Yıl: 2024 Cilt: 20 Sayı: 1 Sayfa Aralığı: 72 - 78 Metin Dili: İngilizce DOI: 10.4274/BMJ.galenos.2024.2023.10-3 İndeks Tarihi: 10-06-2024

Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate

Öz:
Objective: The primary aim of this study was to investigate the effects of autologous intrauterine platelet-rich plasma (IU-PRP) infusion during ovulation induction with clomiphene citrate (CC) on endometrial thickness (EMT) and clinical pregnancy in patients with polycystic ovary syndrome (PCOS) and thin endometrium. The secondary outcome was to detect possible transformations in oligomenorrheic cycles after PRP. Methods: This study was conducted on 35 anovulatory PCOS patients aged between 22 and 29 years who applied for infertility treatment. The patients had a thin endometrium in their past history. EMT 7 mm was considered thin endometrium. The diagnosis of PCOS was made according to the revised Rotterdam criteria. A total of 35 patients were divided into two groups according to whether they received PRP or not. Twenty patients received CC plus PRP treatment, whereas 15 patients received CC treatment alone. Patients in both groups were administered CC at a dose of 100 mg/day for 5 days, starting from the 3rd day of progesterone-related withdrawal bleeding. Follicular development and EMT were recorded using transvaginal ultrasonography. In cases with EMT <7 mm, approximately 0.5-1 mL of autologous PRP was infused with the IUI catheter, four days after CC treatment, i.e., on the ninth day of the cycle. EMT was measured and recorded again 3 and 6 days after PRP. Timed intercourse was recommended for cases with a follicle with a mean diameter of at least 16-18 mm. The biochemical and clinical pregnancy rates of both groups were recorded. Results: Both groups were similar in terms of participant age and body mass index. All participants in the CC plus PRP group were successfully infused with autologous PRP on the ninth day of the cycle. The serum estradiol, testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and LH/FSH ratios of both groups were similar. Biochemical pregnancy and clinical pregnancy rates of the CC plus PRP group were significantly higher than those of the CC alone group (p<0.03 and p<0.02, respectively). Although clinical pregnancy was detected in 5 individuals in the PRP group (25%), clinical pregnancy was recorded in 2 individuals in the CC alone group (13.3%). There was no significant change in the oligo/anovulatory cycle patterns of patients with and without PRP. EMT values on the sixth (4.96±2.11 mm vs. 4.68±2.47 mm, p<0.37) and eighth days were similar between the two groups (5.11±3.10 mm vs. 5.29±3.01 mm, p<0.51). Compared with the CC alone group, the EMT values measured both at day 12 (6.34±1.09 mm vs. 5.47±3.90 mm, p<0.02) and at day 15 (7.44±2.60 mm vs. 6.23±2.70 mm, p<0.01) in the PRP group were found to be significantly higher. Conclusion: IU-PRP infusion in PCOS patients with thin endometrium who underwent ovulation stimulation with CC significantly increased both EMT and clinical pregnancy rates.
Anahtar Kelime:

Otolog Trombosit Açısından Zengin Plazma İntrauterin Perfüzyonu, Klomifen Sitrat Nedeniyle İnce Endometriyumu Düzelterek Doğurganlık Sonucunu İyileştirir

Öz:
Amaç: Bu çalışmanın temel amacı ince endometriyuma sahip polikistik over sendromu (PKOS) hastalarında ovulasyon indüksiyonu sırasında klomifen sitrat (KS) ile otolog intrauterin trombositten zengin plazma (IU-PRP) infüzyonunun endometriyal kalınlık (EMT) ve klinik gebelik üzerine etkilerini araştırmaktır. İkincil sonuç, PRP sonrası oligomenoreik döngülerdeki olası dönüşümleri tespit etmektir. Gereç ve Yöntem: Bu çalışma, infertilite tedavisi için başvuran, yaşları 22-29 arasında değişen 35 anovulatuar PKOS hastası üzerinde gerçekleştirildi. Hastaların geçmiş anamnezlerinde ince endometriyum mevcuttu. Endometriyal kalınlığın 7 mm’nin altında olması ince endometriyum olarak kabul edildi. PKOS tanısı revize edilmiş Rotterdam kriterlerine göre konuldu. Toplam 35 hasta PRP alıp almamalarına göre iki gruba ayrıldı. Yirmi hastaya KS artı PRP tedavisi uygulanırken, 15 hastaya yalnızca KS tedavisi uygulandı. Her iki gruptaki hastalara progesterona bağlı çekilme kanamasının 3. gününden itibaren 5 gün süreyle 100 mg/gün dozunda KS verildi. Foliküler gelişim ve endometriyal kalınlık transvajinal ultrasonografi ile kaydedildi. Endometriyal kalınlık <7 mm olan olgulara KS tedavisinden dört gün sonra yani siklusun dokuzuncu gününde IUI kateteri ile yaklaşık 0,5-1 mL otolog PRP infüze edildi. EMT, PRP’den 3 ve 6 gün sonra tekrar ölçüldü ve kaydedildi. Ortalama çapı en az 16-18 mm olan folikül olgularında zamanlı ilişki önerildi. Her iki grubun biyokimyasal ve klinik gebelik oranları kaydedildi. Bulgular: Her iki grup da katılımcı yaşı ve vücut kitle indeksi açısından benzerdi. KS artı PRP grubundaki tüm katılımcılara döngünün dokuzuncu gününde başarıyla otolog PRP uygulandı. Her iki grubun serum östradiol, testosteron, luteinize edici hormon (LH), folikül stimülan hormon (FSH) ve LH/FSH oranları benzerdi. KS artı PRP grubunun biyokimyasal gebelik ve klinik gebelik oranları, yalnızca KS grubuna göre anlamlı derecede yüksekti (sırasıyla p<0,03 ve p<0,02). PRP grubunda 5 kişide (%25) klinik gebelik tespit edilirken, sadece KS grubunda 2 kişide (%13,3) klinik gebelik kaydedildi. PRP uygulanan ve uygulanmayan hastaların oligo/anovulatuar siklus paternlerinde anlamlı bir değişiklik olmadı. Altıncı gün (4,96±2,11 mm vs. 4,68±2,47 mm, p<0,37) ve sekizinci gündeki EMT değerleri iki grup arasında benzerdi (5,11±3,10 mm vs. 5,29±3,01 mm, p<0,51). Yalnızca KS grubuyla karşılaştırıldığında, EMT değerleri hem 12. günde (6,34±1,09 mm vs. 5,47±3,90 mm, p<0,02) hem de 15. günde (7,44±2,60 mm vs. 6,23±2,70 mm, p<0,01) PRP grubunda anlamlı olarak yüksek bulunmuştur. Sonuç: KS ile ovulasyon stimülasyonu uygulanan ince endometriyumlu PKOS hastalarında uygulanan IU-PRP infüzyonu hem endometriyal kalınlığı hem de klinik gebelik oranlarını anlamlı derecede artırmaktadır.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA Özyurt R, Bulutlar E, yılmaz b (2024). Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. , 72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
Chicago Özyurt Ramazan,Bulutlar Eralp,yılmaz banu Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. (2024): 72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
MLA Özyurt Ramazan,Bulutlar Eralp,yılmaz banu Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. , 2024, ss.72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
AMA Özyurt R,Bulutlar E,yılmaz b Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. . 2024; 72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
Vancouver Özyurt R,Bulutlar E,yılmaz b Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. . 2024; 72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
IEEE Özyurt R,Bulutlar E,yılmaz b "Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate." , ss.72 - 78, 2024. 10.4274/BMJ.galenos.2024.2023.10-3
ISNAD Özyurt, Ramazan vd. "Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate". (2024), 72-78. https://doi.org/10.4274/BMJ.galenos.2024.2023.10-3
APA Özyurt R, Bulutlar E, yılmaz b (2024). Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. Bakırköy Tıp Dergisi, 20(1), 72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
Chicago Özyurt Ramazan,Bulutlar Eralp,yılmaz banu Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. Bakırköy Tıp Dergisi 20, no.1 (2024): 72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
MLA Özyurt Ramazan,Bulutlar Eralp,yılmaz banu Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. Bakırköy Tıp Dergisi, vol.20, no.1, 2024, ss.72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
AMA Özyurt R,Bulutlar E,yılmaz b Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. Bakırköy Tıp Dergisi. 2024; 20(1): 72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
Vancouver Özyurt R,Bulutlar E,yılmaz b Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate. Bakırköy Tıp Dergisi. 2024; 20(1): 72 - 78. 10.4274/BMJ.galenos.2024.2023.10-3
IEEE Özyurt R,Bulutlar E,yılmaz b "Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate." Bakırköy Tıp Dergisi, 20, ss.72 - 78, 2024. 10.4274/BMJ.galenos.2024.2023.10-3
ISNAD Özyurt, Ramazan vd. "Autologous Platelet-rich Plasma Intrauterine Perfusion Improves the Fertility Outcome by Correcting the Thin Endometrium due to Clomiphene Citrate". Bakırköy Tıp Dergisi 20/1 (2024), 72-78. https://doi.org/10.4274/BMJ.galenos.2024.2023.10-3