South Clin Ist Euras. 2024; 35(2): 120-126 | DOI: 10.14744/scie.2024.53765

In Vitro Fertilizasyon ve Spontan Gebelikler Arasýndan Ýntrahepatik Gebelik Kolestazý Geliþen Hastalarýn Obstetrik Sonuçlarýnýn Karþýlaþtýrýlmasý: Üçüncü Basamak Bir Hastanede Dört Yýllýk Deneyim

Murat Levent Dereli¹, Sadullah Özkan¹, Asya Kalayci Öncü², Fahri Burcin Fýratlýgil¹, Pýnar Yýldýz³, Serap Topkara Sucu⁴, Özgür Kartal⁵, Emre Mat⁶, Yaprak Engin-Ustun^{2
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GÝRÝÞ ve AMAÇ: Gebeliðin intrahepatik kolestaz (GÝK), uygun müdahaleler yapýlmazsa ölü doðum riskinin 4 ila 10 kat artmasýyla iliþkili, gebeliðe özgü en yaygýn karaciðer hastalýðýdýr. Çalýþmanýn amacý, spontan ve in vitro fertilizasyon (IVF) ile elde edilen gebelikler arasýnda GÝK geliþen tekil gebeliklerin obstetrik sonuçlarýný karþýlaþtýrmaktýr
YÖNTEM ve GEREÇLER: Ocak 2018 ile Eylül 2022 tarihleri arasýnda doðum yapan kadýnlar geriye dönük olarak deðerlendirildi. Dahil etme kriterleri uygulandýktan sonra, spontan olarak gebe kalan (grup 1, n=74) ve IVF ile gebe kalan (grup 2, n=17) toplam 91 GÝK’li hasta çalýþmaya uygun bulundu. Grup 2’deki hastalar embriyo transfer yöntemine göre taze embriyo transferi (n=9) ve dondurulmuþ embriyo transferi (n=8) olmak üzere iki alt gruba ayrýldý.
BULGULAR: Yaþ, gravidite ve parite dýþýndaki perinatal sonuçlar ve demografik özellikler benzerdi. Grup 2’de yaþ anlamlý derecede yüksek iken [32 (27-35) vs. 27 (24-31), p=0,017], gravidite ve parite grup 1’de anlamlý olarak yüksekti [2 (1-3) vs. 1 (1-2), p=0.021 and 0 (0-1) vs. 0 (0-0), p=0.009]. Aspartat (AST) ve alanin (ALT) transaminaz seviyeleri, total açlýk safra asit (TASA) düzeyleri ve ursodeoksikolik asit tedavi dozu, dondurulmuþ embriyo transfer grubunda taze embriyo transfer grubuna göre anlamlý derecede yüksekti [126 (83-242)’ya karþý 32 (31-43), p=0.001; 200±123.9’a karþý 51±39.4, 0.001; 44±20.4’e karþý 15±5.0, p=0.001, and 100 (750-1250)’e karþý 750 (750-750), p=0.004].
TARTIÞMA ve SONUÇ: Sonuçlarýmýz, özellikle donmuþ embriyo transfer yönteminin kullanýldýðý IVF gebeliklerinde östrojen tedavisine baðlý olarak yüksek TASA, ALT ve AST düzeyleri arasýnda bir iliþki olduðunu göstermektedir. Eksojen östrojenin etkisini netleþtirmek için geniþ örneklemli prospektif çalýþmalara ihtiyaç vardýr.

Anahtar Kelimeler: Gebeliðin intrahepatik kolestazý, perinatal sonuçlar, perinatal yönetim, total açlýk safra asidi, tüp bebek.

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Comparison of Obstetric Outcomes in Patients with Intrahepatic Cholestasis of Pregnancy Between Pregnancies Following In Vitro Fertilization and Spontaneous Conception: Four-Year Experience in a Tertiary Care Hospital

Murat Levent Dereli¹, Sadullah Özkan¹, Asya Kalayci Öncü², Fahri Burcin Fýratlýgil¹, Pýnar Yýldýz³, Serap Topkara Sucu⁴, Özgür Kartal⁵, Emre Mat⁶, Yaprak Engin-Ustun^2
1Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye
²Department of Obstetrics and Gynecology, Ankara Etlik Zübeyde Haným Maternity Training and Research Hospital, Ankara, Türkiye
³Department of Obstetrics and Gynecology, Division of Perinatology, Ümraniye Training and Research Hospital, Istanbul, Türkiye
⁴Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Türkiye
⁵Private Obstetrics and Gynecology Clinic, Istanbul, Türkiye
⁶Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kartal Doctor Lütfi Kýrdar City Hospital, Istanbul, Türkiye

INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease, associated with a 4 to 10-fold increased risk of stillbirth if appropriate interventions are not taken. The aim of the study was to compare the obstetric outcomes of singleton pregnancies with ICP in which pregnancies were achieved spontaneously and by in vitro fertilization (IVF).
METHODS: Women who gave birth between January 2018 and September 2022 were evaluated retrospectively. After applying the inclusion criteria, a total of 91 patients with ICP were eligible, consisting of spontaneously conceived (group 1, n=74) and IVF-conceived (group 2, n=17) pregnancies. The participants in group 2 were classified into two subgroups: fresh embryo transfer (n=9) and frozen embryo transfer (n=8), depending on the method of embryo transfer.
RESULTS: Perinatal outcomes and demographic characteristics, with the exception of age, gravidity, and parity, were similar. While age was significantly higher in group 2 [32 (27-35) vs. 27 (24-31), p=0.017], gravidity and parity were significantly higher in group 1 [2 (1-3) vs. 1 (1-2), p=0.021 and 0 (0-1) vs. 0 (0-0), p=0.009]. Aspartate (AST) and alanine (ALT) transaminase levels, fasting total bile acid (FTBA) level, and treatment dose of ursodeoxycholic acid were significantly higher in the frozen embryo transfer group than in the fresh embryo transfer group [126 (83-242) vs. 32 (31-43), p=0.001; 200±123.9 vs. 51±39.4, 0.001; 44±20.4 vs. 15±5.0, p=0.001, and 100 (750-1250) vs. 750 (750-750), p=0.004].
DISCUSSION AND CONCLUSION: Our results suggest that there is an association between high FTBA, ALT, and AST levels due to estrogen treatment in IVF pregnancies, especially when the frozen embryo transfer method was used.

Keywords: Intrahepatic cholestasis of pregnancy, in-vitro fertilization, perinatal management, perinatal outcomes, total fasting bile acids.

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