Do follicular fluid advanced glycation end products levels affect the ovarian response in unexplained infertility?

OBJECTIVE: To compare the advanced glycation end products (AGEs) levels in follicular fluid according to the different ovarian responses of women who underwent controlled ovarian stimulation due to unexplained infertility and to examine the relationship between these levels and pregnancy outcomes. METHODS: Sixty-three women who underwent fresh IVF/ICSI cycles with GNRH antagonist protocol were divided into 3 groups according to the number of retrieved oocytes as suboptimal (4-9 oocytes), optimal (10-15 oocytes) and high (>15 oocytes) responders. AGEs levels in follicular fluid were measured by ELISA method. RESULTS: AGEs levels were 6.81 ± 2.20 µg/ml, 5.30 ± 2.01 and 6.44 ± 1.43 µg/ml in suboptimal, optimal and high response group, respectively. AGEs level was significantly higher in suboptimal response group than in optimal response group. The cutoff level of 6.19 µg/ml had a sensitivity of 59.3% and a specificity of 66.7% in distinguishing the suboptimal response group from the optimal response group. However, there were no statistically significant difference between AGEs levels and clinical pregnancy and live birth rates. CONCLUSION: Increased AGEs level in follicular fluid may be associated with decreased ovarian response during controlled ovarian stimulation in unexplained infertility case, however, it does not provide information about pregnancy outcomes.

Selection of a correct treatment protocol in caesarean scar pregnancies.

OBJECTIVE: This study aims at assessing the effectiveness of various treatment protocols with the help of some parameters in caesarean scar pregnancies. METHODS: A total of 26 patients were assessed in the study. The patients were divided into 4 groups. Group 1 consisted of those who had a wedge resection (n = 7), group 2 those who had a suction curettage (n = 10), group 3 those who had a systemic methotrexate (MTX) (n = 5) and group 4 those who had a systemic + local MTX (n = 4). The ßHcg half-lives, haemoglobin levels at the time of admittance and discharge, and hospital stays of the groups were compared. RESULTS: The difference between group 1 and group 4 was found significant (p = 0.002) with respect to days of hospital stay. There was no statistically significant difference between the groups with respect to ßHcg half-lives and haemoglobin values. CONCLUSION: The results of our study showed that there were no significant differences between treatment outcomes when appropriate protocols were employed. Therefore, the important point in CSPs is to assess correctly the type of CSP, the myometrial thickness and the patient's hemodynamic condition and select the most appropriate protocol accordingly rather than trying to establish a single standard treatment protocol.

Relationship between serum estrogen concentration and propofol consumption: A prospective observational study of patients undergoing oocyte retrieval.

AIM: Controlled ovarian hyperstimulation results in elevated levels of estrogen during in vitro fertilization (IVF). Although serum ovarian steroid hormones were found to influence central nervous system and anesthetic requirements, the relationship between propofol requirements and serum estrogen concentration in women undergoing oocyte retrieval has not been studied. The aim of this study was to determine the relationship between serum estrogen and progesterone concentrations and the required propofol dose for loss of consciousness (LOC). METHODS: Ninety patients undergoing oocyte retrieval for IVF were enrolled. Anesthesia was induced by administration of 200 mL/h propofol (1%) infusion to reach LOC. Anesthesia was maintained with a propofol infusion guided by entropy. The correlation between estrogen, progesterone levels and propofol dose at the time of LOC was analyzed. Emergence time from anesthesia and total propofol consumption were recorded. RESULTS: The mean serum estradiol concentration was 1825 ±1135 pg/mL. There was a significant positive correlation between serum estradiol and propofol dose required for LOC (Pearson's correlation r = 0.28, P = 0.008). Progesterone had no significant correlation with total propofol dose at the time of LOC. Patients with high estradiol levels (higher than the median value) had similar propofol requirement for LOC, total propofol consumption and emergence time with patients who had low (below the median value) levels. CONCLUSION: Although increased estrogen levels create a positive correlation with propofol dose for LOC, estrogen does not seem to be the only factor for anesthetic requirement of patients undergoing controlled ovarian hyperstimulation.

Does the anti-Müllerian hormone truly reflect ovarian response in women with endometrioma?

In this study, our aim was to determine which factor is more correlated with the number of oocytes retrieved in patients with endometrioma compared with controls undergoing in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI) cycles: antral follicle count (AFC) or anti-Müllerian hormone (AMH). A total of 60 women with endometrioma and a control population of 60 women without endometrioma in the same period were randomly selected underwent the injection IVF-ICSI treatment. No significant differences were found between the groups in terms of age (28.78 ± 3.49 vs. 29.52 ± 2.47, p = .187), body mass index (23.62 ± 2.05 vs. 23.91 ± 2.11, p = .449), duration of infertility [(3 (2-4) vs. 3 (2-3), p = .139)], AMH level (1.52 ± 0.51 vs. 1.32 ± 0.92, p = .133), duration of stimulation [(9 (9-10) vs. 10 (9-10), p = .135)], total gonadotropin dose [(2750 (2262.5-3337.5) vs. 2770 (2680-3562.5), p = .125)], endometrial thickness [(10 (10-11) vs. 10 (9-11), p = .463)], fertilisation rates (67.20 ± 18.04 vs. 62.28 ± 17.13, p = .123), grade I embryo (43.3% vs. 30%, p = .185), clinical pregnancy rates (40% vs. 26.7%, p = .123), and the perinatal outcomes between the groups. The AFC was higher in the controls than in those with endometrioma (9.20 ± 1.80 vs. 6.32 ± 2.04, p < .001). The number of oocytes retrieved was also higher in the controls than in those with endometrioma [(7 (6-8) vs. 4 (4-5.75), p < .001)]. We found that women with endometrioma had a significantly lower number of oocytes retrieved than the controls despite the same AMH levels in both groups. AFC is a better marker of ovarian response than AMH in women with endometrioma undergoing IVF-ICSI. Impact statement What is already known on this subject? Utilising the ovarian reserve is important in the success of ovarian stimulation and in evaluating the success of assisted reproductive technologies. The anti-Müllerian hormone (AMH) level and the antral follicle count (AFC) are widely used in the prediction of ovarian functional reserve and response. However, no perfect marker exists in the evaluation of ovarian reserve and ovarian response. What do the results of this study add? Our study demonstrated that women with endometrioma have a significantly lower number of oocytes retrieved than the controls, despite the same AMH levels in both groups; which strongly suggests that AFC is a better reflection of ovarian response than AMH in women with endometrioma undergoing an in vitro fertilisation-intracytoplasmic sperm injection (IVF-ICSI). What are the implications of these findings for clinical practice and/or further research? This important issue has been reviewed and discussed for years, however, the conclusions are still controversial. Additional research is needed to understand which ovarian reserve test could better predict ovarian response outcome?

The relationship between breast density and bone mineral density in never users of postmenopausal hormone therapy.

BACKGROUND: Estrogen is known to affect both mammographic breast density and bone mineral density (BMD), but there are inconsistent results about the association of these density measurements in postmenopausal women. Furthermore, there are scarce data on the relationship between breast density and BMD in never users of postmenopausal hormone therapy. AIM: In this study, we examined the relationship between mammographic breast density and BMD in postmenopausal women who were never hormone replacement therapy users. METHODS: A total of 293 postmenopausal women were enrolled in this cross-sectional study. Mammograms and BMD measurements for screening purposes were obtained. Assessment of mammographic breast density was performed by using breast imaging reporting and data system classification. The BMD was measured using dual-energy X-ray absorptiometry of the lumbar spine and femoral neck. RESULTS: Grade 1 breast density was observed in 64 women (21.8 %), grade 2 in 113 women (38.6 %) and grades 3 and 4 in 116 (39.6 %) women. Breast density decreased with increasing age and body mass index (BMI). Meanwhile, no significant differences were detected in BMD measures of the hip (p = 0.14) and lumbar spine (p = 0.29) among the breast density categories. After adjusting for age and BMI, the differences in the mean BMD at the hip and lumbar spine across the breast density categories remained insignificant (p = 0.26 and 0.11, respectively). CONCLUSION: There is no evidence of a relationship between mammographic breast density and BMD in postmenopausal women who had never used hormone replacement therapy.

Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

OBJECTIVES: The purpose of this study was to determined the predictive value of maternal serum alpha-fetoprotein (MSAFP) as a marker for adverse pregnancy outcomes. MATERIAL AND METHODS: This study was carried out at Dr. Zekai Tahir Burak Women's Health Education and Research Hospital between 2009 and 2010. This study included a total of 1,177 pregnant women, including 170 in the study group and 1,007 in the control group. Pregnancy outcomes and characteristics were analyzed with regard to the MSAFP value. RESULTS: Gestational week, birth weight and APGAR scores were significantly lower in the elevated MSAFP group (p < 0.001). Adverse pregnancy outcomes, such as preterm delivery, preterm premature rupture of membranes (PPROM), oligohydramnios and intrauterine growth restriction (IUGR) rates were increased in the elevated MSAFP group. CONCLUSIONS: Although ultrasound outweighs as a screening method for neural tube defects and non-invasive prenatal testing outweighs for aneuploidy screening MSAFP level in the second trimester is still an important predictor for poor maternal/fetal outcomes.

Effect of luteal phase support with vaginal progesterone in intrauterine insemination cycles with regard to follicular response: a prospective randomized study.

OBJECTIVE: To investigate the effect of luteal phase support with vaginal progesterone on pregnancy rates of the gonadotropin-stimulated intrauterine insemination (IUI) cycles in patients with unexplained infertility with regard tofollicular growth. STUDY DESIGN: A total of 149 patients with unexplained infertility who underwent 166 recombinant follicle stimulated hormone--stimulated IUI cycles were prospectively randomized into 2 groups for luteal phase support. The study group (n = 71) received vaginal progesterone gel supplementation, and the control group (n = 78) received no drug for luteal support. The clinical pregnancy rates and live birth rates per cycle and per patient were compared between the groups. RESULTS: The differences between the groups with regard to clinical pregnancy rates and live birth rates per patient or per cycle were not different among all patients. In cycles with > 1 dominant follicle (multifollicular response), the clinical pregnancy rate per patient was significantly higher in the supported cycles as compared with the unsupported cycles (28.2% vs. 11.4%, respectively, p = 0.04). Reproductive outcomes in cycles with a single dominant follicle (monofollicular response) were not different between supported and unsupported cycles. CONCLUSION: Luteal phase support with vaginal progesterone affects the success of gonadotropin-stimulated IUI cycles with multifollicular response but not with monofollicular response.

Obstetric outcomes of patients with abortus imminens in the first trimester.

PURPOSE: We aimed to find out the effect of abortus imminens (AI) on obstetric outcomes of pregnancies which continued beyond the 24th week of gestation. METHODS: In this prospective study, 309 patients with AI were divided into high-risk group (with a risk factor for spontaneous abortus) (n = 92) and low-risk group (without a risk factor) (n = 217). The control group (n = 308) was chosen randomly. RESULTS: In AI group, preterm delivery, preterm premature rupture of membranes (PPROM), cesarean section (C/S) delivery, postpartum uterine atony and need of a neonatal intensive care unit (NICU) rates were significantly higher than control group. Gestational diabetes mellitus, PPROM, still birth, low APGAR scores were seen more frequently in the high-risk patients than in the control group. Furthermore in the high-risk group, preterm delivery, malpresentation, C/S delivery and need of NICU were increased much more than in the low-risk group. Gestational hypertension/preeclampsia, oligo/polyhydramniosis, intrauterine growth retardation, placenta previa, abruption of placenta, chorioamnionitis, congenital abnormalities, delivery induction, cephalopelvic disproportion, fetal distress and manual removal of placenta were not different among the groups. CONCLUSIONS: Patients with AI history, especially with high-risk factors can have adverse obstetric and neonatal results. So their antenatal follow-up has to be done cautiously for the early signs and symptoms of these complications.

Influence of ultrasound-guided artificial insemination on pregnancy rates: a randomized study.

PURPOSE: To evaluate the influence of ultrasound guidance during intrauterine insemination (IUI) on pregnancy rates (PRs). The impacts of two different groups of providers were also investigated. METHODS: Study population consisted of 387 gonadotropin stimulated IUI cycles performed for unexplained infertility. The patients were randomized into two groups as ultrasound-guided IUI (n = 180) and classical IUI (n = 207). Pregnancy rates were compared. Two groups were further analyzed based on the experience of the provider (senior versus junior subgroups) who performed IUI. RESULTS: Pregnancy rates were higher in the ultrasound-guided IUI group (17.2%) compared to the classical IUI (10.1 %) (p = 0.042). In further analysis based on the experience of the provider; in the classical IUI group, PRs were similar for both subgroups, however, in the ultrasound-guided group it was higher when IUI was performed by a senior physician (21.7 versus 9.2%, p = 0.033). Logistic regression revealed that the experience of the provider was the independent variable for improved PRs. CONCLUSIONS: Ultrasound guidance improves PRs only when a senior provider performs the IUI procedure. It seems that the experience of the provider physician is one of the determinants of IUI success.

The impact of single embryo transfer policy on pregnancy outcomes after legislative change.

We evaluated the effect of mandatory single embryo transfer (SET) on live birth rates and pregnancy outcomes in Turkey. A retrospective study was conducted in Zekai Tahir Burak Women's Health Education and Research Hospital. Four hundred and four patients undergoing intracytoplasmic sperm injection (ICSI) cycles were included in the study. In Turkey, the number of embryos to be transferred in an assisted cycle was limited to three under normal circumstances until 6 March 2010. After that, new legislation was introduced to promote the application of SET. Outcomes were compared in periods of 1 year before and after the new law. We compared pregnancy outcomes of all assisted reproductive cycles in SET cycles (group 1: n = 281) with double embryo transfer (DET) cycles (group 2: n = 123). There were significant differences in oocyte number, multiple pregnancy, gestational age, birth weight and perinatal fetal morbidity between the groups (p = 0.023, 0.001, 0.001, 0.001, 0.001, respectively). But there were no differences in age, baseline FSH, infertility period, stimulation protocol, stimulation day, gonadotrophin dose, clinical pregnancy rate, abortion rate, live birth rate and cesarean rate (p > 0.05). These results suggest that under the new legislation multiple pregnancy rates and perinatal complications are significantly reduced without causing a significant decline in the pregnancy rates.

Is there a detrimental effect of higher gonadotrophin dose on clinical pregnancy rate in normo-responders undergoing ART with long protocol?

BACKGROUND: In recent years, it has become evident that ovarian stimulation, although a central component of in vitro fertilization (IVF), may itself has detrimental effects on oogenesis, embryo quality, endometrial receptivity, and perhaps also perinatal outcomes. OBJECTIVE: To evaluate the effect of higher gonadotrophin dose on clinical pregnancy rate in normo-responder ICSI cycles with long protocol. METHODS: A retrospective study was planned in the Department of Reproductive Endocrinology of Zekai Tahir Burak Women's Health Education and Research Hospital. 362 normo-responders undergoing ICSI cycles with long protocol were included in the study. Group 1 (n = 260): Total gonadotrophin dose <2198 IU and Group 2 (n = 102): Total gonadotrophin dose >2198 IU. Laboratory IVF outcome, clinical pregnancy rate were evaluated. RESULT(S): There was no statistically significant difference between peak estradiol levels, endometrial thickness, fertilization rates among the Group 1 versus Group 2 (p > 0.05). But there was a statistically significant difference in age, baseline FSH, oocyte number, 2PN, and clinical pregnancy among the Group 1 versus Group 2. Clinical pregnancy rate were significantly higher in Group 1 compared with Group 2 (p < 0.001). Lower gonadotrophin dose, 2PN was an independent positive predictor of clinical pregnancy (OR 2.65 for gonadotrophin dose, OR 1.1 for 2PN) CONCLUSION(S): Higher total gonadotrophin dose adversely affect clinical pregnancy in normo-responder patients undergoing ICSI cycles with long protocol.

The Effect of Active and Passive Maternal Smoking During Pregnancy on the Uterine Artery Blood Flow and Obstetric Outcomes: A Prospective Study.

BACKGROUND AND AIM: Maternal smoking is associated with an increased risk of obstetric and neonatal complications during pregnancy. We aimed to investigate the effects of active and passive smoking on fetal-maternal blood flow and fetal complications in mid-trimester pregnant women. METHODS: This prospective study was conducted at Zekai Tahir Burak Women's Research and Training Hospital and included women who were 20 to 22 weeks old, with no fetal anomalies, and with a singleton pregnancy. The data used in the analysis were obtained from a total of 168 pregnant women (50 smokers, 50 passive smokers, and 68 non-smokers). Starting from their 20th week of pregnancy, the women were examined at least once in each trimester. Fetal and maternal pregnancy results were evaluated. Fetal biometry, umbilical, and uterine artery Doppler ultrasonography were performed. To evaluate the flow in these veins, the pulsatility index, resistance index, and systole/diastole (S/D) ratio were performed. RESULTS: The mean age of study patients was 25.06 ± 4.36 years and the mean gestational week was 20.03 ± 0.6 weeks. In terms of the umbilical artery pulsatility index (UMBAPI), umbilical artery systolic/diastolic ratio (UMBAS/D),uterine artery resistance index (UARI), uterine artery pulsatility index (UAPI), and uterine artery systolic/diastolic ratio (UAS/D) levels, the mean value of the smoker group was significantly higher compared to the non-smoker group (p<0.001, p=0.043, p=0.021, p=0.020, and p=0.037, respectively). The birth weight of the fetus was significantly lower in the active and passive smoker groups than in the non-smoker group (p=0.009 and p=0.006, respectively). The number of patients diagnosed with intrauterine growth restriction (IUGR) and oligohydramnios were significantly higher in the smoker group than in the passive smoker and non-smoker groups (p=0.003 and p<0.001, respectively). The risk of low birth weight (OR, (95% CI): 3.38 (2.05 - 5.57); p=0.024), oligohydramnios (OR (95% CI): 13.44 (5.22 - 34.57); p=0.001), IUGR (OR (95% CI): 9.33 (4.50 - 19.33); p=0.001), and preterm birth (OR (95% CI): 4.56 (1.25 - 17.32); p=0.001) increased significantly in the active and passive cigarette exposure groups, compared to the non-smokers. CONCLUSION: During pregnancy, both smoking and passive exposure to cigarette smoke adversely affect the fetus and the newborn. Uterine and umbilical artery Doppler measurements in pregnant women who smoke are significantly higher than the pregnant women who do not smoke.

Early or late response in poor responders: does it make a difference in cycle outcome?

Ovarian response to stimulation mainly determines the length of stimulation. However, there is no clarity in the literature regarding the optimal duration required to achieve oocyte maturity in patients with the poor ovarian response (POR) defined by Bologna criteria. Therefore, a total of 267 cycles that fulfilled the inclusion criteria were selected retrospectively. Group A constitute of patients with a stimulation period < 9 d (n = 70); and group B included patients with a stimulation period ≥ 9 d (n = 133). The results showed that antral follicle count (5.72 ± 1.82 vs. 5.10 ± 1.78, p = 0.023), serum oestradiol level on hCG day (1286.88 ± 778.18 pg/mL vs. 820.14 ± 479.04 pg/mL, p = 0.001), and total gonadotropin dose used (2949.53 ± 727.92 IU vs 2020.94 ± 415.17 IU, p = 0.0001) were higher in group B when compared to group A. Although the number of total (5.47 ± 3.32 vs 3.86 ± 2.15, p = 0.0001) and mature oocytes retrieved (4.34 ± 2.88 vs 2.84 ± 1.67, p = 0.0001) were higher in group B, no significant difference was observed in the pregnancy rates between groups (25.6 vs 15.7%, p > 0.05). In conclusion, no deleterious effect of a shorter duration of stimulation on cycle outcome was seen in patients with POR.

Serum brain natriuretic peptide and C-reactive protein levels in adolescent with polycystic ovary syndrome.

OBJECTIVE: Our primary aim was to investigate whether N-terminal pro-brain natriuretic peptide (NT-proBNP) increases in adolescent with polycystic ovary syndrome (PCOS) compared with healthy controls and secondary aim was to determine whether metabolic and hormonal differences exist between groups. METHODS: In this cross-sectional study, 25 adolescent patients with PCOS and 25 normal ovulatory control not suffering from PCOS were involved in the study. Fasting serum NT-proBNP, C-reactive protein (CRP), homocystein, insulin levels and biochemical and hormonal parameters were measured. RESULTS: Serum NT-proBNP was not significantly different in PCOS subjects (0.62 ± 0.80 vs 1.12 ± 1.51 ng/mL, p = 0.154). The mean serum fasting insulin levels (22.64 ± 10.51 vs 13.32 ± 3.97 mIU/mL, p = 0.001) and Homeostasis Model Assessment Insulin-Resistance Index (HOMA-IR) levels (5.16 ± 1.81 vs 2.97 ± 0.89, p = 0.001) were significantly high in the study group. The median serum CRP levels were not significantly different between groups (1 [1-12] vs 1 [1-19] g/dL, p = 0.286). CONCLUSIONS: The present study demonstrated that the levels of BNP, CRP and homocystein were not different in PCOS subjects. Serum insulin levels and HOMA-IR were significantly higher in PCOS subjects. Possible serum markers for PCOS-related metabolic abnormalities and cardiovascular events, may not present in the adolescent years.

Vitamin E effect on controlled ovarian stimulation of unexplained infertile women.

PURPOSE: To determine Vit E effect on the treatment outcomes of women with unexplained infertility undergoing controlled ovarian stimulation and intrauterine insemination (IUI). METHODS: The study group (Group A, n053) underwent controlled ovarian stimulation with clomiphene citrate with Vit E administration, 400 IU/day p.o. while the control group(Group B, n050) underwent ovulation induction without VitE. Treatment outcomes were compared between the groups. RESULTS: There were no significant differences between the two groups with respect to the demographic outcomes. The difference in endometrial thickness on the day of hCG administration was significant between the two groups (p00.001).The effect of receiving Vit E on the implantation and the on going pregnancy rates were assesed Odds Ratio (OR) and corresponding 95% Confidence Intervals (CI). Receiving Vit E was not significantly associated with the implantation and the ongoing pregnancy rates; OR 0 1.22, 95% CI (0.44­3.4)and OR 0 1.43, 95% CI (0.49­4.1), respectively. CONCLUSION: Vit E administration may improve the endometrial response in unexplained infertile women via the likely antioxidant and the anticoagulant effects. It may also modulate the antiestrogenic effect of clomiphene citrate and the problem of a thin endometrium in these cycles may beadjusted

Endometrial thickness measurement throughout a menstrual cycle in non-obese infertile patients with polycystic ovary syndrome.

PURPOSE: To analyze the changes in the endometrial thickness in infertile polycystic ovary syndrome (PCOS) patients throughout an entire menstrual cycle and compare the changes to those seen in infertile patients without PCOS. METHODS: This prospective, cross-sectional study was conducted in a total of 58 non-obese, infertile women with PCOS. The endometrial thickness was measured at three different times throughout the menstrual cycle by ultrasound. Age- and body mass index (BMI)-matched control group consisted of 62 non-obese infertile patients without PCOS. Demographic, hormonal and the ultrasonographic measurements of the two groups were compared. RESULTS: Day 3 levels of LH were significantly different between the groups (p=0.013). Ovarian volume measurement was significant between the groups (p=0001). All the endometrial thickness measurements in the early, mid-cycle and late luteal phases were also significantly different; p=0.001 for all. CONCLUSION: The study demonstrated an increased endometrial stripe measurements throughout a menstrual cycle in infertile patients with PCOS, when compared to infertile patients without PCOS.

Appropriate interval between endometrial polyp resection and the proceeding IVF start.

PURPOSE: Endometrial polyp is the commenest pathology among the structural uterine abnormalities. In this study we compared the IVF outcomes of patients who underwent hysteroscopic endometrial polyp excision with respect to the time interval between the polyp resection and the subsequent IVF cycle. MATERIALS AND METHODS: A total of 60 patients were divided into two groups according to the time interval between the hysteroscopic polyp resection and the start of the following IVF cycle. Of these, 29 patients had the IVF procedures <6 months after the polyp resection, whereas in 31 patients comprising the comparison group, IVF interventions were done ≥ 6 months after the resection. The IVF outcomes were compared. RESULTS: Differences in the mean number of retrieved oocytes, metaphase II (MII) oocytes and transferred embryos, ratios of MII oocytes, and G1, G2 and G3 embryo rates were insignificant between the groups (p > 0.05). The fertilization, implantation, and clinical pregnancy rates were also similar between the groups (p > 0.05). CONCLUSION: IVF outcomes seem to be unrelated to the time interval between the hysteroscopic polyp resection and the initiation of the IVF; the success rates may not be superior if the treatment is started in the first few months postoperatively.

A reliable way to predict intraabdominal adhesions at repeat cesarean delivery: scar characteristics.

OBJECTIVE: To evaluate association between scar characteristics and intraabdominal adhesions at repeat cesarean delivery. DESIGN: A prospective, cross-sectional study. SETTING: Tertiary Government Maternity Training Hospital in Ankara, Turkey. POPULATION: 295 pregnant women with at least one prior cesarean delivery. METHODS: All women were at least 36 weeks pregnant. Appearance of previous cesarean delivery scars was categorized into three groups - flat, depressed and elevated. Pigmentation status was also noted (non-pigmented or pigmented). MAIN OUTCOME MEASURES: Intraoperatively detected adhesions, evaluated and classified into three groups (no adhesion, filmy adhesion and dense adhesion groups) by a modified Nair's classification. RESULTS: Elevated scars had significantly more dense adhesion formation than depressed ones (31.4 vs. 12.7%, p=0.02). No difference was found for dense adhesions when depressed and flat scars were compared (12.7 vs. 6.8%, p=0.124). Of flat scars, 93.2% were free of dense adhesions. Pigmented scars had more dense adhesions than non-pigmented (26.6 vs. 9.3%, p<0.01). Using logistic regression analysis scar length, scar width and appearance of scar (flat or non-flat) were directly related to adhesion formation. CONCLUSION: There is an association between scar type and adhesions, particularly for hypertrophic scars and dense adhesions.

Live birth rates of low prognosis patients according to POSEIDON criteria; A retrospective cohort study.

OBJECTIVE: The aim of the study was to compare the outcome of assisted reproductive treatment fresh cycles, in patients with low prognosis which were stratified according to the POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) criteria. MATERIALS AND METHODS: This retrospective cohort study including all fresh assisted reproductive treatment cycles age < 44 years, between January and December 2017 was carried out from patient records of Zekai Tahir Burak Women Health Care Education and Research Hospital IVF Clinic. A total of 525 IVF cycles were analyzed and 276 patients fulfilling the POSEIDON criteria for poor ovarian response (POR) were included in the study. RESULTS: Implantation rate, clinical pregnancy rate, and early miscarriage rate were similar in four POSEIDON groups. Live birth rate (LBR) is statistically higher in unexpected POR groups and also significantly higher in POSEIDON group 3 when compared with POSEIDON group 4. CONCLUSION: LBRs are not homogenous in low prognosis patients fulfilling POSEIDON criteria and it seems unexpected POR groups have the most favorable pregnancy outcomes. In unexpected POR groups, age was not a determinant factor in IVF success but in the expected group, age is the most powerful determinant factor.

Treatment of clomiphene citrate-related ovarian cysts in a prospective randomized study. A single center experience.

AIM: The present study aims to compare the effectiveness of placebo, low dose and very low dose oral contraceptives (OC) in the treatment of clomiphene citrate (CC)-related ovarian cysts. METHODS: A prospective randomized placebo controlled study was undertaken at the Infertility Department of Dr. Zekai Tahir Burak Women's Health Education and Research Hospital. A total of 3250 primary infertile patients were administered CC for ovulation induction because of ovulatory dysfunction and/or unexplained infertility. One hundred and eighty-six women who were diagnosed with CC-related ovarian cysts greater than 20 mm on the third day of the following menstrual cycle, were eligible for the study. Group 1 (n = 62) was treated with very low dose OC (100 microg levonorgestrel + 20 microg ethinyl estradiol [EE]), group 2 (n = 62) with low dose OC (150 microg desogestrel + 30 microg EE) and group 3 (n = 62) with a placebo. The first control was 4 weeks later. Women with persistent cysts (n = 57) were called in 4 weeks later to continue the same treatment. RESULTS: Demographic data were similar among the groups. At the first month, the regression rates of ovarian cysts were 64.5, 61.3 and 66.1% in groups 1, 2 and 3, respectively (P = 0.849). Among the 57 women (20, 19 and 18 from groups 1, 2 and 3, respectively) with persistent cysts, the regression rates were 65.0, 63.2 and 55.6%, respectively at the second month (P = 0.821). Persistence of ovarian cysts was significantly higher in women with a longer duration of CC treatment than in women with a shorter duration (P < 0.001). CONCLUSION: Any treatment might be appropriate for patients with a CC-related ovarian cyst. However, there is no evidence to administer OC for treating CC-related ovarian cysts. Expectant management may also achieve similar success rates.