Oguz Yucel

Is methotrexate administration needed for the treatment of caesarean section scar pregnancy in addition to suction curettage

Abstract Objective This study evaluated the clinical outcomes and safety of treating caesarean scar pregnancy (CSP) by means of suction curettage followed when required by Foley tamponade, with or without methotrexate (MTX) therapy preceding the curettage. Methods Twenty-five patients with CSP were identified between August 2008 and April 2012. The first team of doctors treated Group A patients (n = 11) with systemic MTX followed by dilatation and suction curettage whereas the second team of doctors carried out only a suction curettage on women of Group B (n = 14). If uncontrolled vaginal bleeding occurred in either group during or after the operation, a Foley catheter, guided by real time transabdominal ultrasound, was placed in the uterine cavity against the site where the CSP had been implanted. Results Clinical outcomes in the two groups − including mean estimated blood loss, major complication rate, and hospital length of stay − were comparable. Surgeons used Foley catheter balloons for tamponade in six of the 11 patients in Group A and in seven of the 14 patients in Group B. Treatment was successful in ten of 11 cases in group A and 13 of 14 cases in group B. Group Bs mean duration of treatment (2.36 ± 0.49 days) was significantly shorter than that of Group A (14.45 ± 4.96 days; p < 0.001). Conclusion Suction curettage, followed when needed by Foley catheter tamponade, is an effective treatment for CSP.

Comparison of estradiol and progesterone priming/antagonist/letrozole and microdose flare-up protocols for poor responders undergoing intracytoplasmic sperm injection

Abstract Background: To compare the effect of the GnRH antagonist/letrozole/gonadotropin protocol with the microdose GnRH agonist flare-up protocol in poor ovarian responders for intracytoplasmic sperm injection. Materials and methods: One hundred twenty-one consecutive patients suspected of having or with a history of poor ovarian response between January 2009 and June 2010, who were undergoing ICSI were enrolled. The microdose flareup (MF) protocol was used in 79 patients and the estradiol + progesterone/letrozole + gonadotropin and GnRH antagonist (EP/ALG) protocol was used in 42 patients. Results: Age of the patients, duration of infertility, basal FSH, the total gonadotropin consumption, duration of stimulation, E2 level on the day of hCG administration, the number of embryo transferred, the fertilization rate, implantation rate, clinical pregnancy rate and the live birth rate were not statistically different (p > 0.05). Only the number of oocytes retrieved was significantly higher in the EP/LGA group (1.7 ± 0.7 versus 2.6 ± 0.6). Conclusion: The EP/LGA protocol has no significant improvement against the microdose flare-up protocol in poor responder patients. Chinese abstract 背景：比较卵巢低反应性卵胞浆内单精子注射中GnRH拮抗剂/来曲唑/促性腺激素方案与微量GnRH激动剂flare-up方案的效果。 材料与方法：研究对象为2009年1月到2010年7月之间、怀疑卵巢低反应性或曾有卵巢低反应性史的121例行ICSI的患者。79例患者应用微量flare-up（microdose flare-up，MF）方案，42例患者应用雌二醇+黄体酮/来曲唑+促性腺激素和GnRH拮抗剂（estradiol + progesterone/letrozole + gonadotropin and GnRH antagonist，EP/ALG）方案。 结果：两组患者年龄、不孕时间、基础FSH水平、促性腺激素总用量、刺激时间、hCG日雌二醇水平、移植卵母细胞数量、受精率、移植率、临床妊娠率、活产率无统计学差异（p＞0.05）。EP/LGA方案只有获卵数明显高于MF方案（1.7 ± 0.7 vs 2.6 ± 0.6）。 结论：EP/LGA方案与微量刺激方案相比并不显著改善卵巢低反应性患者的反应性。

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination.

INTRODUCTION Intrauterine insemination (IUI) after controlled ovarian hyperstimulation (COH) was applied to selected infertile patients to determine the effect of gonadotropin-releasing hormone (GnRH) antagonists in IUI cycles, in which recombinant follicle-stimulating hormone (rFSH) had been used for COH. METHODS This study was conducted between April 1, 2009 and June 10, 2009, and involved a total of 108 patients. These patients had primary or secondary infertility, which resulted in an indication for IUI, and they each received two cycles of ovarian stimulation treatment with clomiphene citrate. The patients were randomised into two groups--patients in group A received rFSH + GnRH antagonist (n = 45), while those in group B received only rFSH (n = 63). RESULTS The mean age of the patients was 31.84 ± 3.73 years and the mean body mass index (BMI) was 24.40 ± 1.88 kg/m(2). The mean age and BMI of the patients in groups A and B were not significantly different. There was no significant difference in the mean total rFSH dose administered (988.33 IU in group A and 871.83 IU in group B). When compared to group B, the mean number of follicles that were > 16 mm on the human chorionic gonadotropin (HCG) trigger day was significantly higher in group A (1.58 and 1.86, respectively; p < 0.05). When the two groups were compared, there were no statistically significant differences in the number of cancelled cycles due to premature luteinisation (none in group A vs. two in group B) and the rate of clinical pregnancy (8.9% in group A vs. 7.9% in group B). CONCLUSION No significant improvement in the clinical pregnancy rates was observed when GnRH antagonists were used in COH + IUI cycles, despite the significant increase in the number of follicles that were > 16 mm on HCG trigger day.

Preeclampsia as a Rare Cause of Hyponatremia

Background: Severe hyponatremia is a very rare, mortal complication of preeclampsia and has been described in fourteen cases. Case presentation: A previously well, 29-year-old woman, gravida 2, para 1, was admitted at 34 weeks’ gestation with premature contractions. Her blood pressure was 150/90 mm Hg in both arms and she had mild proteinuria. On the third day of hospitalisation, sodium level was 120 mEq/L. On the same day, patient started to have headache. Cesarean delivery was performed because of prior cesarean section. On the first postoperative day, serum sodium level fell to 115 mEq/L. Patient had a generalised seizure After 24 hours of oral fluid restriction and 50 ml/hour isotonic sodium chloride administration, serum sodium increased to 127 mmol/L and by 48 hours, it returned to normal. Conclusion: The prediction, prevention and management of hyponatremia in preeclamptic patients require attention since this condition may predispose to convulsions, maternal mortality and fetal damage.

The effect of different preparations of hormone therapy on tumor necrosis factor-α levels in women with surgical menopause

The aim of the present prospective controlled study was to examine the influence of 17β-estradiol and tibolone on tumor necrosis factor-α (TNF-α) levels in healthy women with surgical menopause. Forty-five surgically menopausal women were included in the study. Thirty women were randomized to receive tibolone 2.5 mg or 17β-estradiol 2 mg daily for 16 weeks. Fifteen surgically menopausal women who refused hormone therapy served as controls. Serum was collected from the subjects at baseline and at the end of the study for TNF-α assay. Neither tibolone nor 17β-estradiol showed a significant influence on TNF-α level at the end of 16 weeks in comparison with baseline. Although tibolone induced a trend toward decreased level of TNF-α (3.30 ± 0.42 vs. 2.56 ± 1.94 μg/dl), this was non-significant. The slight increase observed in TNF-α level in the control group was also insignificant (3.60 ± 1.20 vs. 4.10 ± 0.70 μg/dl). Overall, these results demonstrate no significant effects of either tibolone or 17β-estradiol on circulating TNF-α level in surgically menopausal women. However, the significant difference achieved between the tibolone and control group after treatment is promising and needs to be investigated in trials with longer treatment periods.