Esra Çetinkaya

Microdose gonadotropin-releasing hormone agonist flare-up protocol versus multiple dose gonadotropin-releasing hormone antagonist protocol in poor responders undergoing intracytoplasmic sperm injection–embryo transfer cycle

OBJECTIVE To compare the efficacy of microdose GnRH agonist (GnRH-a) flare-up and multiple dose GnRH antagonist protocols in patients who have a poor response to a long luteal GnRH-a protocol. DESIGN Prospective, randomized, clinical study. SETTING University hospital. PATIENT(S) Forty-two poor responder patients undergoing intracytoplasmic sperm injection (ICSI)-embryo transfer cycle. INTERVENTION(S) Twenty-one patients received microdose leuprolide acetate (LA) (50 microg twice daily) starting on the second day of withdrawal bleeding. The other 21 patients received 0.25 mg of cetrorelix daily when the leading follicle reached 14 mm in diameter. MAIN OUTCOME MEASURE(S) Serum E(2) levels, number of growing follicles and mature oocytes, embryo quality, dose of gonadotropin used, cancellation, fertilization, implantation rate and pregnancy rate (PR). RESULT(S) The mean serum E(2) concentration on the day of hCG administration was significantly higher in the microdose GnRH-a group than in the GnRH antagonist group (1,904 vs. 1,362 pg/mL). The clinical PRs per started cycle of microdose GnRH-a and GnRH antagonist groups were 14.2% and 9.5%, respectively. There were no statistically significant differences in the other ovulation induction characteristics, fertilization and implantation rates. CONCLUSION(S) Microdose GnRH-a flare-up protocol and multiple dose GnRH antagonist protocol seem to have similar efficacy in improving treatment outcomes of poor responder patients.

Uterocutaneous fistula after surgical treatment of an incomplete abortion: methylene blue test to verify the diagnosis

IntroductionUterocutaneous fistula is an extremely rare clinical condition that can be seen after pelvic or uterine surgery. It can also complicate some obstetric procedures.CaseWe report of an unusual case of an uterocutaneous fistula that developed in a multiparous woman after surgical evacuation of an incomplete first trimester septic abortion. The fistula tract was depicted on computed tomography, and to verify the diagnosis methylene blue was given through a transcervically introduced uterine catheter, and blue dye flow out through the external opening of fistula was observed. At laparatomy fistula tract was completely excised along with the enclosing omentum. Postoperative recovery and follow-up were uneventful.DiscussionPossible mechanisms of development of such a rare condition, and diagnostic and treatment options are discussed.

Effects of umbilical cord milking on the need for packed red blood cell transfusions and early neonatal hemodynamic adaptation in preterm infants born ≤1500 g: a prospective, randomized, controlled trial.

Objective: The aim of this study was to evaluate the effects of umbilical cord milking (UCM) on the need for packed red blood cell (PRBC) transfusion and hematologic and hemodynamic parameters in very-low–birth-weight infants. Methods: The infants were randomized into 2 groups: group 1 (UCM) and group 2 (control). The primary outcome was the number of PRBC transfusions during the first 35 days of life. The secondary outcome measures were the hemodynamic variables during the first 24 hours of life. Results: A total of 44 infants were included with 22 infants in each group. Two of 21 infants in group 1 and 4 of 21 infants in group 2 received transfusion in the first 3 days of life (P=0.384). The number and volume of PRBC transfusions were similar in both groups. However, the levels of hemoglobin (Hb) at the first and 24th hour of life were significantly higher in group 1. Phlebotomy volume was found as a statistically significant risk factor for the need for PRBC transfusion (P=0.005). Conclusions: UCM in delivery room results in a higher Hb level in the first day of life. In these groups of infants, phlebotomy losses may impact the transfusion need.

Effect of hormone replacement therapy on serum levels of tumor markers in healthy postmenopausal women

OBJECTIVE The effect of hormone replacement therapy (HRT) on serum levels of tumor markers is barely defined. The aim of this study was to evaluate the effect of HRT on levels of tumor markers CA 125, CA 15-3, CA 19-9, CEA and alpha-FP. METHODS Retrospective analysis of prospectively collected data in healthy postmenopausal women under oral estrogen replacement therapy (ERT, conjugated equine estrogen (CEE) 0.625 mg (n = 21) or estradiol 2 mg (n = 31)), and continuous combined estrogen and progesterone regimen (HRT, CEE 0.625 mg plus medroxyprogesterone acetate 2.5 mg (n = 34) or estradiol 2 mg plus norethisterone acetate 1 mg (n = 37)). One hundred and twenty-three healthy women among a sampled population of 654 postmenopausal patients with complete records, initial normal tumor marker levels, and at least 1 year of follow-up were included into the study. Tumor markers were measured with 1-year interval. RESULTS Fifty-two (41.5%) patients were under ERT and 71 (58.5%) were under combined HRT. The number of months since menopause, age and age at menopause did not influence tumor marker levels at first admission. All of the tumor marker levels were in normal range after 1 year. Pretreatment CA 125 II, CA 15-3 and CEA levels were significantly low (median and range) 5.0 (1.0-11.8) versus 7.45 (1.0-18.1) U/ml for CA 125, 27.05 (7.3-37.5) versus 32.6 (12.5-37.9) U/ml for CA 15-3, 0.88 (0.58-2.8) versus 1.34 (0.53-2.41) ng/ml for CEA in women with hysterectomy when compared to women without hysterectomy. There was no effect of ERT on CA 125 II, CA 19-9, CEA and alpha-FP levels. E2 led to a significant decrease in post-treatment CA 15-3 levels [32.9 (8.1-34.9) vs. 18.1 (6.7-31.4); P < 0.001]. CA 125 levels were only significantly reduced in hysterectomised women using continuously combined HRT [7.9 (2.6-17.7) vs. 5.6 (1.3-19.2) for CEE+MPA, and 7 (1-18.1) vs. 5.8 (1.8-17.4) for E2 + NETA; P < 0.05]. There was a small, but not significant, increase in CA 125 levels in women under ERT. CONCLUSION Although there was a statistically significant decrease in CA 15-3 levels in current E2 and E2 + NETA users, and a decrease in CA 125 levels in combined regimens, this change is clinically not relevant in healthy postmenopausal women. This data will be useful for the caregivers in the management and follow-up of cancer survivors who preferred replacement therapy as the only treatment of their postmenopausal symptoms.

The value of the progesterone-to-estradiol ratio on the day of hCG administration in predicting ongoing pregnancy and live birth rates in normoresponders undergoing GnRH antagonist cycles

OBJECTIVE To investigate the relationship of the progesterone-to-estradiol (P/E2) ratio on the day of hCG administration with ongoing pregnancy rates in patients with normal ovarian reserve undergoing GnRH antagonist cycles. STUDY DESIGN Observational cohort study including 129 women with normal ovarian reserve undergoing the GnRH antagonist protocol at the IVF unit of Ankara University School of Medicine. Receiver operating characteristics (ROC) analysis was performed to determine cut-off values for the P/E2 ratio detrimental to IVF/ICSI-ET outcomes. The ongoing pregnancy rate was the primary outcome measure. Groups were compared using the independent-samples Students t-test, Mann Whitney and Chi-Square tests. Multivariate logistic regression analysis was used to study the association between the variables and the P/E2 ratio. RESULTS The optimal cut-off value for P/E2 ratio in GnRH antagonist cycles was 0.48; ongoing pregnancy rates and live birth rates were found to be significantly higher in patients with P/E2 ratios≤0.48 than those with>0.48 (50% vs 22.4%, p=0.001 and 38.5% vs 19.7%, p=0.02, respectively). In logistic regression analysis, the P/E2 ratio was found to be an independent predictor for pregnancy, but the sensitivity (69%), specificity (61%) and overall accuracy (67%) were low as a predictor test for cycle outcome. CONCLUSION Although a P/E2 ratio≤0.48 on the day of hCG administration was associated with significantly higher ongoing pregnancy and live birth rates, it has poor predictive value for cycle outcome in patients with normal ovarian reserve undergoing GnRH antagonist cycles.

Ectopic ovary autotransplanted over rectosigmoid colon: a case report

OBJECTIVE To report a case of an alive ectopic ovary over rectosigmoid colon serosa that was removed by laparoscopy. DESIGN Case report. SETTING Department of Obstetrics and Gynecology. PATIENT(S) A 30-year-old nulliparous woman. INTERVENTION(S) Ultrasonography, laparoscopy, and pathologic assessment. MAIN OUTCOME MEASURE(S) Alive and functional ectopic ovarian tissue in the cul-de-sac over rectosigmoid colon serosa. RESULT(S) At pathologic assessment, an alive ectopic ovary with focal infarct areas was determined. CONCLUSION(S) The treatment should be excision of the mass. However, in asymptomatic and nulliparous women who have future fertility desire, protecting the ectopic ovary to not decrease the ovarian reserve might be a beneficial option.

Ektopik Gebelik Olgularında Tanı Kriterlerinin Tedavi Seçimine Etkisi

Amac: Ektopik gebelik olgularinda tedavi seciminde rol oynayan faktorleri belirlemek. Hastalar Ve Yontem: Ankara Universitesi Tip Fakultesi Kadin Hastaliklari ve Dogum Anabilim Dali’nda Ocak 1998-Temmuz 2006 tarihleri arasinda ektopik gebelik tanisi konulan ve tedavi edilen toplam 150 hastanin verileri retrospektif olarak degerlendirildi. Sonuclar: Toplam 150 hastanin 109’una (%72,9) cerrahi uygulanirken, 23 hasta (%15,3 ) parenteral Metotreksat ile tedavi edildi. Onsekiz hasta (%11,8 ) tedavi verilmeden izlendi. Cerrahi uygulanan 109 hastanin 83’une (%76,1) laparoskopi, 26’sina (%23,9) laparotomi uygulandi. Laparoskopi yapilan 55 hastaya (%66) salpinjektomi, 23 hastaya (%27,6) salpingostomi yapilirken, kalan 5 hastada (%6,4) fimbrial yerlesim gosteren gebelik materyali fimbrial uctan ekstirpe edildi. Laparotomi olan butun hastalara salpinjektomi yapildi. Tedavi verilmeden takip edilen hastalarda bhCG duzeyleri anlamli olarak daha dusuktu (P < 0,05). Laparotomi yapilan hastalarda b-hCG duzeyi, laparoskopi yapilan gruba gore anlamli olarak yuksekti (P < 0,05). Nullipar hastalarda metotreksat tedavivisi ve tedavisiz izlem, cerrahi tedaviye gore daha yuksek oranda tespit edildi (P < 0,05). Sonuc: Ektopik gebelik tedavisinde, hastanin klinigi ve fertilite durumu uygun tedavi seciminde goz onunde bulundurulmasi gereken noktalardir. β-hCG duzeyleri degiskenlik gostermesine ragmen genellikle klinikle yakindan iliskilidir.