Yılda Arzu Aba

Menstrual cycle characteristics of young females with occult primary ovarian insufficiency at initial diagnosis and one-year follow-up with serum amh level and antral follicle count

Occult primary ovarian insufficiency (also known as incipient ovarian failure or diminished ovarian reserve) is defined as serum AMH level ≤1.1ng/mL in women under age 30. Limited data is available regarding the prevalence of occult POI, the preceding menstrual characteristics and its natural course in otherwise healthy young females. We aimed in this prospective observational study to determine the prevalence of occult POI in young females (< age 30) screened with serum AMH measurement; and analyze the patterns of change in their menstruation at initial assessment and one-year follow-up in relation to the changes in ovarian reserve quantitatively assessed with AMH and AFC. 963 young female college students under age 30 voluntarily participated in this study. 43 of them (4.4%) were diagnosed with occult POI as their AMH levels were ≤ 1.1ng/mL. Thirty-eight (83.4%) of them have regular cycles and denied any menstrual irregularity in the last 12 months. This rate was not statistically different from 7.3% of those with AMH>1.1ng/mL who reported at least one abnormal menstrual cycle in the last year (p = 0.36). Cycle length was significantly shorter in females with AMH ≤ 1.1ng/mL compared to those with AMH>1.1ng/mL (25.1±3.2 vs. 31.2±2.8 respectively, p<0.001). Karyotype, FMR-1 mutation analyses and auto-antibody screening returned normal in all. At one-year follow-up AMH, AFC and mean cycle length were further reduced compared to their values at initial assessment. Now, a greater proportion of the participants with occult POI were menstruating regularly at every 21 days compared to the initial evaluation one year ago (39.5% vs. 13.9% respectively, p = 0.013). Twenty-five underwent oocyte cryopreservation. These findings underscore the importance of screening young females with AMH for possible occult POI. It also emphasizes that young females with critically diminished ovarian reserve may continue to menstruate regularly without any characteristic menstrual abnormality other than shortening of cycle length.

EFFECTIVENESS OF UMBILICAL ARTERY DOPPLER EXAMINATION, CARDIOTOCOGRAPHY AND AMNIOTIC FLUID INDEX APPLIED IN EARLY INTRAPARTUM PERIOD IN DIAGNOSIS OF FETAL DISTRESS

The present study aims to find an alternative solution to continuous monitoring with Cardiotocography (CTG) during intrapartum management process of pregnant women with no previous antenatal follow-up, and to diagnose low-risk pregnancies and avoid the financial burden and discomfort to the pregnant woman resulting from continuous monitoring. Randomly selected 114 term pregnant women with expected vaginal delivery, singleton pregnancies and no major fetal abnormalities were included in the study. Routine obstetric ultrasonography (USG) and uterine artery (UA) doppler measurements were administered. The pregnant women included in the study had an average gestation period of 38.3 ± 1.3, average age of 26.1 ± 5.3, average parity of 2.1 ± 1.5 and average infant birth weight of 3280 ± 442 g. 13 pregnant women were considered to have fetal distress following continuous monitoring with cardiotocography. Furthermore, decreased amniotic fluid index was detected in 9 of them. 10 cases were assessed to be pathological as a result of Uterine Artery Doppler examination. In two cases deemed pathological, fetal distress developed and found to be statistically insignificant. No statistically significant difference was found between decreased amniotic fluid index cases and non-decreased amniotic fluid index cases in terms of C-section application due to fetal distress. In our study, Cardiotocography + Amniotic Fluid Index measurement was determined to be the most valuable combination as the delivery room admission test.

Effect of music therapy on the anxiety levels and pregnancy rate of women undergoing in vitro fertilization-embryo transfer: A randomized controlled trial

PURPOSE The aim of this study was to determine the effect of music therapy on the anxiety levels and pregnancy rates of women who underwent in vitro fertilization-embryo transfer. METHODS This prospective randomized controlled trial was conducted with 186 infertile women who presented to the In Vitro Fertilization Unit at the American Hospital in Turkey between April 2015 and April 2016. The infertile women who met the inclusion criteria were assigned to the music therapy group or the standard therapy group through block randomization. The study data were collected using the Personal Information Form, and State-Trait Anxiety Inventory. Early treatment success was determined by serum beta human chorionic gonadotrophin levels seven or ten days after the luteal day zero. For the analysis, descriptive statistics, chi-square test, Fishers exact test, independent sample t-test were used. RESULTS After the embryo transfer, the mean state anxiety scores decreased in both groups, and the mean trait anxiety score decreased in the music therapy group; however, the difference was not statistically significant (p>0.05). Clinical pregnancy rates did not differ between the music (48.3%) and standard (46.4%) therapy groups. CONCLUSION After the two sessions of music therapy, state and trait anxiety levels decreased and pregnancy rates increased, but the difference was not significant. Therefore, larger sample sizes and more sessions are needed to evaluate whether music therapy has an effect on clinical outcomes.