Ahmet Erdem

Impact of luteal phase support on pregnancy rates in intrauterine insemination cycles: a prospective randomized study

OBJECTIVE To determine the impact of luteal phase support on pregnancy rates in ovarian stimulation and intrauterine insemination (IUI) cycles with gonadotropins in couples with unexplained infertility. DESIGN Prospective randomized controlled trial. SETTING University-based infertility clinic. PATIENT(S) Two hundred fourteen couples with unexplained infertility who were treated during 427 ovarian stimulation and IUI cycles with recombinant FSH. INTERVENTION(S) Patients underwent ovarian stimulation with recombinant FSH combined with IUI. Patients randomized into the study group (n = 109) received luteal phase support in the form of vaginal progesterone gel (Crinone 8% gel). Patients randomized into the control group (n = 105) received no luteal phase support. MAIN OUTCOME MEASURE(S) Clinical pregnancy and live birth rate per cycle and per patient. RESULT(S) Demographic data were found to be homogeneous between the study and control groups. Clinical pregnancy rates per cycle and per patient were significantly higher in the study group (21.1% and 39.4%, respectively) compared with the control group (12.7% and 23.8%, respectively). Live birth rate per cycle and per patient was also significantly higher in patients with luteal support (17.4% and 35.8%, respectively) compared with control subjects (9.3% and 18.1%, respectively). CONCLUSION(S) Luteal phase support with vaginal progesterone gel significantly affects the success of ovarian stimulation and IUI cycles in patients with unexplained infertility.

Comparison of Basal and Clomiphene Citrate Induced FSH and Inhibin B, Ovarian Volume and Antral Follicle Counts as Ovarian Reserve Tests and Predictors of Poor Ovarian Response in IVF

AbstractPurpose: To compare basal and clomiphene citrate (CC) induced follicle-stimulating hormone (FSH), estradiol (E2), and inhibin B levels with ultrasound indices of ovarian reserve in infertile women and to test the prognostic value of these tests on response to ovarian stimulation in in vitro fertilization (IVF). Methods: Fifty-six patients had basal and CC induced serum hormone levels and ultrasound measured mean ovarian volume (MOV) and mean antral follicle counts (MFC). Thirty-two patients were then appropriately selected to have a total of 41 cycles of IVF/ICSI treatment. Results: Women with diminished ovarian reserve had lower MOV, MFC, day 3 and day 10 inhibin B levels (p< 0.001). Only basal and CC induced FSH and inhibin B correlated with MOV and MFC. Poor responders in IVF/ICSI had higher basal FSH (p< 0.05), lower basal and induced inhibin B levels (p< 0.05), and lower MOV and MFC (p< 0.01) than normal responders. Ovarian volume alone was better than age and basal hormones in predicting poor ovarian response, while abnormal CC test was the only independent significant factor in predicting ovarian response. However, age was the only independent predictor of pregnancy in IVF as compared to hormonal and ultrasound indices of ovarian reserve. Conclusion: CC test and ovarian volume are better than other hormonal and sonographic tests in predicting the response to ovarian stimulation in IVF cycles.

Comparison of transvaginal ultrasonography and saline infusion sonohysterography in evaluating the endometrial cavity in pre- and postmenopausal women with abnormal uterine bleeding.

Objective:To compare the diagnostic accuracy of transvaginal ultrasonography (TVUS) and saline infusion sonohysterography (SIS) of the endometrial cavity in pre- and postmenopausal women with abnormal uterine bleeding. Design:In a prospective study, TVUS and concurrent SIS findings of 100 pre- and 33 postmenopausal women were recorded. The pathological diagnoses of the specimens, obtained by means of dilatation and curettage, hysteroscopy, and hysterectomy, were taken as reference and compared with the results of TVUS and SIS. Results:When TVUS and SIS findings were compared with pathological results, the sensitivity and specificity of TVUS in diagnosing endometrial pathologies were 83% and 70.6%, respectively, whereas the sensitivity and specificity of SIS were 97.7% and 82.4%, respectively. The sensitivity and specificity of SIS in the diagnosis of endometrial polyps were 100% and 91.8%, respectively, and in the diagnosis of fibroids were 95% and 100%, respectively. Conclusion:SIS is more accurate than TVUS alone in the evaluation of the endometrial cavity in women with abnormal uterine bleeding.

Age-related changes in ovarian volume ,antral follicle counts and basal follicle stimulating hormone levels: comparison between fertile and infertile women

Our objective was to compare the relationship between age ,basal follicle stimulating hormone (FSH) level and ultrasound-measured mean ovarian volume (MOV) and mean antral follicle counts (MFC) in a group of infertile and fertile women between the ages of 35 and 45 years. Menstrual cycle day 3 serum FSH ,MOV and MFC were analyzed in 62 infertile and 53 fertile women. Basal FSH and MFC did not differ between infertile and fertile women ,whereas MOV was significantly smaller in infertile women (p < 0.05). In the infertile group ,there was a negative correlation between MOV and age (ρ = -0.389, p < 0.05) ,between MOV and basal FSH (ρ = 0.495 ,p < 0.01) ,and between MFC and age (ρ = -0.553 ,p < 0.01). In the fertile group ,there was a strong negative correlation between MOV and basal FSH (ρ = -0.631 ,p < 0.01) ,and between MFC and basal FSH (ρ = -0.710 ,p < 0.01). Mean basal FSH ,MOV and MFC did not differ between subgroups of patients with different causes of infertility. In the infertile group ,patients with small ovaries of volume less than 1.8 cm3 (mean volume -1 SD) had higher mean basal FSH (p < 0.05) and lower MFC (p < 0.01) levels than patients with normal ovarian volume. In conclusion ,transvaginal ultrasound (TVU) indices and indirect hormonal parameters of ovarian reserve were similar in infertile and fertile women aged between 35 and 45 years. It is suggested that ,in infertile women above 35 years of age ,TVU rather than hormonal parameters be preferred ,based on our data showing a stronger association between age and TVU indices of ovarian reserve than between age and increase in basal FSH level. Thus ,TVU assessment of ovarian volume and antral follicle counts is a practical and cost-effective ,if not better ,technique for ovarian reserve testing.

Angiogenesis, p53, and bcl-2 expression as prognostic indicators in endometrial cancer: Comparison with traditional clinicopathologic variables

&NA; We investigated the relation of expression of tumor‐suppressor gene product p53, apoptosis‐regulator gene product bcl‐2, and CD34 (as a measure of microvessel density [MVD]) with traditional clinicopathologic prognostic variables in endometrial carcinoma (histologic type, grade, depth of myometrial invasion, angiolymphatic invasion, lymph node involvement). In specimens from 63 patients with endometrial carcinoma, the mean MVD (64.38±28.71 microvessels per 200× field) was not related to any clinicopathologic variables. Nuclear p53 expression was detected in 15 (23.8%) patients and was higher in nonendometrioid carcinomas (p<0.05) and in tumors with increasing histologic grade (p<0.001). Cytoplasmic bcl‐2 staining was seen in 79.3% of the tumors. There was a negative correlation between bcl‐2 expression and histologic type and tumor grade (p<0.05). In survival analysis, patient age, FIGO stage, high expression of p53, low expression of bcl‐2, and high and intermediate MVD values were found to be the most significant prognostic indicators of survival (p<0.05). In multivariate regression analysis, FIGO stage and low bcl‐2 expression were found to be the only independent indicators of prognosis (p<0.05).

The relationship of homocyteine, B12 and folic acid with the bone mineral density of the femur and lumbar spine in Turkish postmenopausal women

ObjectiveThe relationship of homocyteine, B12 and folic acid with osteoporosis has already been studied in various populations. We compared the important factors in the metabolism of homocysteine, such as homocysteine, B12 and folic acid levels, of Turkish postmenopausal women, and their relationship with the femur and lumbar spine bone mineral density.MethodsThis cross-sectional study was conducted at Gazi University, Department of Obstetrics and Gynecology. The study group consisted of 178 postmenopausal women. Serum homocysteine, folic acid and Vitamin B12 were measured. BMD was measured using DEXA at the right femoral neck and lumbar spine (L1–L4).ResultsUpon evaluation of both the femur and lumbar spine, it was determined that osteoporosis could be associated with a homocysteine level above the median and with a B12 value under the lowest quintile value.ConclusionPlasma Hcy and vitamin B12, but not folate levels, were associated with osteoporosis. Future interventional studies are needed to determine methods to reduce Hcy levels with dietary supplements and extra vitamin B12, which will restore bone health and reduce risk of fractures.

The effect of maternal anemia and iron deficiency on fetal erythropoiesis: comparison between serum erythropoietin, hemoglobin and ferritin levels in mothers and newborns.

Objective: Maternal and fetal serum erythropoietin levels were correlated with hemoglobin, mean corpuscular volume and serum ferritin in a group of anemic pregnant women to evaluate the effect of maternal anemia on fetal erythropoiesis. Methods: Serum erythropoietin, ferritin, hemoglobin and mean corpuscular volume were investigated in 33 pregnant women with anemia, 11 women with normal hematological parameters and in their newborns. Results: Maternal serum erythropoietin concentration (mean ± SEM) was significantly higher in the anemic group (145.2 ± 42.9 mU/ml) as compared to the control group (37.3 ± 7.6 mU/ml) (p < 0.05). In newborns, all parameters were comparable in both groups except cord serum erythropoietin concentration (mean ± SEM) which was significantly higher in newborns born to anemic women (43.9 ± 5.3 mU/ml) than controls (29.4 ± 3.7 mU/ml) (p < 0.05). In the anemic group, maternal serum erythropoietin was inversely correlated to maternal hemoglobin (r = -0.375, p = 0.03), maternal hemoglobin was inversely correlated to cord serum erythropoietin (r = -0.552, p = 0.001) and maternal ferritin was correlated to fetal ferritin (r = 0.521, p = 0.002). Conclusion: Although cord hemoglobin and mean corpuscular volume were not affected by maternal anemia, increased cord serum erythropoietin levels related to low maternal hemoglobin levels suggest an induced fetal erythropoiesis in maternal anemia.

Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation

The objective of this cross-sectional study was to identify the prognostic factors that influence the outcome of ovarian stimulation with intrauterine insemination (IUI) cycles using gonadotrophins in couples with unexplained and mild male-factor subfertility. A total of 838 cycles in 456 women with unexplained and mild male-factor subfertility attending a university-based infertility clinic was evaluated. Of these cycles, 139 resulted in pregnancy (16.6% per cycle) and 96 out of 98 ongoing pregnancies resulted in live term birth. Live birth rate per patient and per cycle was 21.1% and 11.4%, respectively. Multivariate logistic regression analysis demonstrated that duration of infertility (P = 0.034), type of infertility (P = 0.003), aetiology of infertility (P = 0.004), number of treatment cycles (P = 0.0001) and number of dominant follicles before human chorionic gonadotrophin (HCG; P = 0.024) were significant independent factors to predict clinical pregnancy. The duration of infertility (P = 0.043), number of treatment cycles (P = 0.0001) and number of dominant follicles before HCG (P = 0.024) were significant independent factors to predict live birth. In conclusion, for subfertile couples having shorter duration of subfertility, multifollicular response to gonadotrophins and in their first treatment cycle are more likely to succeed a live birth with IUI treatment using recombinant gonadotrophins.

Expression of vascular endothelial growth factor and assessment of microvascular density with CD 34 and endoglin in proliferative endometrium, endometrial hyperplasia, and endometrial carcinoma

The aim of this study was to compare vascular endothelial growth factor (VEGF), CD 34, and endoglin expressions as markers of angiogenesis in proliferative endometrium (PE), endometrial hyperplasia (EH), and endometrial carcinoma (EC) and to find the possible impact of angiogenesis on malign transformation. Formalin-fixed, paraffin-embedded tissues from 12 patients with PE, 23 patients with simple EH and complex EH with atypia, and 31 patients with EC were included. A semiquantitative scoring system was used to assess the intensity and degree of staining of VEGF. Microvessel density (MVD) was assessed with endoglin and anti-CD 34 in most vascular areas. VEGF expression was significantly higher in EC and EH than PE, but there was no difference between EC and EH. According to CD 34 staining, there were no differences in MVD between groups. However, mean MVD counts assessed by endoglin were significantly higher in EC than PE and EH. Although VEGF expression in EC was significantly higher, it did not correlate with other measures of angiogenesis. MVD using endoglin seemed to reflect neoplastic angiogenesis better than CD 34

Surgical Treatment of Urinary Stress Incontinence by a Suburethral Sling Procedure Using a Mersilene Mesh Graft

A suburethral sling procedure using a Mersilene mesh has been performed in 24 patients. Six patients had recurrent incontinence after an unsuccessful past operation. A postoperative follow-up was done for an average of 24 months. Twenty-three patients were free of symptoms, while only 1 patient had recurrent incontinence. The suburethral sling procedure can be applied to all patients, particularly for recurrent stress urinary incontinence, with reasonable cure rates when performed with a proper technique.