according to criterias, received long agonist protocol, antagonsit protocol and mild stimulation for KOH; achieved ovum fertilization with ICSI method and transfer was provided with obtained embryos.Findings: In antagonsit group mean embryo transfer rates were 1,90±0,84, while were 2,00±0,40 in agonist group and 2.00±0.36 in mild group (p=0,172). Similar pregnancy rates (long antagonist group %41,9; antagonist group %30, mild group %40) show that it is likely to obtain oocytes with sufficient numbers and competent quality in mild stimulation group. Mild protocol has identical ongoing pregnancy rates with other conventional methods.Conclusion: Mild stimulation is a cost effective and patient-friendly regimen, that optimizes balance between result and risk of treatment.