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Objective: To report the first case of massive intraabdominal hemorrhage after transvaginal ultrasonographically guided oocyte retrieval that was successfully managed with angiographic uterine artery embolization., Design: Case report., Setting: Assisted reproduction unit of a tertiary university hospital., Patient(s): A 40-year-old woman with a history of primary infertility presented 10 days after oocyte retrieval because of severe abdominal pain, vomiting, and vaginal bleeding for 3 days. She had a history of mild factor VIII deficiency for 3 years., Intervention(s): Evaluation of the intraabdominal hemorrhage with ultrasonography and angiography. Management of oocyte pickup complicated with intraabdominal hemorrhage., Main Outcome Measure(s): Treatment of massive life-threatening intraabdominal hemorrhage with bilateral uterine artery embolization., Result(s): After transfusion with 2 units of fresh-frozen plasma and packed red blood cell, an interventional radiologist performed percutaneous transcatheter pelvic angiography to detect abnormal vascularization and vascular blush consistent with hemorrhage and then immediate bilateral uterine artery embolization was done. The patient was discharged from the hospital 5 days later without any remarkable complications., Conclusion(s): Angiographic uterine artery embolization under fluoroscopic guidance is a successful nonsurgical approach for the treatment of oocyte pickup-induced life-threatening hemorrhage., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effectiveness of IV calcium infusion on prevention of ovarian hyperstimulation syndrome (OHSS) in patients with polycystic ovary syndrome undergoing assisted reproductive techniques cycles., Design: A retrospective comparative study., Setting: Assisted reproduction techniques centre in Turkey., Patient(s): Four hundred fifty-five women with high risk for OHSS., Intervention(s): The patients in group I (n = 84) were administered IV calcium gluconate for prevention of OHSS, and the patients in group II (n = 371) comprised the control group, with no manipulation for prevention of OHSS and were age- and body mass index-matched with the study group., Main Outcome Measure(s): Ovarian hyperstimulation syndrome rate, clinical pregnancy rate., Result(s): Mean (±SD) ages of the women in the calcium infusion group (group I) and the control group (group II) were comparable (30.5 ± 4.3 vs. 31.4 ± 3.9, respectively). Ovarian hyperstimulation syndrome was found in 16.2% (60 patients) in group II, whereas in group I, only 3 patients (3.6%) developed OHSS. Interestingly, all the hyperstimulation cases in group I were mild, and there was no severe effect. Implantation rates were similar in both groups. Furthermore, we obtained clinical pregnancy in nearly 40.5% in group I and 28.8% in group II. The live-birth rate was 38.1% in the calcium infusion group and 24.8% in the control group., Conclusion(s): Intravenous calcium infusion resulted in a significantly lower rate of development of OHSS for patients with polycystic ovary syndrome and high risk of OHSS. This novel therapy may be used for prevention of OHSS effectively., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the effect of CO(2) pneumoperitoneum on the ovaries in an experimental pneumoperitoneum model., Design: Experimental controlled study., Setting: University hospital., Patient(s): Sixteen adult female conventional rabbits., Intervention(s): Group I (8 rabbits) was not subjected to intra-abdominal pressure (IAP). In group II (8 rabbits), IAP insufflation was performed at 12 mm Hg. In total, 60 minutes of pneumoperitoneum and 10 minutes of reperfusion were maintained. Ovarian blood flow (OBF) was studied using laser Doppler flowmetry. The time points of OBF measurements were as follows: OBFbaseline, 10 minutes before insufflation; OBF30min, 30 minutes after pneumoperitoneum; OBF60min, 60 minutes after pneumoperitoneum; and OBFreperfusion, 10 minutes after pneumoperitoneum desufflation. Mean OBF changes during CO(2) pneumoperitoneum (OBFmean) were also assessed., Main Outcome Measure(s): Blood perfusion units, tissue malondialdehyde values, and histopathologic damage scores., Result(s): In group II, mean OBF values were significantly lower than in group I, especially for OBF30min, OBF60min, OBFreperfusion, and OBFmean. The mean tissue malondialdehyde value for group II was significantly higher than in the control group (104.48 +/- 20.07 nmol/g vs. 64.12 +/- 8.77 nmol/g, respectively). Compared with group I, in group II histologic specimens of the ovaries had higher scores for follicular cell degeneration, vascular congestion, hemorrhage, and inflammatory cell infiltration., Conclusion(s): Pneumoperitoneum, even at normal IAP levels, leads to significant oxidative stress-induced biochemical and histologic damage to the ovaries., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the effects of sudden intra-abdominal pressure (IAP) changes on the terminal ileum in a pneumoperitoneum model., Design: An experimental controlled study., Setting: University hospital in Turkey., Animal(s): Thirty-two adult female Sprague-Dawley rats., Intervention(s): The rats were divided into four groups. Group 1 was not subjected to IAP. In group 2, IAP insufflation was performed continuously to keep the IAP at 10 mmHg. Groups 3 and 4 underwent an insufflation-desufflation procedure: group 3 was fluctuated 5 times, and group 4 was fluctuated 10 times within the pneumoperitoneum period of 60 minutes. Thirty minutes after the desufflation, the terminal ileum was removed for the measurement of tissue malondialdehyde (MDA) values and histopathological examination., Main Outcome Measure(s): The tissue MDA values and histopathological damage scores., Result(s): The tissue MDA values in the IAP groups (groups 2, 3, and 4) were significantly increased when compared with those of the control group. The mean MDA value in group 4 was higher than that in groups 2 and 3. Histopathologic oxidative damage scores in the mucosa and submucosal layers were significantly higher in groups 2 and 3, compared with those of the control group. However, the highest histopathologic damage scores were observed in group 4., Conclusion(s): Unexpected desufflation-insufflation even at normal IAP levels during laparoscopy leads to significant oxidative stress-induced damage in the terminal ileum.

Objective: To examine the effects of unopposed estrogen (E) and tibolone therapy on coagulation and natural anticoagulant systems in surgical menopause., Design: A randomized, double-blind, placebo-controlled study., Setting: University hospital clinic in Turkey., Patient(s): Ninety healthy surgically postmenopausal women., Intervention(s): Ninety surgically postmenopausal women were randomized into three groups: unopposed conjugated ET (0.625 mg/d, group 1), tibolone (2.5 mg/d, group 2), and identical tablets of placebo (group 3)., Main Outcome Measure(s): Effects on parameters in the clotting cascade at baseline and after 24 weeks of treatment., Result(s): After 6 months, fibrinogen, lipoprotein (a), and factor VIIa were decreased, and activated partial thromboplastin time was increased significantly in the ET group compared with in the placebo group. However, tibolone significantly decreased only the serum levels of factor VIIa and factor IX and prolonged the activated partial thromboplastin time, compared with placebo group. In addition, conjugated ET caused a significantly greater decrease in serum fibrinogen level than did tibolone., Conclusion(s): Neither E nor tibolone therapy led to activation of coagulation in the surgically menopausal women. Both preparations changed the overall hemostatic balance to a more fibrinolytic state.

Objective: To describe a patient with primary primitive neuroectodermal tumor of the ovary with two successful spontaneous pregnancies., Design: Case report., Setting: Tertiary center for gynecologic oncology., Patient(s): A 25-year-old woman with two spontaneous pregnancies 5 months after and 2 years after conservative treatment of International Federation of Gynecology and Obstetrics stage IC primary primitive neuroectodermal tumor of the ovary., Intervention(s): Assessment of extraovarian spread with staging laparotomy. Four courses of BEP (bleomysin, etoposide, cisplatin) and, for recurrent disease, six courses of salvage VIP (vinblastin, iphosphamide, mesna, cisplatin) chemotherapy., Main Outcome Measure(s): Two successful deliveries and no residual ovarian cancer., Results(s): A healthy, normal female infant weighing 3600 g was delivered by cesarean section at 38 weeks' gestation. Sixteen months later another infant, a healthy, normal male weighing 3500 g, was delivered by cesarean section at 38 weeks' gestation. No residual cancer was detected at follow-up 12 months after the last delivery., Conclusion(s): Conservative fertility-preserving treatment might be considered in patients with primary primitive neuroectodermal tumor of the ovary. Without any assisted reproductive technologies, spontaneous pregnancies might occur.