The therapeutic effects of coenzyme Q10 on surgically induced endometriosis in Sprague Dawley rats.

The aim of this study was to evaluate the effects of coenzyme Q10 in the treatment of endometriosis rat models. Twenty seven Sprague Dawley rats were divided into four groups; Control Group (n = 7; Endometriosis group), Reference Group (n = 6; Endometriosis + Buserelin acetate, 20 mg/kg), CoQ10 Group-I (n = 7; Endometriosis + CoQ10, 50 mg/kg) and CoQ10 Group-II (n = 7; Endometriosis + CoQ10, 100 mg/kg). At the end of the experiment, all the rats were sacrificed, and the volume and histoarchitecture of endometrial implants were evaluated. The mast cells were determined by Toluidine blue and collagen fiber density was analysed by Masson's Trichrome staining. Tumour necrosis factor and vascular endothelial growth factor (VEGF) levels were analysed by enzyme-linked immunosorbent assay in peritoneal fluid and VEGF and matrix metalloproteinase-9 (MMP-9) were evaluated by immunohistochemistry. Terminal deoxynucleotidil transferase-mediated dUTP Nick end labelling (TUNEL) was also used for the detection of apoptotic cells. The CoQ10 treatment significantly decreased the volume of endometriotic implants, VEGF, and MMP-9 immunoreactivity and increased TUNEL-positive cells. The findings of the study suggest that CoQ10 can be used in endometriosis treatment by suppressing the endometriotic implants.IMPACT STATEMENTWhat is already known on this subject? Endometriosis is a gynaecological disorder and previous studies have shown that different treatments with antioxidants cause significant regression in the endometriotic implants.What the results of this study add? In this study, CoQ10 reduced intra-abdominal adhesion scores and volume of the endometriotic implants. In addition, CoQ10 treatment affected mast cell, TNF-α, VEGF, and MMP-9.What of these findings for clinical practice and/or further research? CoQ10 treatments may be possible to apply, it can contribute to science in terms of a new therapeutic treatment for endometriosis. Further studies are required to evaluate the Coenzyme Q10's effects on pain and subfertility in endometriosis.

Does LH supplementation in poor responders affect granulosa cells apoptosis rate in ART? A prospective randomised controlled trial.

The aim was to compare granulosa cell's (GCs) apoptosis rate with (group A) or without (group B) luteinising hormone (LH) supplementation in poor ovarian responders (PORs) during controlled ovarian stimulation (COS). After oocyte retrieval, the follicular fluid was analysed by cytoflowmetry. Primary outcomes were GCs apoptosis rate in terms of viability, early apoptosis, late apoptosis and necrosis. Secondary outcome was clinical pregnancy rate. The viability was 96.7{IQR: 8} and 83.5{IQR: 20} for groups A and B, respectively (p < .001). Late apoptosis rates were significantly lower in group A (median 1.5, {IQR: 3.1}) than group B (median 9.5, {IQR: 20.6}) (p < .001). Median early apoptosis rates were 1.4 {IQR: 2.9} and 5.2 {IQR: 6.5} for group A and B respectively (p = .04). No significant difference was observed in the clinical pregnancy rate. Although LH seems necessary in PORs to decrease late granulosa apoptosis rates, this does not improve clinical pregnancy rates.IMPACT STATEMENTWhat is already known on this subject? LH supplementation during COS has long been an issue in PORs to overcome the rFSH responsiveness due to the LH polymorphism. LH receptors have also been on GCs and their expression increases in preovulatory follicles. GCs apoptosis rates may show the oocyte quality and reproductive potential of oocyte retrieved and the requirement for LH supplementation.What do the results of this study add? The present study shows that LH supplementation during COS for PORs promotes the GC viability and reduces early/late apoptosis rates. Similarly, the number of MII oocytes was significantly higher in the LH regimen group. However, there was no significant difference in terms of clinical pregnancy rates.What are the implications of these findings for clinical practice and/or further research? The oocyte quality parameters such as higher GC viability and lower GC early/late apoptosis rates verify the LH supplementation in PORs during COS. However, the limited size of this study requires further multi-centre research in a larger cohort of patients. Results obtained with a sensitive and validated method will help clinicians to make better decisions in patient care.

The impact of using culture media containing granulocyte-macrophage colony-stimulating factor on live birth rates in patients with a history of embryonic developmental arrest in previous in vitro fertilization cycles

Objective: To investigate the effect of using culture media containing granulocyte-macrophage colony-stimulating factor (GM-CSF) on embryological data and reproductive outcomes in patients with early embryonic developmental arrest. Material and Methods: Retrospective case-control study. A total of 39 patients, whose embryos were incubated with culture media containing GM-CSF due to embryonic developmental arrest in two previous in vitro fertilization (IVF) cycles in-between January 2016 and November 2017 at Hacettepe University IVF Center, were enrolled. Control group was generated among patients with first IVF attempts due to tubal factor in the same time period. All embryos in the control group were incubated with single step culture medium (without GM-CSF). For the control group selection, matching was done 1:2 ratio considering female age, body mass index, number of M-II oocyte retrieved, and number of embryo transferred (n=80). Results: Demographic features and embryological data were comparable between two groups. Number of fertilized oocytes (2-pronuclear) was 3.7±2.0 in GM-CSF group and 3.9±2.5 in the control (p=0.576). Overall, number of embryos transferred (1.3±0.5 vs 1.3±0.5, respectively) and blastocyst transfer rate (67.6% vs 59.2%, respectively; p=0.401) were similar. For the reproductive outcomes, implantation rate (32.3% vs 33.1%, respectively; p=0.937), clinical pregnancy rate (33.3% vs 32.5%, respectively; p=0.770), and live birth rate (25.2% vs 26.2%, respectively; p=0.943) were similar. Conclusion: Using GM-CSF-containing culture media in patients with two previous failed IVF attempts due to embryonic developmental arrest might rectify embryological data and reproductive outcomes. To make solid conclusion further randomized controlled trials are warranted.

Does multifollicular development and number of intermediate follicles contribute to the effect of luteal phase support with vaginal progesterone gel in intrauterine insemination cycles?

Luteal phase deficiency as a result of multifollicular development which produces supraphysiological progesterone and estradiol levels and benefit of luteal phase support have been proven in assisted reproductive technique (ART) treatment. But, there were some controversial results in intrauterine insemination (IUI) cycles whether luteal phase support (LPS) with progesterone have an impact on pregnancy outcome. To assess the efficacy of vaginal progesterone gel in the gonadotropin-induced IUI cycles, this retrospective data analysis compared the luteal phase support and control group in terms of clinical pregnancy (CPR) and live birth rates (LBR). In subgroup analysis, multifollicular and monofollicular growth were analyzed separately. In total, after exclusion criteria, 380 IUI cycles were analyzed, cycles were grouped as LPS(+) and LPS(-) with 190 and 190 cycles, respectively. CPR and LBR were comparable between groups (11.6% vs. 10.5, p = .74 and 8.9% vs. 8.4%, p = .75 respectively). Although multifollicular growth demonstrated higher pregnancy outcomes than monofollicular growth, intermediate follicles (14-16 mm) had a positive impact on pregnancy outcome in monofollicular growth like multifollicular subgroup. We found no difference in CPR and LBR according to the luteal phase vaginal progesterone gel. Nevertheless, multifollicular cycles and also monofollicular growth cycles with two and more intermediate follicles may have benefit LPS in gonadotropin-induced IUI cycles.

A new approach to prevent ischemia/reperfusion injury in a rat model: remote ischemic conditioning.

PURPOSE: To evaluate the effect of remote ischemic conditioning (RIC) on ovarian ischemia/reperfusion injury in a rat model. METHODS: A total of 36 Wistar albino rats with a body weight of 220-250 g were used for this study. Right adnexal torsion was performed for 180 min, and at the end of the period, the adnex was released and the abdomen was reclosed for 180 min for reperfusion. Torsion and detorsion procedures were applied to all rats except group 1 (sham, control). The right lower extremity was tied to perform remote tissue ischemia in groups 3, 4, 5, and 6. The goal of the procedure, which was purplish discoloration and pulselessness of the extremity, was maintained. After 5 min of ischemia, reperfusion was achieved for 5 min. Repeating this procedure 3 times was defined as hypoxia attacks (RIC). Retrieved ovaries were examined for tissue injury with biochemical, histopathologic, and immunohistochemical analysis. RESULTS: Unlike the control group, vascular congestion, hemorrhage, edema, and inflammatory cell infiltration were observed in group 2 (only I/R [ischemia/reperfusion]). In groups 3 (I/R + RIC), 4 (I/R + RIC), 5 (I/R + RIC), and 6 (I/R + RIC), edema and inflammatory cell infiltration were not observed. However, vascular congestion and hemorrhage that were detected in these groups were higher than in group 1 (Control) and less than in group 2 (I/R). The Caspase-3 Index was found to be increased in all groups compared to group 1 (P < .001). However, the increase in the RIC-performed groups was significantly less than in group 2. The apoptotic index, which was determined by the TUNEL, was also found to be increased in all groups compared to group 1 (P < .001). When the comparison was made in relation to group 2, the decrease of AI in RIC-performed groups was statistically significant, except the decrease in group 6 (P = .29). CONCLUSIONS: It is not clinically conceivable to prepare the tissue for pre-ischemia in ovarian torsion. However, the RIC application, which will be initiated if torsion is suspected when arrangements are made for surgery, might be a simple, effective, and inexpensive approach to prevent I/R injury in the clinic.

Is ovarian volume a good predictor to determine metabolic syndrome development in polycystic ovary patients.

The aim of this study was to investigate the findings of ultrasound that could predict the metabolic syndrome (MetS) which may develop in polycystic ovary syndrome (PCOS) patients. A total of 96 consecutive PCOS patients, who were scheduled for any gynaecologic examination from January 2015 to January 2016 and who were eligible for the study, were prospectively enrolled in it. About 15.6% of PCOS patients were diagnosed with MetS. The mean age of the MetS patients and the non-MetS patients were 25.8 and 23.3, respectively (p = .056). The mean ovary volume was calculated as being 11.7 mL in the MetS patients and as 9.6 mL in the non-MetS patients (p = .027). The Doppler and the other ultrasound findings were compared between the groups and no significant difference was observed. When a receiver operator characteristic curve analysis was conducted for the ovarian volume to predict MetS, the area under curve was 0.67 (95% CI, 0.52-0.81). The optimum cut-off point for OV was determined at 9.2 mL, with the sensitivity and specificity of 80.0% and 50.6%, respectively. The risk of developing MetS appears to be higher in PCOS patients with higher OV values. Impact statement What is already known on this subject? Metabolic syndrome is not rare in PCOS patients. There are several studies to specify a predictor for MetS development in PCOS. Most are biochemical predictors, such as hyperandrogenemia, a visceral adiposity index, lipid accumulation product, adiponectin index and a leptin-to-adiponectin ratio. What do the results of this study add? The ultrasound markers to predict the insulin resistance at PCOS is already used, but are new for predicting MetS. What are the implications of these findings for clinical practice and/or further research? Ultrasound is an available tool in most clinics and predicting MetS is important for the future health problems of PCOS patients.

An appropriate way to predict fetal gender at first trimester: anogenital distance.

BACKGROUND: Using anogenital distance to determine fetal sex is a new method. There is only one study in the literature. We predict that it will pass through the literature as a new method that can be used in determining fetal sex especially in first trimester. INTRODUCTION: Determination of fetal gender before birth has been a matter of curiosity for both the family and the clinician. In the presence of gender-linked genetic disease, it becomes an obligation instead of an interest. The aim of this study was to determine the fetal gender accurately at first trimester with anogenital distance (AGD) and to investigate the correlations of nuchal translucency (NT), fetal heart rate (FHR), and crown-rump length (CRL) with AGD. MATERIALS AND METHODS: In this prospective cross-sectional study, AGD measurement was performed in 111 patients with singleton pregnancy from 11 to 13 weeks and 6 days (CRL 45-84 mm). Measurements of AGD ≥4.8 mm were identified for males, and AGD <4.8 mm for females. RESULTS: Genders were demonstrated accurately for males as 76.7% and for females as 97.1%. The mean value of AGD was 3.6 mm for females and 5.1 mm for males. There were no relations between fetal gender and FHR and also NT. CONCLUSIONS: Gender can be detected with great accuracy in gestations between 11 to 13 weeks and 6 days by using AGD. CRL and gestational week (GW) were determined as nonsignificant predictors of fetal gender by AGD measurement. In order to obtain more accurate results with AGD, consideration of further studies with larger series in different races is recommended.

Protective effects of vitamin D on ischemia-reperfusion injury of the ovary in a rat model.

OBJECTIVES: The aim of the present study is to investigate probable acute effects of vitamin D on ischemia-reperfusion injury in the rat ovary. MATERIALS AND METHODS: A group of 30 Wistar albino rats was divided into five groups of 6 each. Group 1: underwent laparotomy only and the ovaries were removed. Group 2: 3-hr ischemia followed by excision of the ovaries. Group 3: 3-hr ischemia and 3-hr reperfusion and the ovaries were removed. Group 4: vitamin D was administered 30 min prior to the 3-hr of ischemia and the ovaries were excised at the end of ischemia period. Group 5: vitamin D was administered 30 min prior to the 3-hr of ischemia and 3-hr reperfusion then the ovaries were removed at the end of reperfusion. The ovaries excised in each group also underwent biochemical and histopathologic analysis. MDA (malondialdehyde), SOD (superoxide dismutase), NO (nitric oxide), TAS (total antioxidant score), TOS (total oxidant score) were analyzed as biochemical parameters. RESULTS: There were no significant differences between groups in TAS, TOS, or OSI (P>0.05). MDA levels were lower in the vitamin D treatment groups especially in group 5, significantly (P<0.05). In the histopathologic evaluation, we established that an improvement with vitamin D treatment. According to tissue injury scores, vascular congestion score was significantly different between group 3 and 5 (P<0.05). CONCLUSION: Vitamin D seems an effective molecule for protection of ischemia-reperfusion injury in rat ovary. There is some significant improvement in oxidative damages with vitamin D treatment.

Retrospective evaluation of clinical and pathological features, as well as diagnostic and treatment protocols of primary vaginal malignancy.

OBJECTIVES: Our study aimed to determine the epidemiological characteristics and diagnostic and treatment protocols of primary vaginal carcinoma. Also, we compared the clinical and pathological features of primary vaginal carcinoma which intersect with cervical and vulvar carcinomas. MATERIAL AND METHODS: Sixteen patients with primary vaginal carcinoma, admitted to the Department of Gynecologic Oncology, Izmir Tepecik Training and Research Hospital between January 1983 and December 2012, were evaluated retrospectively. FIGO (International Federation of Gynecology and Obstetrics) Surgical staging was performed. The SPSS (Statistical Package for Social Sciences) program was used for statistical analyses. RESULTS: The histological distribution of the 16 patients with primary vaginal carcinoma was as follows: 9 patients (56.3%) with squamous cell carcinoma (SCC), 5 (31.3%) with rhabdomyosarcoma, and 2 (12.5%) with adenocarcinoma. CONCLUSION: The stage of the disease was found the be the main factor affecting the survival.

Assessment of clinicopathological features, evaluation of treatment, and prognosis of clear cell and serous papillary endometrial carcinoma.

OBJECTIVES: We aimed to evaluate and compare the clinical and pathological features, diagnosis, treatment, and prognosis of uterine papillary serous carcinoma (UPSC) and clear-cell carcinoma (CC). MATERIAL AND METHODS: Thirty-four patients who were operated on for UPSC and CC carcinoma at the Izmir Tepecik Research and Teaching Hospital, between January 1983 and December 2014, were included. Patients were evaluated for the following factors: age, gravidity, parity, preoperative CA-125, tumor size, myometrial and lymphovascular invasion, lymph node tumor metastasis, presence of atypical cells in peritoneal cytology, pathology results, operation types, whether or not they received postoperative adjuvant therapy, prognosis, and death rate. RESULTS: The stage of the disease was the main factor affecting disease-free and the overall survival. Cisplatin-based chemotherapy was partially effective in patients with postoperative recurrence, while postoperative adjuvant radiotherapy proved to be more effective in preventing relapse. CONCLUSION: The studied parameters generally were concordant with the literature but, due to the relatively small sample size, more comprehensive and multicenter studies are needed to generate valid results.

Risk factors for surgery in patients with tuba-ovarian abscess.

OBJECTIVE: To determine the factors that increases the need of surgery in the treatment of tuba-ovarian abscess. MATERIAL AND METHOD: Fifty patients, who were diagnosed with tuba-ovarian abscess between January 2005 and December 2010 at Aegean Obstetrics and Gynecology Education and Research Hospital, were reviewed retrospectively. Patients were divided into two groups as Group A includes 19 patients treated medically and Group B includes 31 patients treated surgically. Patient characteristics of both groups were compared in terms of risk factors, clinical findings, abscess size and length of hospital stay. RESULTS: The mean age of the patients was 41.2 ± 10.4 (range 19-73). A statistically significant difference was found between the mean age of the patients (37.4 ± 8.6) treated medically and the mean age of the patients (43.5 ± 10.8) treated surgically (p 0.042). The patients treated medically were younger than those treated surgically. In addition, there was a statistically significant difference between the groups in terms of abscess sizes (p 0.001, 81.7 ± 38.2 and 43.5 ± 19.0 mm, respectively). Accordingly, the size of abscess was larger in the surgical treatment group. No significant difference was found between the two groups in terms of smoking status and duration of hospital stay (p 0.157, 0.085, respectively). Previous attacks of PID, history of minor uterine operation and use of IUD's were not different between the groups (p 0.166, 0.490, 0.080, respectively). CONCLUSION: Being older in age and having larger abscess size increase proceeding to surgery in patients with tuba-ovarian abscess.

Ectopic ovary confirmed by ovarian stimulation in a case of unicornuate uterus.

OBJECTIVE: To present a case of unicornuate uterus with ipsilateral ectopic ovary and renal agenesis. DESIGN: Case report. SETTING: Research hospital. PATIENT(S): A 26-year-old woman with a 5-year history of primary infertility was admitted to our clinic. A unicornuate uterus without contralateral horn, with ipsilateral ectopic ovary and renal agenesis, was diagnosed. INTERVENTION(S): Diagnostic laparoscopy, ovarian stimulation. MAIN OUTCOME MEASURE(S): During laparoscopy, a unicornuate uterus without a contralateral horn, together with ectopic ovary, was observed. RESULT(S): We visualized the right ectopic ovary on ultrasound after ovarian stimulation. CONCLUSION(S): We present a rare clinical entity that exhibits a unicornuate uterus without a contralateral horn, with ipsilateral right ectopic ovary and renal agenesis together. We conclude that ovarian stimulation is a useful approach in the diagnosis of ectopic ovaries.