ORİJİNAL ARAŞTIRMALAR
Açıklanamayan İnfertil Hastaların IUI Sikluslarında hCG Günü Önerilen Koitusun Gebelik Oranına Etkisi
Evaluation of Pregnancy Rate in IUI Cycles of Unexplained Infertile Patients for whom hCG Day Coitus is Recommended
Received Date : 14 Jan 2024
Accepted Date : 06 Mar 2024
Available Online : 02 Apr 2024
Dilay GÖK KORUCUa, Oğuzhan GÜNENCa, Latife Nevin PEHLİVANLAR DARa
aUniversity of Health Sciences, Konya City Hospital, Clinic of Obstetrics and Gynecology, Konya, Türkiye
Doi: 10.24074/tjrms.2024-101439 - Makale Dili: EN
Turkish Journal of Reproductive Medicine and Surgery. 2024;8(2):63-8.
ÖZET
Amaç: Bu çalışmanın amacı, erkek subfertilitesi olan açıklanamayan infertil hastaların IUI sikluslarında hCG gününde önerilen koitusun intrauterin
sperm sayısını artırarak gebelik ve canlı doğum oranlarını etkileyip etkilemediğini araştırmaktır. Gereç ve Yöntemler: Ali Kemal Belviranlı
Kadın Doğum ve Çocuk Hastanesi İnfertilite Kliniği dosyalarından 2018-2020 yılları arasında 300 hasta verisi retrospektif olarak toplandı.
18-35 yaş grubunda açıklanamayan infertilitesi olan, antral folikül sayısı normal sınırlarda olan, FSH değeri <10 U/L ve HSG ile kanıtlanmış tüp
açıklığı olan hastalar çalışmaya dahil edildi. Erkek partnerlerde total hareketli sperm sayısının (TMS) 5X106 ile 15X106 arasında olması erkek
subfertilitesi olarak kabul edildi. Tüm hastalara IUI öncesinde gonadotropinler uygulandı. Katılımcıların koitus durumu ile gebelik sonuçları arasındaki
ilişkiyi belirlemek için ki-kare bağımsızlık testi yapıldı. Bulgular: Retrospektif olarak incelenen hasta dosyalarından 297 hastanın 152'sine
sadece IUI önerilirken, 145'ine IUI ’ a ek olarak hCG gününde koitus önerildiği tespit edildi. Doğumla sonuçlanan 29 gebelikten 8 hastaya IUI
ile birlikte hCG yapıldığı gün koitus uygulandığı ve 21 hastaya sadece IUI uygulandığı tespit edildi. Erkek subfertilite hastalarında IUI'ye ek olarak
hCG tetik gününde önerilen cinsel birleşmenin canlı doğum oranlarını iyileştirmediği (p>0,05) belirlendi. Sonuç: İnseminasyonla birlikte koitus
önerilmesi geleneksel bir öneri olmasına rağmen, erkek subfertilitesi olan açıklanamaya infertil hastaların gonadotropinlerle indüklenmiş IUI
sikluslarında Hcg günüde önerilen koitusun canlı doğum sonuçlarını iyileştirmediği sonucuna vardık.
Anahtar Kelimeler: Koitus; intrauterin inseminasyon; erkek subfertilitesi
ABSTRACT
Objective: Aim of this study is to investigate whether the recommended coitus on the day of hCG affects pregnancy and live birth rates by increasing
intrauterine sperm count in IUI cycles of unexplained infertile patients with male subfertility. Material and Methods: 300 patients data
is collected retrospectively from the files of the Ali Kemal Belviranlı Maternity and Children's Hospital İnfertility Clinic between 2018 and
2020. Patients with unexplained infertility in the 18-35 age group whose antral follicle count were within normal limits, FSH value <10 U/L and
proven tubal patency by HSG were included in the study. In male partners, total motile sperm count (TMS) between 5X106 and 15X106 were
considered as male subfertility. All patients were induced with gonadotropins before IUI. Chi-square test of independence were conducted to determine
the relationship between the coitus status of the participants and pregnancy outcomes. Results: We have seen from the retrospectively
reviewed patient files that while 152 of 297 patients were recommended only IUI, 145 of them were offered coitus on the day of hCG. 8 patients
with 29 pregnancies that resulted in delivery applied coit on the day of hCG together with IUI and 21 patients did not apply coitus on hCG day.
It was determined that recommended coitus on hCG trigger day in adition to IUI does not improve live birth rates (p>0,05) with male subfertility
patients. Conclusion: Although it is a conventional recommendation to suggest coitus with insemination, we concluded that coitus does not
improve pregnancy outcomes with male subfertility.
Keywords: Coitus; intrauterin insemination; male subfertility
REFERANSLAR
- Zegers-Hochschild F, Adamson GD, Dyer S. et al. The international glossary on infertility and fertility care. Human Reproduction. 2017;32(9):1786-801. [Crossref] [PubMed] [PMC]
- Cooper TG, Noonan E, Von Eckardstein S. et al. World Health Organization reference values for human semen characteristics. Human Reproduction Update. 2010;16(3),231-245. [Crossref] [PubMed]
- Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Human Reproduction Update. 2015;21(4):411-26. [Crossref] [PubMed]
- Jenkins J, Daya S, Kremer J. et al. European Classification of Infertility Taskforce (ECIT) response to Habbema et al.' Towards less confusing terminology in reproductive medicine: a proposal'. Human Reproduction. 2004;19(12):2687-8. [Crossref] [PubMed]
- Kişnişçi HA, Gökşin E, Durukan T. et al. Male Infertility, Andrology. Basic Gynecology and Obstetrics, Ed. Ankara: Güneş, 1996.
- Miller JH, Weinberg RK, Canino NL, Klein NA, Soules MR. The pattern of infertility diagnoses in women of advanced reproductive age. American Journal of Obstetrics and Gynecology. 1999;181(4):952-7. [Crossref] [PubMed]
- Aboulghar MA, Mansour RT, Serour GI, Amin Y, Abbas AM, Salah IM. Ovarian superstimulation and intrauterine insemination for the treatment of unexplained infertility. Fertility and Sterility. 1993;60(2):303-6. [Crossref] [PubMed]
- Penzias A, Bendikson K, Falcone T.et al. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertility and Sterility. 2020;113(2):305-22. [Crossref] [PubMed]
- Van Rumste MME, Custers IM, Van der Veen F, Van Wely M, Evers JLH, Mol BWJ. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Human Reproduction Update. 2008;14(6):563-70. [Crossref] [PubMed]
- Ho PC, So WK, Chan YF, Yeung WB. Intrauterine insemination after ovarian stimulation as a treatment for subfertility because of subnormal semen: a prospective randomized controlled trial. Fertil Steril. 1992;58(5):995-9. [Crossref] [PubMed]
- Dodson WC, Haney AF. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility. Fertility and Sterility. 1991;55(3):457-67. [Crossref] [PubMed]
- Burr RW, Siegberg R, Flaherty SP, Wang XJ, Matthews CD. The influence of sperm morphology and the number of motile sperm inseminated on the outcome of intrauterine insemination combined with mild ovarian stimulation. Fertility and Sterility. 1996; 65(1):127-32. [Crossref] [PubMed]
- Brasch JG, Rawlins R, Tarchala S, Radwanska E. The relationship between total motile sperm count and the successof intrauterine insemination. Fertility and Sterility. 1994;62(1):150-4. [Crossref] [PubMed]
- Silverberg KM, Johnson JV, Olive DL, Burns WN, Schenken, RS. A prospective, randomized trial comparing two different intrauterine insemination regimens in controlled ovarian hyperstimulation cycles. Fertility and Sterility. 1992;57(2):357-61. [Crossref] [PubMed]
- Tur-Kaspa I, Dudkiewicz A, Confino E, Gleicher N. Pooled sequential ejaculates: a way to increase the total number of motile sperm from oligozoospermic men. Fertility and Sterility. 1990;54(5):906-9. [Crossref] [PubMed]
- Matilsky M, Battino S, Ben-Ami M, Geslevich Y, Eyali V, Shalev E. The effect of ejaculatory frequency on semen characteristics of normozoospermic and oligozoospermic men from an infertile population. Human Reproduction. 1993;8(1):71-3. [Crossref] [PubMed]
- Gökçe A, Semen Analysis and Interpretation: 2010. WHO. Turiksh Urol Sem. 2011;2:1-7.
- Lin H, Li Y, Ou S. et al. The relationship of total progressive motile sperm count with the outcome of IUI? An analysis of 5171 cycles. Gynecological Endocrinology. 2022;38(11):954-9. [Crossref] [PubMed]
- Bahadur G, Almossawi O, Zaid Z. et al. Semen characteristics in consecutive ejaculates with short abstinence in subfertile males. Reprod Biomed Online. 2015;32:323-8. [Crossref] [PubMed]
- Horvath PM, Bohrer M, Shelden RM, Kemmann E. The relationship of sperm parameters to cycle fecundity in superovulated women undergoing intrauterine insemination. Fertil Steril 1989; 52:288-94. [Crossref] [PubMed]
- Reindollar RH, Regan MM, Neumann PJ, Levine BS, Thornton KL. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertile Sterile. 2010; 94:888-99. [Crossref] [PubMed]
- Huang FJ, Chang SY, Chang JC, Kung FT, Wuu JF, Tsai MY. Timed intercourse after intrauterine insemination for treatment of infertility. Eur J Obstet Gynaecol Reprod Biol. 1998;80:257-61. [Crossref] [PubMed]
- Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil Steril. 2001;75:661-8. [Crossref] [PubMed]
- Uzunbatak F. Açıklanamayan infertil hastalarda cinsel ilişkinin ovulasyon indüksiyonu ile intrauterin inseminasyon yapılan hastalarda gebelik oranlarına etkisi (Tıpta uzmanlık tezi). Ankara: Gazi Üniversitesi; 2017. [Link]