Association between overactive bladder and serum nerve growth factor concentrations in women with high-grade uterine prolapse.

INTRODUCTION AND HYPOTHESIS: The association between overactive bladder (OAB) and uterine prolapse remains unclear. The extent of the role of serum nerve growth factor (NGF) levels in this relationship is also not known. Therefore, our study evaluated the association among OAB, high-grade uterine prolapse and serum NGF levels. METHODS: A total of 90 patients participated in our study and were grouped as follows. Group I included patients with high-grade uterine prolapse and OAB, group II included patients with only high-grade uterine prolapse, and group III included healthy women without uterine prolapse or OAB. Serum NGF level analysis was performed in all groups. RESULTS: Serum NGF levels varied greatly among the three groups, with significantly higher levels in group 1 than in groups 2 and 3 (p < 0.001). Serum NGF levels with a cutoff point of 120.49 pg/ml identified women with significant OAB symptoms to discriminate among groups with a sensitivity of 80%, specificity of 86.7%, positive predictive value of 75.0%, negative predictive value of 89.7% and positive likelihood ratio of 6.01 (p < 0.001). CONCLUSIONS: Our study showed that NGF-related pathways may play an active role in the pathophysiology of OAB with high-grade uterine prolapse patients based on obstruction hypothesis.

The impact of cryotherapy for symptomatic cervical ectropion on female sexual function and quality of life.

In rare cases, cervical ectropion causes symptoms such as abundant leucorrhoea, postcoital bleeding, recurrent cervicitis, pelvic pain, and dyspareunia. Cryotherapy is a commonly used treatment for symptomatic cervical ectropion. We assessed the impact of cryotherapy on sexual function and quality of life among patients with symptomatic cervical ectropion. In this prospective observational study, 73 patients were assessed before and six months after cryotherapy treatment using the Female Sexual Function Index (FSFI) and Short Form-12 Health Survey questionnaires. The double-freeze cryotherapy procedure was performed using a cryotherapy unit, and liquid nitrogen was used as a refrigerant. The mean physical and mental quality of life scores were significantly improved after treatment. With the exception of the pain domain, the overall and domain FSFI scores exhibited no significant differences before and after cryotherapy. The sexual pain domain scores were significantly increased after treatment. There was a statistically significant improvement in vaginal discharge, pelvic pain, and postcoital bleeding symptoms after the cryotherapy. We concluded that cryotherapy is an effective and feasible treatment for symptomatic cervical ectropion. Although cryotherapy results in improved quality of life scores, it has no significant impact on female sexual function.Impact statementWhat is already known on this subject? Cryotherapy is the most preferred treatment option for symptomatic cervical ectropion. Its feasibility and effectiveness with respect to symptom relief have been observed in previous studies. No study has evaluated quality of life and sexual function after cryotherapy among patients with symptomatic cervical ectropion.What do the results of this study add? Although the patients' quality of life scores were significantly improved after treatment, no significant improvement was observed in overall and domain sexual function scores, with the exception of the pain domain. The sexual pain domain scores were significantly improved after cryotherapy.What are the implications of these findings for clinical practice and/or further research? Patients should not expect better sexual function after cryotherapy. Comparative studies should seek to identify the ideal treatment option, which would result in both symptom relief and better sexual function.

Comparison of hysterectomy cases performed via conventional laparoscopy or vaginally assisted natural orifice transluminal endoscopic surgery: a paired sample cross-sectional study.

Hysterectomy is one of the most frequent gynaecological procedures performed for various uterine pathologies. There are several approaches for conducting hysterectomies, including abdominal, vaginal, laparoscopic and robotic. Recently, natural orifices transluminal endoscopic surgery (NOTES) has emerged as an alternative approach for conducting hysterectomies. In this study, we aimed to compare the results of total laparoscopic hysterectomy (TLH) and vaginally assisted-NOTES (vNOTES) hysterectomy procedures for the treatment of benign gynaecological diseases. Ninety-nine patients, who underwent conventional TLH or vNOTES hysterectomies, were included in this study. The operation time, presence of per/postoperative complications, visual analogue scale (VAS) scores at postoperative sixth and 24th hours, and the duration of hospital stays were all analysed. The duration of surgery was significantly shorter in the vNOTES hysterectomy group (79.56 ± 32.54 min) compared to the TLH group (120.67 ± 38.35 min) (p: < .001). Also, postoperative hospital stays were significantly shorter in favour of the vNOTES hysterectomy group (44 ± 16.47 h) compared to the TLH group (57.86 ± 21.31 h) (p: .002). These results indicate that vNOTES hysterectomy can be a promising approach for treating a variety of different uterine pathologies and, furthermore, that it can be an alternative to TLH.Impact statementWhat is already known on this subject? A hysterectomy can be done in a variety of different ways, such as abdominal, laparoscopic, vaginal, and robotic. Even though the standard practice guidelines recommend that a vaginal hysterectomy (VH) should be the first choice of treatment, it can be challenging in cases of non-descendent and large uteruses. In such cases, NOTES hysterectomy can be an alternative option.What do the results of this study add? The study has shown that vNOTES is associated with a shorter operation and briefer postoperative hospitalisation time, in comparison to TLH.What are the implications of these findings for clinical practice and/or further research? This study speculates that vNOTES is an approach which may offer better outcomes than a conventional laparoscopy. Further randomised controlled trials with larger sample sizes, however, should be conducted in order to establish the place of vNOTES in hysterectomy surgeries.

Assessment of the retinal and choroidal microvascularization in polycystic ovary syndrome: an optical coherence tomography angiography study.

PURPOSE: To examine the retinal, peripapillary, choroidal microvascularization and the choroid thickness (CT) of the patients with polycystic ovary syndrome (PCOS) using optical coherence tomography angiography (OCT-A) and compare the results to measurements obtained from healthy controls. METHODS: In total, 47 eyes of 47 patients recently diagnosed with PCOS and 47 eyes of 47 age-matched healthy women were included in this study. An RT XR Avanti instrument with AngioVue software was used for the OCT-A imaging using 6 × 6 mm macular and 4.5 × 4.5 mm optic nerve head scans. Quantitative vessel density results of superficial capillary plexus (SCP), deep capillary plexus (DCP) and radial peripapillary capillaries (RPC); flow area and flow density of choriocapillaris; and foveal avascular zone (FAZ) area were analyzed. CT was evaluated by using the measurements obtained from the subfoveolar area. RESULTS: No significant differences were detected between the groups for any of vessel density results for the SCP, DCP, and RPC as well as the FAZ area. The difference in the choriocapillaris flow area and flow density between the groups was not statistically significant. The choroid was significantly thicker in women with PCOS than in the healthy group (p = 0.002). CONCLUSION: Retinal and choroidal microvascularization was comparable between the women who were evaluated early after diagnosed with PCOS and age-matched healthy controls. Choroid was found thicker in patients with PCOS than in healthy women. OCT-A, as a new and noninvasive imaging method, may help in understanding the effect of PCOS on the posterior segment of the eye.

The effect of being diagnosed with human papillomavirus infection on women's sexual lives.

PROBLEM: Objective studies that use validated questionnaires are needed to evaluate the changes in the sexual functions of women diagnosed with human papillomavirus (HPV) infection. METHOD OF STUDY: The study comprised 80 sexually active women diagnosed with a high-risk HPV infection. These patients were divided into four groups as follows: group 1, HPV 16/18-positive and normal cytology; group 2, HPV 16/18-positive and abnormal cytology; group 3, non-16/18 HPV-positive and abnormal cytology; and group 4, non-16/18 HPV-positive and normal cytology. The sexual functions and anxiety statuses of the patients were assessed via the Female Sexual Function Index (FSFI) and Beck anxiety inventory (BAI) questionnaires, respectively, at their first clinical visits and then 2 months later. RESULTS: There was no statistically significant difference among the study groups in terms of the overall FSFI and domain sub-scores at either of the visits. Women who tested positive for the high-risk HPV 16/18 strains had a significantly less sexual desire after being informed about the test results. Those with HPV 16/18 and normal cytology had significantly higher anxiety levels at their second than first visits. The BAI scores of the HPV 16/18-positive women (normal or abnormal cytology) at the second visit were significantly higher than those of non-16/18 HPV-positive women with normal cytology. There was no significant difference between the patients with normal and abnormal cytology results regarding the difference of BAI, overall and domain FSFI sub-scores at the first and second visits. The desire and lubrication domain scores of the HPV 16/18-positive patients significantly decreased after the first visit compared with those of the non-16/18 HPV-positive patients. CONCLUSION: HPV 16/18 positivity decreases women's total FSFI and desire domain sub-scores.

Diagnostic value of preoperative ultrasonography, cervical length measurement, and POP-Q examination in cervical elongation estimation.

INTRODUCTION AND HYPOTHESIS: Cervical elongation (CE) has not been clearly defined and has similar symptoms to pelvic organ prolapse. We aimed to evaluate the diagnostic value of preoperative POP-Q examinations, ultrasonographic measurements, and direct cervical length measurement with a Foley catheter in predicting CE on postoperative hysterectomy specimens. METHODS: Fifty-six patients who underwent vaginal hysterectomy for apical pelvic organ prolapse were included. The patients were divided into two groups based on the hysterectomy specimens' corpus/cervix ratio (CCR) as follows: the non-CE group, CCR > 1; the CE group, CCR < 1. The preoperative direct cervical length measurement was performed using 10-French Foley catheters. The recommended cutoff values and sensitivity/specificity analysis of the cervical measurements with Foley, ultrasound, and C-D measurements according to POP-Q were determined by the receiver-operating characteristic analysis. RESULTS: There were 13 patients (23%) in the non-CE group and 43 patients (76%) in the CE group. The mean cervical measurements with Foley catheter and ultrasound, C-D diameter, and postoperative cervix measurements were 49.4 ± 12.6 mm, 42.14 ± 9.4 mm, 41.4 ± 17.2 mm, and 49.5 ± 13 mm, respectively. Cervical measurement with a Foley catheter had 65% sensitivity and 62.5% specificity with a 47.5-mm cutoff value. Among these preoperative measurements, Foley catheter measurements were the most compatible with postoperative cervical measurements. There was no significant association between CE and age, body mass index, menopause duration, point C, and point D. CONCLUSION: Cervical length measurement with a Foley catheter may be preferred for estimation of CE.

Endocan as a predictor of increased cardiovascular risk during the menopausal transition period.

PURPOSE: Our aim was to investigate the serum endocan levels and carotid artery intima-media thickness (CIMT) measurements of pre- and postmenopausal patients to clarify the relationship between the menopausal transition and endothelial injury. METHODS: This cross-sectional study was conducted on women who were premenopausal and postmenopausal between January 2019 and June 2019. The patients were divided into two groups according to premenopausal (n = 32) and postmenopausal (n = 32) status. Serum endocan levels were assessed by enzyme-linked immunosorbent assay (ELISA). CIMT ultrasonographic measurements were determined. Hormonal and biochemical parameters were measured. The validated Menopause Rating Scale (MRS) questionnaire was used on all women. RESULTS: Serum endocan levels were significantly higher in the postmenopausal group than in the premenopausal group (222.90 ± 121.00 ng/L and 146.62 ± 41.88 ng/L, p = 0.033, respectively). The mean CIMT was significantly higher in the postmenopausal group than in the premenopausal cohort (0.70 ± 0.14 mm and 0.58 ± 0.11 mm, p < 0.001, respectively). A positive correlation was found between body mass index (BMI), systolic blood pressure (SBP), abdominal circumference (AC), and CIMT and postmenopausal serum endocan levels. Serum endocan levels with a cutoff point of 141.14 ng/L identified women with significant CIMT levels with sensitivity of 73.8% and specificity of 77.3%. A positive correlation was found between CIMT and endocan and total MRS scores. CONCLUSION: Serum endocan levels were associated with CIMT during the menopausal transition period. Increased circulating endocan levels can be a predictor of cardiovascular risk in pre- and postmenopausal women.

Effect of metformin and detorsion treatment on serum anti-Müllerian hormonelevels and ovarian histopathology in a rat ovarian torsion model

Background/aim: Adnexal torsion is a common gynaecological emergency, and considered to be a problem mostly in reproductive-age women. To evaluatethe effect of metformin and detorsion treatment on reducing ovarian reserve in an ovarian torsion model. Materials and methods: Twenty-four nonpregnant, Wistar Hannover rats were included in the study. Animals were divided into 3 groups: the control group, the detorsion only group, and the metformin + detorsion group. The first group received only laparotomy. In the second group, ovaries were fixed to the abdominal wall after performing 360° ovarian torsion, followed by detorsion after a 3-h period of ischemia. The third group underwent the same torsion and detorsion procedures as the second group, and received 50 mg/kg metformin by gavage for 14 days. Ovarian damage scores, follicle counts, and AMH levels were evaluated. Results: The total damage score was significantly increased in the detorsion only group compared to the metformin+detorsion and control groups. Pre-operative/post-operative AMH decreases were statistically significant in negative direction in the detorsion only group when compared to the metformin+detorsion and control groups (P = 0.001). Conclusion: Metformin+detorsion treatment may be effective in protecting the ovarian reserve after ovarian torsion.

The effectiveness of neutrophil to lymphocyte ratio in prediction of medical treatment failure for tubo-ovarian abscess.

AIM: We aimed to compare the neutrophil-to-lymphocyte ratio (NLR) in tubo-ovarian abscess (TOA) patients who responded to medical treatment or who underwent surgical intervention due to medical treatment failure. METHODS: The files of the patients, hospitalized in our Obstetrics and Gynecology Department with TOA diagnosis between August 2015 and December 2017, were evaluated retrospectively. The conservative management group was comprised of 38 of the 81 patients (46.9%) who responded to sole medical treatment with the triple antibiotic regimen (gentamicin-clindamycin-ampicillin) and the surgical intervention group was comprised of 43 patients (53.1%) who did not respond to medical treatment and needed further surgery and/or interventional radiologic abscess drainage. Demographic and clinical data, imaging findings, and laboratory results including NLR were compared between two groups. RESULTS: There were statistically significant differences between the groups in terms of age, TOA diameter, white blood cell and neutrophil counts, and NLR levels (P < 0.05). The mean NLR was 7.4 ± 5.8 for the conservative management group and 10.3 ± 5.8 for the surgical intervention group (P = 0.004). The area under the curve (AUC) for NLR was 0.69 (threshold value was ≥6.97, 95% confidence interval, sensitivity 79.1%, specificity 57.9%). On multiple regression analysis, a significant correlation was identified between age, NLR and resistance to the medical treatment. CONCLUSION: Neutrophil-to-lymphocyte ratio and age are significantly higher in patients with medical treatment failure and NLR could be used as a novel marker in addition to white blood cell in the prediction of medical treatment failure in TOA patients.

The relationship between menopausal symptoms and metabolic syndrome in postmenopausal women.

The most common symptoms during menopausal transition and menopause are vasomotor symptoms. We aimed to investigate the relationship between menopausal symptoms and metabolic syndrome (MetS) in postmenopausal women. Two hundred and fifty-four and 317 postmenopausal women were in the MetS and non-MetS groups, respectively. The total menopause rating scale and psychological subscale scores were higher in the MetS group than the non-MetS group, and the differences were significant (p < .05). A positive correlation was found between the abdominal circumferences, systolic-diastolic blood pressures, triglycerides and total MRS scores. However, a significant positive correlation was found between the abdominal circumference and total urogenital scores (p = .008). Impact statement What is already known on this subject? MetS and its dominant component (abdominal obesity) significantly increase the prevalence and severity of menopausal symptoms. Data regarding the relationship between metabolic syndrome (MetS) and vasomotor symptoms remain limited. What do the results of this study add? We showed that sleeping problems, depressive symptoms and bladder problems were more frequently encountered in the MetS group than in the non-MetS group (p<0.05). What are the implications of these findings for clinical practice and/or further research? There is a need for more randomised controlled studies to demonstrate the relationship between MetS and the severity of menopausal symptoms.

Association between Metabolic Syndrome and Serum Nerve Growth Factor Levels in Women with Overactive Bladder.

OBJECTIVE: This study aimed to determine the association between overactive bladder (OAB), metabolic syndrome (MetS) and serum nerve growth factors (NGF). STUDY DESIGN: Serum samples from a group of 90 women that included patients with OAB (group 1), patients with both OAB and MetS (group 2) and healthy women without OAB and MetS (group 3). Each group included 30 patients. Serum levels of NGF were compared among the groups. RESULTS: When the groups were compared with respect to NGF levels, group 2 was found to have significantly higher NGF levels (p = 0.001). A NGF threshold of >380 ng/mL had a sensitivity of 81.7% and a specificity of 100% to discriminate between groups 2 and 3. CONCLUSION: Our findings support the theory that possible sympathetic overactivity, proinflammatory status, oxidative stress and other pathological conditions associated with MetS and potentially involved in the development of OAB lead to increased serum NGF levels. These findings may help to shed light on the complicated pathogenesis of OAB.

Hormonal effect on the relationship between migraine and female sexual dysfunction.

It is not a well-established finding in migraine that female sexual dysfunction (FSD) emerging as a natural course of disease, as a result of accompanying depression/anxiety, or an underlying endocrinological abnormality. Our aim is evaluating the relationship among frequency and severity of migraine, FSD, depression, anxiety, and related hormones in migrainous women. We examined 80 migrainous female and 62 controls cross sectionally. Beck Depression and Anxiety Inventories, Female Sexual Dysfunction Inventory, Migraine Disability Assessment Test, and hormonal analysis were done. Independent risk factors were identified by logistic regression analysis and cut-off values were measured with Receiver Operating Curve. FSD was not related to frequency or severity of migraine. Although depression and anxiety was related to arousal and lubrication, they had limited effect in FSD. There were correlations between prolactin (PRL), desire and lubrication, follicular-stimulating hormone FSH and orgasm, luteinizing hormone (LH), and pain. Also FSH-LH combination and PRL were found as independent factors for FSD. FSH-LH combination and PRL were found as independent factors which had effect on FSD in migraine. Our study is a precursor study about the effect of several hormones on FSD and migraine relationship. Hormonal effect on FSD in migraine will be clearer with future studies.

Intramuscular versus intravenous prophylactic oxytocin for postpartum hemorrhage after vaginal delivery: a randomized controlled study.

PURPOSE: Prevention of postpartum haemorrhage (PPH) is essential in the pursuit of improved health care for women. Oxytocin, the most commonly used uterotonic agent to prevent PPH, has no established the route of administration. In this study we aimed to compare whether the mode of oxytocin administration, i.e., intravenous and intramuscular administration, has an effect on the potential benefits and side effects. MATERIALS AND METHODS: A total of 256 women were randomised into two groups: intramuscular group (128) or intravenous group (128). RESULTS: Estimated blood loss during the third stage of labour was similar between the two groups (p = 0.572). Further there were no statistically significant difference was noted between the two groups in terms of the mean duration of labor, duration of the third stage of labor, manual removal of the placenta, need for instrumental delivery, need for blood transfusion, PPH ≥500 mL, PPH ≥1000 mL, or length of hospital stay. CONCLUSION: Using oxytocin by intravenous and intramuscular route has a similar efficacy and adverse effects.

The relationship between epicardial adipose tissue thickness and oxidative stress parameters in patients with isolated polycystic ovary syndrome.

PURPOSE: The aim of this study is to evaluate the correlation between epicardial adipose tissue thickness and oxidative stress parameters in patients with polycystic ovarian syndrome. METHODS: The study included 35 patients with PCOS and 35 healthy women. Transthoracic echocardiography was used to measure the epicardial adipose tissue thickness (EATT) of all patients. For all patients, serum TOS, TAS, hs-CRP, and insulin levels were measured according to the literature, and the HOMA-IR values were calculated. Independent samples t-test, Pearson's correlation analysis, multivariate logistic regression analysis, and receiver operator characteristic curve (ROC) analysis were used in the statistical analysis. RESULTS: Between the patient group and the control group, EATT was significantly higher in the PCOS group compared to the control group (5.4 ± 1.4 mm and 3.9 ± 1.6 mm, respectively; p < 0.001). Similarly, TOS, TAS, and hs-CRP levels were significantly higher in the PCOS group compared to the control group (p < 0.01 for all). The correlation analysis showed a significant positive correlation between EATT and TAS and hs-CRP (r = 0.349, p < 0.01 and r = 0.352, p < 0.01, respectively). Multivariate regression analysis showed a significant correlation between PCOS and EATT, TAS, and diastolic blood pressure (p < 0.05 for all). CONCLUSIONS: Epicardial adipose tissue may play a major role in PCOS pathogenesis by leading to an increase in oxidative stress.

Plasma serotonin levels are elevated in pregnant women with hyperemesis gravidarum.

PURPOSE: This study aimed to determine the association between serotonin and hyperemesis gravidarum. MATERIALS AND METHODS: Plasma samples of 87 women in their first trimester pregnancies with HG (n = 28), morning sickness of pregnancy (n = 30) and control (n = 29) groups were obtained. Plasma levels of serotonin were compared between the groups, and the correlations with severity of symptoms using modified PUQE (Pregnancy Unique Quantification of Emesis) scoring, BMI, E2, hCG and TSH were calculated. RESULTS: When the groups were compared with respect to serotonin levels, the group with hyperemesis gravidarum was found to have significantly higher serotonin levels (p = 0.001). A significant positive correlation was found between the serotonin level and the PUQE score in all study subjects (r = 0.578, p = 0.0001). A serotonin threshold of >277.58 ng/mL had a sensitivity of 75%, specificity of 86.4%, positive predictive value of 72.4%, negative predictive value of 87.9%, and a likelihood ratio of 5.53 (p = 0.0001). CONCLUSIONS: Our findings support the possible role of serotonin in the pathogenesis of hyperemesis gravidarum.

Agreement between colposcopy results using the Reid Colposcopic Index and histopathology.

OBJECTIVES: The aim of the study was to evaluate the diagnostic efficacy of colposcopy and to determine the strength of correlation between colposcopic impression using the Reid Colposcopic Index (RCI) and histopathology MATERIAL AND METHODS: This was a prospective cross-sectional study carried out at the colposcopy clinic of Bakirköy Dr Sadi Konuk Education and Research Hospital, Department of Obstetrics and Gynecology, between June 2011 and September 2011. A total of 105 women who met the selection criteria were included in the study. All women underwent colposcopy and the final diagnosis was made using RCI. Colposcopy-guided biopsy was obtained from the abnormal areas. In cases when colposcopy did not reveal any lesion, a four-quadrant biopsy from the squamocolumnar junction was taken, which served as the gold standard. RESULTS: According to the Reid scoring system, there were 60% of benign cases, whereas 27.6%, 5.7%, and 6.7% of the women were diagnosed with CIN 1, CIN 2, CIN 3, respectively As far as histologic results were concerned, 62.9% of the subjects were benign, whereas 25.7%, 3.8%, and 7.6% of the patients were diagnosed with CIN 1, CIN 2, CIN 3, respectively. The correlation between the Reid scoring system and histologic results was statistically significant (p > 0.05). CONCLUSIONS: The correlation between colposcopic lesions graded with RCI and histology was strong, particularly in women who had HGSIL on a Pap smear. Good correlation between colposcopic imaging using RCI and histopathology makes it a reproducible technique, easy to implement in colposcopy clinics.

Genitourinary symptoms and their effects on quality of life in women with uterine myomas.

INTRODUCTION AND HYPOTHESIS: This study was designed to determine the presence of genitourinary symptoms and their effects on quality of life (QOL) in women with uterine myomas. METHODS: A total of 145 women with ultrasonography (US) diagnosis of anterior myoma were divided into two groups according to myoma size: (1) those ≤5 cm (n = 75), and (2) those >5 cm (n = 70). The control group comprised previously matched 94 women with a normal-appearing uterus on US. Study participants answered the Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Pelvic examination was performed, and urinary symptoms were recorded. The chi-square test and Fischer's exact test were used to compare qualitative data. The Kruskal-Wallis test and Dunn's test were used to compare groups. Statistical significance was set at P <0.05. RESULTS: The frequency of genitourinary symptoms was significantly higher in women with myomas, including stress urinary incontinence (SUI), urgency, frequency, urge urinary incontinence (UUI), and dyspareunia. SUI and mixed urinary incontinence (MUI) were the most common symptoms associated with myoma size. Total UDI-6 scores were significantly higher in women with myomas than in control patients (P < 0.0001). UDI scores associated with UI and obstructive symptoms were higher in women with myomas >5 cm than in other women. IIQ scores regarding physical activity, travel, and emotional health were significantly higher in women with myomas >5 cm than in other women (P < 0.001). CONCLUSIONS: Urinary tract dysfunction is associated with anterior myomas, increasing in association with myoma size, and significantly affects QOL.

Comparison of estradiol and progesterone priming/antagonist/letrozole and microdose flare-up protocols for poor responders undergoing intracytoplasmic sperm injection.

BACKGROUND: To compare the effect of the GnRH antagonist/letrozole/gonadotropin protocol with the microdose GnRH agonist flare-up protocol in poor ovarian responders for intracytoplasmic sperm injection. MATERIALS AND METHODS: One hundred twenty-one consecutive patients suspected of having or with a history of poor ovarian response between January 2009 and June 2010, who were undergoing ICSI were enrolled. The microdose flareup (MF) protocol was used in 79 patients and the estradiol + progesterone/letrozole + gonadotropin and GnRH antagonist (EP/ALG) protocol was used in 42 patients. RESULTS: Age of the patients, duration of infertility, basal FSH, the total gonadotropin consumption, duration of stimulation, E2 level on the day of hCG administration, the number of embryo transferred, the fertilization rate, implantation rate, clinical pregnancy rate and the live birth rate were not statistically different (p > 0.05). Only the number of oocytes retrieved was significantly higher in the EP/LGA group (1.7 ± 0.7 versus 2.6 ± 0.6). CONCLUSION: The EP/LGA protocol has no significant improvement against the microdose flare-up protocol in poor responder patients.

Comparing the efficacy of intrauterine lidocaine and paracervical block in decreasing the pain associated with endometrial biopsy: a randomised trial.

PURPOSE: Almost 50% of the patients experience moderate-to-severe pain during endometrial biopsy. The study aimed to examine the effectiveness of intrauterine lidocaine for relieving pain during endometrial biopsy. METHODS: A randomised trial was conducted in 120 patients undergoing endometrial biopsy. Sixty-seven women were assigned to the paracervical block group and 53 were assigned to the intrauterine lidocaine group. The main outcome measure was pain intensity, measured using the visual analogue scale, during and after the procedure. RESULTS: The groups were similar with regard to age, body mass index, gravidity, total number of previous vaginal deliveries, menopausal status, and uterine depth. The pain scores immediately after the procedure were similar in the groups (p = 0.079). However, the pain scores 30 min after the procedure were significantly lower in the intrauterine group than in the paracervical group (p = 0.0001). CONCLUSIONS: Compared to paracervical block, intrauterine lidocaine may be the preferred anaesthesia for endometrial biopsy, and it does not cause any serious complications.