Funda Gode

Influence of follicular fluid GDF9 and BMP15 on embryo quality

OBJECTIVE To evaluate the association between follicular fluid levels of propeptide and mature forms of growth differentiation factor (GDF) 9 and bone morphogenetic protein (BMP) 15 with subsequent oocyte and embryo quality. DESIGN Prospective clinical study. SETTING University hospital. PATIENT(S) Eighty-one infertile patients who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). INTERVENTION(S) The expression levels of the propeptide and mature forms of follicular fluid GDF9 and BMP15 were determined by western blot analysis. The levels of follicular fluid hormones (FSH, E2, and P) were measured with automated chemiluminescent enzyme immunoassays. MAIN OUTCOME MEASURE(S) The relationships between the levels of GDF9 and BMP15, hormones, oocyte maturation, and embryo quality. RESULT(S) Mature GDF9 levels were significantly correlated with the nuclear maturation of oocytes. The mean mature GDF9 level was 4.87±0.60 in the high-embryo-quality group and 1.45±0.81 in the low-embryo-quality group. There were no statistically significant differences in embryo quality among the patients regarding propeptide GDF9 and BMP15 expression status. There was a negative correlation between follicular fluid levels of P and the mature form of GDF9. CONCLUSION(S) Higher mature GDF9 levels in the follicular fluid were significantly correlated with oocyte nuclear maturation and embryo quality.

Juvenile cystic adenomyosis mimicking uterine malformation: a case report

Cystic adenomyosis is a rare form of adenomyosis mostly seen in middle aged women. We report a case of cystic adenomyosis in a juvenile patient presenting with severe dysmenorrhea refractory to any given medication. The patient initially was diagnosed as uterus bicornis with an obstructed rudimentary horn. Surgical exploration and excision of the cystic mass relieved the symptoms of the patient.

Value of maternal procalcitonin levels for predicting subclinical intra-amniotic infection in preterm premature rupture of membranes.

To determine whether procalcitonin (ProCT) levels can be used to predict subclinical intra‐amniotic infection by comparing maternal plasma levels in preterm premature rupture of membranes (PPROM) and premature rupture of membranes (PROM) at term with the levels in healthy pregnant women.

The effect of drospirenone (3 mg) with ethinyl estradiol (30 mcg) containing pills on ovarian blood flows in women with polycystic ovary syndrome: a case controlled study.

OBJECTIVE To evaluate whether oral contraceptive pill (OCP) therapy has any effects on ovarian stromal blood flow by using pulsed and color Doppler at the end of 3 months follow-up period of OCP-users and non-users with or without polycystic ovary syndrome (PCOS). STUDY DESIGN 200 patients were included in the study. The patients were designed into four groups as follows; Group 1: PCOS patients that received OCP containing 30 mcg ethinyl estradiol (EE) plus 3mg drospirenone for 3 months (DRP n=50); Group 2: PCOS patients that received no medication (n=50); Group 3: Healthy controls that received OCP (EE plus DRP) (n=50); Group 4: healthy controls that received no medication (n=50). Resistance index (RI) and pulsatility index (PI) of both ovarian arteries, hormonal, anthropometric and biochemical parameters were assessed before and after 3 months. RESULTS There was a significant increament in RI and PI of both ovarian arteries in healthy controls (Group 3) and in women with PCOS (Group 1) who received OCP (p<0.001). The increment rate in both Doppler parameters were significantly higher in women with PCOS (Group 1) than healthy controls (Group 3) (p<0.001). Whereas RI and PI values of both ovaries remained unchanged in all untreated women with or without PCOS (Groups 2 and 4). CONCLUSION OCP therapy reduced ovarian vascularization in both PCOS and healthy users after 3 months of therapy and this decrease is especially noticeable in women with PCOS.

Late-onset maternal mortality after amniocentesis.

hypertension (160/110 mmHg), headaches, visual disturbances and generalized edema. During ultrasound evaluation, severe fetal hydrops and placentomegaly were observed and the diagnosis of mirror syndrome was made. At Doppler evaluation, the pulsatility index (PI) of both uterine arteries was normal and notching was absent. Maternal laboratory tests revealed mild anemia (hemoglobin: 10.6 g/dL, hematocrit: 31.7%) and nephrotic proteinuria (3.6 g/24 h). Due to clinical signs of preeclampsia, maternal serum concentrations of sFlt-1 and PlGF were measured by automated electrochemiluminescence immunoassay (Roche Diagnostics, IN), using an Elecsys 2010/Hitachi equipment. The serum levels of sFlt-1 and PlGF at the moment of the diagnosis were 14,699 pg/mL and 239 pg/mL, respectively. The sFlt-1/PlGF ratio was 61.5. Due to the clinical signs of severe preeclampsia and extremely compromised fetus, the patient received treatment with magnesium sulfate and labor induction was initiated. A live baby weighting 1000 g was born, but he died after 1 h. The weight of the placenta was 1500 g. A new assessment of sFlt-1 and PlGF was made 48 h after delivery. The serum levels of sFlt-1 and PlGF at this time were 1122 pg/mL and 21.4 pg/mL, respectively (Fig. 1). The maternal screening for infection demonstrated acute CMV infection. The histological examination of placental samples demonstrated chronic villitis with lymphoplasmacytic infiltrate and multifocal cytomegalic inclusion. Additional findings were edematous villi, Fig. 1. Serum concentrations of sFlt-1 and PlGF

Comparison of the morphokinetic parameters of embryos according to ovarian reserve in IVF cycles

Abstract The aim of this study is to evaluate the impact of ovarian reserve and age of women on early morphokinetic parameters of embryos with a time-lapse monitoring system. In total, 197 infertile couples with poor ovarian reserve (Group 1, n = 41), normal ovarian reserve (Group 2, n = 59), or polycystic ovaries (Group 3, n = 97) were included. The time from insemination to the following events were analyzed: pronuclear fading (Pnf) and cleavage to 2, 3, 4 and 5 cells. The optimal ranges for morphokinetic parameters of t5, s2 and cc2 in each group were also evaluated. In total, 1144 embryos were evaluated. Morphokinetic parameters did not differ statistically between the groups. Data were analyzed according to different age groups (20–30, 30–40, >40). The morphokinetic parameters did not differ statistically in Group 1 and 3. In Group 2, the times from insemination to tPnf, t2, t3, t4 were significantly shorter in the younger age group than the older age group (p < 0.05). The percentages of optimal embryos, according to t5, s2 and cc2, did not differ statistically between the groups. In conclusion, ovarian reserve did not seem to affect the morphokinetic parameters of embryos.

Comparison of corifollitropin alfa and daily recombinant follicle-stimulating hormone in poor responder patients undergoing in vitro fertilization cycles

Objective: The aim of this study was to compare the effect of corifollitropin alfa (CFA) and recombinant follicle-stimulating hormone (rFSH) in poor-responder patients undergoing antagonist cycles. Materials and Methods: The study was a retrospective analysis of the treatment results of 214 poor responder patients who had been admitted to the In Vitro Fertilization Unit of İzmir Medical Park Hospital between November 2014 and November 2016. Intracytoplasmic sperm injections were performed in 38 patients (group 1) with CFA, and the remaining 176 (group 2) with rFSH for controlled ovarian hyperstimulation. Results: The age, body mass index, anti-müllerian hormone level, duration of infertility, duration of induction and antral follicle number were similar in the two groups. There was no difference in the total aspirated oocyte counts, mature oocyte ratio, fertilization rate, implantation rate, and clinical pregnancy rates between the two groups. The implantation rate was 9/38 (23.6%) in group 1 and 42/176 (23.8%) in group 2, whereas the clinical pregnancy rates were 16.3% and 17.2%, respectively. Conclusion: No difference was found in terms of oocyte count, fertilization rate, implantation rate, and clinical pregnancy rates of CFA or rFSH use in the antagonist cycles in poor-responder patients.

Serum Procalcitonin and Proinflammatory markers in Polycystic Ovary Syndrome

Objective: We evaluated levels of procalcitonin and proinflammatory markers in patients with polycystic ovary syndrome (PCOS) and compared them with controls in the Black Sea region of Turkey. Study Design: This prospective controlled study involved patients with PCOS (n=59) and healthy age-matched controls (n=26; total, n=85). Serum procalcitonin (PCT), white blood cells (WBCs), high-sensitivity C-reactive protein (h-CRP), homocysteine (Hcy) levels, insulin resistance, and lipid profiles were compared between the PCOS and control groups. The same parameters were also compared between overweight and normal-weight PCOS patients. Results: Serum PCT, Hcy, h-CRP, and WBC levels were similar in the PCOS and control groups. High-density lipoprotein (HDL) levels were lower in the PCOS group than in the control group (p <0.05). In a subgroup analysis of the PCOS group, there were no significant differences between overweight and normal-weight PCOS patients with regard to proinflammatory markers (serum WBC, h-CRP, Hcy, PCT levels). However, total cholesterol, LDL, and triglyceride levels were significantly higher in overweight PCOS patients (p <0.005). Serum HDL levels were significantly lower in the overweight PCOS group than in the normal-weight group (p <0.005). Fasting insulin and HOMA-IR levels were significantly higher in overweight PCOS than normal-weight PCOS patients (p<0.05). Conclusions: Serum PCT, h-CRP, WBC, and Hcy levels were within normal ranges in PCOS patients. These results may be related to the relatively young age and regional differences in the study group.