Search

This study was conducted to determine the pregnancy rates of women who underwent IVF treatment at Zeynep Kamil Maternity and Children’s Hospital IVF Unit between March 2010 and 2012 after the regulations about Assisted Reproduction Technics and IVF(In Vitro Fertilization) Units. A total of embryo transfer (ET) of 1187 IVF cycle under going one or two embryos transfer were retrospectively analysed. The pregnancy rates following one or two embryos transfers were found to be (n=891) 19,9% and (n=250) 30,4%, respectively. The pregnancy rate was significantly higher than those under went one embryo transfer (p< 0,001). Key words: single embryo transfer, double embryo transfer, pregnancy rate, Bu çalışmada tek ve sartlı iki embriyo transferi (ET) yönetmeliği sonrası Zeynep Kamil Kadın Hastalıkları ve Doğum Eğitim Arastırma Hastanesi Tüp Bebek ünitesinde IVF yapılan hastalarda gebelik oranlarının belirlenmesi amaçlandı. Merkezimizde Mart 2010 ve Mart 2012 tarihleri arasında bir veya iki ET yapılan 1187 hastanın sonuçları retrospektif olarak değerlendirildi. Gebelik oranlarının tek embriyo transferi yapılan hastalarda % 19,9, iki embriyo transferi yapılanlarda ise % 30,4 olduğu gözlendi. Gebelik oranları iki embriyo transferi yapılan hastalarda tek embriyo transferine göre anlamlı derecede yüksek bulundu (p< 0,001).Anahtar kelimeler: tek embriyo transferi, iki embriyo transferi, gebelik oranı

Objectives: To investigate whether a lower than expected number of oocyte after ≥14 mm follicle aspiration during OPU has any effect on pregnancy outcomes Methods: This is a retrospective study done between 2010 and 2013 at the IVF Unit of the Zeynep Kamil Women and Children Diseases Education and Research Hospital, dealing with the medical records of infertile patients who underwent IVF cycle and controlled ovarian stimulation with long agonist or fix antogonist protocol. The patients included into the study were those diagnosed with a primary infertility, aged between 23 and 39, at a BMI of 22-28 kg/m2 and having received the first or second IVF treatment. Male factor, presence of uterine anomaly, patients with serious endometriosis and patients with low ovarian reserve were all excluded from the study. Typically, oocyte pick-up was performed in all the patients 35.5 hours after the hCG implementation. Single or double embryo transfer was performed, where available. Patients were classified into two groups. Group 1 consisted of those with no difference between ≥14 mm aspirated follicle number and expected number of oocyte or with 1 missing number of oocyte at the most. Group 2 consisted of those with at least ≥2 missing number of oocyte between aspirated follicle number and expected number of oocyte. Statistical analysis was performed using Student’s t test for continuous variables and chi-square test for categorical variables. Additionally, a Linear regression analysis was conducted between the total number of oocyte and pregnancy. Results: In total, 387 treatment cycles were included into the study. Group 1 consisted of 134 patients and Group 2 consisted of 252 patients. Antral follicle number (12.8 ± 4.3 and 14.5 ± 4.1, P = 0.0007), hCG day E2 value (1990.7 ± 1056.4 and 2515.2 ± 1332.7, P < 0.0001) and the the number of aspirated follicle during OPU (9.1 ± 4.4 and 13.7 ± 5.5, P < 0.0001) were significantly higher in Group 2; whereas on the other hand, daily gonadotropin dose (290.9 ± 79.9 and 273.4 ± 74.4, P = 0.034) and total gonadotropin doses (2545 ± 1031.8 and 2247.7 ± 901.9, P = 0.004) were significantly higher in Group 1. The pregnancy rate was significantly higher in Group 1 (29.1% and 19.4%, P = 0.041). No correlation was observed between the number of oocyte and pregnancy (r = 0.082, P = 0.107). Conclusions: The number of aspirated follicles during IVF treatment being higher than the collected number of oocyte leads to a statistically significant fall in the pregnancy rates. There is no correlation between the number of oocyte and pregnancy.

The effectiveness of assisted hatching to improve embryo transfer outcome remains controversial. The current study analyses the impact of zona thinning by laser on pregnancy rates after a failed, fresh, nondonor cycle. The study presents the comparative results of two consecutive treatments of the same patients, which were treated under same conditions in same clinic. Materials and Methods: Pregnancy results of 188 couples 376 cycles were examined. These patients met one of the following criteria: 1st group: ≥35 years of age, 2nd group: Thick zona pellucida of the embryo, 3rd group: More than one IVF-embryo transfer attempts with no clear reason. Embryos of these patients did not have laser treatment during their first trial, while the zona of the embryos of the same patients were thinned by laser during their second try. All laboratory conditions, mediums as well as clinicians and embryologists were the same for the subsequ ent therapies. The pregnancy rates of each attempt were statistically examined according to the day of the transfer. Results: Clinical pregnancy rates increased significantly after hatching both on 2nd and 3rd day transfers on the group with advanced age. The rates were obviously higher after 3rd day transfers on the patients who had embryos with thick zona as well as at the patients who had several attempts before with no clarified reason. Conclusions: Statistical results show that zona thinning causes improved pregnancy rates in subsequent cycles. Laser treatment of embryos should definitely be considered for the patients with at least one prior implantation failure., Amaç Embriyo transferlerinin başarısını arttırmak için uygulanan zona pellusidanın inceltilme işlemi olan “assisted hatching” in başarısı halen tartışmalıdır. Bu çalışmada; daha önce başarısız embriyo transferi öyküsü olan hastalarda ikinci kez taze embriyo transfer edilmeden önce zona tabakasının inceltilmesinin gebelik oranları üzerine değişiminin incelenmesi amaçlanmıştır. Çalışmada; aynı hastanın, aynı klinikte ve aynı koşullar altında yapılan ard arda iki tedavisinin sonuçları karşılaştırılmıştır. Gereç ve Yöntem: Kliniğe en az iki kez başvuran 188 çifte ait toplam 376 siklusun gebelik sonuçları değerlendirilmiştir. Hastalar aşağıdaki kriterlere göre gruplandırılmıştır: 1. Grup: 35 yaş ve üzeri, 2. Grup : Zona pellusidası kalın embriyolara sahip hastalar, 3. Grup: Birden fazla IVF-embriyo transfer denemesi olan ve başarısızlığın nedeni saptanamamış hastalar. Tüm bu hastaların embiryolarına ilk denemelerinde lazer uygulaması yapılmamış, ancak ikinci denemelerinde embriyoların zona pellusidaları lazer ile inceltilmiştir. Tüm laboratuvar olanakları, kullanılan medyumlar, hasta ile ilgilenen klinisyen ve embriyologların bu birbirini takip eden iki tedavide aynı olmasına dikkat edilmiştir. 2. Ya da 3. Gün transfer uygulanan hastalar değerlendirmeye alınmıştır. Gebelik oranları transfer gününe göre istatistiksel olarak karşılaştırılmıştır. Sonuçlar: İleri yaş hastaları içeren grupta gerek 2. gerekse 3. Gün transfer yapılan hastalarda klinik gebelik oranları belirgin şekilde artmıştır. Zona pellusidası kalın embriyoya sahip çiftlerde ve neden saptanamamış hastalarda ise 3. gün transferlerinin ardından gebelik oranlarında belirgin artış görülmüştür. İstatistiksel sonuçlar; ardarda gelen iki siklus karşılaştırıldığında zona inceltme işleminin gebelik oranının arttırdığını göstermektedir. Bu sonuçlara göre; başarısız implantasyon öyküsü olan hastalarda embriyoların lazerle zona pellusidasının inceltilmesi mutlaka düşünülmesi gereken bir yöntem olmalıdır.