Gülşah İlhan

The role of ovarian reserve markers in prediction of clinical pregnancy

Abstract To evaluate the role of ovarian reserve markers in the prediction of clinical pregnancy and embryo transfer accomplishment among poor responder IVF applicants. 304 female poor responder IVF applicants were included in this prospective cohort study conducted at the IVF-unit. Antral follicle count, FSH, LH, E2, AMH and IVF outcomes were compared in pregnant and non-pregnant groups as well as in ET vs. non-ET groups. The number of retrieved oocytes was significantly correlated positively with AMH and AFC, and negatively with FSH and age. Quartiles of FSH and AFC were similar to the rate of pregnancy. Quartiles of AMH (<25%/25–75% and <25%/>75%) were statistically significant. Mean serum levels for AMH were significantly lower in the non-ET group. Our findings seem to indicate that day 3 AMH values can predict ET accomplishment with a sensitivity of 96% and a specificity of 35%. Quartiles of AMH <25% (< 0.21 ng/mL) can predict the IVF results among poor responder IVF applicants. Impact statement Various cut-off values have been determined for day 3 serum AMH values. These values help to determine the groups that are expected to give normal, high or low response to stimulation and decide the treatment options. In contrast to other groups of patients, poor responders cannot reach the embryo transfer stage for several reasons. These are; absence of a mature oocyte after oocyte pick-up, fertilisation failure without male factor or poor embryo quality. In the present study; a cut-off value of 0.33 ng/mL for the prediction of ET accomplishment in poor responder patients was determined with a sensitivity of 96%. Additionally, clinical pregnancy could not be achieved under the value of 0.21 ng/mL day 3 AMH values. It is important to clarify the embryo transfer success of poor responder patients prior to expected treatment success. Pre-treatment counselling for these patients would lessen the disappointment that may develop after treatment. The cost-effectiveness of treatments below these AMH values can be determined by further studies.

The impact of abdominal and laparoscopic hysterectomies on women’s sexuality and psychological condition

Objective: To investigate whether there were any differences in the quality of life, sexual function, and self-esteem of patients who underwent total laparoscopic hysterectomy (TLH) (n=42) and total abdominal hysterectomy (TAH) (n=42). Materials and Methods: All premenopausal patients who underwent TLH or TAH because of benign uterine disorders were enrolled. The sexual function and quality of life status were assessed preoperatively and 6 months postoperatively using three standardized validated questionnaires: the Arizona Sexual Experiences Scale (ASEX), the Symptom Checklist-90-Revised (SCL-90-R), and the Rosenberg Self-Esteem Scale (RSES). Results: Preoperative ASEX, SCL-90-R and RSES scores were not different among the hysterectomy subgroups. The postoperative SCL-90-R scores were also not different among the hysterectomy subgroups. The postoperative RSES scores were significantly lower (p<0.05) than the preoperative scores for all procedures (indicating improved self-esteem) but did not differ among the groups. The postoperative ASEX scores were significantly decreased (p<0.01) as compared with the preoperative scores (indicating improved sexual function). When the average score of each item of the ASEX score was compared in both groups, significant differences were observed in sexual drive and arousal in the laparoscopy group (p<0.01). Conclusion: Women undergoing TLH for benign uterine disease may have better outcomes related to certain sexual function parameters than women undergoing TAH.

The course and outcomes of complicated gallstone disease in pregnancy: Experience of a tertiary center

Objective: To evaluate the course and outcomes of pregnant patients with complicated gallstone disease and to reveal the experience of a tertiary center. Materials and Methods: The records of 92.567 patients were evaluated using searches for diagnoses with the terms of pregnant, pregnancy, gallstone, cholecystitis, cholangitis, choledocholithiasis, pancreatitis, and endoscopic retrograde cholangiopancreatography in pregnancy in the hospital database. Patients’ age, week of gestation, parity, body mass index, definitive diagnosis, attack episodes, treatment modalities, and obstetric and neonatal complications were evaluated. Results: Overall, 59 women were diagnosed as having complicated gallstone disease in pregnancy. Acute cholecystitis was the most commonly diagnosed complicated gallbladder disease (62.7%). Cholecystectomy was performed in 15 women during gestation. Perinatal outcomes were as follows: one (1.7%) maternal death, 4 (6.8%) preterm deliveries, 5 (8.5%) low-birth-weight fetuses, and 1 (1.7%) missed abortion were encountered. No fetal abnormalities were encountered. Conclusion: A significant proportion of women experience biliary disease during pregnancy. Herein, we presented our clinical experience because the diagnosis, course, and management of complicated gallstone disease in pregnancy is complicated.

Effects of fetal cardiac anomalies on ductus venosus and aortic isthmus doppler profiles

PurposeTo demonstrate the blood flow profiles of fetuses with cardiac anomalies at the level of Ductus venosus (DV) and Aortic isthmus (AI) to evaluate the effects of fetal cardiac anomalies on these profiles, and how these profile changes contribute to cardiac anomaly screening studies as a marker.MethodsDV and AI doppler studies were applied to 64 singleton pregnant women with fetal cardiac anomalies and 74 pregnant women with healthy fetuses. DV-PVIV (peak velocity index for veins) for DV and IFI (isthmic flow index) for AI were used.ResultsDV doppler studies in fetuses with cardiac anomalies and healthy fetuses did not show statistically significant difference. But the results of the AI doppler studies had statistically significant difference in the fetal cardiac anomaly group with the exception of cases with dilatation and regurgitation. When right-sided heart anomaly and the remaining cases were compared with the control groups, AI doppler results also showed lower IFI values.ConclusionsDV doppler studies in the second or third trimester may not be suitable as a screening test for congenital heart disease, but AI doppler studies might be considered as a supporting parameter. But further studies are needed for routine clinical use.

What is Turkish women's opinion about vaginal delivery?

Objective: To determine Turkish women’s opinion about vaginal birth. Materials and Methods: This prospective cohort study was conducted in Department of Obstetrics and Gynecology of Süleymaniye Maternity Research and Training Hospital in İstanbul, Turkey, between February 2015 and April 2015. The participants of this study were 100 primiparous pregnant women who had vaginal deliveries. The women were interviewed face-to-face after the birth. Data were collected through a socio-demographic and clinical questionnaire. Results: Ninety percent of the women reported vaginal birth as the ideal mode of delivery route; a minority of the women (10%) had decided on cesarean birth before having a vaginal birth. Anxiety of pain was the major factor that influenced choice of delivery type before giving birth. After vaginal birth, 84% of women were satisfied with vaginal birth and reported that they would prefer vaginal birth for their next pregnancy. However, 16% reported that they would prefer cesarean birth for their next pregnancy due to pain of labor, pain of episiotomy, anxiety, and prolonged duration of labor. Conclusion: The results suggest the majority of women prefer to give birth vaginally and reported vaginal birth as the ideal choice.

Effect of intrauterine insemination treatment on sexual function and quality of life for infertile women

Objectives: To evaluate the effect of intrauterine insemination (IUI) on sexual functioning, quality of life and psychological well-being. Methods: One hundred and thirty four infertile women going to IUI treatment as study group and 134 women who do not report any infertility complaint attending to gynecology clinic for routine control as control group were enrolled. Demographic data of the patients were collected. Patients were asked to complete Female Sexual Functioning Index (FSFI), Beck Depression Inventory (BDI) and SF 36 form. Results: Total FSFI score (mean±SD) for study group was 23.4±4.1 and 24.8±3.4 for control group (p<0.05). This means a lower sexual function for patients going to IUI. There were also statistically significant differences according to subscales of FSFI scores for sexual desire, arousal and satisfaction. Mean±SD scores for Beck Depression Inventory analysis was 18.6±9.8 for study group and 18.5±7.1 for control group. According to SF-36 scores, there were statistically significant differences between the groups for four subscales: Role physical,bodily pain,general health and vitality. Conclusions: Going to an IUI treatment has negative effects on FSFI scores and some of SF 36 scores but we did not find a significant negative effect on BDI scores.

Effects of daytime versus night‐time cesarean deliveries on Stage II lactogenesis

The circadian timing system has a rhythm and one of the roles of this system is the mediation of hormonal and metabolic adaptations to lactation. This study was conducted to determine whether the time to stage II lactogenesis differed in women who underwent cesarean section (CS) in the daytime (DT) or night‐time (NT).

Preliminary evaluation of foetal liver volume by three-dimensional ultrasound in women with gestational diabetes mellitus

Abstract The aim of the study was to assess the standard foetal biometric measurements and foetal liver volume (FLV) in pregnancies complicated by gestational diabetes mellitus (GDM) at the time of GDM screening and to compare the results with foetuses in normal pregnancies. Ninety-seven pregnant women with normal singleton uncomplicated pregnancies between 24 and 28 weeks of gestation were allocated into GDM (+) (n: 33) and GDM (−) (n: 64) groups based on their 75 g oral glucose tolerance test results. Foetal biometric measurements and FLV measurements of the groups were compared. Although there were no significant differences in the standard biometric measurements between the two groups, FLV was significantly higher in the women with GDM (p < .01). The ROC analysis implied that with a cut-off value of FLV of 32.72 cm3 for GDM prediction, the sensitivity was 78.8% and specificity was 56.3%. We suggest that FLV measurements during the second-trimester ultrasound scanning may be a tool for the prediction of GDM in the obstetric population. Impact statement What is already known on this subject? GDM is an important pregnancy disease, because of its possible foetal and maternal complications. Besides the standard biometric measurements, some other foetal body dimensions such as the anterior abdominal wall thickness, skinfold thickness, adipose tissue thickness, Wharton’s jelly thickness, foetal liver length and foetal liver volume (FLV) have been evaluated as ultrasound parameters of glycaemic control. While the evaluation of foetal liver dimensions has a role in identifying foetal growth acceleration, previous studies addressed patients with insulin-dependent diabetes mellitus rather than gestational diabetes mellitus, utilised two-dimensional ultrasound and did not argue the diagnostic value of these findings. What do the results of this study add? In our study, besides the standard biometric measurements, the FLV measurements were evaluated by a three-dimensional ultrasound. Although there were no significant differences in the standard biometric measurements between the GDM (+) and GDM (−) groups, the FLV was significantly higher in women with GDM. The FLV was found to be a potential predictive factor for GDM. The ROC analysis implied that as a cut-off value of FLV of 32.72 cm3 for GDM prediction, the sensitivity was 78.8% and the specificity was 56.3%. What are the implications of these findings for clinical practise and/or further research? Screening for GDM with oral glucose tolerance test within the limited weeks of gestation may not always be feasible. On the other hand, the mid-trimester ultrasound scanning is done almost in all pregnancies. Accordingly, FLV measurement might be an alternative method for the GDM diagnosis.

Which factors are associated with the recurrence of endometrioma after cystectomy

Abstract Endometrioma is the most common form of endometriosis and is a sign of wide-spread disease in symptomatic patients. Medical treatment options can be successful in endometrioma smaller than 1 cm, but ineffective for growing and symptomatic endometriomas. Conservative surgical interventions that preserve fertility, such as laparoscopic removal or destruction of endometriotic tissue or aspiration of cystic content are typically used to treat the condition. One of the most frustrating aspects of endometrioma treatment is disease recurrence. The underlying mechanisms explaining recurrence are uncertain. Several risk factors have been evaluated in order to predict recurrence after cystectomy. In looking at the results overall, our study can conclude that the presence of greater cyst dimension, higher CA-125 level, presence of preoperative symptoms of non-cyclic pelvic pain, dysmenorrhoea and adhesion extension may be associated with recurrent endometrioma. In clinical practice, identification of risk factors for recurrence helps clinicians to inform patients. Impact statement What is already known on this subject: Endometrioma is the most common form of endometriosis and is a sign of wide-spread disease in symptomatic patients. One of the most frustrating aspects of endometrioma treatment is disease recurrence. Several risk factors have been evaluated in order to predict recurrence after cystectomy. However, the risk factors have not been precisely defined. What the results of this study add: This study aimed to investigate the contribution of possible risk factors to the recurrence of endometrioma after laparoscopic surgery. In looking at the results overall, our study can conclude that the presence of greater cyst dimension, higher CA-125 level, adhesion extension, presence of preoperative symptoms of non-cyclic pelvic pain and dysmenorrhoea may be associated with recurrent endometrioma. What the implications of these findings are for clinical practice and/or further research: In clinical practice, identification of risk factors for recurrence helps clinicians to inform patients. Detection of preoperative risk factors would be helpful in counselling patients on their future prognosis. This may also increase treatment success by providing accurate preoperative treatment planning and by assisting the scheduling of postoperative follow-ups.

The effect of the systematic birth preparation program on fear of vaginal delivery and quality of life

PurposeThe aim of this study was to assess the impact of systematic birth preparation program on fear of vaginal delivery and quality of life (QoL) in pregnant women who request elective cesarean delivery without any obstetric indication.MethodsThis study was conducted prospectively. A total of 100 women who requested elective cesarean delivery due to psychosocial reasons were included into the study. Women were divided into two groups according to their desire to participate in the systematic birth preparation program. Group A: case group (n = 50) consisted of women who participated in the systematic birth preparation program. Group B: control group (n = 50) received usual antenatal care. All patients were interviewed with questionnaires including the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) and Edinburgh Postnatal Depression Scale (EPDS) at postpartum 6th week. Type of delivery, maternal request for cesarean section, scores for QoL, and postpartum depression were compared between the two groups.ResultsVaginal delivery rate was significantly higher in among the patients who received the systematic birth preparation program (group A: 78%, group B: 56%). Maternal request for elective cesarean section significantly decreased after the systematic birth preparation program (group A: 8%, group B: 28%). In group A, the WHOQOL-BREF-TR mean scores (SD) for physical domain, psychological domain, and environmental domain were significantly higher than the values exhibited in group B. In scores of the postpartum depression scale, there were no significant differences between the two groups (p = 0.075).ConclusionsThe current study indicates that systematic birth preparation program may decrease the rate of elective cesarean delivery by reducing fear of vaginal delivery and improve the quality of life at postpartum period.