Erhan Simsek

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).

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.

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.

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.

Metabolic and endocrine effects of metformin and metformin plus cyclic medroxyprogesterone acetate in women with polycystic ovary syndrome

To evaluate the metabolic and endocrine effects of treatment with cyclic medroxyprogesterone acetate (MPA) plus metformin compared with metformin alone in women with PCOS.

Atorvastatin for ovarian torsion: effects on follicle counts, AMH, and VEGF expression

OBJECTIVE(S) To determine if atorvastatin protects ovarian follicles against ischemia reperfusion (I/R) injury and to determine how anti-Müllerian hormone (AMH) and vascular endothelial growth factor-A (VEGF-A) expression is altered. STUDY DESIGN This experimental study was conducted at the Baskent University Animal Research Laboratory. Forty-four rats were arbitrarily assigned into four groups of 11 rats each. The control group underwent a laparotomy. The atorvastatin group received atorvastatin (10mg/kg/day), by oral gavage 7 days before and 7 days after the sham operation. The torsion group had bilateral torsion and detorsion of the ovaries. The atorvastatin+torsion group received atorvastatin (10mg/kg/day) 7 days before and 7 days after the torsion/detorsion operation. At day 7, the animals were euthanized and their ovaries were removed. Ovarian follicles were counted, and AMH and VEGF-A expression was determined. The Kruskal-Wallis, χ(2), or Fishers exact test were used when appropriate. RESULTS Primordial follicles (p=0.001), VEGF-A expression (p=0.018) and vascularization (p=0.02) were significantly higher in the atorvastatin group compared to controls. Primordial (p=0.002), primary (p=0.001), and secondary follicles (p=0.001), AMH expression (p=0.001), and vascularization (p=0.001) were lower in the torsion group compared with the control group. Primordial follicles (p=0.001), AMH (p=0.001) and VEGFA expression (p=0.001), and vascularization (p=0.001) were significantly higher in the atorvastatin+torsion group compared to the torsion group. CONCLUSION(S) Atorvastatin increased the primordial follicle pool and vascularization and protected primordial follicles and vascular structures against I/R injury.

Repeated ovariopexy failure in recurrent adnexal torsion: combined approach and review of the literature

Adnexal torsion is a well-known but poorly recognized gynecological emergency. Most cases are in the reproductive age group and many are related to ovarian and paraovarian masses. Adnexal torsion can also occur, however, in normal-looking ovaries with elongated utero-ovarian ligaments. The authors describe the case of a young woman presenting with a sixth recurrence of right adnexal torsion with polycystic ovaries. She had had two failed ovarian fixation efforts in the third and fifth laparoscopies. A combined ovarian fixation method is described, fixing the ovary to the pelvic side wall and shortening the utero-ovarian ligament, at elective surgery one month after the detorsion operation. Ovarian fixation after adnexal torsion is not standardized and best method of fixation remains unresolved.

Absence of unilateral adnexa associated with asymptomatic adnexal torsion and autoamputation

We present the case of a patient who had a pelvic mobile mass and unilateral absence of unilateral ovary and ipsilateral partial fallopian tube, which may be associated with asymptomatic adnexal torsion. She had had no previous abdominal operations and no history of acute abdominal pain, nausea or vomiting. There are two possible reasons for unilateral absence of adnexa: one is adnexal torsion and the other is congenital malformation.