Umit Korucuoglu

Impact of embryo replacement depth on in vitro fertilization and embryo transfer outcomes.

OBJECTIVE To investigate the impact of embryo replacement depth on IVF and embryo transfer outcomes. DESIGN Retrospective analysis (May 2005 to November 2008) of 5,055 ultrasound-guided embryo transfers belonging to 3,930 infertile couples. The distance between the fundal endometrial surface and the catheter tip was measured and accordingly, patients were divided into five groups. SETTING Anatolia IVF Center, Ankara, Turkey. PATIENT(S) All patients enrolled in the IVF program undergoing embryo transfer. INTERVENTION(S) No patient received any additional procedure or intervention. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate (PR) and ongoing PR. RESULT(S) Mean total number of embryos transferred in groups 4 and 5 were significantly higher than in groups 2 and 3. Analysis of PRs and outcome of gestations in the five groups studied yielded similar PRs in all groups except for group 1. CONCLUSION(S) Pregnancy rates and ongoing PRs are higher if the embryos are replaced at a distance >10 mm from the fundal endometrial surface. In addition because significantly more embryos were replaced in cycles where the transfers occurred at a distance of >20 mm, a distance>10 mm to <20 mm seems to be the best site for embryo transfer to achieve higher PRs.

Intravenous leiomyomatosis treated with aromatase inhibitor therapy

[1]. The gonads of these patients develop into ovaries in utero, but then degenerate into streaks owing to the lack of a second X chromosome [1]. Cesarean is the usual mode of delivery in these patients [3], but in the present case the patient had a spontaneous vaginal delivery. Gonadal neoplasm can occur in up to 30% of cases and gonadoblastoma accounts for the majority of tumors [2]. Gonadoblastoma may synthesize estrogens or testosterone and is associated with dysgerminoma in 50% of cases [4]. In one case report 5 different histological subtypes of germ cell malignancies were described [4]. Early diagnosis is important and immediate gonadectomy is strongly recommended, as these tumors may even develop in infancy. A multidisciplinary approach with psychological support is important for the management of patients with pure gonadal dysgenesis. Normal uterine function including vaginal delivery is possible in these patients. References

Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation

The objective of this cross-sectional study was to identify the prognostic factors that influence the outcome of ovarian stimulation with intrauterine insemination (IUI) cycles using gonadotrophins in couples with unexplained and mild male-factor subfertility. A total of 838 cycles in 456 women with unexplained and mild male-factor subfertility attending a university-based infertility clinic was evaluated. Of these cycles, 139 resulted in pregnancy (16.6% per cycle) and 96 out of 98 ongoing pregnancies resulted in live term birth. Live birth rate per patient and per cycle was 21.1% and 11.4%, respectively. Multivariate logistic regression analysis demonstrated that duration of infertility (P = 0.034), type of infertility (P = 0.003), aetiology of infertility (P = 0.004), number of treatment cycles (P = 0.0001) and number of dominant follicles before human chorionic gonadotrophin (HCG; P = 0.024) were significant independent factors to predict clinical pregnancy. The duration of infertility (P = 0.043), number of treatment cycles (P = 0.0001) and number of dominant follicles before HCG (P = 0.024) were significant independent factors to predict live birth. In conclusion, for subfertile couples having shorter duration of subfertility, multifollicular response to gonadotrophins and in their first treatment cycle are more likely to succeed a live birth with IUI treatment using recombinant gonadotrophins.

Effect of different degrees of glucose intolerance on maternal and perinatal outcomes

Objective. To evaluate the effect of markedly elevated 50-g glucose loading test (GLT) (≥200 mg/dL) and equivocal 100-g GLT (one abnormal value) results on maternal and perinatal outcomes. Methods. Retrospective analysis of 2029 singleton pregnancies screened for gestational diabetes mellitus (GDM). Maternal and perinatal outcomes in five different groups with different degrees of glucose intolerance were compared. First group consisted of patients with normal 50-g test, second group was formed by patients with abnormal 50-g glucose test but a normal 100-g test. Third group included patients with one abnormal value after 100-g test. Patients in the fourth group were diagnosed to have GDM after an abnormal 100-g test. Patients in the fifth group had a value ≥200 mg/dL after 50-g test and were diagnosed to have GDM. Results. Macrosomia and large for gestational age incidence were highest in the group with one elevated glucose tolerance test (GTT) value. Hospitalisation rates, hypoglycemia, hyperbilirubinemia and polycythemia were more common in neonates born to mothers with one elevated GTT value and to mothers with a GLT > 200 mg/dL. Conclusion. Adverse maternal and perinatal outcomes in patients with one elevated GTT value and in patients with a GLT value > 200 mg/dL warrant close glucose monitoring and treatment in these groups even in the absence of a diagnostic abnormal GTT.

Incidence of stress urinary incontinence among women in Turkey

Abstract The aim of this study was to determine the incidence of stress urinary incontinence among women at the age of 15 and above who applied to the primary health care centers in Ankara, Turkey. We applied the urinary stress incontinence questionnaire to 2,601 women at the age of 15 or above who consulted to the “mother–child health care and family planning centers” in January 2002. To evaluate the urinary incontinence status with respect to age groups and other risk factors, chi-square test was used. Stress incontinence prevalence was 16.1% in our population. Age was a statistically significant risk factor affecting the incidence of stress incontinence. As the number of gravida increases, the frequency of stress incontinence increases (p<0.05). Presence of a systemic disease was also an important risk factor (p<0.05). Alcohol use and smoking were not found to affect the incidence of urinary stress incontinence (p>0.05). As urinary incontinence greatly influences life quality and social and psychological status of the person, and also creates economic burden, predisposing factors of stress incontinence should be well defined and measures should be taken to encourage women experiencing this problem to visit a doctor and to get an efficient treatment.

Endometrial mRNA expression of matrix metalloproteinases, their tissue inhibitors and cell adhesion molecules in unexplained infertility and implantation failure patients

The aim of this study was to analyse whether some cases of unexplained infertility and implantation failure after IVF could be explained by different expression levels of the matrix metalloproteinases (MMP-2, 9), their tissue inhibitors (TIMP-2, 3) and intercellular (ICAM-1) and vascular (VCAM-1) adhesion molecules in endothelial cells. Total RNA was extracted from the endometrial tissues of 41 women (unexplained infertile, group 1, n = 15; fertile volunteers, group 2, n = 15 and patients with implantation failure after IVF, group 3, n = 11). MMP-2, MMP-9, TIMP-2, TIMP-3, ICAM-1 and VCAM-1 mRNA expression levels were measured quantitatively using real-time polymerase chain reaction. In the endometrium from women with unexplained infertility and implantation failure after IVF, MMP-2 and TIMP-3 expression were significantly decreased when compared with the fertile group (P < 0.05 and P </= 0.001 respectively). In addition, a marked decrease was observed in the expression of VCAM-1 in women with unexplained infertility. These results suggest that the expression of gelatinase A (MMP-2), TIMP-3 and VCAM-1, at least at the transcriptional level, might be regulated by common factors and signalling pathways. The present study adds new and important data in this field and highlights the complex preparation of the endometrium for implantation at the molecular level.

Effects of chronic treatment with valproate and oxcarbazepine on ovarian folliculogenesis in rats

Purpose: We aimed to define the morphologic effects of valproate (VPA) and oxcarbazepine (OXC) on ovarian folliculogenesis in rats.

Antioxidant enzyme activities and lipid peroxidation in preeclampsia

Oxidative stress and uncontrolled lipid peroxidation are considered to be key events in preeclampsia. The aim of this study was to elucidate the relation between superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT) and xanthine oxidase (XO) enzyme activities and levels of thiobarbituric acid reactive substance (TBARS) parameters that were measured in maternal plasma, umbilical cord plasma and placental tissues of patients with preeclampsia and those having a healthy pregnancy [1]. Human placental tissues, fasting maternal blood and cord blood were obtained from 13 patients with preeclampsia and 13 healthy pregnant women at Gazi University Medical School Department of Obstetrics and Gynecology. Some characteristics of the subjects studied are summarized in Table 1. Results are illustrated in the Table 2. SOD activities and TBARS levels increased while GSH-Px activities decreased in maternal blood and GSH-Px and CAT activities decreased. However, TBARS levels increased in cord blood of preeclamptic cases when compared with the healthy pregnancies. Moreover, SOD and CAT enzyme activities decreased while GSH-Px activities increased in preeclamptic placentae. Also, maternal plasma, umbilical cord plasma and placental tissue XO activities increased in preeclamptic cases. Reduced uteroplacental flow in preeclampsia leads to placental hypoxia and oxidative stress. SOD, GSH-Px and CAT are antioxidant enzymes responsible for the defense against oxidative tissue damage [2]. In this study, SOD levels showed a decline in placentae of preeclamptic women. Our results are consistent with the literature as GSH-Px is concerned. In the study mentioned, CAT levels decreased both in maternal, cord plasma and placental tissues of preeclamptic patients when compared with the healthy pregnancy control group. This might result from elevated free radicals suppressing GSH-Px and CAT activities in patients with preeclampsia. XO is an integral mediator of reactive oxygen species generation. XO increases in maternal, cord plasma and placental

Gonadotropin-releasing hormone analog combined with a low-dose oral contraceptive to treat heavy menstrual bleeding

To compare the effects of low‐dose oral contraceptives used alone and in combination with a gonadotropin‐releasing hormone (GnRH) analog to treat heavy menstrual bleeding.

Urogenital symptoms of postmenopausal women in Turkey.

Objective: The objective of this study was to collect data on the prevalence and risk factors of urogenital symptoms in postmenopausal women in Turkey. Design: The study was performed with the participation of 510 postmenopausal women who presented to previously defined clinics for reasons other than urogenital complaints. Women completed a questionnaire including questions about their demographic properties and their urogenital symptoms. Data were analyzed by SPSS 10.0. The chi-square test was the statistical test of choice. Results: The mean age of participants was 58.64 ± 8.14 years. The mean age of menopause was 47.21 ± 4.36 years. Urinary frequency was found to be the most common postmenopausal urogenital symptom (16.5%), followed by stress incontinence (10.4%), dyspareunia (10%), and vaginal dryness (9.6%). Risk factors investigated were found not to affect the prevalence of the vaginal symptoms in postmenopausal women. Dysuria was found to be more common in women with diabetes mellitus (P = 0.022) and in women who had given birth to more children (P = 0.018). Stress incontinence was more common in those 60 years of age or older (P = 0.03), in those who had been in the postmenopausal period for more than 20 years (P = 0.01), and in those who had more than three pregnancies (P = 0.047) or who had given birth to more than three children (P = 0.011). Diabetes mellitus (P = 0.001) and use of hormone therapy (P = 0.001) significantly increased the prevalence of urinary frequency. Conclusions: Urogenital symptoms observed in our population were found to be fewer than reported previously. Symptoms that appear in the postmenopausal period may be related to several factors such as age, number of births, time elapsed since menopause, presence of diabetes mellitus, and use of hormone therapy, but this topic requires further study.