Tayfun Kutlu

The Effects of Oxidative Stress on Outcomes of Assisted Reproductive Techniques

Purpose: To investigate the impact of oxidative stress on pregnancy success by monitoring malondialdehyde levels in follicular fluid. Methods: Forty five couples were enrolled in this prospective study. Following long protocol of GnRH analogues and r-FSH treatment, oocyte retrieval and intracytoplasmic sperm injection were performed. Malondialdehyde levels were assayed by thiobarbutiric acid reacting substances test. Students t-test and χ2 test were used for statistical analysis. Results: Patients were divided into two groups; group I (pregnancy positive, n = 20), group II (pregnancy negative, n = 25). There was no statistical significant difference in terms of age, infertility period, FSH levels on the third day, number of oocytes retrieved and fertilization rates between the two groups. Pregnancy rates were found to be decreasing in higher malondialdehyde levels. Conclusion: Malondialdehyde can be used as a marker of oxidative stress and a potential marker in predicting assisted reproductive techniques outcome.

Clinical, endocrine, and metabolic effects of acarbose, a α-glucosidase inhibitor, in overweight and nonoverweight patients with polycystic ovarian syndrome

OBJECTIVE To determine the clinical, endocrine, and metabolic effects of acarbose use in overweight and nonoverweight patients with polycystic ovarian syndrome (PCOS). DESIGN Prospective analysis. SETTING Gynecology and infertility clinic of a tertiary care medical center. PATIENT(S) Seventy-four patients with PCOS and 30 healthy women. INTERVENTION(S) Acarbose use. MAIN OUTCOME MEASURE(S) Clinical findings of hyperandrogenism, body mass indices, LH, FSH, DHEAS, total T, PRL, basal insulin, fasting glucose/insulin levels, and lipid profiles. RESULT(S) Acarbose treatment improved LH/FSH levels, decreased total T, DHEAS, basal insulin, low-density lipoprotein, very low-density lipoprotein, and triglyceride levels, and increased high-density lipoprotein levels in patients with PCOS. Basal insulin and fasting glucose/insulin levels reacted more significantly in overweight patients undergoing acarbose treatment. CONCLUSION(S) Acarbose has been found to improve insulin levels and thus glucose/insulin ratios more effectively in overweight patients compared with nonoverweight patients with PCOS. This drug seems to be an effective drug to be used in overweight as well as nonoverweight patients with PCOS.

Area under the curve of temporal estrogen and progesterone measurements during assisted reproductive technology: Which hormone is the main determinant of cycle outcome?

Is there any relationship between estrogen and progesterone concentrations during assisted reproductive technology (ART)? Which hormone is the main determinant of impaired endometrial receptivity?

High estrogen exposure may not be detrimental on endometrial receptivity in women with PCOS

Abstract The study aimed to assess the effect of high estrogen exposure and coasting on cycle outcome in women at risk for developing ovarian hyperstimulation syndrome (OHSS). Retrospective case–control study was conducted to figure out the outcomes of GnRH antagonist cycles in which women were at risk to develop OHSS. Women who underwent coasting (n = 100) were compared with a control group of women who did not undergo coasting (n = 287). Effect of endometrial estrogen exposure was determined by calculating area under curve of temporal estrogen measurements (AUCEM) through the cycle. Among 387 women with PCOS, 100 cases were required to undergo coasting to avoid OHSS. All participants reached to embryo transfer stage and clinical pregnancy rate was 44% in group with coasting whereas 39% in group without coasting (p > .05). AUCEM was a significant predictor for the cases who required coasting to avoid OHSS (AUC = 0.754, p < .001). Optimal cut off value was calculated to be 6762 with 71% sensitivity and 67% specificity. ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women with coasting (AUC = 0.496, p > .05). Consistently, ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women without coasting (AUC = 0.494, p > .05). In conclusion, neither coasting nor the high endometrial estrogen exposure was found to have detrimental effect on endometrial receptivity and cycle outcome in PCOS.

Clinical analyses of successful and previously failed intracytoplasmic sperm injection cycle parameters in patients with poor ovarian reserve

Objective: To determine some major characteristic differences between two consecutive successful and unsuccessful intracytoplasmic sperm injection (ICSI) cycles in poor responders. Materials and Methods: Sixty women with poor ovarian response as determined using the Bologna criteria underwent ICSI cycles following an unsuccessful trial. Some parameters of both cycles including age, body mass index (BMI), serum follicle-stimulating hormone (FSH) and estradiol levels, antral follicle count, gonadotropin dosage, duration of stimulation, antagonist starting day, duration of antagonist administration, endometrial thickness at trigger day, number of total and fertilized oocytes, embryo transfer day, number of embryo cells, and fertilization rate were compared in the same patients to identify predictors of cycles with clinical pregnancy. Results: The mean age, BMI, serum FSH, estradiol concentrations, and antral follicle count were 35.9 years (range, 30-42 years), 25.9 kg/m2 (range, 18.4-33.5 kg/m2), 10.9 IU/mL (range, 7-13 IU/mL), 52.9 pg/mL (range, 11.6-75 pg/mL), and 4.7 (range, 2-10), respectively. A comparison of cycle characteristics showed a significantly higher total number of mature and fertilized oocytes in successful cycles. The fertilization rate was also significantly higher in cycles with clinical pregnancy. Early initiation of antagonist was shown to result in favorable outcomes. A comparison of embryo characteristics showed that transfer of higher-stage embryos and embryos with higher numbers of cells had a significant impact on cycle outcomes. Conclusion: Our comparison of parameters of failed and successful ICSI cycles in poor responders revealed significantly earlier antagonist initiation, higher total number of mature and fertilized oocytes, fertilization rate, and significantly higher stage of embryo development and cell numbers at transfer in cycles that resulted in clinical pregnancy.

Acute fetal heart rate tracing changes secondary to cigarette smoking in third trimester pregnancies

Abstract Objective: In this study, we aimed to assess the acute alterations on some features of fetal heart rate (FHR) tracings in third trimester pregnancies. Methods: Data of FHR tracing records were obtained from 79 otherwise healthy pregnant women aged between 18 and 41. Among 79 women, 39 were nonsmokers while the remaining were chronic smokers (six or more cigarettes per day, with an average of 10 cigarettes per day). The baseline of tracings, the number of accelerations and decelerations of FHR, as well as the FHR mean, standard deviation, short-term variability of FHR were all calculated for each participant. The results of smokers and nonsmokers, then the results of smokers before and after smoking were compared. Results: Comparison of some demographic and FHR tracing characteristics between smoker and nonsmoker groups indicated significantly decreased variability in smoker group. All FHR tracing characteristics were compared before and, immediately after cigarette smoking and revealed significantly higher mean baseline, lower variability and acceleration after smoking a cigarette. Conclusion: Even in a short time period, smoking is associated with some changes in FHR monitorization characteristics, detailed analyses of these changes may clarify the pathophysiology of smoking associated perinatal outcome.

Short Term Alterations of Hormone Profile Following Oocyte Pick-Up in Women with Polycystic Ovarian Syndrome to Assess the Effect of Multiple Needle Entries Into the Ovarian Cortex and Stroma

Objective: Some hormonal alterations after ovarian diathermy have been proposed in previous studies. Based on this data, we aimed to analyze some hormone profile changes following oocyte pick-up in women with polycystic ovarian syndrome. Study Designs: A total of 50 women with polycystic ovarian syndrome underwent ovarian stimulation for IVF cycle with an indication of anovulatory infertility. Some hormone profiles with the insulin resistance were assessed before and after oocyte pick-up to (early in the morning before starting stimulation and repeated 1 month later from oocyte pick-up day) assess whether high number of needle entries into the ovarian cortex and stroma result in similar effect with the diathermy. Results: Comparison of some variables revealed significantly decreased HOMA-IR and serum total testosterone concentrations after intervention. Correlation analyses showed significant correlations between number of needle entries, change in HOMA-IR, baseline total testosterone level and change in AMH level. Conclusion: Our data showed significant metabolic and hormonal alterations following oocyte pick up consistent with the effect of ovarian diathermy in women with polycystic ovarian syndrome.

Does the Modification of Starting Gonadotropin Dose During ICSI Cycle Have Any Significant Impact on Cycle Outcome

OBJECTIVE: The aim of this study was to figure out the impact of gonadotropin dose alteration requirements due to high response or unresponsiveness on intracytoplasmic sperm injection cycle outcomes in a standard group of patients. STUDY DESIGN: One hundred cycles with same gonadotropin dosage along the stimulation were compared with 100 cycles in which gonadotropin dose alterations were needed due to high response or unresponsiveness. Groups were compared in terms of age, body mass index, serum follicle stimulating hormone and estradiol levels, antral follicle count, gonadotropin dosage, duration of stimulation, endometrial thickness at trigger day, number of total, mature and immature oocytes and finally the clinical pregnancy rates. RESULTS: There were significant differences between groups with regard to gonadotropin starting dose, total gonadotropin dose, duration of stimulation, estradiol level at trigger day, number of total oocytes and metaphase 1 oocyte number. Clinical pregnancy rates were similar between groups. CONCLUSION: Dose alteration requirement along intracytoplasmic sperm injection cycle result in high number of total and metaphase 1 oocyte yields, higher starting gonadotropin and total gonadotropin dose, duration of stimulation and estradiol level at trigger day, however clinical pregnancy rates were similar between groups.

Serum substance P concentrations to predict oocyte maturation index and clinical pregnancy

Abstract Aim: The aim of this study was to assess the predictive value of serum substance P (SP) concentrations on oocyte maturation and clinical pregnancy. Methods: Ninety-three women with unexplained infertility underwent intracytoplasmic sperm injection (ICSI) cycles. Antagonist protocol was started for each participant and at the day of oocyte pick up, serum samples were obtained from each participant to assess SP concentrations, and these concentrations were utilized to predict mature/total oocyte ratio and clinical pregnancy. Results: SP concentration was a significant predictor for mature/total oocyte ratio > 0.75 and clinical pregnancy. In correlation analyses, maturation index was significantly correlated with FSH (r= −0.226, p = 0.03), estradiol (r = 0.239, p = 0.021), peak estradiol (r = 0.414, p < 0.001), and substance P (r = 0.796, p < 0.001). In multivariate analyses, number of immature (beta coefficient = −0.379, p < 0.001), mature oocyte (beta coefficient = 0.473, p < 0.001), SP concentration (beta coefficient = 0.723, p < 0.001) and maturation index (beta coefficient = −0.387, p = 0.003) were significantly associated with clinical pregnancy. Conclusion: SP concentrations at the day of oocyte pick up may be used to predict clinical pregnancy and may be an indirect indicator for cycle outcome in assisted reproductive technology (ART).

Histeroskopi yapılan primer ve sekonder infertil hastalarda histerosalpingografi ve transvaginal ultrasonografinin tanısal değerinin incelenmesi

Amac: Histeroskopi (H/S) yapilan primer ve sekonder infertil IVF hastalarinda, intrauterin patolojilerin saptanmasinda H/S ve patoloji sonuclarini altin standart kabul ederek; transvajinal ultrasonografi (TVS) ve histerosalpingografinin (HSG) sensitivite, spesifite, pozitif ve negatif prediktif degerlerini hesaplamak ve intrauterin patolojilerin bu gruplardaki sikligini belirlemektir. Gerec ve Yontem: Bu calisma Zeynep Kamil Egitim ve Arastirma Hastanesi infertilite ve tup bebek poliklinigine Ocak - Agustos 2013 tarihleri arasinda basvuran ve H/S yapilan, primer (Grup 1) ve sekonder (Grup 2) infertil 227 hasta ile yapilmis prospektif kesitsel tarzda bir calismadir. H/S, TVS ve/veya HSG’de patolojiden suphelenilen ya da iki IVF basarisizligi olan hastalara yapildi. Calismanin birincil sonucu, H/S gold standart kabul edilerek TVS ve HSG’nin primer ve sekonder infertil hasta gruplarinda uterin patolojileri saptamadaki spesifite, sensitivite, pozitif prediktif deger (PPD) ve negatif prediktif degerlerinin (NPD) hesaplanmasi ve ikincil sonucu, gruplarda H/S sonuclarina gore intrauterin patoloji sikliginin belirlenmesidir. Sonuc: Grup 1’de intrauterin patolojilerin tespit edilmesinde TVS’nin sensitivite, spesifite, PPD ve NPD degerleri sirasiyla %71, %47, %34 ve %81 ( p=0.042 ) ve Grup 2’de spesifite %69 ve PPD’si %16 (p=0.35) iken total hasta grubunda sirasiyla %72, %49, %33 ve %84 idi ( p=0.014 ). Grup 1’de uterin patolojilerin saptamasinda HSG’nin olcum parametreleri sirasiyla %57, %46, %74 ve %29 (p=0.75) iken, Grup 2’de %60, %36, %71, %25 (p=1) ve total grupta %55, %48, %74, %28 (p=0.8) idi. H/S’de primer infertil hastalarin %56.25’inde ve sekonder infertil hastalarin %36.8’inde intrauterin patolojilere rastlandi. Yorum: TVS ve HSG intrauterin patolojileri yakalamada birbirlerine yakin sensitivite ve spesiviteye sahiptir. Fakat TVS’nin NPD, HSG’nin ise PPD daha yuksektir. Total grup ve primer infertil grupta intrauterin lezyonlarin taninmasinda TVS’nin tanisal bir arac olarak kullanimi istatistiksel olarak anlamlidir.