Aysun Karabulut

Predictors of fertility quality of life (FertiQoL) in infertile women: analysis of confounding factors

OBJECTIVE Infertility may adversely influence quality of life (QoL). The aim of this study was to compare QoL in women with primary and secondary infertility, and identify factors associated with poor and good QoL. STUDY DESIGN Quality of life was measured using the FertiQoL tool in 273 patients attending an infertility clinic, and demographic and clinical characteristics of the patients were recorded. Patients with primary and secondary infertility were compared for QoL subscales, and other confounding factors were investigated using multiple regression analysis. RESULTS Women with secondary infertility obtained higher scores in emotional, mind/body, and social domains of the core subscale, tolerability domain of the treatment subscale, and total QoL (p<0.05). Women desiring psychological support showed lower scores in all domains except environment. Prolonged duration of infertility was associated with lower scores of mind/body, social, tolerability domains and total QoL score (p<0.05). Multiple regression analysis showed that the status of education and secondary infertility had a positive impact, whereas prolonged duration of infertility and desire for psychological support had a negative impact on total QoL scores. CONCLUSION QoL scores were better in patients with secondary infertility and higher educational status, whereas scores were negatively affected by prolonged duration of infertility and desire for psychological support.

Evaluation of cervical screening results in a population at normal risk.

To evaluate the frequency of dysplasia and other cervical conditions in a population at normal risk, and compare demographic characteristics of the women with normal and abnormal results.

Serum Vitamin B12 and Folate Concentrations and the Effect of the Mediterranean Diet on Vulnerable Populations

Low vitamin B12 and folate levels in expectant mothers may lead to low stores in babies. The aim of this study was to determine the frequencies of vitamin B12 and folate deficiencies in pregnant women and neonates, and to assess the effect of maternal vitamin status on babies’ vitamin levels in the Aegean region of Turkey, where the Mediterranean diet (mainly fresh fruits and vegetables) is adopted. We studied 72 pregnant women and their singleton-term babies. Venous blood samples of expectant mothers were collected 1 h before delivery and cord blood of babies were obtained at birth. The mean vitamin B12 in maternal and cord blood serum was 163.1 ± 72.0 pg/mL and 146.2 ± 102.5 pg/mL, and the mean folate, 9.8 ± 4.8 ng/mL and 15.8 ± 3.8 ng/mL, respectively. There were statistically significant correlation between maternal and cord blood serum vitamin B12 (r = 0.61, P = .04) and folate levels (r = 0.65, P < .001). 70.8% of the mothers and 83.9% of the babies were vitamin B12 deficient (<200 pg/mL). Neither group showed folate deficiency. The mean level of vitamin B12 in mothers significantly varied by the type of diet (241.6 (72.1) pg/mL versus 155.9 (68.2) pg/mL; P = .012). Vitamin B12 deficiency in pregnant women and neonates may be a public health problem in our community. The Mediterranean diet in these vulnerable groups may be an aggravating factor for vitamin B12 deficiency. Prenatal screening of all expectant mothers, prenatal supplementation of vitamin B12, and an increase in animal-source food intake may improve expectant mothers vitamin B12 level.

Granulocytic sarcoma of the cervix: Is hysterectomy necessary?

Discussion Neuroendocrine carcinoma of the uterine cervix (NCC) is rare, highly aggressive and prone to metastasis. SCNCC is most common among the NCC and comprises 1 – 3% of cervical carcinoma whose aetiology and predisposing risk factors are poorly understood (Van Nagell et al. 1988). SCNCC exhibits aggressive behaviour and poor prognosis, even aft er multimodal therapy, as very limited data is available for understanding of both management and eff ective therapy. Th e occurrence of leiomyoma between the vagina and rectum is rare. Its aetiology is unknown, although there is much speculation. A MEDLINE search for articles with keywords ‘ small cell neuroendocrine carcinoma of cervix ’ in the last 10 years yielded eight reports, and a search of the entire English literature for leiomyoma between vagina and rectum yielded none. Some studies have demonstrated a relationship between HPV infection and NCC of the cervix (Stoler et al. 1991). In 2011, the Society of Gynaecological Oncology issued a clinical document summarising the available literature on NCC of the female reproductive tract. In a recent study on the 5-year survival rate of patients with FIGO stage IB1, the survival rate was 50 – 60%, which was signifi cantly poorer than the 90% rate for patients with stage IB1 of squamous cell carcinoma (Viswanathan et al. 2004). Recent retrospective data suggests that surgery may improve the clinical outcome and radiation is used with concurrent etoposide/ cisplatinum. For advanced stage disease, metastatic sites are treated with platinum-based combination chemotherapy (Dowell 2010). SCNCC have a reported 5-year survival of 36% (Sevin et al. 1996). Periodic full body imaging with CT or PET/CT to evaluate neurological symptoms, mental status changes or pulmonary metastases are necessary. Th e histopathology report is vital for the appropriate management and off ers relief to the suff ering woman. For the gynaecologist and oncologist, a lapse in diagnosis or treatment can prove disastrous. Th is case is reported for its rarity in the realms of cervical malignancy, as well as the unusual site for occurrence of a leiomyoma, between the vagina and rectum, and the concurrent presence of both.

Evaluation of confounding factors interfering with sexual function in women with minimal pelvic organ prolapse

To evaluate the effects of confounding factors on sexual function in women with minimal pelvic organ prolapse (POP).

Effects of menopause, diabetes mellitus and steroid use on type I mesh-induced tissue reaction in a rat model.

OBJECTIVE To evaluate the effects of menopause, use of steroids, diabetes mellitus, and site of implantation on the tissue response to type I polypropylene mesh used in pelvic reconstructive surgery. STUDY DESIGN Forty mature female albino rats were used in the study. Inflammatory reaction and mesh-tissue detachment strength were studied in 4 different animal models; control (GI), menopause (GII), steroid+menopause (GIII), and diabetes mellitus+menopause (GIV) groups. Two pieces of 1cm×1cm type I macro porous polypropylene monofilament mesh were fixed over rectus abdominis muscle on both sides of the midline, and 0.5cm×0.5cm in size was placed into paravaginal area. Nine weeks later, implanted sling materials in the vaginal region and the right abdominal side were harvested with surrounding tissue for histopathologic examination, whereas the left sided meshes were used for the mechanical testing of detachment strength. RESULTS The mean detachment strengths in groups were, 595±274g for GI, 410±161g for GII, 610±202g for GIII, and 457±250g for GIV (p>0.008). Inflammatory process was more intense in menopause and DM+menopause groups for both abdominal and vaginal tissues (p<0.008). There was no difference between control and steroid+menopause groups, and DM+menopause and menopause groups (p>0.008). Comparison of tissue reaction caused by meshes in abdominal and vaginal area showed more intense granulocyte infiltration in abdominal region whereas more prominent inflammation and necrosis in the vaginal site (p<0.05). CONCLUSION The abdominal and vaginal region show differences in tissue reaction to type I mesh, and menopause was the most determining factor on the intensity of mesh induced inflammatory response.

Effect of IVF failure on quality of life and emotional status in infertile couples

OBJECTIVE To investigate the effect of a previous IVF failure on the quality of life and emotional distress, in couples undergoing IVF treatment. Experiencing IVF failure might cause differences on the anxiety-depression and quality of life scores of the couples, compared to the ones who were undergoing IVF treatment for the first time. STUDY DESIGN This study included 64 couples who had previously experienced at least one IVF failure (Group 1) and 56 couples without history of IVF failure (Group 2) in a private Assisted Reproductive Center, Istanbul, Turkey. A sociodemographic data form, the FertiQoL International and Hospital Anxiety (HAD-A) and Depression scale (HAD-D) for evaluating the status of distress, were administered for the study. RESULT(S) FertiQoL scores were compared between the groups, the environment scale of the quality of life in treatment section was found to be significantly higher in Group 1 compared with Group 2 (p=0.009). The HAD-A and HAD-D scores did not differ significantly between the groups. Group-variables were investigated using multilevel analysis, the infertility duration and income level were found to have an effect on the subscales of quality of life (p=0.009 and p=0.001 respectively) in Group 2. Depression scores were higher in couples with infertility duration of below five years in Group 1 and Group 2 compared to couples with infertility duration of five years or above (MANOVA analysis). The level of education was found to affect the scores of HAD-D in Group 2, but not in Group 1 (p=0.011). The score of HAD-D was significantly affected by the family type only in Group 2 (p=0.009); the depression score of the couples living with a nuclear family was found to be higher compared with the couples living in a traditional family (p=0.021). CONCLUSION(S) Fertility-specific quality of life scores reveals better results regarding the orientation to the treatment environment in the couples with a previous IVF failure, compared to first IVF cycle couples. Treatment failure does not elevate the level of anxiety, while the effect on depression scores changes according to duration of infertility.

Ovarian sclerosing stromal tumour with elevated CA19-9 levels

Sclerosing stromal tumour (SST) of the ovary is a rare benign tumour of the ovarian stroma, first described in 1973 (Chalvardjian and Scully 1973). Although it is classified within the sex cord str...

Evaluation of risk factors and effect of physical activity in caesarean section in nulliparous women.

Objective: The aim of this study was to evaluate risk factors for caesarean section (CS) in nulliparous women and to determine the effect of physical activity on ease of labour. Methods: A prospective observational study, including 282 nulliparous women at 37–41 gestational weeks was conducted. Maternal demographic characteristics, obstetric history and Modified Grimby scale for evaluation of physical activity were noted. Patients were classified into spontaneous labour and induction group. Multiple logistic regression model was used to assess independent risk factors for type of delivery. Results: Caesarean rate was increasing with higher educational status (p < 0.001). Maternal height, maternal and paternal age were higher, whereas dilatation on admission was lower in CS group (p < 0.05). Maternal age, weight gain and CS rate were higher in induction group (p < 0.05). Fetal distress as a cause of CS was detected higher in induction group (p < 0.05). Physical activity has no significant effect on mode of delivery (p > 0.05). Maternal height (p = 0.011), and cervical dilatation on admission (p = 0.004) were identified as predictor factors for CS. Conclusion: Cervical dilatation is the most important negative predictive factor for CS, whereas, moderate physical activity has no effect on mode of delivery. Fetal distress was the most frequent cause of CS in induction group.

Evaluation of risk factors in cesarean delivery among multiparous women with a history of vaginal delivery.

OBJECTIVE To predict the risk of cesarean delivery (CS) for multiparous women who have undergone previous vaginal delivery. MATERIAL AND METHODS A prospective observational study was performed, among multiparous pregnancies that were between 38 and 41 gestational weeks and had a singleton, vertex presentation fetus. Womens physical activity score, obstetric history, intrapartum and postpartum events were assessed. Multivariable logistic regression was used to explore risk factors associated with CS. RESULTS Of the 245 total 83.7% had spontaneous labor and 16.3% were induced. Seventy-five percent of the induced women required CS, whereas only 19.5% of those with spontaneous labor required CS (p<0.001). The logistic regression analysis model included maternal weight gain, physical activity score, cervical dilatation, and fetal weight as the predictors of CS. We detected 7 (10%) maternal complications in women who underwent intrapartum CS. CONCLUSION Labor induction is significantly associated with increased risk of cesarean delivery among previously vaginally delivered women and maternal weight gain, physical activity score, cervical dilatation, and fetal weight are most accurate parameters in the prediction of the risk of CS delivery. Intrapartum CS has an increased risk of maternal morbidity.