آثار قرص پیشگیری از بارداری بر موفقیت باروری لقاح آزمایشگاهی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و زایمان، دانشکده پزشکی دانشگاه علوم پزشکی بابل

2 مربی گروه مامایی، دانشکده پزشکی دانشگاه علوم پزشکی بابل

3 استادیار گروه زنان و زایمان، دانشکده پزشکی دانشگاه علوم پزشکی بابل

چکیده

مقدمه: این مطالعه به منظور تعیین تأثیر قرص های پیشگیری از بارداری در دوره درمانی قبل از لقاح
آزمایشگاهی براین نوع باروری طراحی شد.
روش کار: این مطا لعه کارآزمایی بالینی تصادفی کنترل شده، در مرکز ناباروری فاطمهالزهـراء دانـشگاه
علوم پزشکی بابل از سال1383 -84 انجام شد. 102 زن با علت ناباروری لولـهای، چـسبندگی لگنـی، دوره
طبیعی تخمکگذاری، سن کمتر از40 سال و فاقد اخـتلالات عامـل مردانـه، وارد مطالعـه شـدند. 51 زن در
دوره قبل از درمان لقاح آزمایشگاهی، قرص پیشگیری از بارداری مصرف کردنـد و همـین تعـداد زن هـیچ
درمان دارویی قبل از دوره درمـانی دریافـت نکردنـد. دسـتورالعمل حـساسیتزدایـی هیپـوفیز بـا آنـالوگ
GnRH در هر دو گروه به طور مشابه استفاده شد که برحسب شرایط فردی ، سـن، میـزان FSH مرحلـه
اولیه فولیکولر، تعداد آمپولهای گنادوتروپین تنظـیم شـد. هـر دو گـروه از نظـر میـانگین سـن، طـول مـدت
ناباروری، LH ,FSH مرحله فولیکولر اولیه و علت ناباروری یکسان بودنـد. همچنـین دوبـار سـونوگرافی
مهبلی، یک بار قبل از دوره درمانی در زمان قاعدگی و بـار دوم در شـروع دوره و روز سـوم، بـه منظـور
2 تشخیص عارضه کیستتخمدانی انجام شد. در تجزیه و تحلیـل آمـاری از آزمونهـای تـی،
X و تجزیـه و
تحلیل رگرسیون چند متغیره استفاده شد.
نتـایج: میـانگین تعـداد فولیکولهـا در مـصرف کننـدگان قـرص ضـد بـارداری نـسبت بـه گـروه کنتـرل
اخـتلاف (6/6 ± 5/5 مقابـل در 5/7 ± 4/1) شـده اسـتخراج تخمکهای و (8/8 ± 4/6مقابل در 6/4 ± 3/7)
معنی داری نداشت. در گروه مصرف کننده قرص های پیشگیری از بارداری، تعداد آمپولهای hMG در هر
مقابـل در 15/8 ± 11/8)در گنادوترویینی تحریک مدت طول و (34/8± 14/6 مقابل در 39/9 ± 19/5 )دوره
13/5 ± 7/1) به طور معنی داری بیشتر از گروه کنترل بود (p<0/05). میزان بروز عارضه تـشکیل کیـست
تخمدان در دو گروه یکسان بود.
نتیجه گیری: مصرف قرص های پیـشگیری از بـارداری در دوره قبـل ازلقـاح آزمایـشگاهی ، بـر بهبـود
باروری تاثیر نداشت. 

کلیدواژه‌ها


عنوان مقاله [English]

The Effects of Oral Contraceptive Pills on Fertilization in IVF Cycle

نویسندگان [English]

  • Sedigheh Esmailzadeh 1
  • Mahboubeh Faramarzi 2
  • Mahtab Zinalzadeh 3
  • Tahere Nazari 3
چکیده [English]

Introduction: This study was planned to determine the effects of the administration of pretreatment oral contraceptive pills on in vitro fertilization.
 
Material and Methods: A clinical randomized controlled trial was conducted in Fatemeh – Alzahra Hospital of Babol University of Medical Sciences from 2004 – 2005, on 102 women with tubal or pelvic adhesive disease as the cause of their infertility, normal ovulatory cycle, of age under 40 years, and no male factor. Pretreatment with oral contraceptive pills was administered for 51 patients, and a similar number of women did not receive any pretreatment. The flare protocol was used in all treatment cycles combined with an individualized dose of human menopausal gonadotrophin depending on previous response, age, and early follicular stage serum FSH level. Both groups were similar in the mean of women’s age, the duration of infertility, the mean of FSH and LH levels, and the distribution of various infertility etiologies. Transvaginal ultrasonograghy was performed twice in pre-treatment cycle and initial cycle on day 2 to identify complication of ovarian cysts formation.
 
Results: The mean number of follicles (6. 4 ± 3.7 vs 8.8± 4.6) and oocyte retrieved 5.7± 4.7 vs 6.6 ± 5.5) were similar in OCP and control groups. OCP group had significantly the mean number of administration of ampoules of hMG used per cycle (39.9 ± 19.5 vs 34.8± 14.6) and the duration of ovarian stimulation (75.8± 11.8 vs 13.5 ± 7.1) more than the control group (P < %5). The ovarian cyst formation was similar in the two groups. Fertilization rate had no significant difference between OCP and control group (%54 vs 43%). In multivariate analysis, independent predictors of clinical fertilization were women’s age with negative correlation and the number of oocytes with positive correlation.
 
Conclusion: Pre- treatment of OCP cycle with oral contraceptives did not improve fertilization OCP cycle

کلیدواژه‌ها [English]

  • oral contraceptive pills
  • in vitro fertilization
1. Surrey E, Bower J, Hill D, Ramsey J, Surrey M. Clinical and endocrine effects of a
microdose GnRH agonist flare regimen administered to poor responders who are
undergoing in vitro fertilization. Fertil Steril 1998; 69: 419-24.
2. Raga F, Bonill – Musoles F, Casan Em, et al. Recombinant follicle stimulating hormone
stimulation in poor responders with normal basal concentrations of follicle stimulating
hormone and estradiol: improved reproductive outcome. Hum Reprod 1999; 14: 1431 – 4.
3. Lashen H, Ledger W, Lopez – Bernal A, et al. Poor responders to ovulation induction: is
proceeding to in – vitro fertilization worthwhile? Hum Reprod 1999; 14: 964 – 9.
4. Faber B – Mayer J, Cox B, Jones D, et al. Cessation of gonadotropin – releasing hormone
agonist therapy combined with high – dose gonadotropin stimulation yields favorable
pregnancy results in low responders. Fertil Steril 1998; 69: 826- 30.
5. Karande V, Morris R, Rinehart J, et al. Limited success using the “flare" protocol in poor
responders in cycles with low basal follicle – stimulating hormone levels during in vitro
fertilization. Fertil Steril 1997; 67: 900 – 3.
6. Lindheim S, Barad D, Witt B, et al. Short- term gonadotropin suppression with oral
contraceptives benefits poor responders prior to controlled ovarian hyperstimulation. J
Assist Reprod Genet 1996; 16: 745–7.
7. Schoolcraft W, Schlenker T, Gee M , Stevens J, Wagley L. Improved controlled ovarian
hyperstimulation in poor responder in vitro fertili zation. Patients with a microdose follicle –
stimulating hormone flare, growth hormone protocol. Fertil Steril 1997; 67: 93 – 7.
8. Mizyen E, sabatini L, Lower A, et al. Does pretreatment with progestogen or oral
contraceptive pills in low responders followed by the GnRH a Flare protocol improve the
outcome of OCP – ET? J Assisted Reproduct Gene 2000; 17 (3): 140 – 46.
9. Russell JB. Precycle estrogen treatment and poor responders. Assisted Reprod Rev 1995;
5: 82 – 89.
10. Keay SD, Liversedge N H, Mathur R S, et al. Assisted conception following poor ovarian
response to gonadotrophin stimulation. Br J Obstet Gynaecol 1997; 104: 521-7.
11. Taylor S N, Lu P , Rye P H, et al .Oral contraceptive , not GnRH suppression , may be
responsible for low endogenous LH during OCP cycle. Fetil Steril 2001; suppl 1 ,76(3):
52 370.
12. Bilgan mm, mahutte NG, Dean N,et al. Effects of pretreatment with an oral Contraceptive
on the time required to achieve pituitary suppression with gonadotrophin – releasing
hormone analogues and on subsequent implantation and pregnancy rates. Fetil Steril 1998
Dec; 70 (6): 106 3-9.
13. Copperma AB, Mukherjee T,Sadler B ,et al. Pre–treatment with oral contraceptive pill
improves outcome in OCP cycles of poor- responders using the GnRH antagonist. Fetil
Steril 2003 suppl.3; 80: S 108.
14. Keltz MD, Sharma P, Stein D E. Comparison of FSH flare in poor responders undergoing
in vitro fertlization (OCP) with and without prior oral contraceptive suppression. Fetil
Steril 2003 suppl. 3 ; 80: S 107.
15. Scott RT, Novort D, Enhancement of ovarian responsiveness with microdoses of
gonadotropin – releasing hormone agonist during ovulation for in vitro fertilization. Fetil
Steril 1994; 61:880- 885.
16. Kolibianakis E M, Albano C, Tournaye H, et al. Pre- treatment with oral contracetive pill
affects adversely implantation rate in OCP /ICSI cycles stimulated with rec – FSH and
GnRH antagonists. Ferti Steri 2003; suppl. 3; 80 : 0-177.
17. World Health Organization. Laboratory manual for the examination of human semen and
sperm–cervical mucus interaction. Cambridge, Eugland: Cambridge university press;
1992. 
 
18. Ran SL, king sland C, campbell S, et al. The long protocol of administration of GnRH is
a superior to the short protocol of ovarian stimu- lation for in vitro fertilization. Fertil
steril 1992; 57: 810 – 4.
19. Flattarelli J, Denis F , Lauria C. Basal antral follicle number and main ovarian diameter
predict cycle camcelled and ovarian responsiveness in ART cycle. Fertil Steril 2000; 74
(3): 512 – 1.
20. Land IA, Yarmalinskaya MI, Dumoulin IC, et al.High dose human menopausal
gonadotropin stimulation in poor responders dose not improve in vitro fertilization
outcome. Fertil Steril 1996; 65: 961-50.
21. Mirkin s, stadtmauer LA,Gibbon WE ,et al. Clinical and endocrine impact of pretreatment
with oral Contraceptive pills in poor responders undergoing OCP with a combination of
microdose flare leuprolide acetate and high dose qonadotropins. Fertil Steril 2003 suppl.
3; 80: p – 205
22. Bancsi L, Broekmans F, Eijkemans M, et al .Predictors of poor ovarian response in
invitro fertilization: a prospective study comparing basal markers of ovarian reserve. Ferti
Steril 2002; 77(2): 328- 336
23. Iwas A, Ando H, kunok, et al. Use of Follicle- Stimulating Hormone test to predict poor
response in In Vitro Fertilization. Obstet 8 Gynecol 2005; 105(3): 645-52.
24. Ramsewak SS, Duffy S, Taylor T, et al. The oral Contraceptive pill effectively permits
cycle batching for an intermittent in vitro fertilization programme in Trinidad and
Tobago. West Indian Med T 2005 Mar; 54 (9): 127- 9.
25. Kovacs p, Bar PE, witt BR. Hypothalamic – pituitary suppression with oral contraceptive
pills does not improve outcome in poor responder patients undergoing in vitro
fertilization – embryo transfer cycle. T Assist Reprod Genet 2001 Jul ; 18 (7) : 391 – 4.
26. Talebian S, Krey L C , Noyes N. Use of oral contraceptives with GnRH antgonists and
recombinant gonadotropin sin OCP cycles have no deleterious effect on pregnancy
outcome. Fetil Steril 2004 suppl . 2; 82: S 234.
27. Branig, E f, Estess M. A. minimal stimulation OCP using clomiphen citrate and oral
contraceptive pill pretreatment for LH suppression. Fetil Steril 2000; 7(3): 587- 590
28. Popovic- Todorvic B, Loft A, Lindhard A, et al. A prospective study of predictive factors
of ovarian response in “standard” OCP/ ICSI patients treated with recombinant FSH, A
suggestion for a recombinant FSH dosage normogram. Hum Reprod 2003; 18 (4): 781-
787.
29. Templeton A, Morris ID, parslow W. Factors that affect outcome of in- vitro fertilization
trea ment. Lancet 1996; 348: 1402-6.
30. Kupka M,Dorn C, Richter O, et al. Impact of reproductive history on in vitro fertilization
and intracytoplasmic sperm injection outcome: evidence from the German OCP Registry.
Ferti Steril 2003; 60(3): 508- 16.
31. Ashkenazi J, orvieto R, Gold – Deuteh R, et al. The impact of woman’s age and sperm
parameters on fertilization rates in OCP cycles. Europ J obstetrics 8 Gynecol Reproduct
Biol 1996; 60 (2): 155- 9.