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Objective: To compare efficacy and safety of recombinant follicule stimulating hormone (r-FSH) and highly purified urinary FSH (HP-uFSH) in polycystic ovary syndrome (PCOS) patients undergoing intracytoplasmic sperm injection (ICSI). Method: This was a prospective randomized study conducted at Kocaeli University Faculty of Medicine, Department of Obstetrics and Gynecology, in vitro fertizilization (IVF) Unit. A total of 91 PCOS patients undergoing ICSI were randomly assigned to receive either r-FSH (n = 46) or HPuFSH (n = 45) with a gonadotropin releasing hormone (GnRH) antagonist protocol. The main outcome measures were the number of mature oocytes retrieved, embryo quality, pregnancy rates, implantation rates. Results: The number of mature oocytes retrieved, fertilization rates, the number of cryopreserved embryos were significantly higher in r-FSH group (p = 0.024, p = 0.023, p = 0.026 respectively) while the total dose of FSH used was significantly lower in the same group (p = 0.023). Pregnancy rates, clinical pregnancy rates were higher in r-FSH group although not statistically significant (52.2% versus 35.6%, p = 0.11, 37% versus 28.9%, p = 0.41 respectively). Overall therapy costs per clinical pregnancy were associated with a 9.94% increase in r-FSH group whereas costs per pregnancy were not different between groups. Conclusion: r-FSH is superior than HP-uFSH in PCOS regarding fertilization rates, the number of mature oocytes retrieved and cryopreserved embryos, pregnancy rates although overall therapy costs per clinical pregnancy are higher. Keywords: ART, HP-uFSH, PCOS, rec-FSH Amac: ICSI uygulanan PCOS hastalarinda rekombinant FSH (r-FSH) ve yuksek oranda saflastirilmis uriner FSH'nin (HP-uFSH) etkinligini ve guvenligini karsilastirmaktir. Yontem: Kocaeli Universitesi Tip Fakultesi Kadin Hastaliklari ve Dogum Anabilim Dali Tup Bebek Unitesi'nde yurutulen prospektif randomize bir calismadir. ICSI uygulanan toplam 91 PCOS hastasi, bir GnRH antagonist protokolu ile r-FSH (n = 46) ve HP-uFSH (n = 45) almak uzere rastgele belirlendi. Ana sonuc olcutleri; alinan olgun oosit sayisi, embriyo kalitesi, gebelik oranlari, implantasyon oranlariydi. Bulgular: Alinan olgun oosit sayisi, dollenme oranlari, dondurularak saklanan embriyo sayisi r-FSH grubunda anlamli olarak daha yuksek (sirasiyla p = 0,024, p = 0,023, p = 0,026), ayni grupta kullanilan toplam FSH dozu ise anlamli olarak daha dusuktu (p = 0,023). Gebelik oranlari, klinik gebelik oranlari r-FSH grubunda istatistiksel olarak anlamli olmamakla birlikte daha yuksekti (sirasiyla %52,2'ye karsi %35,6, p = 0,11, %37'ye karsi %28,9, p = 0,41). Klinik gebelik basina genel tedavi maliyetleri, r-FSH grubunda %9,94'luk bir artisla iliskilendirilirken, gebelik basina maliyetler gruplar arasinda farkli degildi. Sonuc: r-FSH, PCOS'de fertilizasyon oranlari, alinan olgun oosit sayisi ve dondurularak saklanan embriyolar, gebelik oranlari acisindan HP-uFSH'den ustundur, ancak klinik gebelik basina genel tedavi maliyetleri daha yuksektir. Anahtar kelimeler: ART, HP-uFSH, PCOS, rec-FSH

We report the case of a benign mesenchymal spindle-cell tumor located on fetal neck, diagnosed during prenatal ultrasound and magnetic resonance investigation. A 30-year-old woman (gravida 2, para 1) was referred to our perinatology unit for evaluation of a fetal neck mass that had been identified on ultrasonography at 29 weeks gestation. A right lateral neck mass was observed (size: 42×40 mm) that extended from the preauricular region to right clavicula. Fetal MRI revealed a solid heterogeneous mass arising from the right lateral neck and there was no invasion around tissue and no extension of the mass into the chest. At 37 weeks after birth, we observed that the mass was subcutaneous and there was no invasion to the surrounding tissue. The trachea was not compressed and there was no extension of the mass into the chest. Then, the neck mass was completely resected after birth without any complications. Histopathological examination of tumor was consistent with mesenchymal spindle-cell tumor. Immunohistochemical staining with CD34 and actin was positive; however, caldesmone, epithelial membrane antigen (EMA), and S-100 was negative. Fetal MRI performed during the pregnancy for investigation of fetal neck masses detected on ultrasound gives compatible results observed in the neonate after birth and maintains adequate findings for follow-up and planning of treatment.

The aim of this study was to review our exogenous cesarean scar pregnancy (CSP) cases that were managed through transabdominal ultrasound (TAUS)-guided suction curettage either alone or with a concomitant additional therapeutic modality. The study was carried out over a 6-year period and we compared clinical outcomes, success rates and complication profiles between the two therapeutic approaches.A total of 33 exogenous CSP patients who were managed by suction curettage were extracted from the medical records. The patients were analyzed according to the intervention applied in the two groups as: TAUS-guided suction curettage alone (Group 1); and additional therapeutic tools, such as systemic or intracavitary administration of methotrexate and intracavitary ethanol instillation, in combination with suction curettage (Group 2). Basic demographic and clinical characteristics of women experiencing hemorrhagic complications and those who did not after the treatment were also compared.There were no cases of uterine perforation, hysterectomy or unresponsiveness to treatment in our analyzed CSP cases. Four patients, two in each group, required blood transfusion. Our success rate in the overall patient population was 87.8% (29/33). Fourteen out of 16 patients who were treated with TAUS-guided suction curettage alone, and 15 out of 17 patients who received other interventional treatment modalities preceding suction curettage revealed successful resolution of the CSP without any complication (P = 0.948). Clinical and demographic characteristics of women who experienced any hemorrhagic complication did not significantly differ from those who did not.In appropriate CSP cases, TAUS-guided suction curettage appears to be a reliable treatment option with acceptable success rates and similar complication profile to other therapeutic options.