Anormal uterin kavite: İnvitro fertilization - embriyo transfer (IVF-ET) sonuçları üzerinde etkisi var mı?
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Date
2021
Authors
Koşan, Bahadır
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
AMAÇ: Bu çalışmada konjenital uterin anomalilerin iyi kalite embriyo transferinden sonra üreme sonuçları üzerindeki etkilerinin değerlendirilmesi amaçlandı. MATERYAL-METOT: Çalışma Ocak 2011 ile Ocak 2020 tarihleri arasında, Bursa Uludağ Üniversitesi Kadın Hastalıkları ve Doğum Anabilim Dalı Üremeye Yardımcı Tedaviler Merkezinde iyi kalite embriyo transferi yapılan hastaların elektronik hasta dosyaları ve histerosalpingografi (HSG) görüntüleri retrospektif olarak incelenerek gerçekleştirildi. Bu kohortta konjenital uterin anomaliler majör/minör olarak sınıflandırılarıp majör uterin anomaliler çalışmadan dışlandı. Hastaların HSG’deki uterin kavite görüntüleri araştırmaya kör iki Üreme Endokrinolojisi uzmanı tarafından ESHRE/ESGE ve ASRM sınıflamalarına göre yeniden analiz edildi. Analiz edilen görüntüler her iki sınıflamaya göre de normal/anormal uterin kavite olmak üzere iki ayrı gruba ayrıldı. IVF sonuçları, normal/anormal uterusu olanlar ve anomali tipine göre alt gruplar arasında karşılaştırıldı. Uzmanlar arasındaki uyum Cohen’s Kappa testi ile incelendi. İstatistiksel olarak normal dağılıma uymayan veriler Mann Whitney U testiyle, kategorik veriler kikare testiyle analiz edildi. BULGULAR: Çalışmada 400 hasta değerlendirildi. Olguları inceleyen uzmanların uyum düzeyleri ‘önemli düzeyde’ saptandı (ESHRE&ESGE: Kappa değeri (Κ):0,652 (p<0,001); ASRM: Κ:0,625 (p<0,001)). Hastaların verileri her iki sınıflamaya göre de karşılaştırıldığında median yaş (ESHRE: Normal:31 / Anormal:33,5 (p=0,031) ASRM: Normal:31 / Anormal:32 (p=0,036)) haricinde istatistiksel farklılık izlenmedi ( p>0,05). Her iki sınıflama sisteminde de canlı doğum oranı, uterusu normal ve anormal olan kadınlar arasında benzerdi (ESHRE: %20,4’e karşı %20,7 (p=1,00) / ASRM: %20’ye karşı %21,4 (p=0,863)). Gruplar arasında biyokimyasal ve klinik gebelik oranları da benzerdi. Her iki sınıflamada anomali tipine göre alt grup analizi yapıldığında canlı doğum ve klinik gebelik oranlarında anlamlı farklılık yoktu (Sırasıyla ESHRE&ESGE p=0,465 / P=0,821 ASRM p= 0,958 /p=0,955). TARTIŞMA: Majör uterin anomaliler dışlandıktan sonra bir bütün olarak konjenital uterin anomaliler, ESHRE&ESGE ve ASRM sınıflamaları kullanılarak tanımlandığında, yardımcı üremeyi takiben klinik gebelik ve canlı doğum oranlarını etkilememektedir. Her iki sınıflamada da alt grup analizlerinde arkuat uterus, uterin septum ve dismorfik uterusun klinik gebelik ve canlı doğum oranı üzerinde etkisi saptanmamıştır.
OBJECTIVE: In this study, it was aimed to evaluate the effects of congenital uterine anomalies on reproductive outcomes after good quality embryo transfer. METHOD: The study was carried out by retrospectively examining the electronic patient files and hysterosalpingography (HSG) images of the patients who had good quality embryo transfer at Bursa Uludağ University Gynecology and Obstetrics Department between January 2011 and January 2020. In this cohort, congenital uterine anomalies were classified as major / minor, and major uterine anomalies were excluded from the study. The uterine cavity images of the patients in HSG were re-analysed according to the ESHRE / ESGE and ASRM classifications by two reproductive endocrinologists blinded to the study. Analysed images were divided into two groups as normal / abnormal uterine cavity according to both classifications. IVF results were compared between those with normal / abnormal uterus and subgroups according to the type of anomaly. The agreement between experts was examined using the Cohen's Kappa test. The data that did not comply with the normal distribution statistically were analysed with the Mann Whitney U test, and the categorical data were analysed with the chi-square test. RESULT(S): In the study 400 patients were evaluated. The correspondence levels of the experts who examined the cases were found to be "substantial agreement" (ESHRE&ESGE: Kappa value (Κ):0.652 (p<0.001); ASRM: Κ:0,625 (p<0.001)) .When the data of the patients were compared according to both classifications, no statistical difference was observed except for the median age (ESHRE: Normal:31 / Abnormal:33.5 (p=0.031) ASRM: Normal:31 / Abnormal:32 (p=0.036); ( p>0.05)). In both classification systems, the live birth rate was similar between women with normal and abnormal uterus (ESHRE: %20.4 versus % 20.7 ( p=1.00) / ASRM: %20 versus % 21.4 (p=0.863)). Biochemical and clinical pregnancy rates were similar between the groups. When subgroup analysis was performed according to the type of anomaly in both classifications, there was no significant difference in live birth and clinical pregnancy rates. (ESHRE&ESGE p=0.465 / P=0.821 ASRM p= 0.958 /p=0.955; respectively). CONCLUSION(S): When congenital uterine anomalies as a whole, after excluding major uterine anomalies, are defined using the ESHRE & ESGE and ASRM classifications, they do not affect clinical pregnancy and live birth rates following assisted reproduction. In both classifications, in the vi subgroup analysis, the effect of arcuate uterus, uterine septum and dysmorphic uterus on clinical pregnancy and live birth rate was not detected.
OBJECTIVE: In this study, it was aimed to evaluate the effects of congenital uterine anomalies on reproductive outcomes after good quality embryo transfer. METHOD: The study was carried out by retrospectively examining the electronic patient files and hysterosalpingography (HSG) images of the patients who had good quality embryo transfer at Bursa Uludağ University Gynecology and Obstetrics Department between January 2011 and January 2020. In this cohort, congenital uterine anomalies were classified as major / minor, and major uterine anomalies were excluded from the study. The uterine cavity images of the patients in HSG were re-analysed according to the ESHRE / ESGE and ASRM classifications by two reproductive endocrinologists blinded to the study. Analysed images were divided into two groups as normal / abnormal uterine cavity according to both classifications. IVF results were compared between those with normal / abnormal uterus and subgroups according to the type of anomaly. The agreement between experts was examined using the Cohen's Kappa test. The data that did not comply with the normal distribution statistically were analysed with the Mann Whitney U test, and the categorical data were analysed with the chi-square test. RESULT(S): In the study 400 patients were evaluated. The correspondence levels of the experts who examined the cases were found to be "substantial agreement" (ESHRE&ESGE: Kappa value (Κ):0.652 (p<0.001); ASRM: Κ:0,625 (p<0.001)) .When the data of the patients were compared according to both classifications, no statistical difference was observed except for the median age (ESHRE: Normal:31 / Abnormal:33.5 (p=0.031) ASRM: Normal:31 / Abnormal:32 (p=0.036); ( p>0.05)). In both classification systems, the live birth rate was similar between women with normal and abnormal uterus (ESHRE: %20.4 versus % 20.7 ( p=1.00) / ASRM: %20 versus % 21.4 (p=0.863)). Biochemical and clinical pregnancy rates were similar between the groups. When subgroup analysis was performed according to the type of anomaly in both classifications, there was no significant difference in live birth and clinical pregnancy rates. (ESHRE&ESGE p=0.465 / P=0.821 ASRM p= 0.958 /p=0.955; respectively). CONCLUSION(S): When congenital uterine anomalies as a whole, after excluding major uterine anomalies, are defined using the ESHRE & ESGE and ASRM classifications, they do not affect clinical pregnancy and live birth rates following assisted reproduction. In both classifications, in the vi subgroup analysis, the effect of arcuate uterus, uterine septum and dysmorphic uterus on clinical pregnancy and live birth rate was not detected.
Description
Keywords
Subfertility, Konjenital uterin anomaliler, Arcuat uterus, Septat uterus, Dismorfik uterus, Klasifikasyon sistemi, In vitro fertilizasyon, Embriyo transferi, Histerosalpingografi, Obstetrik sonuçlar, Subfertilite, Congenital uterine anomalies, Arcuate uterus, Septate uterus, Classification system, In vitro fertilization, Embryo transfer, Hysterosalpingography, Obstetric outcome
Citation
Koşan, B. (2021). Anormal uterin kavite: İnvitro fertilization - embriyo transfer (IVF-ET) sonuçları üzerinde etkisi var mı?. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.