Müberra Koçak

Metformin therapy improves ovulatory rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome.

OBJECTIVE To evaluate the effect of metformin therapy on hyperandrogenism, insulin resistance, cervical scores, ovulation, and pregnancy rates in clomiphene citrate-resistant women with polycystic ovary syndrome (PCOS). DESIGN Prospective, randomized, double-blind, placebo-controlled study. SETTING Infertility clinic of a tertiary referral center. PATIENT(S) Fifty-six women with clomiphene citrate-resistant PCOS. INTERVENTION(S) Two cycles of oral metformin therapy (850 mg, twice daily) in group I and placebo therapy (twice daily) in group II. Clomiphene citrate (100 mg/day) on cycle days 3-7 of the second cycle in both groups. MAIN OUTCOME MEASURE(S) Insulin, T, DHEAS, FSH, LH, body mass index (BMI), waist-to-hip ratio, endometrial thickness, cervical score, ovulation, and pregnancy rates in clomiphene-induced cycles after metformin therapy. RESULT(S) Metformin therapy resulted in a significant decrease in total T, LH level, LH/FSH ratio, insulin resistance, and mean BMI. No difference in waist-to-hip ratio, DHEAS level, and fasting insulin level was observed. Clomiphene citrate induction resulted in higher ovulation rates and thicker endometrium in the metformin group than in the placebo group. There was higher cumulative pregnancy rate in the metformin group; however, there was no significant difference in the pregnancy rate between the two groups. CONCLUSION(S) Metformin therapy not only decreases hyperandrogenism and insulin resistance but also improves ovulation rates, cervical scores, and pregnancy rates in clomiphene citrate-resistant women with PCOS.

Laparoscopic management of ovarian dermoid cysts: a review of 47 cases.

Background Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary. In the recent years, transvaginal sonographic diagnosis of ovarian dermoid cysts together with laparoscopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts. Patients and Methods The preoperative findings, operative techniques and post-operative complications were retrospectively reviewed in women who underwent laparoscopic surgery for dermoid cysts, between January 2000 and May 2003. Results In 47 women aged 21 to 53 years (median, 38.8 years), 93.6% had a unilateral cyst with a diameter of 17 to 108 mm (median, 51 mm). Clinical presentations were pain (62%), abnormal vaginal bleeding (21%) and ovarian torsion (2%), whilst 17% were diagnosed incidentally during routine examination. Surgery included cystectomy (57%), total (36%) or partial oophorectomy (6.4%) and laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (2%). During the cyst extraction, minimal spillage occurred in 42.5% of the cases and none developed chemical peritonitis. In 2 patients, conversion to laparotomy (4.3%) was required, one for sigmoid colon injury and one for malignant ovarian tumor detected via frozen section. The median operating time was 80 minutes (range, 35–180 minutes). Conclusion Using strict adherence to guidelines for preoperative clinical assessment and intra-operative management, laparoscopic treatment of dermoid cysts appears to be a safe procedure.

Laparoscopic Conservation of the Ovaries in Cases with Massive Ovarian Oedema

Two women, one 27 years old (case 1) and the other 20 years old (case 2), were evaluated due to right lower quadrant pain. The lactate dehydrogenase level was increased in case 1 and the dihydroepiandostrone level was increased in both cases. Preoperative transvaginal ultrasonography revealed solid masses, but the tumour markers were within normal limits. At laparoscopy, oedematous ovaries were diagnosed in both cases. Untwisting of the ovaries and laparoscopic wedge resection combined with frozen section analysis resulted in conservation of the ovaries in both cases. The patients are symptom-free after 1 year of follow-up.

Sister-chromatid exchange frequencies in postmenopausal hormone replacement patients.

Our objective was to evaluate the frequency of sister-chromatid exchange (SCE) during hormone replacement therapy in postmenopausal women. Thirty-four asymptomatic postmenopausal women with a minimum 12 months since last menstrual period and surgical menopausal women were included in the study. Seventeen patients who were in spontaneous menopause were administered conjugated estrogen and medroxyprogesterone acetate (group A), and the others who were in surgical menopause were given 17beta-estradiol only (group B). Peripheral lymphocytes were obtained at the beginning and at the end of the third month of therapy. The mean age of the patients was 50. 67+/-4.79. There were statistically significant differences in terms of SCE frequencies between pre- and posttreatment levels of both groups (p<0.001 and p=0.003, respectively). It is likely that estrogens with or without progesterone have an effect in increased SCE frequency and this issue may be an evidence for the increased potential for malignancies.

Risk for Malignant and Borderline Ovarian Neoplasms Following Basic Preoperative Evaluation by Ultrasonography, Ca125 Level and Age

OBJECTIVE To verify the basic preoperative evaluation in the discrimination between benign and malignant adnexal masses in our clinical practice. MATERIALS AND METHODS Data were collected on the records of 636 women with adnexal masses who had undergone surgery either by open or endoscopic approaches. Those with obvious signs of malignancy, any history of cancer, emergency surgeries without basic evaluation were excluded. The preoperative features by age, ultrasound and serum Ca125 level were compared with final histopathological diagnosis at the four departments of the institution. These are the general gynecology (Group 1: exploratory laparotomy), the gynecologic endoscopy (Group 2: laparoscopy and adnexectomy), the gynecological oncology (Group 3: staging laparotomy) and the gynecologic endocrinology and infertility (Group 4: laparoscopy and cystectomy). RESULTS There were simple and complex cyst rates of 22.3% and 77.2%, respectively. There were 86.3% benign, 4.1% (n:20) borderline ovarian tumor (BOT) and 6.4% (n:48) malignant lesions. There were 3 BOT and 9 ovarian cancers in Group 1 and one BOT and two ovarian cancer in the Group 2. During the surgery, 15 BOT (75%) and 37 ovarian cancer (77%) were detected in the Group 3, only one BOT was encountered in the Group 4. The risk of rate of unsuspected borderline or focally invasive ovarian cancer significantly increased by age, size, complex morphology and Ca125 (95% CI, OR=2.72, OR=6.60, OR=6.66 and OR=4.69, respectively). CONCLUSIONS Basic preoperative evaluation by comprehensive ultrasound imaging combined with age and Ca125 level has proved highly accurate for prediction of unexpected malignancies. Neither novel markers nor new imaging techniques provide better information that allow clinicians to assess the feasibility of the planned surgery; consequently, the risk of inadvertent cyst rupture during laparoscopy may be significantly decreased in selected cases.

Lyophilised hMG versus rFSH in women with unexplained infertility undergoing a controlled ovarian stimulation with intrauterine insemination: a prospective, randomised study

Purpose. To compare the efficacy of lyophilised urinary hMG (HP-hMG) with recombinant FSH (rFSH) in women with unexplained infertilıty undergoing a controlled ovarian hyperstimulation with intrauterine insemination (IUI). Methods. Forty-nine consecutively seen women with unexplained infertility were randomised to a controlled ovarian hyperstimulation with IUI cycle either with rFSH or HP-hMG. The outcome was compared by independent samples t-test. Results. The mean patient age and duration of infertility were not different (29.5 ± 5.7 and 4.9 ± 2.7 years in rFSH; 28.8 ± 3.2 and 6 ± 4.2 in HP-hMG group) (p = 0.6 and p = 0.2). The mean body mass index (BMI) and basal hormones were similar. Total dose of gonadotropin used (710 ± 236 vs. 636 ± 185 IU) and duration of the cycles (9 ± 2.1 vs. 8.3 ± 2.3 days) showed no significant difference (p = 0.2). Number of follicles, serum oestradiol (E2), and the endometrial thickness on the day of hCG were comparable. Two singletons in each group were obtained. Conclusions. These data suggest that HP-hMG and rFSH may be equally suitable in mild ovarian stimulation for unexplained infertilıty. Further data derived from larger study population are needed to determine whether higher amounts of two gonadotropins in this subgroup might produce any benefits or unfavourable effects.

A seminoma case which occurred in a patient with familial testicular feminization syndrome

The frequency of androgen insensitivity syndrome in the general population is between 1:20,000 and 1:60,000 and is inherited in an X-linked recessive manner (1, 2). The presence of affected relatives with an X-linked recessive inheritance pattern tends to support the diagnosis. Many authors have pointed out the occurrence of this syndrome in multiple family members in multiple generations with transmission through the maternal line. If a diagnosis of complete androgen insensitivity syndrome is made prior to puberty, the testicles may be left in their site until after puberty to allow the patient to feminize, since gonadal neoplasia has not been found until the third decade of life (3). This article discusses the syndrome and the gonadectomy procedure followed for three sisters in their early thirties. Three sisters with the definitive diagnosis of familial androgen insensitivity syndrome were admitted to our clinic; one of whom displayed neoplastic transformation, which resulted in seminoma, is presented.

Coexistence of endometriosis and uterine septum in patients with abortion or infertility

Aim:  To investigate the coexistence of endometriosis and uterine septum patients whose complaints are abortion and infertility.

Diagnostic accuracy and efficacy of color Doppler mapping for tubal patency.

Aim:  To evaluate the diagnostic accuracy of color Doppler mapping for tubal patency, comparing its results with those of hysterosalpingography (HSG) and laparoscopy.

Influence of family structure on sexual behavior of Turkish female adolescents

Abstract Background: The aim of this study was to evaluate the link between romantic relationship and/or sexual activity of adolescents, and family structure. Methods: Medical records of 1087 adolescent girls were evaluated for age, statute (student, working, out-of-school), incidence of romantic relationship and sexual activity, and family structures. Results: Teenager students had significantly less romantic relationships and experience of sexual intercourse than other groups. Parent-adolescent communication was negatively correlated with absence of romantic relationship and sexual intercourse. Conclusion: Adolescents who have left school and are working constitute a population having higher romantic relationships and sexual intercourse experiences compared with the student adolescents. Good relationships with parents were associated with less risky sexual behavior. Close relationships with school delay the onset of sexual activity.