ﻪﻠﺠﻣ مﻮﻠﻋ يزار ﻲﻜﺷﺰﭘ هرود
20
، هرﺎﻤﺷ 111
، رﻮﻳﺮﻬﺷ
http://rjms.tums.ac.ir 1392
ﻲﺸﻫوﮋﭘ ﻪﻟﺎﻘﻣ
ﻪﻣﺪﻘﻣ
هدﺎـﻣآ رﻮـﻈﻨﻣ ﻪﺑ ،يرورﺎﺑﺎﻧ نﺎﻣرد ﺰﻛاﺮﻣرد يزﺎـﺳ
ﻢﻧﺎﺧ هﺪـﻨﻨﻛ ﻪـﻌﺟاﺮﻣ يﺎﻫ ﻖـﻳﺮﻃ زا نﺎـﻣرد ياﺮـﺑ
شور يرورﺎﺑ ﻚﻤﻛ يﺎﻫ (Assisted reproductive
technology)
ﻚـﻤﺨﺗ كﺮـﺤﻣ يﺎﻫوراد زا يراﺬـﮔ
ﻦﻴﭘوﺮﺗودﺎــــﻨﮔ) ﻲــــﻣ هدﺎﻔﺘــــﺳا (ﺎــــﻫ
.دﻮــــﺷ
ﻦﻴﭘوﺮﺗودﺎﻨﮔﻻﻮﻤﻌﻣ ﺎـﻫ
تﺎـﻧاﻮﻴﺣرد و
نﺎـﺴﻧا ياﺮـﺑ
ﺶﻳاﺰـﻓا ﻚﻳﺮﺤﺗ
يراﺬـﮔ ﻚـﻤﺨﺗ هدﺎﻔﺘـﺳا
هﺪـﺷ و
ﺚﻋﺎﺑ ﺶﻳاﺰﻓا يﺎﻬﻜﻤﺨﺗ داﺪﻌﺗ ﻞﺑﺎﻗ
سﺮﺘﺳد ياﺮـﺑ
يﺎﻬﺸﻫوﮋﭘ ﺪﺷر
و
ﻲـﻠﺜﻣ ﺪـﻴﻟﻮﺗ و ﻮﻤﻧ ﺮـﻴﻈﻧ
حﺎـﻘﻟ
) ﻲــﻤﺣر جرﺎــﺧ In Vitro Fertilization
ﻪــﺑ ﺎــﻳ
رﺎﺼﺘﺧا (IVF
دﺎﺠﻳا و نارﻮﻧﺎﺟ ﻚﻴﻧﮋﺴﻧاﺮﺗ
ﻲﻣ ﺪﻧﻮﺷ
1) . ( ياﺮــﺑ ﻚــﻳﺮﺤﺗ ﻚــﻤﺨﺗ
زا يراﺬــﮔ يﺎــﻫوراد
هدﺎﻔﺘﺳا ﻒﻠﺘﺨﻣ ﻲﻣ
ﻲـﺧﺮﺑ ﻪﻛ دﻮﺷ زا
ﻦـﻳا ﺎـﻫوراد
ﻞﻣﺎــﺷ Human Menopausal
Gonadotropins
hMG)
،( Human Chorionic
Gonadotropin
) hCG و( گﻮﻟﺎــــــﻧآ Gonadotropin-Releasing
Hormone )
GnRH ﻲﻣ (
ﺪﻨﺷﺎﺑ ) 2 (.
ﻲـﻧاﺮﮕﻧ زا ﻲﻜﻳ
ﻞﻜﻴـﺳ ﺎـﺑ ﻪـﻄﺑار رد يﺎـﻫ يﺎـﻫ
ﺶﻴـﺑ ﻚـﻳﺮﺤﺗ مرﺪﻨﺳ زوﺮﺑ ،يراﺬﮔ ﻚﻤﺨﺗ كﺮﺤﺗ
ناﺪـﻤﺨﺗ ﺪـﺣ زا Hyper Stimulation
Ovarian
Syndrome OHSS)
( ) 3 ( ﻲﺋﻮـﻠﻗ ﺪـﻨﭼ ﻲﮕﻠﻣﺎﺣ و
ﺖﺳا ) 4
، 5 (.
زوﺮﺑ زا يﺮﻴﮕﺸﻴﭘ ياﺮﺑ ﺮﺿﺎﺣ لﺎﺣ رد
ﻞﻜﻴﺳ ،نآ ﻞـﺴﻨﻛ ار يراﺬـﮔ ﻚـﻤﺨﺗ ﻚﻳﺮﺤﺗ يﺎﻫ
ﻲﻣ ﻢﺋﻼﻋ ترﻮﺻ ﻦﻳا ﺮﻴﻏ رد .ﺪﻨﻨﻛ ترﻮـﺼﺑOHSS
زوﺮﺑ ﺖﻴﺳآ ًﺎﺘﻳﺎﻬﻧ و ﻢﻜﺷ ﺦﻔﻧ و درد ،غاﺮﻔﺘﺳا ،عﻮﻬﺗ
:يﺮﻴﺼﻧ ﺎﺿر ،ﻲﺳﺎﻨﺷ ﺖﺴﻳز سﺎﻨﺷرﺎﻛ
ﻲﻫﺎﮕﺸﻧاد دﺎﻬﺟ ﻲﺘﺴﻳز مﻮﻠﻋ ﻦﻳﻮﻧ يﺎﻫ يروﺎﻨﻓ هﺎﮕﺸﻫوﮋﭘ ﺎﻨﻴﺳ ﻦﺑا
، .ناﺮﻳا ،ناﺮﻬﺗ [email protected]
ﺮﺘﻛد ﻲﺋاﺮﻗ نﺎﻄﻠﺳ ﻪﻟﺎﻫ :
،يژﻮﻟﻮﺗﺎﭘ رﺎﻳدﺎﺘﺳا ﻲﻫﺎﮕﺸﻧاد دﺎﻬﺟ ﻲﺘﺴﻳز مﻮﻠﻋ ﻦﻳﻮﻧ يﺎﻫ يروﺎﻨﻓ هﺎﮕﺸﻫوﮋﭘ
ﺎﻨﻴﺳ ﻦﺑا ، .ناﺮﻳا ،ناﺮﻬﺗ [email protected]
ﺮﺘﻛد هدازﺪﻤﺤﻣ ﻪﻧﺎﺴﻓا :
،نﺎﻤﻳاز و نﺎﻧز رﺎﻳدﺎﺘﺳا ﻲﻫﺎﮕﺸﻧاد دﺎﻬﺟ ﻲﺘﺴﻳز مﻮﻠﻋ ﻦﻳﻮﻧ يﺎﻫ يروﺎﻨﻓ هﺎﮕﺸﻫوﮋﭘ
ﺎﻨﻴﺳ ﻦﺑا ، .ناﺮﻳا ،ناﺮﻬﺗ
ﺮﺘﻛد ﻲﻧﺎﻧرز ﻦﺴﺣﺮﻴﻣا :
،يژﻮﻟﻮﻧﻮﻤﻳا رﺎﻴﺸﻧاد ﻲﻫﺎﮕﺸﻧاد دﺎﻬﺟ ﻲﺘﺴﻳز مﻮﻠﻋ ﻦﻳﻮﻧ يﺎﻫ يروﺎﻨﻓ هﺎﮕﺸﻫوﮋﭘ
ﺎﻨﻴﺳ ﻦﺑا ، .ناﺮﻳا ،ناﺮﻬﺗ [email protected]
ﺮﺘﻛد ﻲﻧاﺮﻬﺗ يﺪﺟ دﻮﻤﺤﻣ :
،يژﻮﻟﻮﻧﻮﻤﻳا دﺎﺘﺳا ﻲﻫﺎﮕﺸﻧاد دﺎﻬﺟ ﻲﺘﺴﻳز مﻮﻠﻋ ﻦﻳﻮﻧ يﺎﻫ يروﺎﻨﻓ هﺎﮕﺸﻫوﮋﭘ
ﺎﻨﻴﺳ ﻦﺑا ، ناﺮﻳا ،ناﺮﻬﺗ [email protected].
* ﺮﺘﻛد رﺎﺒﺗ ﻲﻗدﺎﺻ ﻲﻠﻋ :
،ﻲﻫﺎﮕﺸﻳﺎﻣزآ مﻮﻠﻋ ياﺮﺘﻛد ﻲﻫﺎﮕﺸﻧاد دﺎﻬﺟ ﻲﺘﺴﻳز مﻮﻠﻋ ﻦﻳﻮﻧ يﺎﻫ يروﺎﻨﻓ هﺎﮕﺸﻫوﮋﭘ
ﺎﻨﻴﺳ ﻦﺑا ، ناﺮﻳا ،ناﺮﻬﺗ *) هﺪﻨﺴﻳﻮﻧ (لﻮﺌﺴﻣ .
ﺶﺠﻨﺳ ﻲﻧاﻮﺨﻤﻫ ﻲﺳرﺮﺑ ﺢﻄﺳ
ﻖﻴﻗر ﺖﻟﺎﺣ ود رد اﺰﻳﻻا شور ﻪﺑ لﻮﻳداﺮﺘﺳا نﻮﻣرﻮﻫ
ﻢﻧﺎﺧ مﺮﺳ رد ﺖﻗر نوﺪﺑ و هﺪﺷ يراﺬﮔ ﻚﻤﺨﺗ كﺮﺤﻣ يﺎﻫوراد ﺎﺑ نﺎﻣرد ﺖﺤﺗ يﺎﻫ
هﺪﻴﻜﭼ
ﻪﻨﻴﻣز و : فﺪﻫ ﻲﺳرﺮﺑ ﺢﻄﺳ ناﺰـﻴﻣ دﻮـﺟو زا نﺎـﻨﻴﻤﻃا رﻮـﻈﻨﻣ ﻪﺑ يراﺬﮔ ﻚﻤﺨﺗ ﻚﻳﺮﺤﻣ يﺎﻫوراد ﺎﺑ نﺎﻣرد ﺖﺤﺗ يﺎﻫ ﻢﻧﺎﺧ مﺮﺳ رد لﻮﻳداﺮﺘﺳا نﻮﻣرﻮﻫ
زا ﺶﻴـﺑ ﻚـﻳﺮﺤﺗ مرﺪﻨﺳ ضراﻮﻋ زوﺮﺑ زا يﺮﻴﮔﻮﻠﺟ ﻦﻴﻨﭽﻤﻫ و يرورﺎﺑﺎﻧ نﺎﻣرد ﺪﻨﻳآﺮﻓ رد ﻚﻤﺨﺗ ﻲﻓﺎﻛ داﺪﻌﺗ ﻪﺑ ﻦﺘﻓﺎﻳ ﺖﺳد ﺖﻬﺟ نﻮﻣرﻮﻫ ﻦﻳا ﺐﺳﺎﻨﻣ ﺪـﺣ
يروﺮﺿ و ﻢﻬﻣ يﺮﻣا ،ناﺪﻤﺨﺗ ار نﻮـﻣرﻮﻫ لﻮـﻜﻟﻮﻣ ﻲﻌﻗاو ﺖﻈﻠﻏ يﺮﻴﮔ هزاﺪﻧا ﻲﻳﺎﻧاﻮﺗ ،لﻮﻤﻌﻣ يﺎﻫ شور ،لﻮﻳداﺮﺘﺳا نﻮﻣرﻮﻫ ندﻮﺑ ﻻﺎﺑ دراﻮﻣ رد .ﺪﺷﺎﺑ ﻲﻣ
ﻣ ﻦﻳا فﺪﻫ ،ﺶﻳﺎﻣزآ ﻦﻳا ياﺮﺑ نﺎﻨﻴﻤﻃا ﻞﺑﺎﻗ هدوﺪﺤﻣ ﻦﻴﻴﻌﺗ و لﻮﻳداﺮﺘﺳا نﻮﻣرﻮﻫ يﺮﻴﮔ هزاﺪﻧا ياﺮﺑ اﺰﻳﻻﺎﺷور ﺖﻴﺳﺎﺴﺣ ناﺰﻴﻣ ﻲﺳرﺮﺑ .ﺪﻧراﺪﻧ ﻲﻣ ﻪﻌﻟﺎﻄ
.ﺪﺷﺎﺑ
شور رﺎﻛ : رد ﻲﻌﻄﻘﻣ ﻪﻌﻟﺎﻄﻣ ﻦﻳا (Cross-Sectional)
، داﺪﻌﺗ 132 ﻢﻧﺎﺧ نﺎﻣرد ياﺮﺑ ﻪﻛ نﺎﻣرد ﻲﺼﺼﺨﺗ قﻮﻓ ﺰﻛﺮﻣ ﻪﺑ يورﺎﺑﺎﻧ
يرورﺎﺑﺎﻧ ﻦﺑا ﺎﻨﻴﺳ ﻪﻌﺟاﺮﻣ
ﺎﺑ و هدﻮﻤﻧ يﺎﻫ وراد كﺮﺤﻣ .ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ ،ﺪﻧدﻮﺑ هﺪﺷ ﻚﻳﺮﺤﺗ ،يراﺬﮔ ﻚﻤﺨﺗ اﺰﻳﻻا لﻮﻳداﺮﺘﺳا ﺖﻴﻛ زا ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
رﻮﺸﻛ ﺖﺧﺎﺳDRG نﺎﻤﻟآ
ﻪﺟﻮﺗ ﺎﺑ .ﺪﺷ هدﺎﻔﺘﺳا ﻂﻳاﺮﺷ ﻪﺑ
راﺮﻗ ﻪﻌﻟﺎﻄﻣ درﻮﻣ ﻪﻛ ﻲﻨﻴﻌﺟاﺮﻣ زا ﺮﺗﻻﺎﺑ ﺎﻬﻧآ مﺮﺳ لﻮﻳداﺮﺘﺳا ناﺰﻴﻣ ،ﺪﻨﺘﻓﺮﮔ
Pg/ml 200 ﻲﺳرﺮﺑ ﺖﻬﺟ .دﻮﺑ ندﻮﺑ ﻲﻄﺧ ناﺰﻴﻣ
ﺖﺒﺴﻧ ﺎﺑ نارﺎﻤﻴﺑ ﻦﻳا مﺎﻤﺗ مﺮﺳ ﻪﻧﻮﻤﻧ ،شور ﻦﻳا 1:4
و ﺪﺷ ﻖﻴﻗر ﺎﺑ راﺰﻓا مﺮﻧ زا هدﺎﻔﺘﺳا Excel
ﻪﺴﻳﺎﻘﻣ رادﻮﻤﻧ ﻢﺳر و
.ﺪﻧﺪﺷ
ﻪﺘﻓﺎﻳ ﺎﻫ : ﺎﺑ ﻪﻛ ﺪﺷ هﺪﻫﺎﺸﻣ ﺶﻳاﺰﻓا
ﺖﻈﻠﻏ زا ﺶﻴﺑ لﻮﻳداﺮﺘﺳا Pg/ml
2000 ﻖﻴﻗر و ﻢﻴﻘﺘﺴﻣ رادﻮﻤﻧ ﻦﻴﺑ فﻼﺘﺧا ، هﺪﺷ
ﻲـﻄﺧ ًﺎﺣﻼﻄـﺻا و ﺪـﺑﺎﻳ ﻲﻣ ﺶﻳاﺰﻓا
نوﺪﺑ شور رادﻮﻤﻧ ندﻮﺑ ﺖﻗ ر
ﻦﻴﺑ زا .دور ﻲﻣ
ﻪﺠﻴﺘﻧ :يﺮﻴﮔ ﺖﻈﻠﻏ رد ﻲﻣﺮﺳ لﻮﻳداﺮﺘﺳا يﺎﻫ زا ﺶﻴﺑ
Pg/ml 2000 ﻪﻧﻮﻤﻧ ندﻮﻤﻧ ﻖﻴﻗر ﻪﺑ زﺎﻴﻧ ﺪـﻫاﻮﺨﻧ دﺎﻤﺘﻋا ﻞﺑﺎﻗ ﺖﻗر نوﺪﺑ شور ﺞﻳﺎﺘﻧ و ﺪﺷﺎﺑ ﻲﻣ ﺎﻫ
ﻮـﺑ ﻲـﻄﺧ ناﺰـﻴﻣ ﻪﻛ دﺮﻴﮔ راﺮﻗ ﻪﺟﻮﺗ درﻮﻣ ﺰﻴﻧ ﺮﮕﻳد يﺎﻫ هﺎﮕﺸﻳﺎﻣزآ ﻲﺘﺣ ﺎﻳ و يرورﺎﺑﺎﻧ نﺎﻣرد ﺰﻛاﺮﻣ يﺎﻫ هﺎﮕﺸﻳﺎﻣزآ رد ﺪﻳﺎﺑ عﻮﺿﻮﻣ ﻦﻳا .دﻮﺑ يﺎـﻫ شور ند
اﻮﻣ مﺎﮕﻨﻫ رد ﺎﺗ ددﺮﮔ ﺺﺨﺸﻣ هدﺎﻔﺘﺳا درﻮﻣ .دﺮﻴﮔ ترﻮﺻ يزﺎﺳ ﻖﻴﻗر ،ﺮﺗﻻﺎﺑ ﺮﻳدﺎﻘﻣ ﺎﺑ ﻪﻬﺟ
ﻠﻛ ﻴ هژاوﺪ ﺎﻫ : ،لﻮﻳداﺮﺘﺳا ELISA ﻚﻤﺨﺗ ﻚﻳﺮﺤﺗ ،يرورﺎﺑﺎﻧ ، .ناﺮﻳا ،يراﺬﮔ
:ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ 1
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مﻮﻠﻋ ﻪﻠﺠﻣ يزار ﻲﻜﺷﺰﭘ
هرود 20 هرﺎﻤﺷ ، 111 ، رﻮﻳﺮﻬﺷ 1392
13
هﺪﺷ ﻖﻴﻗر و ﺖﻗر نوﺪﺑ لﻮﻳداﺮﺘﺳا ﺖﻈﻠﻏ ﺞﻳﺎﺘﻧ ﻪﺴﻳﺎﻘﻣ-1رادﻮﻤﻧ ESTRADIOL CONSENTRATION …
ESTRADIOL TEST
ELISA DIRECT
ELISA DILUTED×
4
ﺪــﻨﻛ ﻲــﻣ )
6 (.
زور رد لﻮﻳداﺮﺘــﺳا ﻲﻣﺮــﺳ ﺖــﻈﻠﻏ
زا ﻲﺑﻮـﺧ ﻲﻨﻴﺑ ﺶﻴﭘ ،ﻦﻴﭘوﺮﺗودﺎﻨﮔ ﺎﺑ نﺎﻣرد مرﺎﻬﭼ يرادرﺎـﺑ ﻪـﺠﻴﺘﻧ و يراﺬﮔ ﻚﻤﺨﺗ ﻚﻳﺮﺤﺗ ﺖﻴﻘﻓﻮﻣ رد ﻞﻜﻴــﺳ ﻲــﻣ ﻪــﺋارا ارIVF
ﺪــﻫد ) 7 ( ﻦﻴــﻨﭽﻤﻫ
عوﺮــﺷ زور رد لﻮﻳداﺮﺘــﺳا ﺢﻄــﺳ ﻊﻳﺮــﺳ ﺶﻳاﺰــﻓا ﺎﺑ نﺎﻣرد زوﺮـﺑ ﻲﻨﻴﺑ ﺶﻴﭘ ناﻮﻨﻋ ﻪﺑ ،hCG
OHSS
دﻮــﺷ ﻲــﻣ هدﺎﻔﺘــﺳا )
8 (.
يﺮــﻴﮔ هزاﺪــﻧا ﻦﻳاﺮﺑﺎــﻨﺑ
مﺎـﺠﻧا ﺖﻬﺟ ﻪﻛ ﻲﻳﺎﻫ ﻢﻧﺎﺧ رد لﻮﻳداﺮﺘﺳا نﻮﻣرﻮﻫ زا ،ﺪﻧﻮـﺷ ﻲـﻣ هدﺎـﻣآ يرورﺎـﺑ ﻚـﻤﻛ يﺎﻫ ﻚﻴﻨﻜﺗ ﻪــﺠﻴﺘﻧ شراﺰــﮔ و هدﻮــﺑ رادرﻮــﺧﺮﺑ ﻲﻳﻻﺎــﺑ ﺖــﻴﻤﻫا ﻪــﺑ هﺎﮕــﺸﻳﺎﻣزآ يﻮــﺳ زا ﺖــﻴﻌﻗاو ﻪــﺑ ﻚــﻳدﺰﻧ ،رﺎــﻤﻴﺑ ﻂﻳاﺮــﺷ زا عﻼــﻃا رﻮــﻈﻨﻣ ﻪــﺑ ﻦﻴــﺼﺼﺨﺘﻣ نداد نﺎﺸﻧ ،ﻲﺳرﺮﺑ ﻦﻳا فﺪﻫ .دراد تروﺮﺿ ﺖﻴﻤﻫا
ﺮﺘﺳا يﺮﻴﮔ هزاﺪﻧا يﺎﻫ شور ﺖﻴﺳﺎﺴﺣ ياﺮـﺑ لﻮﻳدا
يرورﺎﺑﺎﻧ نﺎﻣرد ﺰﻛاﺮﻣ نارﺎـﻤﻴﺑ ﻂﻳاﺮـﺷ ﻪـﺑ ﻪﺟﻮﺗ ﺎﺑ
شور ﻪـﻛ ﻲﻳﺎـﺠﻧآ زا .ﺪﺷﺎﺑ ﻲﻣ ﺰﻛاﺮﻣ عﻮﻧ ﻦﻳا يﺎـﻫ
ياﺮـﺑ ﻪـﻧ ﺪﻧا هﺪﺷ ﻲﺣاﺮﻃ لﺎﻣﺮﻧ داﺮﻓا ياﺮﺑ ،دﻮﺟﻮﻣ كﺮـﺤﻣ يﺎـﻫ وراد ﺎـﺑ نﺎـﻣرد ﺖـﺤﺗ ﻪـﻛ ﻲﻧارﺎﻤﻴﺑ
ﺎـﻫ ﺖـﻈﻠﻏ ﺺﻴﺨـﺸﺗ ﻲﻳﺎﻧاﻮﺗ اﺬﻟ ،ﺪﻨﺘﺴﻫ ار ﻻﺎـﺑ ي
و دﺮـﻛ ﺺﺨـﺸﻣ ﺖـﺴﻳﺎﺑ ﻲـﻣ ار ناﺰﻴﻣ ﻦﻳا .ﺪﻧراﺪﻧ ،ﻲﻌﻗاو ﺖﻈﻠﻏ ﻪﺑ ﻦﺘﻓﺎﻳ ﺖﺳد ياﺮﺑ ﻪﻛ ﺖﺳا ﻲﻬﻳﺪﺑ ناﺰﻴﻣ ﻦﻳا زا ﺮﺗﻻﺎﺑ ﺖﻈﻠﻏ ﺎﺑ يﺎﻫ ﻪﻧﻮﻤﻧ يزﺎﺳ ﻖﻴﻗر نﺪﻣآ ﺖﺳﺪﺑ ترﻮﺻرد ﻪﻛ اﺮﭼ ؛ﺖﺳا ﺮﻳﺬﭘﺎﻧ بﺎﻨﺘﺟا ﻞﻴﻟﺪـــﺑ ﻪـــﻛ ﻲـــﻌﻗاو ناﺰـــﻴﻣ زا ﺮـــﺘﻤﻛ ﺞﻳﺎـــﺘﻧ ﺖﻳدوﺪــﺤﻣ
،ﺪــﺷﺎﺑ ﻲــﻣ ﺖــﻴﻛ يﺮــﻴﮔ هزاﺪــﻧا يﺎــﻫ
هﺪـﺸﻧ لﺮـﺘﻨﻛ ﻢﺋﻼﻋ زوﺮﺑ لﺎﻤﺘﺣا ﺶﻳاﺰـﻓا OHSS
نارﺎﻤﻴﺑ ياﺮﺑ ار ﻲﻬﺟﻮﺗ ﻞﺑﺎﻗ ﻲﻨﻴﻟﺎﺑ تاﺮﻄﺧ و ﻪﺘﻓﺎﻳ .ﺖﺷاد ﺪﻫاﻮﺧ ﺮﺑ رد
شور رﺎﻛ
ﻲــــﻌﻄﻘﻣ ﻲــــﺳرﺮﺑ ﻚــــﻳ ﻪــــﻌﻟﺎﻄﻣ ﻦــــﻳا
(Cross-Sectional) ﻲﻣ
داﺪـﻌﺗ يور ﺮـﺑ ﻪـﻛ ﺪـﺷﺎﺑ
132 ﺖﺳا هﺪﺷ ﺶﻣﺎﺠﻧا نز رﺎﻤﻴﺑ نﺎﻣرد ﺖﻬﺟ ﻪﻛ
و يرورﺎـﺑﺎﻧ نﺎـﻣرد ﻲﺼﺼﺨﺗ قﻮﻓ ﺰﻛﺮﻣ ﻪﺑ يرورﺎﺑﺎﻧ ﻚـﻳﺮﺤﺗ ﺖﺤﺗ و هدﺮﻛ ﻪﻌﺟاﺮﻣ ﺎﻨﻴﺳ ﻦﺑا رﺮﻜﻣ ﻂﻘﺳ (كﺮـﺤﻣ يوراد عﻮـﻧ زا ﺮﻈﻧ فﺮﺻ) يراﺬﮔ ﻚﻤﺨﺗ رد ﻪـﺘﺨﻟ نﻮـﺧ ترﻮﺼﺑ ﺎﻫ ﻪﻧﻮﻤﻧ .ﺪﻧدﻮﺑ ﻪﺘﻓﺮﮔ راﺮﻗ ﻪﻟﻮﻟ زا ﺲـﭘ و هﺪـﺷ يروآ ﻊﻤﺟ ﺰﻣﺮﻗ ﺖﻜﺟﻮﻧو يﺎﻫ
رود رد ،ﻞﻣﺎﻛ دﺎﻘﻌﻧا 4400rpm
ﺑ تﺪﻣ ﻪ 5 ﻪـﻘﻴﻗد
.ﺪﺷ يزﺎﺳاﺪﺟ ﺎﻬﻧآ مﺮﺳ ﺲﭙﺳ و ﺪﻧﺪﺷ ژﻮﻴﻔﻳﺮﺘﻧﺎﺳ رد لﻮﻳداﺮﺘـﺳا نﻮﻣرﻮﻫ يﺮﻴﮔ هزاﺪﻧا ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
ﻪـﺑ ﺮـﻄﻘﻣ بآ ﺎـﺑ هﺪـﺷ ﻖـﻴﻗر و ﻢﻴﻘﺘﺴﻣ ﺖﻟﺎﺣ ود ﺖﺒﺴﻧ 1:4 شور ﺎﺑ ELISA
ﺖـﻴﻛ زا هدﺎﻔﺘـﺳا ﺎﺑ و
Estradiol ترﻮــﺻ نﺎــﻤﻟآ رﻮــﺸﻛ ﺖﺧﺎــﺳDRG
اﺪﻫﺎﺸﻣ ،ﺖﻗر ﻦﻳا زا هدﺎﻔﺘﺳا ﺖﻠﻋ .ﺖﻓﺮﮔ ﻲﺑﺮﺠﺗ ت
،نارﺎﻤﻴﺑ ﺮﺜﻛا رد لﻮﻳداﺮﺘﺳا ﺖﻈﻠﻏ سﺎﺳا ﺮﺑ و هدﻮﺑ ﺮـﺜﻛا رد ﻪـﻛ ﻢﻳﺪﻴـﺳر ﻪﺠﻴﺘﻧ ﻦﻳا ﻪﺑ ﻮـﻣ
ﻖـﻴﻗر ،درا
ﺖﺒﺴﻧ ﻪﺑ ﺎﻫ ﻪﻧﻮﻤﻧ يزﺎﺳ 1:4
ﻦـﻳا ﺖﻈﻠﻏ ﺪﻧاﻮﺗ ﻲﻣ
ﺶﻫﺎـﻛ ﺖـﻴﻛ ﻲﻧاﺮﺤﺑ راﺪﻘﻣ زا ﺮﺘﻤﻛ ﻪﺑ ار نﻮﻣرﻮﻫ ﺎـﺑ ﻪﻃﻮﺑﺮﻣ رادﻮﻤﻧ ،ﺞﻳﺎﺘﻧ ندروآ ﺖﺳﺪﺑ زا ﺲﭘ .ﺪﻫد راﺰﻓا مﺮﻧ زا هدﺎﻔﺘﺳا Excel
.ﺪﺷ ﻢﺳر
ﻪﺘﻓﺎﻳ ﺎﻫ رادﻮﻤﻧ رد ﻪﻛ رﻮﻄﻧﺎﻤﻫ ﻲﺳرﺮﺑ ﻦﻳارد 1
ﺺﺨـﺸﻣ
ودﺮـﻫ رد مﺮـﺳ لﻮﻳداﺮﺘـﺳا ﺖـﻈﻠﻏ تاﺮﻴﻴﻐﺗ ،ﺖﺳا ﺎــﺗ هﺪــﺷ ﻖــﻴﻗر و ﻢﻴﻘﺘــﺴﻣ ﺖــﻟﺎﺣ Pg/ml
2000
ﺶﻳاﺰـﻓا ﺎـﺑ ﻲـﻟو .ﺪﻧراد يﺰﻴﭼﺎﻧ فﻼﺘﺧا و ﺎﺘﺳاﺮﻤﻫ ﺰـﻓا فﻼﺘﺧا ﺖﻈﻠﻏ ﻦﻳا ًﺎﺣﻼﻄـﺻا و ﺪـﺑﺎﻳ ﻲـﻣ ﺶﻳا
ندﻮﺑ ﻲﻄﺧ ﻲـﻣ ﻦﻴـﺑ زا ﺖـﻗر نوﺪـﺑ شور رادﻮﻤﻧ
ﺺﺨـﺸﻣ رادﻮﻤﻧ رد ﻪﻛ رﻮﻄﻧﺎﻤﻫ ﺮﮕﻳد فﺮﻃ زا .دور دﺪﻋ ناﺰﻴﻣ ،ﺖﺳا زا ﻢﻴﻘﺘﺴﻣ ﺖﻟﺎﺣ رد هﺪﺷ شراﺰﮔ
دﺪــﻋ Pg/ml 3000 رد ﻦــﻳا و دور ﻲــﻤﻧ ﺮﺗﻻﺎــﺑ
ﺖـﻟﺎﺣ رد رﺎـﻤﻴﺑ نﺎـﻤﻫ ﺖـﺴﺗ ﻪﺠﻴﺘﻧ ﻪﻛ ﺖﺴﻴﻟﺎﺣ زا ﺮﺘــﺸﻴﺑ هﺪــﺷ ﻖــﻴﻗر Pg/ml
9000 .ﺪــﺷﺎﺑ ﻲــﻣ
ﻪـﻛ ﻲﺗﺎـﺸﻳﺎﻣزآ ﺞﻳﺎـﺘﻧ ﻂـﻘﻓ ،شور ﻦﻳا رد ﻦﻳاﺮﺑﺎﻨﺑ زا ﺮـﺘﻤﻛ ﺎـﻳ ﺮﺑاﺮﺑ لﻮﻳداﺮﺘﺳا نﻮﻣرﻮﻫ ناﺰﻴﻣ Pg/ml
2000 ﺞﻳﺎـﺘﻧ درﻮـﻣ رد و هدﻮـﺑ دﺎـﻤﺘﻋا ﻞـﺑﺎﻗ ﺪﺷﺎﺑ
ﺖﻈﻠﻏ ﻦﻳا زا ﺶﻴﺑ ندﺮـﻛ ﻖـﻴﻗر زا ﺲﭘ ﺖﺳا مزﻻ
،ترﻮـﺼﻨﻳا ﺮـﻴﻏ رد .دﻮﺷ مﺎﺠﻧا ﺖﺴﺗ ًادﺪﺠﻣ ،ﻪﻧﻮﻤﻧ ﺖـﺳﺪﺑ ﻲـﻌﻗاو راﺪﻘﻣ زا ﺮﺗ ﻦﻴﻳﺎﭘ بذﺎﻛ رﻮﻄﺑ ﺞﻳﺎﺘﻧ
يﺮﻴﺼﻧ ﺎﺿر نارﺎﻜﻤﻫ و
ﻪﻠﺠﻣ مﻮﻠﻋ يزار ﻲﻜﺷﺰﭘ
هرود 20 هرﺎﻤﺷ ، 111
، رﻮﻳﺮﻬﺷ
http://rjms.tums.ac.ir 1392
14
ﻂـﺳﻮﺗ ﺖـﺳردﺎﻧ يﺮـﻴﮔ ﻢﻴﻤـﺼﺗ ﺎـﺑ ﺮـﺠﻨﻣ و هﺪﻣآ ﺎــﺑ ﻂﺒﺗﺮــﻣ تﻼﻜــﺸﻣ زوﺮــﺑ و ﺪــﺷ ﺪــﻫاﻮﺧ ﻚــﺷﺰﭘ ﻪﻠﺌـﺴﻣ ﻦـﻳا .دﻮـﺑ ﺪـﻫاﻮﺧ ﺮﻳﺬـﭘﺎﻧ بﺎﻨﺘﺟا OHSS
ﺖﻴﻓﺮﻇ و ﺖﻴﺳﺎﺴﺣ هﺪﻨﻫد نﺎﺸﻧ شور ﻦﻴﻳﺎﭘ
يﺎـﻫ
.ﺖﺳا لﻮﻳداﺮﺘﺳا نﻮﻣورﻮﻫ يﺮﻴﮔ هزاﺪﻧا لﻮﻤﻌﻣ
ﺚﺤﺑ يﺮﻴﮔ ﻪﺠﻴﺘﻧ و
فﺪﻫ يﺎـﻫ شور ﻪـﺴﻳﺎﻘﻣ و ﻲـﺳرﺮﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا
ﻢــﻫ ﺎــﺑ ﻒــﻠﺘﺨﻣ نداد نﺎــﺸﻧ ،فﺪــﻫ ﻪــﻜﻠﺑ ﺖــﺴﻴﻧ
ﺖﻴﻤﻫا نﻮـﻣرﻮﻫ ﻲـﻌﻗاو راﺪـﻘﻣ شراﺰﮔ و ﺺﻴﺨﺸﺗ
لﻮﻳداﺮﺘﺳا ﺪﺷﺎﺑ ﻲﻣ
ﺦـﺳﺎﭘ ،تﺎﺸﻳﺎﻣزآ زا ﻲﺧﺮﺑ رد .
راﺰـﺑا ﺮﻫ ﺎﻳ هﺎﮕﺘﺳد ﺖـﻈﻠﻏ ﺮـﺑاﺮﺑ رد يﺮـﻴﮔ هزاﺪـﻧا
ﺖﺴﻴﻧ ﻲﻄﺧ ﻪﻧﻮﻤﻧ )
9 ( نﺎـﺸﻧ هﺪـﻣآ ﺖـﺳﺪﺑ ﺞﻳﺎﺘﻧ .
يﺮــﻴﮔ هزاﺪــﻧا لﻮــﻤﻌﻣ يﺎــﻫ شور ﻒﻌــﺿ هﺪــﻨﻫد و لﺎﻣﺮﻧ ﺖﻟﺎﺣ رد ﻪﻛاﺮﭼ ﺖﺴﻴﻧ لﻮﻳداﺮﺘﺳا نﻮﻣرﻮﻫ ،يراﺬـﮔ ﻚـﻤﺨﺗ ﻚـﻳﺮﺤﺗ يﺎـﻫوراد فﺮـﺼﻣ نوﺪﺑ ﺖــﻴﻛ ناﺰــﻴﻣ يﺮــﻴﮔ هزاﺪــﻧا ﺖــﻴﻠﺑﺎﻗ ﺞــﻳار يﺎــﻫ
ﻴﻧ نوﺪﺑ ار لﻮﻳداﺮﺘﺳا ﺎﻬﻨﺗ و ﺪﻧراد يزﺎﺳ ﻖﻴﻗر ﻪﺑ زﺎ
ﻪـﺑ ﺮﺠﻨﻣ ﻪﻛ ﺎﻫوراد زا ﻪﺘﺳد ﻦﻳا فﺮﺼﻣ ترﻮﺻ رد ﻢـﻫ نآ و ددﺮـﮔ ﻲﻣ داﺮﻓا نﻮﺧ لﻮﻳداﺮﺘﺳا ﺶﻳاﺰﻓا زا ﺶﻴﺑ يﺎﻫ ﺖﻈﻠﻏ رد Pg/ml
2000 ﻖﻴﻗر ﻪﺑ زﺎﻴﻧ
ﺖـﻗر نوﺪـﺑ شور ﺞﻳﺎﺘﻧ و ﺪﺷﺎﺑ ﻲﻣﺎﻫ ﻪﻧﻮﻤﻧ ندﻮﻤﻧ رد ﺪــﻳﺎﺑ عﻮــﺿﻮﻣ ﻦــﻳا .دﻮــﺑ ﺪــﻫاﻮﺨﻧ دﺎــﻤﺘﻋا ﻞــﺑﺎﻗ يﺎﻫ هﺎﮕﺸﻳﺎﻣزآ ﻲـﺘﺣ ﺎـﻳ و يرورﺎـﺑﺎﻧ نﺎـﻣرد ﺰﻛاﺮﻣ
ﻪـﻛ دﺮﻴﮔ راﺮﻗ ﻪﺟﻮﺗ درﻮﻣ ﺰﻴﻧ ﺮﮕﻳد يﺎﻫ هﺎﮕﺸﻳﺎﻣزآ ﺪـﻳﺎﺑ هدﺎﻔﺘـﺳا درﻮـﻣ يﺎﻫ شور ندﻮﺑ ﻲﻄﺧ ناﺰﻴﻣ ،ﺮﺗﻻﺎﺑ ﺮﻳدﺎﻘﻣ ﺎﺑ ﻪﻬﺟاﻮﻣ مﺎﮕﻨﻫ رد ﺎﺗ ددﺮﮔ ﺺﺨﺸﻣ ﻪــﻛ ﺖــﺳا ﻲﻬﻳﺪــﺑ .دﺮــﻴﮔ ترﻮــﺻ يزﺎــﺳ ﻖــﻴﻗر ﻲـﻄﺧ ﻪـﺑ ﻪـﺟﻮﺗ ﺖـﻴﻤﻫا زا لﺎـﺜﻣ ﻚﻳ لﻮﻳداﺮﺘﺳا ــﺷﺎﺑ ﻲــﻣ ﺎــﻫ ﺖــﺴﺗ ندﻮــﺑ مﺮــﺘﺤﻣ نارﺎــﻜﻤﻫ و ﺪ
ﻲﻣ يﺎـﻫ ﺖـﺴﺗ ﻪـﻴﻠﻛ درﻮﻣ رد ار ﻪﺟﻮﺗ ﻦﻳا ﺖﺴﻳﺎﺑ
.ﺪﻨﺷﺎﺑ ﻪﺘﺷاد ﻲﻤﻛ
ﺮﻜﺸﺗ و ﺮﻳﺪﻘﺗ
يﺪـﻬﻣﺪﻤﺤﻣ ﺮـﺘﻛد يﺎـﻗآ بﺎﻨﺟ زا ﻪﻠﻴﺳو ﻦﻳﺪﺑ
يﺎـﻫ يروﺎـﻨﻓ هﺎﮕـﺸﻫوﮋﭘ مﺮـﺘﺤﻣ ﺖﺳﺎﻳر يﺪﻧﻮﺧآ
ﻲﻫﺎﮕـﺸﻧاد دﺎـﻬﺟ ﻲﺘﺴﻳز مﻮﻠﻋ ﻦﻳﻮﻧ -
و ﺎﻨﻴـﺳ ﻦـﺑا
رﺮـﻜﻣ ﻂﻘـﺳ و يرورﺎﺑﺎﻧ نﺎﻣرد ﻲﺼﺼﺨﺗ قﻮﻓ ﺰﻛﺮﻣ ﻦــﺑا يرﺎــﻳ حﺮــﻃ ﻦــﻳا ياﺮــﺟا رد ار ﺎــﻣ ﻪــﻛ ﺎﻨﻴــﺳ
ﻢﻳراد ار ﺮﻜﺸﺗ لﺎﻤﻛ ﺪﻧدﻮﻣﺮﻓ ﻦﻤﺿ رد .
زا دراد ﺎـﺟ رﺰﻳاوﺮﭘﻮــﺳ داﺰــﻬﺑ فﺮــﺸﻣ ﺲﮔﺮــﻧ ﻢﻧﺎــﺧ رﺎﻛﺮــﺳ
ﻲـﺼﺼﺨﺗ قﻮـﻓ ﺰـﻛﺮﻣ ﻲـﺒﻃ ﺺﻴﺨـﺸﺗ هﺎﮕﺸﻳﺎﻣزآ
سﺎﭙـﺳ ﺎﻨﻴـﺳ ﻦـﺑا رﺮـﻜﻣ ﻂﻘـﺳ و يرورﺎﺑﺎﻧ نﺎﻣرد يﺎـﻫ ﻚﻤﻛ حﺮﻃ ﻦﻳا رد ﻪﻛ ﻢﻴﻨﻛ يراﺬﮔ يرﺎﻴـﺴﺑ
.ﺪﻨﺘﺷاد لوﺬﺒﻣ
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7th edition. Lippincott Williams & Wilkins;
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Original Article http://rjms.tums.ac.ir
Razi Journal of Medical Sciences Vol. 20, No. 111, Aug-Sep 2013 15
Evaluation ofcoordination between diluted and undiluted serum estradiol levels using ELISA method inwomenunder treatment with ovulation
induction drugs
Reza Nasiri, BSc, Avicenna research institute, Tehran, Iran. [email protected]
Haleh Soltanghoraee, MD, Assistant professor of pathology, Avicenna Research Institute, Tehran, Iran.
Afsaneh Mohammadzadeh, MD, Assistant professor of gynecology, Avicenna research institute, Tehran, Iran.
Amir HasanZarnani, PhD, Associate professor of immunology, Avicenna research institute, Tehran, Iran.
Mahmud Jeddi-Tehrani, PhD, Professor of immunology, Avicenna research institute, Tehran, Iran.
*Ali Sadeghitabar, PhD, Avicenna research institute, Tehran, Iran (*Corresponding author).
Abstract
Background: Measurement of estradiol level in women under treatment with ovulation induction drugs to make sure about sufficient ovum number in the infertility treatment protocol and also to prevent OHSS phenomenon, is an important and necessary factor. In case of high levels of Estradiol hormone, routine methods are unable to detect the real concentration of the hormone molecules. We are aimed to demonstrate the sensitivity of the ELISA method for Estradiol measurement and reliable range of this test.
Methods: In this cross-sectional study, 132 women were studied who have appealed to Avicenna infertility clinic for infertility treatment and have stimulated with ovulation induction drugs. DRG ELISA Estradiol kit made in Germany was used in this study.
According to the studied population, serum Estradiol levels were higher than 200Pg/ml. To check the linearity of this method, serum samples of all these patients diluted 1:4 and were compared using EXCEL software and charts.
Results: It was observed that, in Estradiol hormone concentrations higher than 2000 Pg/ml, the difference between the diluted and undiluted graphs increased and the linearity of the graph disappeared without dilution.
Conclusions: Dilution is necessary for the serum Estradiol concentrations more than 2000 Pg/ml and the results without dilution is not reliable. It should be considered in all infertility laboratories and also in other labs that the test linearity should be appointed in each lab to be applied in cases with higher concentrations.
Keywords: Estradiol, ELISA, Infertility, Ovulation Induction, Iran.
