Serdar Dilbaz

Analysis of risk factors associated with uterine perforation by intrauterine devices.

Objective: To determine the risk factors for intrauterine devices (IUDs) being displaced into the abdominal cavity. Methods: This prospective follow-up study was conducted between 1996 and 2002, at the family planning clinic of a referral hospital. All 8343 women who had a copper T-380A IUD inserted underwent ultrasound examination after 1 year. Relative risk estimates and logistic regression analyses were performed to determine the risk factors associated with uterine perforation by intrauterine devices. Results: Eighteen uterine perforations occurred during the study, giving an incidence of 2.2 per 1000 insertions. When the time elapsed after the last delivery until IUD insertion is considered, postplacental insertion and insertion after 6 months postpartum were found not to increase the risk of uterine perforation. However, IUD insertion 0-3 months postpartum increased the risk of uterine perforation (odds ratio (OR) 11.7, 95% confidence interval (CI) 2.8-49.2) as did insertions at 3-6 months postpartum (OR 13.2, CI 2.8-62). Increasing parity decreased the risk (OR 0.04, CI 0.01-0.1) and increasing number of abortions increased the risk (OR 2.1, CI 1.2-3.6). Conclusion: It is safer to postpone IUD insertion until 6 months after delivery.

Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue

OBJECTIVE To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months. DESIGN Prospective, randomized, controlled study. SETTING The reproductive endocrinology unit of a tertiary, research and education hospital. PATIENT(S) Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study. INTERVENTION(S) The patients were treated with either LNG-IUS (n = 20) or GnRH-a (n = 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks. MAIN OUTCOME MEASURE(S) Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP). RESULT(S) The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction. CONCLUSION(S) Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis.

Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics

Summary The aim of the presented study is to determine the effect of different sperm parameters on the pregnancy rate of intrauterine insemination (IUI) cycles in women with favourable fertility characteristics treated for infertility. Medical records of 212 infertile couples who had undergone a total of 253 cycles were reviewed retrospectively. Inclusion criteria for women were age <35 years, antral follicle count >5, FSH <15 IU/ml, and at least one patent tube documented by HSG or laparoscopy. Clinical pregnancy rates were achieved as 15.8% per cycle, and 18.8% per couple. Woman’s age, partner’s age, total number of motile sperm (TMS) and motility, significantly influenced pregnancy rate. Pregnancy rate was the highest when women were aged <25 and TMS >10 × 106. Partner’s age significantly affected the pregnancy rate per cycle in women aged <30 years and TMS >10 × 106. Woman’s age (OR: 5.4 95% CI: 1.2–24.3) and TMS (OR: 0.06 95% CI: 0.003–0.89) were predictor variables as regards to pregnancy. Pregnancy rate was the highest in IUI cycles when woman was <25 years old, TMS was >10 × 106, and morphology was >4%. Male age was found to be another determining factor for IUI success, even if they had a normal spermiogram.

Comparison of single and multiple dose methotrexate therapy for unruptured tubal ectopic pregnancy: a prospective randomized study

Objective. To compare the success rates of single and multiple dose methotrexate protocols for the treatment of unruptured tubal ectopic pregnancy. Design. Prospective randomized controlled trial. Setting. Maternity and teaching hospital in Turkey. Population. One hundred twenty women treated with methotrexate therapy for unruptured tubal ectopic pregnancy. Methods. Sixty‐two women received a single dose and 58 received a multiple dose methotrexate regimen. Main outcome measures. Success rate of methotrexate therapy (women successfully treated with one injection and women who completed four doses). Results. In the single dose group, treatment was considered successful in 50 women (80.6%), whereas in the multiple dose group, 52 women (89.7%) responded to treatment (p = 0.21; OR 0.90, 95%CI 0.77–1.05). The average number of days required for human chorionic gonadotropin (hCG) levels to fall below 5 mU/mL was longer in the single dose (22.3 ± 7.6) compared with the multiple dose group (18.3 ± 10.7) (p = 0.03). In the single dose group fewer or 17 women (24.7%) experienced side‐effects compared to 28 (48.3%) of those who had multiple doses (p = 0.02, OR 0.57, 95%CI 0.35–0.92). Conclusion. A multiple dose methotrexate regimen for the treatment of unruptured tubal ectopic pregnancy is not more effective than a single dose one. In addition, multiple doses may cause more side‐effects, but the time for hCG levels to fall below 5 mU/mL is shorter.

Helicobacter pylori Seropositivity and Stool Antigen in Patients With Hyperemesis Gravidarum

The objective of this paper is to investigate whether Helicobacter pylori is an etiologic factor in hyperemesis gravidarum. Thirty one patients with hyperemesis gravidarum and twenty nine pregnant controls without hyperemesis gravidarum were included in this prospective study. All pregnant women were examined both for Helicobacter pylori serum immunoglobulin G antibodies (HpIgG Ab), showing chronic infection, and Helicobacter pylori stool antigens (HpSA), showing active gastrointestinal colonization. Chi-square and Student t tests were used accordingly for statistical analysis. Helicobacter pylori seropositivity was 67.7% in the patients with hyperemesis gravidarum and 79.3% in the control group (χ2 = 1.02, P = .31). HpSA was detected in 22.6% of patients with hyperemesis gravidarum, whereas 6.9% of patients in the control group. The difference was not statistically significant (χ2 = 2.89, P = .08). In this study, no relation was found between Helicobacter pylori and hyperemesis gravidarum. The low social status of women in both groups could be one of the reasons for the high prevalence of Hp infection.

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.

Does cigarette smoking really have detrimental effects on outcomes of IVF

OBJECTIVE Cigarette smoke contains many toxic chemicals associated with poor reproductive outcome and reduced fertility. It also has a negative effect on sperm motility and morphology. The aim of this study was to analyze the effects of male and female cigarette smoking on the outcomes of in vitro fertilization (IVF). STUDY DESIGN In this comparative prospective analysis, the effects of smoking on outcomes of IVF including semen parameters, oocyte quality, fertilization rate, transfer day embryo scores and pregnancy rates were analyzed. For this purpose, patients were grouped based on their follicular or seminal fluid cotinine (a nicotine metabolite) levels as smokers and non-smokers (non-smokers: female (n=171), male (n=118), smokers: female (n=43), male (n=96)). RESULTS The mean age and baseline hormonal levels of all groups were found to be comparable. While the numbers of total and mature oocytes collected were higher in the smoker group (p=0.005 and p=0.006, respectively), oocyte quality index, fertilization rate, embryo development rate and pregnancy rate were not significantly different between the groups (p>0.05). Analysis based on the type of ovarian hyperstimulation protocol (GnRH agonist, antagonist and others) showed that within the antagonist group the mean age of smokers was significantly lower and the total number of collected oocytes was significantly higher compared with non-smokers. Cigarette smoking among men did not have a significant negative effect on outcomes of IVF whether their partners were smokers or nonsmokers. Regression analysis did not give any significant difference when male and/or female smoking status was analyzed for fertilization rates, transferred embryo qualities and clinical pregnancy rates. CONCLUSION Cigarette smoking does not have detrimental effects on outcomes of IVF.

Effect of etonogestrel implant on serum lipids, liver function tests and hemoglobin levels

BACKGROUND This study aimed to assess the possible effects of etonogestrel implant (Implanon, Organon, Oss, The Netherlands) on total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and Hb levels in a sample of Turkish population. STUDY DESIGN Healthy women of childbearing potential who had applied to our Family Planning Clinic for a contraceptive method and had chosen to have an Implanon insertion after thorough counseling about all family planning methods and screening for eligibility for Implanon use were enrolled in the study. Serum concentrations of TC, TG, HDL-C, LDL-C, AST, ALT and Hb levels were tested before and at 3 and 6 months after insertion. Baseline mean parameters were compared with mean parameters at 3 and 6 months for statistical significance using paired-samples t test. RESULTS Eighty-two women eligible for the study were included. Mean age of the patients was 27.5+/-4.8 years. When compared to the baseline values, there was a statistically significant decrease in the TC (p<.001), HDL-C (p<.001) and TG (p=.006) at the end of the third month, while there was a significant increase in Hb values (p=.01). The decrease in TC (p=.001) and HDL-C (p<.001) and increase in Hb value (p=.03) persisted by the end of sixth month while the decrease in TG was transient. A statistically significant increase in mean ALT level was observed at 6 months (p=.03). CONCLUSION The effect of Implanon on liver functions and lipid metabolism does not lead to unhealthy alterations. Increase in Hb can be attributed to the high frequency of amenorrhea in patients.

Vesical calculus formation around a migrated copper-T 380-A.

The authors report a case of intravesical migration of an intrauterine contraceptive device ( IUD) with secondary stone formation in a 28-year-old woman who presented with recurrent urinary tract infections. After incomplete removal of the migrated copper-T 380-A from the pelvic cavity by laparoscopy, cystoscopy was performed and the arms of the IUD with the calculus formed around them were removed via the cystoscope. Intravesical migration of an IUD should be suspected in any woman with an unretrieved device and with recurrent urinary symptoms.

Posterior sling (infracoccygeal sacropexy): An alternative procedure for vaginal vault prolapse

This study of 30 patients evaluated the effectiveness and safety of the posterior sling (infracoccygeal sacropexy) in the surgical treatment of vaginal vault prolapse. The patients were reevaluated 3 months, 6 months and yearly postoperatively. Coexisting preoperative symptoms of pelvic pain, urgency, nocturia and ‘obstructed’ micturition feeling were followed‐up. There was remarkable improvement in vault prolapse and in coexisting symptoms.