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.

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.

Effects of dehydroepiandrosterone (DHEA) on follicular dynamics in a diminished ovarian reserve in vivo model.

The objective of this study was to determine whether there are changes in primary, primordial, and growing follicles after dehydroepiandrosterone (DHEA) administration in rats that have diminished ovarian reserve (DOR) due to 4-vinylcyclohexene diepoxide (VCD) application, and to examine the mechanism of the probable effect of DHEA on folliculogenesis. Two groups of Wistar rats were used. In Group A unilateral oophorectomy (eight rats) was carried out on day-0. The remaining study ovary was removed by relaparotomy after VCD (160 mg/kg, intraperitoneally) was administered for 15 days. In Group B unilateral oophorectomy (eight rats) was carried out on day-0. The remaining study ovary was removed by relaparotomy after VCD (160 mg/kg, intraperitoneally) administration for 15 days followed by DHEA (60 mg/kg body weight) daily for 45 days. Primordial, primary, and growing (secondary+antral) follicles were counted in 1,664 sections from 32 ovaries. In all three types of follicles (primordial, primary, and growing), the number of follicles significantly decreased in the study ovaries compared to the control ovaries in both Group A and Group B. In Group B, atresia rates were significantly lower in the study ovary compared to the control ovary in all of the follicular groups: primordial (p=0.02), primary (p=0.01), and growing (p=.027). To demonstrate the probable effects of DHEA on follicular dynamics, we also compared the study ovaries in both groups; the primordial (p=0.027), primary (p=0.031), and growing (p=0.04) number of follicles were significantly higher in Group B compared to Group A. In conclusion, our findings suggest that DHEA administration in DOR rats due to VCD results in a larger follicular pool. Decreased atresia may be one of the possible effects of DHEA in DOR cases. Whatever the mechanism, DHEA treatment potentially may be useful clinically as a means to increase the number of gonadotropin-responsive follicles for ovarian stimulation.

The role of perivitelline space abnormalities of oocytes in the developmental potential of embryos.

OBJECTIVE: In assisted reproductive technology (ART), high embryo quality is closely related to high-quality oocytes. Cytoplasmic maturation and extracytoplasmic maturation are the most important components in determining oocyte quality. One of the most important components of extracytoplasmic maturation is perivitelline abnormalities. The aim of this study is to determine the effect of perivitelline abnormalities on the development of high-quality embryos. MATERIAL AND METHODS: The study material consisted of 217 of 1154 oocytes from 98 intracytoplasmic sperm injection (ICSI) cycles undertaken due to male factor infertility. Only cycles with long gonadotropin-releasing hormone analogs combined with recombinant Follicle-stimulating hormone (rec-FSH) were included in study. We compared 105 metaphase-II oocytes that had dominantly perivitelline space abnormalities (large perivitelline space with or without granules) with 112 normal metaphase-II oocytes, based on the embryo grade determined by Alpha Scientists in Reproductive Medicine and the European Society of Human Reproduction and Embryology (ESHRE) Special Interest Group of Embryology. Normal metaphase-II oocytes were characterized by a round, clear zona pellucida; a small perivitelline space containing a single unfragmented first polar body; and a pale, moderately granular cytoplasm with no inclusions. RESULTS: The development rates of Grade I, II, and III embryos were 68.5%, 23.8%, and 7.7%, respectively, in the 105 oocytes with perivitelline abnormalities. The development rates of Grade I, II, and III embryos were 82.1%, 17.9%, and 0%, respectively, in the 112 morphologically normal oocytes. When compared with normal oocytes, Grade I (68.5% vs. 82.1%, p value; 0.019) and Grade III (7.7% vs. 0%, p value; 0.003) embryo development rates were significantly lower in oocytes that had perivitelline abnormalities. CONCLUSION: It is important to analyze oocyte quality using multiple parameters, including the perivitelline space. Perivitelline space abnormalities might negatively affect embryo development in male factor-infertile couples that are stimulated with rec-FSH. Therefore, when choosing embryos for transfer, we must take into consideration the historical oocyte data.

Follicular fluid and serum vascular endothelial growth factor, interleukin (IL)-1ß and glycodelin concentrations: comparison between long-gonadotropin-releasing hormone (GnRH)-agonist and GnRH-antagonist cycles: a randomized controlled trial.

In this randomized controlled trial, we aimed to examine whether differences exist among patients who underwent assisted reproductive technology treatment with a long-GnRH-agonist compared to a GnRH-antagonist protocol in terms of levels of follicular fluid (FF) and serum concentrations of vascular endothelial growth factor (VEGF), glycodelin and interleukin (IL)-1ß on the day of oocyte pick-up (OPU). In 80 infertile couple with male factor or unexplained infertility, 40 women stimulated with GnRH-antagonist protocol and 40 women with the long-GnRH-agonist protocol. FF and blood serum samples were obtained simultaneously from 80 women during the OPU procedure and the concentrations of VEGF, IL-1ß and glycodelin were measured with commercially available kits. Concentrations of FF VEGF, IL-1ß and glycodelin were not significantly different in the long-GnRH-agonist and GnRH-antagonist groups, and neither were serum concentrations of VEGF, IL-1ß and glycodelin. According to our results in at least, we can say that minor differences between these protocols in terms of clinical pregnancy do not depend on VEGF, glycodelin or IL-1ß.

Comparison of nonsteroidal anti-inflammatory drugs and misoprostol for pain relief during and after hysterosalpingography: prospective, randomized, controlled trial.

STUDY OBJECTIVE: To assess whether vaginal misoprostol or oral nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain during and 30 minutes after hysterosalpingography (HSG). DESIGN: Randomized prospective, controlled, parallel-group study (Canadian Task Force classification I). SETTING: University teaching hospital. PATIENTS: One hundred sixty-eight women with primary infertility who underwent HSG for evaluation of infertility. INTERVENTIONS: Patients were randomly assigned to 1 of 3 groups. Group 1 received 200 µg misoprostol vaginally 6 hours before HSG; group 2, 50 mg diclofenac potassium orally 45 to 60 minutes before HSG; and group 3, no medication. The primary outcome of the study was to evaluate the severity of pain during and 30 minutes after the procedure using a visual analog scale (VAS) ranging from 1 (very favorable) to 10 (very unfavorable). The secondary outcomes were to assess the rate of completion and the vasovagal effects including nausea, vomiting, sweating, weakness, syncope, hypotension, and bradycardia. MEASUREMENTS AND MAIN RESULTS: There was no statistically significant difference in the median (25%-75%) VAS pain scores between women administered vaginal misoprostol (median, 6.7 cm; range, 4.7-9 cm) and the control group (median, 6.7 cm; range, 4.6-8.8 cm) during the HSG. However, women in the NSAID group (median, 5.5 cm; range, 3-7.6 cm) reported less pain than did those in the misoprostol group (p = .009) and the control group (p = .03). At 30 minutes after HSG, there was no significant difference in the median VAS pain scores between patients administered NSAIDs (median, 2.3 cm; range, 1.4-4.2) or misoprostol (median, 2.3 cm; range, 1.2-4.4) and the control group (median, 2.2 cm; range, 1.3-4.4). CONCLUSIONS: There is no benefit in terms of pain reduction with the use of misoprostol during HSG or at 30 minutes after the procedure. However, NSAIDs are associated with pain relief during the HSG procedure.

Frequency and determinants of urogenital symptoms in postmenopausal Islamic women.

OBJECTIVE: The objective of this study was to evaluate the frequency of genitourinary symptoms and their relationships with several factors in a large cohort of postmenopausal women in Turkey. METHODS: We performed a cross-sectional study to review genitourinary complaints among 1,328 postmenopausal women; 1,071 of these women were enrolled in the study. They were questioned about their vaginal and urinary symptoms, and the relationships between these symptoms and their demographic characteristics were evaluated. RESULTS: The most common vaginal and urinary symptoms were dryness (n = 358; 33.4%) and nocturia (n = 421; 39.3%), respectively. Cigarette smoking and regular exercise were not associated with any vaginal symptoms (P > 0.05), with the exception of an association between regular exercise and vaginal dryness (P = 0.026). Nocturia was more common in women older than 60 years (P = 0.001) and in obese women (P = 0.013). Based on multiple binary logistic regression analysis, lower educational status (primary school vs secondary school or higher) and higher parity were the factors most significantly associated with the appearance of at least three vaginal symptoms. Lower educational status was associated with vaginal pain (P = 0.002; odds ratio [OR], 1.75), itching (P < 0.001; OR, 1.23), and discharge (P = 0.011; OR, 1.46). Higher parity was associated with vaginal itching (P < 0.001; OR, 1.23), discharge (P = 0.07; OR, 1.18), and burning (P = 0.012; OR, 1.16). Body mass index (BMI) was the only factor that was significantly associated with the appearance of at least three urinary symptoms, with each one-unit increase in BMI increasing the risk of urgency (P < 0.001; OR, 1.06), nocturia (P < 0.001; OR, 1.06), and frequency (P = 0.009; OR, 1.04). CONCLUSIONS: We identify associations between the frequency of genitourinary complaints and educational status, parity, and BMI. There is no association between regular exercise and urogenital symptoms. However, prospective studies are needed to evaluate the effects of regular exercise on urogenital symptoms. When examining postmenopausal women with risk factors for urinary and vaginal symptoms, clinicians should evaluate these symptoms more thoroughly to facilitate earlier treatment.

Factors predictive of clinical pregnancy in the first intrauterine insemination cycle of 306 couples with favourable female patient characteristics.

The objective of this study was to evaluate the factors predictive of clinical pregnancy in the first superovulation/intrauterine insemination (SO/IUI) cycle of couples with favourable female characteristics. We analyzed retrospectively the first SO/IUI cycle of 306 infertile couples with mild male factor infertility and unexplained infertility. The women had a favourable prognosis in terms of ovarian reserve. Univariate logistic regression analyses identified body mass index (BMI) [odds ratio (OR) = 0.9, P = 0.014], sperm concentration [OR = 1.007, P = 0.007] and inseminating motile sperm count (IMC) [OR = 1.007, P = 0.032] as significant predictive factors of clinical pregnancy. Multivariate logistic regression analysis identified BMI [OR = 0.87, P = 0.008] and sperm concentration [OR = 1.008, P = 0.011] as significant factors. Pregnant and non-pregnant groups did not differ significantly in terms of the age and smoking status of the woman, duration and type of infertility, length of the stimulation, total gonadotropin dosage or antral follicle count. Of the female characteristics investigated, BMI was the most significant predictive factor of clinical pregnancy in the first SO/IUI cycle of couples with unexplained or mild male factor infertility and favourable female characteristics. In overweight women, weight loss should be advised before starting SO/IUI. Sperm concentration and IMC were significant male predictive factors for clinical pregnancy in the first SO/IUI.

A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles.

OBJECTIVE(S): To compare the clinical pregnancy rates between intrauterine insemination (IUI) simultaneously or 34-36 h following hCG injection in gonadotropin-stimulated IUI cycles. STUDY DESIGN: Randomized, prospective, controlled, study conducted in a university infertility clinic. Of 923 infertile couples, 220 couples with unexplained infertility or mild male factor infertility were included to the study. Before ovarian stimulation patients were randomized into two groups: IUI at 34-36 h after hCG injection (group I) (n=106) and IUI simultaneously with hCG administration (group II) (n=98). The primary outcome was clinical pregnancy rates. RESULTS: There was no significant difference between the groups according to baseline patient and cycle characteristics. Clinical pregnancy rates were 9.4% and 12.2% in group I and group II, respectively (p=0.523). Although group II had better outcomes there was no statistically significant difference in clinical pregnancy rates between the different timing methods: IUI simultaneously with hCG versus IUI at 34-36 h after hCG (odds ratio (OR)=1.35, 95% CI 0.53-3.42). CONCLUSION(S): There is no difference in simultaneous use of hCG injection compared to cycles in which IUI is performed after 34-36 h following hCG injection. Prospective randomized trials with larger sample sizes or meta-analyses are required.

Effectiveness of vaginal misoprostol and rectal nonsteroidal anti-inflammatory drug in vaginoscopic diagnostic outpatient hysteroscopy in primarily infertile women: double-blind, randomized, controlled trial.

STUDY OBJECTIVE: To assess whether vaginally administered misoprostol or rectally administered nonsteroidal anti-inflammatory drug reduces pain during vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile patients. DESIGN: Double-blinded, randomized, controlled trial (Canadian Task Force classification I). SETTING: Department of reproductive medicine at a university teaching hospital. PATIENTS: One hundred fifty-eight primarily infertile women who underwent outpatient hysteroscopy for evaluation of infertility. INTERVENTIONS: Patients were randomly assigned to 3 groups. Women in group 1 received 200 µg misoprostol vaginally at 6 hours before outpatient hysteroscopy and placebo tablets rectally at 60 minutes before the procedure. Women in group 2 received placebo tablets rectally at 6 hours before outpatient hysteroscopy and 100 mg diclofenac sodium rectally at 60 minutes before the procedure. Women in group 3 received placebo tablets vaginally at 6 hours before outpatient hysteroscopy and placebo tablets rectally at 45 to 60 minutes before the procedure. Patients were asked to record severity of pain, which was the primary outcome of the study, during the outpatient hysteroscopy procedure by using a visual analog scale ranging from 1 (very favorable) to 10 (very unfavorable). Secondary outcomes included procedural time from introduction of the hysteroscope through the external cervical os and visualization of the uterine cavity, patient acceptance recorded by the patient using a 5-point Likert scale, post-procedural analgesic requirements, and vasovagal effects. MEASUREMENTS AND MAIN RESULTS: Median (range) pain scores for the women in group 1 (4.75 [3.12-6.54]) and group 2 (5.01 [2.8-7.05]) were not significantly different from those in group 3 (4.15 [2.17-6.92]) (p = .57). There was also no significant difference in patient acceptance (Likert scale) (p = .67), vasovagal symptoms (p = .84), procedure time (p = .05), and post-procedural analgesic requirement (p = .71). CONCLUSIONS: We were unable to demonstrate a benefit in pain reduction and patient acceptance with the use of vaginal misoprostol or rectal NSAIDs during vaginoscopic diagnostic outpatient hysteroscopy in nulliparous infertile women without a history of cervical stenosis. Trials investigating the optimal time for vaginal misoprostol premedication for pain relief in vaginoscopic outpatient hysteroscopy are needed. New interventions and/or drugs should be studied to decrease pain perception during vaginoscopic outpatient hysteroscopy.

Relationship between oxidative stress and clinical pregnancy in assisted reproductive technology treatment cycles.

PURPOSE: To examine the relationship between serum total oxidant (TOS) and antioxidant (TAS) levels and clinical pregnancy in assisted reproductive technology (ART) cycles. METHODS: Prior to and after oocyte pick-up (OPU) and embryo transfer (ET), blood samples were collected from gynecologically normal females (n = 70) who were enrolled for ART solely due to male factor infertility. TAS, TOS levels and oxidative stress indexes (OSI: TOS/TAS) in four phases of treatment cycle (pre and post OPU and ET) between clinically pregnant and non-pregnant patients were compared. Critical cut-off values of significantly different TAS, TOS levels and OSIes for clinical pregnancy were established. RESULTS: The TAS levels in patients with clinical pregnancy were significantly higher in all of the four phases of the cycle. Post-OPU and pre-ET TOS levels were significantly higher in clinically pregnant patients. According to OSIes; only the pre-OPU OSI was significantly lower in clinically pregnant patients compared with non-pregnant ones. Moreover, the highest area under the ROC curve (AUC) from the seven different significant measurements [1) pre-OPU OSI, 2) pre-OPU TAS, 3) post-OPU TAS, 4) pre-ET TAS, 5) post-ET TAS, 6) post-OPU TOS, 7) pre-ET TOS] was related to pre-OPU OSI. CONCLUSIONS: In ART cycles, women with a higher total antioxidant status prior to and after OPU and prior to and after ET have an increased probability of clinical pregnancy. Additionally; OSI before OPU was one of the most important determinants for clinical pregnancy, so the oxidant and antioxidant balance is as important as the antioxidant concentration alone.

Incompletely Evaluated ART Leading to Ectopic Pregnancy and Cerebral Thrombosis.

We presented a cerebral venous thrombosis case associated with lack of proper medical evaluation required for confirmation of suppression and exclusion of current pregnancy before starting assisted reproductive technology (ART) cycle. This is a case-report study about a 37-year-old woman who presented to emergency room with abdominal pain and tenderness. Initial human chorionic gonadotropin (hCG) value was 17616 IU/L. Endometrium was heteregenous and incompatible with a normal intrauterine pregnancy. She had a history of antagonist protocol/controlled ovarian hyperstimulation (COH) started 38 days ago in a different in vitro fertilization (IVF) center. Because of the fertilization failure, she had no embryo transfer. With ectopic pregnancy diagnosis, we made surgical exploration and observed a material which was consistent with ectopic pregnancy on the right tuba uterina. Partial salpingectomy was applied because of actively bleeding ectopic pregnancy. Two days after discharging from hospital; she presented to emergency room again with syncope and generalized tonic-clonic seizure. By cranial tomography generalized edema, cerebral venous thrombosis was established. Enoxaparine sodium 0.6 ml twice daily was administered. Six days after hospitalisation, she was discharged with normal neurological examination under phenytoin 200 mg daily and enoxaparine sodium 0.6 ml daily. Before ART treatment, clinicians must always rule out the likelihood of existing pregnancy by measuring estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH). On the other hand, low-molecularweight heparine may be effective in cerebral venous thrombosis treatment. Therefore, intracerebral thrombosis is one of the rare mortal complications of ART.

The effects of infertility on sexual functions and dyadic adjustment in couples that present for infertility treatment.

OBJECTIVE: The aim of this study was to determine the effects of infertility on sexual functions and dyadic adjustment in infertile couples that seek infertility treatment. MATERIALS AND METHODS: The Beck Depression Inventory (BDI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), and Dyadic Adjustment Scale (DAS) were administered to the infertility group (n = 220) and control group (n = 110). None of the study participants had an Axis I psychiatric disorder. RESULTS: There wasn't a significant difference in BDI score between the 2 groups. None of the study participants had clinical depression. Men in both groups reported more problems according to GRISS total scale and subscale scores (except the avoidance subscale) than the women. Women in both groups reported more problems according to GRISS avoidance subscale score than did the men. Men in the control group reported more problems on the GRISS frequency subscale, as compared men in the infertile group. Women in the control group reported more problems based on GRISS total score, and GRISS frequency, satisfaction, touch, and avoidance subscale scores, as compared to the women in the infertile group. The men in the infertile group were more satisfied with dyadic adjustment than the women in the infertile group. The men and women in the control group had higher DAS total score, and DAS consensus and emotional expression subscale scores. CONCLUSION: The differences in sexual functions between the infertile and control groups were not significant. Both women and men in the infertility group reported more dyadic adjustment problems than those in the control group.

Early postoperative changes in testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin after hysterectomy with or without concomitant oophorectomy.

OBJECTIVE: To investigate the cross-sectional associations of hysterectomy and oophorectomy status, chronological age, and body mass index with early postoperative plasma levels of total and free T, DHEAS, and sex hormone-binding globulin (SHBG). DESIGN: A cross-sectional study. SETTING: University hospital. PATIENT(S): Ninety-two women age 35-47 years who were scheduled for hysterectomy and/or oophorectomy, advocated for benign gynecological pathologies. INTERVENTION(S): Ninety-two eligible premenopausal women underwent hysterectomy and/or oophorectomy, with plasma T, DHEAS, and SHBG levels assayed before surgery and during the postoperative period. MAIN OUTCOME MEASURE(S): Effects of time x operation and age x operation interactions between oophorectomized and nonoophorectomized groups and within-subject main effect of time on plasma androgen levels. RESULT(S): Of 92 women, hysterectomy alone was performed in only 49 (53.3%) cases. Oophorectomy, either unilateral or bilateral, was performed in 35.8% of cases. Age x within-group interactions exhibited an important difference (P=.03) in total T levels. The time x between- and within-group interaction effects on plasma DHEAS levels of postoperative day 7, compared with day 1, were statistically significant (P<.001). The effect of time x group interaction was remarkable, in terms of SHBG levels during the postoperative period. Age x oophorectomy interaction exhibited a statistically significant change of decline in DHEAS levels on postoperative day 7 (P=.05). CONCLUSION(S): The present study demonstrated a time and operation effect decline in plasma DHEAS levels. In contrast, the time x operation interaction on SHBG levels exhibited an increase toward postoperative day 7.

Are the site, diameter, and number of endometrial polyps related with symptomatology?

OBJECTIVE: The objective of the study was to evaluate the relationship among polyp site, number, diameter, and symptomatology in endometrial polyps in reproductive and postmenopausal women. STUDY DESIGN: One hundred fifty-five subjects with endometrial polyps were evaluated retrospectively. Sociodemographic characteristics, endometrial thickness, polyp number, diameter, and site were reviewed, and their relations with abnormal uterine bleeding were tested. RESULTS: A total of 36.1% of the patients in the postmenopausal group and 44.4% of the patients in the reproductive-aged group were asymptomatic. In addition, 37.3% of polyps in the reproductive-aged and 29.2% in the postmenopausal group were multiple. Polyp number, diameter, and site were not different among the 2 groups (P = .282, P = .469, and P = .485, respectively). When patients were evaluated as a whole, symptomatology was not related with polyp number, diameter, and site (P = .677, P = .334, and P = .699, respectively). CONCLUSION: Many endometrial polyps are asymptomatic and multiple in nature. Polyp site, number, and diameter do not correlate with symptomatology.

Associated factors with urogenital score in natural and surgical menopause.

OBJECTIVE: To anticipate the factors associated with urogenital symptoms in both natural and surgical menopause. METHODS: A retrospective analysis was performed comprising 267 cases with spontaneous menopause and 87 surgical menopause cases without any use of hormone replacement therapy. Sociodemographic characteristics, reproductive and medical history, urogenital scale and psychological subscale of Greene Climacteric Scale were assessed and correlated with the age of menopause, time past since last menstrual period, parity, body mass index (BMI), mode of delivery among two groups. RESULTS: Mean age of women enrolled to the study were 46.8+/-0.3 years and 44.4+/-0.25 years, for natural and surgical menopause cases, respectively. Mean parity had no correlation with urogenital scale in two groups. However, a positive correlation was apparent between the time since last menstrual period, psychological subscore of Green Climacteric Scale and urogenital score in both women with natural and surgical menopause. BMI was negatively correlated with urogenital score among two groups (r(p)=-0.85, p=0.04). CONCLUSIONS: Intensity and frequency of urogenital symptoms and climacteric complaints as expressed in the Greene Climacteric Scale increase during menopausal transition. Care should be taken to ameliorate the quality of life (QOL) and to confront these problems in post-menopausal women.

The hirsutism scoring system should be population specific.

The aim of our study was to evaluate severity of hirsutism, assessed via the Ferriman-Gallwey scoring system in 12 different androgen-sensitive skin areas among 65 consecutive hirsute patients with functional androgen excess (polycystic ovary syndrome and idiopathic hirsutism) from the Central Anatolian region of Turkey. Results of this descriptive study showed that the buttocks/perineum, sideburn, and neck areas greatly contributed to the total hirsutism score, rather than the upper arm, upper back, and upper abdomen.

Related factors in bone mineral density of lumbal and femur in natural postmenopausal women.

OBJECTIVE: To assess possible factors affecting the bone mineral density (BMD) in postmenopausal women. METHODS: A retrospective analysis of 267 cases with spontaneous menopause within 3 years of period was performed. None of the enrolled cases were taken any hormone replacement therapy and/or treatment for osteoporosis. BMD measurements were done in lumbal vertebral (L1-L4) and left femur (neck, intertrochanteric and ward triangle) via dual energy X-ray absorbtiometry (DEXA) method, yielding corresponding T-scores of above-mentioned areas. In addition, age at menarche, parity, menopausal age, duration of postmenopausal state, lactation, physical activity, cigarette smoking, dietary calcium intake, oral contraceptive use and body mass index (BMI) were determined. RESULTS: There were no relationships between BMD and age at menarche, parity, menopausal age, lactation, physical activity, smoking, dietary calcium intake and oral contraceptive use. Two associated factors with BMD were BMI and time since menopause. BMI was found to be positively and time since menopause was negatively correlated with BMD of both lumbal region and femur. CONCLUSIONS: BMD changes and its related factors should be kept in mind during postmenopausal years. Therefore, adequate peak bone mass and related life style measures should be achieved to confront osteoporosis-related symptoms and its consequences.

Attitudes to and management of fertility among primary health care physicians in Turkey: an epidemiological study.

BACKGROUND: The subject of infertility has taken its place in the health sector at the top level. Since primary health care services are insufficient, most people, especially women, keep on suffering from it all over the world, namely in underdeveloped or developing countries. The aim of this study was to determine primary care physicians' opinions about the approach to infertility cases and their place within primary health care services (PHCSs). METHODS: The study was conducted between October 2003 and April 2004. The study group comprised 748 physicians working in PHCSs. They were asked to fill in a questionnaire with questions pertaining to infertility support, laboratory and treatment algorithms, as well as the demographic characteristics. The data was evaluated using the chi square test, percentage rates and a logistic regression model. RESULTS: The multivariate analyses showed that having a previous interest in infertility and having worked for a postgraduate period of between 5-9 years and > or = 10 years were the variables that most positively influenced them in their approach to cases of infertility (p < 0.05, each one). Just 28.7% of the physicians indicated that they believed cases of infertility could be evaluated at the primary care level. The most frequently proposed reason for indicating 'difficulty in practice' (n = 533) was inadequate provision of equipment in PHCSs (55.7%). The physicians reported that they were able to perform most of the supportive treatments and proposals (between 64.6%-87.7%). The most requested laboratory investigations were the instruction of patients in taking basal body temperatures and semen analysis (89.7% and 88.7%, respectively). The most preferential course of treatment was that of sexually transmitted diseases (95.5%). CONCLUSION: It is clear that not enough importance is attached to the provision of care to infertile couples within PHCSs. This leads us to conclude that an integration of infertility services in primary care would be appropriate after strengthening the PHCSs.

Symptom distribution among infertile and fertile endometriosis cases with different stages and localisations.

OBJECTIVE: To evaluate endometriosis patients' symptoms and relate them to different stages and locations of endometriosis and also to fertility/infertility of the patients. STUDY DESIGN: Sixty-eight patients diagnosed with endometriosis constituted the population investigated in this cross-sectional observational study, 55 and 13 of whom were diagnosed from the visual findings recorded during laparoscopy and laparotomy, respectively. All cases were categorised as early- (stages I and II) or late (stages III and IV)-stage endometriosis and as fertile or infertile endometriosis. The extent of endometriosis was further divided into peritoneal, ovarian, and ovarian and peritoneal. Symptoms of dysmenorrhoea, deep dyspareunia, dyschesia and dysuria and also depressive mood state were analysed and compared among those different groups. RESULTS: Cyclic chronic pelvic pain was more relevant in late-stage endometriosis (P = 0.04). Deep dyspareunia, painful defecation, dysuria, infertility, and depressive state did not differ with stages of endometriosis or fertility status. Admission for pelvic pain of any duration was more prevalent among fertile patients with endometriosis (P = 0.008). Chronic noncyclic pelvic pain was more frequently observed in patients with fertile than in those with infertile endometriosis (P = 0.01). More cases in the fertile group experienced noncyclic pelvic pain (P = 0.04). More patients admitted with cyclic pelvic pain had ovarian or ovarian and peritoneal endometriosis than peritoneal endometriosis only (P = 0.03). Infertility was more prevalent among peritoneal endometriosis cases than among those with ovarian or peritoneal and ovarian involvement (P = 0.008). CONCLUSION: Symptoms of endometriosis may predict the stage and localisation of the disease to some extent.