Evaluation of the effect of preoperative rectal misoprostol use on the postoperative outcomes of hysteroscopic myomectomy.

AIM: In this study, we aimed to evaluate the effect of using two doses of rectal misoprostol on postoperative results in hysteroscopic myomectomy. METHODS: This retrospective study was carried out at two hospitals in which the medical records of patients who underwent hysteroscopic myomectomy between November 2017 and April 2022 were evaluated, and subjects were grouped depending on the administration of misoprostol before hysteroscopy. In recipients, two rectal doses of misoprostol (400 µg) were administered, 12 h and 1 h before the planned operation. Outcomes evaluated were: postoperative reduction in hemoglobin (Hb), pain at 12 and 24 h (VAS score), and length of hospital stay. RESULTS: The mean age of 47 women in the study group was 27.38 ± 5.12 (range 20-38) years. Hb levels reduced significantly in both groups after hysteroscopic myomectomy (p < 0.001). In misoprostol recipients, VAS score was found to be significantly lower at 12 h (p < 0.001) and 24 h after the operation (p = 0.004). Multiple linear regression analyses for each of the outcomes revealed the following: greater myoma size was associated with greater Hb decrease (p = 0.010), misoprostol use was associated with lower 12th and 24th hour VAS scores (p < 0.001), longer duration of operation was associated with higher 12th and 24th hour VAS scores (p < 0.001), and finally, longer duration of operation was associated with prolonged hospital stay (p = 0.001). CONCLUSIONS: The use of two doses of rectal misoprostol before hysteroscopic myomectomy was effective in reducing postoperative pain. Prospective, population-based studies evaluating different uses of misoprostol in hysteroscopic myomectomy are needed.

A study of the objective benefits and safety of Er-YAG laser in the treatment of genitourinary syndrome of menopause.

The aim of this study is to evaluate changes in vaginal pH and epithelium maturation after erbium-doped yttrium aluminum garnet (Er-YAG) laser treatment, and to assess its safety and efficacy on the symptoms of genitourinary syndrome of menopause (GSM). This was a retrospective study conducted between November 2019 and April 2022 and included 32 women diagnosed with GSM who had not benefitted from lubrication treatment and could not or would not use estrogen. Patients received three sessions of Er- YAG laser. All patient data before and after treatment were obtained from computer records. Vaginal maturation index (VMI), maturation value (MV) and vaginal pH values of the patients before and after laser treatment were compared. We also evaluated post-procedural complications and symptoms. Mean age was 59.72 ± 5.66 years. After laser therapy, there was a significant decrease in vaginal pH (p < 0.001) and the proportion of parabasal cells in VMI (p < 0.001), while there was a significant increase in MV (p < 0.001) and the proportion of superficial cells in VMI (p < 0.001). In 84.4% of the patients, GSM-related symptoms regressed completely or decreased to a tolerable level. Patients in which symptoms disappeared completely had significantly lower mean age (p = 0.002) and duration of menopause (p = 0.009). The laser procedure resulted in complications including mucosal injury in 5 (15.6%) patients (all recovered spontaneously) and vaginal burning sensation in 2 (6.3%) patients. Vaginal Er-YAG laser treatment may be a safe and effective alternative treatment method in a population of women with GSM who do not want to or cannot use estrogen therapy.

Effects of sperm separation methods before intrauterine insemination on pregnancy outcomes and live birth rates: Differences between the swim-up and microfluidic chip techniques.

Various sperm preparation techniques have been developed to obtain functionally, genetically and morphologically high-quality competent spermatozoa for use in assisted reproductive technologies, which may affect treatment options and thus pregnancy outcomes and live birth rates. We aimed to compare swim-up washing procedure (SWP) and microfluidics sperm sorting (MSS) with regard to sperm separation, pregnancy outcomes and live birth rates in infertile couples receiving intrauterine insemination. A total of 326 couples with unexplained infertility who underwent intrauterine insemination were enrolled in this retrospective cohort study and were divided into 2 groups according to sperm preparation technique. The MSS and SWP methods were used to prepare sperm in 178 and 148 patients, respectively. The median sperm concentration reduced significantly from 51 (30-100) million/mL to 20 (10-40) million/mL in the MSS group, and from 45 (26-80) million/mL to 25 (11-48) million/mL in the SWP group (both P < .001). Median motility increased significantly from 30.43 ± 17.79 to 57.48 ± 20.24 in the MSS, and from 32.89 ± 13.92 to 43.91 ± 20.11 in SWP (both P < .001). There was a difference between groups after preparation regarding sperm concentration (better with SWP) and motility (better with MSS) (P = .018 and P < .001, respectively). A total of 86 (26.4%) pregnancies were observed in participants and the clinical pregnancy rate was 23% in the MSS group and 30.4% in the SWP group (P = .133). Fifty-one infants were born alive and a great majority (n = 47) were delivered at term. Multivariate logistic regression analysis showed that higher duration of infertility was independently associated with lower live birth success (odds ratio: 0.811, 95% confidence interval: 0.662-0.996; P = .045). Other variables, including female age, type and reason of infertility, number of cycles, and sperm motility and concentration, were found to be nonsignificant (P > .05). We observed nonsignificant worse reproductive results using microfluid sperm selection in comparison to the pellet swim-up technique (live birth rate = 12% vs 20%). Our evidence is of limited quality due to the retrospective design of this study and sufficiently powered RCTs are needed to evaluate whether sperm selection based using a microfluidic chip is better, similar, or worse than the pellet swim-up technique.

Eight-Hour Time-Restricted Feeding: A Strong Candidate Diet Protocol for First-Line Therapy in Polycystic Ovary Syndrome.

We aimed to investigate the effects of a 6-week program of 8 h time-restricted feeding (TRF) diet in polycystic ovary syndrome (PCOS), as determined by anthropometric, hormonal, metabolic profiles, and fecal calprotectin level. Thirty women diagnosed with PCOS underwent a 6-week 8 h TRF diet intervention. Age, anthropometric features (body mass index (BMI), waist-to-hip ratio (WHR)) and biochemical results were recorded. Free androgen index (FAI, defining hyperandrogenism) and the homeostatic model assessment-insulin resistance (HOMA-IR) were calculated. Baseline (pre-diet) and 6-week post-diet findings were compared. Mean age was 25.57 ± 2.67 years. BMI (p < 0.001) and WHR (p = 0.001) were found to have significantly decreased after the diet, as well as the percentage of patients defined to have hyperandrogenism (p = 0.016). Reproductive hormone levels, FAI (p < 0.001) and HOMA-IR (p < 0.001) were improved significantly. Metabolic parameters associated with glucose and lipid profiles were also significantly improved after the diet. Additionally, fecal calprotectin levels demonstrated a significant decrease from pre-diet to post-diet (p < 0.001). In conclusion, a 6-week diet intervention with 8 h TRF may be a suitable and effective intermittent fasting protocol that can be used as a first-line option in PCOS.