Ilgin Turkcuoglu

Random-start controlled ovarian hyperstimulation for emergency fertility preservation in letrozole cycles.

OBJECTIVE To report an emergency approach of random-start controlled ovarian hyperstimulation (COH) in the late follicular or luteal phase of the menstrual cycle for embryo cryopreservation in patients with cancer. DESIGN Case series. SETTING Academic tertiary referral centers. PATIENT(S) Three patients with a diagnosis of breast cancer requiring emergency fertility preservation in the late follicular or luteal phase of the menstrual cycle. INTERVENTION(S) After baseline pelvic ultrasound and hormonal evaluation, random-start COH was commenced immediately on menstrual cycle days 11, 14, or 17 with use of letrozole 2.5 mg/d and recombinant FSH 150 to 300 IU/d. Gonadotropin-releasing hormone antagonist was administered to prevent ovulation in all cases. Ovulation was triggered with either 250 μg of recombinant hCG or 10,000 IU of urinary hCG. MAIN OUTCOME MEASURE(S) Number of oocytes harvested, maturity and fertilization rates, number of embryos frozen. RESULT(S) Nine to 17 oocytes were harvested, resulting in the freezing of seven to 10 embryos with the mean maturity and fertilization rates of 58.8% to 77.7% and 69.2% to 87.5%, respectively. CONCLUSION(S) In an emergent setting, ovarian stimulation can be started at a random cycle date for the purpose of fertility preservation without compromising fertilization rates in letrozole cycles.

GnRH agonist trigger for women with breast cancer undergoing fertility preservation by aromatase inhibitor/FSH stimulation

Aromatase inhibitors can be utilized to minimize oestrogen exposure in breast cancer patients undergoing gonadotrophin stimulation. This retrospective-prospective study determined whether using a gonadotrophin-releasing hormone agonist (GnRHa) trigger instead of human chorionic gonadotrophin (HCG) would reduce oestrogen exposure and improve cycle outcomes in aromatase inhibitor cycles. Seventy-four breast cancer patients who desired fertility preservation, with normal ovarian reserve and < 45 years of age received letrozole 5mg/day plus recombinant FSH 150-300 IU/day for ovarian stimulation. Subjects either received HCG 5000-10,000 IU (n=47) or leuprolide acetate 1mg (GnRHa, n=27) as trigger. Oestradiol measurements were repeated 4 days after the trigger and subjects were evaluated for ovarian hyperstimulation syndrome (OHSS). In the GnRHa group, oestradiol concentrations dropped significantly after the trigger than the HCG group (P=0.013) and there was a lower incidence of OHSS. GnRHa trigger resulted in a higher number and percentage of mature oocytes and a higher number of cryopreserved embryos or oocytes compared with HCG. GnRHa trigger improves outcomes by increasing the yield of mature oocytes and embryos in aromatase inhibitor cycles and also decreases the post-trigger oestradiol exposure as well as OHSS risks in women with breast cancer.

Four spontaneous pregnancies and three live births following subcutaneous transplantation of frozen banked ovarian tissue: What is the explanation?

OBJECTIVE To report the long-term follow-up of an experimental heterotopic ovarian transplantation with frozen-thawed ovarian tissue. DESIGN Long-term follow-up of an experimental surgery; case report. SETTING Academic reproductive medicine center. PATIENT(S) A 28-year-old cancer survivor with previous Hodgkin disease and relapse. INTERVENTION(S) Laparoscopic oophorectomy for ovarian cryopreservation before preconditioning chemotherapy for hematologic stem cell transplantation. Ovarian tissue thawing and subcutaneous heterotopic ovarian transplantation in the lower abdominal wall 2½ years after the hematologic stem cell transplantation. MAIN OUTCOME MEASURE(S) Resumption of ovarian function after transplantation, recovery of fertility, and pregnancy outcome. RESULT(S) Follicle development was observed in the graft 2 months after transplantation, and a P value of 14 ng/mL indicated ovulation. The patient conceived spontaneously four times within 5 years and delivered three children. The in situ ovary remained atrophic but showed occasional follicle activity contemporaneously with the graft. CONCLUSION(S) The mechanism behind spontaneous restoration of fertility with consecutive viable pregnancies after a heterotopic ovarian transplantation needs to be explored. Further laboratory and clinical research will be needed to explore the true origin of pregnancies after ovarian transplantations.

Maternal and fetal adropin levels in gestational diabetes mellitus

Abstract Aim: To evaluate maternal and cord blood serum adropin concentrations in pregnant women with gestational diabetes mellitus (GDM). Study design: Twenty pregnant women with GDM and 20 gestational age-matched healthy pregnant women participated in the study. Maternal serum and cord blood adropin levels were assessed using an enzyme immunosorbent assay, at the time of birth. The relation of maternal serum and cord blood adropin levels with metabolic parameters were also assessed. Results: The mean maternal and cord serum adropin in the GDM group were significantly lower than those of the control women (P=0.01 and P<0.001, respectively). Maternal serum adropin levels did not correlate with either fetal serum adropin levels or maternal metabolic values. Conclusion: The data suggest that low adropin levels may contribute to the underlying pathogenesis of GDM.

Evaluation of histopathological features and pregnancy outcomes of pregnancy associated adnexal masses.

Summary The aim of this study was to evaluate the pathological features and pregnancy outcomes of pregnancy-associated adnexal masses, between 2001 and 2007. During this period, 0.3% of deliveries (35) were associated with adnexal masses. Torsion or rupture of the adnexal mass complicated pregnancy in 17.1% (6/35) of the cases. The most common histopathological diagnosis was dermoid cyst in 40% of cases (14/35), and 8.5% of cases (3/35) were malignant, including borderline ovarian lesion. None of the patients had an adverse pregnancy outcome due to emergency laparotomy. Pregnancy-associated persistent adnexal masses with large size, complex or solid appearance and bilateral location can be managed surgically, which can decrease the risk of complications, such as torsion or rupture and which can diagnose malignancies early.

Meydanli compression suture: new surgical procedure for postpartum hemorrhage due to uterine atony associated with abnormal placental adherence.

Aim:  To inform about the clinical results of a new uterine compression suture technique used in the surgical management of postpartum hemorrhage due to uterine atony associated with abnormal placental adherence.

Surgical Removal of Endometrioma Decreases the NF-kB1 (p50/105) and NF-kB p65 (Rel A) Expression in the Eutopic Endometrium During the Implantation Window

We aimed to investigate whether the surgical removal of endometrioma alters the nuclear factor-kappa B1 (NF-kB1; p50/105) and NF-kB p65 (Rel A) expression in the eutopic endometrium of infertile women with endometrioma before and after laparoscopic removal of the ovarian endometrioma during the mid-secretory phase. Infertile women with endometrioma (n = 15) were enrolled. Infertile patients with nonendometriotic ovarian cyst (n = 10) and healthy fertile women (n = 10) were recruited as controls. Endometrial samples were obtained before and 3 months after the laparoscopic cystectomy. The NF-kB1 (p50/105) levels were analyzed by enzyme-linked immunosorbent assay (ELISA) in the endometrium of all groups before and after laparoscopic ovarian cystectomy during implantation window. Expression of NF-kB1 (p50/105) in eutopic endometrium was significantly higher in infertile women with endometrioma compared to nonendometriotic cyst and fertile controls (P < .05). Laparoscopic cystectomy resulted in a significant decrease in NF-kB1 expression in women with endometrioma. The NF-kB p65 (Rel A) immunoreactivity of eutopic endometrium decreased significantly subsequent to the surgical removal of the endometrioma. In conclusion, increased endometrial NF-kB expression may contribute to endometriosis-associated infertility.

Maternal and fetal serum orexin-A levels in gestational diabetes mellitus.

Aim:  Evidence suggests that orexin regulates food consumption, glucose metabolism and insulin secretion. Orexin may have a role in the pathogenesis of type II diabetes mellitus, however its role in gestational diabetes mellitus is not known. We aimed to assess maternal serum and cord blood orexin‐A (OXA) concentrations in pregnant women with gestational diabetes mellitus (GDM).

Presumed nasolacrimal endometriosis.

A 13-year-old girl was admitted with a complaint of cyclic bleeding from the left inferior punctum with menstruation. Crusted hemorrhage was noticed in the tear meniscus of the left eye and just inferior to the left caruncle. With gradient-echo magnetic resonance imaging, the hemorrhagic tissue in the nasolacrimal canal was demonstrated and the diagnosis of nasolacrimal endometriosis was made. Nasolacrimal endometriosis is a rare ocular condition. Its management and histologic diagnosis remain challenging.

Evaluation of asymmetric dimethylarginine, nitric oxide levels and associated independent variables in obese and lean patients with polycystic ovarian syndrome

Objective. To evaluate the asymmetric dimethylarginine (ADMA) and nitric oxide (NO) levels in obese and lean patients with polycystic ovarian syndrome (PCOS) and find out their relation with hormonal and metabolic parameters. Methods. Twenty-two obese, 18 lean patients with PCOS and 11 obese, 24 lean healthy control patients were enrolled prospectively. Plasma ADMA and NO levels and arginine/ADMA ratio were evaluated on 3rd day of menstrual cycle after at least 10 h overnight fasting. Results. Plasma ADMA, NO levels and arginine/ADMA ratio were similar in the groups. ADMA level did not correlate with the hormonal and metabolic parameters in patients with PCOS. However, NO correlated inversely with fasting insulin (r = −0.353, p = 0.041) and homeostasis model of insulin resistance (HOMA-IR) (r = −0.379, p = 0.027). Arginine/ADMA ratio also correlated inversely with fasting insulin (r = −0.339, p = 0.050). In multinomial regression analysis the risk of low NO was associated independently with high fasting insulin (OR = 1.19, 95% CI 1.001–1.42, p = 0.049) and high HOMA-IR in patients with PCOS (OR = 2.26, 95% CI 1.03–4.98, p = 0.042). Conclusions. Insulin resistance may be the underlying mechanism of endothelial dysfunction through NO pathway in PCOS.