Oosit toplama sırasındaki folikül yıkamanın fertilite prezervasyonu siklusları sonuçlarına etkisi, retrospektif çalışma
Öz
Amaç: Kanser hastalarının kemoterapi sonrası yumurtalık rezervlerini kaybetme riski altında olduğu göz önüne alındığında, fertilite prezervasyonu (FP) döngülerinde oosit kalitesini en üst düzeye çıkarmak çok önemlidir. Amacımız, FP için letrozol ve gonadotropinler ile oositleri veya embriyoları korumak için kontrollü yumurtalık stimülasyonu uygulanan kadınlarda elde edilen oosit ve embriyo sayısını maksimize etmede foliküler yıkamanın yararlılığını belirlemekti.
Gereç ve Yöntem: Fertilite prezervasonu planlanan meme kanserli olgular retrospektif olarak tarandı. Çift lümenli yıkama yaklaşımı (ÇLY) kullanılarak oositlerin aspire edildiği 11 döngü, oositlerin tek lümenli aspirasyon (TLA) yoluyla alındığı yaş uyumlu 31 döngü ile karşılaştırıldı. 10 mm ve üzerinde ölçüm yapılan tüm foliküller aspire edildi. ÇLY grubunda, foliküller 6 defaya veya oosit elde edilene kadar yıkandı.
Bulgular: Ortalama yaş ve anti-müllerian hormon (AMH) değerleri ÇLY ve TLA grupları arasında benzerdi (sırasıyla, yaş:39,8 ± 0,48 / 37,9 ± 0,74; p=0,162; AMH: 1,69 ± 0,37 / 1,47 ± 0,25 ng/mL p=0,635). Pik estradiol seviyeleri ÇLY grubunda anlamlı olarak daha yüksekti (ÇLY / TLA: 1022,66 ± 205,45 / 715,5 ± 33,69 pg/mL, p= 0,026). Toplam gonadotropin dozu ( ÇLY / TLA: 5345 ± 344 / 5017 ± 108 IU, p= 0,236) ve toplam letrozol dozu (ÇLY / TLA: 59,0 ± 2,84 / 57,9 ± 1,08 mg, p=0,633) her iki grupta benzerdi. Tetikleme öncesi ultrasonografide 10 mm üzerindeki folikül sayısı temel alındığında benzer sayıda folikül saptandı (16,2 ± 1,2 / 12,5 ± 1,3; p=0,16). Çift lümenli yıkama yaklaşımı ile daha yüksek toplam oosit sayısı (17,4 ± 2,3 / 10,9 ± 1,2; p=0,015) ve daha yüksek sayıda olgunlaşmamış oosit elde edildi (8,36 ± 1,12 / 3,53± 0,45; p < 0,001). Ancak dondurularak saklanan embriyoların sayısındaki fark istatistiksel anlamlılığa ulaşmadı (7,2 ± 1,94 / 5,2 ± 0,79; p = 0,279).
Sonuçlar: Fertilite prezervasyonu döngülerinde ÇLY kullanımı, küçük foliküllerden elde edilen immatür oosit sayısını arttırabilir. Çift lümenli yıkama yaklaşımının nihai embriyo verimini artırmadaki değeri, FP uygulanan kadınlar arasında daha geniş prospektif çalışmalarda araştırılmalıdır.
Anahtar Kelimeler
Kaynakça
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68: 394–424.
- Kudela E, Samec M, Kubatka P, Nachajova M, Laucekova Z, Liskova A, et al. 2019. Breast Cancer in Young Women: Status Quo and Advanced Disease Management by a Predictive, Preventive, and Personalized Approach. Cancers (Basel), 11: 1791.
- Kasum M, Beketić-Orešković L, Peddi PF, Orešković S, Johnson RH. 2014. Fertility after breast cancer treatment. European Journal of Obstetrics Gynecology and Reproductive Biology, 173: 13–8
- Rodriguez-Wallberg KA and Oktay K. 2010. Fertility preservation in women with breast cancer. Clinical Obstetrics and Gynecology, 53: 753–762.
- Dolmans MM, Lambertini M, Macklon KT, Almeida Santos T, Ruiz-Casado A, Borini A, et al. 2019. EUropean REcommendations for female FERtility preservation (EU-REFER): A joint collaboration between oncologists and fertility specialists. Critical Reviews in Oncology/Hematology, 138: 233–240.
- Baber R, Porter R, Picker R, Robertson R, Dawson E, Saunders D. Transvaginal ultrasound directed oocyte collection for in vitro fertilization: successes and complications. J Ultrasound Med 1988; 7 (7): 377–9.
- Waterstone JJ, Parsons JH. A prospective study to investigate the value of flushing follicles during transvaginal ultrasound-directed follicle aspiration. Fertil Steril 1992; 57 (1): 221–3.
- Haydardedeoglu B, Cok T, Kilicdag EB, Parlakgumus AH, Simsek E, Bagis T. In vitro fertilization–intracytoplasmic sperm injection outcomes in single versus double-lumen oocyte retrieval needles in normally responding patients: a randomized trial. Fertil Steril 2011; 95 (2): 812–4.
- Wongtra-Ngan S, Vutyavanich T, Brown J. Follicular flushing during oocyte retrieval in assisted reproductive techniques. Cochrane Database Syst Rev 2010:CD004634.
- Evelyn Mok-Lin, Anate Aelion Brauer, Glenn Schattman, Nikica Zaninovic, Zev Rosenwaks, and Steven Spandorfer Follicular flushing and in vitro fertilization outcomes in the poorest responders: a randomized controlled trial Human Reproduction, Vol.28, No.11 pp. 2990–2995, 2013
- Scott RT, Hofmann GE, Muasher SJ, Ascota AA, Kreiner DK, Rosenwaks Z. 1989. A prospective randomized comparison of single and double – lumen needles for transvaginal follicular aspiration. Journal of In Vitro Fertilisation and Embryo Transfer 6: 98 – 100.
- Ektoras Georgiou , Pedro Melo, Julie Brown, Ingrid E Granne 2018. Follicular flushing during oocyte retrieval in assisted reproductive techniques Cochrane Database Syst Rev 2018 Apr 26; 4 (4): CD004634.
The effect of follicle flushing during oocyte retrieval on fertility preservation cycle outcomes, retrospective study
Öz
Aim: In oncology cases, chemo-radiotherapy treatments affect the ovarian reserve negatively, and fertility-preserving (FP) approaches are recommended in this patient group. Our purpose was to evaluate the efficacy of follicular flushing to increase oocyte and embryo retrieval in women undergoing controlled ovarian stimulation to preserve oocytes or embryos using gonadotropin in combination with aromatase inhibitors for FP.
Materials and Methods: In our study, breast cancer cases were screened retrospectively. Eleven cycles in which oocytes were retrieved using the Double-lumen washing technique (DLF) in the same age group were compared with the cycle in which the oocytes were aspirated by single-lumen aspiration (SLA). All follicles displayed above 10 mm were aspirated. In the DLF group, oocyte was washed up to retrieval or up to 6 times.
Results: Mean age and anti-mullerian hormone (AMH) levels were not significantly different in both groups (age: 39.8 ± 0.48 vs. 37.9 ± 0.74 years; p=0.162; AMH: 1.69 ± 0.37 vs. 1.47 ± 0.25 ng/mL; p=0.635, respectively), maximum estradiol levels were significantly higher in the flushing group. (DLF vs SLA: 1022.66 ± 205.45 vs 715.5 ± 33.69 pg/mL; p= 0.026). Total dose of gonadotropins (DLF vs. SLA: 5345 ± 344 vs. 5017 ± 108 IU; p= 0.236) and total dose of aromatase inhibitors (DLF vs. SLA: 59.0 ± 2.84 vs. 57.9 ± 1.08 mg; p=0.633) were not different. According to the number of follicles >10 mm on the trigger day, a similar number of follicles was stated (DLF vs. SLA: 16.2 ± 1.2 vs. 12.5 ± 1.3; p=0.16). The total number of oocytes retrieved in the DLF group (17.4 ± 2.3 vs 10.9 ± 1.2; p=0.015; respectively) and metaphase 1 oocytes (8.36 ± 1.12 vs 3.53 ± 0.45; p < 0.001) were statistically significantly higher. However, the number of cryopreserved embryos was statistically similar in both groups. (DLF vs. SLA: 7.2 ± 1.94 vs. 5.2 ± 0.79; p = 0.279).
Conclusions: Administration of DLF in ovarian stimulation cycles in oncology patients may increase the number of immature oocytes retrieved from non-dominant follicles. The value of DLF in increasing the total number of embryos should be investigated in randomized controlled trials in patients undergoing fertility preservation.
Anahtar Kelimeler
Kaynakça
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. 2018. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 68: 394–424.
- Kudela E, Samec M, Kubatka P, Nachajova M, Laucekova Z, Liskova A, et al. 2019. Breast Cancer in Young Women: Status Quo and Advanced Disease Management by a Predictive, Preventive, and Personalized Approach. Cancers (Basel), 11: 1791.
- Kasum M, Beketić-Orešković L, Peddi PF, Orešković S, Johnson RH. 2014. Fertility after breast cancer treatment. European Journal of Obstetrics Gynecology and Reproductive Biology, 173: 13–8
- Rodriguez-Wallberg KA and Oktay K. 2010. Fertility preservation in women with breast cancer. Clinical Obstetrics and Gynecology, 53: 753–762.
- Dolmans MM, Lambertini M, Macklon KT, Almeida Santos T, Ruiz-Casado A, Borini A, et al. 2019. EUropean REcommendations for female FERtility preservation (EU-REFER): A joint collaboration between oncologists and fertility specialists. Critical Reviews in Oncology/Hematology, 138: 233–240.
- Baber R, Porter R, Picker R, Robertson R, Dawson E, Saunders D. Transvaginal ultrasound directed oocyte collection for in vitro fertilization: successes and complications. J Ultrasound Med 1988; 7 (7): 377–9.
- Waterstone JJ, Parsons JH. A prospective study to investigate the value of flushing follicles during transvaginal ultrasound-directed follicle aspiration. Fertil Steril 1992; 57 (1): 221–3.
- Haydardedeoglu B, Cok T, Kilicdag EB, Parlakgumus AH, Simsek E, Bagis T. In vitro fertilization–intracytoplasmic sperm injection outcomes in single versus double-lumen oocyte retrieval needles in normally responding patients: a randomized trial. Fertil Steril 2011; 95 (2): 812–4.
- Wongtra-Ngan S, Vutyavanich T, Brown J. Follicular flushing during oocyte retrieval in assisted reproductive techniques. Cochrane Database Syst Rev 2010:CD004634.
- Evelyn Mok-Lin, Anate Aelion Brauer, Glenn Schattman, Nikica Zaninovic, Zev Rosenwaks, and Steven Spandorfer Follicular flushing and in vitro fertilization outcomes in the poorest responders: a randomized controlled trial Human Reproduction, Vol.28, No.11 pp. 2990–2995, 2013
- Scott RT, Hofmann GE, Muasher SJ, Ascota AA, Kreiner DK, Rosenwaks Z. 1989. A prospective randomized comparison of single and double – lumen needles for transvaginal follicular aspiration. Journal of In Vitro Fertilisation and Embryo Transfer 6: 98 – 100.
- Ektoras Georgiou , Pedro Melo, Julie Brown, Ingrid E Granne 2018. Follicular flushing during oocyte retrieval in assisted reproductive techniques Cochrane Database Syst Rev 2018 Apr 26; 4 (4): CD004634.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Aralık 2021 |
| Gönderilme Tarihi | 16 Ekim 2021 |
| Yayımlandığı Sayı | Yıl 2021 |