Is there a relationship between the psychological state of infertile patient and ovarian reserve indicators?

Objective: This study explored the relationship between reduced ovarian reserve and the psychological state of infertile women. Materials and Methods: This cross-sectional, single-center study was conducted with 106 infertile women. The Beck Depression Inventory (BDI) was used to assess patients' propensity for depression. The data relating to infertility, such as causes of infertility, type of infertility (primary or secondary), duration of infertility, and treatment status [previous assisted reproductive technologies (ART) treatment and ART treatment failure] were recorded for each patient. The ovarian reserve was determined using laboratory tests [anti-Mullerian hormone (AMH); follicle-stimulating hormone (FSH)] and transvaginal ultrasonography to measure the antral follicle count (AFC) in each ovary. Results: There was no significant relationship between the total score obtained from the Beck depression scale and AFC, AMH, thyroid-stimulating hormone, FSH, estradiol, and prolactin measurements (p>0.05). There was no significant difference between the groups regarding depression levels based on the cause of infertility (p=0.412). Additionally, the type of infertility (primary, secondary) did not differ between the groups (p=0.586). There were no differences on the BDI scale regarding the level of depression between patients who underwent in vitro fertilization (IVF) treatment (history of previous IVF treatment failure) and those who did not. Conclusion: There was no significant association between AFC and AMH levels and the depression state of infertile patients.

The Emerging Role of AI in Patient Education: A Comparative Analysis of LLM Accuracy for Pelvic Organ Prolapse.

OBJECTIVE: This study aimed to evaluate the accuracy, completeness, precision, and readability of outputs generated by three Large Language Models (LLMs): GPT by OpenAI, BARD by Google, and Bing by Microsoft, in comparison to patient education material on Pelvic Organ Prolapse (POP) provided by the Royal College of Obstetricians and Gynecologists (RCOG). METHODS: A total of 15 questions were retrieved from the RCOG website and input into the three LLMs. Two independent reviewers evaluated the outputs for accuracy, completeness, and precision. Readability was assessed using the Simplified Measure of Gobbledygook (SMOG) score and the Flesch-Kincaid Grade Level (FKGL) score. RESULTS: Significant differences were observed in completeness and precision metrics. ChatGPT ranked highest in completeness (66.7%), while Bing led in precision (100%). No significant differences were observed in accuracy across all models. In terms of readability, ChatGPT exhibited higher difficulty than BARD, Bing, and the original RCOG answers. CONCLUSION: While all models displayed a variable degree of correctness, ChatGPT excelled in completeness, significantly surpassing BARD and Bing. However, Bing led in precision, providing the most relevant and concise answers. Regarding readability, ChatGPT exhibited higher difficulty. The study found that while all LLMs showed varying degrees of correctness in answering RCOG questions on patient information for Pelvic Organ Prolapse (POP), ChatGPT was the most comprehensive, but its answers were harder to read. Bing, on the other hand, was the most precise. The findings highlight the potential of LLMs in health information dissemination and the need for careful interpretation of their outputs.

Levonorgestrel-releasing intrauterine device to treat abnormal uterine bleeding; not one treatment option fits all.

Objective: Initially, medical treatment options are preferred in patients with abnormal uterine bleeding (AUB) who are hemodynamically stable. The aim of the present study was to investigate the effectiveness of a levonorgestrel-releasing intrauterine device (LNG-IUD) in reducing bleeding symptoms in patients with AUB stratified by underlying pathology. Material and Methods: In line with the polyp, adenomyosis, leiomyoma, malignancy (and hyperplasia), coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified classification system, patients who were administered LNG-IUD due to adenomyosis, endometrial hyperplasia, leiomyoma and AUB due to not otherwise classified causes were included in the study. Results: A total of 172 otherwise patients with a mean age of 42.58±5.00 years were included. The distributions in the adenomyosis, endometrial hyperplasia, leiomyoma and otherwise unclassified groups were 30.8%, 12.8%, 26.2%, and 30.2%, respectively. Overall effectiveness of LNG-IUD in reducing menstrual bleeding was 82%. The proportion whose bleeding decreased was 95.50% in the endometrial hyperplasia group, 88.70% in the adenomyosis group, 55.60% in the leiomyoma group and 92.30% in the not otherwise classified group. The power of the current study was 99%. The efficacy of LNG-IUD was significantly less in the leiomyoma group (p<0.05) and thus this group were more likely to require surgical intervention. The overall incidence of spotting was 50%. Amenorrhea developed in 14% of patients. Conclusion: While LNG-IUD was more effective in reducing symptoms of AUB in patients with adenomyosis, endometrial hyperplasia and not otherwise classified causes, LNG-IUD was less effective in cases of leiomyoma.

Increased maternal mortality in unvaccinated SARS-CoV-2 infected pregnant patients.

The aim of this study was to demonstrate the poor prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in unvaccinated pregnant women. In this retrospective study, the clinical and laboratory parameters of 26 pregnant or immediately postpartum patients, who were hospitalised and needed intensive care unit (ICU) follow-up due to coronavirus disease 2019 (COVID-19) infection were reported. All pregnant patients who followed up in the ICU were unvaccinated. The mortality rate was calculated as 34.62% in the patients included in the study who were admitted to the ICU. Among patients hospitalised in the ICU, the maternal mortality and stillbirth rates associated with COVID-19 infection were found to be 156.28/100,000 and 11.54%, respectively. Preterm birth occurred in 58.33% of the patients who delivered. 79.17% of the patients were delivered by caesarean section. Lymphopenia, high ferritin, interleukin-6, lactate dehydrogenase, D-dimer and C-reactive protein values were found to be associated with mortality. The course of pregnant patients with COVID-19 infection is not always predictable. Clinical and laboratory data should be evaluated in combination for disease prognosis. Adequate information should be given about the importance of vaccination.Impact StatementWhat is already known on this subject? The SARS-CoV-2 infection has caused a public health crisis worldwide. As a result of studies on coronavirus disease 2019 (COVID-19) infected pregnant women, it was observed that there was an increase in maternal and perinatal mortality. There has been an increase in intensive care unit (ICU) admissions, especially after patients infected with the Delta variant. The pandemic continues with an unpredictable course of the new variants.What do the results of this study add? Compared to the pre-pandemic period, COVID-19 infection caused a more than 10-fold increase in maternal mortality, particularly after the Delta variant. In intensive care follow-up, low lymphocyte count, high lactate dehydrogenase, D-dimer, C-reactive protein, ferritin and interleukin-6 values are indicators of poor prognosis.What are the implications of these findings for clinical practice and/or further research? COVID-19 infection causes increased maternal mortality. Considering that all of the patients admitted to the ICU in our study were unvaccinated, pregnant women should be encouraged to get vaccinated.

Symptom-related Ki-67 expression in endometrial polyps.

OBJECTIVE: The aim of this study was to compare Ki-67 expression in endometrial polyps that present with different abnormal uterine bleeding patterns. STUDY DESIGN: A total of 120 women diagnosed with endometrial polyps were included in the study. In this prospective study, tissue samples taken by hysteroscopic polypectomy method between September 2019 and September 2020 at Bursa City Hospital were examined. The main study groups were determined as premenopausal and postmenopausal patients. The patients' complaints at first admission to the hospital, demographic, histopathological and immunohistochemical features were recorded. RESULTS: Ki-67 glandular and stromal expressions were higher in the premenopausal patient group (p = 0.016 and p = 0.005 respectively). Median Ki-67 gland and stroma measurements; was higher in patients with heavy menstrual bleeding (HMB) than in patients with intermenstrual bleeding (IMB), patients with postmenopausal bleeding (PMB), and patients who were asymptomatic [(p = 0.012, p = 0.011 and p = 0.009 respectively); (p < 0.001, p < 0.001 and p = 0.004 respectively)]. The median Ki-67 stroma measurement was found to be higher in the patient group whose complaint persisted after polypectomy (p = 0.034). In the estimation of response to treatment, the cut-off value for Ki-67 stromal expression was determined as ≤ 6%. CONCLUSION: High Ki-67 expression in endometrial polyps is associated with HMB and may predict the continuation of abnormal uterine bleeding after polypectomy.