بررسی نتایج حاصل از درمان توسط تکنیک‌های کمک باروری در بیمارستان شهید بهشتی اصفهان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشیار، گروه علوم تشریحی، دانشکده‌ی پزشکی و آزمایشگاه نازایی، بیمارستان شهید بهشتی اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 متخصص زنان و زایمان، بخش نازایی، بیمارستان شهید بهشتی اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 آزمایشگاه نازایی، بیمارستان شهید بهشتی اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 بخش نازایی، بیمارستان شهید بهشتی اصفهان، اصفهان، ایران

5 استادیار، گروه علوم تشریحی، دانشکده‌ی پزشکی و آزمایشگاه نازایی بیمارستان شهید بهشتی اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: امروزه استفاده از تکنیک‌های کمک باروری، مشکل بسیاری از افراد نابارور را برطرف نموده است. تکرار سیکل‌های درمانی، صرف وقت و هزینه‌ی به نسبت زیاد و مشکلات احتمالی ناشی از بیهوشی‌های مکرر، محققین را به سمت یافتن راه‌هایی برای پیش‌بینی میزان موفقیت هر یک از تکنیک‌ها هدایت نموده است. این تحقیق، با هدف بررسی میزان موفقیت روش‌های کمک باروری انجام گرفت.روش‌ها: مطالعه‌ی حاضر، گذشته نگر بود و جمعیت مورد مطالعه، 71 زوجی بودند که طی شش ماهه‌ی اول سال 1392 جهت انجام تکنیک‌های کمک باروری به مرکز درمان ناباروری شهید بهشتی شهر اصفهان مراجعه کرده بودند. معیار اصلی در حصول نتایج، بارداری بالینی دو هفته پس از قرار دادن جنین در رحم مادر بود. اطلاعات مورد نیاز مانند سن و نتایج آزمایش‌های مایع منی و نیز نتیجه‌ی حاصل از انجام تکنیک‌های کمک باروری، از پرونده‌ی این بیماران استخراج شد.یافته‌ها: از کل زوج‌های تحت بررسی، 42 مورد تحت درمان به روش تلقیح داخل رحمی اسپرم (IUI یا Intrauterine insemination) و 29 مورد تحت درمان به روش لقاح آزمایشگاهی (IVF/ICSI یا In vitro fertilization/Intracytoplasmic sperm injection) قرار گرفتند. از 42 دوره IUI، 10 دوره‌ی موفق (8/23 درصد) و از 29 دوره IVF/ICSI نیز 7 دوره‌ی موفق (1/24 درصد) دیده شد. میانگین سنی زنان و مردان و مدت زمان ناباروری در دو گروه موفق و ناموفق در مورد روش IUI اختلاف آماری معنی‌داری نداشت. در حالی که این میانگین در مورد روش IVF/ICSI معنی‌دار بود. میان پارامتر‌های اسپرمی نیز بین دو گروه موفق و ناموفق در گروه درمانی IUI ارتباط آماری معنی‌داری یافت نشد، اما در مورد گروه درمانی IVF/ICSI درصد اسپرم‌های سریع به صورت معنی‌داری در دو گروه موفق و ناموفق متفاوت بود.نتیجه‌گیری: آنالیز مرسوم منی و سن زن و شوهر نمی‌توانند پیش‌بینی کننده‌ی نتایج استفاده از روش IUI باشند، اما میزان موفقیت روش IVF/ICSI در موارد سن پایین‌تر زوجین، همچنین مدت زمان ناباروری کمتر و پارامترهای اسپرمی بهتر، افزایش می‌یابد. 

کلیدواژه‌ها

عنوان مقاله [English]

Evaluation of the Success Rate of Assisted Reproductive Techniques (ART) in Shahid Beheshti Infertility Center, Isfahan, Iran

نویسندگان [English]

  • Roshanak Abutorabi 1
  • Vida Razavi 2
  • Shekufeh Baghazadeh 3
  • Laleh Sharegh 4
  • Fatemeh Sadat Mostafavi 5
1 Associate Professor, Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences AND Infertility Laboratory, Shahid Beheshti Hospital, Isfahan, Iran
2 Gynecologist, Department of Infertility, Shahid Beheshti Hospital, Isfahan, Iran
3 Infertility Laboratory, Shahid Beheshti Hospital, Isfahan, Iran
4 Department of Infertility, Shahid Beheshti Hospital, Isfahan, Iran
5 Assistant Professor, Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences AND Infertility Laboratory, Shahid Beheshti Hospital, Isfahan, Iran
چکیده [English]

Background: Today, usage of assisted reproductive techniques (ART) has been resolved the problem of many infertile couples. Repeated treatment cycles, long time and high cost, problems due to repeated anesthesia, has been directed the researchers to find ways to predict the success rate of each method. This study aimed to evaluate the success of assisted reproductive techniques in Isfahan Shahid Beheshti infertility center, Iran.Methods: In this retrospective study, 71 couples referred to this center for assisted reproductive techniques during the first six months of 2013 were enrolled. The main criterion for a positive result was clinical pregnancy two weeks after embryo transfer. Required information such as age, semen analysis and outcome of assisted reproductive techniques, were obtained from patients' medical records.Findings: Of all couples, 42 cases were treated with intrauterine insemination (IUI) and 29 cases were treated with in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). 23.8% of IUI cycles and 24.1% of IVF/ICSI cycles were successful. The mean age and duration of infertility in both successful and unsuccessful IUI groups were not statistically significant; while these diferences in the cases of IVF/ICSI were significant. In addition, there were no significant differences between the sperm parameters in successful and unsuccessful IUI treated groups; but in IVF/ICSI treated group, we found significant differences in the percent of fast motile sperms between successful and unsuccessful groups.Conclusion: Conventional analysis of semen and couple’s age cannot predict the outcome of IUI; but the success rate of IVF/ICSI is related to the age of couples, as well as shorter duration of infertility and better semen parameters.

کلیدواژه‌ها [English]

  • Infertility
  • Intrauterine insemination
  • In-vitro fertilization
  • Intracytoplasmic sperm injection
  • Sperm parameters

مراجع

  1. Sharlip ID, Jarow JP, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al. Best practice policies for male infertility. Fertil Steril 2002; 77(5): 873-82.
  2. Nallella KP, Sharma RK, Aziz N, Agarwal A. Significance of sperm characteristics in the evaluation of male infertility. Fertil Steril 2006; 85(3): 629-34.
  3. Duran HE, Morshedi M, Kruger T, Oehninger S. Intrauterine insemination: a systematic review on determinants of success. Hum Reprod Update 2002; 8(4): 373-84.
  4. Kalra SK, Barnhart KT. In vitro fertilization and adverse childhood outcomes: what we know, where we are going, and how we will get there. A glimpse into what lies behind and beckons ahead. Fertil Steril 2011; 95(6): 1887-9.
  5. Sigman M. Therapeutic insemination. In: Sciarra J, editor. Gynecology and obstetrics. Philadelphia, PA: Lippincott Williams and Wilkins; 1999. vol 67. p. 7-8.
  6. Jarvela IY, Tapanainen JS, Martikainen H. Improved pregnancy rate with administration of hCG after intrauterine insemination: a pilot study. Reprod Biol Endocrinol 2010; 8: 18.
  7. Zadehmodarres S, Oladi B, Saeedi S, Jahed F, Ashraf H. Intrauterine insemination with husband semen: an evaluation of pregnancy rate and factors affecting outcome. J Assist Reprod Genet 2009; 26(1): 7-11.
  8. Gibbs RS, Karlan BY, Haney AF, Nygaard IE. Danforth's obstetrics and gynecology. Philadelphia, PA: Lippincott Williams and Wilkins; 2008.
  9. Sunderam S, Chang J, Flowers L, Kulkarni A, Sentelle G, Jeng G, et al. Assisted reproductive technology surveillance --- United States, 2006. MMWR Surveill Summ 2009; 58(SS05): 1-25.
  10. Sunderam S, Kissin DM, Flowers L, Anderson JE, Folger SG, Jamieson DJ, et al. Assisted reproductive technology surveillance--United States, 2009. MMWR Surveill Summ 2012; 61(7): 1-23.
  11. Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod 1999; 14(3): 698-703.
  12. Gezginc K, Gorkemli H, Celik C, Karatayli R, Cicek MN, Olakoglu MC. Comparison of single versus double intrauterine insemination. Taiwan J Obstet Gynecol 2008; 47(1): 57-61.
  13. Demirol A, Gurgan T. Comparison of different gonadotrophin preparations in intrauterine insemination cycles for the treatment of unexplained infertility: a prospective, randomized study. Hum Reprod 2007; 22(1): 97-100.
  14. Freour T, Jean M, Mirallie S, Langlois ML, Dubourdieu S, Barriere P. Predictive value of CASA parameters in IUI with frozen donor sperm. Int J Androl. 2009; 32(5): 498-504.
  15. Demir B, Dilbaz B, Cinar O, Karadag B, Tasci Y, Kocak M, et al. Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics. J Obstet Gynaecol 2011; 31(5): 420-3.
  16. Jahanian M, Khadem N, Mousavifard N, Torabizadeh A, Vahid-Roudsari F, Yousefi Z, et al. The correlation between total normal motile sperm and Pregnancy outcome after Intrauterine Insemination. J Reprod Fertil 2001; 2(6): 48-53. [In Persian].
  17. Berry CW, Brambati B, Eskes TK, Exalto N, Fox H, Geraedts JP, et al. The Euro-Team Early Pregnancy (ETEP) protocol for recurrent miscarriage. Hum Reprod 1995; 10(6): 1516-20.
  18. Mehrafza M, Nobakhti N, Atrkar Roushan Z, Dashtdar H, Oudi M, Hosseini A. The correlation between semen parameters and pregnancy outcome after intrauterine insemination. Iran J Reprod Med 2003; 1(1): 29-32.
  19. Chung PH, Verkauf BS, Mola R, Skinner L, Eichberg RD, Maroulis GB. Correlation between semen parameters of electroejaculates and achieving pregnancy by intrauterine insemination. Fertil Steril 1997; 67(1): 129-32.
  20. Shulman A, Hauser R, Lipitz S, Frenkel Y, Dor J, Bider D, et al. Sperm motility is a major determinant of pregnancy outcome following intrauterine insemination. J Assist Reprod Genet 1998; 15(6): 381-5.
  21. Yalti S, Gurbuz B, Sezer H, Celik S. Effects of semen characteristics on IUI combined with mild ovarian stimulation. Arch Androl 2004; 50(4): 239-46.
  22. Cano F, Simon C, Remohi J, Pellicer A. Effect of aging on the female reproductive system: evidence for a role of uterine senescence in the decline in female fecundity. Fertil Steril 1995; 64(3): 584-9.
  23. Abdalla HI, Burton G, Kirkland A, Johnson MR, Leonard T, Brooks AA, et al. Age, pregnancy and miscarriage: uterine versus ovarian factors. Hum Reprod 1993; 8(9): 1512-7.
  24. Bellver J, Garrido N, Remohi J, Pellicer A, Meseguer M. Influence of paternal age on assisted reproduction outcome. Reprod Biomed Online 2008; 17(5): 595-604.
  25. 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(4): 661-8.
  26. Miller DC, Hollenbeck BK, Smith GD, Randolph JF, Christman GM, Smith YR, et al. Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination. Urology 2002; 60(3): 497-501.
  27. Wainer R, Albert M, Dorion A, Bailly M, Bergere M, Lombroso R, et al. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination. Hum Reprod 2004; 19(9): 2060-5.
  28. Badawy A, Elnashar A, Eltotongy M. Effect of sperm morphology and number on success of intrauterine insemination. Fertil Steril 2009; 91(3): 777-81.
  29. Freour T, Jean M, Mirallie S, Dubourdieu S, Barriere P. Computer-Assisted Sperm Analysis (CASA) parameters and their evolution during preparation as predictors of pregnancy in intrauterine insemination with frozen-thawed donor semen cycles. Eur J Obstet Gynecol Reprod Biol 2010; 149(2): 186-9.
  30. Haim D, Leniaud L, Porcher R, Martin-Pont B, Wolf JP, Sifer C. Prospective evaluation of the impact of sperm characteristics on the outcome of intra-uterine insemination. Gynecol Obstet Fertil 2009; 37(3): 229-35. [In French].
  31. Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril 2010; 93(1): 79-88.
  32. Berker B, Sukur YE, Kahraman K, Atabekoglu CS, Sonmezer M, Ozmen B, et al. Absence of rapid and linear progressive motile spermatozoa "grade A" in semen specimens: does it change intrauterine insemination outcomes? Urology 2012; 80(6): 1262-6.
  33. Sun Y, Li B, Fan LQ, Zhu WB, Chen XJ, Feng JH, et al. Does sperm morphology affect the outcome of intrauterine insemination in patients with normal sperm concentration and motility? Andrologia 2012; 44(5): 299-304.
  34. Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod 1996; 11(9): 1892-6.
  35. Dodson WC, Haney AF. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility. Fertil Steril 1991; 55(3): 457-67.
  36. Hassani Bafrani H, Abedzadeh M, Fruzanfard F, Tabasi Z. Effects of patient age, duration and cause of infertility and number of pre-ovulatory follicles on intrauterine insemination outcomes. Koomesh 2010; 12(1): 59-65. [In Persian].
  37. Harlow CR, Cahill DJ, Maile LA, Talbot WM, Mears J, Wardle PG, et al. Reduced preovulatory granulosa cell steroidogenesis in women with endometriosis. J Clin Endocrinol Metab 1996; 81(1): 426-9.
  38. Crosignani PG, Walters DE. Clinical pregnancy and male subfertility; the ESHRE multicentre trial on the treatment of male subfertility. European Society of Human Reproduction and Embryology. Hum Reprod 1994; 9(6): 1112-8.
  39. Hughes EG, Collins JA, Gunby J. A randomized controlled trial of three low-dose gonadotrophin protocols for unexplained infertility. Hum Reprod 1998; 13(6): 1527-31.
  40. Peterson CM, Hatasaka HH, Jones KP, Poulson AM, Jr., Carrell DT, Urry RL. Ovulation induction with gonadotropins and intrauterine insemination compared with in vitro fertilization and no therapy: a prospective, nonrandomized, cohort study and meta-analysis. Fertil Steril 1994; 62(3): 535-44.
  41. Sabbaghian M, Modarresi T, Hosseinifar H, Daliri Hampa A, Karimian L, Ghaffari F, et al. Predictive value of semen parameters and age of the couple in pregnancy outcome after Intrauterine insemination. Tehran Univ Med J 2013; 71(8): 530-5. [In Persian].
  42. Sahakyan M, Harlow BL, Hornstein MD. Influence of age, diagnosis, and cycle number on pregnancy rates with gonadotropin-induced controlled ovarian hyperstimulation and intrauterine insemination. Fertil Steril 1999; 72(3): 500-4.
  43. Hwang K, Walters RC, Lipshultz LI. Contemporary concepts in the evaluation and management of male infertility. Nat Rev Urol 2011; 8(2): 86-94.
  44. Yousefi B, Azargon A. Predictive factors of intrauterine insemination success of women with infertility over 10 years. J Pak Med Assoc 2011; 61(2): 165-8.
مجله دانشکده پزشکی اصفهان
دوره 32، شماره 306 - شماره پیاپی 306
آذر و دی 1393
صفحه 1767-1781

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سابقه مقاله

  • تاریخ دریافت: 16 شهریور 1393
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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