Cem Akarsu

Smooth endoplasmic reticulum aggregations in all retrieved oocytes causing recurrent multiple anomalies: case report

OBJECTIVE To document the relationship between smooth endoplasmic reticulum (SER) aggregations and recurrent fetal anomalies. DESIGN Case report. SETTING Private IVF center. PATIENT(S) A 28-year-old woman with an 11-year history of primary infertility. INTERVENTION(S) Three consecutive cycles of intracytoplasmic sperm injection (ICSI) in the same patient. MAIN OUTCOME MEASURE(S) Clinical pregnancy, live birth, fetal anomaly. RESULT(S) In three consecutive ICSI cycles, a total of 59 MII oocytes were retreived in the same patient, all displaying SER aggregations. The fertilization rate per cycle was 80%, 50%, and 42%, respectively. A total of 12 embryos were transferred in three ICSI cycles, of which 11 were grade 1 embryos. Two of the three cycles ended up with clinical ongoing pregnancies but with multiple fetal anomalies. CONCLUSION(S) This is the first case reported with SER aggregations in all retrieved oocytes in three consecutive ICSI cycles. The repetetive multiple fetal anomalies possibly related to oocyte dysmorphism are of concern.

The effect of uterine volume on uterine artery Doppler velocimetry in the myomatous state

This study aimed at testing the hypothesis that lower uterine arterial (UA) Doppler indices are caused by increased uterine volume rather than the presence of myoma. Uterine volumes were calculated and uterine and/or myomal arterial pulsatility index (PI) and resistance index (RI) were obtained by transvaginal color Doppler ultrasonography. The mean uterine volume in the myomatous group (276.2 cm3; range 65-928 cm3, n = 100) was significantly greater than that of the control group (101.4 cm3; range 36-171 cm3; n = 60; p = 0.00). The mean UA PI and RI values in the study group were significantly lower than their corresponding values in the control group (0.77 +/- 0.08 and 1.69 +/- 0.47 vs. 0.82 +/- 0.06 and 1.97 +/- 0.49, respectively, p = 0.01). When the myomatous uterine volumes of the study group were categorized into two subgroups (< 200 and > or = 200 cm2) the UA PI and RI values were lower in the latter group (p = 0.006 and p = 0.015, respectively). However, after analysis of receiver-operator-characteristic curves, none of the UA Doppler indices could differentiate the myomatous uterus from the normal uterus.

Hemodynamic assessment in pelvic inflammatory disease by transvaginal color Doppler ultrasonography

One of the major signs of inflammation is a change in vascular flow and caliber. It is possible to detect these changes with the help of transvaginal color Doppler velocitometry. The purpose of this study was to evaluate the changes in pelvic circulation in cases with pelvic infection and to correlate these findings with other infectious parameters. The study group consisted of 20 cases who had the diagnosis of pelvic inflammatory disease (PID). Resistance index (RI) and pulsatility index (PI) were measured with transvaginal color Doppler ultrasonography in the uterine and ovarian arteries as well as at the tubouterine junction three times in a one-month period. At the same time the body temperature, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and leukocyte counts were recorded. Infectious parameters declined to normal values, following a pattern parallel to clinical improvement from the first until day 30. Infectious parameters revealed significant differences between days 1-7, 1-30 and 7-30. On the other hand, low resistance in all three measurement points exhibited a rapid increase on the day 7 day and plateaued until the day 30 day. Color Doppler velocitometry measurements revealed significant differences between days 1-7 and 1-30 but not between days 7-30. These findings demonstrate that as the infection subsides, the changes in vascular flow return to normal before infectious parameters do. In conclusion, it is possible to detect decreased vascular resistance in acute infection with the help of transvaginal color Doppler ultrasonography. Furthermore, color Doppler ultrasonography can accurately detect regression of the infectious process before body temperature and acute phase reactants do.

BIRTH OF A HEALTHY BOY USING FRESH TESTICULAR SPERM IN A PATIENT WITH KLINEFELTER SYNDROME COMBINED WITH KARTAGENER SYNDROME

OBJECTIVE To report a case of Klinefelter syndrome combined with Kartagener syndrome. DESIGN Case report. SETTING Private IVF center. PATIENT(S) A 35-year-old man with Klinefelter syndrome combined with Kartagener syndrome causing primary infertility. INTERVENTION(S) Testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S) Sperm recovery, fertilization, and live birth. RESULT(S) Ovulation induction of the female partner, recovery of spermatozoa by TESE from the male partner and ICSI of 9 metaphase II oocytes resulted in two fertilized oocytes. The delivery of a healthy boy with normal anatomy and 46,XY karyotype was achieved after the transfer of only one 4-cell grade 1 embryo. CONCLUSION(S) To our knowledge, this case with nonmosaic Klinefelter syndrome combined with Kartageners syndrome is unique and demonstrates the revolutionary aspects of assisted reproductive technologies (ART) concerning male factor infertility.

Prediction of perinatal outcome by middle cerebral artery doppler velocimetry

The relationship between pulsatility index (PI) in the middle cerebral artery (MCA) and adverse perinatal outcome was studied in 162 normal and 75 high-risk pregnancies. The intrapartum cardiotocographic (CTG) findings, the mode of delivery, 1 and 5-minute Apgar scores, the pH level of the umbilical artery, admission to the neonatal intensive care unit (NICU) and the incidence of intrauterine fetal growth retardation were recorded. In the low risk group, the PI values in the MCA were only affected in growth retarded fetuses (P = 0.0084). In the high-risk group, there was an association between the MCA PI values and 5-minute Apgar scores (P = 0.0397), umbilical artery pH values (P = 0.0068) and development of IUGR (P = 0.0376). In both groups, an abnormal intrapartum CTG, the 1-minute Apgar score, cesarean section for fetal distress and admission to the NICU were not related to PI values in the MCA. Our present study suggests that doppler flow measurement of MCA provides useful information about perinatal outcome, especially in the high-risk pregnancies.

Outcome of intracytoplasmic sperm injection using fresh and cryopreserved‐thawed testıcular spermatozoa in 83 azoospermic men with Klinefelter syndrome

To report the outcome of intracytoplasmic sperm injection (ICSI) cycles using fresh or cryopreserved‐thawed testicular spermatozoa of men with Klinefelter syndrome (KS).

Two successful pregnancies achieved by converting an in vitro fertilization cycle to an intrauterine insemination cycle in five cases with documented premature ovulation

We here report two successful pregnancies obtained by converting an in vitro fertilization (IVF) cycle to an intrauterine insemination (IUI) cycle in five poor responder patients whose oocyte pick-up (OPU) procedures were canceled due to documented premature ovulation immediately before OPU. To our knowledge, this is the first article that demonstrates that switching an IVF cycle to an IUI cycle when premature ovulation occurs on the day of OPU can produce successful pregnancies, even in poor responder patients.