Müberra Namlı Kalem

Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility.

OBJECTIVE The aim of the present retrospective study was to evaluate intrauterine insemination (IUI) clinical experiences and to define the variables for predicting success. MATERIAL AND METHODS The present study was an observational trial performed in a private IVF center on subfertile couples who had applied for treatment between 2002 and 2012, in which the data of 503 IUI cases were retrospectively reviewed. Couples who had been diagnosed with unexplained and mild male subfertility were included. The primary outcome measure was the clinical pregnancy rate in an attempt to form a predictive model for the odds of a clinical pregnancy. Recorded parameters were used to determine the prediction model. RESULTS Utilizing univariate logistic regression analysis, clinical pregnancy was positively associated with the duration of infertility (OR=1.09, p=0.089), secondary infertility (OR=1.77, p=0.050), and +4 sperm motility after preparation (OR=1.03, p=0.091). Following an adjustment analysis involving a multivariate logistic regression, clinical pregnancy was still found to positively associate with secondary infertility (OR=2.51, p=0.008). CONCLUSION IUI success in secondary infertile couples who were in the unexplained infertility and mild male subfertility groups was higher than that in primary infertile couples, and the chances of pregnancy increased as sperm numbers with +4 motility increased. It is difficult to concomitantly evaluate all these parameters and to determine a predictive parameter in IUI independent from other factors.

Effect of body mass index and age on in vitro fertilization in polycystic ovary syndrome

OBJECTIVE The aim of this study was to investigate age-related variations in the effect of body mass index (BMI) on in vitro fertilization (IVF) outcomes. MATERIAL AND METHODS This was a cohort study conducted by retrospectively investigating the IVF cycles of 653 polycystic ovary syndrome (PCOS) patients under the age of 40 years who were diagnosed based on the Rotterdam criteria in a private IVF clinic between 2005 and 2015. The study included data from 653 IVF cycles of PCOS patients. The patients were classified into three groups based on their BMI, i.e., normal weight (n=299), overweight (n=208), and obese (n=146). The patients were also grouped by age: 562 patients were under the age of 35 years and 91 patients were above the age of 35 years. Then, BMI- and age-related variations in the IVF cycle parameters and clinical pregnancy rates of patients with PCOS were investigated. The Mantel-Haenszel Chi-square statistical assessment method was used to determine whether the effect of BMI on IVF outcomes varies with age. RESULTS Variations in cycle variables with BMI and age showed that IVF cycles were negatively affected by increases in obesity and age. Clinical pregnancy rates were found to be lower in the obese group than in the other groups, particularly in the age group above 35 years; however, this difference could not be proven statistically. CONCLUSION The present study evaluated obesity and clinical pregnancy rates in IVF cycles in PCOS patients according to age groups, and particularly in the obese group, the clinical pregnancy rates were observed to be lower in the age group ≥35 years than in the other BMI groups; however, this difference was found to be statistically insignificant.

Investigation of possible maternal and fetal factors which affect umbilical coiling index

Abstract Aim: The aim of this study was to investigate the possible maternal and fetal factors, which affect the Umbilical Coiling Index (UCI). Methods: This prospective, observational, analytic study was conducted using the data of 380 women with term pregnancy and newborns who presented at a University Hospital. Hemoglobin (Hb), ferritin, iron, and the total iron binding capacity (TIBC) of the maternal blood were measured, and transferrin saturation was estimated based on the ratio between serum iron and TIBC. Blood gases, ferritin, iron, and TIBC of the umbilical cord were also measured, and the transferrin saturation was calculated. The length and thickness of the umbilical cord, numbers of coilings, weight of placenta, neonatal weight were registered. The UCI was calculated dividing the total number of coils by the length of the umbilical cord (in cm). Results: A positive, linear, and statistically significant relationship was found between the UCI scores and the umbilical cord blood transferrin saturation, umbilical cord thickness, and the first- and fifth-min APGAR scores (p = .044, p < .001, p = .008, p = .022, respectively). No statistically significant relationship was found between the maternal Hb values and the UCI scores (p = .472). In addition, there was no statistically significant relationship between the UCI scores and maternal ferritin, maternal transferrin saturation and umbilical cordon ferritin levels (p = .940, p = .681, and p = .975, respectively). Conclusions: A positive correlation was found between the UCI and umbilical cord transferrin saturation and between the newborn APGAR scores. However, this finding is not sufficient to explain the relationship of the umbilical cord dynamics with the newborn wellbeing and coiling.

Chemokine (C-C motif) ligand-2 (CCL2) and oxidative stress markers in recurrent pregnancy loss and repeated implantation failure

PurposeThe main purpose of this study is to evaluate the inflammatory response and oxidative stress together in the cases of recurrent pregnancy loss (RPL) and repeated implantation failure (RIF).MethodsThis is a cross-sectional study conducted to compare infertile patients who have RIF and patients with RPL histories in terms of CCL2, TAS, TOS, and OSI. To this end, two study groups were formed by primary-infertile women with RIF history and women with nulliparous RPL history who consulted a university hospital between 2014 and 2016, and a control group was formed by multiparous women who had no pregnancy loss. With 30 women in each group, 90 women in total were included in the study. CCL2, TAS, and TOS blood levels were measured and oxidative stress index was calculated in all participants.ResultsThe patients with RPL and RIF had higher levels of CCL2 than those in the control group. The TOS, TAS, and OSI levels did not differ in RPL and RIF groups from the control group. No statistically significant relationship was found between CCL2 and the TOS, TAS, and OSI values.ConclusionsOxidative stress markers in the pregestational period did not have a predictive value in the RPL and RIF. CCL2 might be useful in risk prediction.

Methods for endometrial preparation in frozen-thawed embryo transfer cycles

Frozen-thawed (FT) embryo transfer is a procedure used for the storage and transfer of excess embryos obtained during in vitro fertilization- intracytoplasmic sperm injection cycles. In recent years, improvements in laboratory conditions and limitations on the number of embryos to be transferred have led to a progressive increase in FT embryo transfer cycles. However, the best solution for endometrial preparation in these cycles is still a matter of debate. In this study, we aimed to review the current methods of endometrial preparation in FT embryo transfer cycles. In light of the current literature, it is hard to determine which method is the best for endometrial preparation. It is therefore necessary to conduct randomized controlled studies in a prospective design, which will also evaluate the above-mentioned factors.

Problems and Complications During the Treatment of Infertility in Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is the most frequent endocrine disorder existing in women in their reproductive years and it is one of the most evaluated and discussed subjects of reproductive medicine with regard to its diagnosis and treatment. Patients with PCOS constitute the most difficult population in the management of infertility. The factors that increase the success rates in the treatment of PCOS infertility are: pretreatment changes in life style, dietetic and psychological support, a detailed evaluation of the couple and the appropriate selection of the treatment protocol, a wide-spectrum approach to maintaining ovarian and endometrial synchronization in the management of the cycle, and well-developed laboratory conditions to support embryonic quality. However, even if these conditions are provided, OHSS, cancellations of the cycle, poor oocyte, and embryo qualities, unsuccessful fertilization and implantation, chromosomal abnormalities and early losses may still be experienced.

Ginger (zingiber officinale) might improve female fertility: A rat model

Background: Ginger (Zingiber officinale) is a well known and extensively used antioxidant in traditional remedies. In this study, we aimed to investigate the effects of ginger powder on ovarian folliculogenesis and implantation in rats. Methods: There were two study groups. In the 5‐day treatment group (one estrous cycle), 100 mg ginger powder, 200 mg ginger powder or distilled water was given for 5 days to the three subgroups each containing seven rats. In the 10‐day treatment group, same doses were given for 10 days (two estrous cycle) to the three subgroups each containing seven rats. At the end of the 5th and 10th days, ovarian volumes, ovarian weights, primordial follicles, antral follicles, atretic follicles, and corpus luteum counts were assessed. To evaluate the angiogenic effects of ginger, vascular endothelial growth factor (VEGF) and for the antioxidant effects of ginger endothelial nitric oxide synthase (eNOS) were examined in the ovaries and in the endometrium immunohistochemically. Results: In the 5‐day treatment group, antral follicle count and ovarian stromal VEGF were significantly high in the 100 mg ginger subgroup in comparison to the control group (p < 0.05). In the 10‐day treatment group, endometrial VEGF and ovarian stromal eNOS were significantly high in the 100 mg ginger subgroup in comparison to the control group (p < 0.05). There was no statistically significant difference at 200 mg ginger dose both in 5‐day and 10‐day treatment groups. Conclusion: The increases in the antral follicle count and ovarian stromal VEGF in the 100 mg/5‐day treatment subgroup indicate that ginger have positive effects on folliculogenesis in short term with low dose. Additionally, ginger may enhance implantation in rats in long term with low dose.

A case of twin IVF pregnancy complicated with sclerosing encapsulating peritonitis diagnosed at caesarean delivery

Ebru Yuce, Nil€ ufer Akgun, Ayse Alt{ndis Bal, Muberra Namli Kalem, Reyhan Bayrak and Candan Iltemir Duvan Department of Gynecology and Obstetrics, Koru Hospitals, Ankara, Turkey; Department of Gynecology and Obstetrics, Amerikan Hospital, Istanbul, Turkey; Department of Gynecology and Obstetrics, Haymana State Hospital, Ankara, Turkey; Obstetric and Gynecology, Gurgan Clinic, Ankara, Turkey; Pathology, Private Practitioner, Ankara, Turkey; Department of Gynecology and Obstetrics, HRS Hospital, Ankara, Turkey

ADAMTS 1, 4, 12, and 13 levels in maternal blood, cord blood, and placenta in preeclampsia

ABSTRACT The aim of this study is to compare ADAMTS (A Disintegrin and Metalloprotease Domains with Thrombospondins motifs) 1, 4, 12, and 13 levels in maternal and cord blood and placental tissue between preeclampsia and uncomplicated pregnancies. The enzyme-linked immunosorbent assay (ELISA) results showed that ADAMTS 1, 4, 12, and 13 levels in the maternal and cord blood were lower in the preeclampsia group than in the control group. Based on the immunohistochemistry (IHC) results, ADAMTS 1, 4, and 12 levels in placental tissues were higher in the preeclampsia group. According to the polymerase chain reaction (PCR) results, ADAMTS 1, 4, and 12 were higher, whereas ADAMTS 13 was lower in the preeclampsia group than in the control group.

The Effect of Progesterone Usage in the First Trimester on Fetal Nuchal Translucency

Objective: To evaluate the possible association between progesterone use in the first trimester of pregnancy and fetal nuchal translucency (NT). Material and Methods: This is an observational case-control study, which was conducted with patients who underwent nuchal scans between March 2015 and February 2016 and consequently delivered live and healthy babies. The study group was composed of assisted reproductive technology pregnancies and used intravaginal progesterone 180 mg/day until gestational week 12. The control group comprised pregnant women who became pregnant spontaneously without using any progesterone preparation in the first trimester. Results: One hundred sixty-four (57.5%) of 285 patients were in the control group and 121 (42.5%) were in the progesterone group. Age, bodyweight, gravidity, and parity number of previous births and abortus, gestational week, crown-rump lengths, free β-human chorionic gonadotropin, pregnancy-associated plasma protein A, and NT values of the progesterone and control groups were recorded and we investigated whether there was a statistically significant difference between the two groups in terms of these parameters; maternal weight was found to be higher in the progesterone group than in the control group and the difference between the groups was statistically significant (p=0.019 and p=0.025). Whether the difference in NT was caused by the effect of maternal weight was investigated using the covariance analysis test and maternal weight was not found to be statistically significant in the model (p=0.284). Conclusion: Fetal NT was increased in the progesterone group compared with the untreated group in healthy pregnancies.