Esma Sarıkaya

Melatonin improves the oocyte and the embryo in IVF patients with sleep disturbances, but does not improve the sleeping problems

PurposeWe aimed to analyse the in vitro fertilization-embryo transfer (IVF-ET) outcomes of the patients with sleep disturbances who were administered melatonin.MethodsA total of 60 patients with sleep disturbances were divided into two groups. The study group (group A, n = 30) had underwent the IVF-ET with melatonin administration and the control group (group B, n = 30) without melatonin. Sleeping status after melatonin administration and the IVF outcomes were compared between the two groups.ResultsSleeping status change was not significant (p > 0.05). The mean number of the retrieved oocytes, the mean MII oocyte counts, the G1 embryo ratio were significantly higher in the melatonin administered group (group A) than that the non-administered group (group B); p = 0.0001; p = 0.0001; p < 0.05 respectively.ConclusionIVF patients with sleep disorders may benefit from melatonin administration in improving the oocyte and the embryo quality, but the sleeping problem itself may not be fixed.

Evaluation of ADAMTS12, ADAMTS16, ADAMTS18 and IL-33 serum levels in pre-eclampsia

Abstract Objective: Pre-eclampsia is the result of impaired trophoblast invasion and spiral artery remodeling managed by inflammatory response in its etiology and physiopathology. The aim of this study was to compare serum molecules including IL-33, ADAMTS12, ADAMTS16 and ADAMTS18 levels between pre-eclampsia and control groups and to investigate the role of these molecules in pre-eclampsia. Methods: Forty-one women diagnosed as pre-eclampsia between 30 and 40 weeks of gestation and 41 non-complicated pregnant women were enrolled in this cross-sectional, case–control prospective study. ELISA method was used to determine IL-33, ADAMTS12, ADAMTS16 and ADAMTS18 levels within serums in two groups. Results: Serum ADAMTS12 and IL-33 levels were significantly lower in pre-eclampsia group (p < 0.001 and p: 0.028, respectively), however, in sub-group analysis, no significant difference was observed (p > 0.05). The cut-off value of ADAMTS12 levels to discriminate pre-eclampsia with %73.17 sensitivity and %92.68 specificity was 8.27 ng/ml while the cut-off value for IL-33 was 0.23 pg/ml with 82.93% sensitivity and 53.66% specificity. Conclusion: Pre-eclampsia is associated with lower serum IL-33 and ADAMTS12 levels.

A new biological marker candidate in female reproductive system diseases: Matrix metalloproteinase with thrombospondin motifs (ADAMTS).

Playing a key role in the pathophysiology of many diseases, A Disintegrin-like and Metalloproteinase with Thrombospondin type-1 motif (ADAMTS) proteinases have been attracted more attention in obstetrics and gynecology. First discovered in 1997, this zinc-dependent proteinase family has 19 members today. These enzymes, which are located in the extracellular matrix (ECM), have a lot of very important functions, like matrix formation and resorption, angiogenesis, ovulation, and coagulation. In addition, in the pathogenesis of cancer, inflammation, arthritis, and connective tissue diseases, ADAMTS proteinases have crucial roles. The purpose of this review is to collect previous studies about obstetrics and gynecology that are related to ADAMTS enzymes and discuss the subject in many aspects to give an idea to the investigators who are interested in the subject.

Comparison of C-reactive protein levels in pregnancies with retained and removed intrauterine device

Objective. We aimed to investigate possible alterations in circulating levels of the high sensitivity (hs)-C-reactive protein (CRP) reflecting tissue inflammation in patients who conceived with an intrauterine device (IUD) and in pregnancies after IUD removal in early pregnancy. Methods. Serum hs-CRP levels were measured in 30 pregnant women with retained IUD and 18 pregnancies after IUD removal in early pregnancy. Rates of total miscarriage, premature rupture of membranes (PROMs), low birth weight, placental abruption, and preterm delivery were also documented. Results. Serum levels of CRP were significantly higher in pregnant women with retained IUD than pregnancies with removed IUD. Total miscarriage, PROMs, placental abruption, and preterm delivery rates were significantly higher in pregnant women with retained IUD compared with pregnancies after IUD removal in early pregnancy. Conclusions. Serum CRP concentrations are increased in pregnant women with retained IUD. Our findings also suggest that the pregnancies with retained IUDs that are not removed are at increased risk for adverse pregnancy outcomes.

Low VEGF expression in conceptus material and maternal serum AFP and β-hCG levels as indicators of defective angiogenesis in first-trimester miscarriages

OBJECTIVE The aims of this study were to assess the relationship between early miscarriages and vascular endothelial growth factor (VEGF) expression and to determine the serum levels of first-trimester maternal alpha-fetoprotein (AFP) and human chorionic gonadotropin (β-hCG) as markers of angiogenesis and predictors of abortion and intrauterine fetal loss. MATERIAL AND METHODS The present study was a prospective, single-center, randomized controlled clinical trial. Ninety-five women who were 6-10 weeks pregnant between May and June 2010 were included in the study. The subjects were divided into three groups, i.e., incomplete abortion (IA) (n=31), intrauterine death (IU-D) (n=32) and control (elective pregnancy termination) (n=32). Feto-placental materials were compared based on immune staining for VEGF in the pathology laboratory, and maternal serum samples were tested in the hormone laboratory. RESULTS Serum β-hCG levels in the patient groups were significantly lower than the controls (p=0.001). The serum AFP level was lower than the controls in the IA group while it was higher than the controls in the IU-D (p=0.016). Immunohistochemistry showed that the cytotrophoblast, syncytiotrophoblast and endometrial gland epithelium were weakly stained for VEGF in the patient groups (IA and IU-D) in comparison to the control group (p=0.06, p=0.028, p=0.006). CONCLUSION Early pregnancy losses are related to insufficient angiogenesis, and maternal serum AFP and β-hCG can be used as markers of angiogenesis in the first trimester.

Office hysteroscopic findings in patients with two, three, and four or more, consecutive miscarriages

ABSTRACT Objectives To assess hysteroscopic findings in patients with two, three, and four or more, consecutive miscarriages, and to compare the prevalence of uterine abnormalities between women with different numbers of such miscarriages. Methods Two hundred and sixty-five women with two or more consecutive miscarriages were enrolled in the study. Patients were divided into three groups according to the number of their miscarriages: Group 1 (two miscarriages, n = 151), Group 2 (three miscariages, n = 69), and Group 3 (four or more miscarriages, n = 45). All participants underwent a diagnostic hysteroscopy. Congenital (arcuate uterus, septate uterus, unicornuate uterus) and acquired uterine abnormalities (intrauterine adhesions, polyp and submucous myoma) were recorded. The hysteroscopic results were compared between the groups. Results No anomalies were detected in 152 patients (57%), whereas 43 (16%) had a septate uterus, 30 (11%) an arcuate uterus, three (1%) a unicornuate uterus, 18 (7%) intrauterine adhesions, 17 (6 %) endometrial polyps, and two (1%) a submucous myoma. No significant differences were found between the groups with regard to either congenital or acquired uterine abnormalities. Conclusions Patients with two, three, and four or more consecutive miscarriages have a similar prevalence of uterine anatomical abnormalities. Diagnostic hysteroscopy should be carried out after two such miscarriages.

Increased oxidative stress markers may be a promising indicator of risk for primary ovarian insufficiency: a cross-sectional case control study

PURPOSE The aim of this study was to evaluate serum levels of inducible nitric oxide synthase (INOS), myeloperoxidase (MPO), total antioxidant status (TAS), and total oxidative status (TOS) in women with primary ovarian insufficiency (POI) and to compare them with healthy fertile women. We also examined the possible risk factors associated with POI. METHODS This cross-sectional case control study was conducted in Zekai Tahir Burak Womens Health Education and Research Hospital. The study population consisted of 44 women with POI (study group) and 36 healthy fertile women (control group). In all patients, serum levels of INOS, MPO, TAS, and TOS were determined. INOS and MPO levels were measured by enzyme-linked immunosorbent assay whereas colorimetric method was used for evaluating TAS and TOS levels. Age, body mass index (BMI), obstetric history, smoking status, family history, comorbidities, sonographic findings, complete blood count values, C-reactive protein and baseline hormone levels were also analyzed. Students t-test or Mann-Whitney U test was used to compare continuous variables between the groups; categorical data were evaluated by using Pearson χ2 or Fisher exact test, when appropriate. Binary logistic regression method was used to identify risk factors for POI. RESULTS We found significantly elevated levels of INOS (234.1±749.5 versus133.8±143.0; p=0.005), MPO (3,438.7±1,228.6 versus 2,481.9±1,230.1; p=0.001), and TOS (4.3±1.4 versus 3.6±1.4; p=0.02) in the sera of the study group when compared to the BMI-age matched control group. However, difference in serum levels of TAS were not significant between the 2 groups (1.7±0.2 versus 1.6±0.2; p=0.15). Logistic regression method demonstrated that BMI <25 kg/m2, nulliparity, family history of POI, smoking, and elevated serum levels of INOS, MPO, and TOS were independent risk factors for POI. CONCLUSION We found an increase in INOS, MPO, and TOS in women with POI. These serum markers may be promising in early diagnosis of POI. Further large-scale studies are required to determine whether oxidative stress markers have a role in diagnosing POI.

Twin Pregnancies with Single Fetal Death: Analysis of 38 Cases

The objective of this study is to evaluate fetal and maternal outcomes of twin pregnancies with intrauterine single fetal death. In 13 cases, intrauterine death of one fetus was found during the first trimester; in 25 cases, it was found after the first trimester. Obstetric complications and fibrinogen levels were compared. There were no significant differences in the number of preterm delivery, preeclampsia, and intrauterine growth restriction and there were significant differences in gestational age at delivery and birth weight between groups. Coagulation disorders did not occur. The risk for adverse pregnancy outcomes with a single fetal death during and after the first trimester is similar.

Possible association of medications during pregnancy with low estriol level of the triple antenatal screening test

Objective: Our purpose was to reach the reasons of isolated low levels of maternal serum unconjugated estriol (uE3) levels (≤0.3 multiples of the median (MoM)) in the triple-marker screen with special emphasis on maternal diseases and medications used for them. Methods: Single center retrospective cross-sectional analysis. Of 13,367 non-smoking women with identified singleton pregnancies screened for triple test, during 3-year period (2007–2009), a group of women with isolated low serum uE3 levels (≤0.3 MoM) (n = 14) were selected as the study group. Results: Of these 14 women, no one gave birth with ichthyosis. Five patients had, isolated very low uE3 levels (<0.01 MoM). Of these women, one had umbilical cord knot, one was on corticosteroid and three were on propylthiouracil treatment. So, there was history of maternal drug intake in 28.5% of cases with isolated low uE3 (≤0.3 MoM). This rate increases to 80% in cases with very low uE3 levels (<0.01 MoM). Conclusions: Maternal diseases and medications used during pregnancy can affect fetus and antenatal screening test results. This is important during counseling of patients and to perform the appropriate antenatal and postnatal evaluation of the mother and fetus with multidisciplinary approach.

ADAMTS-3, -13, -16, and -19 levels in patients with habitual abortion

A disintegrin‐like and metalloproteinase domain with thrombospondin‐type 1 motifs (ADAMTS) protein superfamily includes 19 secreted metalloproteases. Proteolytic substrates of ADAMTS enzymes have been linked to reproductive function. The aim of this study was to investigate serum ADAMTS‐3, ‐13, ‐16, and ‐19 levels in women with habitual abortions compared with those in healthy controls. A total of 86 women were enrolled in this prospective case‐control study. ADAMTS‐3, ‐13, ‐16, and ‐19 values were recorded and analyzed in association with demographic and clinical parameters. There were no statistically significant differences between the two groups in terms of demographics. No statistically significant differences were observed between the groups with regard to ADAMTS‐13 and ‐19 levels (p > 0.05). However, ADAMTS‐3 and ‐16 were significantly higher in the study group than in the control group (p = 0.004 and p = 0.005, respectively). To estimate habitual abortions using an area under receiver operating characteristic curve analysis, the cutoff values for ADAMTS‐3 and ‐16 were found to be 87.28 ng/mL (sensitivity, 64.44%; specificity 68.29%) and 15.75 ng/mL (sensitivity, 66.67%; specificity 68.29%), respectively. In conclusion, the pregnancy‐loss rate seems to be affected by both ADAMTS‐3 and ‐16.