Obturator nerve endometriosis: A systematic review of the literature.

Background: Symptomatic obturator nerve endometriosis is a rare condition. In this paper, we aim to review and discuss the characteristics of obturator nerve endometriosis in light of current literature. Methods: An electronic search was conducted using the PubMed/Medline database. Results: Symptomatic obturator nerve endometriosis is rare; only 8 cases have been reported in the literature. Symptoms including difficulty walking, weak thigh adduction and pain in the inner thigh, which are all related to obturator nerve function, could be seen in the case of the entrapment of the nerve by endometrial nodules. A history of recurrent symptoms during menstrual cycles and physical examination, combined with appropriate radiologic imaging, led to a suspicion of obturator nerve involvement. Conclusion: Early diagnosis and surgical treatment of obturator nerve endometriosis is essential to minimise the nerve damage caused by recurrent cycles of bleeding and fibrosis, which are characteristics of endometriosis. The laparoscopic minimally invasive technique is feasible for the surgery of obturator nerve endometriosis. It offers the advantage of precise discrimination of vital structures and excellent access to deep anatomic sites. What is New?: Obturator nerve endometriosis may be a severe cause of chronic pelvic pain in women of reproductive age. Treatment may be achieved surgically and in experienced hands, laparoscopic surgery would be the preferred choice.

Surgical Treatment of Catamenial Chest Pain: Excision of diaphragmatic endometriosis during robot-assisted laparoscopic surgery.

Background: 10% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions often require surgical treatment. Objective: This video aims to demonstrate the appearance of diaphragmatic endometriosis and describe our experience with robot-assisted laparoscopic excision of full thickness diaphragmatic endometriosis. Materials and Methods: The patient was a 37-year-old female with the complaint of cyclical right shoulder pain (for 1 year). She previously had caesarean section scar and umbilical endometriosis excision procedures. The magnetic resonance imaging (MRI) of the abdomen highlighted three endometriotic nodules, one of which was described as full thickness on the right hemi-diaphragm. The patient underwent a robot-assisted laparoscopic endometriosis surgery as a joint procedure between the gynaecology and general surgery teams. The falciform ligament was completely divided to obtain full views of the endometriotic lesions on the diaphragm. Superficial diaphragmatic lesions were first excised. The larger deep nodule, which was described on the MRI, was then excised with the full thickness of diaphragm. Pleural cavity was entered intentionally to achieve complete excision of the nodule. Laparoscopic assessment of the right lower pleural cavity through this opening did not show any endometriotic lesions. After the excision, the diaphragm was repaired with a barbed suture. Negative pressure suction of the pleural cavity was performed at the end of this repair instead of using a chest tube. Results: The patient was discharged on the 3rd day with no complications encountered. Histopathological examination confirmed endometriosis. The patient was asymptomatic three months after surgery. Conclusion: Robotic-assisted surgery is an easy and safe choice especially in such challenging dual compartment surgeries by providing a 3D view that abolishes sensory loss and increases depth perception, providing better manoeuvrability with tremor absence.

Association between TSH Values and GFR Levels in Euthyroid Cases with Metabolic Syndrome.

BACKGROUND: Metabolic syndrome (MetS) is associated with the risk of developing chronic kidney disease. Although the negative effects of high thyroid-stimulating hormone (TSH) values on glomerular filtration rate (GFR) levels have been known for years, the negative effects of increased TSH on GFR in euthyroid cases have been reported in recent years. This study was aimed at investigating the association between the effect of increased TSH values and estimated-GFR (eGFR) levels in euthyroid cases with MetS. METHODS: For this hospital-based descriptive study, 191 MetS cases (123 females, 68 males) were evaluated. Those whose TSH was not within 0.5-4.5 uIU/mL, eGFR was <40 mL/min/1.73 m2, and/or reported any thyroid/kidney disease were excluded. Partial correlation coefficients were calculated to investigate the relationship between the eGFR values and several other numerical variables while controlling for age and BMI in addition to the adjusted gender effect. Thereafter, the multiple linear regression analysis with a stepwise variable selection approach was used to reveal the independent factors that could affect the logarithmically transformed eGFR. RESULTS: The median age was 52 (19-65) years, the median eGFR was 94.3 (41.3-194) mL/min/1.73 m2, and the median TSH was 1.58 (0.50-4.50) uIU/mL in the whole group. Increased TSH even in the normal range was associated with eGFR after adjusting for age and body mass index (BMI), especially in females. The high age (b = -0.160, p=0.005), high BMI (b = -0.134, p=0.020), high TSH (b = -0.380, p < 0.01), and high uric acid (b = -0.348, p < 0.01) were found as significant predictors of the eGFR in MetS patients. CONCLUSION: Independent of age and BMI, elevated TSH even in the euthyroid range showed an association with the eGFR in female MetS cases who had normal kidney functions. This correlation was stronger than the correlations between the eGFR and the MetS diagnostic parameters. These findings need further studies on the issue..

Is early embryo cleavage a factor to increase success in all types of ICSI indications?.

PURPOSE: The authors aimed to compare early embryo cleavage with pregnancy rates in intracytoplasmic sperm injection/embryo transfer (ICSI/ET) cycles due to male infertility or tubal factor infertility (TFI). MATERIALS AND METHODS: 412 ICSI/embryo transfer cycles undergoing treatment for over two years were prospectively analyzed; 337 of the cycles were due to male infertility, whereas 75 suffered from tubal factors. Non-early cleaved (NEC) embryos were used for ET in 271 male factor and 67 tubal factor cycles, whereas early cleavage embryos were used for embryo transfer in 66 male factor and eight tubal factor cycles. RESULTS: In 66 out of 337 cycles (19.58 %) in male factor group and in eight out of 75 tubal factor cycles (10.66%), early cleavage (EC) embryos were obtained (p = 0.069). The clinical pregnancy rate was significantly elevated in EC subgroup (34.8%) compared to NEC subgroup (20.6%) (p = 0.015) in the male factor infertility group. The clinical pregnancy rate was non-significantly elevated in EC subgroup (37.5%) compared to NEC subgroup (23.8%) (p = 0.410) in the TFI group. CONCLUSIONS: The authors found that the implantation and pregnancy success of EC embryos vary with the therapeutic indication. The success rate would be low even with usage of EC embryos in untreated cycles of TFI.

Comparison of follitropin alfa and urinary gonadotropins in IVF cycles.

AIM: The aim of this study was to compare human menopausal gonadotropins with recombinant follicle stimulating hormone-follitropin alpha following a long down-regulation protocol in intra cytoplasmic sperm injection cycles in our clinic, and to review the outcomes in the light of preceding studies. METHODS: This was a retrospective study. Among a total number of 2798 patients who had undergone IVF/ICSI applications, 579 eligible patients were included, and their data were evaluated retrospectively. Three hundred eighteen patients were treated with follitropin alpha and 255 patients were treated with hMG. Total units of follitropin alpha preparations used in ovulation induction, total number of meiois-2 phase oocytes, total number of used oocytes in ICSI cycle, fertilization rate and clinical pregnancy rates of both groups were analyzed. RESULTS: Mean duration of stimulation was longer in the group of patients treated with rFSH-α compared to the second group of patients treated with hMG (8.88 days and 8.55 days, respectively; P<0.05). The number of transferred embryos were 3.08 and 2.68 for patients treated with follitropin alpha and hMG, respectively (P<0.05). Clinical pregnancy rates were %28 and %33 in the groups of patients treated with follitropin alpha and hMG, respectively. Even though a greater clinical pregnancy rate was noted in the hMG group, there was no statistically significant difference between the two groups (P>0.05). CONCLUSION: Our results indicate that there is no statistically significant difference between follitropin alpha and human menopausal gonadotropin in terms of the clinical pregnancy rates.

Elevated LH levels draw a stronger distinction than AMH in premature ovarian insufficiency.

OBJECTIVES: A significant number of individuals have high serum follicle stimulating hormone (FSH) levels but do not meet the criteria for diagnosis of premature ovarian insufficiency (POI) due to ongoing menstruation. We compared a group of women with elevated FSH levels and POI with a control group in terms of biochemical markers. METHODS: In this cross-sectional retrospective study, 38 POI cases and 48 cases of elevated FSH were compared to 89 individuals in a control arm in terms of biochemical markers. The receiver operating characteristics curve was calculated to assess the utility of anti-Müllerian hormone (AMH) levels to discriminate women with elevated FSH levels accompanied by POI from those women with elevated FSH levels but not defineable as having POI. RESULTS: A multiple regression analysis revealed that only the AMH level was significantly different for the discrimination between the control and elevated FSH groups. AMH and estradiol levels were found to be statistically significant for the discrimination between control and POI cases. However, only luteinizing hormone (LH) was found to be significant for distinguishing between women with elevated FSH and POI, interestingly excluding the serum AMH level in this context. CONCLUSIONS: AMH was the most important and superior marker to differentiate both POI cases and patients with an elevated FSH level from the controls; however, it did not show the same resolution for differentiating POI cases from those with elevated FSH. Moreover, we conclude that the serum LH level is the most useful marker for differentiating POI cases from women with elevated FSH levels.