Cem Fıçıcıoğlu

Effect of vaginal misoprostol application for cervical softening in pregnancy interruption before ten weeks of gestation

Objective. To determine the effect of vaginal misoprostol application for cervical dilatation and to determine the lime taken for pregnancy interruption.

The Effects of Oxidative Stress on Outcomes of Assisted Reproductive Techniques

Purpose: To investigate the impact of oxidative stress on pregnancy success by monitoring malondialdehyde levels in follicular fluid. Methods: Forty five couples were enrolled in this prospective study. Following long protocol of GnRH analogues and r-FSH treatment, oocyte retrieval and intracytoplasmic sperm injection were performed. Malondialdehyde levels were assayed by thiobarbutiric acid reacting substances test. Students t-test and χ2 test were used for statistical analysis. Results: Patients were divided into two groups; group I (pregnancy positive, n = 20), group II (pregnancy negative, n = 25). There was no statistical significant difference in terms of age, infertility period, FSH levels on the third day, number of oocytes retrieved and fertilization rates between the two groups. Pregnancy rates were found to be decreasing in higher malondialdehyde levels. Conclusion: Malondialdehyde can be used as a marker of oxidative stress and a potential marker in predicting assisted reproductive techniques outcome.

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.

Which cut-off value of serum anti-Müllerian hormone level can predict poor ovarian reserve, poor ovarian response to stimulation and in vitro fertilization success? A prospective data analysis

Abstract The aim of our study is to demonstrate which cut-off value of serum anti-Müllerian hormone (AMH) level can predict poor ovarian reserve, poor ovarian response to stimulation and IVF outcomes. About 311 of 520 women enrolled IVF treatment cycle that meets inclusion criteria were recruited for this prospective data analysis. Data were collected for: age, duration of infertility, basal FSH and AMH level, total dosage of gonadotropins, maximum estradiol levels, duration of stimulations, total number of oocytes retrieved and clinical PR. Mean AMH was 1.76 ± 1.4 ng/ml and mean age was 33.25 ± 5.5 years. Clinical PR was 39.8% (n = 124). AMH was inversely correlated to total dosage of gonadotropins and age, AMH positively had a significant correlation with maximum estradiol levels, duration of stimulations and total number of oocytes retrieved. The patients in both categories of AMH levels, ≤0.5 and ≤1 ng/ml responded poorly to ovarian stimulation, had significantly higher total dosage of gonadotropins used and FSH levels on cycle day 3, lower maximum E2 levels and clinical PR. AMH could be an acceptable screening test in prediction of ovarian reserve, response to ovarian stimulation and PRs. AMH cut-off value ≤1 ng/ml may predict poor ovarian reserve, poor ovarian response to stimulation and IVF outcomes.

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.

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.

Melatonin treatment results in regression of endometriotic lesions in an ooferectomized rat endometriosis model.

OBJECTIVE We aimed to determine the effects of melatonin treatment on endometrial implants in an oopherectomized rat endometriosis model. MATERIAL AND METHODS This study is a prospective, randomised, controlled experimental study. It was carried out at the Experimental Research Center of Yeditepe University (YUDETAM). Twenty-two, female, non-pregnant, nulligravid Spraque-Dawley albino rats were included in our study. Endometriosis was surgically induced in oopherectomized rats. Rats were randomised into two groups: control group and melatonin group. In the melatonin group, rats were treated with melatonin (20 mg/kg/day) for two weeks. After the operations were performed to assess the regression of the endometriotic lesions, melatonin treatment was stopped. At the end of the sixth week necropsies were performed to assess the rate of recurrence. The volume and histopathological scores of endometriotic foci were examined. RESULTS Volumes of the endometriotic lesions significantly decreased in the melatonin group. Also, when the melatonin group was analysed within itself, endometriotic lesion volumes decreased and histopathological scores increased significantly. CONCLUSION Melatonin causes regression of the endometriotic lesions in rats and improvement in their histopathological scores.

FERTILITY PRESERVING SURGICAL MANAGEMENT OF METHOTREXATE-RESISTANT CESAREAN SCAR PREGNANCY

Implantation within the fibrous tissue of a cesareanscar is considered to be the rarest form of ectopic preg-nancy, and it constitutes a life-threatening condition[1,2]. It comprises 6.1% of all ectopic pregnancies incases with a history of at least one cesarean delivery [3].The clinical presentation varies from light and painlessvaginal bleeding to moderate abdominal pain [4]. Manyasymptomatic pregnancies may still be easily misdiag-nosed, leading to uterine curettage, followed by massivehemorrhage and emergency hysterectomy [5]. Althoughthere are several interventions, such as dilatation andcurettage (D&C) under ultrasound guidance, local orsystemic injection of methotrexate (MTX), hysteroscopicremoval of the ectopic pregnancy, uterine artery emboli-zation, laparotomy or laparoscopic excision, currentlyused for maintaining uterine integrity, none have beenuniversally accepted or found to be completely reliable[1,2,6–8,10,11,12,13]. Here, we presentour experiencein the management of a case of cesareanscar ectopicpregnancy.A 40-year-old, gravida 3, para 1, woman presentedto our hospital with vaginal bleeding and noncramp-ing pain following D&C for inevitable abortion atanother hospital. Her obstetrics history revealed onelower transverse cesarean section performed 2 yearspreviously because of fetal death

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.