Multiple Inherited Thrombophilic Gene Polymorphisms in Spontaneous Abortions in Turkish Population.

The aim of this study was to investigate the possible role of multiple inherited thrombophilic gene variations in women with unexplained spontaneous abortions. For this purpose, the Factor V Leiden (FVL) (rs6025), Prothrombin G20210A (rs1799963), MTHFR C677T (rs1801133), PAI-1 4G/5G (rs1799889), ACE I/D (rs1799752), eNOS E298D (rs1799983), and Apo E E2/E3/E4 (rs429358) polymorphisms were genotyped and correlated in spontaneously aborted fetal materials, their mothers and fertile women. Twenty three abortion materials, 22 women with ≥1 unexplained fetal loss, and 22 control subjects with at least two healthy term infants as a control group were studied. Target SNPs for each gene were analyzed by real time-PCR technique after genomic DNA isolation from maternal blood-EDTA, control group blood-EDTA and spontaneously aborted fetal tissues. Some cases had a single thrombophilic polymorphism, but the rest of the patients and fetal materials had combined thrombophilic polymorphisms. The PAI-1 4G/5G+4G/4G (P= 0.0017), 4G/4G (P= 0.0253), eNOS 894GT+894TT (P=0.0011) genotypes and T allele (P=0.0185), Apo E E3/E4+E3/E2+E2/E4 (P<0.0001) genotypes, E2 (P<0.0001) and E4 (P<0.0001) alleles were higher in spontaneously aborted fetal materials when compared to their mothers and control group. The Factor V Leiden rs6025, Prothrombin G20210A, MTHFR C677T, ACE I/D genotypes were different for each group but not statistically significant due to relatively small size of the samples (P>0.05). Our results indicated that combined thrombophilic gene variations may be associated with increased risk for spontaneous abortions and results need to be confirmed by larger sample size.

Fetal Vegf Genotype is More Important for Abortion Risk than Mother Genotype.

VEGF gene has been reported to be related with many diseases and recurrent pregnancy loss in various studies. Concerning the role of VEGF polymorphisms in pregnancy losses, generally mothers genotypes have been analyzed. To evaluate the association between VEGF A +405G/C (rs2010963), -460T/C (rs833061), +936C/T (rs3025039) and - 2578A/C (rs699947) polymorphisms and spontaneous abortion, we studied the genotypes of spontaneously aborted fetuses, their mothers and healthy controls. 23 spontaneously aborted fetal materials, 22 mothers who had these abortions and 86 healthy controls were included in this study. rs2010963, rs833061, rs3025039 and rs699947 polymorphisms were analyzed by Real Time PCR technique after genomic DNA isolation from all subjects. The frequencies of VEGF A rs2010963 GG genotype and rs2010963 G allele were higher in fetuses compared both with mothers and healthy controls. VEGF A rs3025039 TT genotype and rs3025039 T allele frequencies were higher in fetuses comparing with mothers. VEGF A rs833061 CT and TT genotypes frequencies were higher in fetuses comparing with mothers. We ascertained that VEGF A rs2010963, rs833061 and rs3025039 are the risk factors for spontaneous abortion in fetal genotypes comparing with their mothers and healthy controls.

[Evaluation of anti-Toxoplasma gondii antibody distribution and risk factors among pregnant women admitted to obstetrics polyclinic of Canakkale Onsekiz Mart University Hospital]. / Çanakkale Onsekiz Mart Üniversitesi Tip Fakültesi Hastanesi Obstetri Poliklinigine Müracaat Eden Gebelerde Anti-Toxoplasma gondii Antikorlarinin Dagilimi ve Risk Faktörlerinin Irdelenmesi.

OBJECTIVE: In this study, we aimed to investigate Toxoplasma gondii seroprevalence and risk factors in pregnant women. METHODS: A total of 196 patients, admitted to the clinic in the first trimester and with ongoing pregnancy follow-up of between May 2012 and January 2013, were included in the study. Toxoplasma IgG and IgM antibodies were detected by ELISA test in blood samples obtained from patients during routine screening. SPSS statistical software, version 19.0 was used to analyze the data. Descriptive statistics were used to present the data, percentage, mean, and standard deviation. Chi-square test was used for categorical variables. p-value for statistical significance was defined as p<0.05. RESULTS: The mean age was 29.07±5.3 years in our study group. Anti-Toxoplasma IgG and IgM antibodies were found in 28.8% and 2.7%, respectively; 58.9% of pregnant women in the study reported that they had done at least one risky behavior during their pregnancy. However, there was no significant association between T. gondii IgG antibody positivity and risk factors, such as pregnancy, feeding animals in the past years, and consumption of raw food products (p>0.05). CONCLUSION: We found that Toxoplasma IgG antibody seropositivity (28.8%) was similar to that found in the other studies from western Turkey.

The effect of anaesthesia technique on maternal and cord blood ischaemia-modified albumin levels during caesarean section: a randomized controlled study.

OBJECTIVE: Ischaemia-modified albumin (IMA) is an early marker for various ischaemic events, including cardiac ischaemia. This study determined variations in IMA levels during caesarean section, performed under general anaesthesia or with combined spinal epidural anaesthesia. METHODS: Full-term, healthy pregnant women were allocated to undergo caesarean section, using either general anaesthesia or combined spinal epidural anaesthesia. IMA and albumin levels were measured in maternal serum samples taken immediately prior to caesarean section and 30 min into the procedure, as well as from serum taken from cord blood after double clamping. RESULTS: At total of 51 healthy pregnant women underwent either general anaesthesia (n = 28) or combined spinal epidural anaesthesia (n = 23). Within-group analysis of the general anaesthesia group showed that both IMA levels and IMA/albumin ratios were significantly higher at 30 min of surgery compared with the immediate preoperative period. CONCLUSIONS: Lower IMA levels in the combined spinal epidural anaesthesia group may have been due to improved balancing of oxidative stress during caesarean section. Further research on IMA levels during caesarean section should take into account the method of anaesthesia used.

Premature progesterone elevation impairs implantation and live birth rates in GnRH-agonist IVF/ICSI cycles.

INTRODUCTION: Our aim was to investigate the clinical significance of premature elevated progesterone levels in women with good ovarian response treated with long gonadotropin-releasing hormone agonist (GnRH-a) cycles and IVF. Premature elevated progesterone levels refer to a rise in serum progesterone levels on the day of human chorionic gonadotrophin (hCG) administration for final oocyte maturation above a threshold level, which is usually arbitrarily defined. MATERIALS AND METHODS: This is a retrospective case study, which consists of 1,045 treatment cycles in women with low P/E2 [progesterone (ng/mL) x 1,000/estradiol (pg/mL)] on the day of hCG. Elevated P levels on the day of hCG administration were defined as >1.1 ng/mL. The data of the control group (< or =1.1 ng/mL, n = 900 patients) were compared with those of the high P group (>1.1 ng/mL, n = 145). RESULTS: Compared with the control group, those in the high progesterone group had higher levels of estradiol on the day of hCG (3,143 vs. 2,382 pg/ml) (p: 0.000) and higher numbers of MII oocytes (14.0 and 12.9) (p: 0.001). The total number of embryos and the number of good-quality embryos transferred did not differ significantly between the groups. Implantation rate (18.1 vs. 24.4%) (p: 0.008), and live birth rate (27.6 vs. 40%) (p: 0.004), were significantly lower in patients with high progesterone levels. OR and 95% CI were 0.57 (0.39-0.84) for the live birth rate. CONCLUSION: In women stimulated with GnRHa and hMG/FSH for IVF, elevated serum progesterone levels on the day of hCG administration were associated with diminished implantation rates and live birth rates regardless of ovarian reserve.

The impact of rescue in vitro fertilization converted from high-response gonadotropin intrauterine insemination cycles in terms of implantation and pregnancy rates as compared with matched controls.

OBJECTIVE: To determine whether conversion of high-response gonadotropin/intrauterine insemination (IUI) cycles to "rescue" in vitro fertilization (IVF) yields a higher implantation and pregnancy rate as found in matched IVF controls. DESIGN: A prospective study with a retrospective controlled section. SETTING: Baskent University Department of Obstetrics and Gynecology. PATIENT(S): Thirty-two patients switched from high response gonadotropin/IUI cycles to "rescue" IVF, 202 women with polycystic ovaries (PCO), and 452 women without PCO from the IVF database. INTERVENTION(S): High-response gonadotropin/IUI cycles were converted to IVF to avoid cycle cancellation and high-order multiple pregnancies. MAIN OUTCOME MEASURE(S): Clinical parameters and characteristics of controlled ovarian hyperstimulation and intracytoplasmic sperm injection results. RESULT(S): The pregnancy rate was 78.1% in the rescue IVF group: 66.3% and 58.2% in the PCO and non-PCO groups, respectively. Clinical pregnancy rates and ongoing pregnancy rates also tended to be higher in the rescue IVF group but the difference was not statistically significant. The main difference between the groups was in the implantation rate: 37.5% in the rescue IVF group, which was greater than that of the PCO and non-PCO groups (27.58% and 24.46%, respectively). CONCLUSION(S): Our study demonstrates that conversion of gonadotropin IUI cycles in patients with excessive follicles to IVF is a safe, effective strategy. Implantation rates are higher than those in hyper-responder and normal responder IVF patients.

Effect of cervical mucus aspiration before intrauterine insemination.

OBJECTIVE: To determine whether cervical mucus aspiration before intrauterine insemination (IUI) has any effect on clinical pregnancy rates. METHOD: The outcomes of 186 IUI cycles in 95 consecutive patients in whom mucus was aspired prior to IUI were compared retrospectively with those of 1057 IUI cycles in 505 women. RESULTS: The pregnancy rate was 15.1% (28 pregnancies for 186 cycles) in the cervical mucus aspiration group and 9.9% (105 pregnancies for 1057 cycles) in the control group (P=0.05). Mucus aspiration led to significantly increased pregnancy rates for women with unexplained infertility (24% in the aspiration group vs 9.5% in the control group; P=0.04). CONCLUSION: Cervical mucus aspiration before IUI might improve clinical pregnancy rates by yet-to-be-defined mechanisms.