ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
Dergisi

Turkish Journal of Reproductive Medicine and Surgery

Dernek Sitesi
Kayıtlı İndexler
ORİJİNAL ARAŞTIRMALAR

Endometrium Hazırlık Süresinin Dondurulmuş-Çözülmüş Embriyo Transfer Sonuçları Üzerine Etkisi
Effect of Endometrium Preparation Time on Frozen-Thawed Embryo Transfer Results
Received Date : 22 Nov 2022
Accepted Date : 06 Jan 2023
Available Online : 18 Jan 2023
Doi: 10.24074/tjrms.2022-94438 - Makale Dili: TR
TJRMS. 2022;6(3):197-202.
ÖZET
Amaç: Bu çalışmanın amacı; in vitro fertilizasyon (IVF) tedavisi gören kadın hastalarda, dondurulmuş-çözülmüş embriyo transferi (DET) sürecinde endometrium hazırlık süresinin IVF sonuçlarına etkisini değerlendirmektir. Gereç ve Yöntemler: Retrospektif olarak yapılan bu çalışmaya Ocak 2020-Ocak 2022 yılları arasında infertilite nedeniyle başvuran 18-35 yaş arası, IVF tedavisi görmüş ve bu tedavisinde DET yapılan 225 hasta dahil edilmiştir. Uterin anomali nedeniyle histeroskopi yapılan, tekrarlayan gebelik kaybı olan, DET sürecinde spontan ovulasyon gelişen, son kontrolde endometriyal kalınlık 7 mm altında kalan, 35 yaş üstü olan, embriyo biyopisi yapılan ve tedaviye uyum göstermeyen hastalar çalışmaya dahil edilmemiştir. Çalışmaya alınan hastalar endometrium hazırlık süresine göre 2 gruba ayrılmıştır. Embriyo transfer sürecinde 1. gruptaki 112 hastaya endometrium hazırlığı için 20 günlük tedavi verilmiştir. İkinci gruptaki 113 hastaya ise endometrium hazırlığı için 16 günlük tedavi uygulanmıştır. IVF tedavisinde DET yapılan her 2 gruptaki hastaların IVF tedavi sonuçları birbiriyle karşılaştırılmıştır. Bulgular: Dondurulmuş-çözülmüş embriyo transferi yapılan hastaların toplam yaş ortalaması 28 ± 5.12 idi. Gruplar arasında yaş (p=0.69), infertilite süresi (p=0.82), eğitim durumu (ilköğretim p=0.58, lise p=0.71, üniversite p=0.63) ve vücut kitle indeksi (p=0.37) gibi sosyodemografik özellikler açısından istatistiksel olarak anlamlı bir farklılık bulunmadı (p>0.05). IVF sonuçları bakımından olgularda endometrium hazırlık süresi karşılaştırıldığında implantasyon (p=0.342), biyokimyasal gebelik (p=0.417), klinik gebelik (p=0.384), abortus (p=0.557) ve canlı doğum (p=0.489) açısından istatistiksel olarak anlamlı farklılık saptanmadı (p>0.05). Birinci gruptaki uzun protokol uygulanan hastaların son kontrolünde ölçülen endometriyum kalınlıkları ortalaması 9.1 mm (7.2mm-10.4mm), 2. gruptaki kısa protokol uygulanan hastaların son kontrolünde ölçülen endometriyum kalınlıkları ortalaması 8.6 mm (7.1mm-9.2mm) olarak tespit edildi (p=0.12). Sonuç: İnfertil hastaların DET sürecinde endometrial hazırlık süresinin uzaması hem hasta hem de sağlık ekibi üzerinde iş yükü artışına sebep olmaktadır. Endometrial hazırlık süresinin kısalmasının IVF tedavi başarısını olumsuz etkilemediği tespit edilmiştir. IVF tedavi sürecinde endometrial hazırlık süresinin kısalmasının, hasta takibini kolaylaştırma, aksaklıkları minimalize etme ve gebelik sonuçlarını olumsuz etkilememesi nedenleriyle uygulamaya alınması önerilir.
ABSTRACT
Objective: The aim of this study; evaluate the effect of endometrial preparation time on IVF outcomes during the frozen-thawed embryo transfer (FET) process in female patients undergoing in vitro fertilization (IVF) treatment. Material and Methods: In this retrospective study, 225 patients aged 18-35 years who applied for infertility between January 2020 and January 2022, received IVF treatment and underwent DET in this treatment were included. Patients who underwent hysteroscopy due to uterine anomaly, had recurrent pregnancy loss, developed spontaneous ovulation during the DET process, had an endometrial thickness below 7 mm at the last control, were over 35 years old, underwent embryo biopsy and were not compliant with the treatment were not included in the study. The patients included in the study were divided into 2 groups according to the endometrial preparation time. These patients were divided into 2 groups according to the endometrial preparation time. During the embryo transfer process, 112 patients in group 1 received 20 days of treatment for endometrial preparation. 113 patients in the second group were treated for 16 days for endometrial preparation. IVF treatment results of patients in both groups who underwent FET in IVF treatment were compared with each other. Results: The mean age of patients who underwent frozen-thawed embryo transfer was 28 ± 5.12 years. There were statistically significant sociodemographic characteristics such as age (p=0.69), duration of infertility (p=0.82), education (primary school p=0.58, high school p=0.71, university p=0.63) and body mass index (p=0.37) between the groups. no significant difference was found (p>0.05). When the endometrial preparation time was compared in terms of IVF results, there was a statistically significant difference in terms of implantation (p=0.342), biochemical pregnancy (p=0.417), clinical pregnancy (p=0.384), abortion (p=0.557) and live birth (p=0.489). not detected (p>0.05). The mean endometrial thicknesses measured at the last control of the patients in the first group who were applied the long protocol were 9.1 mm (7.2mm-10.4mm), and the mean of the endometrial thicknesses measured at the last control of the patients in the second group who were applied the short protocol was 8.6 mm (7.1mm-9.2mm) (p= 0.12). Conclusion: The prolongation of the endometrial preparation period in the DET process of infertile patients causes an increase in workload on both the patient and the healthcare team. It has been determined that the shortening of the endometrial preparation time does not adversely affect the success of IVF treatment. It is recommended that the shortening of the endometrial preparation time during the IVF treatment process be put into practice because it facilitates patient follow-up, minimizes disruptions and does not adversely affect pregnancy outcomes.
REFERANSLAR
  1. De Geyter C, Wyns C, Calhaz-Jorge C, et al. 20 years of the European IVF-monitoring Consortium registry: what have we learned? A comparison with registries from two other regions. Hum Reprod. 2020;35(12):2832-49. [Crossref]  [PubMed]  [PMC] 
  2. Glujovsky D, Pesce R, Sueldo C, Quinteiro Retamar AM, Hart RJ, Ciapponi A. Endometrial preparation for women undergoing embryo transfer with frozen embryos or embryos derived from donor oocytes. Cochrane Database Syst Rev. 2020;10(10):CD006359. [Crossref]  [PubMed]  [PMC] 
  3. Mumusoglu S, Polat M, Ozbek IY, et al. Preparation of the Endometrium for Frozen Embryo Transfer: A Systematic Review. Front Endocrinol (Lausanne). 2021;12:688237. [Crossref]  [PubMed]  [PMC] 
  4. Weissman A. IVF Worldwide Survey Results: Frozen-Thawed Embryo Transfer. (2017). Available at: [Link] 
  5. Glujovsky D, Farquhar C. Cleavage-stage or blastocyst transfer: what are the benefits and harms? Fertil Steril. 2016;106(2):244-50. [Crossref]  [PubMed] 
  6. Han AR, Park CW, Lee HS, Yang KM, Song IO, Koong MK. Blastocyst transfer in frozen-thawed cycles. Clin Exp Reprod Med. 2012;39(3):114-7. [Crossref]  [PubMed]  [PMC] 
  7. Chen H, Lv JQ, Wu XM, et al. Blastocyst-stage versus cleavage-stage embryo transfer in the first frozen cycles of OHSS-risk patients who deferred from fresh embryo transfer. Gynecol Endocrinol. 2015;31(9):698-701. [Crossref]  [PubMed] 
  8. Van Steirteghem AC, Liu J, Joris H, et al. Higher success rate by intracytoplasmic sperm injection than by subzonal insemination. Report of a second series of 300 consecutive treatment cycles. Hum Reprod. 1993;8(7):1055-60. [Crossref]  [PubMed] 
  9. von Versen-Höynck F, Schaub AM, Chi YY, et al. Increased Preeclampsia Risk and Reduced Aortic Compliance With In Vitro Fertilization Cycles in the Absence of a Corpus Luteum. Hypertension. 2019;73 (3):640-9. [Crossref]  [PubMed]  [PMC] 
  10. Dall'Agnol H, García Velasco JA. Frozen embryo transfer and preeclampsia: where is the link? Curr Opin Obstet Gynecol. 2020;32(3):213-18. [Crossref]  [PubMed] 
  11. Keskin U, Yüksel B, Ercan CM ve ark. Dondurulmuş-Çözünmüş Embriyo Transfer Sikluslarında Oral ve Transdermal Östrojen Desteğinin Gebelik Sonuçları Üzerine Etkisi. Gülhane Tıp Dergisi. 2015;57:280-3.
  12. Boynukalin FK, Turgut NE, Gultomruk M, et al. Impact of elective frozen vs. fresh embryo transfer strategies on cumulative live birth: Do deleterious effects still exist in normal & hyper responders? PLoS One. 2020;15(6):e0234481. [Crossref]  [PubMed]  [PMC] 
  13. Biliangady R, Pandit R, Tudu NK, et al. Is It Time to Move Toward Freeze-All Strategy? - A Retrospective Study Comparing Live Birth Rates between Fresh and First Frozen Blastocyst Transfer. J Hum Reprod Sci. 2019;12(4):321-6. [Crossref]  [PubMed]  [PMC] 
  14. Zhang W, Xiao X, Zhang J, et al. Clinical outcomes of frozen embryo versus fresh embryo transfer following in vitro fertilization: a meta-analysis of randomized controlled trials. Arch Gynecol Obstet. 2018;298(2):259-72. [Crossref]  [PubMed] 
  15. Kalem Z, Kalem MN, Gürgan T. Methods for endometrial preparation in frozen-thawed embryo transfer cycles. J Turk Ger Gynecol Assoc. 2016;17(3):168-72. [Crossref]  [PubMed]  [PMC] 
  16. Karabulut S, Korkmaz O, Delikara N, Keskin İ. Dondurulmuş-Çözülmüş Embriyo Sikluslarında Anne Yaşına Göre Optimum Transfer Gününün Belirlenmesi. Zeynep Kamil Tıp Bülteni. 2018;49(1):133-5. [Crossref] 
  17. Mensing L, Dahlberg ES, Bay B, Gabrielsen A, Knudsen UB. Endometrial preparation methods prior to frozen embryo transfer: A retrospective cohort study comparing true natural cycle, modified natural cycle and artificial cycle. Arch Gynecol Obstet. 2022;306(4):1381-8. [Crossref]  [PubMed]  [PMC] 
  18. Bourdon M, Santulli P, Maignien C, et al. The deferred embryo transfer strategy improves cumulative pregnancy rates in endometriosis-related infertility: A retrospective matched cohort study. PLoS One. 2018;13(4):e0194800. [Crossref]  [PubMed]  [PMC] 
  19. Sekhon L, Feuerstein J, Pan S, et al. Endometrial preparation before the transfer of single, vitrified-warmed, euploid blastocysts: does the duration of estradiol treatment influence clinical outcome? Fertil Steril. 2019;111(6):1177-85. [Crossref]  [PubMed] 
  20. Jiang WJ, Song JY, Sun ZG. Short (seven days) versus standard (fourteen days) oestrogen administration in a programmed frozen embryo transfer cycle: a retrospective cohort study. J Ovarian Res. 2022;15(1):36. [Crossref]  [PubMed]  [PMC] 
  21. Scott R, Navot D, Liu HC, Rosenwaks Z. A human in vivo model for the luteoplacental shift. Fertil Steril. 1991;56(3):481-4. [Crossref]  [PubMed] 
  22. Csapo AI, Pulkkinen MO, Ruttner B, Sauvage JP, Wiest WG. The significance of the human corpus luteum in pregnancy maintenance. I. Preliminary studies. Am J Obstet Gynecol. 1972;112(8):1061-7. [Crossref]  [PubMed] 
  23. Neumann K, Depenbusch M, Schultze-Mosgau A, Griesinger G. Characterization of early pregnancy placental progesterone production by use of dydrogesterone in programmed frozen-thawed embryo transfer cycles. Reprod Biomed Online. 2020;40(5):743-51. [Crossref]  [PubMed] 
  24. Miles RA, Paulson RJ, Lobo RA, Press MF, Dahmoush L, Sauer MV. Pharmacokinetics and endometrial tissue levels of progesterone after administration by intramuscular and vaginal routes: a comparative study. Fertil Steril. 1994;62(3):485-90. [Crossref]  [PubMed] 
  25. Bulletti C, De Ziegler D, Giacomucci E, et al. Vaginal drug delivery: the first uterine pass effect. Ann N Y Acad Sci. 1997;828:285-90. [Crossref]  [PubMed] 
  26. Cicinelli E, de Ziegler D, Bulletti C, Matteo MG, Schonauer LM, Galantino P. Direct transport of progesterone from vagina to uterus. Obstet Gynecol. 2000;95(3):403-6. [Crossref]  [PubMed] 
  27. Devroey P, Pados G. Preparation of endometrium for egg donation. Hum Reprod Update. 1998;4(6):856-61. [Crossref]  [PubMed] 
  28. Navot D, Laufer N, Kopolovic J, et al. Artificially induced endometrial cycles and establishment of pregnancies in the absence of ovaries. N Engl J Med. 1986;314(13):806-11. [Crossref]  [PubMed] 
  29. Borini A, Dal Prato L, Bianchi L, Violini F, Cattoli M, Flamigni C. Effect of duration of estradiol replacement on the outcome of oocyte donation. J Assist Reprod Genet. 2001;18(4):185-90. [Crossref]  [PubMed]  [PMC]