ORİJİNAL ARAŞTIRMALAR
POSEIDON 3-4 Düşük Over Rezervi Olgularda Ardışık Kontrollü Ovarian Stimülasyon (KOS)
Sequential Ovarian Stimulation for POSEIDON Group 3-4 Poor Responders
Received Date : 28 Aug 2022
Accepted Date : 01 Dec 2022
Available Online : 15 Dec 2022
Emre Göksan PABUÇCUa, Nilüfer AKGÜNb, Ece GARİBOĞLU DALGINc, Recai PABUÇCUa
aDepartment of Obstetrics and Gynecology, Faculty of Medicine, Ufuk University Ankara, Türkiye
bDepartment of Obstetrics and Gynecology, Ankara Education and Research Hospital, Ankara, Türkiye
cDepartment of Embryology, Centrum Clinic IVF Center, Ankara, Türkiye
Doi: 10.24074/tjrms.2022-93110 - Makale Dili: EN
TJRMS. 2022;6(2):152-6
ÖZET
Amaç: DuoStim (double ovarian stimulation) en önemli kısım kontrollü ovarian stimulasyon için overlerden oosit toplanması (OPU) (foliküler faz) ve 2. OPU (luteal
faz) için en uygun stimülasyon protokolünün belirlenmesidir. Çalışmamızda ardışık stimülasyon tedavisi etkisi, toplanan oosit sayısı, oosit maturasyonu, fertilizasyon
ve blastosist oranlarını POSEIDON 3-4 gruplarında analiz edilmesi planlandı. Gereç ve Yöntem: POSEIDON 3-4 grup hastalara özel bir merkezde ardışık KOS protokolü
uygulanması planlandı. Ovarian stimülasyonu, gonadotropin kombinasyonunu 300 IU/gün fiks doz (150 IU recFSH+75 IU rec LH ile ek 75 IU rec FSH ile
birlikte) ile başlandı. Medroksi progesteron asetat 10mg/gün kullanılarak antagonist etki sağlandı. Son oosit matürasyonu 0.2 mg Triptorelin ile indüklendi. İlk oosit
toplanmasından iki gün sonra aynı protokol ve doz ile ikinci stimülasyon başlandı. Ovulasyon, rec hCG (250 mcg) ile bolus GnRH-a ile indüklendi. Klivaj ve blastosist
embriyo sayıları hesaplandı. Bulgular: 98 siklusu oluşturan 49 POSEIDON 3-4 hastası çalışmaya dahil edildi. Ortalama yaş 34.4 ±6 yıl ve serum AMH düzeyi
0.85 ±0.2 ng/ml idi. 1. ve 2. siklus oosit stimülasyon süresi (8,8±3,1'e karşı 8,2±3,6 gün) ve kullanılan toplam gonadotropin dozu (2829±840'a karşı 1846±421 IU)
benzerdi. Alınan ortalama oosit sayısı (1.9'a karşı 2.1) ve M2 oositlerin (1.4'e karşı 1.7) benzerdi. Ortalama oosit maturasyon oranları da benzer idi. (Sırasıyla %77.5;
%75.6, p=0.8). Oositler için siklus başına ortalama fertilizasyon oranları farklılık göstermedi (%84.7'ye karşı %68.6, p=0.06). Siklus başına ortalama blastosist oranı
sırasıyla %63 ve %69 idi (p=0.8). DuoStim sonrası hastaların %79.6'sında 1. ve 2. siklustan sonra veya her ikisinden sonra en az 1 embriyo elde edildi. Sonuç: Özellikle
oosit elde etme olasılığı az olan hastalarda embriyo ve blastosist elde etme süresini kısaltmak için ardışık KOS etkili bir yöntem olabilir. Ayrıca ardışık stimülasyon
protokolü ile hem 1. hem de 2. siklusta aynı sayıda oosit ve blastosit oranları elde edilebilmekte ve bu yöntemle hastalara zaman kazandırabilmektedir. Özellikle POSEIDON
3-4 grupları için daha büyük ölçekli randomize kontrollü çalışmaların yapılması önerilir.
Anahtar Kelimeler: Ardışık ovarian stimülasyon; POSEIDON grup 3-4; düşük over rezervi
ABSTRACT
Objective: The most important issue in both the follicular and luteal phases of the same ovarian cycle (DuoStim) is determining the most appropriate stimulation protocol
for the 1st OPU (follicular phase) and 2nd OPU (the luteal phase). We analyzed the POSEIDON 3-4 groups undergoing sequential stimulation treatment to investigate
the effects on oocyte number, oocyte maturation, fertilization, and blastocyst rate. Material and Method: POSEIDON 3-4 groups were scheduled for a
sequential stimulation protocol in a private fertility center. Ovarian stimulation was started with a fixed dose of 300 IU/day of a combination of gonadotropins (150
IU recFSH+75 IU rec LH along with an additional 75 IU rec FSH). Medroxy progesterone acetate 10mg/day using. Final oocyte maturation was induced with 0.2 mg
triptorelin. Two days after the first retrieval, the second stimulation was initiated with the same protocol and daily dose. Ovulation was induced with a bolus of GnRHa
with rec hCG (250mcg). One or two cleavage or blastocyst stage embryos were calculated. Results: 49 POSEIDON 3-4 patients were included in the final analysis,
representing 98 cycles. The mean age was 34.4 ±6 years, and the serum AMH level was 0.85 ±0.2 ng/ml. The duration of stimulation (8.8±3.1 vs 8.2±3.6 days)
and the total dose of gonadotropin used (2829±840 vs 1846±421 IU) were comparable. The mean number of oocytes retrieved (1.9 vs 2.1) and M2 oocytes (1.4 vs
1.7) were comparable. Mean oocyte maturation rates per cycle were also comparable (75.6% vs. 77.5%, respectively, p=0.8). Mean fertilization rates per cycle did
not differ for oocytes collected (84.7% vs. 68.6%, p=0.06). The mean blastocyst rate per cycle was 63% and 69% respectively (p=0.8). At least 1 embryo was retrieved
after the 1st and 2nd cycle or both in 79.6% of patients after DuoStim. Conclusion: DuoStim can be an effective method to reduce the time to achieve embryo and
blastocyst, especially in POSEIDON 3-4. Also, with the sequential stimulation protocol, we can obtain the same number of oocytes and blastocyte rates in both cycles,
and this methodology can save patients time. Further large-scale randomized controlled trials are recommended, especially for the POSEIDON 3-4 groups.
Keywords: Sequential ovarian stimulation; POSEIDON group 3-4; poor responders
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