Recep Emre Okyay

Myomectomy during cesarean section.

To evaluate the outcome of myomectomy during cesarean section and to compare it with a control group.

Value of maternal procalcitonin levels for predicting subclinical intra-amniotic infection in preterm premature rupture of membranes.

To determine whether procalcitonin (ProCT) levels can be used to predict subclinical intra‐amniotic infection by comparing maternal plasma levels in preterm premature rupture of membranes (PPROM) and premature rupture of membranes (PROM) at term with the levels in healthy pregnant women.

The effect of post-wash total progressive motile sperm count and semen volume on pregnancy outcomes in intrauterine insemination cycles: a retrospective study.

OBJECTIVE The purpose of this study was to determine the impact of post-wash total progressive motile sperm count (TPMSC) and semen volume on pregnancy outcomes in intrauterine insemination (IUI) cycles. MATERIAL AND METHODS The retrospective study included a total of 156 cycles (141 couples) and was performed in our center over a 24-month period. The semen parameters were recorded for each man and each insemination. The semen samples were re-evaluated after the preparation process. Post-wash TPMSC values were divided into four groups; Group 1: <1×10(6); Group 2: 1-4.9×10(6); Group 3: 5-9.9×10(6); Group 4: 10×10(6) and >10×10(6). Post-wash inseminated semen volume was divided into three groups; Group 1: 0.3 mL; Group 2: 0.4 mL; Group 3: 0.5 mL. The effect of post-wash total progressive motile sperm and semen volume on pregnancy outcomes was evaluated. RESULTS The pregnancy rates per cycle and per couple were 27.56% and 30.49%, respectively. There was not a significant relationship between the inseminated semen volume and pregnancy rate (p>0.05). However, a significant linear-by-linear association was documented between the TPMSC and pregnancy rate (p=0.042). CONCLUSION Our findings suggest that the post-wash inseminated semen volume should be between 0.3-0.5 mL. An average post-wash total motile sperm count of 10×10(6) may be a useful threshold value for IUI success, but more studies are needed to determine a cut-off value for TPMSC.

Different Effects of Myoinositol plus Folic Acid versus Combined Oral Treatment on Androgen Levels in PCOS Women

Recently, myoinositol (myo-ins) and folic acid combination has gained an important role for treating Polycystic Ovary Syndrome (PCOS), in addition to combined oral contraceptives (COC). We aimed to examine myo-ins effects on anti-Mullerian hormone (AMH) levels and compare them with those ones obtained administering COC. In this prospective study, 137 PCOS patients, diagnosed according to Rotterdam criteria and admitted to the Reproductive Endocrinology and Infertility Outpatient Clinic at Dokuz Eylul University (Izmir, Turkey), were included. After randomization to COC (n = 60) and myo-ins (n = 77) arms, anthropometric measurements, blood pressure, Modified Ferriman Gallwey scores were calculated. Biochemical and hormonal analysis were performed, and LH/FSH and Apo B/A1 ratios were calculated. Data analysis was carried out in demographically and clinically matched 106 patients (COC = 54; myo-ins = 52). After 3-month treatment, increase in HDL and decreases in LH and LH/FSH ratio were statistically more significant only in COC group when compared with baseline (in both cases p > 0.05). In myo-ins group, fasting glucose, LDL, DHEAS, total cholesterol, and prolactin levels decreased significantly (for all p < 0.05). Progesterone and AMH levels, ovarian volume, ovarian antral follicle, and total antral follicle counts lessened significantly in both groups (for all p < 0.05). In PCOS treatment, MYO is observed more effective in reductions of total ovarian volume and AMH levels.

Late-onset maternal mortality after amniocentesis.

hypertension (160/110 mmHg), headaches, visual disturbances and generalized edema. During ultrasound evaluation, severe fetal hydrops and placentomegaly were observed and the diagnosis of mirror syndrome was made. At Doppler evaluation, the pulsatility index (PI) of both uterine arteries was normal and notching was absent. Maternal laboratory tests revealed mild anemia (hemoglobin: 10.6 g/dL, hematocrit: 31.7%) and nephrotic proteinuria (3.6 g/24 h). Due to clinical signs of preeclampsia, maternal serum concentrations of sFlt-1 and PlGF were measured by automated electrochemiluminescence immunoassay (Roche Diagnostics, IN), using an Elecsys 2010/Hitachi equipment. The serum levels of sFlt-1 and PlGF at the moment of the diagnosis were 14,699 pg/mL and 239 pg/mL, respectively. The sFlt-1/PlGF ratio was 61.5. Due to the clinical signs of severe preeclampsia and extremely compromised fetus, the patient received treatment with magnesium sulfate and labor induction was initiated. A live baby weighting 1000 g was born, but he died after 1 h. The weight of the placenta was 1500 g. A new assessment of sFlt-1 and PlGF was made 48 h after delivery. The serum levels of sFlt-1 and PlGF at this time were 1122 pg/mL and 21.4 pg/mL, respectively (Fig. 1). The maternal screening for infection demonstrated acute CMV infection. The histological examination of placental samples demonstrated chronic villitis with lymphoplasmacytic infiltrate and multifocal cytomegalic inclusion. Additional findings were edematous villi, Fig. 1. Serum concentrations of sFlt-1 and PlGF

Myo-inositol administration positively effects ovulation induction and intrauterine insemination in patients with polycystic ovary syndrome: a prospective, controlled, randomized trial

Abstract Objectıve: The aim of the study is to investigate the effect of myo-inositol (MYO) on pregnancy rates of patients diagnosed with polycystic ovary syndrome (PCOS) who undergone controlled ovulation induction and intrauterine insemination (IUI). Methods: A total of 196 infertile patients diagnosed with PCOS and admitted to Dokuz Eylul University Faculty of Medicine were included in the study between March 2013 and May 2016. The patients in group 1 (n = 98) were given 4 g MYO and 400 μg folic acid before and during ovulation induction. The patients undergone controlled ovarian hyperstimulation (COH) with recombinant FSH and IUI. The patients in group 2 (n = 98), were given recombinant FSH directly and 400 μg folic acid. The primary outcome measure of this study was the clinical pregnancy rate. Results: In group 1, 9 patients conceived spontaneous pregnancy. During COH + IUI treatment three cycles were canceled in group 1 and 8 cycles in group 2. Total rFSH dose and cycle duration were significantly lower and clinical pregnancy rates were higher in group 1. The pregnancy rate for group 1 was %18.6 and for group 2 was %12.2. Conclusıons: This study shows that MYO should be considered in the treatment of infertile PCOS patients. MYO administration increases clinical pregnancy rates, lowers total rFSH dose and the duration of the ovulation induction.

Corrigendum to “Different Effects of Myoinositol plus Folic Acid versus Combined Oral Treatment on Androgen Levels in PCOS Women”

[This corrects the article DOI: 10.1155/2016/3206872.].

Do preeclampsia symptoms resolve after intrauterine death of a fetus

We present two cases of twin pregnancies without resolution of preeclamptic symptoms after intrauterine death of one twin. Case 1: A nulliparous woman aged 37 years was referred at 26 weeks of gestation because of arterial hypertension, edema, and growth restriction in one twin. Three weeks later the restricted twin died. During the following three weeks, ultrasound examinations showed a reduced growth velocity of the surviving fetus and reversed umbilical flow. At the end of the 34th week of gestation, cesarean section was performed and a healthy female infant was delivered. Case 2: A nulliparous woman aged 33 years with a 27-week twin pregnancy was referred because of arterial hypertension and discordant growth. The restricted twin died at 31 weeks of gestation. Following the death, within two weeks the growth of the co-twin started to slow down and reversed end diastolic flow presented. At the end of the 33rd week of gestation, cesarean section was performed and a healthy female infant was delivered. The interesting point of these cases was the secondary effects on the co-twins. During the time after intrauterine deaths of one twin, the surviving fetuses started to show a reduced growth velocity and reversed umbilical flow and mothers had increased blood pressure and proteinuria again. We think that both cases are evidence of late on-set systemic maternal effects (such as systemic maternal endothelial activation and/or systemic maternal inflammatory response) depends on preeclampsia.

Abnormal patterns of blood flow through the uterine arteries: Is it a clue for placental abruption in clinically suspected cases?

Placental abruption is defi ned as ‘ premature separation of normally implanted placenta from uterus, generally characterised by abdominal/pelvic pain, vaginal bleeding and uterine tenderness ’ . It complicates approximately 1% of births and is one of the most important causes of maternal morbidity and perinatal mortality (Tikkanen 2011). Th erefore, accurate diagnosis of abruption and, possibly, prediction of its worsening are extremely important when considering a conservative treatment. However, as is oft en the case, the classic triad is present only in minority of cases. Moreover, ultrasonography, despite recent technical advances, is not sensitive in detection of abruption (Glantz and Purnell 2002). Unfortunately, the most sensitive indicator of abruption still seems to be the presence of foetal compromise.

The effect of intrauterine insemination time on semen parameters.

OBJECTIVE The purpose of this observational study was to determine whether semen parameters (concentration, motility) were affected by the interval between the onset of postwash sperm incubation and intrauterine insemination (IUI) time. MATERIAL AND METHODS Semen specimens of 100 normozoospermic men collected at the clinic were allowed 20 minutes for liquefaction at room temperature. Semen samples were subjected to both macroscopic and microscopic examinations. After centrifugation in a density gradient column and sperm-washing medium, the samples were kept in an incubator. After 30 minutes, 60 minutes, and 120 minutes, the concentration and motility were recorded. RESULTS According the results of the Bonferroni post hoc test, there were significant differences in values of mean sperm count, percent progressive sperm motility, and total motile sperm count between 30 minutes and 120 minutes (p=0.000, p=0.000, and p=0.000) and between 60 minutes and 120 minutes (p=0.000, p=0.000, and p=0.001), but there was no significant difference between 30 minutes and 60 minutes (p=1, p=0.173, and p=1). CONCLUSION This study demonstrated that sperm parameters are negatively affected from prolonged incubation time. A maximum 60-minute limit of the interval between the onset of postwash sperm incubation and IUI time may increase pregnancy rates.