Management of menopause in women with a history of endometriosis.

Due to increasing life expectancy, women spend a significant part of their lives in menopause. Women with a history of endometriosis are more likely to become menopausal at an early age due to bilateral oophorectomy or repeated ovarian surgery. In addition, some medical therapies used for endometriosis, such as gonadotropin releasing hormone agonists or progestins reduce bone mineral density. Furthermore, women with endometriosis have a higher background risk of cardiovascular disorders and hypercholesterolemia. Hence, it is important to recommend the use of hormone replacement therapy (HRT) to these women when they become menopausal, at least until the age of natural menopause. Although based on limited data, there is a possibility of reactivation of symptoms of endometriosis or its lesions, and a theoretical possibility of malignant transformation, although this remains unproven. Therefore, women should be advised in the light of this information before starting HRT after the age of natural menopause and are asked to seek help if they experience symptoms that may indicate these changes. Estrogen only HRT should be avoided and combined HRT preparations should be recommended, even after a hysterectomy.

The effect of dietary habits on oocyte/sperm quality.

The effects of diet and nutritional habits on reproductive cells can be categorized in a variety of ways. In this review, the literature is divided, based on the dietary consumption effects on oocytes and sperm. Topics on dietary patterns and the intrauterine effect of maternal nutrition are covered. In general fruits, vegetables, whole greens, fish, legumes, and also dietary sources containing unsaturated fats can improve reproductive germ cell quality. In epidemiological studies, the food intake frequency questionnaire is one of the most common methods to assess diet. Due to methodological heterogeneity in dietary assessment and inadequacy in the measurement of dietary intake in the questionnaires used, several unreliable results may be reported. Thus, the quality of evidence needs to be improved, since nutritional diets may not be so simply objective and they are inadequate to explain obvious underlining mechanisms. In addition, various compounds that may be ingested can affect molecular mechanisms, influenced by other external factors (drugs, pesticides, smoking, alcohol) and changes in human nutritional parameters. Artificial Intelligence has recently gained widespread interest and may have a role in accurate analysis of dietary patterns for optimal nutritional benefit. Therefore, future prospective randomized studies and objective measurements, consisting of molecular level analysis of the impact on cells and clear-cut methods are needed for accurate assessment of the effect of dietary habits on reproductive treatment.

Do Meteorological Variations and Climate Changes Affect Hyperemesis Gravidarum?

BACKGROUND: To estimate a possible association between the effects of daily meteorological variation and climatological changes (temperature, air pressure, humidity, sunniness level) on pregnant women with hyperemesis gravidarum (HG) according to symptoms grade and hospitalization state. METHODS: A retrospective study was conducted with 118 patients diagnosed and hospitalized with HG. HG patients were graded as mild, moderate, or severe according to the Pregnancy Unique Quantification of Emesis (PUQE-24) scale. Data regarding demographic characteristics, PUQE scale value, gestational week on hospitalization, hospital admission and discharge dates, weather conditions, daily meteorological values during hospitalization ( temperature, air pressure, humidity, sunniness level), seasonal averages, and daily changes were recorded. Weather records were obtained from the Ankara Meteorology General Directorate (Ankara, Turkey). Differences between groups were compared according to HG grade. RESULTS: HG cases were classified as mild (33.1%), moderate (44.9%), or severe (22.0%). The number of hospitalization days significantly differed between these three groups (p<0.05). In contrast, no statistically significant differences were identified between the HG grade level groups in regard to humidity, pressure, temperature, and sunniness level data (p>0.05). In addition, no statistically significant relationship was identified between HG grades and seasonal conditions according to the chi-square test (p>0.05). CONCLUSION: Changes in the meteorological and climate values examined were independent of symptom severity and hospitalization rate for our HG patients. However, it is possible that climate changes occurring around the world may affect the pregnancy period and should be further investigated.

Investigation of possible maternal and fetal factors which affect umbilical coiling index.

AIM: The aim of this study was to investigate the possible maternal and fetal factors, which affect the Umbilical Coiling Index (UCI). METHODS: This prospective, observational, analytic study was conducted using the data of 380 women with term pregnancy and newborns who presented at a University Hospital. Hemoglobin (Hb), ferritin, iron, and the total iron binding capacity (TIBC) of the maternal blood were measured, and transferrin saturation was estimated based on the ratio between serum iron and TIBC. Blood gases, ferritin, iron, and TIBC of the umbilical cord were also measured, and the transferrin saturation was calculated. The length and thickness of the umbilical cord, numbers of coilings, weight of placenta, neonatal weight were registered. The UCI was calculated dividing the total number of coils by the length of the umbilical cord (in cm). RESULTS: A positive, linear, and statistically significant relationship was found between the UCI scores and the umbilical cord blood transferrin saturation, umbilical cord thickness, and the first- and fifth-min APGAR scores (p = .044, p < .001, p = .008, p = .022, respectively). No statistically significant relationship was found between the maternal Hb values and the UCI scores (p = .472). In addition, there was no statistically significant relationship between the UCI scores and maternal ferritin, maternal transferrin saturation and umbilical cordon ferritin levels (p = .940, p = .681, and p = .975, respectively). CONCLUSIONS: A positive correlation was found between the UCI and umbilical cord transferrin saturation and between the newborn APGAR scores. However, this finding is not sufficient to explain the relationship of the umbilical cord dynamics with the newborn wellbeing and coiling.

Body Mass Index Effects Kruger's Criteria in Infertile Men.

BACKGROUND: The aim of this study is to evaluate the relationship between sperm parameters and body mass index (BMI) in the male spouses with infertility complaints, who had reffered to our clinic. MATERIALS AND METHODS: The male spouses from 159 couples reffering to our clinic because of infertility, during a six-month period, were included in the study. In this prospective case control study, the included men were categorized as non-obese (BMIP<25 kg/m2), overweight (BMI 25-29 kg/m2) and obese (BMI ≥30 kg/m2) according to their BMIs. The assessed sperm parameters consisted of; sperm concentration, Kruger morphology, progressive motility level, and volume pH levels. The statistical significant level was set as less than 0.05. RESULTS: The assessed group consisted of 159 patients applying to our clinic with infertility symptoms. Fifty-three non-obese, 53 overweight and 53 obese men were eligible for the study. There was statistically significant differences in sperm volume (P<0.001), progressive motility (P<0.001), postwash sperm count (P<0.001) and Kruger (P<0.001) morphology among the patient groups grouping according to the BMI levels. CONCLUSION: In this study, increased BMI was associated with decreased semen quality, affecting volume, concentration, and motility. further studies with a wider range of prospective cases need to be conducted in order to investigate the effects on male fertility in more detail.

Chemokine (C-C motif) ligand-2 (CCL2) and oxidative stress markers in recurrent pregnancy loss and repeated implantation failure.

PURPOSE: The main purpose of this study is to evaluate the inflammatory response and oxidative stress together in the cases of recurrent pregnancy loss (RPL) and repeated implantation failure (RIF). METHODS: This is a cross-sectional study conducted to compare infertile patients who have RIF and patients with RPL histories in terms of CCL2, TAS, TOS, and OSI. To this end, two study groups were formed by primary-infertile women with RIF history and women with nulliparous RPL history who consulted a university hospital between 2014 and 2016, and a control group was formed by multiparous women who had no pregnancy loss. With 30 women in each group, 90 women in total were included in the study. CCL2, TAS, and TOS blood levels were measured and oxidative stress index was calculated in all participants. RESULTS: The patients with RPL and RIF had higher levels of CCL2 than those in the control group. The TOS, TAS, and OSI levels did not differ in RPL and RIF groups from the control group. No statistically significant relationship was found between CCL2 and the TOS, TAS, and OSI values. CONCLUSIONS: Oxidative stress markers in the pregestational period did not have a predictive value in the RPL and RIF. CCL2 might be useful in risk prediction.

Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey.

OBJECTIVES: To determine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on maternal and fetal complications, and to examine whether Turkish women achieve the recommended gestational weight gain. We also investigated the relationship between pregnancy weight gain and mode of delivery, with an examination of maternal anthropometry.  Methods: A retrospective cross-sectional study was conducted on a population of 986 pregnant women between November 2011 and November 2015 at Atatürk Education and Research Hospital, Ankara, Turkey. Maternal age, BMI, monthly weight gain during pregnancy, infant birth weight, gender, and maternal and fetal adverse outcomes were evaluated. Results: The frequency of maternal complications was positively associated with elevated pre-pregnancy BMI (p less than 0.05), and weight gain during pregnancy was associated with parity and increased infant birth weight (p less than 0.05). However, no correlations were observed between mean pregnancy weight gain and maternal complications (p greater than 0.05). The percentage of women who gained the Institute of Medicine (IOM)-recommended amount of weight was the highest in the underweight BMI group (54.1%) and the lowest in the obese BMI group (24.3%). Pregnancy weight gain exceeded IOM recommendations in the overweight (56.3%) and obese (52.5%) groups. Conclusions: While maternal weight gain during pregnancy affects neonatal body weight, higher pre-pregnancy BMI has an adverse effect on recommended weight gain during pregnancy, with increased maternal complications.

The relationship between postmenopausal women's sclerostin levels and their bone density, age, body mass index, hormonal status, and smoking and consumption of coffee and dairy products.

PURPOSE: To investigate the relationship between postmenopausal women's sclerostin levels and bone density and the factors that may affect this relationship. MATERIALS AND METHODS: 135 postmenopausal patients' ages, BMIs, hormonal statuses, BMD values, and smoking, and consumption of coffee and dairy products were compared with their sclerostin levels. RESULTS: No statistical relationship was found between sclerostin level and age in the group with osteoporosis (p = 0.204, r = -0.305). There was a positive, high-level relationship between sclerostin levels and BMI in the osteoporosis group and it was found to be statistically significant (p < 0.001, r = 0.786). No statistical relationship was found between sclerostin level and age in the non-osteoporosis group with (p = 0.496, r = -0.88). There was a positive, moderate relationship between sclerostin levels and BMI in the non-osteoporosis group and it was found to be statistically significant (p < 0.001, r = 0.505). No statistically significant relationship could be found between sclerostin levels and vitamin D (p = 0.723), PTH (p = 0.112), FSH (p = 0.795), E2 (p = 0.627), TSH (p = 0.517), T3 (p = 0.788), and T4 (p = 0.664) blood levels. No significant difference was found among the groups formed by smoking, consumption of coffee and milk, and dairy products, either (p = 0.405; p = 0.626; p = 0.234, respectively). It was monitored that sclerostin's negative effect observed on BMD scores was independent from age; however, it had a positive correlation with BMI. CONCLUSION: As blood sclerostin levels increase, bone mineral density decreases. This negative effect of sclerostin on bone density increases as BMI increases, too. Effects of sclerostin levels on bone density are independent from age, and they are not affect by levels of vitamin D: PTH, FSH, E2 and thyroid hormones, and daily activities, such as smoking and consumption of coffee and milk and dairy products, either.

Correlations of maternal neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with birth weight.

OBJECTIVE: The aim of this study is to investigate the possible correlation of hemogram parameters including neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with birth weight and gestational week. MATERIALS AND METHODS: This prospective study has been conducted with 783 patients. The maternal age, parity, gestational age, type of delivery, values of complete blood count (CBC) variables and the weight of newborn were recorded. We analyzed the statistical differences between the NLR, PLR, hemoglobin (HGB), platelet distribution width (PDW), red cell distribution width (RDW), mean platelet volume (MPV), platelet, neutrophil, lymphocyte and white blood cells (WBC) in terms of the birth weight. RESULTS: There was no statistically significant difference in the NLR in terms of the birth weight (p = 0.097), whereas there was a statistically significant difference in the PLR (p < 0.001). In correlation analyses, a linear, negative, weak and statistically significant correlation was detected between NLR and PLR with the birth weight of infant and gestational week (p = 0.011 and p < 0.001, respectively). CONCLUSION: This prospective study is the first in the literature which investigates the correlation of NLR and PLR with the week of birth and birth weight of the infant. Our study suggested that the maternal NLR and PLR are negatively correlated with the week of birth and birth weight of the infant.

Electrocardiographic P-Wave Duration, QT Interval, T Peak to End Interval and Tp-e/QT Ratio in Pregnancy with Respect to Trimesters.

BACKGROUND: P-wave duration helps to determine the risk of atrial arrhythmia, especially atrial fibrillation. QT interval, T peak to end interval (Tp-e), and Tp-e/QT ratio are electrocardiographic indices related to ventricular repolarization which are used to determine the risk of ventricular arrhythmias. We search for any alterations in electrocardiographic indices of arrhythmia in the pregnancy period with respect to trimesters. METHODS: We enrolled 154 pregnant and 62 nonpregnant, healthy women into this cross-sectional study. Maximum and minimum P-wave durations (Pmax, Pmin), and QT intervals (QTmax, QTmin) were measured from 12 leads. QT measurements were corrected using Fridericia (QTc-Fr) and Bazett's (QTc-Bz) correction. Tp-e interval was obtained from the difference between QT interval, and QT peak interval (QTp) measured from the beginning of the QRS until the peak of the T wave. Tp-e/QT ratio was calculated using these measurements. RESULTS: Pmax were 93.0 ± 9.1, 93.9 ± 8.9, 97.9 ± 5.6, 99.0 ± 6.1 in nonpregnant women, first, second, third trimesters of pregnancy, respectively (P = 0.001); whereas Pmin values were not significantly different. QTc-Fr max were 407.4 ± 14.2, 408.5 ± 16.1, 410.1 ± 13.1, 415.1 ± 10.1 (P = 0.007); Tp-e were 72.7 ± 6.2, 73.2 ± 6.5, 77.2 ± 8.9, 87.2 ± 9.6 (P < 0.001); and Tp-e/QT were 0.17 (0.14-0.20), 0.17 (0.14-0.20), 0.18 (0.15-0.23), 0.20 (0.16-0.25) in nonpregnant women, first, second, and third trimesters of pregnancy respectively (P < 0.001). None of the participants experienced any arrhythmic event. CONCLUSIONS: P-wave duration is prolonged in the second trimester, and resumes a plateau thereafter. Maximum QTc interval, Tp-e interval and Tp-e/QT ratio are increased in the late pregnancy. Although these indices are altered during the course of pregnancy, they all remain in the normal ranges.