Bulent Haydardedeoglu

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus

Common carotid artery intima‐media thickness (CIMT) is a non‐invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM).

Conventional testicular sperm extraction combined with the microdissection technique in nonobstructive azoospermic patients: a prospective comparative study

OBJECTIVE To perform conventional and microdissection testicular sperm extraction (TESE) at the same session and compare their effectiveness. DESIGN Prospective comparative study. SETTING University hospital setting. PATIENT(S) The study included 335 patients with nonobstructive azoospermia. INTERVENTION(S) Microdissection TESE was performed to 77 patient with atrophic testes. An additional 258 patients underwent conventional TESE using three incisions on three quadrants of the testis (upper, middle, and lower). Microdissection TESE was performed by enlarging the middle incision vertically when no spermatozoa could be detected using the conventional technique. MAIN OUTCOME MEASURE(S) Sperm retrieval, fertilization, clinical pregnancy rate (PR), and live birth rate were evaluated. The relation between sperm retrieval rate and FSH level and testis volume was also investigated. RESULT(S) Spermatozoa was detected in 33.7% of patients using conventional TESE. The spermatozoa detected increased to 50.8% using microdissection TESE. The increase was statistically significant. In the primary microdissection TESE group, the surgical retrieval rate was 20.8%. The overall sperm retrieval rate was 43.9%. There was a significant relation between the sperm retrieval rate and testis volume, whereas there was no relation between sperm retrieval rate and FSH levels. The overall fertilization rate, clinical PR, and live birth rate were 57.1%, 50.4%, 36.4%, respectively. CONCLUSION(S) Conventional TESE combined with microdissection TESE can be used in selected patients. Sperm retrieval rate of TESE can be low in patients with atrophic testes.

The Effect of Prior Varicocelectomy in Patients With Nonobstructive Azoospermia on Intracytoplasmic Sperm Injection Outcomes: A Retrospective Pilot Study

OBJECTIVES To examine our retrospective data on the outcomes of intracytoplasmic sperm injection (ICSI) and to determine whether a history of varicocele repair in men with nonobstructive azoospermia (NOA) undergoing an ICSI cycle was optimizing or not. METHODS This retrospective study was conducted on Baskent University Department of Obstetrics and Gynecology, IVF Unit, and Department of Urology. Infertile couples suffering from NOA scheduled to an ICSI cycle, which was controlled ovarian hyperstimulation with a gonadotropin or gonadotrophin-releasing hormone-agonist protocol, selected for the study were divided into 2 groups: group 1 (n = 31) included NOA patients who had undergone prior varicocele repair, and group 2 (n = 65) included NOA patients who had not undergone varicocele repair. RESULTS There was a significant difference between the 2 groups considering the sperm retrieval rate, which was higher in the varicocele repair group (sperm retrieval rate 60.81% and 38.46% respectively, P = .01). The clinical pregnancy rate and live birth rate were significantly higher in the varicocelectomy group (74.2% vs 52.3% and 64.5% vs 41.5%, respectively, P <.05). CONCLUSIONS Varicocele repair in NOA might be considered in patients undergoing ICSI cycle.

Single versus double intrauterine insemination in multi-follicular ovarian hyperstimulation cycles: a randomized trial

BACKGROUND The rationale for double insemination is to create the opportunity for a longer fertilization period as follicle rupture may occur over a wide interval (approximately 22-47 h) after hCG administration in ovarian hyperstimulation (OH) with intrauterine insemination (IUI) cycles. This randomized study evaluates the effectiveness of single versus double IUI in only OH cycles with multi-follicular development. METHODS We conducted a single center trial, 228 eligible patients were randomized for this study on the day of hCG. Only cycles with multi-follicular development without premature luteinization (progesterone levels >1 ng/ml on the day of hCG), were included in the study. Multi-follicular development has been defined as at least two dominant follicles reaching minimum > or = 15 mm diameter in which one of them is >17 mm. OH cycles with more than five dominant follicles (>15 mm in diameter) were excluded from the study. In the single IUI group (Group 1 = 112 patients) IUI was applied 36 h after the hCG injection and in the double IUI group (Group 2 = 114 patients) the first IUI was performed 18 h after hCG administration and the second IUI was performed 40 h after hCG administration. The primary end-point is to compare live birth rates (LBRs) between single and double IUI arms. RESULTS LBRs were 10.7% (12/112 patients) in the single IUI group and 12.3% (14/114) in the double IUI group and the difference was not statistically significant (P = 0.835, OR = 1.16, 95% CI: 0.51-2.64). In the unexplained infertility group the LBR was 11.1% (5/45 patients) with single IUI and 18.4% (9/49) with double IUI (P = 0.393). In the mild male factor group this rate was 10.4% (7/67) and 7.7% (5/65) in the single and double IUI groups, respectively (P = 0.764). CONCLUSION Our study did not find any difference in LBRs between single and double IUI groups in OH cycles with multi-follicular development. To the best of our knowledge this is the first report with this kind of study design. The study was registered at clinicaltrials.gov: NCT 00993902.

Transvaginal ultrasound-guided local methotrexate administration as the first-line treatment for cesarean scar pregnancy: Follow-up of 18 cases

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, which occurs in previous cesarean section scar tissue, with an incidence of 1 in 1800–3000 pregnancies. Transvaginal ultrasound‐guided local methotrexate (MTX) administration presents as a non‐systemic option with possible better penetration to the pregnancy site. We present the management of 18 patients with CSP solely by transvaginal ultrasound‐guided local MTX administration. All patients were treated with local MTX with a dose of 50 mg/m2. Eleven (61.1%) of the patients did not need any further intervention. Four patients (22.2%) were treated with additional single‐dose systemic MTX due to inadequate alteration in blood β‐human chorionic gonadotrophin levels. Three patients (16.7%) required hysteroscopy and/or laparotomy. We suggest that transvaginal ultrasound‐guided local MTX treatment may be considered as a first‐line treatment for CSP.

Polycystic ovary syndrome and increased polyp numbers as risk factors for malignant transformation of endometrial polyps in premenopausal women

To determine the pre‐malignant and malignant potential of endometrial polyps and to assess whether different clinical parameters are associated with malignancy in the polyps of premenopausal women.

Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: a single centre experience

We aimed to investigate sperm retrieval rates (SRR) by testicular sperm extraction (TESE), factors affecting SRR, and fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and live birth rate (LBR) in patients with presumed Sertoli‐cell‐only syndrome in testis biopsy (SCOS). We retrospectively evaluated files of 134 patients with SCOS who underwent TESE. Group I were patients in whom spermatozoa were retrieved and Group II were patients in whom no spermatozoa could be retrieved. SRR, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), and testosterone levels, and the volume of testicles were compared between groups. In addition, FR, IR, CPR and LBR were determined. Sperm retrieval was achieved in 37 (27.6%) patients (Group I), and the remaining 97 (72.4%) patients made Group II. There were no significant differences in age, infertility time, testicular volume, serum FSH, LH and testosterone levels between Groups I and II (p > 0.05). Intracytoplasmic sperm injection (ICSI) was performed in 36 patients. FR, IR, and CPR were 60.86 ± 23.03, 36.53 ± 41.78 and 51.3% respectively. Cycle and patient based LBRs were 37.8 and 45.1% respectively. SRR in SCOS is lower than patients with non‐obstructive azoospermia (NOA) in general. No parameters to predict spermatozoa retrieval were determined. In patients with SCOS, ICSI achieves similar live birth rate to other patients with NOA.

In vitro fertilization-intracytoplasmic sperm injection outcomes in single- versus double-lumen oocyte retrieval needles in normally responding patients: a randomized trial.

We compared the retrieval efficiency of single- (direct follicular aspiration) and double-lumen-needle (attained with follicular flushing) procedures in normal-responder IVF-intracytoplasmic sperm injection cycles. This prospective randomized study did not demonstrate a beneficial effect of double-lumen needle retrieval compared with single-needle retrieval in normal-responder IVF-intracytoplasmic sperm injection cycles in terms of retrieved oocytes, clinical pregnancy rates, and live birth rates.

Effect of cervical mucus aspiration before intrauterine insemination.

To determine whether cervical mucus aspiration before intrauterine insemination (IUI) has any effect on clinical pregnancy rates.

Can calcium ionophore “use” in patients with diminished ovarian reserve increase fertilization and pregnancy rates? A randomized, controlled study

OBJECTIVE To determine whether calcium ionophore solution can improve the fertilization rate in patients with diminished ovarian reserve whose partners have normal sperm parameters. DESIGN Between January 2014 and August 2014, patients with diminished ovarian reserve were randomized to make artificial oocyte activation with calcium ionophore solution. SETTING University hospital. PATIENT(S) A total of 296 patients who had diminished ovarian reserve and partners with normal sperm parameters were included in the study. INTERVENTION(S) Metaphase 2 oocytes were treated with calcium ionophore solution (GM508 Cult-Active) for 15 minutes just after intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S) Fertilization rate, implantation rate, clinical pregnancy rate, ongoing pregnancy rate. RESULT(S) Fertilization, implantation, pregnancy, and ongoing pregnancy rates for the calcium ionophore and control groups were 60.7% and 55.4%, 12.8% and 10.7%, 21% and 12.8%, and 10.9% and 6.1%, respectively. CONCLUSION(S) This is the first prospective, randomized, controlled study to analyze the effect of calcium ionophore solution on fertilization rate in patients with diminished ovarian reserve. We did not observe any differences in fertilization, clinical pregnancy, or ongoing pregnancy rates between the groups. We propose that fertilization ratios could not be increased by artificial oocyte activation via application of calcium ionophore solution in patients with diminished ovarian reserve. CLINICAL TRIAL REGISTRATION NUMBER NCT02045914.