Berfu Demir

Efficacy of citalopram on climacteric symptoms.

Objective: The aim of this study was to evaluate the efficacy of citalopram for climacteric symptoms and to assess the combined effect of citalopram and hormone therapy (HT) on climacteric symptoms in women inadequately responsive to HT alone. Design: The study included 100 postmenopausal women who were allocated into one of four groups: (1) citalopram, (2) placebo, (3) citalopram + HT, or (4) placebo + HT. The women who were unable or unwilling to take HT were randomly placed in groups 1 and 2. The women who were inadequately responsive to HT were randomly placed in groups 3 and 4. The initial dose of citalopram was 10 mg/day in groups 1 and 3. After 1 week, the dose was increased to 20 mg/day. After starting the medication, follow-up visits took place during the fourth and eighth weeks of treatment. During the first and eighth weeks, women completed two questionnaires: a modified Kupperman index and the Menopause-Specific Quality of Life Questionnaire. Results: Mean hot flash scores significantly improved in all groups (P < 0.05). The reduction rates were 37% in group 1, 13% in group 2, 50% in group 3, and 14% in group 4. Psychosocial complaints and mean values on the Kupperman index significantly decreased in all groups (P < 0.05). Physical well-being significantly improved in groups 1, 3, and 4 (P < 0.05). The decrease in all scores was significantly greater in groups 1 and 3 compared to groups 2 and 4 (P < 0.01). Conclusion: Citalopram is an effective alternative treatment option for patients who do not want to take HT for the alleviation of climacteric symptoms. Adjuvant treatment with a selective serotonin reuptake inhibitor increases the effectiveness of HT for the treatment of climacteric symptoms in women who had responded inadequately to HT.

Effect of strontium ranelate on fracture healing in the osteoporotic rats

The aim of this study was to evaluate the effect of strontium ranelate (SrR) on fracture healing in the osteoporotic rat model. Forty female Sprague–Dawley rats aged 3 months were enrolled in the study. Osteoporosis was induced by bilateral ovariectomy and subsequent daily heparin injection started 1 week after surgery and lasted for 4 weeks. Osteoporosis was confirmed by a reduction of bone mineral density (BMD). Twenty of the osteoporotic rats were assigned to the SrR group and the remaining 20 to the control group. An open right tibial midshaft transverse fracture was created and then an intramedullary fixation was performed. SrR group was treated by 450 mg/kg/day SrR per oral. Six weeks after surgical induction of fracture, all animals were sacrificed. One animal from each group died after ovariectomy. Two tibiae from the control group failed to unite. SrR‐treated group showed higher mechanical strength and fracture stiffness when compared to the control group (p = 0.006, p = 0.001, respectively). SrR‐treated group had mature woven bone or predominantly woven bone compared with osteoporotic control group (p = 0.038). SrR‐treated groups callus maturity was significantly higher than control group (p = 0.001). SrR is associated with better fracture healing in the osteoporotic rat model.

Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics

Summary The aim of the presented study is to determine the effect of different sperm parameters on the pregnancy rate of intrauterine insemination (IUI) cycles in women with favourable fertility characteristics treated for infertility. Medical records of 212 infertile couples who had undergone a total of 253 cycles were reviewed retrospectively. Inclusion criteria for women were age <35 years, antral follicle count >5, FSH <15 IU/ml, and at least one patent tube documented by HSG or laparoscopy. Clinical pregnancy rates were achieved as 15.8% per cycle, and 18.8% per couple. Woman’s age, partner’s age, total number of motile sperm (TMS) and motility, significantly influenced pregnancy rate. Pregnancy rate was the highest when women were aged <25 and TMS >10 × 106. Partner’s age significantly affected the pregnancy rate per cycle in women aged <30 years and TMS >10 × 106. Woman’s age (OR: 5.4 95% CI: 1.2–24.3) and TMS (OR: 0.06 95% CI: 0.003–0.89) were predictor variables as regards to pregnancy. Pregnancy rate was the highest in IUI cycles when woman was <25 years old, TMS was >10 × 106, and morphology was >4%. Male age was found to be another determining factor for IUI success, even if they had a normal spermiogram.

Insulin resistance and its relationship with high molecular weight adiponectin in adolescents with polycystic ovary syndrome and a maternal history of polycystic ovary syndrome

OBJECTIVE To assess the rate of insulin resistance (IR) and the relationship between IR and high molecular weight (HMW) adiponectin in normal weight adolescents with polycystic ovary syndrome (PCOS) and a maternal history of PCOS. DESIGN Case-controlled study. SETTING Adolescent clinic of a teaching and research hospital. PATIENT(S) Forty normal weight adolescents with PCOS and a maternal history of PCOS and 40 normo-ovulatory age- and body mass index (BMI)-matched controls. INTERVENTION(S) A 75-g oral glucose tolerance test (OGTT) was performed for each participant. MAIN OUTCOME MEASURE(S) Homeostasis model assessment of IR and HMW adiponectin. RESULT(S) There were no statistically significant differences between the PCOS and control groups in terms of fasting glucose, fasting insulin, and lipid parameters. Although total and free T were significantly higher, HMW adiponectin levels were significantly lower in the PCOS group compared with the control group. When the PCOS group was compared according to the IR, the HMW adiponectin level was significantly lower in the adolescents with PCOS and IR. The adolescents with PCOS and biochemical hyperandrogenemia had significantly lower HMW adiponectin levels and significantly higher homeostasis model assessment of IR score compared with the adolescents with PCOS and normoandrogenemia. CONCLUSION(S) The adolescents with PCOS had a significantly increased rate of IR without clinical findings of metabolic disorders or obesity. The HMW adiponectin levels were negatively correlated with IR.

The effects of estrogen therapy and estrogen combined with different androgenic progestins on carbohydrate and lipid metabolism in overweight-obese younger postmenopausal women.

Objective. The aim of the present study was to compare the effect of three different progestins with differing androgenicity on carbohydrate and lipid metabolism in overweight–obese younger postmenopausal women. Additionally, the relationship between testosterone and insulin resistance was assessed. Methods. The study included 125 postmenopausal women. Estradiol (E2) 2 mg/day was given to 20 hysterectomized women and the remaining 105 women were randomized into three treatment groups: E2 2 mg/day plus dienogest 2 mg/day (n=35); E2 2 mg/day plus norethisterone acetate (NETA) 1 mg/day (n=35); E2 2 mg/day plus medroxyprogesterone acetate (MPA) 2.5 mg/day (n=35). A 75-g oral glucose tolerance test was performed at the initial and 3-month visit. Serum glucose, insulin, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides were measured before and after treatment. Results. A significant treatment-related increase was observed only in the E2/MPA group for insulin resistance (p=0.031). When the change in the insulin/glucose ratio was compared, the E2 group was significantly different from the E2/MPA and E2/NETA groups (p=0.008 and 0.02, respectively). Only the E2/dienogest group showed a treatment-related increase in fasting glucose level (p=0.037). A decrease in total cholesterol and LDL-C levels was observed in all groups (p=0.004 and 0.012, respectively). The only significant decrease in HDL-C level was observed in the E2/NETA group (p=0.005). Conclusion. Estrogen therapy had a positive effect on carbohydrate and lipid metabolism in overweight–obese postmenopausal women. The addition of progestin to estrogen therapy attenuated estrogens positive effects slightly; however, the biological actions of the three different androgenic progestins used did not result in any variation.

Acquired uterine arteriovenous malformation after Caesarean section

Uterine arteriovenous malformations (AVM) are accepted as potentially life-threatening abnormalities. These lesions have been classified as congenital or acquired. The most common cause of acquired lesions is previous uterine trauma (surgery, malignancy, gestational trophoblastic disease) which leads to vascular wall injury within the myometrium that is covered by endometrium. The main clinical presentation of AVM is recurrent, profuse vaginal bleeding refractory to medical treatment. The management of AVM relies on accurate diagnosis by eliminating all other causes that manifest themselves by vaginal bleeding.

Lyophilised hMG versus rFSH in women with unexplained infertility undergoing a controlled ovarian stimulation with intrauterine insemination: a prospective, randomised study

Purpose. To compare the efficacy of lyophilised urinary hMG (HP-hMG) with recombinant FSH (rFSH) in women with unexplained infertilıty undergoing a controlled ovarian hyperstimulation with intrauterine insemination (IUI). Methods. Forty-nine consecutively seen women with unexplained infertility were randomised to a controlled ovarian hyperstimulation with IUI cycle either with rFSH or HP-hMG. The outcome was compared by independent samples t-test. Results. The mean patient age and duration of infertility were not different (29.5 ± 5.7 and 4.9 ± 2.7 years in rFSH; 28.8 ± 3.2 and 6 ± 4.2 in HP-hMG group) (p = 0.6 and p = 0.2). The mean body mass index (BMI) and basal hormones were similar. Total dose of gonadotropin used (710 ± 236 vs. 636 ± 185 IU) and duration of the cycles (9 ± 2.1 vs. 8.3 ± 2.3 days) showed no significant difference (p = 0.2). Number of follicles, serum oestradiol (E2), and the endometrial thickness on the day of hCG were comparable. Two singletons in each group were obtained. Conclusions. These data suggest that HP-hMG and rFSH may be equally suitable in mild ovarian stimulation for unexplained infertilıty. Further data derived from larger study population are needed to determine whether higher amounts of two gonadotropins in this subgroup might produce any benefits or unfavourable effects.

ABO and Rh blood groups distribution in patients with endometriosis

We read with interest the article ABO and Rhesus (Rh) blood groups distribution in patients with endometriosis by Matalliotakis et al. [1]. We would like to make comments presenting our results and discuss a possible relation with the results and distribution of the blood group types according to the countries. Endometriosis aVects 8–10% of women in their reproductive years and occurs in 30–50% of women with infertility [2, 3]. Widely accepted theory for the development of the endometriosis is retrograde menstruation. However, it was hypothesized that viability of the endometrial cells on the peritoneal cavity, ectopic implantation, invasion, and maintenance of endometriosis could be related with the potential defective response of the immune system. Although, a number of genetic polymorphisms were identiWed in the selected endometriosis populations, there was no consistent evidence yet. The blood type classiWcation is based on the presence or absence of the inherited antigenic substances including proteins, carbohydrates, glycoproteins or glycolipids on the surface of the red blood cells. The blood group antigen expression can increase cellular motility or facilitate the interaction between tumor cells and endothelium of distant organs in the tumor studies [4]. The potential behavioral resemblance with the ectopic implantation and invasion between the endometriosis and tumor cells may be explained with diVerent antigenic substances of the blood types. In our study, medical records of the operations with laparoscopy or laparotomy in the Infertility Clinic of the Etlik Zübeyde HanÂm Women’s Health Teaching and Research Hospital between 1 January 2007 and 31 March 2009 were reviewed. A total of 307 patients diagnosed as endometriosis were included in the study group. These patients with endometriosis were divided two subgroups as follows: stage I–II (n: 207) and stage III–IV (n: 100). A total of 142 patients were operated with non-endometriotic ovarian cyst or tubal occlusion included in the control group. Rh factor positivity was signiWcantly high in the endometriosis group compared with the control group (84 vs. 76%, respectively; P: 0.03). There was no signiWcant diVerence between the groups for the ABO blood types (Table 1). No diVerences were determined in ABO blood types and Rh factor in women with endometriosis according to the stages. Also, only endometrioma cases (n: 92) were compared with the control group, and no signiWcant diVerence was observed with the ABO and Rh blood groups. Rh factor distribution is presented as 89% Rh+ and 11% Rh¡ according to the data on the Turkish population, presented in [5]. Also in the same data, it is seen that the Wrst and the second dominant blood types are group A and group B (43 and 34%), respectively. In our results, the reason of the signiWcance in the Rh factor may be explained with the low rate of Rh positivity in the control group compared to the mean of the Turkish population. Recently, Matalliootakis et al. reported that ABO and Rh blood group distribution were signiWcantly diVerent in the endometriosis group compared with the control group [1]. According to the ABO blood type distribution in USA data in whole population, 42% A, 44% O, 10% B and 4% AB B. Demir · B. Dilbaz · M. Zahran Department of Obstetrics and Gynecology, Etlik Zübeyde HanÂm Women’s Health Teaching and Research Hospital, Ankara, Turkey

The impact of unilateral salpingectomy on antral follicle count and ovarian response in ICSI cycles: comparison of contralateral side

Abstract Objective: To determine the impact of salpingectomy on the ovarian reserve. Comparisons are made with the contralateral side in patients with unilateral salpingectomy undergoing intracytoplasmic sperm injection (ICSI) cycles. Study design: Patients under 40 with unilateral salpingectomy and without history of ovarian surgery were selected for the multicentre retrospective study. Women with bilateral salpingectomy and history of endometriosis were excluded from the study. Antral follicle count, controlled ovarian hyperstimulation (COH) parameters and number of collected oocytes were the main outcome measures of the study. Results: A total of 56 patients were eligible for this study. The mean age of the patients was 31.6 ± 4.7 years. The reasons for the salpingectomy were hydrosalpinx (39.3%, n = 22) and ruptured ectopic pregnancy (60.7%, n = 34). The ongoing pregnancy rate per embryo transfer was 30.6%. There was no statistically significant difference between the operated and non-operated sides in antral follicle count (AFC), follicles  ≥ 17 mm and 10–17 mm on day of human chorionic gonadotrophin (hCG), or number of aspirated oocytes. In the subgroup analysis, AFC, number of growing follicles on day of hCG and number of collected oocytes were comparable between the ectopic pregnancy group and hydrosalpinx group. Conclusion: The study suggests that salpingectomy is not associated with detrimental effects on AFC and ovarian response.

Estradiol supplementation in intracytoplasmic sperm injection cycles with thin endometrium

Objective: To evaluate the efficacy of estradiol supplementation starting on the day of human chorionic gonadotrophin (hCG) in patients with thin endometrium in intracytoplasmic sperm injection (ICSI) cycles. Methods: A total of 117 consecutive patients with the endometrial thickness on the hCG day ≤8 mm were rewieved. Estradiol supplementation was given in 57 patients and the remaining 60 patients were accepted as control group. Estradiol supplemented (ES) group received estradiol hemihydrate 4 mg/day started on the day of hCG. Luteal phase was supported using the vaginal progesterone gel in both groups. Clinical pregnancy rate, implantation rate, miscarriage rate, endometrial thickness on the day of oocyte pick-up and on the day of embryo transferred were accepted as main outcome measures. Results: There were no statistical differences in terms of clinical pregnancy rate (28.1% vs. 23.3%), implantation rate (16% vs. 10.4%), miscarriage rate (21% vs. 31.6%), endometrial thickness on the oocyte pick-up day (8.5 ± 1.8 vs. 8.4 ± 1.4, mm) and embryo transferred day (9.6 ± 2.9 vs. 10.3 ± 2.4, mm) in the ES group vs. control group. Conclusion: Estradiol supplementation starting on the hCG day for the patients with thin endometrium does not provide any benefit on the pregnancy outcome in ICSI cycles.