Vaginal Hysterectomy at the Time of Total Colpocleisis: A Single-Center Experience.

OBJECTIVE: This study aims to evaluate the five-year experience of a single center regarding the total colpocleisis procedure. METHODS: This is a retrospective review of 24 women who underwent total colpocleisis at the study center between January 2017 and January 2023. Every participant was informed about this study, and written consent was obtained from each participant who then took Pelvic Floor Distress Inventory-20 (PFDI-20), Body Appreciation Scale-2 (BAS-2) and Decision Regret Scale (DRS) questionnaires consecutively. RESULTS: Eight patients (33.3%) underwent total colpocleisis, whereas 16 patients (66.7%) had concomitant colpocleisis and vaginal hysterectomy. The number of total colpocleisis cases did not change significantly with respect to the past years (p=0.117). The patients who underwent total colpocleisis and the patients who had concurrent colpocleisis and hysterectomy were statistically similar with respect to age, gravidity, chronic disease, blood group, American Society of Anesthesiologists classification, anesthesia type, surgery timing and preoperative and postoperative hemoglobin values (p>0.05 for all). Operative time was significantly shorter in patients who had colpocleisis alone (p=0.001). Both patient groups were also statistically similar in aspects of blood loss, transfusion need, hospital stay, postoperative complications and follow-up time as well as PFDI-20, BAS-2 and DRS scores (p>0.05 for all). Endometrial atrophy (56.3%), endometrial hyperplasia (18.8%) and adenomyosis (12.5%) were the most common histopathological findings detected in vaginal hysterectomy specimens. CONCLUSION: The combination of vaginal hysterectomy and total colpocleisis appears as a safe and efficient approach which does not contribute to the surgery-related morbidity despite the significantly longer operative time.

Investigation of the Relationship between Spontaneous Abortion, Serum Pesticides, and Polychlorinated Biphenyl Levels.

Occupational and environmental chemical exposure have been associated with adverse reproductive consequences. This study investigates the relationship between spontaneous abortion and blood pesticide and polychlorinated biphenyl (PCB) levels. A survey was conducted, and blood samples were collected from 200 patients, consisting of 100 cases with spontaneous abortion and 100 cases with normal deliveries. A total of 150 different pesticides, including organophosphates, organochlorines, carbamates, and pyrethroids, were screened in the collected blood samples and analyzed quantitatively using Tandem mass spectrometry-specifically in combination with liquid chromatography and gas chromatography-tandem mass spectrometry methods. Eight types of PCBs were analyzed with the gas chromatography-tandem mass spectrometry method. The groups were compared based on these analyses. The mean age of the participants was 28.09 ± 4.94 years. In 59% of the spontaneous abortion group, 5.05 ± 1.97 chemicals were detected in different amounts. (p < 0.05). Analysis of the samples identified the presence of ß-Hexachlorocyclohexane (ß-HCH), delta-hexachlorocyclohexane (δ HCH), Hexachlorobenzene (HCB), Pentachlorobiphenyl-28 (PCB-28), Pentachlorobiphenyl-52 (PCB-52), o,p'-Dichlorodiphenyldichloroethylene (o,p'-DDE), p,p'-Dichlorodiphenyldichloroethylene (p,p'DDE), o,p'-Dichlorodiphenyldichloroethane (o,p'-DDD), p,p'-Dichlorodiphenyldichloroethane (p,p'-DDD), Pentachlorobiphenyl-118 (PCB-118), Pentachlorobiphenyl-101 (PCB-101), Pentachlorobiphenyl-153 (PCB-153), Pentachlorobiphenyl-138 (PCB-138), Pentachlorobiphenyl-202 (PCB-202), Pentachlorobiphenyl-180 (PCB-180) as well as Fibronil, Buprimate, Acetoclor, Acemiprid, Pentimanthalin, and Triflokystrobin. The spontaneous abortion group had significantly higher exposure to PCB-101, PCB-52, PCB-138, and δ-HCH (p < 0.05). Women included in the study had high pesticide and PCB exposure rates. Many of the blood samples contained multiple pesticides with endocrine-disrupting effects. Higher exposure to organochlorine compounds in the serum was identified in the group with spontaneous abortions.

The impact of timing for estrogen supplementation in polycystic ovary syndrome patients undergoing primed in vitro maturation.

OBJECTIVE: This study aims to determine the effects of early and late onset estrogen supplementation on the immature oocyte retrieval, fertilization and clinical pregnancy rates in follicle stimulating hormone (FSH) and human chorionic hormone (hCG) primed in vitro maturation (IVM) cycles of the patients with polycystic ovary syndrome (PCOS). METHODS: This is a retrospective analysis of 161 patients with PCOS who underwent FSH and hCG primed IVM. Group 1 included 120 patients who received early onset estrogen supplementation while group 2 consisted of 41 patients who had late onset estrogen supplementation in primed IVM cycles. Immature oocyte (germinal vesicle and/or metaphase I) retrieval and fertilization rates were the primary outcomes, whereas clinical pregnancy and live rates were the secondary outcomes. RESULTS: Group 1 patients had significantly higher body mass index and more previous IVF attempts (p = 0.001 and p = 0.008, respectively). All of the retrieved oocytes from the PCOS patients were either germinal vesicle or metaphase I oocytes and there were no metaphase II oocytes among the retrieved oocytes. Both groups had statistically similar numbers of metaphase I and fertilized oocytes (p > 0.05 for both). However, group 1 patients had significantly lower number of germinal vesicle oocytes but significantly higher number of metaphase II oocytes (p = 0.001 for both). Both groups had statistically similar fertilization (85.0% vs 78.0%), clinical pregnancy (49.2% vs 43.9%) and live birth (37.5% vs 39.0%) rates (p > 0.05 for all). CONCLUSION: Early onset estrogen supplementation appears to improve the quality of retrieved immature oocytes and contribute to the maturation of oocytes in stimulated IVM cycles.

A Comparative Multicentric Study on Serosal and Endometrial Myomectomy During Cesarean Section: Surgical Outcomes.

OBJECTIVE: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). METHODS: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. RESULTS: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). CONCLUSIONS: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.

In vitro maturation with letrozole priming: Can it be a solution for patients with cancerophobia? A pilot study.

OBJECTIVE: To investigate whether letrozole priming could be used efficiently in patients undergoing in vitro maturation (IVM) as compared with follicle-stimulating hormone (FSH) priming. MATERIALS AND METHODS: This is a retrospective analysis of 63 patients who underwent IVM due to the high risk of Ovarian Hyperstimulation syndrome (OHSS) (n=39), cancerophobia (n=16), and desire for IVM after failed in vitro fertilization attempts (n=8). Forty-two patients received FSH priming and 21 patients received letrozole priming. RESULTS: The patients who had FSH or letrozole priming were statistically similar with respect to age, body mass index, duration of infertility, basal antral follicle count, serum anti-Müllerian hormone levels, and IVM indications (p>0.05 for all). When compared with the FSH priming group, the number of germinal vesicle oocytes, metaphase II and fertilized oocytes were significantly higher (p=0.003, p=0.001, and p=0.016, respectively), but the number of metaphase I oocytes was significantly lower in the letrozole priming group (p=0.002). The patients who received FSH and letrozole priming had statistically similar rates of implantation (33.3% vs 37.0%, p=0.709), clinical pregnancy (31.5% vs 33.3%, p=0.848), twinning (1.9% vs 3.7%, p=0.611), and live birth (24.1% vs 29.6%, p=0.682). CONCLUSION: Potential indications for IVM include patients with increased risk for OHSS and contraindication for hyperestrogenism. Aromatase inhibitors can be used to preserve the fertility of patients with estrogen-sensitive cancers. Letrozole priming appears to be an efficient approach in patients who undergo IVM, with likely less cost than FSH priming.

Vaginal ultrasound-guided ovarian needle puncture compared to laparoscopic ovarian drilling in women with polycystic ovary syndrome.

STUDY OBJECTIVE: To compare pregnancy outcomes in PCOS women undergoing transvaginal ovarian injury (TVOI) and laparoscopic ovarian drilling (LOD) DESIGN: 126 infertile patients with PCOS were included in this prospective cohort study CANADIAN TASK FORCE CLASSIFICATION OF LEVEL OF EVIDENCE: IIA. SETTING: University-affiliated fertility center. PATIENTS: Sixty-seven infertile patients with the history of failed in vitro maturation underwent follow-up as the TVOI group. Fifty-nine infertile women who underwent LOD acted as controls. All subjects had PCOS with menstrual irregularity and were anovulatory by repetitive serum progesterone levels. INTERVENTIONS: The LOD group underwent six cauterizations of a single ovary with 30W for 4-6 s. Failed IVM subjects with 20-30 needle punctures per ovary acted as the TVOI group. Subjects were followed for six months. MEASUREMENTS AND MAIN RESULTS: There was not a significant difference between the groups when the cases were evaluated in terms of spontaneous pregnancy or miscarriage rates. BMI levels decreased in both the TVOI and the LOD groups in a similar fashion. However, serum AMH and AFC decreased greater after LOD than they did with TVOI over the six-month duration of the study (p < 0.001 in both cases). CONCLUSIONS: Preliminary data suggest that TVOI likely represents a safer, less costly and equally effective manner of surgical ovulation induction in anovulatory PCOS women when compared to LOD.

Serum Preptin and Amylin Levels with Respect to Body Mass Index in Polycystic Ovary Syndrome Patients.

BACKGROUND Preptin and amylin are pancreatic hormones which participate in glucose homeostasis. This study aimed to evaluate how serum preptin and amylin levels are altered in polycystic ovary syndrome (PCOS) patients and healthy women based on BMI groups (<25 kg/m² and ≥25 kg/m²). MATERIAL AND METHODS This was a prospective randomized control study of 40 PCOS patients and 40 healthy women who were matched with respect to BMI (<25 kg/m² and ≥25 kg/m²). RESULTS When compared to the healthy women, PCOS patients had significantly higher ovarian volumes, Ferriman-Gallwey scores, and free and total testosterone levels, but significantly lower amylin concentrations (p=0.001, p=0.001, p=0.049, p=0.021, and p<0.001, respectively). Both the normal-weight and overweight PCOS patients had significantly lower amylin levels than the normal-weight and overweight controls (p<0.001, p=0.009, p=0.001, and p=0.001, respectively). Amylin levels were negatively and significantly correlated with the Ferriman-Gallwey scores (r=-0.272, p=0.001) and ovarian volume (r=-0.206, p=0.007). Serum preptin levels were not elevated in either group. CONCLUSIONS Serum preptin levels are statistically similar in PCOS patients and BMI-matched healthy controls. Serum amylin levels are significantly higher in healthy controls than PCOS patients whether they are slim or overweight. These findings suggest the presence of mechanisms that can prevent the elevation in serum amylin concentrations that can occur in response to the impaired glucose metabolism in PCOS patients.

The effects of different therapeutic modalities on cardiovascular risk factors in women with polycystic ovary syndrome: A randomized controlled study.

OBJECTIVE: This study was designed to evaluate the effects of 3 mg drospirenone/30 µg ethinyl estradiol (OC) alone or combined with 1700 mg metformin on metabolic risk factors. MATERIALS AND METHODS: In this randomized, prospective, controlled study, 87 non-obese (18-30 BMI) women of reproductive age (18-39) with polycystic ovary syndrome (PCOS) were assigned to control (n = 17), OC (n = 21), combination (n = 20) and metformin (n = 29) therapy groups. RESULTS: Adiponectin levels changed -28.27%, -20.37% and 35.78% after OC, combination and metformin therapies, respectively. High sensitive C-reactive protein levels (hsCRP) changed with OC, combination and metformin therapies by 102.32%, 3.2% and -7.14%, respectively. Plasminogen activator inhibitor-1 levels decreased 41.34% in the metformin group. Apolipoprotein-B levels changed in a manner similar to changes in hsCRP levels. The homeostatic model insulin resistance index changed significantly between the groups following treatment (p = 0.001). CONCLUSION: Six cycles of treatments with OC alone may cause metabolic variables to deteriorate in non-obese women with PCOS. The addition of metformin to OC may ameliorate some aspects of this effect.

Plasma L-carnitine levels of obese and non-obese polycystic ovary syndrome patients.

It is well-known that plasma L-carnitine concentrations are significantly decreased in obese individuals. A study showed that L-carnitine concentrations are significantly lower in lean PCOS patients than in lean healthy women. Thus, it has been suggested that lowered L-carnitine is associated with PCOS. This study also showed that the women with PCOS had significantly lower L-carnitine levels than those of the healthy controls. In addition, this study hypothesised that low L-carnitine levels in PCOS patients were associated with obesity and/or insulin resistance. Moreover, plasma L-carnitine concentrations were found to be statistically similar in PCOS patients and healthy controls, when controlled for obesity. This study implied that L-carnitine could be used as an adjunctive therapy in the management of insulin resistance or obesity in women who have PCOS. Further research might be planned to clarify the clinical effects of L-carnitine administration in PCOS patients with insulin resistance and/or obesity.

Increased oxidative stress is associated with insulin resistance and infertility in polycystic ovary syndrome.

OBJECTIVES: The present study aims to investigate the role of oxidant-antioxidant status in young women with polycystic ovary syndrome (PCOS). MATERIAL AND METHODS: Seventy-one women with PCOS and 53 healthy controls are compared in aspect of demographic characteristics, biochemical data, hormones, and oxidant-antioxidant status. RESULTS: The PCOS group had significantly lower zinc, higher malondialdehyde and gluthathione peroxidase and lower serum catalase levels than the control group (p = 0.016, p < 0.001, p = 0.043 and p = 0.025 respectively). The PCOS patients with IR had significantly higher malondialdehyde, lower catalase and serum zinc levels than the PCOS patients without IR (p = 0.015, p = 0.010, p = 0.001 respectively). The infertile PCOS patients had significantly higher malondialdehyde, lower catalase and serum zinc levels than the fertile PCOS patients (p = 0.022, p = 0.045,p = 0.001 respectively). There was a statistically significant and positive correlation between HOMA-IR and malondialdehyde values (r = 0.523, p = 0.001), between HOMA-IR and glutathione peroxidase values (r = 0.468, p = 0.001) and between HOMA-IR and zinc values (r = 0.601, p = 0.001). There was a statistically significant and negative correlation between HOMA-IR and catalase values (r = -0.493, p = 0.001). CONCLUSIONS: The patients with PCOS are under oxidative stress and this oxidative stress seems to be the highest in patients with IR and with infertility. Despite the prominent increase in the oxidative stress, there was a variation in the antioxidant response.

Is elective single-embryo transfer a viable treatment policy in in vitro maturation cycles?

OBJECTIVE: To compare the clinical outcome of single-embryo transfer (SET) with double-embryo transfer (DET) in in vitro maturation (IVM) cycles performed in patients with polycystic ovary syndrome (PCOS), and to determine which factors predict those outcomes. DESIGN: A retrospective analysis. SETTING: Private assisted reproduction center. PATIENT(S): One hundred and fifty-nine women with PCOS. INTERVENTION(S): In vitro maturation with elective SET or DET conducted between September 2007 and May 2014. MAIN OUTCOME MEASURE(S): Live-birth rates. RESULT(S): Single-embryo transfer was performed in 83 patients (52.2%), and DET was performed in 76 patients (47.7%). When compared with the patients who had DET, the patients who had SET were statistically significantly younger (32.4 ± 3.5 vs. 24.1 ± 4.2 years) and had a shorter infertility duration (9.2 ± 4.5 vs. 4.4 ± 2.1 years), fewer previous ART cycles (<2 prior attempts, 39.5% vs. 6%; ≥2 prior attempts, 60.5% vs. 0), fewer collected oocytes (15.1 ± 4.6 vs. 12.6 ± 3.8), fewer metaphase II oocytes (9.0 ± 4.1 vs. 5.7 ± 2.9), fewer fertilized oocytes (8.2 ± 3.7 vs. 3.6 ± 2.3), and a higher implantation rate (27% vs. 47%). The SET and DET groups had similar embryo quality and similar clinical pregnancy (44.6% vs. 44.7%) and live-birth rates (34.9% vs. 34.2%). Twin pregnancy rates were statistically significantly higher in the DET compared with the SET groups (9.2% vs. 2.4%). CONCLUSION(S): In vitro maturation is a successful assisted reproduction technique that can be an alternative to conventional in vitro fertilization in women presenting with PCOS-related infertility. Our observations suggest that SET is a feasible option to prevent multiple pregnancies while maintaining the live-birth rate.

Systematic review: What is the best first-line approach for cesarean section ectopic pregnancy?

This systematic review aims to analyze the case reports, case series, or clinical studies describing the women with cesarean scar ectopic pregnancy (CSEP), and thus, to determine the efficacy and safety of different primary treatment modalities in the management of CSEP. A thorough search of electronic databases showed that 274 articles on CSEP were published between January 1978 and April 2014. Systemic methotrexate, uterine artery embolization, dilatation and curettage (D&C), hysterotomy, and hysteroscopy were the most frequently adopted first-line approaches. The success rates of systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy were 8.7%, 18.3%, 39.1%, 61.6%, and 92.1%, respectively. The hysterectomy rates were 3.6%, 1.1%, 0.0%, 7.3%, and 1.7% in CSEP cases that were treated by systemic methotrexate, uterine artery embolization, hysteroscopy, D&C, and hysterotomy, respectively. The ability to achieve a subsequent term pregnancy is related to successful systemic methotrexate treatment (p = 0.001) or hysterotomy (p = 0.009). Future term pregnancy was significantly more frequent in the hysterotomy group (p = 0.001). Hysteroscopy and laparoscopic hysterotomy are safe and efficient surgical procedures that can be adopted as primary treatment modalities for CSEP. Uterine artery embolization should be reserved for cases with significant bleeding and/or a high suspicion index for arteriovenous malformation. Systemic methotrexate and D&C are not recommended as first-line approaches for CSEP, as these procedures are associated with high complication and hysterectomy rates.

Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Turkish women with abnormal uterine bleeding.

AIM: The present study aims to determine how transvaginal ultrasonography and histopathological examination findings are correlated in a cohort of premenopausal and postmenopausal Turkish women with abnormal uterine bleeding. METHODS: This is a retrospective review of 350 Turkish women who underwent transvaginal ultrasonography and suction curettage as a result of abnormal uterine bleeding. RESULTS: Sonographic appearance of the endometrium was normal in 244 patients (69.7%), while homogeneous thickening was detected in 47 patients (13.4%) and cystic thickening in 21 patients (6.0%). A sonographic diagnosis of endometrial polyp was made in 38 patients (10.9%). Histopathological analysis of endometrial samplings revealed proliferative endometrium (36%), secretory endometrium (24.6%), decidualization (10.9%), endometrial polyp (8.3%), endometritis (6.8%), endometrial hyperplasia (4.6%), irregular shedding (3.7%), atrophic endometrium (3.1%), endometrial cancer (1.1%) and placental retention (0.9%). The sonographic and histopathological findings correlated significantly (χ(2) = 122 768, P = 0.001; r = 0.215, P = 0.001). Approximately 51% of the women with homogeneous endometrial thickening had proliferative endometrium. Only 44.7% of the women with ultrasonographically visualized endometrial polyps had histopathologically diagnosed endometrial polyps. Nearly 57% of the women with cystic endometrial thickening had proliferative endometrium. CONCLUSION: If there is no facility for hysteroscopy or hysteroscopy-guided endometrial biopsy for women with abnormal uterine bleeding, transvaginal ultrasonography findings can be efficiently used to make a preliminary diagnosis and, thus, notify the pathologists.

L-Carnitine: a new insight into the pathogenesis of endometrial cancer.

OBJECTIVES: The present study aims to specify the role of L-carnitine in the pathogenesis of endometrial cancer by comparing the serum total L-carnitine levels of endometrial cancer patients with those of healthy women. METHODS: Serum total L-carnitine concentrations were measured in patients with endometrioid-type endometrial cancer (n = 20) and healthy controls (n = 20) who were matched with respect to age and body mass index (BMI). RESULTS: Stage I endometrial cancer was diagnosed in 12 women (60.0%) whereas three women (15.0%) had stage II disease, three women (15.0%) had stage III disease and two women (10.0%) had stage IV disease. The healthy controls and endometrial cancer patients were statistically similar in aspect of age, gravidity, parity, BMI, waist-to-thigh ratio, waist-to-hip ratio, menopause, complete blood count parameters, and serum biochemistry. Serum total L-carnitine levels of women with endometrial cancer were significantly lower than those of healthy women (respectively, 5,519.4 ± 2,712.5 vs 7,940.8 ± 3,566.6 ng/dl, p = 0.021). Moreover, serum total L-carnitine levels decreased significantly and progressively with advancing stage (stage I vs II vs III vs IV; 6,294.0 ± 2,885.1 vs 5,800.0 ± 441.2 vs 4,016.0 ± 2,833.3 vs 2,560.0 ± 67.9 ng/dl; p = 0.021). CONCLUSIONS: This is the first study to hypothesize that L-carnitine deficiency participates in the pathogenesis of endometrial cancer by means of a mechanism which is unrelated with obesity and increased amount of fat in human body.

Anti-Mullerian hormone is a better marker than inhibin B, follicle stimulating hormone, estradiol or antral follicle count in predicting the outcome of in vitro fertilization.

OBJECTIVE: The present study aims to compare anti-Mullerian hormone (AMH) with other ovarian reserve markers and to find a cut-off value of AMH for predicting ovarian response towards controlled ovarian hyperstimulation in an in vitro fertilization (IVF) program. MATERIALS AND METHODS: A prospective analysis was performed in 180 patients undergoing their first IVF trial, which is being conducted at a department of assisted reproduction in a tertiary medical center. The main outcome measures were determined as age and antral follicle count as well as the serum concentrations of follicle stimulating hormone, luteinizing hormone (LH), estradiol (E2), inhibin B and AMH. The predictive power of the aforementioned measures in specifying ovarian response was determined by means of discriminate analyses. RESULTS: As expected, day 3 LH levels were significantly high in the poor responder group. The poor responders had significantly lower antral follicle counts, retrieved oocyte number, and mature oocyte counts as well as day 3 AMH levels (5.8 ± 2.32 vs. 1.8 ± 0.80 ng/ml). There was a positive correlation with antral follicle count, basal AMH, E2 and follicle count on the day of HCG administration and negative correlation with age. The AMH level was addressed as the only significant factor in determination of mature oocyte number. A cut-off point for serum AMH concentration indicating the value of 2.97 ng/ml was found to predict the poor ovarian response with a sensitivity of 100.0% and a specificity of 89.6%. However, the same cut-off point was not as predictive for the non-conception circumstance. CONCLUSION: The present study concludes that AMH is a promising biochemical marker for the prediction of ovarian response and that a cut-off point indicating the value of 2.97 ng/ml can be adopted for this prediction.

Fertility outcome after conservative surgery for borderline ovarian tumors: a single center experience.

OBJECTIVE: The present study aims to document the experience of a single center on the reproductive outcome of a cohort of women who were treated with conservative surgery for borderline ovarian tumors and to specify whether their fertility potential is associated with age, tumor histology and surgery type. METHODS: A total of 55 women who had undergone conservative surgery for borderline ovarian tumors between January 1999 and January 2009 were eligible. Recurrence rate, fertility outcome and the number of pregnancies were analyzed retrospectively. RESULTS: Among the study group, 11 women were not sexually active both at the time of surgery and during the follow-up period. Thus, a total of 44 patients attempted pregnancy after conservative surgery and 52.3% of them (23 out of 44) were able to conceive either spontaneously or by in vitro fertilization. The ability to conceive was shown to be associated with age, tumor histology and type of conservative surgery. As expected, the fertility potential correlated positively with decreasing age (correlation coefficient = 0.705, p = 0.001). Moreover, the existence of non-serous histology and the implementation of unilateral cystectomy were found to be associated with the ability to reach a clinical pregnancy (correlation coefficient = 0.585, p = 0.001 and correlation coefficient = 0.587, p = 0.001, respectively). CONCLUSIONS: The primary treatment of borderline ovarian tumors refers to conservative surgery. Younger age, non-serous histology and unilateral cystectomy appear to be associated with favorable reproductive outcome in women who undergo conservative surgery for borderline malignancy of ovary.

A rare tumor of the female genital tract: primary ovarian leiomyosarcoma.

INTRODUCTION: Primary ovarian leiomyosarcomas are rare gynecological tumors, which usually affect postmenopausal women. MATERIALS AND METHODS: This short communication aims to remind this uncommon malignant pathology by describing a case and presenting a short review of the literature. CONCLUSION: Unfortunately, these tumors are aggressive and have a poor prognosis.

A systematic review: endometriosis presenting with ascites.

BACKGROUND: The present review aims to increase the awareness of the gynecologists by analyzing all the case reports which refer to endometriosis presenting either with only ascites or with massive ascites with pleural effusion. METHODS: To conduct the present review, the CENTRAL (in the Cochrane Library, current issue), MEDLINE (Silver Platter, from 1950 to 2010), and EMBASE (from 1950 to 2010) electronic databases were searched. As a result, all the publications based on the keywords relating to the review topic were acquired. RESULTS: Since the description of first case in 1954, endometriosis-related ascites was reported to occur in a total of 63 women who were aged between 19 and 51 years. Approximately 63.0% of the recruited women for whom ethnicity was specified were of African origin (29 out of 46). Of the 50 subjects with known obstetric history, 41 (82.0%) were nulliparous. Abdominal distention, anorexia/weight loss, abdominal pain, and menometrorrhagia were the most frequently encountered clinical symptoms, whereas pelvic mass was the most common physical finding. The serum concentrations of CA 125 were between 20 and 3,504 IU/ml for 19 women whose CA 125 levels were determined. Pleural effusion was also present in 38.1% of the reviewed subjects (24 out of 63). The clinical features of the women with endometriosis-related ascites and pleural effusion were similar to those of the women who had only endometriosis-related ascites. CONCLUSION: Endometriosis-related ascites and/or pleural effusion refers to extensive disease with a high risk for recurrence which usually affects non-Caucasian, nulliparous women of reproductive age and leads to clinical symptoms resembling those of an ovarian malignancy. Therefore, clinicians should consider endometriosis in differential diagnosis of pelvic masses and also include endometriosis in diagnostic workup of ascites or pleural effusion.