Gonadotropin-Releasing Hormone Analog Combined with Depot Medroxyprogesterone Acetate in the Management of Endometrial Hyperplasia A Prospective Randomized Clinical Study.

OBJECTIVE: To compare the effectiveness of combined treatment of depot medroxyprogesterone acetate (MPA) with gonadotropin-releasing hormone (GnRH) analog and depot MPA alone in the management of simple endometrial hyperplasia without atypia among heavy bleeders. STUDY DESIGN: Thirty- four patients with endo- metrial hyperplasia with- out atypia were selected in this prospective randomized study. Group I consisted of 15 patients who were treated with depot MPA combined with GnRH analog. Group 2 consisted of 19 patients who were treated with depot MPA alone. Injections were applied at the beginning of the study and at the end of the 3rd month. Endometrial biopsies were performed at the end of the 6th month. Main outcome measures were endometrial response and reduction of duration and amount of menstrual bleeding. RESULTS: Total and mean duration of menstruation and total number of standardized pads used were signifi- cantly decreased in both groups. These parameters were also significantly lower in group 1 than in group 2 at the end of both the 3rd and 6th months of the study (p<0.01). Endometrial response rates were significant- ly higher in group I than in group 2 (100% vs. 44.4%, respectively, p <0.05). CONCLUSION: Management of endometrial hyper- plasia with GnRH analog in addition to depot MPA provides prompt endometrial response and rapid menstru- al cycle control.

Effect of blood and mucus on the success rates of embryo transfers.

OBJECTIVES: To provide information about the effects of blood and mucus on the embryo transfer (ET) catheters after transfer on embryo transfer outcomes. STUDY DESIGN: Retrospective analysis of 8311 ultrasound-guided embryo transfers performed in a single center. In 6897 cases (82.9%), there were no blood on the catheter after ET, 1168 transfers were associated with mild blood (14.1%), 33 transfers with moderate blood (0.4%) and 213 transfers with severe blood (2.6%). A total of 6162 transfer catheters were free of mucus (74.8%), whereas mucus was detected on 2081 catheters (25.2%). RESULTS: The implantation rate (IR) was highest in the group with no blood on the transfer catheter, and lowest in the group with severe blood on the catheter. The clinical pregnancy rate (CPR) was lowest in the group with severe blood on the catheter. The presence of mucus on the catheter was found to have no effect on IR, CPR, biochemical pregnancy rates, miscarriage rates and live birth rates. CONCLUSIONS: This study showed decreased IR, CPR and live birth rates in ETs associated with blood on the catheter. Mucus on the catheter appeared to be a simple contamination in this study and pregnancy rates remained unaffected.

Effect of air bubble localization after transfer on embryo transfer outcomes.

OBJECTIVES: Our study aimed to provide information about the effects of air bubble localization after transfer on embryo transfer outcomes. STUDY DESIGN: Retrospective analysis of 7489 ultrasound-guided embryo transfers. Group 1 included 6631 embryo transfers in which no movement of the air bubbles was observed after transfer. Group 2 consisted of 407 embryo transfers in which the air bubbles moved towards the uterine fundus spontaneously, a little time after transfer. Group 3 included 370 embryo transfers in which the air bubbles moved towards the uterine fundus with ejection, immediately after transfer. Group 4 consisted of 81 embryo transfers in which the air bubbles moved towards the cervical canal. RESULTS: The four patient groups were different from one another with respect to positive pregnancy tests. Post hoc test revealed that this difference was between group 4 and other groups. CONCLUSIONS: An initial finding of our study was significantly decreased positive pregnancy test rates and clinical pregnancy rates with air bubbles moving towards the cervical canal after transfer. Although air bubbles moving towards the uterine fundus with ejection were associated with higher pregnancy rates, higher miscarriage rates and similar live birth rates were observed compared to air bubbles remaining stable after transfer.

Management of endometrial polyps diagnosed before or during ICSI cycles.

This retrospective study aimed to shed light on the management options of endometrial polyps diagnosed before or during intracytoplasmic sperm injection (ICSI) treatment. The study included all fresh ICSI cycles performed in the Anatolia IVF Center between July 2005 and January 2009. Group 1 consisted of 47 patients who were diagnosed with an endometrial polyp before their ICSI cycle. All patients diagnosed with an endometrial polyp by transvaginal ultrasonography before the ICSI cycle underwent hysteroscopic polyp resection. Group 1 was compared with 47 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 2). Group 3 included 128 patients diagnosed with an endometrial polyp during stimulation in their ICSI cycles. Group 3 was compared with 128 matched control patients without endometrial polyps who underwent standard ICSI cycles (group 4). Patients diagnosed with an endometrial polyp before ICSI cycles were similar to their controls with regard to clinical pregnancy (29.8% versus 38.3%) and live-birth (25.5% versus 31.9%) rates per transfer, as were patients diagnosed with an endometrial polyp during ovarian stimulation (clinical pregnancy rates 45.3% versus 46.9%; live-birth rates 40.6% versus 39.8%). In conclusion, further studies are required to identify the most appropriate management of endometrial polyps.

Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey.

OBJECTIVES: To determine the prevalence and factors associated with diastasis recti abdominis (DRA) MATERIAL AND METHODS: Between January 2011 and May 2011, we examined 95 patients, aged between 19-24, for the presence of DRA during an ultrasonographic exploration in Mus Obstetrics and Gynecology Hospital, Mus, Turkey DRA was graded by the number of fingerbreadths between the medial edges of the bellies of the rectus abdominis muscle, 3-4 cm above the umbilicus. The exclusion criteria included urogynecologic problems since childhood, excessive protrusion of the vagina due to loss of support, pregnancy obesity less than 6 months postpartum. The relationship between DRA and parity previous abdominal surgery pelvic relaxation as well as type of parity was assessed. RESULTS: Positive correlation was found between parity and DRA (r = 0.77; p < 0.001). Although there was no significant difference between DRA and the type of delivery among primiparous patients (p = 0.556), DRA increased significantly in the second cesarean section patients (p = 0.004). In this trial, cystocele and rectocele were established in 57% and 43% of patients with DRA, while descensus uteri was present in 10 (52%) patients. CONCLUSIONS: Increased parity and recurrent abdominal surgery seem to increase the risk of DRA. However; the importance of DRA in the young women remains unknown.

Expression of the imprinted IGF2 and H19 genes in the endometrium of cases with unexplained infertility.

OBJECTIVE: As genomic imprinting plays a critical role in the development of the placenta, the aim of this study was to detect whether the expression levels of the imprinted genes IGF2 and H19 in the endometrium differ between infertile and fertile women. STUDY DESIGN: Total RNA was extracted from 30 (15 unexplained infertile and 15 fertile) women's endometrial tissue. cDNA was synthesized from total RNAs of each sample. IGF2 and H19 mRNA expression levels were measured quantitatively using the Real Time PCR method. In order to determine the allelic expression of IGF2 and H19, genomic DNA was extracted from endometrial tissues. RESULTS: When compared with the control group, increased mRNA expression of IGF2 was detected (1.5-fold change, P=0.015) in the unexplained infertility group. In contrast, H19 expression was lower in the infertility group as compared to the control group (4-fold change, P<0.0001). Restriction analysis of cDNA-derived PCR product showed that all patients and controls indicated monoallelic expression of IGF2 and H19. CONCLUSION: Our results showed that altered expression of these imprinted genes might affect implantation and that their timely and appropriate activation is important for proper functioning. To understand the molecular epigenetic basis of implantation and placental development, genomic imprinted genes should be further investigated.

Impact of embryo replacement depth on in vitro fertilization and embryo transfer outcomes.

OBJECTIVE: To investigate the impact of embryo replacement depth on IVF and embryo transfer outcomes. DESIGN: Retrospective analysis (May 2005 to November 2008) of 5,055 ultrasound-guided embryo transfers belonging to 3,930 infertile couples. The distance between the fundal endometrial surface and the catheter tip was measured and accordingly, patients were divided into five groups. SETTING: Anatolia IVF Center, Ankara, Turkey. PATIENT(S): All patients enrolled in the IVF program undergoing embryo transfer. INTERVENTION(S): No patient received any additional procedure or intervention. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (PR) and ongoing PR. RESULT(S): Mean total number of embryos transferred in groups 4 and 5 were significantly higher than in groups 2 and 3. Analysis of PRs and outcome of gestations in the five groups studied yielded similar PRs in all groups except for group 1. CONCLUSION(S): Pregnancy rates and ongoing PRs are higher if the embryos are replaced at a distance >10 mm from the fundal endometrial surface. In addition because significantly more embryos were replaced in cycles where the transfers occurred at a distance of >20 mm, a distance>10 mm to <20 mm seems to be the best site for embryo transfer to achieve higher PRs.

Endometrial mRNA expression of matrix metalloproteinases, their tissue inhibitors and cell adhesion molecules in unexplained infertility and implantation failure patients.

The aim of this study was to analyse whether some cases of unexplained infertility and implantation failure after IVF could be explained by different expression levels of the matrix metalloproteinases (MMP-2, 9), their tissue inhibitors (TIMP-2, 3) and intercellular (ICAM-1) and vascular (VCAM-1) adhesion molecules in endothelial cells. Total RNA was extracted from the endometrial tissues of 41 women (unexplained infertile, group 1, n = 15; fertile volunteers, group 2, n = 15 and patients with implantation failure after IVF, group 3, n = 11). MMP-2, MMP-9, TIMP-2, TIMP-3, ICAM-1 and VCAM-1 mRNA expression levels were measured quantitatively using real-time polymerase chain reaction. In the endometrium from women with unexplained infertility and implantation failure after IVF, MMP-2 and TIMP-3 expression were significantly decreased when compared with the fertile group (P < 0.05 and P

Effect of different degrees of glucose intolerance on maternal and perinatal outcomes.

OBJECTIVE: To evaluate the effect of markedly elevated 50-g glucose loading test (GLT) (>or=200 mg/dL) and equivocal 100-g GLT (one abnormal value) results on maternal and perinatal outcomes. METHODS: Retrospective analysis of 2029 singleton pregnancies screened for gestational diabetes mellitus (GDM). Maternal and perinatal outcomes in five different groups with different degrees of glucose intolerance were compared. First group consisted of patients with normal 50-g test, second group was formed by patients with abnormal 50-g glucose test but a normal 100-g test. Third group included patients with one abnormal value after 100-g test. Patients in the fourth group were diagnosed to have GDM after an abnormal 100-g test. Patients in the fifth group had a value >or=200 mg/dL after 50-g test and were diagnosed to have GDM. RESULTS: Macrosomia and large for gestational age incidence were highest in the group with one elevated glucose tolerance test (GTT) value. Hospitalisation rates, hypoglycemia, hyperbilirubinemia and polycythemia were more common in neonates born to mothers with one elevated GTT value and to mothers with a GLT > 200 mg/dL. CONCLUSION: Adverse maternal and perinatal outcomes in patients with one elevated GTT value and in patients with a GLT value > 200 mg/dL warrant close glucose monitoring and treatment in these groups even in the absence of a diagnostic abnormal GTT.

Recurrent septo-optic dysplasia accompanied by omphalocele: a case report.

Septo-optic dysplasia, also known as de Morsier syndrome, is a rare congenital entity almost always characterized by hypoplasia/dysplasia of the optical nerve, chiasma or optic radiations and the complete or partial absence of the septum pellucidum. It may also be accompanied by other malformations, including multiple facial dysmorphism, midline defects, cleft lip and palate, musculoskeletal and other non-neurological eye features. Various cases have been reported which have presented various combinations of symptoms and stigmata of the syndrome. We here present a unique case of septo-optic dysplasia with familial repetition, a considerably early antenatal diagnosis and an accompanying omphalocele, a feature never before connected with the syndrome.

Seroprevalences of herpes simplex virus type 2 and Chlamydia trachomatis in Turkey.

OBJECTIVE: Aim was to detect the seroprevalences of Herpes simplex virus type 2 (HSV-2) and Chlamydia trachomatis in a subpopulation of Turkey. MATERIALS AND METHODS: The study was performed in the "Golbasi" rural area of Ankara, the capital city of Turkey. Ten milliliter of peripheral blood was drawn from 1,115 women over 15 years old. Once the sera were separated, ELISA was used to detect seropositivity. Data were transferred to Epi Info Version 6.0 statistical program and the analysis was performed. RESULTS: Among all participants, 53.5% were found to be seropositive for HSV-2 and 52.2% were found to be seropositive for C. trachomatis. CONCLUSION: This study detected a much higher HSV-2 and C. trachomatis seroprevalence for the Turkish population than expected and previously reported. A percentage around 50% for both agents creates an important conflict with the common misbelief of the Turkish population that sexually transmitted diseases are not common in this population. This study points out the importance of preventive measures and the need for greater surveillance for sexually transmitted infections among the Turkish population.

Recurrent mucinous cystadenoma: a laparoscopic approach.

The second most common epithelial tumor of the ovary is mucinous-type, and it constitutes 8-10% of all ovarian tumors. The recurrence of mucinous cystadenoma is very rare after complete excision. Only four such cases have been reported till date. The case presented in this report is the fifth, who had her initial surgery performed by gynecologic oncology team by laparotomy and was followed up by the same group. After recurrence at the same ovary, the patient underwent laparoscopic evaluation and unilateral salpingoophorectomy was performed. The final histopathological diagnosis was mucinous cystadenoma, just the same as the initial cyst.

Vaginal evisceration after trauma unrelated to previous pelvic surgery.

BACKGROUND: Vaginal evisceration is described as extrusion of intraperitoneal contents secondary to the disruption of the vagina. It is an extremely rare emergency condition. OBJECTIVES: To describe a very rare case of vaginal evisceration that occurred after blunt trauma in a patient with no prior pelvic surgery. CASE REPORT: This report describes vaginal evisceration in a 73-year-old female with no prior pelvic surgery, after blunt trauma. The patient was handled by the cooperation of gynecology and general surgery departments. An immediate surgery was performed after stabilization of the patient and no postoperative complications occurred. CONCLUSION: Whatever be the treatment approach, emergency management of vaginal evisceration is critical to the preservation of a viable bowel. Repositioning of viable bowels into the abdominal cavity and appropriate surgical repair are cornerstones of the treatment.

Evaluation of the sexual function and quality of life in raloxifene treated postmenopausal women.

OBJECTIVE: To evaluate the net effect of raloxifene on overall quality of life and sexual function in postmenopausal women. METHODS: The study was performed in the Gynecology and Obstetrics outpatient clinic of Gazi University Faculty of Medicine between January 2002 and February 2005. Fifty postmenopausal women, in whom raloxifene was indicated for prevention and treatment of osteoporosis, were considered the study group. Fifty postmenopausal women who were not osteoporotic were enrolled as the control group. Participants completed a questionnaire composed of several parts (GRISS, BDI and ISI), at the beginning and end of the 12-month treatment period. RESULTS: Two groups were similar to each other with respect to total GRISS scores at the beginning and at the end of the study (P=0.929 and P=0.508; respectively). Raloxifene was associated with a significant improvement from baseline in the total scores of BDI (P=0.0001), whereas this improvement was not significantly different from the control group (P=0.216). With regard to ISI scores, there were no differences between groups in total scores. Raloxifene use did not seem to affect subscores of ISI either. CONCLUSIONS: This study failed to prove any deleterious effect of raloxifene on quality of life and sexual functions.

Gonadotropin-releasing hormone analog combined with a low-dose oral contraceptive to treat heavy menstrual bleeding.

OBJECTIVE: To compare the effects of low-dose oral contraceptives used alone and in combination with a gonadotropin-releasing hormone (GnRH) analog to treat heavy menstrual bleeding. METHODS: Fifty-eight patients with heavy menstrual bleeding were prospectively randomized into two treatment groups to receive either a low-dose oral contraceptive alone (group 1), or combined with a GnRH analog (group 2) for 6 months. The patients' hormonal profiles, and hemoglobin and hematocrit levels were measured at the beginning and at the end of the treatment period. RESULTS: Hemoglobin and hematocrit levels significantly improved in both groups after 6 months of treatment (P<0.05 and P<0.01, respectively). Even in the first month of the study, the number of pads used and the duration of menstruation were significantly decreased in both groups and markedly lower in group 2 (P<0.01). CONCLUSION: The addition of a GnRH analog to low-dose oral contraceptive treatment for heavy menstrual bleeding resulted in better control of vaginal bleeding, even in the first month of therapy.

Manometric evaluation of anal sphincter function after vaginal and cesarean delivery.

OBJECTIVE: To compare anal sphincter function following spontaneous vaginal delivery and cesarean delivery, and assess the association of perineal length and sphincter injury with each delivery mode. METHOD: Perineal length was measured and anal manometric measurements were performed in 120 primigravidas before and after delivery. RESULTS: Mean values for maximum anal resting and squeeze pressures were significantly lower after delivery irrespective of the mode of delivery, but there was a positive correlation between postpartum maximum anal resting pressure and perineal length (r=0.24, P<0.01). CONCLUSION: Anal sphincter function was disturbed after both vaginal and cesarean delivery, a finding weakened by the fact that almost half of the cesareans were performed for cephalopelvic disproportion identified during labor.

Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation.

The objective of this cross-sectional study was to identify the prognostic factors that influence the outcome of ovarian stimulation with intrauterine insemination (IUI) cycles using gonadotrophins in couples with unexplained and mild male-factor subfertility. A total of 838 cycles in 456 women with unexplained and mild male-factor subfertility attending a university-based infertility clinic was evaluated. Of these cycles, 139 resulted in pregnancy (16.6% per cycle) and 96 out of 98 ongoing pregnancies resulted in live term birth. Live birth rate per patient and per cycle was 21.1% and 11.4%, respectively. Multivariate logistic regression analysis demonstrated that duration of infertility (P = 0.034), type of infertility (P = 0.003), aetiology of infertility (P = 0.004), number of treatment cycles (P = 0.0001) and number of dominant follicles before human chorionic gonadotrophin (HCG; P = 0.024) were significant independent factors to predict clinical pregnancy. The duration of infertility (P = 0.043), number of treatment cycles (P = 0.0001) and number of dominant follicles before HCG (P = 0.024) were significant independent factors to predict live birth. In conclusion, for subfertile couples having shorter duration of subfertility, multifollicular response to gonadotrophins and in their first treatment cycle are more likely to succeed a live birth with IUI treatment using recombinant gonadotrophins.

Double aneuploidy in spontaneous miscarriages: two case reports and review of the literature.

The occurrence of double aneuploidy is a relatively rare phenomenon. The clinical presentations are variable depending on the predominating aneuploidy or a combination effect of both. We report the cytogenetic data on products of conception from miscarriages over a period of 5 years. A total of 403 miscarriages were karyotyped and the tissues were villi in all cases. Of 403 cases, 54 cases with single aneuploidy and 2 cases of first-trimester miscarriages with double trisomies were found. These 2 cases with the karyotypes of 48,XXY,+15 and 48,XX,+5,+7 were cited for the first time in this study.

Effects of chronic treatment with valproate and oxcarbazepine on ovarian folliculogenesis in rats.

PURPOSE: We aimed to define the morphologic effects of valproate (VPA) and oxcarbazepine (OXC) on ovarian folliculogenesis in rats. METHODS: Forty female wistar rats (21-24 days old and weighted between 46.4 and 55.3 g) were divided equally into 4 experimental groups, which were applied tap water (control group), 300 mg/kg/day VPA, 100 mg/kg/day OXC, and both VPA and OXC via gavage for 90 days. Ovaries of the rats on proestrous and diesterous phase of estrous cycle according to daily vaginal smear were taken out and placed in a fixation solution. Immunohistochemical and apoptosis (TUNEL) staining protocols were applied. RESULTS: The number of follicles decreased and that of corpora lutea increased significantly in OXC, VPA, and OXC+VPA treated groups compared with control group (p < 0.05). The number of TUNEL positive ovarian follicles was 1.40 +/- 0.52 in control group, but it significantly increased to 3.50 +/- 0.53, 3.50 +/- 0.53, and 4.90 +/- 0.88 in VPA, OXC, and VPA+OXC groups (p < 0.0001). The increase in the number of TUNEL positive granulosa cells was also significant for OXC and VPA+OXC groups (p < 0.0001). Immunohistochemical HSCORE decreased for TGF beta 1 and IGF1 staining and increased for P53 staining in all drug groups compared with control group (p < 0.001). Intensity of P53 labeling increased, while intensity of TGF beta 1, IGF-1, and GDF-9 immunoreactivity decreased significantly in all drug groups compared with control group (p < 0.001). CONCLUSION: Long-term treatment with VPA or OXC from prepuberty to adulthood causes apoptosis and deterioration of folliculogenesis in rat ovarian follicles.