Kazim Emre Karasahin

Antimullerian hormone levels after laparoscopic endometrioma stripping surgery

Objective. To evaluate whether a change takes place in antimullerian hormone (AMH) levels reflecting the ovarian reserve after laparoscopic endometrioma stripping surgery and to demonstrate if there is any correlation between AMH levels and the sizes of endometriomas. Method. Fourty-seven women participated as the study group in this prospective controlled trial, 33 of whom (70.2%) had unilateral and 14 (29.7%) of whom had bilateral endometriomas. Pre- and post-operative serum AMH levels were measured and compared with 17 normo-ovulatory control cases and also correlated with endometrioma sizes. Result(s). Mean pre-operative AMH levels of the study group and the normo-ovulatory control cases did not reveal a statistically significant difference (1.62 ± 1.09 ng/ml and 2.06 ± 0.51 ng/ml, P > 0.05). Mean level of post-operative serum AMH of the study group decreased from 1.62 ± 1.09 to 1.39 ± 1.16. However, this reduction was not statistically significant. (P > 0.05). Pre- and post-operative AMH levels do not reveal a correlation with the size of endometrioma in both group of patients with either unilateral or bilateral endometrioma. Conclusion(s). The presence of the endometrioma does not impair the AMH levels. Laparoscopic endometrioma stripping surgery do not appear to cause a damage in the AMH secreting healthy ovarian tissue, in the short-term follow-up. Laparoscopic stripping surgery of endometriomas in experienced hands is currently a valid approach.

Ultrasonographic evaluation and anti-mullerian hormone levels after laparoscopic stripping of unilateral endometriomas.

OBJECTIVE To evaluate the ovarian reserve after laparoscopic stripping of unilateral endometriomas by comparing the operated and non-operated ovaries. STUDY DESIGN Bilateral ovarian volumes, antral follicle counts, and stromal blood flows were assessed by ultrasonography and anti-mullerian hormone (AMH) levels were analysed in 36 patients who had undergone laparoscopic cystectomy for unilateral ovarian endometrioma. RESULTS Mean antral follicle counts (AFC) of the operated side ovaries were significantly lower on the second postoperative day (3.1 ± 2.4 vs 5.2 ± 3.7; p<0.05) and in the third month (3.7 ± 2.1 vs 6.4 ± 2.7; p<0.05). Pulsatility indices of the operated ovaries were significantly decreased on the second postoperative day (2.22 ± 0.46 vs 1.76 ± 0.51; p<0.05) while resistance indices were increased (0.81 ± 0.06 vs 0.88 ± 0.13; p<0.05). Doppler parameters had recovered and a non-significant decrease in AMH levels of the patients was recorded in the third month after surgery (2.03 ± 0.41 ng/mL vs 1.95 ± 0.62 ng/mL; p>0.05). CONCLUSION Although laparoscopic stripping of endometriomas seems to affect the ovarian reserve in terms of AFCs, it does not have a significant negative impact at the end of three months as assessed by ovarian volumes, Doppler indices and AMH levels. Endometrioma surgery techniques are important in preserving normal functioning ovaries and further studies are necessary for optimising these surgical approaches.

Differences in prevalence of sexual dysfunction between primary and secondary infertile women

OBJECTIVE To examine the impact of type of infertility on female sexual function. DESIGN Comparison of female sexual function index and prevalence in primary infertile women and secondary infertile women. SETTING Hospital. PATIENT(S) One hundred twenty-two primary infertile and 51 secondary infertile women. INTERVENTION(S) Questionnaires (Female Sexual Function Index [FSFI] and Beck Depression Inventory). MAIN OUTCOME MEASURE(S) Prevalence of dysfunction in primary and secondary infertile women. RESULT(S) The prevalence of female sexual dysfunction was 64.8% (n = 79) and 76.5% (n = 39) in primary infertile and secondary infertile women, respectively. In analyses of mean overall and subgroup scores of FSFI, there were significant differences between primary and secondary infertile women in the mean scores of orgasm, satisfaction, and total FSFI. Backward logistic regression identified a model with four significant predictors of sexual dysfunction (group, age, income level, and educational level). Secondary infertile women had a 9.5-fold higher risk of sexual dysfunction than primary infertile women after adjustment for confounding factors. CONCLUSION(S) There was a higher prevalence of sexual dysfunction in secondary infertile women. Secondary infertile women have decreased sexual desire, orgasm, and satisfaction compared with primary infertile women.

Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: Conventional method versus reverse breech extraction

Maternal and fetal morbidity of two different methods of delivering the baby during cesarean section performed in advanced labor when the fetal head is deeply engaged was assessed retrospectively, i.e. delivering as ‘cephalic’ with or without assistance to push up the fetal head from the vagina (head first or push method) and ‘reverse breech extraction’ (feet first or pull method). Records of 182 women with a single fetus in cephalic presentation, who had undergone cesarean section at cervical dilatation at ≥7 cm, with the vertex at or below zero station, were reviewed. Extension of the uterine incision occurred in significantly more women during ‘cephalic’ delivery as compared to ‘reverse breech extraction’ (22.8% versus 2.2%; p = 0.001). Use of ‘reverse breech extraction’ is an attractive and safe alternative to the standard methods for intra‐operative disengagement of a deeply impacted fetal head in order to reduce maternal and fetal morbidity.

Imperforate hymen causing hematocolpos and acute urinary retention in an adolescent girl

Pelvic and abdominal pain is especially common in adolescent age group. Differential diagnosis could be gastrointestinal, renal, gynecological, and psychosomatic causes. The inability to pass urine, which is termed as acute urinary retention (AUR), is an uncommon cause of pelvic pain. The etiology of AUR is age dependent; and in childhood, severe voiding dysfunction may be drug induced with antihistamines or anticholinergic drugs, psychogenic, related to viral infections, congenital anomalies, neurological bladders, or mechanical compression of the urethra via the mass of pelvis [1,2]. Hematocolpos is defined as the accumulation of menstrual blood in the vagina instead of its expulsion, which is usually because of an imperforate hymen. The incidence of imperforate hymen as a congenital obstructive abnormality of the female genital tract is 1:2,000 [3]. We report a case of an adolescent girl who complained of pelvic pain resulting from AUR because of an imperforate hymen, which also mimicked pelvic mass at the differential diagnosis. A 15-year-old girl referred to our tertiary center obstetrics and gynecology department from emergency service with the symptoms of acute severe lower abdominal pain and inability to pass urine. The tentative diagnosis in emergency service was a semisolid pelvic mass measuring about 12 7 9 cm diagnosed by transabdominal ultrasonography. Gynecological examination was not performed at the emergency service; instead, the patient was referred to the obstetrics and gynecology department of our hospital. At the admission of the patient, she seemed very uncomfortable and was cramping with an intermittent pelvic pain. Her temperature was 37 C, pulse rate was 90/min, respiration rate was 18/min, and the blood pressure was 110/78 mmHg. Her personal and family history revealed nothing unusual except the

Lidocaine spray in addition to paracervical block reduces pain during first-trimester surgical abortion: a placebo-controlled clinical trial.

BACKGROUND A variety of anesthetic and analgesic techniques have been used for uterine aspiration, and most clinicians use a paracervical block with or without additional analgesia. We intended to evaluate whether the addition of 10% lidocaine spray to a paracervical block decreases pain during cervical dilation and uterine aspiration. STUDY DESIGN Seventy-seven patients were divided into two groups: paracervical blocks (PCB) (n = 30) and PCB plus 10% lidocaine spray (n = 47). Anticipated and overall perceived pain scores were measured with a standard Visual Analog Scale (VAS). RESULTS Anticipated pain VAS scores of two groups were similar, however overall perceived pain VAS scores demonstrated a significant difference. PCB with Lidocaine only group had 6.56 ± 1.43 cm mean VAS score, whereas lidocaine plus lidocaine spray group had 2.35 ± 1.39 cm, the difference being statistically significant (p < .01). CONCLUSION We found that 10% lidocaine spray safely decreases perceived pain during first-trimester surgical abortion, when used in addition to PCB with lidocaine HCl.

Successful twin pregnancy achieved by assisted reproductive technology in a patient with polycystic ovary syndrome with complex atypical endometrial hyperplasia treated with levonorgestrel-releasing intrauterine system

Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrinopathy and a major cause of infertility. PCOS may be associated with chronic anovulation and endometrial hyperplasia. Conservative treatment should be considered in young women wishing to preserve their fertility. Standard treatment for complex endometrial hyperplasia is the use of high-dose progesterone, whereas we preferred levonorgestrel-releasing intrauterine system (LNG-IUS) as a last resort in our patient who was resistant to oral gestagens. We present a case with complex atypical endometrial hyperplasia treated conservatively in a long-term period first by oral gestagens, then by LNG-IUS. In our case, LNG-IUS was more effective than oral systemic progestins, not only for reducing the menstrual blood loss but also for improving the pathological findings. After extraction of LNG-IUS rapid achievement of pregnancy was carried out by intracytoplasmic sperm injection and embryo transfer and she took home twin babies. To the best of our knowledge, this is the first successful twin pregnancy case with ICSI and ET in a patient with oral gestagen resistant endometrial complex/atypical hyperplasia achieved after application of LNG-IUS. In complex atypical hyperplasia, LNG-IUS should be kept in mind as an effective alternative treatment modality before assisted reproductive technology (ART).

Combined Approach in a Large Placental Chorioangioma Case with Intratumoral Alcohol Injection, Cordocentesis, IU Transfusion, and Amnioreduction

Large placental chorioangiomas (LPCs) are rare complications of pregnancy and these tumors are associated with increased risk of pregnancy complications. We presented a LPC case at 25th week of gestation, complicated by polyhydramnios and preterm labor in which intratumoral alcohol injection was performed succesfully. Cordocentesis, fetal intrauterine transfusion, and amnioreduction were performed at the same session, as a combined approach. The safety of the procedure was shown by the lack of alcohol in the fetal cord blood sample. Intratumoral alcohol injection is a reliable and effective treatment modality in the management of LPCs and may be combined with other invasive procedures.

Neopterin: a promising marker for the inflammation in polycystic ovary syndrome

Background: Several markers of low-grade chronic inflammation are altered in women with polycystic ovary syndrome (PCOS). Neopterin (NEO) is a marker of celullar immunity, and oxidative stress, mainly produced by activated macrophages. We aimed to evaluate the NEO levels in PCOS patients and correlate them with antropometric and biochemical parameters. Methods: The study groups consisted of 69 women with PCOS and 46 healthy controls. Both groups were divided into two subgroups according to their body mass index (BMI): <25 = normoweight, >25 = overweight. The clinical and biochemical parameters and serum NEO levels were analyzed. Results: Circulating levels of NEO were significantly (p < 0.001) higher in women with PCOS (normoweight: 15.9 ± 4.7 nmol/l; overweight 13.3 ± 8.1 nmol/l) compared to controls (normoweight: 8.6 ± 2.0 nmol/l; overweight 9.2 ± 1.8 nmol/l) regardless of their weight classes. Waist-to-hip ratio (WHR) (p < 0.05), free and total testosterone (p < 0.001) were significantly elevated in women with PCOS compared to controls after controlling for the effect of obesity. Conclusion: Circulating NEO level s are elevated in PCOS independent of body mass index supporting the suggestion of PCOS is a low-grade chronic inflammatory state.

Narrow band imaging hysteroscopy: a new diagnostic technique in recurrent IVF failure?

Narrow band imaging (NBI) is an optical filter technology that improves the visibility of capillaries, veins and other subtle tissue structures, by narrowing the bandwidth of spectral transmittance using optical filters. In this short communication, we want to share our preliminary experience in assisted reproductive technology patients where we had used NBI hysteroscopy for the evaluation of uterine cavity abnormalities who had previous IVF failure.