Mustafa Uğur

The value of vascular endothelial growth factor, pregnancy-associated plasma protein-A, and progesterone for early differentiation of ectopic pregnancies, normal intrauterine pregnancies, and spontaneous miscarriages

OBJECTIVE To evaluate the capacity of vascular endothelial growth factor (VEGF), pregnancy-associated plasma protein-A (PAPP-A), and progesterone (P) to discriminate ectopic pregnancies (EP) from nonectopic ones. DESIGN Prospective, case-controlled study. SETTING Tertiary care center. PATIENT(S) Twenty-nine women with EP, 29 women with normal intrauterine pregnancy (nIUP), and 28 women with spontaneous miscarriage, all matched for gestational age. INTERVENTION(S) Serum samples were obtained. MAIN OUTCOME MEASURE(S) Serum concentrations of VEGF, PAPP-A, and P were measured. RESULT(S) Serum VEGF concentrations did not show statistically significant differences among women with EP (median, 55.24 pg/mL; range, 0.20-179.24), spontaneous miscarriages (median, 26.24 pg/mL; range, 0.22-365.24), and nIUP (median, 43.24 pg/mL; range, 0.86-101.24). The median level of P was significantly increased in the nIUP group (20.58 ng/mL; range, 13.9-37.04) compared with the other two groups, but there was no statistically significant difference between the spontaneous miscarriage and EP groups. Like P, PAPP-A values were also significantly higher in the nIUP group than in the other two groups, but the difference between PAPP-A values in the EP and spontaneous abortion groups was statistically insignificant. CONCLUSION(S) VEGF, PAPP-A, and P cannot be used to diagnose EPs, but PAPP-A and P can at least be used to differentiate abnormal pregnancies.

Comparison of GnRH agonists and antagonists in normoresponder IVF/ICSI in Turkish female patients

PurposeTo evaluate the results of gonadotropin-releasing hormone agonist (GnRHa) and gonadotropin-releasing hormone antagonist (GnRHant) use in two demographically matched groups of normoresponder in-vitro fertilisation or intracytoplasmic sperm injection (IVF/ICSI) patients in a prospective study.MethodsWe randomised 93 patients undergoing IVF/ICSI between May 2005 and August 2006. Patients with IVF indications were included except for those with polycystic ovary syndrome or azoospermia, women older than 38 years and those with follicle-stimulating hormone (FSH) ≥10 IU/ml. Patients were stimulated with standard 225 IU recombinant FSH. In Group I (n=45) a daily dose of GnRHant cetrorelix acetate 0.25 mg was administered when follicles reached a diameter of ≥14 mm. Group II (n=48) patients were desensitised with the GnRHa, leuprolide acetate, in a long protocol. Human chorionic gonadotropin (hCG) was administered when at least three follicles of 18 mm in diameter were observed. Oocyte retrieval was scheduled 36 hours following hCG administration and embryos were transferred on day 3 after oocyte retrieval.ResultsThe two groups were homogenous for age, infertility duration, basal FSH and serum oestradiol (E2) (P=0.537, P=0.911, P=0.103 and P=0.733, respectively). In Group II (the GnRHa group) more antral follicles (P<0.001), a longer induction duration (P=0.017) and higher peak E2 levels (P<0.001) were observed. No differences were observed in the number of oocytes retrieved (P=0.749), embryos achieved and transferred (P=0.677), or fertilisation rates (P=0.839) between the two groups. There was no statistically significant difference between groups in clinical pregnancy rates, cycle cancellation and ovarian hyperstimulation (P=0.437, P=0.109 and P=0.415, respectively).ConclusionGnRHant and GnRHa provide comparable results in normoresponder patients, while GnRHant allows a greater flexibility in their treatment.

Use of Neutrophil-to-Lymphocyte Ratio Combined With CA-125 to Distinguish Endometriomas From Other Benign Ovarian Cysts

Purpose: The objective of this study was to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) compared to CA-125 in patients with endometriomas. Methods: This study was designed as a retrospective comparative study. A total of 807 women who underwent surgery due to benign ovarian cysts between January 2008 and January 2013 were included in the study. The NLR and CA-125 levels were assessed separately and together, with a receiver–operating characteristic curve analysis for the diagnosis of endometriomas. Results: The mean serum levels of NLR, CA-125, and combined markers were significantly higher in the study group (all P < .001). According to the highest Youden index, the cutoff values were found to be 23.7 IU/mL for CA-125 at 75% sensitivity and 81% specificity and 1.89 for NLR at 70% sensitivity and 74% specificity. The cutoff value for the combined marker was 41.0 with 80% sensitivity and 82% specificity. There was a positive correlation between NLR and CA-125 (P < .001). Neutrophil-to-lymphocyte ratio was also positively correlated with the endometriosis score (P < .001). Conclusions: Although NLR is a simple and easily applicable marker, CA-125 is superior for differentiating endometriomas from other benign ovarian cysts. The combination of these 2 markers improves diagnostic accuracy.

Tumor markers panel and tumor size of ovarian dermoid tumors in reproductive age.

OBJECTIVE To study whether there is any relationship between a serum tumor markers panel (CA19-9, CA 125, CEA, CA15-3 and AFP) and the tumor size in patients with ovarian dermoid cyst in reproductive age. BACKGROUND Between January 2006-2007, 160 patients were operated in the Department of Infertility, Zekai Tahir Burak Women Health Hospital due to ovarian dermoid cyst. METHODS The clinical data and serum tumor markers levels of operated patients were retrieved from the records of the department. This was a retrospective study. RESULTS Forty-four patients (37.6 %) had high levels of CA 19-9 , twenty-seven patients (19.3 %) had high CA 125 levels, eleven patients (9.4 %) had high levels of CEA, five patients (4 %) had high levels of CA 15-3 and one patient (0.9 %) had high AFP levels at the time of initial surgery. The bilaterality rate was 8.1 %. When grouping the tumor size as 10 cm, the mean serum levels of tumor markers had significantly increased by increasing the tumor size (p<0.05) for CA 19-9, CA 125, CEA. CONCLUSIONS Our study suggests that serum CA 19-9 is probably more accurate marker than other tumor markers in the ovarian dermoid cysts. Also, the most important parameter that affects CA 19-9 elevation in the dermoid cysts, is the tumor size. As the tumor becomes bigger, this relationship becomes more distinct (Tab. 2, Ref. 15).

Serum and follicular fluid Anti-Mullerian hormone concentrations at the time of follicle puncture and reproductive outcome.

OBJECTIVE The objective of the study is to determine and compare the levels of Anti-Mullerian hormone (AMH) and estradiol (E2) in serum and follicular fluid (FF) on the day of oocyte pick up (OPU) with the cycle parameters and the outcome of in vitro fertilization (IVF) treatment. MATERIAL AND METHODS The long stimulation protocol was used in 37 (86%) women; the microdose flare-up protocol was used in 6 (14%) women. Concentrations of AMH and E2 were measured in serum and FF of 43 women undergoing IVF treatment on the day of OPU. RESULTS Significant positive associations were observed between serum AMH concentrations and the total number of oocytes retrieved (r=0.343, p=0.024). Serum AMH and FF AMH levels on the day of OPU were significantly increased in the group of women who achieved clinical pregnancy (p=0.017, p=0.028). For serum AMH, a cut-off level of 1.64 ng/ml was used for the prediction of clinical pregnancy; for FF AMH, a cut-off level of 3.8 ng/ml was used for the prediction of clinical pregnancy. Serum AMH and FF AMH levels were significantly and positively correlated with implantation rate (r=0.401, p=0.008; r=0.317, p=0.039). No significant correlation was found between serum and FF AMH concentrations and fertilization rate. CONCLUSION Serum AMH and FF AMH concentrations are positively correlated with implantation and clinical pregnancy rates.

Tubal sterilization during cesarean section or as an elective procedure? Effect on the ovarian reserve

BACKGROUND The purpose of this study is to compare the effects of tubal sterilization on the ovarian reserve by means of hormonal and ultrasonographic evaluation during a cesarean section or when performed as a planned interval procedure. STUDY DESIGN Fifty women who had undergone tubal sterilization during a cesarean section (n=24) and by minilaparotomy as an elective procedure (n=26) were included in the study. Tubes were ligated with the Pomeroy technique in both groups. The women who had chosen to use barrier method or intrauterine device for contraception (n=30) constituted the control group. Among the women in the control group, two separate control groups were constituted (control 1 and control 2) who were age matched with the women in each study group. Hormone levels including antimüllerian hormone (AMH) and inhibin B and ultrasonographic evaluations were performed on the third day of the menstrual cycle 1 year after the tubal sterilization procedure. RESULTS Mean blood estradiol, follicle stimulating hormone and luteinizing hormone levels on the third day of the cycle postoperative 12 months after the surgical intervention did not show any significant differences in the groups with respect to their age-matched controls. There was no significant difference in terms of mean serum AMH and inhibin B levels between the groups and their age-matched controls. However, significantly higher postoperative levels of mean AMH levels were detected in the tubal sterilization during cesarean section group when compared with the minilaparotomy group, and significantly lower postoperative levels of mean inhibin B were detected in the elective tubal sterilization via minilaparotomy group when compared with the cesarean section group. Statistically significant differences were observed in terms of number of antral follicles and mean ovarian volumes being less in the elective tubal sterilization via minilaparotomy group when compared with age-matched controls. CONCLUSION Intraoperative cesarean section tubal sterilization seems to be a practical and safe method, and has less effect on the ovarian reserve when compared with planned tubal sterilization by minilaparotomy.

Comparison of serum granulocyte colony-stimulating factor levels between preterm and term births.

OBJECTIVE Preterm birth (PTB) is the major obstetric problem in developed countries, accounting for the majority of neonatal mortality and morbidity. Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic cytokine that mediates the increase in leukocytes in pregnancy and may play a role in placentation. We aimed to investigate the differences of serum G-CSF levels between subsequent spontaneous PTB and term-delivered healthy pregnant women. MATERIAL AND METHODS Serum samples, collected from total of 600 singleton otherwise healthy pregnants at 24-28 weeks of gestation during a routine antenatal visit, were used to assess G-CSF levels; 40 of the total pregnants who delivered their infants spontaneously after preterm labor before 37 weeks of gestation were selected as the study group. Also, 120 pregnants were selected as a control group using a 1/3 ratio. Students t-test, chi-square test, Mann-Whitney U-tests, and ROC curve analysis for prediction of PTB were used for the comparison of groups. P<0.05 was accepted as statistically significant. RESULTS There was no significant difference in maternal serum G-CSF levels between the study and control groups (p=0.28) but maternal white blood cell (WBC) count was significantly different between them (p=0.00). In addition, G-CSF was insufficient in the prediction of PTB (AUC=0.419). In the preterm and term groups, no correlation was found between WBC and G-CSF (p=0.165 vs. p=0.703). CONCLUSION There were no differences in serum levels of G-CSF between term- and preterm-delivered pregnants. There was no predictive role for serum G-CSF in PTB.

Entrapment of the small bowel due to improper closure of the parietal peritoneum: a rare cause of re-laparatomy after caesarean section

Abstract The most frequent surgical intervention in obstetric practice is a caesarean section, which is associated with several short- and long-term complications. Re-laparatomy after caesarean section is one of the most distressing of these complications and the reported incidence is 0.12–0.70%. The most common indications for re-laparatomy after caesarean section are bleeding, uterine atony, eventration and haematoma in the muscles. Herein, we report a case of entrapment of the small bowel caused by improper closure of the parieatal peritoneum after a caesarean section that required re-laparatomy. Closure of the parieatal peritoneum is recommended to avoid future development of adhesions, however, stitch intervals should be properly adjusted to prevent incarceration of the small bowel. We recommend closure of the peritoneum after caesarean section, however, stitch intervals should be kept at no more than 1.5 cm to avoid entrapment of the small bowel.

Assesment of changes in uterine and subendometrial blood flows: the use of prediction outcome in IVF cycles

OBJECTIVE: The aim of this study is to evaluate the relationship between uterine Doppler flow and endometrial and subendometrial blood flows and uterine receptivity during IVF cycles. DESIGN: This is a prospective observational study which is conducted at Zekai Tahir Burak Women’s Health Research and Education Hospital, Reproductive Endocrinology Clinic. MATERIALS AND METHODS: Sixty-eight patients from our infertility programme were recruited for this prospective observational study, after giving informed consent. Eight of them were excluded because of total fertilization failure (5 patients) and no sperm extraction in TESE (3 patients). A color Doppler ultrasound examination performed on the day of hCG injection and midluteal phase. Pulsatility and resistance indices of uterine vessels, and vascularization and flow endometrial and subendometrial region were assumed. No Doppler study was done on the endometrium in midluteal phase. RESULTS: There were no significant differences in the age of patients, BMI of patients, duration of infertility,cycle lenght or total number of embryos transferred between women who became pregnant (n 1⁄416) and those who did not (n 1⁄4 44). There were no difference in mean endometrial thickness between the two groups on hCG day and 5-6days after embryo transfer. Mean uterine arterial resistance index (RI) and Pulsatility Index (PI) values were not significantly different in both group on hCG day but both indices were significantly lower in the pregnant than in the non-pregnant group in mudluteal phase (p1⁄40.05 and 0.016, respectively). Also no significant differences were found between the two groups in subendometrial blood flow. CONCLUSION: Patients undergoing IVF-ICSI and embryo transfer, Doppler ultrasound examination of the uterine artery and subendometrial blood flow on hCG day do not discriminate between cycles resulting in conceived and non-conceived but especially low mean PI of uterine artery in 5-6 days after ET can predict pregnancy. Supported by: ZTB Women’s Health Research and Education Hospital, Turkey.