Birgül Gürbüz

Relationship between semen quality and seminal plasma total carnitine in infertile men.

This study was designed to determine any correlation between infertility and semen quality with concentrations of total carnitine in human seminal plasma. Seminal plasma total carnitine concentrations were determined in 79 men. The seminal plasma of 65 infertile men and 14 men as a control group with proved fertility were investigated. The concentrations of total carnitine were reduced significantly in the infertile group compared to the control group (31.52 ± 20.77 vs. 45.52 ± 10.73mg/l, P < 0.05). The 65 infertile men were divided into five groups according to their sperm analysis: normospermia (n = 42), oligospermia (n = 23), asthenospermia (n = 40), teratospermia (n = 44) and oligoasthenospermia (n = 10). Total seminal plasma carnitine concentration differed significantly between controls and the patient groups (P < 0.05). There was a statistically significant positive correlation between seminal plasma total carnitine concentration with total sperm count and the percentage of normal forms (P < 0.05 and P < 0.01, respectively). Total carnitine concentration was found to be low in the asthenospermia group when compared with the group of patients, whose total motile sperm percentage was 51 (P < 0.05). These findings suggest that the determination of seminal carnitine levels may be a useful test in evaluation of male infertility.

Serum levels of inhibin B in men and their relationship with gonadal hormones, testicular volume, testicular biopsy results and sperm parameters.

Currently, serum inhibin B levels, indicating testicular function due directly to its testicular origin, has been used increasingly in assisted reproductive units. Our aim in this prospective study was to evaluate the biological significance of inhibin B in gonadal dysfunctional males and the usefulness of inhibin B for the detection of male reproductive dysfunction. We included 52 oligoazoospermic and 20 normospermic men in this study. In our study serum inhibin B levels had statistically significant negative correlation with serum FSH and LH levels ( P < 0·001, r : 0·781) and statistically moderate positive correlation with oestradiol levels ( P < 0·005, r : 0·292). Inhibin B levels had significantly positive correlation with sperm count ( P < 1·005, r : 0·851) and with testicular volume ( P < 0·001, r : 0·466). Consequently, serum inhibin B level determination is a useful and non-invasive method for the evaluation of male gonadal dysfunction, taking into account its correlation with history, clinical examination, hormonal parameters, testicular volume, spermiogram and testicular biopsy.

High local endometrial effect of vaginal progesterone gel

Our objective was to investigate the first-pass effect to the uterus of progesterone gel administered vaginally. This was a prospective, randomized study of 32 postmenopausal women, attending our menopause clinic. All women used transdermal estradiol (50 μg/day, a patch each week) for 2 weeks. They used either vaginal progesterone gel or intramuscular progesterone in oil 50 mg after 24 h to oppose the transdermal estradiol. Serum progesterone levels and endometrial tissue progesterone levels were determined. Serum progesterone levels were higher in women who used the intramuscular rather than the vaginal route. Although serum progesterone levels in the vaginal group were lower than in the intramuscular group, the endometrial tissue concentration of progesterone was higher. It is concluded that progesterone gel, used vaginally, has a high local effect on the endometrium, without any systemic side-effects due to high plasma progesterone levels.

EFFECTS OF SEMEN CHARACTERISTICS ON IUI COMBINED WITH MILD OVARIAN STIMULATION

To determine the influence of sperm parameters inseminated on the outcome of intrauterine insemination (IUI) in patients undergoing ovarian stimulation with clomiphen citrat (CC) or human menopausal gonadotropin (HMG) therapy, a retrospective review was performed for 2 years on data from the IUI program. 190 couples underwent a total of 268 IUI cycles in which CC or HMG was used for ovulation induction. The initial sperm concentration (mil/ml), motility (percent), preprocessing total motile sperm (TMS) count (million), fast motile sperm (percent) and postprocessing sperm concentration (mil/ml), motility (percent), TMS count, fast motile sperm (percent), sperm morphology, hypoosmotic swelling (HOS) scores, semen leuocytes, and bacteria were analyzed. 268 inseminations were followed by a pregnancy rate of 12% and couple pregnancy rate of 17%. On multivariable logistic regression analysis, total motile sperm (TMS) count, percent motility, and percent of fast motile sperm were independent prognostic factors of fertility. The impact of the preprocessing and postprocessing sperm parameters on pregnancy outcome after IUI was evaluated. There was a trend toward an increasing percent of conception with increasing TMS count, motility, and percent of fast motile sperm. The TMS count, motility and percent of fast motile sperm independently predict success with IUI. Patients with original sperm motility ≥30% had a higher cumulative pregnancy rate (74%) than patient with motility <30% (p < 0.005). Pregnancy rate increased 4 times with motility of ≥30%.

Basal hormone levels in women with recurrent pregnancy loss

The potential role of endocrine abnormalities during the follicular phase in women with unexplained recurrent pregnancy loss was investigated in a retrospective study. Eighty women with recurrent pregnancy loss underwent routine work-up to exclude known associations with the condition. Following investigation ,58 women failed to reveal an identifiable cause ,and were therefore classified as having unexplained recurrent pregnancy loss. The control group consisted of women with known causes of abortions ,such as uterine septum and parental chromosomal abnormalities. Mean age ,gravidity ,parity ,presence of infertility, previous number of miscarriages and duration of marriage were similar in both groups. Day-3 serum levels of follicle stimulating hormone (FSH) ,estradiol ,luteinizing hormone (LH) prolactin ,total testosterone, dehydroepiandrosterone sulfate (DHEAS) and thyroid stimulating hormone (TSH) were compared in the two groups. FSH ,estradiol ,LH ,prolactin and DHEAS concentrations were significantly higher in the unexplained recurrent pregnancy loss group than in the explained recurrent pregnancy loss group ,although serum concentrations of all hormones were within the normal range (p < 0.01). TSH and total testosterone levels were similar in the two groups (p > 0.05). There were no differences in the frequency of abnormal levels of hormones between the two groups (p > 0.05). We conclude that endocrine abnormalities in the follicular phase are not associated with recurrent pregnancy loss.

Doppler evaluation of the uterine, intraovarian, stromal and spiral arteries on the day of human chorionic gonadotrophin administration in controlled ovarian hyperstimulation

The aim of this prospective study was to investigate the ability of transvaginal power Doppler ultrasonography to assess the relationship between the pulsatility indices (PI) of uterine, spiral and ovarian arteries and endometrial thickness on the day of, but just before, human chorionic gonadotrophin administration and the relationship to pregnancy outcome. Fifty-seven patients were recruited to the study. The mean PI values of the uterine arteries demonstrate significant differences between the women who conceived and those who did not. The mean PI values of the intraovarian flow also demonstrated significant differences between the left and right PI values and between the PI of the women who conceived and those who did not. Mean PI values of the spiral arteries and endometrial thickness did not demonstrate any significant difference between the women who conceived and those who did not. The parameters used currently in colour Doppler assessment of ovarian stromal, uterine and spiral artery perfusion are clinically helpful in discriminating prospectively which patients will and will not become pregnant in controlled ovarian hyperstimulation, insemination programme.

Kesintisiz kombine hormon replasman tedavisi kullanan postmenopozal kadınlarda vaginal kanama paternlerinin karşılaştırılması

Objective: To determine the effects of four different types of oral combined continuous hormone replacement therapies on vaginal bleding in postmenopausal women. Materials and Methods: This was a 1 year, prospective, randomized study including 37O postmenopausal women ages between 4057. Tibolone, estradiol hemihidrate 2mg/day + noretisteron acetate 1 mg/day, conjugated estrogen 0.625 mg/day+medroxyprogesteron acetate 2.5 mg/day, conjugated estrogen 0.625 mg/day +medroxyprogesteron acetate 5 mg/day therapies were used by the four study groups. Postmenopansal women were called back for three monthperiods. Results: There was no significant difference for bleeding patterns between the study groups during treatment period. At the end of 1 year, Tibolone and estradiol hemihidrate 2 mg/day + noretisteron acetate Img/day usage did not increase bleeding risk. However relative risk as 3.5-2.2 was found with conjugated estrogen 0.625mg /day+medroxyprogesteron acetate 2.5 mg/day and conjugated estrogen 0.625 mg/day +medroxyprogesteron acetate 5mg/day therapies. Conclusion: At the end of one year followup %96100 of the postmenopausal women had amenorrhea. Irregular bleeding was seen often at the first three months of therapy, and the incidence tended to increase during study. Contrary to literature, the incidence of vaginal bleeding was less in the estradiol hemihidrate 2 mg/day + noretisteron acetate Img/day group when compared with the tibolone group.

Indications and complications for caesarean section

Objective: Aretrospective surveywas conducted to determine the conditions, indications and complications for caesarean section in 2000 patients. Study Design: 2000 women who undenvent caesarean section in our unit were includedin this study. Standard demographic variables, antepartum and postpartum hemoglobin and hematocritlevels, the indications and complications of caesarean section, intrapartum tubalsterilizationrates, APGAR levels and birth-weights offetuses, the meanlength of staying in hospital were recorded. Resuts: The leading or the major indications rates for abdominal deliveries were: repeat caesarean section 30%, fetal distress 23%, cephalo-pelvic disproportionl6.6%, breechpresantation7.7%, twin pregnancy 6.3%, prolonged labor 5%, preeclampsia 4.1%, placenta previal.5%, abruptio-placentae 3.4%, umblical cordprolapsus 1.3%, gestational diabetes mellitus 0.4, fetal anomalies 0.1%. Age ranged from 15-45 years, 5.70% were women under the age of 20, and 57% were betiveen 20 and 30 years of age and 33.3% were women elder than the age of 30. 16.5% of the mothers were primiparae, 83.5% were multiparae. 4.1% ofthem had blood transfusion. 1.3% had wound infections, 0.7% had hematomas. Analysis of caesarean sections in the last three years showed an increasing rate, from 27.3.6% in 2001 to 30.77% in 2002 and 32.99% in 2003. Conclusion: The proportion of pregnancies delivered by caesarean section increased for all indications. The matemal morbidity rate following caesarean deliveryis relatively low.

The relation of sperm function tests and fertilization failure in invitro fertilization

Objective:To investigatethe effects of sperm function test on IVF failure. Methods: In this study spontaneous and the stimulated acrosome reaction (AR) and Hypoosmotic swelling test (HOS) was performed for normospermic samples. Ca ionophore was A23187 used for maximal acrosome loss and hypoosmotic media (Fructose,Na cit-rate 150 mOsm) for swelling of spermatozoa, respec-tively. Results: We found that induced AR results had higher fertilization success than spontaneous AR results and a significant correlation between HOS grade 1-4 and fertilization rates. Conclusion: Stimulated AR test and HOS test grades can predict sperm fertilization ability in IVF.