Tayfun Bagis

Autoimmune Thyroid Disease in Pregnancy and the Postpartum Period: Relationship to Spontaneous Abortion

The aim of this study was to determine the prevalence of autoimmune thyroid disease and the risk of miscarriage in autoimmune thyroid antibody (ATA)-positive women. Eight hundred seventy-six subjects completed the study, and 12.3% were thyroid antibody-positive (4.5% tested positive for both thyroid peroxidase antibody [TPO-Ab] and thyroglobulin autoantibody [Tg-Ab], 4.79% were TPO-Ab-positive only, and 3.1% were Tg-Ab-positive only). Fifty percent of the ATA-positive women and 14.1% of the ATA-negative group had a history of spontaneous abortion. Forty-eight of the ATA-positive women developed postpartum autoimmune thyroid dysfunction (PATD). Of these, 50% had hypothyroidism alone, 31.3% had transient hyperthyroidism followed by hypothyroidism, and 18.8% had transient thyrotoxicosis alone. Of the 48 PATD subjects, 12.5% developed persistent hypothyroidism. None of the ATA-negative women developed any form of thyroid dysfunction. The thyroid-stimulating hormone (TSH) levels in the ATA-positive group were significantly higher than those in the ATA-negative group, and only the ATA-positive women with a history of abortion had significantly higher TSH and lower free thyroxine (FT4) concentrations than the other subgroups. The results revealed a 5.5% prevalence rate for PATD in the study population. In addition to TPO-Ab, Tg-Ab is a useful marker for autoimmune thyroiditis.

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus

Common carotid artery intima‐media thickness (CIMT) is a non‐invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM).

Endoscopy in hyperemesis gravidarum and Helicobacter pylori infection

Objectives: To establish a relationship between hyperemesis gravidarum (HG) and Helicobacter pylori (H. Pylori) infection by histologic testing. Methods: Twenty patients with severe HG (Group I) and 10 volunteer pregnant women without gastric complaints (Group II) were included in the study. Endoscopic evaluations were done in both groups and biopsies were obtained from the antrum and corpus for the histopathologic diagnosis of H. pylori. The groups were compared with the χ2‐test and Fishers exact test where appropriate. Results: H. pylori was diagnosed in 19 (95%) of 20 patients in Group I and 5 (50%) of 10 patients in group II. H. pylori densities in the antrum and corpus were higher in Group I and the differences between the two groups were statistically significant. The biopsy specimens revealed significant inflammation and H. pylori activation processes in patients with HG, and in 18 of 19 patients inflammation scores were greater than +2 on the scale. Pangastritis was demonstrated by endoscopic examination in 17 of 20 patients with HG. Enterogastric reflux was also diagnosed in 10 patients. In the control group, three patients had antral gastritis. Conclusions: We suggest that in patients with intractable nausea and vomiting during pregnancy, pangastritis and enterogastric reflux are the main endoscopic findings and that these findings are closely associated with H. pylori infection, which can be diagnosed histologically. The degree of gastric complaints may be associated with the density of H. pylori infection.

The Effect of Prior Varicocelectomy in Patients With Nonobstructive Azoospermia on Intracytoplasmic Sperm Injection Outcomes: A Retrospective Pilot Study

OBJECTIVES To examine our retrospective data on the outcomes of intracytoplasmic sperm injection (ICSI) and to determine whether a history of varicocele repair in men with nonobstructive azoospermia (NOA) undergoing an ICSI cycle was optimizing or not. METHODS This retrospective study was conducted on Baskent University Department of Obstetrics and Gynecology, IVF Unit, and Department of Urology. Infertile couples suffering from NOA scheduled to an ICSI cycle, which was controlled ovarian hyperstimulation with a gonadotropin or gonadotrophin-releasing hormone-agonist protocol, selected for the study were divided into 2 groups: group 1 (n = 31) included NOA patients who had undergone prior varicocele repair, and group 2 (n = 65) included NOA patients who had not undergone varicocele repair. RESULTS There was a significant difference between the 2 groups considering the sperm retrieval rate, which was higher in the varicocele repair group (sperm retrieval rate 60.81% and 38.46% respectively, P = .01). The clinical pregnancy rate and live birth rate were significantly higher in the varicocelectomy group (74.2% vs 52.3% and 64.5% vs 41.5%, respectively, P <.05). CONCLUSIONS Varicocele repair in NOA might be considered in patients undergoing ICSI cycle.

Single versus double intrauterine insemination in multi-follicular ovarian hyperstimulation cycles: a randomized trial

BACKGROUND The rationale for double insemination is to create the opportunity for a longer fertilization period as follicle rupture may occur over a wide interval (approximately 22-47 h) after hCG administration in ovarian hyperstimulation (OH) with intrauterine insemination (IUI) cycles. This randomized study evaluates the effectiveness of single versus double IUI in only OH cycles with multi-follicular development. METHODS We conducted a single center trial, 228 eligible patients were randomized for this study on the day of hCG. Only cycles with multi-follicular development without premature luteinization (progesterone levels >1 ng/ml on the day of hCG), were included in the study. Multi-follicular development has been defined as at least two dominant follicles reaching minimum > or = 15 mm diameter in which one of them is >17 mm. OH cycles with more than five dominant follicles (>15 mm in diameter) were excluded from the study. In the single IUI group (Group 1 = 112 patients) IUI was applied 36 h after the hCG injection and in the double IUI group (Group 2 = 114 patients) the first IUI was performed 18 h after hCG administration and the second IUI was performed 40 h after hCG administration. The primary end-point is to compare live birth rates (LBRs) between single and double IUI arms. RESULTS LBRs were 10.7% (12/112 patients) in the single IUI group and 12.3% (14/114) in the double IUI group and the difference was not statistically significant (P = 0.835, OR = 1.16, 95% CI: 0.51-2.64). In the unexplained infertility group the LBR was 11.1% (5/45 patients) with single IUI and 18.4% (9/49) with double IUI (P = 0.393). In the mild male factor group this rate was 10.4% (7/67) and 7.7% (5/65) in the single and double IUI groups, respectively (P = 0.764). CONCLUSION Our study did not find any difference in LBRs between single and double IUI groups in OH cycles with multi-follicular development. To the best of our knowledge this is the first report with this kind of study design. The study was registered at clinicaltrials.gov: NCT 00993902.

Detection of insulin resistance in Turkish adults: a hospital‐based study

Aim: The aim of the present study was to investigate the usefulness of insulin sensitivity check indices in our hospital population.

High maternal hemoglobin and ferritin values as risk factors for gestational diabetes.

A number of studies have linked high maternal serum hemoglobin (Hb) levels in pregnancy with increased incidence of adverse pregnancy outcomes such as low birth weight and small-for-gestational-age newborns pre-term births increased perinatal mortality and pre-eclampsia. Lao et al. Identified high maternal hemoglobin at the initial prenatal visit as a risk factor for gestational diabetes mellitus (GDM). This protective study was conducted on 253 non-diabetic Turkish women with singleton pregnancies whose serum Hb level and mean corpuscular volume (MCV) at the initial visit were > 10 g/dl or > 80 fl respectively. The exclusion criteria were first prenatal visit later than 14 weeks of gestation; pre-existing anemia or hemoglobinopathy chronic disease; such as diabetes mellitus renal or gastrointestinal disorder hypo- or hyper-thyroidism GDM diagnosed before 28 weeks gestation. Values signifying the 50th percentile for Hb (12.2 g/dl) and ferritin (Fe) (19.7 µg/l) were established based on these data and two sets of groups were formed based on the initial-visit-findings (Hb above and below the 50th percentile; Fe above and below the 50th percentile). The pairs of groups were compared with respect to maternal pregnancy and infant characteristics and incidence of GDM. At the first trimester prenatal visit; a blood sample from each subject was analyzed for complete blood count MCV fasting serum glucose level and serum levels of Fe vitamin B12 folic acid and insulin. Insulin sensitivity was calculated using the HOMA index. [(Formula: fasting glucose (mmol/l) X fasting insulin (µunits/ml)/22.5]. All women were screened for GDM between 24 and 28 weeks of gestation with a 50-g oral glucose any subject with serum glucose level > 135 mg is subjected to a 3-h 100-g load OGTT. All the OGTT results at 24-28 weeks gestation were interpreted according to the criteria of Carpenter and Coustan. (excerpt)

Intima-media thickness of the carotid arteries is related to serum osteoprotegerin levels in healthy postmenopausal women

Abstract Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and also plays a role in vascular calcification. The objective of this study was to evaluate the relationship between serum OPG levels, and carotid artery intima-media thickness (IMT) and carotid plaque formation in healthy postmenopausal women. We recruited 68 healthy postmenopausal women for the study. Carotid plaque presence and IMT were evaluated by high resolution B-mode ultrasound. IMT was positively correlated with presence of plaque, age, menopause age and OPG, and inversely correlated with Apolipoprotein A1 (Apo A1). Serum OPG level was positively correlated with IMT (r = 0.366; p < 0.003) and age (r = 0.324; p < 0.008), and negatively correlated with Apo A1 (r = –0.481; p < 0.0001). We did not observe any significant relation between plaque occurrence and levels of serum OPG. In regression analysis OPG (p < 0.02) and menopause age (p < 0.05) were independent risk factors for IMT, and age (p < 0.05) and IMT (p < 0.05) were independent risk factors for plaque formation. Although the role of OPG in the vascular biology is poorly understood, our results suggest that elevated levels of serum OPG is associated with IMT and may play a role in the pathogenesis of atherosclerotic disease.

Comparison of the criteria for gestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancy

This is a retrospective study to compare the criteria for diagnosis of gestational diabetes mellitus (GDM) by the National Diabetes Data Group (NDDG), and Carpenter and Coustan criteria, and to study the outcome of GDM when diagnosed by the more sensitive criteria. Six hundred and sixty-two pregnant women were included in this study from the medical records between September 1998 and April 2001. GDM was positive in 6.50% of patients according to Carpenter and Coustan and in 4.08% of patients according to NDDG criteria. Women with GDM were older, had higher fasting and glucose challenge test (GCT) glucose levels, and fetal weight than the normal women. Hypoglycemia was observed only in one infant. Regarding pre-term delivery and preeclampsia, there was no significant difference between the groups. Age, delivery week and fetal weight of patients who had caesarian delivery were significantly higher than spontaneous vaginal delivery. Prevalence of macrosomia in GDM group was higher than in the normal group. There was a significant correlation between the macrosomia and number of positive blood glucose values during OGTT. In multivariate analyses, fasting, GCT and second hour OGTT blood glucose levels, mean parity, and delivery week were independent risk factors for fetal weight. Carpenter and Coustan criteria is more sensitive than the NDDG criteria and women with GDM had a higher frequency of macrosomia and the frequency of macrosomia increases by the number of positive blood glucose levels during OGTT. Tight glycemic control might decrease the prevalence of caesarian delivery, pre-eclampsia, pre-term delivery and hypoglycemia of the infant.

Sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women: a randomized, double blind, placebo-controlled trial.

OBJECTIVE To evaluate the effectiveness of sublingual misoprostol for cervical ripening before diagnostic hysteroscopy in premenopausal women. DESIGN Placebo-controlled, double-blind, randomized trial. SETTING University hospital. PATIENT(S) Fifty-two women with an indication for diagnostic hysteroscopy. INTERVENTION(S) Randomized women who had received either 200 mug of misoprostol (n = 25) or placebo (n = 27) sublingually 2 hours before hysteroscopy. Two subgroups (women with or without previous vaginal delivery) were formed. MAIN OUTCOME MEASURE(S) Number of women requiring cervical dilatation, duration of dilatation, ease of dilatation, and complications during procedure. RESULT(S) In the misoprostol group, 14 patients needed cervical dilatation, versus 21 in the placebo group. Duration of dilatation was longer in the placebo group than in the misoprostol group. In subgroup 1, seven patients in the misoprostol group (n = 13) and nine patients in the placebo group (n = 12) needed cervical dilatation. The duration of the dilatation was similar between the groups. In subgroup 2, both the need for cervical dilatation (58.3% vs. 80.0%) and the duration of dilatation (31.0 +/- 18.8 vs. 73.0 +/- 82.0 seconds) were found to be lower in the misoprostol (n = 15) than in the placebo (n = 12) group, respectively. Those differences were all not significant. CONCLUSION(S) Sublingual misoprostol before diagnostic hysteroscopy did not seem to facilitate cervical ripening statistically; however, the results are remarkable and are promising clinically. Further studies are required to reassess the use of sublingual misoprostol in patients before hysteroscopy.