Hüsnü A. Kişnişçi

Evaluation of adhesion formation after laparoscopic treatment of polycystic ovarian disease.

The incidence and fertility effects of postoperative adhesion formation after laparoscopic ovarian electrocautery or laser photocoagulation of polycystic ovaries has not been adequately analyzed. Short-interval second-look laparoscopy appears to be a useful method for addressing this issue. Employing short-interval second-look laparoscopy 3 to 4 weeks after the initial laparoscopic intervention, we were able to demonstrate adhesions in 6 of 7 patients (85%) treated with ovarian electrocautery and 8 of 10 patients (80%) submitted to laser therapy. The adhesions were amenable to laparoscopic lysis in 12 of 14 patients (85%). The subsequent conception rates within 6 months of second-look laparoscopy that were 57% and 40% in the electrocautery and the Nd:YAG laser groups, respectively, may in part be attributed to the restoration of normal pelvic anatomy during this procedure.

Reproductive performance after conventional metroplasty: an evaluation of 102 cases

OBJECTIVE To evaluate the influence of conventional metroplasty on reproductive performance of symmetric uterine anomalies and determine the complications of these procedures. DESIGN A retrospective clinical analysis of consequently operated 102 women. SETTING Institutional. PATIENTS AND PARTICIPANTS One hundred two patients with bicornuate and septate uterus and a history of late recurrent abortion and/or preterm delivery were included in this study. INTERVENTIONS Jones, Strassman, and Tompkins procedures for metroplasty and McDonald operation for cervical cerclage. MAIN OUTCOME MEASURE The fetal survival rate has increased from 3.7% before operation to 75.0% afterwards. In only two patients uterine rupture was observed. RESULTS Conventional metroplasty improves the fetal survival rate in women with symmetric uterine anomalies. CONCLUSIONS Our results confirm the view that conventional metroplasty seems to be an operation of choice in women with symmetric uterine anomalies and a history of recurrent late abortion and preterm delivery. However, uterine rupture and postoperative infertility may be potential complications.

The results of in vitro fertilization-embryo transfer in couples with unexplained infertility failing to conceive with superovulation and intrauterine insemination*

OBJECTIVE To determine the results of IVF-ET in couples with long-standing unexplained infertility who had failed to conceive with four to six cycles of superovulation and IUI. DESIGN Retrospective case control series. SETTING University IVF-ET center. PATIENTS One hundred seventeen couples with unexplained infertility who had failed to conceive with superovulation and IUI underwent 157 cycles of IVF-ET. Results were compared with 194 tubal factor couples subjected to 250 IVF-ET cycles within the same time period. RESULTS Total fertilization failure events were more common (20.4% versus 7.6%) and tended to be repetitive in couples with unexplained infertility. When total fertilization failure events were excluded, fertilization rates (57.8% versus 60.9%) and cumulative clinical pregnancy rates over three cycles (55.4% versus 46.5%) were similar in unexplained infertility and tubal disease groups. CONCLUSIONS Couples with unexplained infertility failing to conceive with superovulation and IUI have a favorable outcome when treated subsequently with IVF-ET. Conception rates similar to couples with tubal disease may be expected despite a higher incidence of total fertilization failure events.

Pregnancy and its complications after cardiac valve replacement

The outcome of 64 pregnancies in 40 women who conceived after cardiac valve replacement were reviewed. Fetal wastage was 53.2% (25/47) in coumarin administered pregnancies, 36.4% (4/11) using heparin and 16.7% (1/6) without anticoagulants. Two fetal malformations were noted in coumarin administered pregnancies. There were two maternal deaths. Maternal morbidity due to antenatal bleeding, atrial fibrillation, thromboembolic episodes and cardiac failure were found to be 20.0% (8/40), 17.5% (7/40), 10.0% (4/40) and 10.0% (4/40), respectively.

Laparoscopic CO2 laser uterine nerve ablation for treatment of drug resistant primary dysmenorrhea

Twenty women with drug-resistant primary dysmenorrhea were subjected to laparoscopic CO2 laser uterine nerve ablation. Menstrual pain assessed by a linear analog pain score showed a reduction of 33%, decreasing from 7.5 +/- 0.5 preoperatively to 5.0 +/- 1.7 postoperatively. The procedure was free of major complications and should be considered as a second-line therapeutic option in women who have failed medical treatment using nonsteroidal antiinflammatory agents or OCs.

Results of treatment in 182 consecutive patients with genital fistulas

Objectives: To evaluate genital fistulas with the aim of improving strategies to prevent them. Method: An institutional, retrospective, clinical analysis. One hundred eighty‐two patients with genital fistulas managed consecutively between 1970 and 1993 were analyzed. Results: About 60% of all fistulas were attributable to obstetric traumas whereas gynecologic surgery constituted only 24.7% of cases. The contribution of gynecologic surgery increased from 11.1% in 1970–1975 to 60.6% in 1988–1993. Approximately half of the patients had vesico‐vaginal fistulas. Of the 45 patients with fistulas occurring following gynecologic surgery, 19 had undergone simple hysterectomy and eight had undergone radical hysterectomy. All cesarean sections had been performed after failed labor. Hysterectomy was performed due to myoma in nine patients, endometrial hyperplasia in two patients and pelvic relaxation in eight patients. As regards management of fistulas, the transvaginal approach was chosen in the vast majority of patients. The overall success rate after the primary repair of fistulas was 91.5% (162/177). Fifteen patients with failure of the primary repair were subjected to repeat repairs. The second repair was successful in 11 patients but the remaining four needed further repairs. The maximum was seven repairs to a recto‐vaginal fistula before a satisfactory result could be achieved, which had initially occurred after a cesarean section. Conclusion: Although the results of reparative surgery are promising, it would be more useful to encourage national measures to prevent in particular obstetric trauma.

Outpatient Management of Bartholin Gland Abscesses and Cysts with Silver Nitrate

Summary: This study reports results of 52 patients with Bartholin abscesses or cysts who were managed by silver nitrate stick insertion into the cyst or abscess cavity for 48 hours. All patients showed complete healing within 15 days. However, 2 (3.8%) had recurrences within the first 2 months; 1 of these patients was treated with excision and the other by repetition of the same method with no further complaints. Silver nitrate application for Bartholin cysts or abscesses was found to be an effective, simple, inexpensive and the least anaesthetic requiring procedure, which can easily be carried out in the outpatient setting.

Trends in maternal mortality at a university hospital in Turkey

OBJECTIVE: To highlight recent trends in maternal mortality in Hacettepe University Hospital. METHOD: A retrospective clinical analysis of 117 maternal deaths between 1968 and 1992. RESULTS: The overall maternal mortality ratio was 180/100 000 (108/59 993). In terms of 5‐year periods, the maternal mortality ratio declined from 417.7 in 1968‐72 to 73.7 in 1988‐92. Infection was the most common cause of death (59.8%), followed by cardiac disease (8.5%) and hemorrhage (8.5%). Infection related deaths were either due to septic abortion (75.7%) or puerperal sepsis (24.3%). While 73.9% of all deaths were due to infection in 1968‐72, this figure contributed only 9.1% of the deaths in 1988‐92. When infection, hemorrhage, cardiac disease ad toxemia are investigated together, percentages of their contribution varies from 95.7% in 1968‐72 to 54.5% in 1988‐92 period. CONCLUSIONS: Maternal mortality ratios are decreasing significantly in our institution. An another promising finding is the further reduction in direct causes especially in recent years. However, an improvement in the care of pregnant women is necessary to continue this declining trend.

Serum and Peritoneal Fluid CA-125 Levels in Early Stage Endometriosis

Serum and peritoneal fluid (PF) CA-125 levels were assayed using the immunoradiometric assay in 17 women with minimal endometriosis and 21 control women at the time of laparoscopy. Serum levels of CA-125 were not significantly higher in women with minimal endometriosis. Minimal endometriosis was diagnosed with a 70.6% rate of sensitivity and a 71.4% rate of specificity with 16 U/ml as the upper limit of normal. PF CA-125 levels were significantly higher than serum levels but showed no significant difference between control and endometriosis patients.

Fertilization and development of a blastocyst-stage embryo after selective intracytoplasmic sperm injection of a mature oocyte from a binovular zona pellucida : A case report

Purpose:Our purpose is to describe the development of a blastocyst-stage embryo after the selective fertilization of a mature oocyte from a binovular zona pellucida by intracytoplasmic sperm injection (ICSI).Method:A 34-year-old woman underwent intracytoplasmic sperm injection due to severe male-factor infertility. After oocyte retrieval, a binovular zona pellucida including one mature metaphase II oocyte and one immature oocyte at the germinal vesicle stage as well as nine metaphase II oocytes was injected with spermatozoa using a one-to-one approach.Results:The injected mature oocyte of the binovular zona pellucida showed fertilization as evidenced by the presence of two pronuclei and cleaved to a four-cell embryo on the second day, while the uninjected oocyte showed signs of degeneration. On the third day, this embryo further cleaved to six blastomeres with slight fragmentation and it reached the blastocyst stage on the sixth day.Conclusions:Selective fertilization of one oocyte from a binovular zona pellucida by ICSI may lead to the development of a morphologically normal blastocyst-stage embryo which can be used for embryo transfer in the presence of a limited number of embryos.