Guldeniz Aksan

What is the role of office hysteroscopy in women with failed IVF cycles

Recurrent implantation failure (RlF) may be due to unrecognized uterine pathology. Hysterosalpingography, transvaginal ultrasonography, saline infusion sonography and hysteroscopy are the tools to assess the inner architecture of the uterus. Hysteroscopy is considered to be the gold standard; however, the validity of hysteroscopy may be limited in the diagnosis of endometritis and endometrial hyperplasia. The frequencies of unrecognized uterine pathology revealed by hysteroscopy are 18-50% and 40-43% in patients undergoing IVF with or without RlF, respectively. Endometrial polyps may be associated with increased miscarriage rates. Implantation rates are decreased in patients with submucous or intramural fibroids with distorted uterine cavity. There is controversy on the impact of uterine septum less than 1 cm length on pregnancy outcome in IVF cycles. There is paucity of data on the role of hysteroscopy in failed IVF cycles. In the available two randomized controlled trials, pregnancy rates appear to be increased when hysteroscopy is performed; however within the hysteroscopy group, pregnancy rates are comparable among the normal or surgically corrected subgroups. Further studies are warranted to delineate the role of hysteroscopy in patients with failed IVF cycle(s). This review aims to evaluate the validity of office hysteroscopy in failed IVF cycles.

Increasing women's choices in medical abortion: A study of misoprostol 400 μg swallowed immediately or held sublingually following 200 mg mifepristone

Objectives To assess the efficacy and acceptability of two misoprostol regimens (400 μg oral or sublingual) following mifepristone for medical abortion. Methods Women seeking abortion with gestations of 56 days or less since onset of their last menstrual period were offered medical abortion as an alternative to a surgical procedure. A total of 207 eligible and consenting women were given mifepristone (200 mg oral) and the option of taking 400 μg misoprostol either orally or sublingually two days later, with the option of home-use. Two weeks later, treatment success, satisfaction, and the frequency and acceptability of side effects were assessed. Results Most women (97.6%) opted for home use of misoprostol and almost three quarters selected the oral route. Overall efficacy, acceptability of side effects and satisfaction were high in both groups. The success rate was lower after sublingual than after oral administration but not significantly so (91.3% vs. 96.3%, p = 0.23, RR: 0.93, 95% CI = 0.85–1.02). The frequency and average duration of side effects in both groups were comparable except for pain/cramps and fever/chills, which were more frequently associated with the sublingual route. Conclusions This study re-emphasises the feasibility of integrating medical abortion into health services in Turkey and the potential to increase choices for women.

A third evaluation of tertiary cytoreduction

To evaluate the impact of tertiary cytoreductive surgery (TCS) on patient survival and to determine predictors of optimal TCS.

Depth of invasion for appendiceal metastasis of ovarıan cancers: Does it have any clinical significance?

Aim:  Depth of appendiceal metastasis in patients with epithelial ovarian carcinoma (EOC) has not been previously analyzed for a possible relationship with clinico‐pathological variables.