Yunus Aydin

Effectiveness of Vaginal Misoprostol and Rectal Nonsteroidal Anti-Inflammatory Drug in Vaginoscopic Diagnostic Outpatient Hysteroscopy in Primarily Infertile Women: Double-Blind, Randomized, Controlled Trial

STUDY OBJECTIVE To assess whether vaginally administered misoprostol or rectally administered nonsteroidal anti-inflammatory drug reduces pain during vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile patients. DESIGN Double-blinded, randomized, controlled trial (Canadian Task Force classification I). SETTING Department of reproductive medicine at a university teaching hospital. PATIENTS One hundred fifty-eight primarily infertile women who underwent outpatient hysteroscopy for evaluation of infertility. INTERVENTIONS Patients were randomly assigned to 3 groups. Women in group 1 received 200 μg misoprostol vaginally at 6 hours before outpatient hysteroscopy and placebo tablets rectally at 60 minutes before the procedure. Women in group 2 received placebo tablets rectally at 6 hours before outpatient hysteroscopy and 100 mg diclofenac sodium rectally at 60 minutes before the procedure. Women in group 3 received placebo tablets vaginally at 6 hours before outpatient hysteroscopy and placebo tablets rectally at 45 to 60 minutes before the procedure. Patients were asked to record severity of pain, which was the primary outcome of the study, during the outpatient hysteroscopy procedure by using a visual analog scale ranging from 1 (very favorable) to 10 (very unfavorable). Secondary outcomes included procedural time from introduction of the hysteroscope through the external cervical os and visualization of the uterine cavity, patient acceptance recorded by the patient using a 5-point Likert scale, post-procedural analgesic requirements, and vasovagal effects. MEASUREMENTS AND MAIN RESULTS Median (range) pain scores for the women in group 1 (4.75 [3.12-6.54]) and group 2 (5.01 [2.8-7.05]) were not significantly different from those in group 3 (4.15 [2.17-6.92]) (p = .57). There was also no significant difference in patient acceptance (Likert scale) (p = .67), vasovagal symptoms (p = .84), procedure time (p = .05), and post-procedural analgesic requirement (p = .71). CONCLUSIONS We were unable to demonstrate a benefit in pain reduction and patient acceptance with the use of vaginal misoprostol or rectal NSAIDs during vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile women without a history of cervical stenosis. Trials investigating the optimal time for vaginal misoprostol premedication for pain relief in vaginoscopic outpatient hysteroscopy are needed. New interventions and/or drugs should be studied to decrease pain perception during vaginoscopic outpatient hysteroscopy.

Relationship between oxidative stress and clinical pregnancy in assisted reproductive technology treatment cycles

PurposeTo examine the relationship between serum total oxidant (TOS) and antioxidant (TAS) levels and clinical pregnancy in assisted reproductive technology (ART) cycles.MethodsPrior to and after oocyte pick-up (OPU) and embryo transfer (ET), blood samples were collected from gynecologically normal females (n = 70) who were enrolled for ART solely due to male factor infertility. TAS, TOS levels and oxidative stress indexes (OSI: TOS/TAS) in four phases of treatment cycle (pre and post OPU and ET) between clinically pregnant and non-pregnant patients were compared. Critical cut-off values of significantly different TAS, TOS levels and OSIes for clinical pregnancy were established.ResultsThe TAS levels in patients with clinical pregnancy were significantly higher in all of the four phases of the cycle. Post-OPU and pre-ET TOS levels were significantly higher in clinically pregnant patients. According to OSIes; only the pre-OPU OSI was significantly lower in clinically pregnant patients compared with non-pregnant ones. Moreover, the highest area under the ROC curve (AUC) from the seven different significant measurements [1) pre-OPU OSI, 2) pre-OPU TAS, 3) post-OPU TAS, 4) pre-ET TAS, 5) post-ET TAS, 6) post-OPU TOS, 7) pre-ET TOS] was related to pre-OPU OSI.ConclusionsIn ART cycles, women with a higher total antioxidant status prior to and after OPU and prior to and after ET have an increased probability of clinical pregnancy. Additionally; OSI before OPU was one of the most important determinants for clinical pregnancy, so the oxidant and antioxidant balance is as important as the antioxidant concentration alone.

A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles.

OBJECTIVE(S) To compare the clinical pregnancy rates between intrauterine insemination (IUI) simultaneously or 34-36 h following hCG injection in gonadotropin-stimulated IUI cycles. STUDY DESIGN Randomized, prospective, controlled, study conducted in a university infertility clinic. Of 923 infertile couples, 220 couples with unexplained infertility or mild male factor infertility were included to the study. Before ovarian stimulation patients were randomized into two groups: IUI at 34-36 h after hCG injection (group I) (n=106) and IUI simultaneously with hCG administration (group II) (n=98). The primary outcome was clinical pregnancy rates. RESULTS There was no significant difference between the groups according to baseline patient and cycle characteristics. Clinical pregnancy rates were 9.4% and 12.2% in group I and group II, respectively (p=0.523). Although group II had better outcomes there was no statistically significant difference in clinical pregnancy rates between the different timing methods: IUI simultaneously with hCG versus IUI at 34-36 h after hCG (odds ratio (OR)=1.35, 95% CI 0.53-3.42). CONCLUSION(S) There is no difference in simultaneous use of hCG injection compared to cycles in which IUI is performed after 34-36 h following hCG injection. Prospective randomized trials with larger sample sizes or meta-analyses are required.

Factors predictive of clinical pregnancy in the first intrauterine insemination cycle of 306 couples with favourable female patient characteristics

Abstract The objective of this study was to evaluate the factors predictive of clinical pregnancy in the first superovulation/intrauterine insemination (SO/IUI) cycle of couples with favourable female characteristics. We analyzed retrospectively the first SO/IUI cycle of 306 infertile couples with mild male factor infertility and unexplained infertility. The women had a favourable prognosis in terms of ovarian reserve. Univariate logistic regression analyses identified body mass index (BMI) [odds ratio (OR) = 0.9, P = 0.014], sperm concentration [OR = 1.007, P = 0.007] and inseminating motile sperm count (IMC) [OR = 1.007, P = 0.032] as significant predictive factors of clinical pregnancy. Multivariate logistic regression analysis identified BMI [OR = 0.87, P = 0.008] and sperm concentration [OR = 1.008, P = 0.011] as significant factors. Pregnant and non-pregnant groups did not differ significantly in terms of the age and smoking status of the woman, duration and type of infertility, length of the stimulation, total gonadotropin dosage or antral follicle count. Of the female characteristics investigated, BMI was the most significant predictive factor of clinical pregnancy in the first SO/IUI cycle of couples with unexplained or mild male factor infertility and favourable female characteristics. In overweight women, weight loss should be advised before starting SO/IUI. Sperm concentration and IMC were significant male predictive factors for clinical pregnancy in the first SO/IUI.

What is the Risk of Metabolic Syndrome in Adolescents with Normal BMI who have Polycystic Ovary Syndrome

OBJECTIVE The purpose of this study is to evaluate the effect of polycystic ovarian syndrome (PCOS) on the prevalence of metabolic syndrome (MBS) in adolescent girls with normal BMI. MATERIALS AND METHODS Our study group consisted of 63 pubertal girls with a BMI less than 25 kg/m(2) who were referred to our center with signs of hirsutism or oligomenorrhea. The diagnosis of PCOS was based on the recent ESHRE/ASRM proposal and required that all 3 of the Rotterdam criteria for diagnosing PCOS in adolescents be met. The control group consisted of 159 pubertal girls matched for age and BMI. Glucose, insulin, testosterone, and sex hormone-binding globulin, free testosterone and all lipid parameters measured. For to diagnose the cases with MBS, modified Cook criteria were used and cases who had at least 3 of 5 criterias were diagnosed as MBS. RESULTS Girls with PCOS had higher blood pressure parameters (systolic/diastolic) (P < .01), fasting insulin (P = .007), low-density lipoprotein (P = .017), triglyceride (P = .045), total (P < .001) and free testosterone (P = .001) levels compared to control group. There were more cases who had at least 1 Cook criterion in girls with PCOS compared to the control group but the difference was not significant. However, there were more cases who had MBS in girls with PCOS compared to the control group (P = .02). CONCLUSION MBS prevalence is higher in normal BMI adolescent girls with PCOS compared to age and BMI matched control group. So as clinicians, we must search for the MBS criterias in girls with PCOS even if they have a normal BMI.

Vaginal Misoprostol versus a Rectal Nonsteroidal Anti-Inflammatory Drug to Reduce Pain during Pipelle Endometrial Biopsies: A Prospective, Randomized, Placebo-Controlled Trial

Background: To evaluate and compare the efficacy of vaginal misoprostol and a rectal nonsteroidal anti-inflammatory drug (NSAID) on pain relief during Pipelle endometrial biopsies in a placebo-controlled randomized study. Methods: One hundred and fifty-one women who had an indication for a Pipelle endometrial biopsy were randomized into three groups as follows: group 1, vaginal misoprostol; group 2, rectal NSAID, and group 3, control. After the procedure, the women were asked to record their pain severity on a visual analog scale. The secondary outcome of the study was patient acceptability, and vasovagal symptoms and analgesic requirements after the procedure were also recorded. Results: There were no statistically significant differences in the demographic characteristics of the patients. The primary study outcome was the comparison of the median visual analog scale pain scores of groups 1 and 2 versus group 3 (controls); no statistically significant differences were found (p = 0.502). In addition, the patient acceptability (Likert scale), vasovagal symptoms and analgesic requirements after the procedure were similar among the groups (p = 0.204, 1 and 0.546, respectively). Conclusion: Our study did not demonstrate a reduction in pain relief during Pipelle endometrial biopsies for patients receiving vaginal misoprostol or a rectal NSAID when compared to patients receiving placebo treatment.

Sonographically Guided Core Biopsy A Minimally Invasive Procedure for Managing Adnexal Masses

We hypothesized that sonographically guided core biopsy is an effective method for the differential diagnosis of adnexal masses and evaluated patients who underwent core biopsies in our gynecologic oncology department.

Comparison of Nonsteroidal Anti-Inflammatory Drugs and Misoprostol for Pain Relief during and after Hysterosalpingography: Prospective, Randomized, Controlled Trial

STUDY OBJECTIVE To assess whether vaginal misoprostol or oral nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain during and 30 minutes after hysterosalpingography (HSG). DESIGN Randomized prospective, controlled, parallel-group study (Canadian Task Force classification I). SETTING University teaching hospital. PATIENTS One hundred sixty-eight women with primary infertility who underwent HSG for evaluation of infertility. INTERVENTIONS Patients were randomly assigned to 1 of 3 groups. Group 1 received 200 μg misoprostol vaginally 6 hours before HSG; group 2, 50 mg diclofenac potassium orally 45 to 60 minutes before HSG; and group 3, no medication. The primary outcome of the study was to evaluate the severity of pain during and 30 minutes after the procedure using a visual analog scale (VAS) ranging from 1 (very favorable) to 10 (very unfavorable). The secondary outcomes were to assess the rate of completion and the vasovagal effects including nausea, vomiting, sweating, weakness, syncope, hypotension, and bradycardia. MEASUREMENTS AND MAIN RESULTS There was no statistically significant difference in the median (25%-75%) VAS pain scores between women administered vaginal misoprostol (median, 6.7 cm; range, 4.7-9 cm) and the control group (median, 6.7 cm; range, 4.6-8.8 cm) during the HSG. However, women in the NSAID group (median, 5.5 cm; range, 3-7.6 cm) reported less pain than did those in the misoprostol group (p = .009) and the control group (p = .03). At 30 minutes after HSG, there was no significant difference in the median VAS pain scores between patients administered NSAIDs (median, 2.3 cm; range, 1.4-4.2) or misoprostol (median, 2.3 cm; range, 1.2-4.4) and the control group (median, 2.2 cm; range, 1.3-4.4). CONCLUSIONS There is no benefit in terms of pain reduction with the use of misoprostol during HSG or at 30 minutes after the procedure. However, NSAIDs are associated with pain relief during the HSG procedure.

The effect of health-promoting lifestyle education on the treatment of unexplained female infertility

OBJECTIVE This study aimed to reveal the 1) awareness, 2) improvements of a health-promoting lifestyle on women with unexplained infertility having at least one of the risk factors that have been indicated to negatively affect fertility (smoking, body mass index lower than 18.5kg/m2 and more than 25kg/m2, over-exercising or not exercising at all, alcohol consumption, caffeine consumption of more than 300mg/day, and high levels of stress) by means of health-promoting lifestyle education, 3) the effect of this improvement on the result of assisted-reproduction treatment in terms of clinical pregnancy. STUDY DESIGN 64 women diagnosed with unexplained infertility were divided into a group receiving Health-Promoting Lifestyle (HPL) education and a control group. 1) Risk Factors Questionnaire (BMI, Smoking, Alcohol, Stress, Exercise, Caffeine), 2) Depression, Anxiety and Stress Scale, 3) Health-Promoting Lifestyle Profile II. The health promoting lifestyle was given to the education group. The Risk Factors Questionnaire; Depression, Anxiety, Stress Scale and Healthcare-Promoting Lifestyle Profile II were also administered after the first-second-third month of education but before ART treatment. RESULTS A statistically significant decrease was found in the average levels of four variables as; BMI (p<0.001)-stress (p<0.001)-caffeine consumption (p<0.001)-lower exercise levels (p<0.001). Moreover, the total number of risk factors that females had between the first and third interview decreased significantly. Clinical pregnancy rate after ART was 12 (46.1%) and 5 (19.2%) in education and control group consequently (p=0.02). CONCLUSION Health-promoting lifestyle education was found to be effective in reducing the lifestyle risk factors for infertility and increasing the success rates of assisted reproduction treatment by correcting these risk factors.

The role of perivitelline space abnormalities of oocytes in the developmental potential of embryos

OBJECTIVE In assisted reproductive technology (ART), high embryo quality is closely related to high-quality oocytes. Cytoplasmic maturation and extracytoplasmic maturation are the most important components in determining oocyte quality. One of the most important components of extracytoplasmic maturation is perivitelline abnormalities. The aim of this study is to determine the effect of perivitelline abnormalities on the development of high-quality embryos. MATERIAL AND METHODS The study material consisted of 217 of 1154 oocytes from 98 intracytoplasmic sperm injection (ICSI) cycles undertaken due to male factor infertility. Only cycles with long gonadotropin-releasing hormone analogs combined with recombinant Follicle-stimulating hormone (rec-FSH) were included in study. We compared 105 metaphase-II oocytes that had dominantly perivitelline space abnormalities (large perivitelline space with or without granules) with 112 normal metaphase-II oocytes, based on the embryo grade determined by Alpha Scientists in Reproductive Medicine and the European Society of Human Reproduction and Embryology (ESHRE) Special Interest Group of Embryology. Normal metaphase-II oocytes were characterized by a round, clear zona pellucida; a small perivitelline space containing a single unfragmented first polar body; and a pale, moderately granular cytoplasm with no inclusions. RESULTS The development rates of Grade I, II, and III embryos were 68.5%, 23.8%, and 7.7%, respectively, in the 105 oocytes with perivitelline abnormalities. The development rates of Grade I, II, and III embryos were 82.1%, 17.9%, and 0%, respectively, in the 112 morphologically normal oocytes. When compared with normal oocytes, Grade I (68.5% vs. 82.1%, p value; 0.019) and Grade III (7.7% vs. 0%, p value; 0.003) embryo development rates were significantly lower in oocytes that had perivitelline abnormalities. CONCLUSION It is important to analyze oocyte quality using multiple parameters, including the perivitelline space. Perivitelline space abnormalities might negatively affect embryo development in male factor-infertile couples that are stimulated with rec-FSH. Therefore, when choosing embryos for transfer, we must take into consideration the historical oocyte data.