Yavuz Emre Sukur

Ovarian aging and premature ovarian failure

Physiological reproductive aging occurs as a result of a decrease in the number and quality of oocytes in ovarian cortex follicles. Although the reason for the decrease in the quality of the pool and follicular oocytes is not fully understood, endocrine, paracrine, genetic, and metabolic factors are thought to be effective. Nowadays, in order to understand the mechanisms of ovarian aging, genomic research has gained importance. The effect of co-factors, such as telomerase and ceramide, in the ovarian aging process is only getting ascertained with new research studies. The most important tests in the assessment of ovarian aging are antral follicle count and anti-Mullerian hormone.

Preoperative 18F-Fluorodeoxyglucose Positron Emission Tomography/CT in Prediction of Uterine Risk Factors and Lymph Node Metastasis: An Analysis of 111 Endometrioid Endometrial Cancer Patients

Introduction: This study evaluated the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT (PET/CT) in the detection of lymph node metastases and the association between uterine maximum standardized uptake values (SUVmax) and the histopathological features in endometrial cancer patients. Materials and Methods: Patients with endometrioid endometrial cancer underwent preoperative 18F-FDG PET/CT imaging and were staged surgically. 18F-FDG PET/CT findings were compared with final pathology reports. Grade 3 histology or grade 2 histology with myometrial invasion ≥50% was established as a high risk feature. Results: One hundred and eleven patients were analysed. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of 18F-FDG PET/CT in the detection of lymph node metastasis in all patients (n = 111) were 67, 96, 93, 60 and 97%, respectively. In the high-risk group, sensitivity, specificity, accuracy, PPV and NPV of 18F-FDG PET/CT were 75, 92, 91, 60 and 96%, respectively. Uterine SUVmax was found to be associated with myometrial invasion, grade and cervical stromal involvement. Conclusions:18F-FDG PET/CT has limited sensitivity and accuracy in detecting lymph node metastasis. Therefore, as of now, it is not accepted as a modality that can replace lymphadenectomy. SUVmax values can predict high-risk factors.

Signet-ring stromal tumor of the ovary: an extremely rare neoplasm.

Signet-ring stromal tumor (SRST) of the ovary is an extremely rare neoplasm. Herein, we present a SRST of the ovary, which is the twelfth report in the literature. A 44 year-old, G4P2 patient was admitted with the complaint of polymenorrhea. She was operated on for persistent semisolid ovarian mass measuring 5 cm in diameter. The pathological examination confirmed the diagnosis of a benign ovarian SRST. In conclusion, SRST is an extremely rare benign ovarian tumor with good prognosis according to the current literature. Although the recurrence rate or malignant transformation potential of these tumors are not yet known, close follow-up in the post-operative period may be beneficial.

Metformin for the prevention of hypertensive disorders of pregnancy in women with gestational diabetes and obesity: a systematic review and meta‐analysis

Metformin has been reported to reduce the risk of pre‐eclampsia. It is also known to influence soluble fms‐like tyrosine kinase‐1 level, which correlates significantly with the gestational age at onset and severity of pre‐eclampsia. The main aim of this systematic review and meta‐analysis of randomized trials was to determine whether metformin use is associated with the incidence of hypertensive disorders of pregnancy (HDP).

Comparison of intracytoplasmic sperm injection with testicular spermatozoa success in infertile men with obstructive and non-obstructive azoospermia; a retrospective analysis

Abstract The aim of this study was to compare the outcome of intracytoplasmic sperm injection (ICSI) and embryo transfer between couples with infertility due to male non-obstructive azoospermia (NOA) and obstructive azoospermia (OA). A retrospective analysis of 234 couples with azoospermia who were treated by ICSI and embryo transfer between January 2007 and October 2010 was performed. There were 61 couples in NOA group and 173 couples in OA group. Fertilization rates, pregnancy and clinical pregnancy rates were the main outcome measures. The number of retrieved mature oocytes, injected oocytes, metaphase II (MII) oocytes, two distinct pronuclei oocytes, cleavage embryos and embryos transferred was not significantly different between the groups. The fertilization rate was significantly lower in NOA group when compared to OA group (56.2 vs. 66.7%, respectively; p = 0.013) and the pregnancy rate was significantly lower in NOA group than OA group (36.1 vs. 50.9%, respectively; p = 0.046). The clinical pregnancy rates were not statistically different between the patients with NOA and OA azoospermia groups (24.6 vs. 36.4%, respectively; p = 0.09). This study suggests that ICSI and embryo transfer together with testicular sperm extraction results in statistically significant lower fertilization and pregnancy rates in men with NOA when compared to men with OA.

Extraperitoneal leiomyoma of the round ligament of the uterus mimicking adnexal mass

Leiomyomas of the round ligament of the uterus are very rare tumours and they can be present as inguinal, pelvic or vulvar masses (L€ osch et al. 1999). These tumours are more common in the extraperitoneal portion of the ligament, and on the right side including inguinal and vulvar locations (Ali et al. 2012). They occur mostly in premenopausal middleaged women. While most of the cases are asymptomatic some of them might increase in size constantly and become palpable in abdominal or inguinal region. Herein, we report a case of leiomyoma of the left round ligament localised in deep inguinal ring and bulging into the pelvic cavity and mimics adnexal mass.

Predictors of spontaneous reduction in multiple pregnancies conceived following assisted reproductive technology.

OBJECTIVE To identify patient and cycle parameters that relate to spontaneous reduction in multiple pregnancies following in vitro fertilization (IVF) and embryo transfer (ET). STUDY DESIGN A retrospective cohort study was conducted in an academic infertility center. All IVF cycles between January 2007 and June 2008 were evaluated and 69 infertile women were diagnosed with multiple gestation following IVF. Multiple pregnancy was diagnosed by transvaginal sonography at 6-7 weeks gestation following embryo transfer (ET). Repeat ultrasonography undertaken in late first trimester assessed ongoing multiple pregnancy versus occurrence of spontaneous reduction. Patient and IVF cycle parameters were compared between patients experiencing spontaneous reduction (n=26, cases) compared to those where the multiple pregnancy proceeded uneventfully (n=43, controls). RESULTS Spontaneous reduction (SR) was observed in almost 38% of the studied multiple gestations (n=69). Women experiencing SR were significantly older (p=.047), of a leaner body mass (p=.049), and exhibited significantly higher serum estradiol (E(2)) levels in the early follicular phase (p=.016) compared to the controls. Endometrial thickness (EMT) on the day of hCG administration related inversely (p=.017), whereas the number of embryos transferred (ET) related positively with the likelihood of SR (p=.027). On multivariate analyses, EMT and the number of ET were identified as independent predictors of SR following IVF-ET; EMT of less than 10mm was associated with a fourfold increased likelihood of SR (OR 4.18; 95% CI 1.02-17.01) whereas each additional embryo transferred doubled the risk of SR in multiple pregnancies resulting from IVF (OR 2.39; CI 1.02-5.58). CONCLUSIONS In multiple pregnancies conceived following IVF, occurrence of SR is relatively common. Increasing number of ET and EMT measuring <10mm are identified as independent predictors of likelihood of SR. While advancing age, body mass and baseline E(2) levels were associated with likelihood of SR, these associations disappeared on adjusted analyses. The observed relationship between EMT and SR is novel: the underlying mechanisms are unclear and merit further investigation.

Partial monosomy 13 presenting with increased placental thickness and elevated maternal serum alpha-fetoprotein.

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