A Comparison of Success Rates of Embryo Transfer on Weekdays and Weekends.

BACKGROUND: The aim of this study is to examine the effect of the embryo transfer (ET) day on clinical pregnancy success rates in in vitro fertilization-ET (IVF-ET) cycles. MATERIALS AND METHODS: In this retrospective study, we divided patients with infertility who underwent IVF-ET with fresh embryos into two groups depending on whether the ET was performed on weekdays or weekends. The main outcome measure was to compare the clinical pregnancy rates of patients with similar demographic and clinical characteristics who underwent ET on weekdays or weekends. RESULTS: A total of 188 patients underwent IVF-ET on weekdays (n=156) or weekends (n=32). Both groups had similar demographic and cycle characteristics. The overall pregnancy rate was 42.8%. Among the study groups, the weekday group had a 40.2% ET success rate and the weekend group had a 54.8% success rate (P=0.517). Although no statistically significant difference existed between the two groups, we observed an absolute 14.6% increase in pregnancy rate for ETs performed during weekends compared to those performed on weekdays, with a 35% statistical power. CONCLUSION: ETs performed during weekends were more successful than ETs performed during weekdays with an absolute 14.6% increase in clinical pregnancy rate. This finding should be confirmed by conducting further studies with larger groups of patients.

Comparison of Subcuticular Suture Materials in Cesarean Skin Closure.

Aim. Comparison of the rate of wound complications, pain, and patient satisfaction based on used subcuticular suture material. Methods. A total of 250 consecutive women undergoing primary and repeat cesarean section with low transverse incision were prospectively included. The primary outcome was wound complication rate including infection, dehiscence, hematoma, and hypertrophic scar formation within a 6-week period after operation. Secondary outcomes were skin closure time, the need for use of additional analgesic agent, pain score on numeric rating scale, cosmetic score, and patient scar satisfaction scale. Results. Absorbable polyglactin was used in 108 patients and nonabsorbable polypropylene was used in 142 patients. Wound complication rates were similar in primary and repeat cesarean groups based on the type of suture material. Skin closure time is longer in nonabsorbable suture material group in both primary and repeat cesarean groups. There was no difference between groups in terms of postoperative pain, need for additional analgesic use, late phase pain, and itching at the scar. Although the cosmetic results tended to be better in the nonabsorbable group in primary surgery patients, there was no significant difference in the visual satisfaction of the patients. Conclusions. Absorbable and nonabsorbable suture materials are comparable in cesarean section operation skin closure.

Immunohistochemical detection of transforming growth factor-alpha, epidermal growth factor, and vascular endothelial growth factor expression in hyperstimulated rat ovary.

OBJECTIVE: The aim of the present study is to figure out the immunohistochemical expression of transforming growth factor-alpha (TGF-alpha), epidermal growth factor (EGF), and vascular endothelial growth factor (VEGF) in hyperstimulated rat ovaries. METHODS: Twenty Wistar-Albino adult female rats (250-300 g) were taken into the study. The animals were randomly divided into two groups, each containing 10 rats: (i) stimulation group and (ii) control group. In the stimulation group, a stimulation regimen was administered to induce follicular maturity and ovarian hyperstimulation syndrome (OHSS) at the end using a 30-IU follicle-stimulating hormone that was administered subcutaneously for 4 consecutive days, followed by a 30-IU human chorionic gonadotropin on day 5 to induce ovulation. The rats, in the control group, received 0.2 ml of 0.9% NaCl for 5 consecutive days to mimic the conditions of the study animals. At the end of the treatment period, all rats underwent ovariectomy and the sections of ovaries were stained for the TGF-alpha, EGF, and VEGF. RESULTS: The expression of TGF-alpha, EGF, and VEGF in the endothelium, the stroma, the granulosa cells, and the corpus luteum was found to be significantly higher in the stimulated group, compared to that in the control group ( p < 0.05). CONCLUSION: TGF-alpha, EGF, and VEGF are found to have increased in the hyperstimulated ovaries and this finding seems to be involved in the OHSS pathogenesis.

Fetal intra-abdominal umbilical vein dilatation associated with notching in umbilical artery.

INTRODUCTION: Dilatation of the fetal intra-abdominal umbilical vein is a rare entity. It is unclear whether prenatally diagnosed umbilical vein dilatation is associated with an increased risk of fetal anomalies or poor perinatal outcome. Umbilical artery waveform notching may be a predictor of cord abnormalities. It seems reasonable following the baby closely after the diagnosis of both conditions. CASE REPORT AND DISCUSSION: We present here a new case diagnosed by ultrasonography at 30 weeks of gestation with normal fetal outcome and discuss the clinical features and the management of these rare abnormalities.

Effect of angiotensin-converting enzyme-inhibiting therapy on the expression of vascular endothelial growth factor in hyperstimulated rat ovary.

OBJECTIVE: To determine the effect of angiotensin-converting enzyme-inhibiting therapy on the expression of vascular endothelial growth factor (VEGF) in the hyperstimulated rat ovary. DESIGN: Experimental study. SETTING: University animal research laboratory. ANIMAL(S): Thirty Wistar albino adult female rats were studied; 20 rats were stimulated with gonadotropins (groups 1 and 2), and 10 were controls (group 3). Ten of the stimulated rats received additional treatment with enalapril (group 2). INTERVENTION(S): At the end of the treatment period, rat ovaries were subjected to immunohistochemical staining with anti-VEGF antibodies. MAIN OUTCOME MEASURE(S): VEGF staining intensity was graded semiquantitatively, and the H-score was calculated by light microscopic examination of the groups. RESULT(S): VEGF expression was found to be significantly higher in the endothelium and stroma in groups 1 and 2 compared with group 3. Although VEGF immunoreactivity was lower in the stimulation regimen plus enalapril group compared with the stimulation regimen-only group, the difference was insignificant. CONCLUSION(S): Enalapril does not seem to have a significant effect on VEGF expression in the hyperstimulated rat ovary. Because angiotensin II exerts its multiple actions via specific receptors, there may be other factors, such as a receptor blockade, that contribute to the VEGF expression.

Endometrial thickness and the Doppler sonographic parameters of the uterine arteries as discriminators of endometrial status in postmenopausal women receiving anti-hypertensive treatment.

AIM: The aim of the present study was to establish the Doppler sonographic parameters of the uterine arteries in postmenopausal patients with or without hypertension and to determine the value of their measurement in the prediction of endometrial pathology. METHODS: Healthy postmenopausal women (n = 23) and the ones receiving anti-hypertensive medication (n = 34) examined for both endometrial thickness and Doppler velocimetry of the uterine arteries by transvaginal sonography. RESULTS: There was no significant difference between endometrial thickness and uterine artery Doppler sonographic parameters in hypertensive postmenopausal women compared to normotensive controls. CONCLUSION: The role of Doppler examination in the differential diagnosis of endometrial pathology in patients with or without hypertension seemed not to be effective.

Premature luteinization defined as progesterone estradiol ratio >1 on hCG administration day seems to adversely affect clinical outcome in long gonadotropin-releasing hormone agonist cycles.

AIM: To examine the effect of premature luteinization on the outcomes in long gonadotropin-releasing hormone agonist cycles. METHODS: Two-hundred and forty-eight patients who had undergone assisted reproductive technology for infertility treatment between 2001 and 2002 were enrolled into the study. The patients were separated into two groups according to P/E2 ratios on human chorionic gonadotropin administration day. Group A consisted of the patients whose P/E2 ratio was 1 (n = 116) and Group B consisted of the patients with premature luteinization of which P/E2 ratio was > 1 (n = 132). The P/E2 ratio calculation was performed as follows: P (in ng/mL) x dagger 1,000/E2 (in pg/mL). The primary outcome measures included oocyte quality, fertilization rates and clinical pregnancy rates. RESULTS: The mean number of mature oocytes retrieved in the groups were 9.5 +/- 4.8 and 6.4 +/- 3.6, respectively, and the difference was statistically significant (P < 0.05). Although the difference between the fertilization rates in Group A and Group B was not statistically significant (P > 0.05), the clinical pregnancy rates seemed to be affected adversely in the Group B patients with premature luteinization (41.4%versus 28%, respectively; P < 0.05). CONCLUSION: Premature luteinization, defined as P/E2 > 1 on human chorionic gonadotropin administration day, in long gonadotropin-releasing hormone agonist cycles seems to adversely affect clinical outcome.

Different anesthesiologic strategies have no effect on neonatal jaundice.

OBJECTIVE: In this prospective study, we examined the influence of either segmental epidural anesthesia with bupivocaine hydrochloride or general anesthesia with sevoflurane on serum bilirubin levels and jaundice in neonates born with caesarean section. MATERIALS AND METHODS: The patients at 38-40 weeks were included into this prospective study. General anesthesia group (sevoflurane); Group A, (n=66) and segmental epidural anesthesia group (bupivocaine hydrochloride); Group B, (n=76) underwent caesarean section under elective circumstances. Neonatal serum bilirubin levels were determined at the ages of 24 h and 5 days in 142 infants. The sexuality, weight, 5th minute APGAR scores, hematocrit levels of the neonates were recorded. The neonates who needed phototherapy were also noted. The results in Group A and Group B were compared. RESULTS: There was no significant difference on bilirubin levels between two groups and the incidence of hyperbilirubinemia did not differ statistically (p>0.05). The percent of the newborns who needed phototherapy displayed no significant differences between the deliveries by caesarean section under general or segmental epidural anesthesia. CONCLUSION: Our findings support the clinical studies which have not demonstrated an association between different anesthesiologic strategies and neonatal jaundice.

The outcomes of assisted reproductive technology cycles in patients with one or two ovaries.

AIM: To provide a comparison between the follicular response to ovulation induction, and the pregnancy rate of women with a single or two ovaries, undergoing assisted reproductive technology. METHODS: To evaluate the outcome of assisted reproductive technology, 46 treatment cycles in women with one ovary were compared to 123 cycles in women with two ovaries. RESULTS: The mean age of the patients in the two groups were not similar (34.4 +/- 3.8 and 33.1 +/- 4.0, respectively). The one ovary-group had significantly higher mean baseline Follicle Stimulating Hormone levels and required more ampoules for induction. Although the induction period was longer in the one-ovary group, the outcome of the assisted reproductive technology in both groups was similar. The maximum E2 levels on the day of Human Chorionic Gonadotropin administration were significantly lower in the one-ovary group, although endometrial thickness appeared to be the same in both groups. The patients with two ovaries had a significantly higher mean number of mature or immature oocytes aspirated, as well as embryos transferred. Although there was no statistical difference between the two groups following assisted reproductive technology, the pregnancy rate in the two-ovary group was more than double that of the one-ovary group. CONCLUSION: The potential for success after in vitro fertilization is not impaired in women with one ovary.

Effect of ovarian cysts detected on the beginning day of ovulation induction to the success rates in ART cycles.

AIM: In the present study, we examined the outcome of assisted reproductive technology cycles in patients with or without baseline ovarian cysts following gonadotrophin-releasing hormone analogs administration. MATERIALS AND METHODS: Three-hundred and fifty-six patients who had undergone assisted reproductive technology treatment were enrolled in the study. The patients, all of who had undergone cyst aspiration prior to ovarian stimulation, were grouped into two groups according to the absence or presence of ovarian cysts. These two groups were compared on the basis of the clinical pregnancy rates, the baseline E2 levels, the total follicle stimulating hormone ampules used, the total number of days of induction, the maximum E2 levels, the number of oocytes retrieved, the fertilization rates and the number of embryos available for transfer per controlled ovarian hyperstimulation cycle. RESULTS: The number of ampules used for induction was significantly higher in the cyst group 37.2 +/- 13.0, 32.1 +/- 11.7, respectively, (P = 0.001). The number of total induction days was also longer in the cyst group 9.7 +/- 2.2, 8.9 +/- 1.6, respectively, (P = 0.001). There was no difference between the mean E2 levels measured on the human chorionic gonadotropin administration days (P = 0.339). There was also no difference in terms of the number of oocyte retrieved (P = 0.846). The number of embryos transferred did not differ statistically between the groups (P = 0.233). Finally, there was no significant difference between the groups according to the clinical pregnancy rates 25.3%, 30.7%, respectively, (P = 0.218). CONCLUSION: Baseline ovarian cysts have a negative impact on the quality of ovarian hyperstimulation procedure; however, they have no negative effect on the pregnancy rates in IVF cycles.

Intraovarian stromal artery Doppler indices in predicting ovarian response.

OBJECTIVE: To determine the value of ovarian stromal artery Doppler indices in the prediction of ovarian response in in vitro fertilization-embryo transfer (IVF-ET) cycles. STUDY DESIGN: Forty-five cases were involved in the study. Following controlled ovarian hyperstimulation and detection of at least three follicles > 17 mm in diameter by transvaginal sonography in both ovaries, human chorionic gonadotropin was administered and follicle aspiration performed at the 34th-36th hour. The patients were separated into two groups according to the number of oocytes collected. Group I consisted of 8 (18%) patients who had three or fewer oocytes (low-responder cases); group II consisted of 37 (82%) patients who had 4 or more oocytes (good-response cases). RESULTS: A significant negative correlation was found between both the stromal ovarian artery pulsatility index and the number of aspirated follicles (r = -.31, P = .04) and number of oocytes collected (r = -.32, P = .03). Although there was no significant correlation between the resistance index and number of aspirated follicles (r = .24, P = .12), a significant negative correlation was determined between the resistance index and number of oocytes collected (r = -.30, P = .04). Pulsatility and resistance indices were significantly different between the two groups (1.6 +/- 0.5 and 1.2 +/- 0.5, P = .02, versus 0.7 +/- 0.08 and 0.6 +/- 0.08, P = .03, respectively). CONCLUSION: Blood flow in the vessels that supply blood to the follicles in the ovaries in the early follicular phase correlates significantly with ovarian response.