Kötü Over Yanıtlı İnfertil Hasta Popülasyonunda Aromataz Inhibitörlü Kontrollü Ovarian Hiperstimülasyon Protokolleri ile Gerçekleştirilen Intrasitoplazmik Sperm Enjeksiyonu Sonuçlarının Değerlendirilmesi Ve Oral Kontraseptif Tedavinin Bu Sonuçlara Etkisi
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The aim of this study is to evaluate the results of controlled ovarian hyperstimulation (COH) protocols with aromatase inhibitors (AI) used in in vitro fertilisation (IVF) cycles in infertile patients who are especially poor ovarian responders (POR) and effects of oral contraceptive (OCP) pretreatment on these results. 1218 poor ovarian responder patients (1980 cycles) who were administered COH protocols with AI and GnRH antagonist were included in the study. In AI arm there were 1524 patients (1832 cycles) and in AI+OCP arm there were 142 patients (148 cycles). Demographic characteristics, cancelled cycle number, woman?s age (year), body mass index (kg/m2) and infertility interval (month) were similiar between both of these two groups. Antral follicle count was significantly higher in AI arm (5.0±2.7 and 4.3±1.9, p<0,05). Duration of stimulation (day) was shorter in AI arm (9.8±2.8 and 10.9±2.6, p<0,01). Total FSH dose consumption (IU) was lower in AI arm (57.2±14.6 and 64.9±15.3, p<0,01). Outcomes of COH like follicle number whose diameter is >17 mm on hCG administration, follicle number whose diameter is 15-17 mm on hCG administration, follicle number whose diameter is 10-14 mm on hCG administration and endometrial thickness (mm) on hCG administration were comparable between both of these two groups. Cumulus-oocyte complex number, metaphase-II oocyte number, metaphase-II oocyte number / total oocyte number rate (%), fertilization rate (2-pronuclei oocyte number / metaphase-II oocyte number) (%), 2-pronuclei oocyte number, 3rd day existant embryo number, 3rd day existant embryo number which has more than 7 cells and smaller fragmentation rate than %10 and transferred embryo number were comparable between both of these two groups. Clinical pregnancy number per embryo transfer rate was higher in AI arm (21.9% and 11.1%, p<0,05). Also implantation rate was significantly higher in AI arm as compared to AI+OCP arm (14.7% and 8.2%, p<0,05). Live birth rate (%), multiple pregnancy rate (%) and abortus rate (%) were comparable between both of these two groups. In our whole study group, mean gestational period was 36,5±3,5 (29,1-40,2) weeks, 34,4±2,4 (27,7-39,1) weeks, 31,3±0,9 (30,7-32,0) weeks in singletons, twins and triplets respectively. Mean birth weight was 2912±769 (600-5200) grams, 1983±510 (970-2800) grams, 1625±813 (1050-2200) grams in singletons, twins and triplets respectively. In AI arm, major congenital malformation rate was 2,84% (6/211), minor congenital malformation rate was 3,31% (7/211), total congenital malformation rate was 6,16% (13/211) and perinatal mortality rate was calculated as 1,4% (3/211).