Demographic distributions and clinical results of assisted reproduction techniques in Turkey in 2019: a descriptive survey.

Objective: The aim of this study was to describe characteristics and outcomes of assisted reproductive technology (ART) cycles performed in 2019 in Turkey. Material and Methods: One-hundred and sixty-five ART centers in Turkey were invited to submit data. The survey was sent to center directors via e-mail with anonymous links by Qualtrics™. The survey involved questions about their patient characteristics, clinical practices, and outcomes. Results: Forty-one (24.8%) centers responded to e-mails, and data gathered from 25 centers was included in the analyses. In 25 centers, 18,127 fresh or frozen transfers were carried out during the study period, of which 7796 (43.0%) were fresh and the rest were either frozen (45.2%) or embryo transfers (ET) with preimplantation genetic testing (PGT) (11.8%). The live birth rate per ET was as 30.6%, 40.1%, and 50.7% in fresh, frozen and PGT cycles, respectively. A single embryo was transferred in 65.3% of all transfers and singleton live births comprised 86.1% of all deliveries. For cycles with intrauterine insemination, 1407 were started in 2019, and 195 clinical pregnancies, 150 live births with 19 multiple pregnancies occurred. A total of 1513 ART cycles were initiated for foreign patients. Russia (29.6%), Germany (7.4%), Iraq (4.6%), Uzbekistan (3.1%), and Syria (1.4%) were the top five countries with most patients coming to Turkey for ART. Conclusion: The survey results are in parallel with the reports of international institutions and organizations. With repeated editions, the data collected with annual surveys can be used to inform ART practices in the coming years.

Surgical treatment and outcomes of intramedullary tumors by minimally invasive approach: Answer.

The surgical outcomes which evaluated in studies depend on preoperative condition, demographic data of patients, surgical approaches or treatment and local factors. Author argues that the neurological deterioration rate 4,2% which is reported in our study is marvelous and he exemplifies the other studies in literature. Neurosurgeons know that the clinical studies in literature do not compare only their results. Authors compare and evaluate studies with preoperative demographic data, surgical approach, local factors or others between their results. Therefore this detail explains paralogism of the author. The neurological deterioration rate is reported as smaller or similar in our study to the contrary of others due to all the preoperative demographical data were evaluated with others. We suppose the author alludes that the neurological deterioration rate is marvelous since he does not compare all of the demographical data in these clinical studies.

Surgical treatment and outcomes of intramedullary tumors by minimally invasive approach.

Intramedullary tumors are uncommon neoplasms which, without treatment, can cause neurologic morbidity or mortality. The goal of the treatment is complete surgical resection with a minimally invasive approach while preserving neurological status and also spinal stability. Out of 1972 patients with tumors of the spinal canal treated between 1994 and 2017, 168 intramedullary tumors of 417 intradural tumors have been presented. All patients had undergone one surgical resection. The mean age is 43 ± 12 years (range 11-67 years). Tumors were subdivided into 4 groups: cervically located-tumors (n = 43), cervicothoracic-region-tumors (n = 32), thoracic-region-tumors (n = 57), and lumbosacral-region-tumors (n = 36). The mean follow-up time was 37 ± 29 months. Gross-total resection rate was higher in cervical located intramedullary tumors compared to the thoracic intramedullary tumors. Cervical intramedullary tumors showed better postoperative functional outcome than the thoracic intramedullary lesions. In intramedullary tumors, extending more than 3 spinal segments, postoperative worsening was significantly increased. A minimally invasive approach (the bilateral decompression via unilateral hemilaminectomy) was used to remove the tumor while preserving spinal stability. Perioperative permanent morbidity was very low. Intramedullary tumors should be surgically treated as soon as neurological symptoms appear. Patients with thoracic intramedullary tumors and tumor extension of more than three segments were at a higher risk for permanent morbidity. The minimally invasive approach allowed complete removal of the intramedullary tumors, and adequate preservation of vertebral stability while providing a good postoperative course.

Surgical Outcomes of Extraforaminal Microdiskectomy by Midline Incision for Far-Lateral Lumbar Disk Herniation.

BACKGROUND: Far-lateral lumbar disk herniation (FLDH) is defined as a disk herniation located laterally to the medial wall of the pedicle. The aim of our study is to describe the extraforaminal microdiskectomy by midline incision for FLDH, which does not include laminotomy-partial facetectomy, and to evaluate mid-term surgical outcomes. METHODS: 107 patients who underwent surgery for FLDH by midline incision for the first time between 2012 and 2017 were included in our study. The assessment of neurological status of the patients was done by physical examination, preoperative Oswestry Disability Index (ODI), Visual Analog Scala (VAS) scores, and magnetic resonance images. They were then followed-up postoperatively and at 12 months with VAS and ODI tests. RESULT: 58 (54.2%) patients were male and 49 (45.8%) were female. The mean age at the time of surgery was 55.0 ± 8.6 years. The mean ODI scale score was 32.4 ± 6.2 preoperatively, 11.4 ± 2.1 early postoperatively, and 9.7 ± 2.2 in late postoperative follow-up (statistically significant, p = 0.001). The average VAS was 7.51 ± 1.1 preoperatively, 2.74 ± 0.7 early postoperatively, and 0.68 ± 0.08 in late postoperative follow-up (statistically significant, p = 0.001). The average operative time was 41 ± 7 (37 to 58) minutes. CONCLUSIONS: The extraforaminal microdiskectomy without laminotomy by midline incision is a minimally invasive approach for FLDH. Our technique allows a sufficient and safe decompression of the neural structures, and thus results in a significant reduction of the symptoms and disability.

Diagnosis and Treatment of Transforaminal Epidural Steroid Injection in Lumbar Spinal Stenosis.

OBJECTIVES: Transforaminal epidural steroid injection reduces the low back-leg pain and enables daily activities of the patients. In this study, we aim to evaluate the treatment of transforaminal epidural steroid injection for lumbar spinal stenosis, which was mainly performed for lumbar disc herniation and share our diagnostic experience for lumbar spinal stenosis which is treated surgically. METHODS: In our study, 37 patients were included who were treated by transforaminal epidural steroid injection for Grade B lumbar spinal stenosis in our clinic between June-2014 and June-2018. We evaluated the patients at the second weeks, third/sixth months and one year after the treatment by Oswestry-Disability-Index and Visual-Analogue-Scale and followed up for surgical treatment after one year. RESULTS: The mean low back and leg pain Visual Analogue Scale was 5.1±0.3 before the transforaminal epidural steroid injection procedure, and it was 2.7±0.1 after two weeks. It was 2.8±0.2, 3.1±0.1 at three and six months after procedure, respectively. The improvement of low back-leg pain mean Visual-Analogue-Scale is statistically significant at two weeks, three and six months after transforaminal epidural steroid injection procedure, respectively. The mean Oswestry-Disability-Index was 29.6±0.4 before the transforaminal epidural steroid injection procedure, and it was 14.1±0.3 after two weeks. It was 15.3±0.5, 24.4±0.2 at three and six months after procedure, respectively. The improvement of Oswestry-Disability-Index is statistically significant at two weeks, three-six months. CONCLUSION: The transforaminal epidural steroid injection is safe procedure for non-surgical treatment of lumbar spinal stenosis and this procedure may be preferred support to the indication of the surgical treatment of level of lumbar spinal stenosis.

Does multifollicular development and number of intermediate follicles contribute to the effect of luteal phase support with vaginal progesterone gel in intrauterine insemination cycles?

Luteal phase deficiency as a result of multifollicular development which produces supraphysiological progesterone and estradiol levels and benefit of luteal phase support have been proven in assisted reproductive technique (ART) treatment. But, there were some controversial results in intrauterine insemination (IUI) cycles whether luteal phase support (LPS) with progesterone have an impact on pregnancy outcome. To assess the efficacy of vaginal progesterone gel in the gonadotropin-induced IUI cycles, this retrospective data analysis compared the luteal phase support and control group in terms of clinical pregnancy (CPR) and live birth rates (LBR). In subgroup analysis, multifollicular and monofollicular growth were analyzed separately. In total, after exclusion criteria, 380 IUI cycles were analyzed, cycles were grouped as LPS(+) and LPS(-) with 190 and 190 cycles, respectively. CPR and LBR were comparable between groups (11.6% vs. 10.5, p = .74 and 8.9% vs. 8.4%, p = .75 respectively). Although multifollicular growth demonstrated higher pregnancy outcomes than monofollicular growth, intermediate follicles (14-16 mm) had a positive impact on pregnancy outcome in monofollicular growth like multifollicular subgroup. We found no difference in CPR and LBR according to the luteal phase vaginal progesterone gel. Nevertheless, multifollicular cycles and also monofollicular growth cycles with two and more intermediate follicles may have benefit LPS in gonadotropin-induced IUI cycles.

Ultrasound-Guided Microsurgical Excision for Brachial Plexus Schwannomas: Short-Term Clinical Study.

AIM: To describe the ultrasound-guided microsurgical excision technique and to evaluate the surgical outcomes of brachial plexus schwannomas. MATERIAL AND METHODS: Eleven patients who underwent ultrasound-guided microsurgery for small ( < 3 cm) brachial plexus schwannomas between 2013 and 2017 were included in our study. RESULTS: The mean age of the patients was 45 years (range: 30-68 years), with six tumors localized on the right and five on the left side. There were no perioperative or postoperative complications. No postoperative deficits were observed in the patients. CONCLUSION: Surgeons can safely and completely excise most of the benign ( < 3 cm and non-palpable) brachial plexus tumors by the ultrasound-guided microsurgical excision technique.

Surgical outcome and efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum for recurrent lumbar disc herniations.

The reoperation for recurrent lumbar disc herniation (LDH) causes difficulties and low surgical outcome. The operation technique which was preferred in the first surgery has gained importance in reoperation for recurrent-LDH. The aim of our study is to evaluate the efficacy of lumbar microdiscectomy technique with preserving of ligamentum flavum (LF) for recurrent lumbar disc surgery. 149 patients were evaluated in two groups in our study, who were treated for single level recurrent-LDH in our clinic. The first group contains 86 patients who were treated by lumbar microdiscectomy without preserving LF during first surgery in other clinics, the second group contains 63 patients who were treated by lumbar microdiscectomy with preserving of LF during first surgery in our clinic. We investigated age, weight, gender, recurrence-time, level-side of recurrent-LDH, the surgical outcomes and hemorrhage, complications, operation-time. The mean-age was 45,9 ±â€¯12,9, 44,1 ±â€¯11,6 years and mean-weight was 73,4 ±â€¯14,4, 77,3 ±â€¯14,2 kg in two groups. 29 patients were treated for L3-4, 63 patients for L4-5, 57 patients were treated for L5-S1 recurrent LDH. The preoperative and follow-up back-leg pain Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) scores decreased significantly in all patients (p < 0,05). The average operation-time was 70,9 ±â€¯5,2 and 42,3 ±â€¯4,6 min and the average surgical hemorrhage was 91,1 ±â€¯11,3 and 50,3 ±â€¯7,4 ml in 1. group and 2. group respectively. Preserving of LF in first surgery is gaining importance for recurrent lumbar disc surgery with protected anatomical structures. Our technique decreases complication, operation time, surgical hemorrhage and provides good surgical outcomes in recurrent lumbar disc surgery.

Long-Term Clinical Outcome and Reoperation Rate for Microsurgical Bilateral Decompression via Unilateral Approach of Lumbar Spinal Stenosis.

OBJECTIVE: To evaluate long-term outcome and reoperation rate for microsurgical bilateral decompression via unilateral approach of lumbar spinal stenosis, a common degenerative spinal disease of the lumbar spine. METHODS: In this observational prospective study, 918 patients were treated for single-level or multilevel lumbar spinal stenosis by bilateral decompression via unilateral approach between January 2002 and January 2016. Of 918 patients, 180 underwent microdiscectomy with decompression. Follow-up consisted of radiologic investigations, Oswestry Disability Index questionnaire, and 36-Item Short-Form Health Survey at 6 and 12 months postoperatively. RESULTS: There were 492 female patients (53.6%) and 426 male patients (46.4%) with a mean age of 63.83 ± 10.16 years (range, 43-79 years). Symptom duration was 4-49 months. Average follow-up time was 98 months (range, 25-168 months), and reoperation rate was 2.5%. Oswestry Disability Index scores decreased significantly (from 30.65 ± 7.82 to 11.32 ± 2.50 at 6 months and 11.30 ± 2.49 at 12 months), and 36-Item Short-Form Health Survey parameter scores demonstrated a significant improvement in the early and late follow-up results. CONCLUSIONS: Bilateral decompression via unilateral approach for lumbar spinal stenosis allowed a sufficient and safe decompression of the neural structures, resulting in a highly significant reduction of symptoms and disability, acceptable reoperation rate, and improved health-related quality of life.

Cranio-Orbital Tumors: Clinical Results and A Surgical Approach.

OBJECTIVES: In this study, we aimed to share the surgical approaches and clinical experiences of cranio-orbital tumors, which are surgically difficult anatomies. METHODS: A total of 22 orbital tumors with extraorbital-transcranial pathology between January 2004 and December 2017 were retrospectively reviewed. Information was obtained from hospital, operation and outpatient records for this study. Preoperative demographic data, ophthalmologic examination findings, clinical and radiological findings were recorded. All patients had cranial magnetic resonance and cranial computerised tomography examinations at this time. The location of the tumor, its size and its relation to neighboring structures were recorded in the light of these examinations. RESULTS: The lateral approach was performed in 12 cases. The lateral approach was performed with frontotemporal craniotomy. Because of the lateral inferior location of the tumor in three of 12 cases, zygoma osteotomy was added to classical osteotomy. In 10 cases, the anterior approach was applied and the frontal craniotomy was found sufficient in seven cases. In three cases subfrontal craniotomy was added to classical craniotomy. CONCLUSION: The findings obtained in this study suggest that high resection rates can be achieved with appropriate surgical intervention in orbital tumors requiring a transcranial surgical approach. The most important factor in surgical planning is the location of the tumor. The size of the tumor and the expectation of the percentage of surgical removal are the other important factors. In our series, it has reached high excision ratio in most cases with low complication rate, good visual field and eye movements results.

Minimally Invasive Open Surgical Approach and Outcomes for Carpal Tunnel Syndrome.

OBJECTIVES: The most common peripheral neuropathy is carpal tunnel syndrome. The present study aims to describe our minimally invasive open surgical approach for carpal tunnel syndrome and evaluate surgical outcomes. METHODS: We included 217 patients who were operated in our clinic for carpal tunnel syndrome by minimally invasive open surgical approach. Visual Analogue Scale and Functional Outcome Scale scores were obtained preoperative, postoperative at one month and three months to determine surgical outcomes. RESULTS: The mean age of the patients was 55.4±12.8 years (32 to 69), 175 (80.6%) were women and 42 (19.4%) were men. The assessment of carpal tunnel syndrome's etiology showed that 189 (%87.1%) of the cases were idiopathic, 19 (8.8%) had hypothyroidism, 5 (2.3%) had rheumatoid arthritis and 4 (1.8%) were due to pregnancy. The average improvement of VAS between preoperatively and late postoperatively was 5.41±1.05. The average improvement FOS was 17.44±3.06. They were statistically significant. CONCLUSION: The minimally invasive open surgical approach for carpal tunnel syndrome (an average of 1 cm skin incision) is performed with local anesthesia and successful surgical outcomes are achieved.

Midterm outcome of thoracic disc herniations that were treated by microdiscectomy with bilateral decompression via unilateral approach.

Thoracic disc herniation (TDH) surgery carries risks of neurological worsening due to thoracic cord retraction injury. Multiple approaches have been developed aiming for resecting the disc herniations of the thoracic segment. We have conducted a prospective observational study to evaluate the mid-term outcome of thoracic microdiscectomy with bilateral decompression via a unilateral approach (BDUA). Patients were checked pre-operative, post-operative, and late follow-up by Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and radiological images. Twenty-three patients were treated for TDH by microdiscectomy with BDUA between January 2010 and January 2015. Nine patients were female, fourteen were male, and all of those mean age was 51,2 ±â€¯8,3 (range 29-64 years). The mean follow-up time was 22,04 ±â€¯8,59 months (range 13-58 m). The ODI and VAS scores decreased significantly in both postoperative and late follow-up evaluations. Microdiscectomy with BDUA for thoracic disc herniations allowed sufficient and safe decompression of the neural structures and resulted in a significant reduction of symptoms and disability.

A Prospective Study of Interbody Fat Graft Application With the Anterior Contralateral Cervical Microdiscectomy to Preserve Segmental Mobility.

BACKGROUND: Any surgical procedure aims at protecting mobile segments at the operated level, and the sagittal balance of the columna vertebralis. Interbody fusion has become an often applied technique in anterior cervical discectomy. OBJECTIVE: To indicate that a minimally invasive technique in which we use interbody fat graft placement showed great results and effectiveness, especially in patients who were suffering from cervical paramedian disc herniation. METHODS: In this study, 432 patients were observed from 2000 to 2013. All these consecutive patients had paramedian disc herniation. The initial 239 patients (group 1) underwent microdiscectomy without graft placement, whereas the remaining 193 patients (group 2) had a microdiscectomy with interbody fat graft insertion. The Neck Disability Index (NDI) and Short Form-36 (SF-36) were used to evaluate clinical outcomes. They were followed up for 5.3 years (range 2-13 years). RESULTS: Spontaneous radiological fusion was noticed in 12% of group 1 patients and none of the group 2 patients. It has been observed that the mean overall cervical curvature (C2-7) angles and segmental lordosis did not change significantly in late follow-up findings. During both early and late follow-ups, all patients indicated a decreasing NDI score, but in late follow-up, an improving SF-36 score. CONCLUSION: This surgical technique provides good direct decompression and preserves mobility at the treated level, while preventing disc collapse.

Computerized Tomography-Guided Stereotactic Biopsy of Intracranial Lesions: Report of 500 Consecutive Cases.

AIM: Computed tomography (CT)-guided stereotactic brain biopsy has been performed in our clinic since March 1998. In this prospective study, we examined the patient data undergoing stereotactic biopsy and the results of biopsies in 500 consecutive patients. MATERIAL AND METHODS: Between the dates of March 1998 and January 2015, CT-guided stereotactic biopsies were performed by using the Leksell stereotactic frame system (Elekta Instruments EU, Sweden) in 500 patients. A total of 512 procedures were performed in patients consisting of 184 females (36.8%) and 316 males (63.2%), ages ranging from 3 to 81 years (mean 50.40±16.67). RESULTS: Conclusive histopathological diagnosis was not achieved in 17(3.3%) of 512 procedures. Of the others, 173 (33.8%) were high-grade gliomas, 103 (20.1%) were low-grade gliomas, 36 (7%) were malignant lymphomas, 34 (6.6%) were other types of brain tumors, 82 (16%) were metastasis and 67 (13.1%) were non-tumoral lesions. Complications were occurred in ten cases: 3 tumoral bleedings, 2 hypertensive cerebral hematomas, 2 peroperative convulsions, 1 epidural hematoma, 1 myocardial infarction and 1 brain edema. The patients who developed myocardial infarction and hypertensive thalamic hematoma died. The mortality was 0.4% and morbidity was 1.6% in 512 procedures. CONCLUSION: CT-guided stereotactic biopsy is a reliable and a safe procedure in cases with intracranial lesions when histopathological diagnosis is required for the appropriate treatment.

The effect of health-promoting lifestyle education on the treatment of unexplained female infertility.

OBJECTIVE: This study aimed to reveal the 1) awareness, 2) improvements of a health-promoting lifestyle on women with unexplained infertility having at least one of the risk factors that have been indicated to negatively affect fertility (smoking, body mass index lower than 18.5kg/m2 and more than 25kg/m2, over-exercising or not exercising at all, alcohol consumption, caffeine consumption of more than 300mg/day, and high levels of stress) by means of health-promoting lifestyle education, 3) the effect of this improvement on the result of assisted-reproduction treatment in terms of clinical pregnancy. STUDY DESIGN: 64 women diagnosed with unexplained infertility were divided into a group receiving Health-Promoting Lifestyle (HPL) education and a control group. 1) Risk Factors Questionnaire (BMI, Smoking, Alcohol, Stress, Exercise, Caffeine), 2) Depression, Anxiety and Stress Scale, 3) Health-Promoting Lifestyle Profile II. The health promoting lifestyle was given to the education group. The Risk Factors Questionnaire; Depression, Anxiety, Stress Scale and Healthcare-Promoting Lifestyle Profile II were also administered after the first-second-third month of education but before ART treatment. RESULTS: A statistically significant decrease was found in the average levels of four variables as; BMI (p<0.001)-stress (p<0.001)-caffeine consumption (p<0.001)-lower exercise levels (p<0.001). Moreover, the total number of risk factors that females had between the first and third interview decreased significantly. Clinical pregnancy rate after ART was 12 (46.1%) and 5 (19.2%) in education and control group consequently (p=0.02). CONCLUSION: Health-promoting lifestyle education was found to be effective in reducing the lifestyle risk factors for infertility and increasing the success rates of assisted reproduction treatment by correcting these risk factors.

Effects of nasal continuous positive airway pressure therapy on partners' sexual lives.

To assess sexual functioning in male and female partners before and after nasal continuous positive airway pressure (CPAP) therapy in men with obstructive sleep apnea (OSA). Twenty-one male patients with moderate to severe OSA and erectile dysfunction, and their female partner, were recruited into this prospective study. Males diagnosed with OSA were treated with nasal CPAP therapy for 12 weeks. Women were assessed for sexual functioning using the Female Sexual Function Index (FSFI), and for mood status using the Beck Depression Inventory (BDI), before and after their male partner underwent nasal CPAP therapy. Sexual functioning was assessed in men using the International Index of Erectile Function (IIEF), before and after nasal CPAP therapy. After nasal CPAP therapy for OSA in men, IIEF scores were significantly higher than pre-treatment scores. Total pre- and post-treatment IIEF scores (mean ± standard deviation) were 50.28 ± 15.88 and 65.42 ± 7.47, respectively, P < 0.01. Pre- and post-treatment FSFI scores in women were 21.54 ± 6.62 and 29.94 ± 3.76, respectively, P < 0.01. Pre- and post-treatment BDI scores in women were 14.61 ± 9.69 and 12.42 ± 8.92, respectively, P < 0.01. Following treatment of men with OSA, our data indicate benefits for nasal CPAP therapy on sexual functioning in both the male and female partners. Moreover, our findings indicate that improved sexual function in women after their male partner underwent nasal CPAP also had psychological benefits.

What is the Risk of Metabolic Syndrome in Adolescents with Normal BMI who have Polycystic Ovary Syndrome?

OBJECTIVE: The purpose of this study is to evaluate the effect of polycystic ovarian syndrome (PCOS) on the prevalence of metabolic syndrome (MBS) in adolescent girls with normal BMI. MATERIALS AND METHODS: Our study group consisted of 63 pubertal girls with a BMI less than 25 kg/m(2) who were referred to our center with signs of hirsutism or oligomenorrhea. The diagnosis of PCOS was based on the recent ESHRE/ASRM proposal and required that all 3 of the Rotterdam criteria for diagnosing PCOS in adolescents be met. The control group consisted of 159 pubertal girls matched for age and BMI. Glucose, insulin, testosterone, and sex hormone-binding globulin, free testosterone and all lipid parameters measured. For to diagnose the cases with MBS, modified Cook criteria were used and cases who had at least 3 of 5 criteria's were diagnosed as MBS. RESULTS: Girls with PCOS had higher blood pressure parameters (systolic/diastolic) (P < .01), fasting insulin (P = .007), low-density lipoprotein (P = .017), triglyceride (P = .045), total (P < .001) and free testosterone (P = .001) levels compared to control group. There were more cases who had at least 1 Cook criterion in girls with PCOS compared to the control group but the difference was not significant. However, there were more cases who had MBS in girls with PCOS compared to the control group (P = .02). CONCLUSION: MBS prevalence is higher in normal BMI adolescent girls with PCOS compared to age and BMI matched control group. So as clinicians, we must search for the MBS criteria's in girls with PCOS even if they have a normal BMI.