İnfertilite nedeniyle eş spermi ile uygulanan 78 intrauterin inseminasyon (İUİ) siklusunun sonuçları ve İUİ başarısını etkileyen faktörler: Retrospektif bir çalışma

Abstract

Öz:Bu çalışmamızda intrauterin inseminasyon (İUİ) sonuçlarımızın ve sonuçlar üzerine etkili faktörlerin değerlendirilmesini amaçladık. İnfertilite nedeniyle 35 eşte yaklaşık 1 yılda klomifen sitratla over stimulasyonu sonrası uygulanan 78 İUİ siklusunun sonuçları retrospektif analiz edildi. Sperm hazırlamada Discontinuous Gradient Centrifugation (DGC) yöntemi kullanıldı. Erkek-kadın yaşı ve infertilite süresi ortalamaları sırasıyla 29.94±4.72 yıl, 27.46±4.55 yıl ve 63.23±30.88 aydı. On erkek sigara içiyordu. On dört erkek varikoselektomi geçirmişti. Yedi erkekte sol varikosel saptandı. Bütün erkekler normospermikti. Eş başına maksimum 3 İUİ siklusu uygulanmıştı. Eş ve siklus başına gebelik oranları sırasıyla %20 (7/35) ve %8.97 (7/78) idi. Bütün gebelikler normal canlı doğumla sonuçlandı. Üç siklus arasında gebelik oranı açısından fark yoktu. Başarılı grupta erkek ve özellikle kadın yaşı ortalamaları istatistiksel olarak daha düşüktü (sırasıyla p=0.041, p=0.009). DGC sonrası yerinde hareketli sperm yüzdesi dışında bütün semen analizi parametrelerinde oldukça anlamlı düzelme gelişti. Ancak hiçbir parametrenin gebelik üzerinde etkisinin olmadığı saptandı. İnfertilite tipi-süresi ve sigara öyküsünün başarı üzerinde etkisi yoktu. Fizik muayenede varikosel saptanmayanlarda ve önceden başarılı varikoselektomi geçirmiş olanlarda daha yüksek gebelik oranları elde edildi. İnfertil çiftlerde İUİ başarısı üzerinde en etkili faktörler, erkek ve özellikle kadın yaşının genç olmasıdır. Erkekte varikosel olmaması veya başarılı tedavisi başarı üzerinde olumlu etkiler yaratıyor görünmektedir.

Abstract:Introduction: Intrauterine insemination (IUI) with or without controlled ovarian hyperstimulation is a widely used therapeutic option for a variety of causes of infertility. Compared to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), IUI is efficient and more cost-effective than the others for the treatment of unexplained and nonsevere male factor infertility. In this retrospective study, we aimed to determine our IUI outcomes and the variables influencing IUI success. Materials and Methods: To determine the influence of several parameters (age, duration and type of infertility, semen parameters, presence of varicocele, varicocelectomy and smoking histories) on the outcome of IUI in 35 women undergoing ovarian stimulation with clomiphen citrat, a retrospective review of 78 IUI cycles, which were done for the treatment of infertility using fresh husband sperm, was performed for approximately 1 year on data from the IUI program. Results of Pre-IUI evaluations were normal in all women and all men had normal semen analyses results. Discontinuous gradient centrifugation (DGC) with Sil-Select Plus was used for sperm preparation. Maximum number of IUI cycles per couple was three. In statistical analysis, ?2, Fisher's exact and Mann-Whitney U tests for in- and between-group comparisons and Pearson and Spearman tests for correlation analyses were used. Results: Primary and secondary infertility were determined in 25 and 10 couples, respectively. Fourteen men had varicocelectomy history. Ten men were smoking cigarette. Seven men had left varicocele at physical examination. Means of man and woman age and infertility duration were 29.94±4.72 (23-46) years, 27.46±4.55 (20-38) years and 63.23±30.88 (15-123) months, respectively. The pregnancy rate was 8.97% (7/78) per treatment cycle, 20% (7/35) per patient, 5.71% (2/35) for first cycle, 10.34% (3/29) for second cycle and 14.3% (2/14) for third cycle. All pregnancies were normal. No miscarriage, tubal pregnancy, birth defect and prematurity were observed. Difference between the pregnancy rates of each cycle was statistically insignificant (p=0.697). There were statistically significant negative correlations between the pregnancy rate and mean ages of the men and especially women (p=0.041, p=0.009, respectively). However, no correlation was found between pregnancy rate and infertility duration (p=0.108). DGC procedure increased percents of the sperms moving with a slow, meandering forward progression (grade 2) and in a straight line with high speed (grade 4) and decreased percent of sperms with no movement (grade 0) very significantly, without changing the percent of those with sluggish or nonprogressive movement (grade 1). However no-one of the pre and post-DGC semen analysis parameter was found to have influence on pregnancy rate. Pregnancy rates in the primary and secondary infertile couples were statistically indifferent. Pregnancy rates achieved in patients without varicocele or with a history of successful varicocelectomy were higher than those with untreated varicocele and with a history of unsuccessful varicocelectomy. There was not any statistically significant difference between the pregnancy rates in the patients with and without smoking history. Conclusion: The most significant predictors of success of IUI with fresh husband sperm in infertile couples were age of the woman and man. Absence of varicocele and treatment of it seemed to have affirmative effect on pregnancy rate.