Early Compaction Might Be a Parameter to Determine Good Quality Embryos and Day of Embryo Transfer in Patients Undergoing Intracytoplasmic Sperm Injection.

INTRODUCTION: Compaction is the first event in embryo morphogenesis. Blastocyst transfer on day five or six has been widely performed in the last decade. We investigated the clinical value of early compaction on day three for evaluation of the transferred embryo quality and pregnancy. METHODS: Four hundred patients with female factor infertility and 776 fresh embryo transfers were included. Two groups were formed: Early compaction group had embryo transfer with at least one day-three embryo exhibiting early compaction. Transferred embryos without early compaction comprised the control group. Embryo transfer was performed on day three or five after the assessment of embryo compaction by a time-lapse technology system. Each patient underwent only a single cycle of embryo transfer. We analyzed fertilization, pregnancy, and live birth rates. RESULTS: We detected significantly higher numbers of the retrieved oocytes, metaphase II (MII) oocytes, and fertilized oocytes in the early compaction group. Moreover, the transfer of the early compacting embryos on day three resulted in higher pregnancy and live birth rates. CONCLUSION: Our data suggest that early compaction might be a factor to determine good quality embryos and embryo transfer day.

The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies.

OBJECTIVES: In the current study, we aimed to evaluate the effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancy. METHODS: The perinatal outcome data of 11,366 patients who gave birth between 2015 and 2020 were evaluated retrospectively. Patients were subgrouped according to their age as control group (C) (20-29 years), late advanced maternal age group (30-34 years), advanced maternal age group (35-39 years), and very advanced maternal age group (≥40 years). Multinomial logistic regression analyses were performed to test the possible independent role of maternal age as a risk factor for adverse pregnancy outcomes. RESULTS: Statistically significant difference was observed between the control group and the other groups in terms of preterm delivery, preeclampsia, gestational diabetes mellitus (GDM), small gestational age (SGA), large gestational age (LGA), premature rupture of membranes (PROM), high birth weight (HBW), and perinatal mortality rates (p<0.05). An increased risk of the need for neonatal intensive care unit (NICU) and perinatal mortality was observed in groups over 35 years old. CONCLUSIONS: Age poses a risk in terms of preterm delivery, preeclampsia, LGA, GDM, and HBW in the groups over 30 years of maternal age. The rates of PROM, NICU, and perinatal mortality increase in addition to those perinatal results in the groups above 35 years of maternal age.

Is there any difference between pregnancy results after tubal reanastamosis performed laparotomically, laparoscopically, and robotically?

INTRODUCTION: Tubal reanastamosis offers hope to conceive again. However, there are many factors that affect the success of this procedure. In our study we aimed to compare the pregnancy rates of the surgical methods used for tubal reanastamosis in pregnancy requested after tubal sterilization. METHODS: In our study we compared the rates of pregnancies after reanastamosis retrospectively in female patients under the age of 40 who underwent reanastamosis between 2010 and 2019 with laparotomic, laparoscopic and robotic methods. A single layer of 4 quadrant 6/0 number polydioxanone absorbable sutures were used in all surgical methods. A similar surgical technique was used. RESULTS: In surgical methods (laparotomy, laparoscopy, and robotics), there was a statistical difference between the three groups in terms of operation times of surgical methods used for tubal reanastamosis (p < 0.05). Laparotomy, laparoscopy, and robotics pregnancy rates were 52.6% (n = 41), 67.3% (n = 37), 61.2% (n = 63), respectively. There was no statistical difference between groups in terms of pregnancy rates. However, odds ratio (OR) values of the laparoscopy group and robotics group probability of conception were 1.536 (95% confidence interval [CI], 0.813-2.898), 1.111 (95% CI, 0.656-1.879) higher, respectively. CONCLUSIONS: Although there is no statistical difference between the surgical methods used for tubal reanastamosis, we think that the laparoscopic surgical method may be preferable due to the shorter hospital stay. We think that the previous method of bilateral tubaligastion (BTL), the site of reanastasis, and the time between BTL and reanastomosis were effective in pregnancy success.

Isolated fallopian tubal torsion: Reproductive age case series.

AIM: To present our experiences in isolated fallopian tubal torsion (IFTT) case series, which are difficult to diagnose, in light of the literature. METHODS: The data of the patients diagnosed with IFTT surgically in our tertiary hospital between 2018 and 2019 were evaluated. RESULTS: Abdominal lower quadrant pain was present in all nine cases. Abdominal pain was accompanied by nausea in five of the nine cases with vomiting in four of the nine cases. Seven of the patients had pain radiating to the vagina. Only one case of IFTT was diagnosed with transvaginal ultrasonography where left tubal dilation and free fluid in the abdomen was found. Two of the nine cases were operated on with a preoperative diagnosis of IFTT. Seven cases were approached laparoscopically and two cases underwent a laparotomy. During the treatment, two of the nine cases underwent detorsion, while seven of the patients underwent a salpingectomy. CONCLUSION: IFTT is a very rare condition. Therefore, it is difficult to diagnose as it does not come to mind at first glance. Delay of the operation reduces the chance of preserving the tube.

Energy drinks may affect the ovarian reserve and serum anti-mullerian hormone levels in a rat model.

OBJECTIVE: Energy drinks have an impact on concentration levels, physical performance, speed of reaction, and focus, but these drinks cause many adverse effects and intoxication symptoms. The main goal of this study was to determine the effect of energy drink consumption on ovarian reserve and serum anti-mullerian hormone (AMH) levels. MATERIALS AND METHODS: Female Wistar albino rats (n=16) were included and randomized into two groups (n=8). Serum AMH levels were checked before and after energy drinks were given. Eight weeks later, the ovaries and uteruses of the rats were analyzed histopathologically. The number of follicles in the ovaries was counted. RESULTS: The total number of the preantral plus small antral follicles, which show the ovarian reserve, was decreased at the end of eight weeks in both the control group and the energy drink group. There was a statistical difference between them (p=0.021). Also, there was a statistically significant difference in the initial/final AMH (ng/mL) reduction levels between the control group and the energy drink group (p=0.002). AMH levels were decreased more in the energy drink group. CONCLUSION: The consumption of energy drinks can lead to a decrease in ovarian reserve and AMH values and may cause weight gain.

Comparison of the accuracy and reliability of the AmniSure, AMNIOQUICK, and AL-SENSE tests for early diagnosis of premature rupture of membranes.

OBJECTIVE: To compare the accuracy and reliability of the AmniSure, AMNIOQUICK, and AL-SENSE tests with conventional tests to diagnose suspected premature rupture of membranes (PROM). METHODS: A prospective cohort study of 60 pregnant women at 25-36 weeks of pregnancy with suspected PROM was conducted between January and April 2015. AmniSure (Qiagen Sciences LLC, Germantown, MD, USA), AMNIOQUICK (BIOSYNEX, Strasbourg, France), and AL-SENSE (Common Sense Ltd, Caesarea, Israel) tests were performed after conventional tests (ultrasonography, pooling, nitrazine, and fern tests) and women were followed-up for 7 days. Sensitivity, specificity, and diagnostic accuracy, among others, were assessed and compared. RESULTS: For women with a confirmed diagnosis of PROM, the sensitivity and specificity of conventional tests were 93.7% and 100.0%, respectively; diagnostic accuracy was 98.3%. Sensitivity, specificity, and diagnostic accuracy were all 100.0% for AmniSure. Sensitivity, specificity, and diagnostic accuracy for AMNIOQUICK were 75.0%, 97.7%, and 91.6%, respectively. Sensitivity, specificity, and diagnostic accuracy were 75.0%, 86.3%, 83.3%, respectively, for the AL-SENSE pad test. CONCLUSION: The AmniSure test was most sensitive and specific for diagnosing PROM compared with the other tests and is reliable and usable.

Relationship between vasomotor symptoms and metabolic syndrome in postmenopausal women.

Objective This study was performed to compare the vasomotor symptoms and bone mineral density of postmenopausal women with and without metabolic syndrome. Methods We performed a cross-sectional study of 200 postmenopausal women attending routine health check-ups at Marmara Faculty of Medicine Pendik Training and Research Hospital from June 2015 to December 2015. The vasomotor symptoms scored were hot flashes and night sweats. Metabolic syndrome was defined using the consensus criteria of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. Results Women with vasomotor symptoms had no metabolic syndrome and were younger than those without vasomotor symptoms. There was no significant difference in vasomotor symptoms between patients with osteopenia in the femoral neck, total femur, and spine and patients with normal bone mineral density. The vasomotor symptoms were similar between smokers and nonsmokers. Conclusion The presence of metabolic symptoms is inversely associated with metabolic syndrome in postmenopausal women. Lipid abnormalities and a high body mass index may be important metabolic components associated with these symptoms. No relationship is present between vasomotor symptoms and the bone mineral density of the spine, femoral neck, and total femur.

Two Years Follow-Up of Patients with Abnormal Uterine Bleeding after Insertion of the Levonorgestrel-Releasing Intrauterine System.

AIM: To evaluate the efficacy and safety of levonorgestrel-releasing intrauterine system (LNG-IUS) in the long-term treatment of heavy menstrual blood loss in women unrelated to intrauterine pathology. METHODS: One hundred and six parous women aged 33-48 years with recurrent heavy menstrual bleeding (HMB) participated in this study. The women were followed up for 24 months and were assessed for intensity of bleeding both for pre- and post-insertion periods. An LNG-IUS was inserted in each patient within 7 days of the start of menstrual flow. The women were followed up at 1, 3, 6, 12, 18, and 24 months following the insertion of the intrauterine device. RESULTS: One hundred and two women completed the follow-up period and had a significant reduction in the amount of menstrual blood loss. The LNG-IUS was well tolerated by all women. Pre-treatment of the use of the LNG-IUS, endometrial biopsy patterns for irregular proliferative endometrium and for atypical simple hyperplasia were 34/106 (32.08%) and 61/106 (57.55%) respectively and after treatment no abnormal pathologic findings were determined (p < 0.001). CONCLUSION: Our findings indicate that the LNG-IUS is effective for significantly reducing the amount of menstrual blood loss in women with HMB.