Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI.

The aim of this study was to compare the reproductive outcomes between infertile women who underwent hysteroscopic uterine septum resection and those who required a second look hysteroscopy due to residual septum prior to intracytoplasmic sperm injection (ICSI) cycles with selective single 'Grade A' embryo transfer (ET). All second look hysteroscopies were performed due to partial remnant septum in a control three dimensional transvaginal ultrasonography (3D TVUSG) after the first hysteroscopic resection. Miscarriage and biochemical pregnancy rates were not different between the groups while clinical pregnancy and live birth rates were significantly higher in Group 2 than in Group 1. Second look hysteroscopic metroplasty performed to restore remnant septum significantly improves live birth rate as well as clinical pregnancy rates while it appears not to alleviate abortion and biochemical pregnancy rates in women undergoing ICSI-ET.IMPACT STATEMENTWhat is already known on this subject? The effect of hysteroscopic septum resection on reproductive outcomes in IVF treatment in infertile patients with uterine septum is not clearly known.What do the results of this study add? With the selective single ET strategy, complete or partial hysteroscopic correction of the uterine septum before ICSI and subsequent resection of the residual septum with control hysteroscopy significantly increases the live birth rates in the infertile population.What are the implications of these findings for clinical practice and/or further research? In the group of infertile patients with uterine septum, second control hysteroscopy should be performed 1 month later for residual septum or adhesions after hysteroscopic septum resection performed once.

Prevention of Premature Ovulation by Administration of Gonadotropin Releasing Hormone Antagonist the day After Ovulation Triggering in Diminished Ovarian Reserve Patients / Prevenção da ovulação prematura por meio da administração de antagonismo de liberação de gonadotropismo no dia seguinte à ovulação

Abstract Objective The aim of the present retrospective study was to investigate the effectiveness of single-dose gonadotropin releasing hormone (GnRH) antagonist administration, the day after human chorionic gonadotropin (hCG) triggering for final oocyte maturation, on the prevention of premature luteinization in patients with diminished ovarian reserve in in-vitro fertilization (IVF) cycles. The secondary objective of the study was to search the effect of this protocol on pregnancy outcomes. Methods This is a retrospective study including 267 infertile patients who have single antral follicle seen with ultrasonography on the 2nd or 3rd day of the menstrual cycle before starting IVF treatment. We randomized patients into two groups. The case group comprised patients who had single-dose GnRH antagonist injection the day after hCG triggering formed, and the patients who had the standard treatment regime formed the control group. In both groups, the oocytes were collected 36 hours after hCG injection. Results The premature ovulation rate was significantly low in the case group compared with the control group (6.86 versus 20.6% per scheduled cycle) (p=0.022). Also, the oocyte retrieval rate (93.14 versus 67.87% per scheduled cycle) (p=0.013), the oocyte maturity rate (79.42 versus 47.87%) (p=0.041), the fertilization rate (65.68 versus 34.54%) (p=0.018), and the embryo transfer rate per scheduled cycle (44.11 versus 18.78%) (p=0.003) were higher in the GnRH antagonist group than in the control group. Conclusion The administration of GnRH antagonist the day after hCG trigger in IVF treatments of patients with diminished ovarian reserve enabled a significant decrease in the rate of premature ovulation but had no effect on live birth rate.

Resumo Objetivo O objetivo do presente estudo retrospectivo foi investigar a eficácia da administração do antagonista do hormônio liberador da gonadotrofina (GnRH) em dose única no dia seguinte ao desencadeamento da gonadotrofina coriônica humana (hCG) para a maturação final do oócito, na prevenção da luteinização prematura em pacientes com diminuição do ovário reserva em ciclos de fertilização in vitro (FIV). O objetivo secundário do estudo foi pesquisar o efeito deste protocolo nos resultados da gravidez. Métodos Trata-se de um estudo retrospectivo incluindo 267 pacientes inférteis que apresentam um único folículo antral visto por ultrassonografia no 2° ou 3° dia do ciclo menstrual antes de iniciar o tratamento de FIV. Nós randomizamos os pacientes em dois grupos. Os pacientes que receberam injeção de antagonista de GnRH em dose única no dia seguinte ao desencadeamento do hCG formaram o grupo caso, e os pacientes que receberam o regime de tratamento padrão formaram o grupo controle. Em ambos os grupos, os oócitos foram coletados 36 horas após a injeção de hCG. Resultados A taxa de ovulação prematura foi significativamente baixa no grupo caso em comparação com o grupo controle (6,86 versus 20,6% por ciclo programado) (p=0,022). Além disso, a taxa de recuperação de oócitos (93,14 versus 67,87% por ciclo programado) (p=0,013), a taxa de maturidade do oócito (79,42 versus 47,87%) (p=0,041), a taxa de fertilização (65,68 versus 34,54%) (p=0,018) e a taxa de transferência de embriões por ciclo programado (44,11 versus 18,78%) (p=0,003) foram maiores no grupo antagonista de GnRH do que no grupo controle. Conclusão A administração de antagonista de GnRH, no dia seguinte ao desencadeamento de hCG em tratamentos de FIV de pacientes com reserva ovariana diminuída permitiu uma redução significativa na taxa de ovulação precoce,mas não teve efeito na taxa de nascidos vivos.

Levels and Predictors of Anxiety and Depression in Turkish Pregnant Woman During the Covid-19 Pandemic.

OBJECTIVE: In addition to being a medical phenomenon, pandemics affect the individual and society on several levels and lead to disruptions. In the pandemic process, different groups in the population, including pregnant women as a defenseless group, are subjected to psychological threat. The present study aimed to determine the levels of anxiety and depression and related factors in pregnant women during the the coronavirus disease 2019 (Covid-19) pandemic. METHODS: The present cross-sectional study was conducted with 269 pregnant women through face-to-face interviews held in Istanbul, Turkey. Regarding the data collection tools, the Cronbach α reliability coefficient was of 0.90 for the Beck Anxiety Inventory, and of 0.85 for the Beck Depression Inventory. RESULTS: Among the participating pregnant women, 30.5% had mild, 17.5% had moderate, and 5.9% had severe anxiety symptoms, whereas 35.3% had mild, 16.7% had moderate, and 2.2% had severe depression symptoms. We found that those who were concerned about their health had 5.36 times (p = 0.04) more risk of developing anxiety, and 4.82 times (p = 0.01) more risk of developing depression than those who were not concerned. Those who had a history of psychiatric disease had 3.92 times (p = 0.02) more risk of developing anxiety than those without it. CONCLUSION: We determined that about half of the pregnant women included in the study had some degree of anxiety and depression during the COVID-19 pandemic. The risk factors for anxiety and depression among the pregnant women were determined as smoking, concerns about health and getting infected with the coronavirus, history of psychiatric disease, and undergoing regular antenatal care.

OBJETIVO: Além de ser um fenômeno médico, as pandemias também afetam o indivíduo e a sociedade em vários níveis, e causam perturbações. No processo de pandemia, diferentes grupos da população, incluindo mulheres grávidas como um grupo indefeso, estão sujeitos a ameaças psicológicas. Este estudo teve como objetivo determinar os níveis de ansiedade e depressão e os fatores relacionados em mulheres grávidas durante a pandemia de doença do coronavírus 2019 (coronavirus disease 2019, Covid-19, em inglês). MéTODOS: Este estudo transversal foi realizado com 269 mulheres grávidas por meio de entrevistas pessoais em Istambul, Turquia. Com relação às ferramentas de coleta de dados, o coeficiente de confiabilidade alfa de Cronbach foi de 0,90 para a Escala de Ansiedade de Beck, e de 0,85 para a Escala de Depressão de Beck. RESULTADOS: Entre as gestantes participantes, 30,5% apresentaram sintomas de ansiedade leves, 17,5%, moderados, e 5,9%, graves, ao passo que 35,3% apresentaram sintomas de depressão leves, 16,7%, moderados, e 2,2%, graves. Verificou-se que as participantes que se preocupavam com sua saúde tinham 5,36 vezes (p = 0,04) mais risco de desenvolver ansiedade e 4,82 vezes (p = 0,01) mais risco de desenvolver depressão do que aquelas que não se preocupavam. As pacientes que tinham histórico de doença psiquiátrica tinham 3,92 vezes (p = 0,02) mais risco de desenvolver ansiedade do que as que não tinham. CONCLUSãO: Determinou-se que cerca de metade das gestantes incluídas no estudo tiveram algum nível de ansiedade e depressão durante a pandemia de Covid-19. Os fatores de risco para ansiedade e depressão nas gestantes foram determinados como tabagismo, preocupação com a saúde e infecção pelo coronavírus, histórico de doença psiquiátrica, e cuidados pré-natais regulares.

Prevention of Premature Ovulation by Administration of Gonadotropin Releasing Hormone Antagonist the day After Ovulation Triggering in Diminished Ovarian Reserve Patients.

OBJECTIVE: The aim of the present retrospective study was to investigate the effectiveness of single-dose gonadotropin releasing hormone (GnRH) antagonist administration, the day after human chorionic gonadotropin (hCG) triggering for final oocyte maturation, on the prevention of premature luteinization in patients with diminished ovarian reserve in in-vitro fertilization (IVF) cycles. The secondary objective of the study was to search the effect of this protocol on pregnancy outcomes. METHODS: This is a retrospective study including 267 infertile patients who have single antral follicle seen with ultrasonography on the 2nd or 3rd day of the menstrual cycle before starting IVF treatment. We randomized patients into two groups. The case group comprised patients who had single-dose GnRH antagonist injection the day after hCG triggering formed, and the patients who had the standard treatment regime formed the control group. In both groups, the oocytes were collected 36 hours after hCG injection. RESULTS: The premature ovulation rate was significantly low in the case group compared with the control group (6.86 versus 20.6% per scheduled cycle) (p = 0.022). Also, the oocyte retrieval rate (93.14 versus 67.87% per scheduled cycle) (p = 0.013), the oocyte maturity rate (79.42 versus 47.87%) (p = 0.041), the fertilization rate (65.68 versus 34.54%) (p = 0.018), and the embryo transfer rate per scheduled cycle (44.11 versus 18.78%) (p = 0.003) were higher in the GnRH antagonist group than in the control group. CONCLUSION: The administration of GnRH antagonist the day after hCG trigger in IVF treatments of patients with diminished ovarian reserve enabled a significant decrease in the rate of premature ovulation but had no effect on live birth rate.

OBJETIVO: O objetivo do presente estudo retrospectivo foi investigar a eficácia da administração do antagonista do hormônio liberador da gonadotrofina (GnRH) em dose única no dia seguinte ao desencadeamento da gonadotrofina coriônica humana (hCG) para a maturação final do oócito, na prevenção da luteinização prematura em pacientes com diminuição do ovário reserva em ciclos de fertilização in vitro (FIV). O objetivo secundário do estudo foi pesquisar o efeito deste protocolo nos resultados da gravidez. MéTODOS: Trata-se de um estudo retrospectivo incluindo 267 pacientes inférteis que apresentam um único folículo antral visto por ultrassonografia no 2° ou 3° dia do ciclo menstrual antes de iniciar o tratamento de FIV. Nós randomizamos os pacientes em dois grupos. Os pacientes que receberam injeção de antagonista de GnRH em dose única no dia seguinte ao desencadeamento do hCG formaram o grupo caso, e os pacientes que receberam o regime de tratamento padrão formaram o grupo controle. Em ambos os grupos, os oócitos foram coletados 36 horas após a injeção de hCG. RESULTADOS: A taxa de ovulação prematura foi significativamente baixa no grupo caso em comparação com o grupo controle (6,86 versus 20,6% por ciclo programado) (p = 0,022). Além disso, a taxa de recuperação de oócitos (93,14 versus 67,87% por ciclo programado) (p = 0,013), a taxa de maturidade do oócito (79,42 versus 47,87%) (p = 0,041), a taxa de fertilização (65,68 versus 34,54%) (p = 0,018) e a taxa de transferência de embriões por ciclo programado (44,11 versus 18,78%) (p = 0,003) foram maiores no grupo antagonista de GnRH do que no grupo controle. CONCLUSãO: A administração de antagonista de GnRH, no dia seguinte ao desencadeamento de hCG em tratamentos de FIV de pacientes com reserva ovariana diminuída permitiu uma redução significativa na taxa de ovulação precoce, mas não teve efeito na taxa de nascidos vivos.

The relationship between stigma, perceived social support and depression in infertile Turkish women undergoing in vitro fertilization-embryo transfer.

This study was conducted to determine the relationship between the perceived social support, stigmatization and depression in infertile women and the influencing factors. The study was conducted on 298 infertile women at a private hospital between March and September 2019 using a Personal Information Questionnaire, Infertility Stigma Scale (ISS), Beck Depression Inventory (BDI), and Multidimensional Scale of Perceived Social Support (MSPSS). BDI had a significantly positive correlation with ISS and negative correlation with MSPSS. And MSPSS had a significantly negative correlation with ISS. Infertility leads women to suffer various psychosocial problems. Nurses should be aware of these problems during diagnostic procedures for infertility treatment, which should also include psychiatric counseling.

Pregnancy results after intracytoplasmic sperm injection-embryo transfer in patients with infertility due to non-obstructive azoospermia and oligoasthenoteratozoospermia.

This study evaluated pregnancy results after fresh and frozen embryo transfer in males with infertility due to non-obstructive azoospermia and oligoasthenoteratozoospermia. In this retrospective study, a total of 801 embryo transfer cycles were followed up, including 423 fresh embryo transfers and 378 frozen embryo transfers in which intracytoplasmic sperm injection (ICSI) was performed because of male infertility. This study included females aged 28-38 years without uterine, endometrial, ovarian and tubal abnormalities and with regular menstrual cycles (n=801), and males aged 28-38 years with non-obstructive azoospermia and oligoasthenoteratozoospermia. Descriptive statistical methods and the independent t-test were used in the comparison of two groups with normal distribution, the Mann-Whitney U test was used in the comparison of two groups without normal distribution, and the Chi-square test was used to compare categorical variables. There were no statistically significant differences between the fresh embryo transfer group and frozen embryo transfer group in terms of rates of pregnancy, biochemical pregnancy, clinical pregnancy, live birth rate, and abortion rate. There was no difference between fresh embryo transfer and frozen embryo transfer in terms of pregnancy results in couples with non-obstructive azoospermia and oligoasthenoteratozoospermia as male infertility factor.

The relationship between body mass index before pregnancy and the amount of weight that should be gained during pregnancy: A cross-sectional study.

OBJECTIVE: To investigate the adaptation of pregnant women to the recommended weight gain range according to body mass index (BMI) and to determine the factors affecting them. METHODS: This cross-sectional study was performed in a university hospital's obstetrics and gynecology unit (tertiary center) in Turkey. This study was conducted between March 2018 and August 2018 (6 months) in pregnant women. Pregnant women with chronic disease and receiving treatment during antenatal follow-up, with twin pregnancy, with a fetus with a congenital abnormality, and nutritional disturbance were excluded from the study. Eight hundred twelve pregnant women with normal antenatal follow-up and who volunteered to participate were included in the study. RESULTS: The mean age of the participants was 27.66 ± 5.05 years. The mean weight and BMI before pregnancy were near standard in all participants. The group with the highest rate of recommended weight gain according to BMI before pregnancy was the group with low weight pregnant women. The ideal weight gain rate in all groups was 32%. CONCLUSIONS: The groups with overweight and obese pregnant women according to BMI before pregnancy had the highest rates of weight gain, above the recommended limits. BMI before pregnancy directly affects weight gain during pregnancy and the importance of pre-pregnancy counseling and weight loss is emphasized once again.

The outcomes of transobturator tape intervention in the treatment of stress urinary incontinence: Two years' follow-up.

OBJECTIVE: To evaluate the clinical outcomes and the effects on quality of life of transobturator tape surgery during a 2-year follow-up period in our clinics. METHODS: Eighty-seven patients with stress or mixed urinary incontinence who underwent transobturator tape surgery were included in the study conducted in Istanbul. Taksim. Training. and Research Hospital Gynecology and Obstetrics Clinic, between 2011 and 2013. The patients' demographic features, incontinence questionnaires, quality of life scores [Incontinence Impact Questionnaire (IIQ-7) and urinary distress inventories (UDI-6)], examination findings, urodynamic results, stress tests, Q tip tests, number of daily pads, ultrasonography, surgery, and cystoscopy results were recorded. Patients were evaluated 23-27 months (mean: 25.40±1.31 months) after their discharge in terms of symptoms, quality of life scores, urodynamic findings, complications, and stress test. RESULTS: Sixty-three (72.4%) patients had stress incontinence and 24 (27.6%) patients had mixed urinary incontinence. No perioperative complications were observed in our study. After a follow-up period of two years, a significant improvement was detected in the IIQ-7 and UDI-6 questionnaires when compared with the preoperative period. Moreover, the objective cure rate was found as 88.5% (n=77). De novo urge incontinence was obtained in 5.7% (n=5) of patients and was treated with anticholinergics. Perineal pain was present in 3 (3.44%) patients and was treated with analgesics and cold packs. In 2 (2.29%) patients, vaginal mesh erosion was detected and full recovery was achieved with an excision. Urinary retention and bladder perforation was not seen in any patients. CONCLUSION: Our study revealed a high objective cure rate, and an improvement in symptoms and quality of life with the transobturator tape operation.

A comparative randomized study on effect of vaginally administered glyceryl trinitrate placebo on cervical ripening prior to induction of labor in overdue pregnancies.

OBJECTIVE: The aim of this study is to examine the effectiveness and adverse effects of local glyceryl trinitrate (GTN) application during labor compared with a placebo group. METHODS: The study consisted of 70 pregnant women with overdue pregnancies who presented to the hospital for labor induction between January 2009 and January 2011 in the Obstetrics Clinic of Istanbul Süleymaniye Gynecology and Obstetrics Education and Training Hospital. Vaginal suppositories-containing GTN (36/70) or placebo (34/70) was administered to the participants in a randomized fashion. The placebo and GTN involving vaginal ovules used in the study were prepared in the Pharmacy Department of Istanbul University Faculty of Pharmacy. Maternal effects during labor, rates of normal vaginal and C/S deliveries, the interval between the initial medication and delivery, and amount of total oxytocin used were compared between the GTN and placebo groups. RESULTS: There were no significant differences between the GTN and placebo groups regarding bishop scores, the interval between medication and delivery, delivery types, indications for cesarean section, and complications including hyperstimulation, tachysystole, uterine rupture, placental abruption, and uterine atony (P > 0.05). CONCLUSION: Our results revealed that there were no differences between GTN and placebo regarding their effect on cervical ripening in overdue pregnant women.

Chromosome aberrations [dup(1q)] in endometrial cancer: Gene analysis of 54 surgical specimens in Turkey.

OBJECTIVE: We aimed to evaluate the frequency of chromosomal aberrations and mutations in the k-ras or Her-2/neu genes in surgical specimens of endometrial carcinoma and their association with clinicopathological findings. MATERIALS AND METHODS: Fifty-four patients who were treated for endometrial cancer between April 2010 and May 2011 at the Kocaeli University Obstetrics and Gynecology Department, Kocaeli, Turkey were enrolled in a prospective study. Clinical and histopathological findings were recorded. Genetic analysis, which included the detection of chromosomal deletions and duplications, as well as k-ras and Her-2/neu mutations, was performed on endometrial samples from surgical specimens. RESULTS: In 70% of cases, tumor size was >2 cm or covered the entire uterine cavity, affecting mostly corpus (76%) and invading less than half of the myometrium (80%). Forty-six cases (86%) had endometrioid-type carcinoma, and early stage (Stage I, 65%) and higher grade (Grade II-III, 66%) tumors were predominant. Lymph node and lymphovascular involvement was positive in 11% and 28% of the patients, respectively. Chromosomal aberrations (deletion or duplication) and Her-2/neu and k-ras mutations were encountered in 44%, 15%, and 13% of surgical specimens, respectively. The most common chromosomal aberration was dup(1q) (n = 16). Oncogenic mutations in Her-2/neu or k-ras had no association with the severity of endometrial cancer, but the presence of chromosomal aberrations, as a whole or dup(1q) alone, were associated with higher tumor size, deeper myometrial invasion, advanced stage or grade, lymphovascular invasion, and lymph node involvement (p < 0.05 for all). CONCLUSION: Chromosomal aberrations, particularly dup(1q), are related to advanced disease in endometrial cancer. Genetic analysis of cancer tissues may provide important insights in determining disease prognosis.

Evaluation of the efficacy of transobturator tape surgery in the treatment of stress urinary incontinence using urodynamics and questionnaires.

OBJECTIVE: To measure the efficiency of transobturator tape (TOT) surgery using urodynamics and questionnaires in stress urinary incontinence. MATERIALS AND METHODS: Ninety-two patients with stress and mixed urinary incontinency who underwent TOT surgery were selected for the study. We retrospectively examined the patients' urodynamics, ultrasonography, demographic characteristics, incontinency surveys, life quality scores [incontinence impact questionnaire, (IQ-7) and urinary distress inventory (UDI-6)], diagnostic findings, Q-type test, surgical records, and complications. Patients treatment adherence, life quality scores, and urodynamics were evaluated as per the findings and complications following discharge of the patients between 12 and 36 months. Patients with a surgical history as the result of incontinence were excluded from the study. RESULTS: Prior to surgery, 57 (61%, 95) patients had stress urinary incontinence (SUI), and 35 (38%, 05) patients had mixed urinary incontinence (MUI). During surgery, 45 (48%, 91) patients underwent extra pelvic surgical intervention. The mean follow-up time was 22.17±7.55 months. Our subjective success rate was 91%, 3 and the objective success rate was 78%, 3. In the life quality evaluation, a statistically significant improvement was found between IIQ-7 and UDI-6 scores. Parity over 4 was an important failure reason. Two (2%, 17) patients developed vaginal erosion, 2 (2%, 17) of the patients developed temporary urine retention, and 1 (1%, 08) patient developed nova urge incontinence. CONCLUSION: Our study demonstrates that TOT surgery provides high objective and subjective success and has a positive impact on life quality. The ease of application and lower complication rate makes TOT a valuable alternative for other treatment approaches in the surgical treatment of SUI.

Retrospective analysis of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy.

OBJECTIVE: Detection of factors that affect the success of single-dose methotrexate treatment in ectopic pregnancy. MATERIALS AND METHODS: We investigated 99 patients who had been treated with single-dose methotrexate for ectopic pregnancy in our clinic between January 2009 and June 2014. Demographic, clinical, and laboratory results of possible factors that affect treatment success were retrospectively analyzed. Successfully and unsuccessfully treated patients were compared based on their pre-treatment results. RESULTS: The success rate of single-dose methotrexate treatment was found to be 70.7%. No significant difference was found between succesfully and unsuccessfully treated patients before treatment in terms of factors such as gestational weeks, mass size, presence of yolk sac, and presence of free fluid (p=0.224, p=0.201, p=0.200, p=0.200). Serum ß-hCG values in patients whose treatment was unsuccessful was found to be higher compared with the successfully treated group (mean ß-hCG value of unsuccessful group: 4412±3501 mIU/mL; mean ß-hCG value of successful group: 1079±942 mIU/mL; p<0.001). CONCLUSION: Single-dose methotrexate treatment is an effective and reliable method in the treatment of ectopic pregnancy. Elevation of serum ß-hCG value stands as the main prognostic factor that affects the success of single-dose methotrexate treatment.