What should be the strategy in case of a big follicle at the start of the cycle? Shall we start the stimulation or postpone it to the next cycle?/Siklus baslangicinda buyuk folikul saptanmasi durumunda strateji ne olmalidir? Stimulasyona baslanmali mi yoksa bir sonraki siklusa mi ertelenmeli?

• Published in: Turkish journal of obstetrics and gynecology Vol. 19; no. 4; p. 275
• Main Authors: Kopuk, Sule Yildirim, Yuceturk, Aysen, Korun, Zeynep Ece Utkan, Karaosmanoglu, Ozge, Cakiroglu, Yigit, Tiras, Bulent
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01.12.2022
• Subjects: Cysts; Health aspects; Human reproductive technology; Menstrual cycle; Methods; Ovaries; Quality management; Turkey
• ISSN: 2149-9322
• DOI: 10.4274/tjod.galenos.2022.15943

Objective: This study facilitates decision-making when an antral follicle diameter >15 mm is detected at the beginning of the menstrual cycle in poor responder (POR) patients. Materials and Methods: Eighty-three POR patients with at least one leading follicle with a diameter of 15 to 24 mm on the 2nd-4th days of the menstrual cycle were assessed. Results: The mean age of females was 40.1[+ or -]4.8 (26-45), and the mean partners' age was 42.1[+ or -]7.8 (26-65). Fifty-one (61.4%) women underwent an oocyte pick-up procedure 36 h after the first ultrasonographic examination on the 2nd-4th days of the menstrual cycle. Gonadotrophin stimulation was initiated in 32 (38.6%) patients. Among women in whom oocyte retrieval was performed, an oocyte was obtained in 49 (59.75%) patients. In 13 of 49 patients (26.5%), no mature oocytes were obtained. Fertilized 2pn embryos were obtained in 18 of 33 patients (54.5%). Among the fertilized embryos, 12 were good, six were moderate, and two were of poor quality. Following the frozen embryo transfer procedure, one of the two patients experienced a clinical pregnancy. Conclusion: Patients with POR are still difficult to manage both clinically and therapeutically. Since every oocyte is valuable and important, patients should be carefully followed up. Our research will be directed by the need to rule out a physiological ovarian cyst when large antral follicles appear at the beginning of the cycle. The clinician should give them a chance. Keywords: Poor responder, diminished ovarian reserve, big antral follicle Amac: Bu calismada, zayif over yanitli (ZOY) kadinlarda menstruel siklusun baslangicinda antral folikul capi >15 mm saptanmasi durumunda karar vermeyi kolaylastirmayi amacladik. Gerec ve Yontemler: Menstruel siklusun 2.-4. gunlerinde, capi 15-24 mm arasinda olan en az bir onde giden folikulu olan ZOY tanisi konulan 83 kadin degerlendirildi. Bulgular: Ortalama kadin yasi 40,1[+ or -]4,8 (26-45), ortalama partner yasi 42,1[+ or -]7,8 (26-65) idi. Elli bir (%61,4) katilimciya siklusun 2.-4. gunlerinde ilk ultrasonografik incelemeden 36 saat sonra oosit toplama islemi yapildi. Katilimcilarin 32'sine (%38,6) gonadotropin stimulasyonu baslandi. Oosit toplama yapilan, 49 (%59,75) kadindan oosit elde edildi. Kirk dokuz hastanin 13'unde (%26,5) matur oosit elde edilemedi. ICSI yapilan 33 hastanin 18'inde PRECIS: The emergence of big antral follicles at the beginning of the menstrual cycle should not be misdiagnosed as a physiological ovarian cyst and should be given a chance. (%54,5) 2pn embriyo elde edildi. Dollenen embriyolardan 12'si iyi kalitede, 6'si orta kalitede ve 2'si kotu kalitede idi. Iki hastaya dondurulmus embriyo transferi yapildi ve bir hastada klinik gebelikle sonuclandi. Sonuc: ZOY'li hastalarin klinik yonetimi ve tedavisi zordur. Hastalar dikkatle takip edilmelidir; her oosit cok degerli ve onemlidir. Menstruel siklusun 2.-4. gunlerinde buyuk antral folikullerin ortaya cikmasi fizyolojik over kisti ile karistirilmamali ve oosit elde edilebilecek folikul olabilecegi goz onunde bulundurulmalidir. Klinisyen buyuk antral folikul icin bir sans vermelidir. Anahtar Kelimeler: Zayif over yaniti, azalmis over rezervi, buyuk antral folikul