Comparing the effects of endometrial injury with hysteroscopy or Pipelle cannula on fertility outcome.

OBJECTIVE: To compare the effects of mechanical endometrial injury performed with hysteroscopy or Pipelle cannula on fertility outcome in patients with implantation failure. PATIENTS AND METHODS: Sixty patients with a history of two or more failed ICSI despite the transfer of high-quality embryos were equally divided into three groups: Group A - injury with hysteroscopy (n=20), Group B - injury with Pipelle cannula (n=20), Group C - no injury (n=20). Patients in group A underwent endometrial injury with monopolar needle forceps between days 10-12 of the proliferative phase in the preceding cycle before ovarian stimulation. Patients in group B underwent endometrial injury with Pipelle cannula between days 22-24 of the mid-luteal phase in the preceding cycle. Patients in group C had no injuries. Beta-hCG, clinical pregnancy, live birth and miscarriage rates were analyzed among the groups. RESULTS: There were no significant differences in terms of positive pregnancy test, clinical pregnancy and live birth rates between hysteroscopy and Pipelle groups. Compared to the control group, both clinical pregnancy and live birth rates were found to be significantly higher in patients who underwent endometrial injury with hysteroscopy or Pipelle cannula. Miscarriage rates in the control group were significantly higher than those in the Pipella or hysteroscopic injury. CONCLUSIONS: Endometrial injuries performed in the follicular phase with hysteroscopic monopolar forceps or in the secretory phase with Pipelle cannula increase pregnancy and live birth.

Correlation between high Choline metabolite signal in spectroscopy and sperm retrieval chance at micro-TESE.

OBJECTIVE: To determine the relationship between choline (Cho) signal intensity measured before micro-dissection testicular sperm extraction (micro-TESE) and sperm retrieval rates in mTESE in non-obstructive azoospermia (NOA) patients. PATIENTS AND METHODS: A total of 20 patients who underwent testicular MR spectroscopy were included in the study. Participants consisted of 10 patients diagnosed with NOA and 10 fertile cases with normal sperm counts. Both groups of participants underwent bilateral testis MR spectroscopy. Ten patients in the NOA group underwent mTESE after spectroscopy. The signal intensities of Cho, creatine (Cr), lactate, and lipids were analyzed and compared with the results of fertile control. Cho signal intensity detected before mTESE in the NOA group and sperm retrieval rates were compared. RESULTS: Sperm was found in 5 of 10 patients who underwent mTESE. No sperm was found in five NOA cases. The main metabolites detected in NOA cases with sperm in mTESE were Cho and Cr. Cho and Cr signals were found to be significantly lower in NOA cases where no sperm could be found in mTESE. Cho and Cr signal intensities of the fertile group were similar to NOA patients with sperm in mTESE but were significantly higher than those with NOA without sperm. While the cut-off value of Cho was 1.24 ppm (AUC 0.665, p = 0.01 [95% CI: 0.722-1.00]) the cut-off value of Cr was 1.18 ppm (AUC 0.887, p = 0.02 [95% CI]): 0.620-1.00]) for positive sperm retrieval. CONCLUSIONS: Detection of high Cho metabolite in the spectra before TESE in NOA patients increases sperm retrieval rates in mTESE.

Calcium gluconate infusion is not as effective as dopamine agonists in preventing ovarian hyperstimulation syndrome.

OBJECTIVE: The aim of the study was to compare the effectiveness of calcium gluconate and cabergoline therapy in the prevention of ovarian hyperstimulation syndrome (OHSS). PATIENTS AND METHODS: Eight hundred and forty-five women who underwent GnRH antagonist protocol and at high risk for developing OHSS were divided into two groups, those given cabergoline (n=435) or calcium gluconate (n=410). In cabergoline group, 0.5 mg of cabergoline was administered once daily p.o. starting on the day of ovulation trigger and continued until the following 8 days. In calcium gluconate group, intravenous calcium gluconate was administered daily for four days starting on the day of oocyte pickup (OPU). 10 ml of 10% calcium gluconate solution was dissolved in 200 ml of physiological saline and administered by intravenous route within 40 minutes. Infusion was started within the first 30 minutes following the OPU and continued on the 1st, 2nd and 3rd days after OPU. RESULTS: Mild OHSS was developed in 367 (89%) patients receiving calcium gluconate infusion, while 251 patients (57%) in the cabergoline group developed mild OHSS. The frequency of mild OHSS in the calcium group was significantly higher than the cabergoline group (p<.001). Moderate OHSS was observed in 32 people (7.8%) in the calcium gluconate group, while it was observed in 184 people in the cabergoline group (42.3%). Calcium gluconate infusion significantly reduced the development of moderate OHSS compared to cabergoline therapy (p<.001). Severe OHSS developed in 11 patients (2.7%) in the calcium gluconate group, while severe OHSS did not develop in those given cabergoline (0%, p<.001). Clinical pregnancy, live birth and abortion rates were similar in the two groups. When logistic regression analysis was performed, a significant correlation was found between age, BMI, AMH, the number of antral follicle count, OHSS history, paracentesis, progesterone on the day of hCG, 2 PN zygotes, and HbA1c levels and the development of OHSS. No correlation was found between the use of metformin or cetrotide and the development of OHSS. CONCLUSIONS: Calcium gluconate treatment is not effective in the prevention of OHSS.

Treatment of postoperative enterocutaneous fistulas with octreotide in two neonates.

Enterocutaneous fistula (EF) in newborns and prematures is a well-recognized complication after necrotizing enterocolitis and other abdominal surgical procedures. Conservative management consists of bowel rest, antibiotics, wound care, and the administration of drugs that either reduce gastrointestinal motility or secretions. Octreotide decreases gastrointestinal secretions, inhibits or blocks the effects of gastrointestinal hormones, diminishes gut motility and thus reduces the flow through the fistula. We used octreotide and were able to report successful spontaneous closure of a fistula in our 2 neonatal patients, one a premature neonate with necrotizing enterocolitis (NEC) and the other with meconium peritonitis.

Inhibin B levels in peripheral vein do not correlate with inhibin B levels in the spermatic vein in adolescents with varicocele.

This study was conducted to evaluate the inhibin B with FSH and LH levels on spermatogenesis in varicocele patients. The study group consisted of 10 adolescent with left idiopathic varicocele of grade II and III. Blood specimens were obtained from dilated spermatic vein and peripheral vein simultaneously. Peripheral samples were also collected from 7 healthy children as controls. Inhibin B was measured with ELISA inhibin B kits. FSH and LH were analyzed by radioimmunoassay techniques. The results were analyzed using Mann-Whitney U and Spearman's rank tests. A value of p < 0.05 was considered significant. Peripheral FSH, LH and inhibin B levels were the same in the study and control group (p > 0.05). Mean inbibin B levels of spermatic vein were significantly higher than the control and peripheral blood of the study groups (p < 0.05). FSH, LH, and inhibin B levels correlated poorly each other (p > 0.05). Preoperative serum inhibin B concentration could not reliably predict a response to varicocelectomy, but the increase in inhibin B levels after treatment might suggest an improvement in testicular function.

Impact of different hormone replacement therapy regimens on the size of myoma uteri in postmenopausal period: tibolone versus transdermal hormonal replacement system.

OBJECTIVES: To assess the effect of different hormone replacement therapy regimens on myoma uteri in postmenopausal period. METHODS: Totally 46 patients with 60 myomas attending to Department of Obstetrics and Gynecology, Akdeniz University School of Medicine between May 2000 and March 2001 because of postmenopausal symptoms and having myoma uteri were included in this study. These patients were randomized for tibolone and transdermal hormonal replacement therapy system. The patients who were taking hormonal replacement therapy, discontinued the treatments and lost for follow-up were excluded from the study. Impact of the treatments on the size of myoma uteri was evaluated 6 months after starting the therapy. Size of myomas were evaluated by transvaginal sonography before and 6 months after onset of the treatment. RESULTS: Mean age was 57.3 (50-70) and mean gravida 3.6 (1-6) for all the patients. Although, increase in the size of myoma uteri was frequent in transdermal HRT, it was not statistically significant. CONCLUSION: There are no statistical significant differences between tibolone and transdermal hormonal replacement therapy regimens in respect to increase in the size of myoma uteri.