İnfertil kadınlarda histerosalpingografik parametrelerin değerlendirilmesi : 10 yıllık 3. basamak değerlendirme sonuçları
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Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Çanakkale Onsekiz Mart Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: İnfertilite, korunmasız düzenli cinsel iliskiye rağmen 35 yaşın altında bir yıl; 35 yaşın üzerinde 6 ay boyunca gebe kalınamaması olarak tanımlanmaktadır ve bu süreler sonrası çiftlerin etiyolojik faktörler açısından değerlendirilmesi gerekir. İnfertilite şikâyeti ile başvuran çiftler günümüzde giderek artmaktadır. Uygun tanı ve bu tanıya yönelik tedavi planlanarak sağlıklı gebelik ve doğum açısından başarı oranlarını yükseltmek mümkündür. Rutin laboratuvar değerlendirmeleri tamamlanmış bir çiftin tanıya yönelik işlemlerinde çoğu zaman bir sonraki basamağı Histerosalpingografik değerlendirme oluşturmaktadır. Histerosalpingografik değerlendirme bu açıdan bakıldığında bundan sonraki süreçler için belki de en önemli kontrol noktasını oluşturmaktadır. Bu çalışmanın amacı, 2011 -2020 yılları arasında kliniğimizde çekilen HSG görüntülerini literatürdeki güncel parametrelerle yeniden değerlendirmek ve bu parametrelerin gebelik ve canlı doğum ile ilişkisini uygun istatistiksel analizler ile değerlendirip literatüre sunmaktır. Gereç ve Yöntem: Çanakkale 18 Mart Üniversitesi Sağlık Uygulama ve Araştıma Hastanesi Kadın Hastalıkları ve Doğum Kliniğine infertilite şikâyeti ile başvurup, 2011-2020 yıllları arasında HSG' si merkezimizde çekilen, 246 kadın çalışmamıza dahil edilmiştir. Kliniğimzde çekilmiş HSG görüntüleri güncel klavuzlar olan ESHRE, ASRM, CUME kriterlerine göre değerlendirilmiş ve her PACS görüntüsünün parametreleri kayıt altına alınmıştır. Bu parametreler, fundal indentasyon açısı, fundal indentasyon derinliği, lateral indentasyon açısı (sağ ve sol), lateral indentasyon derinliği (sağ ve sol), T açısı (sağ ve sol), cornual açı (sağ ve sol), Uterus uzunluğu, intercornual mesafe, uterin kavite sirküler alanı şeklindedir. Bu elde edilen verilerin primer infertilite, sekonder infertilite ve tekrarlayan gebelik kaybı öyküsü olan hastalardaki dağılımlarını değerlendirdik. Bu çalışmaya dahil edilen hastaların takiplerinde spontan veya yardmcı üreme teknikleriyle gebelik oranları ve canlı doğum oranlarını karşılaştırdık. Elde edilen veriler spss programına yüklenip uygun istatistiksel incelemeler yapılarak bulgular değerlendirilmiştir. Uyum değerlendirmelerinde Cohen's Kappa kullanıldı. İstatistiksel anlamlılık p<0,05 olarak kabul edildi. Bulgular: Fundal indentasyon varlığı ve tubal geçiş ile infertilite şekli arasında istatstisiksel olarak anlamlı düzeyde fark tespit edilmedi. (p>0,05). Fundal indentasyon açısı ortalamlarının gruplarda benzer olduğu görüldü. (p=0,329). Sağ lateral indentasyon derinliği ortalamalarının gebelik oluşmamış (0,2 ± 0,3) ve IUI veya IVF gebelik gözlenmiş bireylerde (0,2 ± 0,3) benzer gözlenmişken spontan gebelik gözlenen kadınlarda sağ lateral indentasyon derinliği ortalamalarının (0,3 ± 0,5) diğer gruplara kıyasla daha yüksek değerde olduğu gözlendi (p=0,028). Benzer olarak sol lateral indentasyon derinliği ortalamalarının gebelik oluşmamış (0,2 ± 0,3) ve IUI veya IVF gebelik gözlenmiş bireylerde (0,2 ± 0,3) benzer gözlenmişken spontan gebelik gözlenen kadınlarda sol lateral indentasyon derinliği ortalamalarının (0,4 ± 0,9) diğer gruplara kıyasla daha yüksek değerde olduğu gözlendi (p=0,048). Canlı doğum gerçekleşmesi bakımından fundus serviks mesafesi ve sirküler uterin kavite alanı ortalamalarının canlı doğum gerçekleştirmiş bireylerde istatistiksel olarak daha yüksek olduğu görüldü. (p<0,05) Diğer tüm parametre ortalamalarının da gruplarda benzer olduğu görüldü. (p>0,05). Sonuç: Uterin alan ve uterus uzunluğundaki artışın gebelik elde edilebilmesi ile ilgili oranları etkilemediğini ancak terme ulaşan canlı doğum oranları üzerinde ise etkili olduğunu tespit ettik. Öte yandan lateral indentasyon derinliğinin ise spontan gebelik elde edilmiş kadınlarda literatürden farklı olarak daha yüksek olduğu sonucuna ulaştık. Ayrıca T –shape uterusa sahip olduğu gözlenen kadınlarda da yine literatürden farklı olarak spontan gebelik elde edilme yüzdesinin yüksek olduğunu tespit ettik. Ancak bu gruba dahil edilen kadınların sayısı (n =6) oldukça kısıtlıydı. Bu olgular ile ilgili dikkat çeken başka bir detay ise gebeliklerin üçte birinin terme ulaşamadığıdır (preterm doğum veya abortus).
Aim: Infertility, one year under the age of 35 despite regular unprotected sexual intercourse; It is defined as the inability to conceive for 6 months over the age of 35, and after this period, the couples should be evaluated in terms of etiological factors. Couples presenting with the complaint of infertility are increasing day by day. It is possible to increase the success rates in terms of healthy pregnancy and birth by planning appropriate diagnosis and treatment for this diagnosis. Hysterosalpingographic evaluation is often the next step in the diagnostic procedures of a couple whose routine laboratory evaluations have been completed. From this point of view, hysterosalpingographic evaluation is perhaps the most important control point for the next processes. The aim of this study is to reevaluate the HSG images taken in our clinic between 2011 and 2020 with the current parameters in the literature and to evaluate the relationship of these parameters with pregnancy and live birth with appropriate statistical analyzes and present them to the literature. Methods : 246 women who applied to Department of Obstetrics and Gynecology of Canakkale 18 Mart University Health Practice and Research Hospital with the complaint of infertility and had their HSG taken in our center between 2011-2020 were included in our study. HSG images taken in our clinic were evaluated according to the current guidelines ESHRE, ASRM and CUME criteria and the parameters of each PACS image were recorded. These parameters are fundal indentation angle, fundal indentation depth, lateral indentation angle (right and left), lateral indentation depth (right and left), T angle (right and left), cornual angle (right and left), Uterus length, intercornual distance, the uterine cavity is in the form of a circular area. We evaluated the distribution of these obtained data in patients with primary infertility, secondary infertility and a history of recurrent pregnancy loss. We compared the pregnancy rates and live birth rates with spontaneous or assisted reproductive techniques in the follow-up of the patients included in this study. The obtained data were loaded into the SPSS program and the findings were evaluated by making appropriate statistical analyzes. Cohen's Kappa was used for compliance assessments. Statistical significance was accepted as p<0.05. Results: There was no statistically significant difference between the presence of fundal indentation and tubal transit and the type of infertility. (p> 0.05). Fundal indentation angle mean values were found to be similar in the groups. (p=0.329). While the mean of right lateral indentation depth was observed to be similar in individuals with no pregnancy (0.2 ± 0.3) and with IUI or IVF pregnancy (0.2 ± 0.3), the mean of right lateral indentation depth in women with spontaneous pregnancy (0.3 ± 0, 5) was observed to be higher than the other groups (p=0.028). Similarly, while the mean left lateral indentation depth was similar in individuals without pregnancy (0.2 ± 0.3) and IUI or IVF pregnancy (0.2 ± 0.3), the mean left lateral indentation depth in women with spontaneous pregnancy (0.4 ± 0.3) 0.9) was observed to be higher than the other groups (p=0.048). In terms of live birth, the averages of fundus cervix distance and circular uterine cavity area were found to be statistically higher in individuals who had a live birth. (p<0.05) It was observed that the mean of all other parameters were similar in the groups. (p> 0.05). Conclusion: We found that the increase in uterine area and uterine length did not affect the rates of achieving pregnancy, but it did affect the rates of live births reaching the term. On the other hand, we concluded that the lateral indentation depth was higher in women with spontaneous pregnancy, unlike the literature. In addition, we found that the percentage of spontaneous pregnancy was higher in women who were observed to have a T-shape uterus, again unlike the literature. However, the number of women included in this group (n = 6) was quite limited. Another remarkable detail about these cases is that one third of pregnancies do not reach the term (preterm birth or abortion).
Aim: Infertility, one year under the age of 35 despite regular unprotected sexual intercourse; It is defined as the inability to conceive for 6 months over the age of 35, and after this period, the couples should be evaluated in terms of etiological factors. Couples presenting with the complaint of infertility are increasing day by day. It is possible to increase the success rates in terms of healthy pregnancy and birth by planning appropriate diagnosis and treatment for this diagnosis. Hysterosalpingographic evaluation is often the next step in the diagnostic procedures of a couple whose routine laboratory evaluations have been completed. From this point of view, hysterosalpingographic evaluation is perhaps the most important control point for the next processes. The aim of this study is to reevaluate the HSG images taken in our clinic between 2011 and 2020 with the current parameters in the literature and to evaluate the relationship of these parameters with pregnancy and live birth with appropriate statistical analyzes and present them to the literature. Methods : 246 women who applied to Department of Obstetrics and Gynecology of Canakkale 18 Mart University Health Practice and Research Hospital with the complaint of infertility and had their HSG taken in our center between 2011-2020 were included in our study. HSG images taken in our clinic were evaluated according to the current guidelines ESHRE, ASRM and CUME criteria and the parameters of each PACS image were recorded. These parameters are fundal indentation angle, fundal indentation depth, lateral indentation angle (right and left), lateral indentation depth (right and left), T angle (right and left), cornual angle (right and left), Uterus length, intercornual distance, the uterine cavity is in the form of a circular area. We evaluated the distribution of these obtained data in patients with primary infertility, secondary infertility and a history of recurrent pregnancy loss. We compared the pregnancy rates and live birth rates with spontaneous or assisted reproductive techniques in the follow-up of the patients included in this study. The obtained data were loaded into the SPSS program and the findings were evaluated by making appropriate statistical analyzes. Cohen's Kappa was used for compliance assessments. Statistical significance was accepted as p<0.05. Results: There was no statistically significant difference between the presence of fundal indentation and tubal transit and the type of infertility. (p> 0.05). Fundal indentation angle mean values were found to be similar in the groups. (p=0.329). While the mean of right lateral indentation depth was observed to be similar in individuals with no pregnancy (0.2 ± 0.3) and with IUI or IVF pregnancy (0.2 ± 0.3), the mean of right lateral indentation depth in women with spontaneous pregnancy (0.3 ± 0, 5) was observed to be higher than the other groups (p=0.028). Similarly, while the mean left lateral indentation depth was similar in individuals without pregnancy (0.2 ± 0.3) and IUI or IVF pregnancy (0.2 ± 0.3), the mean left lateral indentation depth in women with spontaneous pregnancy (0.4 ± 0.3) 0.9) was observed to be higher than the other groups (p=0.048). In terms of live birth, the averages of fundus cervix distance and circular uterine cavity area were found to be statistically higher in individuals who had a live birth. (p<0.05) It was observed that the mean of all other parameters were similar in the groups. (p> 0.05). Conclusion: We found that the increase in uterine area and uterine length did not affect the rates of achieving pregnancy, but it did affect the rates of live births reaching the term. On the other hand, we concluded that the lateral indentation depth was higher in women with spontaneous pregnancy, unlike the literature. In addition, we found that the percentage of spontaneous pregnancy was higher in women who were observed to have a T-shape uterus, again unlike the literature. However, the number of women included in this group (n = 6) was quite limited. Another remarkable detail about these cases is that one third of pregnancies do not reach the term (preterm birth or abortion).
Açıklama
Tıp Fakültesi, Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Anahtar Kelimeler
Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
