Ibrahim Bildirici

The origin of spermatozoa does not affect intracytoplasmic sperm injection outcome

OBJECTIVE To assess whether the origin of spermatozoa, ejaculate or testicular, affects intracytoplasmic sperm injection (ICSI) outcome. STUDY DESIGN Retrospective study of 890 consecutive first ICSI and embryo transfer cycles done for male infertility. The ICSI outcome of ejaculated spermatozoa (n=780) and testicular spermatozoa retrieved from patients with obstructive azoospermia (n=43), non-obstructive azoospermia (n=53) and severe oligoasthenoteratozoospermia (n=14) were compared by using chi-square test, independent t-test and ANOVA with Bonferroni test. RESULTS All azoospermic males had a diagnostic testicular biopsy at least 6 months before the ICSI procedure. Spermatozoa were successfully retrieved in all 43 patients with obstructive azoospermia and in 72.6% of 73 non-obstructive cases. The cycle characteristics of the four groups were similar apart from a younger mean female age in the non-obstructive azoospermia group when compared with the ejaculated spermatozoa group. The fertilization, implantation and clinical pregnancy rates were comparable among the four groups. CONCLUSION Testicular spermatozoa recovered from patients with obstructive and all types of non-obstructive azoospermia were as much as effective as ejaculated spermatozoa in ICSI.

Hyperlipidemic pancreatitis during pregnancy

A case of acute pancreatitis associated with type V hyperlipoproteinemia is reported. A 26-year-old-woman was referred to our department with nausea, vomiting, and severe abdominal pain at 24 weeks gestation. Elevation of pancreatic enzymes with profound hypertriglyceridemia (60 mmol/L) was noticed, and a diagnosis of hyperlipidemic pancreatitis was made on the day of admission. Because she had no history of non-gestational hyperlipidemia, the observed hyperlipidemia was thought to be gestational in origin. The treatment consisted of nasogastric decompression, intravenous hyperalimentation, insulin infusion, and plasma exchanges. Progressive abatement of the symptoms occured, and on the fifth day of admission, complete resolution was observed. On the seventh day of hospitalization, advancing preterm labor and associated fetal distress was diagnosed, which necessitated a cesarean delivery. The infant was lost due to severe immaturity. Pancreatic pseudocyst formation complicated the postpartum period, which was managed by percutaneous drainage. Early diagnosis, close monitoring, consistent supportive treatment and awareness of complications are the key points in the management of gestational pancreatitis.

The effect of vaginal pH on the efficacy of vaginal misoprostol for induction of labor

Background. Misoprostol was reported to be an effective agent for cervical ripening and induction of labor. Our purpose was to evaluate whether vaginal pH affected the efficacy of misoprostol for induction of labor.

Feto-maternal morbidity and mortality after cardiac valve replacement

Background. The aim of this study is to evaluate the fetomaternal morbidity and mortality of the pregnancies of women who conceived after cardiac valve replacement.