Association between circulating neuregulin 4 levels and metabolic, aterogenic, and AMH profile of polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a metabolic disorder associated with obesity and energy metabolic system disturbances in adipose tissue. Neuregulin 4 (NRG4), which is secreted by adipose tissue, regulates energy metabolism. In the present study, we aimed to evaluate the association between serum NRG4 levels in obese and normal weight PCOS patients. This cross-sectional study was conducted at a tertiary hospital in Turkey from April to August 2017. We included 148 women who were divided into four groups as follows: 40 normal weight and 39 obese PCOS women diagnosed according to the Rotterdam criteria as well as 38 normal weight and 31 obese, age-matched, non-hyperandrogenemic women with a regular menstrual cycle (controls). Levels of serum NRG4, anti-Müllerian hormone (AMH), fasting blood glucose (FBG), insulin, and high-sensitivity C-reactive protein (hs-CRP); lipid and hormone profiles; insulin resistance indices [homeostasis model assessment of insulin resistance (HOMA-IR)];and anthropometric parameters were evaluated. Serum NRG4 levels were elevated in the normal weight PCOS group than in the control group. Moreover, serum NRG4 levels were higher in the obese PCOS group than in the normal weight PCOS and obese control groups (p < .01). Serum NRG4 levels were positively correlated with body mass index (BMI); waist/hip ratio; HOMA-IR; and levels of triglycerides, hs-CRP, FBG, insulin, AMH, and dehydroepiandrosterone sulphate. Multiple regression analyses revealed that serum NRG4 levels were independently associated with BMI. Obesity appears to be the most influential factor for NRG4 secretion in PCOS patients. Management of obesity may be a key factor for resolving PCOS-related metabolic abnormalities and fertility problems. Impact Sstatement What is already known on this subject? PCOS is a dynamic syndrome with different clinical and metabolic features during the reproductive age. PCOS is associated with various metabolic abnormalities, such as insulin resistance (IR), glucose intolerance, dyslipidemia, and obesity (particularly visceral obesity) as well as long-term complications, such as type 2 diabetes and cardiovascular diseases. Neuregulin 4 (NRG4), which is secreted by adipose tissue, regulates energy metabolism. What do the results of this study add? To the best of our knowledge, this was the first study investigating NRG4 levels in PCOS patients with different BMIs. Obesity appears to be the most influential factor for NRG4 secretion in these patients. Managing obesity may be a key factor for resolving PCOS-related metabolic abnormalities. What are the implications of these findings for clinical practice and/or further research? Further research in PCOS is warranted to ameliorate obesity, and our study can provide basis for future studies investigating NRG4 levels in PCOS patients with different phenotypes as well as studies of gene polymorphisms, AMH, and infertility and can contribute to the elucidation of problems related to the pathophysiology of PCOS.

The impact of autoimmunity-related early ovarian aging on ICSI cycle outcome.

The aim of this study was to investigate the impact of anti-thyroid peroxidase antibodies (Anti-TPO) on the in vitro fertilization and embryo transfer (IVF-ET) outcome in women with poor ovarian reserve but normal thyrotropin levels. A total of 300 patients with poor ovarian reserve undergoing ICSI cycle from April 2015 to December 2017 were analyzed retrospectively. Subjects were divided into two groups: Group 1: Women with early ovarian aging, Group 2: Women with age related poor ovarian reserve. All subjects underwent anti-thyroid peroxidase antibody (anti-TPO) analysis. The impacts of age and anti-TPO positivity on cycle outcome were assessed. There were no significant differences in basal FSH, basal AMH levels, and antral follicle count between the two main groups. Groups were also comparable in terms of the duration of ovarian stimulation, peak estradiol level, starting gonadotropin dose, total gonadotropin dose, and number of oocytes retrieved. Clinical pregnancy and cycle cancelation rates were significantly higher in group with age-related poor ovarian reserve. While autoimmune thyroid disease rate was significantly higher in group with early ovarian aging. Anti-TPO positivity was a risk factor for poor cycle outcome [RR: 2.8 (95% CI: 1.2-6.3)]. Early ovarian aging may be associated with poorer cycle outcome compared to group with age-related poor ovarian reserve. This difference may be associated with high rate of autoimmunity which led to the impaired endometrial receptivity.

High estrogen exposure may not be detrimental on endometrial receptivity in women with PCOS.

The study aimed to assess the effect of high estrogen exposure and coasting on cycle outcome in women at risk for developing ovarian hyperstimulation syndrome (OHSS). Retrospective case-control study was conducted to figure out the outcomes of GnRH antagonist cycles in which women were at risk to develop OHSS. Women who underwent coasting (n = 100) were compared with a control group of women who did not undergo coasting (n = 287). Effect of endometrial estrogen exposure was determined by calculating area under curve of temporal estrogen measurements (AUCEM) through the cycle. Among 387 women with PCOS, 100 cases were required to undergo coasting to avoid OHSS. All participants reached to embryo transfer stage and clinical pregnancy rate was 44% in group with coasting whereas 39% in group without coasting (p > .05). AUCEM was a significant predictor for the cases who required coasting to avoid OHSS (AUC = 0.754, p < .001). Optimal cut off value was calculated to be 6762 with 71% sensitivity and 67% specificity. ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women with coasting (AUC = 0.496, p > .05). Consistently, ROC analysis showed no predictive value of AUCEM for clinical pregnancy in subgroup of women without coasting (AUC = 0.494, p > .05). In conclusion, neither coasting nor the high endometrial estrogen exposure was found to have detrimental effect on endometrial receptivity and cycle outcome in PCOS.

The Timing of Embryo Transfer Catheter Removal: Should It be Delayed or Done Immediately? A Prospective Randomized Trial.

BACKGROUND/AIMS: Data on the timing of catheter removal technique following embryo transfer (ET) are quite limited. We aimed to compare the reproductive outcomes of intracytoplasmic sperm injection (ICSI)/ET cycles in which the transfer catheter was removed immediately with those in which the catheter was removed after a delay period and hereby to evaluate the impact that the time interval before removal of the catheter following embryo deposit may have on the fertility outcomes. METHODS: A prospective randomized study was designed. ICSI/ET patients <40 years were randomly assigned to either of the group from which catheter was withdrawn immediately within the first 5 s (Group A) or after a 30 s delay (Group B) following ET. RESULTS: Groups A and B consisted of 147 and 148 patients, respectively. Patient demographics and stimulation characteristics were comparable between the groups. Pregnancy rate was 32.2% (95 of 295) and clinical pregnancy rate was 28.8% (85 of 295), whereas ongoing pregnancy was 24.4% (72 of 295) and implantation rate was 29.6% (100 of 338). The comparison of reproductive outcomes revealed no significant differences in pregnancy (p = 0.933), clinical pregnancy (p = 0.673), ongoing pregnancy (p = 0.590), multiple pregnancy (p = 0.801), and implantation rates (p = 0.979) between the groups. CONCLUSION: No significant difference was observed in the reproductive outcomes between the groups; thus, there appears no requirement to delay the withdrawal of the catheter to improve the outcomes in ICSI cycles.

Prospective Randomized Trial Comparing Embryo Transfers of Cases with and without Catheter Rotation during Its Withdrawal.

OBJECTIVE: To compare embryo transfer (ET) technique based on catheter rotation during its withdrawal in cases with unexplained infertility in a prospective, randomized trial (NCT03097042). METHODS: Two hundred intracytoplasmic sperm injection (ICSI) patients undergoing ET with cleaving or blastocyst-stage fresh embryos were randomized into 2 groups: cases with (n = 100), and without (n = 100) catheter rotation during its withdrawal. Groups were matched for age and some clinical parameters. A soft catheter was used to transfer a single embryo with catheter rotation during its withdrawal in the study group and without rotation in the control. The use of a stiff catheter or tenaculum was not needed in any case. Groups were compared in terms of cycle characteristics and clinical pregnancy rates. RESULTS: Pregnancy rate was significantly higher in the study group (41 vs. 26%, p = 0.04). Clinical pregnancy rate was also significantly higher in the study group (39 vs. 25%, OR 1.9 [1.1-3.5], p = 0.05). On the other hand, the ongoing pregnancy rate was similar between the 2 groups (33 vs. 23%, p = 0.2). CONCLUSION: Catheter rotation during its withdrawal may be associated with increased pregnancy and clinical pregnancy rates; however, the difference in ongoing pregnancy rates did not reach statistical significance.

Area under the curve of temporal estrogen and progesterone measurements during assisted reproductive technology: Which hormone is the main determinant of cycle outcome?

AIM: Is there any relationship between estrogen and progesterone concentrations during assisted reproductive technology (ART)? Which hormone is the main determinant of impaired endometrial receptivity? METHODS: This study was conducted from July to December 2016 at the in vitro Fertilization/Intracytoplasmic Sperm Injection unit at Zeynep Kamil Women and Children's Health Training and Research Hospital. A total of 289 women who underwent ART were prospectively screened and areas under the curve of temporal estrogen (AUCEM) and progesterone measurements (AUCPM) were calculated for each participant. Women were included if they had regular menstrual cycles, normal serum prolactin levels and had not received hormone treatment within three months. ART was indicated in all patients for unexplained infertility. Patients were divided into two groups: with (n = 90) and without (n = 199) embryo implantation. The relationship between the two AUCs and ART success was assessed in terms of embryo implantation and clinical pregnancy. RESULTS: Implantation was successful in 90 (31.1%) women, and a fetal heart rate was detected in 83 (28.7%) cases. There was a significant correlation between AUCEM and AUCPM (r = 0.525, P < 0.001). Multivariate regression analysis showed significant associations between failure of implantation, lack of clinical pregnancy and AUCEM (beta coefficient = 0.311, P < 0.001; beta coefficient = 0.297, P < 0.001, respectively) after adjusting for AUCPM. CONCLUSION: Our data showed that the degree of endometrial estrogen exposure is the main factor functioning as a detrimental effect of ovarian stimulation on endometrial receptivity.

Cytoplasmic abnormalities of mature oocytes have a significant effect on fertilization in Bologna poor responders

Background/aim: We aimed to investigate whether oocyte morphologic abnormalities affected cycle outcome in poor responder infertile women who fulfilled the Bologna criteria. Materials and methods: Data were obtained from infertile couples who underwent ICSI and embryo transfer at the Zeynep Kamil Maternity and Children's Health Training and Research Hospital Assisted Reproduction Unit in Istanbul, Turkey. They were allocated to two groups: Group A, poor responders, and Group B, normal responders. All morphological abnormalities of oocytes retrieved were reviewed and grouped as cytoplasmic abnormalities or extracytoplasmic abnormalities. All morphological features were compared between the poor and normal responder groups. ICSI cycle outcomes were described as biochemical pregnancy, fertilization rate, number of top-quality zygotes, top-quality zygote rate, number of embryos transferred, and number of top-quality embryos transferred. The relation between each morphological feature and ICSI outcomes was investigated in each group. Results: The results showed no difference between the groups in terms of morphological features of oocytes. The relation between ICSI cycle outcomes and each oocyte morphological feature was compared in the poor and normal responder groups. Presence of cytoplasmic morphological abnormality was found to significantly correlate with the fertilization rate (P = 0.019) in poor responders. Conclusion: Our data show that oocyte cytoplasmic abnormalities significantly reduce fertilization achievement in poor responders.

N-acetylcysteine leads to greater ovarian protection than enoxaparin sodium in a rat ovarian torsion model.

This study evaluated the effects of N-acetylcysteine (NAC) and enoxaparin on ovarian tissue preservation, ovarian reserve and oxidative damage following ovarian torsion/detorsion injury. Rats were divided into four groups (n = 6/group): control; ischaemia/reperfusion (I/R); I/R + NAC; I/R + enoxaparin. Twenty-four hours after detorsion, ovarian tissues were collected for histopathological analysis and measurement of tissue 8-OHdG, GSH, MDA, MPO and SOD concentrations, as well as pre- and post-operative circulating AMH concentrations. Administration of NAC resulted in more pre-antral follicles compared with enoxaparin treatment and haemorrhage and follicle cell degeneration were more pronounced in I/R + enoxaparin group than I/R + NAC group. Both NAC and enoxaparin led to a significant reduction in ovarian tissue 8-OHdG (P = 0.004 and P = 0.01, respectively) and MPO (P = 0.013 and P = 0.023, respectively) concentrations compared with I/R group, indicating a protective effect against I/R oxidative damage. Only NAC-treated animals showed a significant increase in GSH and SOD concentrations and decrease in MDA concentrations compared with I/R group (P = 0.007, P = 0.024 and P = 0.026, respectively). These results indicate that NAC is more effective than enoxaparin in minimizing ovarian damage and preserving ovarian reserve following ovarian torsion.

Can blood and semen presepsin levels in males predict pregnancy in couples undergoing intra-cytoplasmic sperm injection?

OBJECTIVE: To determine whether semen and plasma presepsin values measured in men with normozoospermia and oligoasthenospermia undergoing invitro-fertilization would be helpful in predicting ongoing pregnancy and live birth. METHODS: Group-I was defined as patients who had pregnancy after treatment and Group-II comprised those with no pregnancy. Semen and blood presepsin values were subsequently compared between the groups. Parametric comparisons were performed using Student's t-test, and non-parametric comparisons were conducted using the Mann-Whitney U test. RESULTS: There were 42 patients in Group-I and 72 in Group-II. In the context of successful pregnancy and live birth, semen presepsin values were statistically significantly higher in Group-I than in Group-II (p= 0.004 and p= 0.037, respectively). The most appropriate semen presepsin cut-off value for predicting both ongoing pregnancy and live birth was calculated as 199 pg/mL. Accordingly, their sensitivity was 64.5% to 59.3%, their specificity was 57.0% to 54.2%, and their positive predictive value was 37.0% to 29.6%, respectively; their negative predictive value was 80.4% in both instances. CONCLUSION: Semen presepsin values could be a new marker that may enable the prediction of successful pregnancy and/or live birth. Its negative predictive values are especially high.

ChatGPT's Efficacy in Queries Regarding Polycystic Ovary Syndrome and Treatment Strategies for Women Experiencing Infertility.

This study assesses the efficacy of ChatGPT-4, an advanced artificial intelligence (AI) language model, in delivering precise and comprehensive answers to inquiries regarding managing polycystic ovary syndrome (PCOS)-related infertility. The research team, comprising experienced gynecologists, formulated 460 structured queries encompassing a wide range of common and intricate PCOS scenarios. The queries were: true/false (170), open-ended (165), and multiple-choice (125) and further classified as 'easy', 'moderate', and 'hard'. For true/false questions, ChatGPT-4 achieved a flawless accuracy rate of 100% initially and upon reassessment after 30 days. In the open-ended category, there was a noteworthy enhancement in accuracy, with scores increasing from 5.53 ± 0.89 initially to 5.88 ± 0.43 at the 30-day mark (p < 0.001). Completeness scores for open-ended queries also experienced a significant improvement, rising from 2.35 ± 0.58 to 2.92 ± 0.29 (p < 0.001). In the multiple-choice category, although the accuracy score exhibited a minor decline from 5.96 ± 0.44 to 5.92 ± 0.63 after 30 days (p > 0.05). Completeness scores for multiple-choice questions remained consistent, with initial and 30-day means of 2.98 ± 0.18 and 2.97 ± 0.25, respectively (p > 0.05). ChatGPT-4 demonstrated exceptional performance in true/false queries and significantly improved handling of open-ended questions during the 30 days. These findings emphasize the potential of AI, particularly ChatGPT-4, in enhancing decision-making support for healthcare professionals managing PCOS-related infertility.

Artificial intelligence and clinical guidance in male reproductive health: ChatGPT4.0's AUA/ASRM guideline compliance evaluation.

BACKGROUND: Male infertility is defined as the inability of a male to achieve a pregnancy in a fertile female by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM). Artificial intelligence, particularly in language processing models like ChatGPT4.0, offers new possibilities for supporting clinical decision-making. This study aims to assess the effectiveness of ChatGPT4.0 in responding to clinical queries regarding male infertility, which is aligned with AUA/ASRM guidelines. METHODS: This observational study employed a design to evaluate the performance of ChatGPT4.0 across 1073 structured clinical queries categorized into true/false, multiple-choice, and open-ended. Two independent reviewers specializing in reproductive medicine assessed the responses using a six-point Likert scale to evaluate accuracy, relevance, and guideline adherence. RESULTS: In the true/false category, the initial accuracy was 92%, which increased to 94% by the end of the study period. For multiple-choice questions, accuracy improved from 85% to 89%. The most significant gains were seen in open-ended questions, where accuracy rose from 78% to 86%. Initially, some responses did not fully align with the AUA/ASRM guidelines. However, by the end of the 60 days, these responses had become more comprehensive and clinically relevant, indicating an improvement in the model's ability to generate guideline-conformant answers (p < 0.05). The depth and accuracy of responses for higher difficulty questions also showed enhancement (p < 0.01). CONCLUSION: ChatGPT4.0 can serve as a valuable support tool in managing male infertility, providing reliable, guideline-based information that enhances the accuracy of clinical decision-making tools and supports patient education.

Risk factors for empty follicle syndrome in diminished ovarian reserve patients undergoing intracytoplasmic sperm injection cycles: A retrospective observational analysis.

The aim of this study is to evaluate the risk factors for empty follicle syndrome (EFS) in patients with diminished ovarian reserve (DOR) undergoing an intracytoplasmic sperm injection cycle. In this retrospective study, patients with DOR were divided into 2 groups according to the presence of empty follicles on the day of oocyte retrieval. Patient age, body mass index (BMI), anti-Müllerian hormone (AMH), baseline follicle stimulating hormone (FSH) and estradiol (E2) levels, basal antral follicle count (AFC), total gonadotropin dose, and day of stimulation were recorded as risk factors. The association between EFS and these variables was assessed using the logistic regression method and ROC curve analysis. Increased BMI, low AMH, higher baseline FSH, low baseline AFC, higher gonadotropin dose, and longer day of ovulation induction were independent risk factors for EFS in patients with DOR. ROC curve analysis showed that BMI, AMH, baseline FSH, baseline AFC, higher gonadotropin dose, and longer ovulation induction days were predictive parameters in this group. According to the current study, higher BMI, lower AMH, higher baseline FSH, lower baseline AFC, higher gonadotropin dose and longer ovulation induction days were independent risk factors for EFS in patients with reduced ovarian reserve.

Effects of obesity on clinical outcomes in diminished ovarian reserve patients undergoing intracytoplasmic sperm injection cycles.

The aim of this study is to evaluate the effects of obesity on clinical outcomes in diminished ovarian reserve (DOR) patients undergoing intracytoplasmic sperm injection cycles. In this retrospective observational cross-sectional study, women admitted to current clinic with DOR undergoing intracytoplasmic sperm injection were divided into 2 groups according to the obesity. Patient age, body mass index, anti-mullerian hormone, baseline follicle stimulating hormone and baseline estradiol levels, antral follicle count, total gonadotropin dose, day of stimulation, number of mature (MII) oocytes, and clinical pregnancy were evaluated. There were no statistically significant differences between groups in terms of age, anti-mullerian hormone, baseline follicle stimulating hormone, baseline estradiol levels, antral follicle count, and clinical pregnancy (P > .05). Total gonadotropin dose, the days of ovarian stimulation were higher and number of MII oocyte were less in the obese group (P < .05). Logistic regression analyses also revealed that the days of ovarian stimulation and number of MII oocyte were significant factors in the study group. ROC curve analysis showed obesity is a negatively affecting factor in DOR patients. Obesity causes more gonadotropin dose longer days of stimulation, and less number of MII oocyte. However clinical pregnancy rate is not negatively affected by obesity according to the current study.

Etanercept protects ovarian reserve against ischemia/reperfusion injury in a rat model.

INTRODUCTION: Etanercept has been widely used in autoimmune diseases for blocking tumor necrosis factor α (TNF-α), which is an inflammatory cytokine. The anti-apoptotic and anti-inflammatory effects of etanercept against ischemia/reperfusion (I/R) injury have been shown for several tissues in rat studies, but to the best of our knowledge, there are no reports on its protective effects following similar injury in ovarian tissue. The aim of this study was to investigate whether etanercept has beneficial effects on ovarian I/R injury, as well as on ovarian reserve. MATERIAL AND METHODS: Twenty-four rats were randomly divided into four groups (n = 6/group): sham (laparotomy only); sham + etanercept; I/R; and I/R + etanercept. Ischemia was induced for 3 h by twisting the ovary, and 24 h after detorsion the ovarian tissues were collected to evaluate histopathologic changes, glutathione (GSH), malondialdehyde (MDA), myeloperoxidase (MPO), and superoxide dismutase (SOD) concentrations for oxidative stress, 8-hydroxy-2'-deoxyguanosine (8-OHdG) for DNA damage, caspase-3 activity for apoptosis and ovarian follicle counts. To measure anti-Mullerian hormone (AMH), serum samples were drawn before and after surgery. RESULTS: Tissue GSH and SOD levels were significantly higher, while MDA and MPO levels were significantly lower in the I/R + etanercept group than in the I/R group (p < 0.05, p < 0.01, respectively). Tissue 8-OHdG and caspase-3 activity were significantly lower in the I/R+etanercept group than in the I/R group (p < 0.05, p < 0.01, respectively). Preoperative and postoperative AMH levels were compared and there was a significant reduction in the I/R and I/R + etanercept groups (p < 0.001, p < 0.001). The reduction of AMH in the I/R + etanercept group was significantly lower than in the I/R group. The primordial, preantral and small antral follicle numbers were also significantly higher in the I/R + etanercept group compared to the I/R group (p < 0.001, p < 0.001, p < 0.005, respectively). CONCLUSIONS: Etanercept attenuated inflammation and related oxidative stress and also helped to preserve ovarian reserve following ovarian I/R damage.

Dual trigger with gonadotropin-releasing hormone and human chorionic gonadotropin for poor responders

OBJECTIVE: To compare metaphase II (MII) rate, fertilization rate, and embryo quality with dual trigger gonadotropin-releasing hormone agonist (GnRH) and normal dose human chorionic gonadotropin (hCG) versus a normal dose hCG trigger in antagonist intracytoplasmic sperm injection (ICSI) cycles of poor ovarian responders. MATERIAL AND METHODS: Patients defined as poor ovarian responders according to the Bologna criteria who underwent ICSI with GnRH antagonist protocol and triggered with dual trigger or hCG alone for oocyte maturation. Main outcome measures were MII rate, fertilization rate, and embryo quality. RESULTS: Total gonadotropin doses and E2 levels on trigger day were higher in the hCG trigger group. There were no significant differences with regard to implantation rate (p=0.304), biochemical pregnancy rate (p=0.815), clinical pregnancy rate (p=0.378), and ongoing pregnancy rate (p=0.635) between the groups. CONCLUSION: Dual trigger of oocyte maturation with GnRH agonist and normal dose hCG in poor responders does not demonstrate improved oocyte maturation, clinical pregnancy, and ongoing pregnancy rates.

Clinical analyses of successful and previously failed intracytoplasmic sperm injection cycle parameters in patients with poor ovarian reserve.

OBJECTIVE: To determine some major characteristic differences between two consecutive successful and unsuccessful intracytoplasmic sperm injection (ICSI) cycles in poor responders. MATERIALS AND METHODS: Sixty women with poor ovarian response as determined using the Bologna criteria underwent ICSI cycles following an unsuccessful trial. Some parameters of both cycles including age, body mass index (BMI), serum follicle-stimulating hormone (FSH) and estradiol levels, antral follicle count, gonadotropin dosage, duration of stimulation, antagonist starting day, duration of antagonist administration, endometrial thickness at trigger day, number of total and fertilized oocytes, embryo transfer day, number of embryo cells, and fertilization rate were compared in the same patients to identify predictors of cycles with clinical pregnancy. RESULTS: The mean age, BMI, serum FSH, estradiol concentrations, and antral follicle count were 35.9 years (range, 30-42 years), 25.9 kg/m2 (range, 18.4-33.5 kg/m2), 10.9 IU/mL (range, 7-13 IU/mL), 52.9 pg/mL (range, 11.6-75 pg/mL), and 4.7 (range, 2-10), respectively. A comparison of cycle characteristics showed a significantly higher total number of mature and fertilized oocytes in successful cycles. The fertilization rate was also significantly higher in cycles with clinical pregnancy. Early initiation of antagonist was shown to result in favorable outcomes. A comparison of embryo characteristics showed that transfer of higher-stage embryos and embryos with higher numbers of cells had a significant impact on cycle outcomes. CONCLUSION: Our comparison of parameters of failed and successful ICSI cycles in poor responders revealed significantly earlier antagonist initiation, higher total number of mature and fertilized oocytes, fertilization rate, and significantly higher stage of embryo development and cell numbers at transfer in cycles that resulted in clinical pregnancy.

Acute fetal heart rate tracing changes secondary to cigarette smoking in third trimester pregnancies.

OBJECTIVE: In this study, we aimed to assess the acute alterations on some features of fetal heart rate (FHR) tracings in third trimester pregnancies. METHODS: Data of FHR tracing records were obtained from 79 otherwise healthy pregnant women aged between 18 and 41. Among 79 women, 39 were nonsmokers while the remaining were chronic smokers (six or more cigarettes per day, with an average of 10 cigarettes per day). The baseline of tracings, the number of accelerations and decelerations of FHR, as well as the FHR mean, standard deviation, short-term variability of FHR were all calculated for each participant. The results of smokers and nonsmokers, then the results of smokers before and after smoking were compared. RESULTS: Comparison of some demographic and FHR tracing characteristics between smoker and nonsmoker groups indicated significantly decreased variability in smoker group. All FHR tracing characteristics were compared before and, immediately after cigarette smoking and revealed significantly higher mean baseline, lower variability and acceleration after smoking a cigarette. CONCLUSION: Even in a short time period, smoking is associated with some changes in FHR monitorization characteristics, detailed analyses of these changes may clarify the pathophysiology of smoking associated perinatal outcome.

Validation of the Turkish Version of the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) in Turkish-Speaking Women.

INTRODUCTION: The Sexual Health Outcomes in Women Questionnaire (SHOW-Q) is designed to evaluate the sexual life of women for satisfaction, orgasm, desire, and pelvic problem interference. The SHOW-Q is important for evaluating worsening of sexual life for patients with pelvic problems and the management of these women to improve their sexual life. AIMS: To validate the Turkish versions of the SHOW-Q for Turkish-speaking women. METHODS: The Turkish version of the SHOW-Q was generated by two independent professional English-to-Turkish translators. The translated version of the SHOW-Q was reverse translated by two bilingual translators whose native language was English. Women with at least one symptom related to pelvic problems (n = 71) and those with no symptoms (n = 38) were included in the present study. MAIN OUTCOME MEASURES: Test-retest reliability analysis, content-face validity, internal consistency reliability, item-total correlations, convergent validity, construct validity, and factorial validity were performed to assess the psychometric properties of the Turkish versions of the SHOW-Q. RESULTS: Test-retest reliability demonstrated good correlation for all subscales. Cronbach α values ranged from 0.735 to 0.892 and indicated high internal consistency. There was a strong correlation for the corresponding subscales between the SHOW-Q and the Female Sexual Function Index. The mean score of each SHOW-Q subscale showed significant differences between symptomatic and asymptomatic patients. CONCLUSION: The Turkish version of the SHOW-Q is a valid and reliable instrument that can be used to evaluate the sexual life of Turkish-speaking women with different pelvic problems.

Do younger women with elevated basal follicular stimulating hormone levels undergoing gonadotropin-stimulated intrauterine insemination cycles represent compromised reproductive outcomes?

OBJECTIVE: To compare stimulation characteristics and reproductive outcomes in women representing elevated and normal day 3 FSH levels and to evaluate the prognostic significance of day 3 FSH on the reproductive outcomes of gonadotropin-stimulated IUI (GS-IUI) cycles in women <35 years. STUDY DESIGN: A cross-sectional study was designed. Unexplained infertility patients at the age ≤36 years, who underwent IUI, following gonadotropin stimulation (GS), were investigated. From 105 women with a day 3 FSH≥ 10U/L, 170GS/IUI cycles were assigned to Group EF; whereas a control group (Group NF, normal FSH) was constituted of 170 cycles with a day 3 FSH levels <10U/L. Demographic and stimulation characteristics as well as reproductive outcomes were compared. Primary outcome measure of this study was the biochemical, clinical and ongoing pregnancy rates. Secondary outcome measures were total gonadotropin dose, duration of gonadotropin stimulation, multiple pregnancy, miscarriage and cycle cancellation rates. RESULTS: ß-hCG positivity, clinical and ongoing pregnancy rates did not differ between women with normal and elevated FSH levels (p=0.234, 0.282 and 0.388, respectively). Total gonadotropin dose, multiple pregnancy and miscarriage rates were not significantly different between the groups (p=0,181, 0.652 and 0.415, respectively). Duration of stimulation was significantly longer and cycle cancellation rate was significantly higher in Group EF than in Group NF (p=0.005 and 0.021, respectively). CONCLUSION: Younger women with elevated day 3 FSH represent comparable reproductive outcomes in GS-IUI cycles to those with normal FSH levels, although they may require longer periods of stimulation and are at higher risk of cycle cancellation. Thus, GS-IUI could be a possible treatment option in this patient group and should not be neglected.

Area under curve of temporal estradiol measurements for prediction of the detrimental effect of estrogen exposure on implantation.

OBJECTIVE: To assess whether the area under the curve of temporal estradiol measurements (AUCEM) during cycles of assisted reproductive technology (ART) can be used to predict failure of implantation and clinical pregnancy. METHODS: In a prospective study, women aged 24-39years undergoing ART at a center in Turkey were enrolled between January and December 2014. Eligible patients had a regular menstrual cycle, normal levels of serum prolactin, and no hormone treatment within the past 3months. The area under the curve of the time course of estradiol measurements was calculated for each participant, and assessed for its ability to predict successful implantation. RESULTS: Among 282 participants, 109 (38.6%) women had successful implantation. There was a significant difference between the two groups of women in AUCEM, estradiol per day (AUCEM divided by duration of stimulation), and endometrial thickness on the day of human chorionic gonadotropin administration (P<0.05 for all). CONCLUSION: The area under the curve of estradiol measurements during ART cycles might be useful for predicting failure of implantation and clinical pregnancy.