The effect of clomiphene citrate on oxidative stress parameters in polycystic ovarian syndrome.

This study aimed to examine the possible association between the oxidative stress parameters and clomiphene citrate resistance in polycystic ovary syndrome. The demographic data, hormone profiles and oxidant and antioxidant values of 50 clomiphene citrate-resistant polycystic ovary syndrome patients (Group 1), 32 clomiphene citrate-sensitive polycystic ovary syndrome patients (Group 2) and 87 non-polycystic ovary syndrome patients (Group 3) were compared. The average age, follicle-stimulating hormone, oestradiol, thyroid-stimulating hormone and prolactin values of the three groups were found to be homogeneous. Ferroxidase, catalase and myeloperoxidase levels were determined to be lower in the clomiphene citrate-resistant group compared to clomiphene citrate-sensitive and non-polycystic ovary syndrome groups (p < .001). As a result, Polycystic ovary syndrome patients with clomiphene resistance had lower antioxidant (catalase and ferroxidase) levels compared to those who were sensitive to clomiphene and who did not have polycystic ovary syndrome. The myeloperoxidase levels also demonstrated the same trend, which might be due to a compensation mechanism.Impact StatementWhat is already known on this subject? In the literature, there are many studies evaluating the association between PCOS and oxidative stress. No research related to antioxidants in clomiphene citrate-sensitive and clomiphene citrate-resistant PCOS patients was found in the relevant literature.What do the results of this study add? In this study, the antioxidants catalase and ferroxidase were found to be lower in PCOS women compared to non-PCOS; however, they were the lowest in clomiphene citrate-resistant PCOS women. Interestingly, myeloperoxidase, which is a part of oxidative stress, was also found to be higher in the non-PCOS group.What are the implications of these findings for clinical practice and/or further research? This study contributes to the literature because it is the first to compare the relation between CC and oxidant and antioxidant markers. These markers will be a guide for PCOS management in patients with CC-R.

Does ischaemia-modified albumin level predict clomiphene citrate resistant polycystic ovary syndrome patients?

This study aims to examine the role of ischaemic-modified albumin (IMA) in predicting clomiphene citrate (CC) resistance in patients with CC-resistant and CC-sensitive infertile polycystic ovary syndrome (PCOS). Sixty women patients admitted to the infertility clinic were evaluated. The patients were divided into two groups. Group 1 comprised 30 infertile PCOS patients with CC resistance; group 2 was the control group comprising 30 infertile PCOS patients with CC sensitivity. Serum IMA levels of PCOS patients with CC resistance were significantly higher than CC sensitivity patients (p < .001). The independent variables BMI and age effects were adjusted according to the logistic regression method with groups. Significant differences were observed between the two groups in the levels of IMA (p = .0005), HOMA-IR (p = .0045), insulin (p = .022), free testosterone (p = .0001) and total testosterone (p = .03) values. By using ROC curve analysis for IMA between study and control groups, cut off point of IMA was calculated as 0.505 U/mL, sensitivity was 80% and specificity was 63%. The area under the curve was 0.926. This shows us that more oxidative stress (OS) occurs in the CC-resistant group. As a reflection of OS in the follicular endocrine, microenvironment may be linked with impaired oocyte developmental competence and embryo quality in association with increased IMA, free testosterone, total testosterone, insulin and HOMA-IR levels.Impact statementWhat is already known on this subject? In previous studies, IMA was compared between PCOS and control groups. In this study, serum IMA levels were measured in infertile PCOS patients resistant to CC for the first time.What the results of this study add? Serum IMA levels were significantly higher in resistant infertile PCOS patients compared to the control group. This shows us that more OS occurs in the CC-resistant group.What the implications are of these findings for clinical practice and/or further research? IMA will be a guide for PCOS management in patients with CC-resistant PCOS.

Increased oxidative stress is associated with thiol/disulphide homeostasis in clomiphene citrate resistant polycystic ovary syndrome.

The purpose of this study was to evaluate the relation CC resistant PCOS and the thiol/disulphide homeostasis, used as a marker of OS, by measuring that exchange using a novel technique. Sixty women patients admitted to the infertility clinic were evaluated. The patients were divided into two groups. Group 1 comprised 30 infertile PCOS patients with CC resistance; Group 2 was the control group comprising 30 infertile PCOS patients with CC sensitivity. Serum total thiol (p = .024), native thiol (p = .0052), disulphide (p = .003), index 1 (p = .001), index 2 (p = .001) and index 3 (p = .001), HOMA-IR (p < .001) and free testosterone (p < .001) were statistically significant. The independent variables BMI and age effects were adjusted according to the logistic regression method with groups. Significant differences were observed between the two groups in the levels of native thiol (p* = .0042), total thiol (p* = .024), disulphide (p* = .0003), index 1 (p* = .0001) index 2 (p*= .0001), index 3 (p* = .0001), HOMA-IR (p* = .0044), insulin (p*= .032) and free testosterone (p* = .0001) values. The thiol/disulphide homeostasis viewed in favour of OS. Like a reflection of OS in the follicular endocrine microenvironment may be linked with increased thiol/disulphide homeostasis, free testosterone, insulin and HOMA-IR levels.Impact statementWhat is already known about this subject? In previous studies, thiol/disulphide homeostasis was compared between PCOS and control groups. In this study, serum thiol/disulphide homeostasis was measured in infertile PCOS patients resistant to CC for the first time.What do the results of this study add? Disulphide concentrations were significantly higher in patients with CC resistant patients thanthe control group. This shows us that more OS occurs in the CC-resistant group.What are the implications of these findings for clinical practice and further research? Thiol/disulphide homeostasis will be a guide for PCOS management in patients with CC-resistant PCOS.

Unscarred uterine rupture and subsequent pregnancy outcome - a tertiary centre experience.

OBJECTIVES: The aim of this study was to investigate the incidence, etiology and obstetric outcomes of rupture in unscarred uterine rupture and in those with a history of uterine rupture MATERIAL AND METHODS: The hospital records of women who had delivered between May 2005 and May 2017 at a tertiary center were examined retrospectively. Data on patients with unscarred uterine rupture in pregnancy who had undergone fertility-preserving surgery were evaluated. RESULTS: During the study period, 185,609 deliveries occurred. Of those, unscarred uterine rupture has occurred in 67 women. There were no ruptures reported in nulliparous women. The rupture was observed in the isthmic region in 60 (89.6%) patients and in the fundus in 7 (10.4%) patients. Thirty-eight (56.7%) patients had undergone a total or subtotal hysterectomy, and 29 (43.3%) patients had received primary repair. Ten patients had reconceived after the repair. Of these, eight patients who had a history of isthmic rupture, successfully delivered by elective C-section at 36-37 wk. of gestation, and two experienced recurrent rupture at 33 and 34 wk. of gestation, respectively. Both patients had a history of fundal rupture, and their inter-pregnancy interval was 9 and 11 mo., respectively. CONCLUSIONS: The incidence of rupture in unscarred pregnant uteri was found to be one per 2,770 deliveries. Owing to the high morbidity, regarding more than half of the cases with rupture eventuated in hysterectomy, clinicians should be prudent in induction of labour for multiparous women since it was the main cause of rupture in this series. Short inter-pregnancy intervals and history of fundal rupture may confer a risk for rupture recurrence. Those risk factors for recurrence should be validated in another studies.

Maternal serum thiol/disulfide homeostasis in pregnancies complicated by fetal hypoxia.

We aimed to evaluate maternal serum thiol/disulphide homeostasis in pregnancies complicated by fetal distress (FD). A total of 100 patients beyond the 34th week of pregnancy were included in this study, and they were divided into two groups. The study group included 50 patients who had been diagnosed with FD; the control group was composed of 50 patients who had shown no signs of FD and who had undergone an elective (previous) caesarean section (CS). The native thiol, total thiol and native thiol/total thiol (%) concentrations were lower in Group 1 patients than Group 2 patients (p < .001). The disulphide, disulphide/native thiol (%) and disulphide/total thiol (%) concentrations were higher in Group 1 patients than Group 2 patients (p < .001). This study suggests that maternal thiol/disulphide homeostasis is impaired in pregnancies complicated by FD.IMPACT STATEMENTWhat is already known about this subject? Oxidative stress (OS) has previously been investigated in FD. This study reports for the first time a new novel and automatic measurement method.What do the results of this study add? This study shows that the thiol balance shifts in the direction of disulphide in the cases of FD.What are the implications of these findings for clinical practice and further research? Thiol balance can be used for the timely diagnosis of FD.

Can clomiphene citrate resistance be predicted by RDW-CV levels in infertile women with PCOS?

OBJECTIVE: To identify whether red blood cell distribution width coefficient of variation (RDW-CV) and mean platelet volume (MPV) levels can predict clomiphene citrate resistance (CC-R) in infertile, anovulatory females with polycystic ovarian syndrome (PCOS). METHODS: A total of 89 infertile patients who were admitted to a tertiary center diagnosed with non-obese PCOS were included in this study. The patients were divided into two groups: the first group comprised 53 non-obese patients with PCOS and CC-R, and the second group included 36 non-obese patients with PCOS and CC-S. RDW-CV, RDW-SD, and MPV values, along with routine whole blood count parameters were compared between the groups. RESULTS: RDW-CV values were found to be significantly higher in the patients with CC-R compared to those with CC-S (P < 0.05). The sensitivity, specificity, positive, and negative predictive values were found to be 69%, 58.1%, 34.5%, and 12.5%, respectively, at an RDW-CV level of 12.85. The odds ratio was calculated as 3.077 (95% CI 1.245-7.603) in terms of the cut-off point. CONCLUSION: We think that RDW-CV which is a marker of inflammation is a simple, cheap, and accessible marker for the prediction of CC resistance.

Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse - a single centre's experience.

OBJECTIVES: The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy. MATERIAL AND METHODS: This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors. RESULTS: Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤ 2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1-1.4)], low preoperative haemoglobin [OR: 0.96 (0.94-0.98)], uterine weight [OR: 2.69 (2.62-2.76)], and long operation time [OR: 1.04 (1.02-1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96-1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve. CONCLUSIONS: Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse.

Ghrelin does not change in hyperemesis gravidarum.

OBJECTIVES: Ghrelin levels can play an important role in maintaining the energy balance of pregnant women. Therefore, we investigated the relationship between HG and Ghrelin. MATERIAL AND METHODS: 50 female patients admitted to the VAN Yüzüncü Yil University, Gynecology and Obstetrics Department were evaluated. The patients were divided into two groups: Group 1 included 25 pregnant women with HG, Group 2 included 25 healthy pregnant women. RESULTS: The two groups showed similarities in terms of age, gravidity, B-HCG and gestational age. There was no statistically significant difference between the two groups in terms of the Ghrelin levels (p = 0.867). CONCLUSIONS: This study shows that there is no difference between Ghrelin levels and HG during pregnancy. Increased Ghrelin in previous studies was attributed to low oral intake. Another study reported lower Ghrelin levels are not the result of, but are rather the cause of, reduced oral intake during. The balancing of these two conditions does not lead to a change in the level of Ghrelin.