Comparison of 2-year follow-up outcomes of laparoscopic lateral suspension and sacrospinous fixation in apical compartment prolapse: an observational study.

PURPOSE: This study aimed to compare the results of patients with laparoscopic lateral suspension (LLS) and sacrospinous fixation (SSF). METHODS: This prospective observational study included 52 patients who underwent LLS and 53 patients who underwent SSF due to pelvic organ prolapse. The pelvic organ prolapse's anatomical cure and the frequency of recurrence have been recorded. Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, and complications were evaluated preoperatively and at the postoperative 24th month. RESULTS: In the LLS group, the subjective treatment rate was 88.4% and the anatomical cure rate for apical prolapse was 96.1%. In the SSF group, the subjective treatment rate was 83.0% and the anatomical cure rate for apical prolapse was 90.5%. There was a significant difference between the groups regarding Clavien-Dindo classification and reoperation (p < 0.05). Female Sexual Function Index, and the Pelvic Organ Prolapse Symptom Score were different between the groups (p < 0.05). CONCLUSIONS: This study showed that there is no difference between two surgical techniques in apical prolapse cure rates. However, the LLS seem preferable in terms of the Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, reoperation, and complications. We need larger sample size studies in terms of incidence of complications and reoperation.

Do Changes in Body Shape Due to Pregnancy Lead to Cosmetic Surgery? A Cross-Sectional Study.

OBJECTIVE: Pregnants and puerperas show different perceptions of their body image and appearance, so authors investigated their perceptions related to pregnancy and puerperium, evaluating their views on cosmetic surgery, by a cross-sectional study. MATERIALS AND METHODS: 5-item questionnaires were administrated to women at first pregnancy and puerperas. Patients were submitted also to Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Body Image Inventory (BII) analysis, indicating the level of anxiety, depression and body dissatisfaction for somatic changes during pregnancy and after childbirth. RESULTS: 186 healthy women, aged between 25-35 years, equally divided in pregnancy and puerperium, were compared in terms of body image, with no significant difference between groups. Analyzing the item "cosmetic surgery is required after all pregnancies", there was a significant difference in puerperas and the item "cosmetic surgery is necessary for postpartum" was the principal. The comparison of BII, BDI, BAI values between pregnants and puerperas showed a significant difference between groups (p<0.00), with higher scores in postpartum patients. CONCLUSION: Body shape and physical dissatisfaction during pregnancy is linked with increased risk of depression in pregnancy and puerperium, pushing women to opt for cosmetic surgery, especially in puerperium.

Effects of HRG and TP73 gene variations on ovarian response.

AIMS: This study aims to investigate whether HRG gene C633T rs9898 and TP73 gene rs4648551 A > G polymorphisms have an effect on ovulation and response to the gonadotropin treatments. MATERIALS AND METHODS: Blood samples were received from a total of 206 individuals (116 patients from whom good quality and optimal of numbers oocytes have not been able to be obtained at the IVF Center of Ondokuz Mayis University, Faculty of Medicine and 90 controls). Genomic DNA was extracted by DNA isolation and SNP genotyping was performed by real-time qPCR method. RESULTS: According to the results, a significant difference was observed between the patient and control groups in terms of the TP73 gene variant, however there was no significant difference regarding HRG gene polymorphism. CONCLUSIONS: Our findings suggest that while AG genotype for TP73 could be a genetic marker for ovarian response, HRG gene C633T variation is not associated with ovarian response in our cohort. Further studies with larger study groups are required to investigate possible associations of these gene variants with ovarian response.

Embryo flash migration in fresh and frozen embryo transfers for day 3 and day 5 embryos.

OBJECTIVE: The aim of this study is to evaluate the embryo flash migration after 60 min from embryo transfer in fresh and frozen cycles. DESIGN: 80 fresh and 81 frozen embryo transfers implemented Ondokuz Mayis University between December 2017 and May 2018 were included in this prospective study. The fresh transfers performed at day 3 embryos as the frozen transfers were day 5 embryos. The distance between the embryo and the fundus was measured in the sagittal plane within 1 min of the transfer. After 60 min of bed rest the distance between the air bubble and the fundus was measured. The transfers were divided into three groups based on the migration of the embryos after the transfer. Embryos were classified as static if they were within 15 mm of their initial position. If they moved more than 15 mm towards the cervix or more than 15 mm towards the fundus, it was classified as cervical and fundal, respectively. RESULTS: There was a statistically significant difference in embryo flash movements between frozen and fresh transfers (p < 0.05). In fresh transfers 48 patients (%60.0) were cervical, 14 patients (%17.5) were static and 18 patients (22.5%) were fundal. In frozen embryo transfers 31 patients (38.3%) were cervical, 31 patients (38.3%) were fundal and 19 (23.5%) patients were static. CONCLUSION: We found that cervical migration is lower in frozen transfers than in fresh transfers. This result may be related with the day of embryo or the endometrium in fresh or frozen cycles. Because in this study the embryos transferred were day 3 in fresh cycle and day 5 in frozen cycle. In frozen transfers there was not any significant difference in embryo position between pregnant and non-pregnant group. But in fresh transfers the cervical migration was significantly high in non-pregnant patients (p < 0.05).

Cost-effectiveness of GnRH antagonist implementation on hCG injection day.

OBJECTIVE: To compare the outcomes of antagonist stimulation protocols and to compare the cost effectiveness. MATERIALS AND METHODS: Between 2011 and December 2017, a total of 354 women who underwent intracytoplasmic sperm injection and controlled ovarian stimulation with antagonist protocols were enrolled in the study. The antagonist implementation on the day of human chorionic gonadotropin (hCG) was continued for 194 of women, whereas the antagonist was stopped 36 hours before in 160 women. The stimulation outcomes of patients and cost-effectiveness of the regimens were compared. RESULTS: There was a significant difference between the groups in terms of number of cryopreserved embryos, mature/immature oocyte ratio, and embryo transfer cancellations (p<0.05). The median value for the mature/immature oocyte ratio was 1.1 (0.2-7.5) and 1 (0.5-15) (p=0.001), and the ET cancellation was 5.3% vs. 1% for group 1 and 2, respectively (p=0.037). There was no difference between the groups in terms of pregnancy rates (p=0.197). CONCLUSION: No difference was found in the clinical pregnancy rates between the two groups. For this reason, the cessation of antagonist implementation on the day of hCG seems more advantageous in terms of cost-effectiveness and fewer injections.

Fertility preservation in Turkey: a global look for nationwide strategy development

As the reproductive technology advanced along with the improved outcome in cancer treatment demands implementing new fertility preservation, developing algorithms on fertility preservation requires tailoring for each society. Here, the authors attempt to modify the current medical literature on fertility preservation for the Turkish population. A PubMed search was conducted using the search term fertility preservation. Initially, 280 items of literature were accessed. In the second evaluation, 126 articles were examined and 154 items were discarded due to the low quality of the literature. In the final round, only 68 publications that were the most relevant were found eligible for inclusion in this review article. In order to develop a more systematic national guideline, forming a multidisciplinary approach to create a web-based network would be the first step. Both physicians and patients will have open access to the information. This database should be linked to an international consortium to stay integrated and open for updating. The aim of this review was to evaluate the relationship between the current situation in our country and the developments in the world in light of the literature, and to establish infrastructure for the development of future approaches in our country.

Relation with postpartum maternal morbidity of different types of anesthesia in preeclamptic patients.

OBJECTIVE: The aim of this study is to investigate the effect of different anesthesia types administered to patients with preeclampsia on postoperative maternal morbidities. METHODS: Medical records of pregnant women complicated with preeclampsia delivered by cesarean from January 2010 to December 2016 in our clinic were retrospectively reviewed. RESULTS: There was not a statistically significant difference between patients receiving spinal anesthesia and general anesthesia in terms of additional parenteral analgesic requirement at postoperative period (p = 0.520). The length of stay in hospital and δHb (preoperative hemoglobin value minus postoperative hemoglobin value) were not different between spinal anesthesia and general anesthesia groups (p = 0.140 and 0.648, respectively). The rate of postoperative antihypertensive medication requirement was statistically significant in patients with severe preeclampsia who underwent general anesthesia (p = 0.009, x2 = 6.867, odds ratios = 4.276 (1.531-11.942)). The time passing to reach the first normal blood pressure level in patients with severe preeclampsia was 11.95 ± 9.11 h in patients with spinal anesthesia, 10.55 ± 4.95 h in patients with general anesthesia, and the difference was not statistically significant (p = 0.504). CONCLUSION: The need for antihypertensive medication is greater in patients with severe preeclampsia receiving general anesthesia. There is a need for comprehensive, prospective, and randomized controlled trials to establish the relationship between postpartum morbidity and the different types of anesthesia.

Organochlorine compounds in the adipose tissue of urban and rural women who gave birth by cesarean delivery in northern Turkey.

In this study, the levels of a group of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in the adipose tissue of women living in northern Turkey who gave birth by cesarean delivery were investigated. Sixty subcutaneous samples were collected in 2013 from women in urban (30) and rural (30) areas. The levels of nine OCPs, namely α-hexachlorocyclohexane (HCH), ß-HCH (lindane), γ-HCH, hexachlorobenzene (HCB), aldrin, and dichlorodiphenyltrichloroethane (DDT) and its metabolites, 2,4'-dichlorodiphenyldichloroethylene (DDE), 4,4'-DDE, 2,4'-DDT, 4,4'-DDT, and 16 PCBs, PCB-28, -52, -70, -74, -81, -99, -101, -118, -138, -153, -156, -170, -180, -183, -187 and -208, were investigated with a gas chromatograph equipped with an electron capture detector (GC-ECD). ß-HCH was detected in nine samples (mean 23.70 ± 4.24 ng g-1 of fat) and γ-HCH was detected in six samples (mean 41.88 ± 12.41 ng g-1 of fat). HCB was detected in five samples (mean 30.97 ± 14.31 ng g-1 of fat), 2,4'-DDT in one sample (5 ng g-1 of fat), 4,4-DDT in two samples (mean 6.70 ± 0.42 ng g-1 of fat), 2,4'-dichlorodiphenyldichloroethylene in three samples (mean 6.27 ± 0.42 ng g-1 of fat), PCB-28 in six samples (mean 10.03 ± 7.79 ng g-1 of fat), PCB-81 in one sample (7.60 ng g-1 of fat) and PCB-118 in one sample (10.20 ng g-1 of fat). In total, organochlorine compounds were detected in 12 (40%) of rural and 12 (40%) of urban women. These results are an indication of the level of organochlorine compounds in the environment where the subjects of the study lived.

The impact of progesterone supplementation on pregnancy rates after intrauterine insemination in patients developing a single follicle.

The objective was to determine whether progesterone support affects pregnancy rates in patients who develop a single follicle. This was a non-randomized prospective controlled study performed on 591 intrauterine insemination (IUI) cycles that developed a single follicle; 337 women received 100 mg oral progesterone daily. The pregnancy rate was 24.3%, or 82 out of 337, in the group receiving progesterone support compared with 14.96%, or 254 out of 591, in the group with no progesterone support. IUI luteal phase supplementation with oral progesterone may improve clinical pregnancy rates when begun the day after insemination.

FMR1 gene mutation screening by TP-PCR in patients with premature ovarian failure and fragile-X.

CGG repeat expansion in the FMR1 gene is associated with fragile X syndrome, fragile X-associated tremor/ ataxia syndrome and fragile X-associated primary ovarian insufficiency. In this study, FMR1 gene mutation screening was carried out in 50 patients. Among them, 12 (%24) were POF and 19 (%38) were Fragile-X. We also examined the parents of the Fragile-X patients. DNA was extracted from blood with kit procedure. To examine expansion of the fragile-X CGG repeat, TP-PCR assay was performed and all amplicons were evaluated on an ABI3130XL Genetic Analyzer System by Fragman analysis. The data were analyzed by Gene Mapper Program. As a result of this study, the patients were identified with the fragile-X whose FMR1 gene CGG alleles have been observed in normal range. However, in patients who were referred with premature ovarian failure, pre-mutation frequency was observed as 6.6%. Only limited study in Turkish population reported frequency of pre-mutation carrier in POF and Fragile-X. Detection of pre-mutation carrier is important for next generation to have healthy siblings. We emphasize that TP-PCR technique is clear, reliable, sensitive, easy and fast method to detect pre-mutation. However, full mutations have to be examined by the technique of Southern blot in the diagnosis of fragile-X.

The combined QF-PCR and cytogenetic approach in prenatal diagnosis.

In this study, the importance of quantitative fluorescence polymerase chain reaction (QF-PCR) aneuploidy diagnosis test which provides earlier and easier results were discussed. The cell cultures and DNA isolations were performed on 100 amniotic fluids. DNA isolations were made from peripheral blood samples of mothers who had blood-stained amniotic fluid samples. The reasons of references of these pregnant women to our division were increased maternal age, positive double/triple screening test and fetal anomaly history. QF-PCR applied to 19 short tandem repeat markers in the chromosomes 13, 18, 21 and genes X and Y chromosomes. All electropherogram peaks were evaluated on ABI3130. Thirty two (32%) samples have high maternal age, seven (7%) have fetal anomaly and the others have double/triple screening test positivity. Ninety-nine (99%) of the 100 amniotic fluid samples were resulted, but one (1%) of them could not examined because of the culture failure. The maternal contamination rates were determined as 3%. Of 100 samples, 2 had trisomy 21 (2%), 1 had trisomy 13 (1%), 1 had structural abnormalities (1%) and the others (97%) have not any aneuploidy. The results of QF-PCR were in compatible with the results of cell culture and chromosome analysis. Although QF-PCR is an easier and an earlier test, it has a limitation of not to able to scan full genome. It is also sensitive for maternal contamination, so it should be tested together with maternal blood samples. QF-PCR aneuploidy test is the fastest diagnostic test for prenatal diagnosis and so it provides less stressful period for pregnant women.

Random anti-Müllerian hormone predicts ovarian response in women with high baseline follicle-stimulating hormone levels : anti-Müllerian hormone in poor responders in assisted reproductive treatment.

OBJECTIVE: To evaluate the predictive value of random serum anti-Müllerian hormone (AMH) in the assessment of ovarian response in patients with diminished ovarian reserve (DOR; diagnosed after the observation of elevated baseline levels of early follicular follicle-stimulating hormone [FSH]) who were undergoing intracytoplasmic sperm injection-embryo transfer (ICSI-ET) and to compare the random serum AMH and baseline FSH levels in these patients for the prediction of poor ovarian response. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: One hundred and thirty-nine patients who were undergoing ICSI-ET cycles with early follicular FSH level >9 IU/mL. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Poor ovarian response in ICSI-ET cycles. RESULTS: For the identification of women at risk of cycle cancellation, an AMH cut-off level ≤1.2 ng/mL had 97.3 % sensitivity, 31.3 % specificity, 33.9 % positive predictive value, and 96.9 % negative predictive value in the women with high baseline FSH levels. An AMH cut-off level ≥1 ng/mL had a sensitivity of 58.7 % and specificity of 95.1 % for prediction of retrieval of 4 or more oocytes. By using a serum AMH cutoff level of 1.5 ng/mL, the ongoing pregnancies were predicted with 83.3 % sensitivity and 82.5 % specificity and yielded a positive predictive value of 31.2 % and a negative predictive value 98.1 %. CONCLUSION: Measurement of random serum AMH level is a useful tool in the prediction of ovarian response in patients with high serum early follicular FSH levels.