Esra Tonguc

The effect of laparoscopic ovarian cystectomy versus coagulation in bilateral endometriomas on ovarian reserve as determined by antral follicle count and ovarian volume: a prospective randomized study

OBJECTIVE To evaluate the effect of two different laparoscopic methods on ovarian reserve as determined by antral follicle count (AFC) and ovarian volume in patients with bilateral endometriomas. DESIGN Randomized prospective study. SETTING Tertiary education and research hospital. PATIENT(S) Forty-eight patients with bilateral endometriomas. INTERVENTION(S) AFC and ovarian volumes determined before and after surgery; coagulation and cystectomy performed on one randomly selected side of each patient for their endometriomas; in vitro fertilization and embryo transfer. MAIN OUTCOME MEASURE(S) Ovarian reserve damage as determined by AFC and ovarian volume, and number of dominant follicles and retrieved oocytes after controlled ovarian hyperstimulation. RESULT(S) In vitro fertilization and embryo transfer were performed for 37 of 48 patients. The number of dominant follicles and the retrieved oocytes were assessed after controlled ovarian hyperstimulation. The postprocedural AFC was 3.67±1.26 and 4.75±0.60 after cystectomy and coagulation, respectively. A statistically significantly greater decrease in AFC was found after cystectomy as compared with coagulation. Postprocedural ovarian volumes were 6.27±1.95 and 9.87±2.01 after cystectomy and coagulation, respectively. A decrease in ovarian volume was found after cystectomy when compared with coagulation. CONCLUSION(S) The decreases in AFC and ovarian volume were found for both coagulation and cystectomy, but the decrease was statistically significantly more frequent in cystectomized ovaries than in coagulated ovaries. Also, in the in vitro fertilization cycles, the ovarian response to ovulation induction was statistically significantly reduced in cystectomized ovaries as compared with coagulated ovaries.

Circulating levels of copeptin, a novel biomarker in pre‐eclampsia

Aims:  Increasing evidence supports the participation of metabolic syndrome and insulin resistance in the pathogenesis of pre‐eclampsia. Copeptin is co‐synthesized with vasopressin and is a new and promising novel marker of metabolic syndrome and insulin resistance. Our aim was to investigate copeptin levels in normotensive pregnant, mild and severe pre‐eclamptic women.

Body mass index is an independent risk factor for the development of endometrial polyps in patients undergoing in vitro fertilization

OBJECTIVE To determine the subgroup of patients in whom office hysteroscopy should be routinely performed before an in vitro fertilization (IVF) program. DESIGN Retrospective cohort analysis. SETTING Tertiary education and research hospital. PATIENT(S) Two hundred twenty-three patients who underwent a uterine evaluation by office hysteroscopy before the IVF and embryo transfer cycle. INTERVENTION(S) The office hysteroscopy was performed in the follicular phase of the menstrual cycle before the IVF cycle. MAIN OUTCOME MEASURE(S) The office findings: number of polyps, number of multiple polyps, and polyp size. RESULT(S) Patients with polycystic ovary syndrome (PCOS) had a higher number of endometrial polyps, but the difference was not statistically significant (28.9% vs. 18.3%). When comparing the patients according to BMI, patients with BMI >or=30 had a statistically significantly higher number of endometrial polyps versus BMI <30 (52% vs. 15%). On the other hand, obesity was positively correlated with the occurrence of polyps, size of the polyps, and occurrence of multiple number of polyps in the correlation analysis. In addition, logistic regression analysis using age, obesity, duration of infertility, and estradiol levels revealed that obesity was an independent prognostic factor for the development of endometrial polyps. CONCLUSION(S) Office hysteroscopy should be performed in patients with BMI >or=30 because obesity may act as an initiator for the pathogenesis of endometrial polyps.

Intrauterine device or estrogen treatment after hysteroscopic uterine septum resection.

To investigate the effects on adhesion formation and pregnancy maintenance of an intrauterine device (IUD) and/or estrogen treatment after hysteroscopic septum resection.

Treatment with oxytocin antagonists before embryo transfer may increase implantation rates after IVF

This report aimed to examine the effects of atosiban on pregnancy outcome after IVF-embryo transfer. A prospective, randomized, placebo-controlled clinical study was performed. A total of 180 women undergoing intracytoplasmic sperm injection who had top-quality embryos were randomly allocated into treatment and control groups. All the patients had infertility due to tubal factor, hormonal-anovulatory disorders, male factor or unexplained reasons. The treatment group received intravenous administration of atosiban before embryo transfer with a total administered dose of 37.5 mg. In the control group, the same number of cycles was performed with placebo medication. The clinical pregnancy rate (PR) per cycle and implantation rate (IR) per transfer were 46.7% and 20.4% in the atosiban-treated group, which were significantly higher than in the control group (28.9% and 12.6%, respectively, P=0.01). The miscarriage rates of groups 1 and 2 were 16.7% and 24.4%, respectively (P=0.01). These results have indicated that atosiban increases the IR and PR after IVF-embryo transfer. These results suggest that atosiban treatment before embryo transfer is effective in priming of the uterus for implantation. This is the first study to investigate the possible contributions of atosiban for improving the PR after IVF-embryo transfer.

Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility

To evaluate the reproductive outcomes of patients with a uterine septum and otherwise unexplained infertility who underwent hysteroscopic metroplasty, and to compare them with those of patients with the same diagnosis who did not have hysteroscopic metroplasty.

A comparison of the effects of three different luteal phase support protocols on in vitro fertilization outcomes: a randomized clinical trial

OBJECTIVE To evaluate the effects of three different luteal phase support protocols on pregnancy and implantation rates, as well as luteal phase hormone profile in intracytoplasmic sperm injection-ET cycles. DESIGN A prospective, randomized study. SETTING A tertiary teaching and research hospital. PATIENT(S) Two hundred eighty-eight patients who were undergoing intracytoplasmic sperm injection with a long protocol of controlled ovarian hyperstimulation. INTERVENTION(S) Group 1 (E(2) + P) received daily P plus 4 mg of E(2), group 2 (hCG + P) received P plus 1,500 IU of hCG, and group 3 (P only) received daily vaginal P gel. Blood samples were drawn on the day of hCG administration, as well as 7 and 10 days after the hCG for the E(2) and P measurements. MAIN OUTCOME MEASURE(S) The clinical pregnancy rate. RESULT(S) No difference existed between the E(2) + P and hCG + P groups with respect to pregnancy rate, but it was significantly lower in the P-only group.The implantation rate was significantly lower in the P-only group than in the other groups.The highest miscarriage rate was in the P-only group (38%). CONCLUSION(S) In assisted reproductive technology cycles including treatment with GnRH agonist, adding 4 mg of oral E(2) to P during the luteal phase significantly increased the pregnancy and implantation rates and decreased the miscarriage rate compared with the use of P only.

Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity

PurposeThe aim of our retrospective study was to assess and to compare the surgical complications of hysterectomy regarding the choice of procedure [abdominal (AH), vaginal (VH), and total laparoscopic hysterectomy (TLH)].MethodsA total of 6,480 patient charts undergone hysterectomy were retrospectively analyzed. Data including transfusion, bladder, ureteral and bowel injury, cuff dehiscence, pulmoner embolus, febrile morbidity, hematoma, reoperation, pelvic wall problems were gathered. The Chi-square test and Student’s t test were used in the statistical analysis.ResultsThe most common perioperative complication was blood transfusion which occurred in 114 patients (2.6%). VH patients required significantly less blood transfusion than AH (2.1, 2.6%, respectively). AH had significantly more bladder injury than VH (0.7, 0.4%, respectively). AH had significantly more ureteral injury than VH (0.2, 0.1%, respectively). AH had the same bowel injury as VH (0.1%). AH and VH necessitated significantly more reoperation than TLH (0.4, 0.2, 0.0%, respectively).ConclusionTo our study, VH ensures less complication rates than AH. In experienced centers, VH can be a reliable alternative to AH. Controlled prospective studies with large patient volumes are required to compare TLH and VH according to complication rates.

The correlation of plasma homocysteine with insulin resistance in polycystic ovary syndrome

Aim:  This study aims to investigate the existence of any relationship between homocysteine levels and insulin resistance in Turkish women with polycystic ovary syndrome.

Comparison of the effectiveness of single versus double intrauterine insemination with three different timing regimens

OBJECTIVE To compare double insemination with two different single insemination regimens. DESIGN Prospective study. SETTING Tertiary education and research hospital. PATIENT(S) Four hundred and fifty patients with unexplained infertility, male factor, and ovulatory dysfunction underwent controlled ovarian hyperstimulation with gonadotropin. INTERVENTION(S) The patients were divided randomly into three groups: patients in group 1 underwent a single preovulatory intrauterine insemination (IUI) performed 24 hours after hCG administration. Patients in group 2 underwent two IUIs performed 12 and 36 hours after hCG administration. Patients in group 3 underwent a single periovulatory IUI performed 36 hours after hCG administration. MAIN OUTCOME MEASURE(S) Pregnancy rate. RESULT(S) The total pregnancy rate per patient was 14.2 % (64 pregnancies in 450 patients). Group 1 had 17 pregnancies (11.3%), while groups 2 and 3 had 21 (14.0%) and 26 (17.2%) pregnancies, respectively. The difference between the three groups in regard to pregnancy rates was statistically not significant. CONCLUSION(S) Despite the 36th hour being the preferred timing for IUI, there was no difference regarding pregnancy rates between single 24th hour and double 12th- and 36th-hour inseminations. This finding suggests that the 24th-hour IUI might be preferred in demanding situations.