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Do bisphenol A (BPA) levels in maternal urine, serum and follicular fluid affect embryo quality and intracytoplasmic sperm hinjection (ICSI) cycle outcomes in women with unexplained infertility? Prospective study conducted between 1 April 2019 and 30 September 2019. The study cohort consisted of 82 women aged between 23 and 33 years who underwent intracytoplasmic sperm injection owing to unexplained infertility and provided urine, blood and follicular fluid samples on the day of oocyte retrieval. Consumption of drinking water from plastic carboys or bottles at home were considered as chronic BPA exposure. Demographic features and IVF outcomes of the patients were collected. Among the 82 women with unexplained infertility, clinical pregnancy was achieved in 22 (26.8%) patients after the IVF and embryo transfer cycle. The patients who consumed tap water had statistically significantly lower BPA values in three body fluids compared with patients who consumed plastic bottled water (all P < 0.001). Women who had grade 1 embryos transferred had lower serum BPA values than women who had grade 2 embryos transferred (10.8 ± 5.2 versus 26.9 ± 22 ng/ml, P = 0.003). Serum and follicular fluid BPA levels were statistically significantly higher in women who failed to achieve clinical pregnancy (P < 0.001, P = 0.006, respectively) and obtain a live birth (both P = 0.007). A negative relationship was found between serum and follicular fluid BPA levels and embryo quality, clinical pregnancy and live birth in these women. In addition, the BPA levels of women who consume tap water at home were lower than those who use plastic bottled water. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the live birth rates in patients with poor ovarian response according to the POSEIDON classification and to evaluate the factors affecting live birth rates in different POSEIDON subgroups. The database of 2,200 patients between 2007 to 2021 including clinical and laboratory findings who underwent infertility treatment for IVF at Etlik Zubeyde Hanim Women's Health and Research Hospital were evaluated. Patients with complete medical records, at least one measurement of anti-Müllerian hormone (AMH) and antral follicle count (AFC) within the three months prior to the initiation of ovarian stimulation, a history of at least one poor ovarian response during IVF/ICSI cycles were included. Patients with incomplete medical records, history of pelvic surgery, premature ovarian insufficiency (FSH≥25 IU/l) or male factor infertility were excluded. The demographic characteristics of the patients, body mass index (BMI), obstetric history\laboratory values during the treatment period (AMH, FSH, LH, E2, progesterone, β-hCG), ultrasonographic findings (antral follicle count, endometrial thickness), presence of comorbidities, IVF treatment protocols and gonadotrophin doses that was used, number of IVF cycles and pregnancy outcomes were evaluated. The patients were classified into four groups according to the POSEIDON criteria (age, AMH and AFC). The study included 773 patients with complete medical and laboratory information. According to the POSEIDON criteria, 221 patients were classified as Group 1, 83 patients as Group 2, 261 patients as Group 3 and 208 patients as Group 4. The live birth rates were highest in Group 1 (35.3%), followed by Group 3 (26.4%), Group 2 (21.7%) and Group 4 (13.5%) (p<0,001) (figure 1). The mean number of total collected oocytes, mature oocytes, and oocytes subjected to ICSI were highest in Group 1, followed by Group 2, Group 3, and Group 4 (p<0,001). Comparing the live birth rates to the quality of transferred embryos, the average number of grade 1 embryos was found to be higher in patients who had a live birth (x̄ =0.68) compared to patients who did not (x̄ =0.57) (p=0.015). Factors affecting the live birth rates were demonstrated in (figure 2). Patient age and ovarian reserve were found as significant determinants of ART success. The predictive value of the patient age on live birth rates could be higher than the ovarian reserve. Additionally, the number and morphology of the transferred embryos, IVF treatment protocol, mature oocyte count, oocytes subjected to ICSI and BMI have prognostic value in predicting live birth rates in patients with poor ovarian reserve. [ABSTRACT FROM AUTHOR]

Subfertility occurs in one out of every ten couples and low semen quality is blamed in approximately 50% of these cases. In many cases of male infertility, the etiology isn't fully understood and the possibilities of detecting these causes are limited. The total motile sperm count (TMSC) is a combination of three critical sperm parameters and useful for sperm evaluation. Although intracytoplasmic sperm injection (ICSI) is a successful treatment option for male infertility, definitive data on which semen parameters affect ICSI outcomes and the prognostic value of TMSC classification for ICSI results are still unclear. The aim of this study was to compare the ICSI results between groups with different TMSC intervals in couples whose female partner was normo-responder and treated for male factor infertility. The data of patients who were treated with the indication of male infertility at the Health Sciences University, Ankara Etlik Zubeyde Hanim Women's Health and Research Hospital IVF Clinic between 2007 to 2021 were evaluated. The data of the couples whose female partner was normo-responder and male partner who had post wash TMSC≤ 5x10⁶ on the day of ICSI (n=293) were retrospectively analyzed. Patients were grouped according to their TMSC values, TMSC< 1x10⁶ as Group 1, 1-3x10⁶ TMSC as Group 2 and 3-5x10⁶ TMSC as Group 3. The patients' body mass index (BMI), age, infertility duration, basal follicle-stimulating hormone level, anti-mullerian hormone level, stimulation protocol, total oocyte count, number of inseminated and fertilized oocytes, fertilization rate, number of embryos transferred, high quality embryo formation on the 2nd and 3rd day, blastulation rate, embryo developmental arrest and pregnancy rates were analyzed retrospectively. The mean fertilization rates at group 1,2 and 3 were 0.42 ± 0.22, 0.52 ± 0.25 and 0.56 ± 0.21 respectively and there was a statistically significant difference of fertilization rates between the three groups (p<0.001). The pregnancy rate was found 26.7% in Group 1, 34.0% in Group 2 and 40.0% Group 3 and there was a significant statistically difference of pregnancy rates (p=0.049) between groups. The embryo developmental arrest rates were 24.1% in Group 1, 14.5% in Group 2 and %10.0 in Group 3 and this difference was statistically significant (p=0.025). (Table 1) On behalf of male infertility IVF outcomes there is a significant relationship between TMSC values, fertilization and pregnancy rates. The increased TMSC values is also increases the pregnancy rates. In addition to this the increase of TMSC value is decreasing the embryonic developmental arrest. ICSI success is not independent of basic sperm parameters. As a result, TMSC is a useful tool incluating quantitative and motility parameters for evaluation of male infertility IVF outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Cigarette smoke contains many toxic chemicals associated with poor reproductive outcome and reduced fertility. It also has a negative effect on sperm motility and morphology. The aim of this study was to analyze the effects of male and female cigarette smoking on the outcomes of in vitro fertilization (IVF). Study design: In this comparative prospective analysis, the effects of smoking on outcomes of IVF including semen parameters, oocyte quality, fertilization rate, transfer day embryo scores and pregnancy rates were analyzed. For this purpose, patients were grouped based on their follicular or seminal fluid cotinine (a nicotine metabolite) levels as smokers and non-smokers (non-smokers: female (n =171), male (n =118), smokers: female (n =43), male (n =96)). Results: The mean age and baseline hormonal levels of all groups were found to be comparable. While the numbers of total and mature oocytes collected were higher in the smoker group (p =0.005 and p =0.006, respectively), oocyte quality index, fertilization rate, embryo development rate and pregnancy rate were not significantly different between the groups (p >0.05). Analysis based on the type of ovarian hyperstimulation protocol (GnRH agonist, antagonist and others) showed that within the antagonist group the mean age of smokers was significantly lower and the total number of collected oocytes was significantly higher compared with non-smokers. Cigarette smoking among men did not have a significant negative effect on outcomes of IVF whether their partners were smokers or nonsmokers. Regression analysis did not give any significant difference when male and/or female smoking status was analyzed for fertilization rates, transferred embryo qualities and clinical pregnancy rates. Conclusion: Cigarette smoking does not have detrimental effects on outcomes of IVF. [Copyright &y& Elsevier]

Objective: To compare tubal patency by using hysterosalpingography (HSG) in women with unruptured ectopic tubal pregnancy who were treated with either single-dose or multiple-dose methotrexate (MTX) regimen. Design: A case series with a retrospective statistical analysis. Setting: Maternity and teaching hospital in Turkey. Patient(s): Sixty-one patients treated with MTX therapy for unruptured tubal ectopic pregnancy. Intervention(s): Thirty-one patients received single-dose and 30 multiple-dose MTX treatment. The HSG was performed 4 to 6 months after treatment to assess tubal patency. Main Outcome Measure(s): Ipsilateral and contralateral tubal obstruction rates. Result(s): Free passage through the ipsilateral tube was observed in 17 of 30 cases (56.7%) after multiple-dose, and 26 of 31 cases (83.9%) after single-dose MTX therapy. Patency of the contralateral tube was higher after single-dose than multiple-dose MTX treatment, although the value was not statistically significant. Binary logistic regression analysis was used to evaluate the parameters of age, gravida, parity, initial titers of beta human chorionic gonadotropin, size of the adnexal mass, and MTX regimen and their correlation with the HSG results after the clinical treatment for unruptured ectopic pregnancy. Only the type of MTX regimen was found to be used as a predictor of ipsilateral tubal obstruction. Conclusion(s): In terms of ipsilateral tubal obstruction, multiple-dose MTX therapy appears to have a greater negative effect on tubal patency than single-dose therapy. [Copyright &y& Elsevier]

Women in the reproductive-age have an approximate 10% possibility of developing endometriosis, and approximately 30−50% of such patients are infertile. Assisted reproductive technology (ART) is effective in the treatment of endometrioid-related infertility. Some studies have reported an increasing risk of unfavorable pregnancy outcome in women with endometriosis such as preterm birth, small for gestational age, preeclampsia and cesarean section rate. In contrast, some other studies did not show higher risk of preterm birth even with a significant sample size. If endometriosis seems to be associated with more obstetrical complications, it is unclear if obstetrical complications depend on endometriosis stage. The main objective of our study was to assess obstetrical complications, in women with stage III and IV endometriosis who conceived following IVF. Women's data concerning IVF pregnancy and neonatal outcome were collected retrospectively from medical database of University of Health Sciences Ankara Etlik Zübeyde HanımWomen's Health Teaching and Training Hospital IVF Clinic. We compared pregnancy outcomes after IVF/ICSI in two groups of pregnant women between 22 and 38 years with a history of infertility. Group A was constituted by singleton pregnancies following ART for moderate and severe endometriosis (rAFS stage III and IV endometriosis). Group B was composed of singleton pregnancies in women with unexplained infertility following ART. For group A, diagnosis of endometriosis was established during a laparoscopic exploration and/or Magnetic resonance imaging (MRI), Group B was the control group composed by women without endometriosis and who underwent IVF during the same period as women from group A. For each group, we included both pregnancies obtained after fresh embryo transfer (ET). A total of 144 pregnant women were included in the study, 48 singleton IVF pregnancies (group A) were compared with 96 singleton IVF pregnancies (group B). We observed an increased risk of intrauterin growth restriction(8.3% vs 1.4%; p = 0.042), and cesarean section (79.1% vs 70.8% p = 0.047)(Table1). Rate of preterm birth, placental abruption and placenta previa were not significantly different between groups. Analysis of outcomes showed that postpartum hemorrhage rate was not higher in endometriosis group. There was no difference between groups in terms of severe neonatal problems. Multivariate analysis of risk factors associated to all obstetrical outcomes considered together were endometriosis and body mass index (Table2). We observed statistically higher rates of intrauterin growth restriction and cesarean section but not an increased risk of postpartum hemorrhage and placenta previa. Despite conflicting results in literature due to a lot of confounding variables, the impact of endometriosis on pregnancy is still debated in women suffering from severe endometriosis. However, we think that an ART pregnancy in a context of severe endometriosis should be considered at risk of adverse obstetrical outcomes. [ABSTRACT FROM AUTHOR]

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive aged women and shares many similarities with metabolic syndrome (MetS) in pathophysiology and clinical features. Metabolic syndrome is defined as a constellation of metabolic disorders including abdominal obesity, glucose intolerance or insulin resistance, dyslipidemia, and hypertension. Studies showed that the prevalence of these metabolic comorbidities in women with PCOS is higher than age-matched women in the general population. As in obesity in general, insulin resistance and dyslipidemia, typical characteristics of MetS, have been deduced to have negative effects on fertility and pregnancy with compromised embryo development, impaired endometrial receptivity, and poor reproductive outcomes. In the present study, we aimed to investigate the effects of MetS on female fertility and IVF outcomes. This retrospective study was carried out at the Health Sciences University, Ankara Etlik Zübeyde HanımWomen's Health Teaching and Research Hospital IVF Clinic. A total of seven hundred and seventy one women with PCOS who underwent IVF cycles were included in the study. The PCOS patients were diagnosed according to the 2003 Rotterdam diagnostic criteria. All subjects were divided into a metabolic syndrome group (metabolic syndrome) and absence of metabolic syndrome group (nonmetabolic syndrome) according to diagnostic criteria. Although there are many definitions of metabolic syndrome, there is consensus that patients were considered to have metabolic syndrome if three of the following five factors were present: fasting glucose of at least 100 mg/dL, central obesity (waist circumference ≥88 cm), high-density lipoprotein (HDL) levels < 50 mg/dL, triglyceride levels of at least 150 mg/dL, and hypertension (defined as diastolic blood pressure ≥85 mmHg and systolic blood pressure ≥130 mmHg). Descriptive statistics and logistic regression models tested the association between metabolic syndrome and overall fertility and in vitro fertilization cycle stimulation characteristics and clinical outcomes. Metabolic syndrome was identified in 220 of 771 infertile women with polycystic ovary syndrome (28.5%). Patients with metabolic syndrome had longer infertility duration (52.5± 10.7 vs 46.7± 8.8, p= 0.005) compared with those without metabolic syndrome. During ovarian stimulation, those with metabolic syndrome required significantly higher and longer doses of gonadotropin and had higher peak estradiol levels, fewer retrieved oocytes. The clinical pregnancy rate and miscarriage rate have shown a significant difference between groups (26.4 % vs 47.5 %, P =0.036; 20.2% vs 13.2% p=0.026, respectively) (Table1). Multivariate logistic regression analysis showed that the number of oocyte retrieved was positively but metabolic syndrome parameters such as triglyceride, waist circumference and BMI were negatively associated with the clinical pregnancy rate (Table 2). Metabolic syndrome and PCOS may have a negative impact on female fecundity and suggests a negative association of MetS and IVF cycle stimulation characteristics and clinical pregnancy outcomes. The prevalence of PCOS in infertile women may be higher than in age-matched reproductive women, therefore, metabolic profile screening prior to assisted reproductive therapy may be recommended to improve the success of IVF treatment in women with PCOS. Further studies are needed to confirm and expand on our observations. [ABSTRACT FROM AUTHOR]

Using 3-D ultrasounds and folliculometry software, follicle sizes, volumes, and follicle counts can be measured in a much shorter time, with fewer errors, independent of human factors and re-evaluable. Although it is emphasized that new criteria based on volume to be determined according to 3-D sonography can improve IVF results, no study has yet been conducted on the timing of the use of GnRH antagonists. Also, the number of studies using artificial intelligence algorithms is quite limited. In this study, we investigated the role of follicle volume and the average diameter (dV) measured using 5D viewer software on antagonist day in predicting implantation success. In addition, we evaluate the prediction of the implantation success of the model using artificial intelligence technology. The study cohort includes thirty-eight female patients aged between 18 and 45 years who underwent ICSI. Regardless of aetiology, follicular growth was monitored both manually and automatically using 3D transvaginal ultrasonography (TVUSG) with 5D viewer software on the day of antagonist administration. The volume of each follicle (FV), dV and the largest diameter in 3 orthogonal planes per follicle were determined by the software. Patients were divided into groups according to FV on the day of antagonist administration, and the relationship between implantation success obtained from patients in each group and FV and dVs was evaluated. In addition, implantation success was correlated using all the features of the patients with the artificial intelligence algorithms. 70% of the patients in the dataset were used as the training set and 30% as the test set. The primary outcome was the relationship between the implantation success and the FV and dV values of the follicles on the antagonist day. The secondary outcome was implantation prediction with artificial intelligence technology using the model, including FV. There was no significant relationship between the presence of implantation and FV's at antagonist day in the groups of 0.50-0.99 cm3, 1.00-1.99 cm3, 2.00-2.50 cm3. However, in the artificial intelligence model we created, the Linear Discriminant Analysis algorithm predicted patients with negative implantations with 100% accuracy. It predicted only two of the patients in the test group correctly and reached 86% accuracy. The F1 score, which is the harmonic mean of the precision and recall values, was 87.5%. Follicle volumes measured on the day of antagonist administration may not predict implantation. However, modeling the images of follicle volumes obtained from 5D viewer software in artificial intelligence technology can successfully predict implantation from follicle volumes at antagonist day. Thus, new and technological criteria can be developed for the day of antagonist administration. [ABSTRACT FROM AUTHOR]

Objective: To report a rare case of male infertility associated with oligoasthenoteratozoospermia and complementary isochromosome 46 XY, i(9)(p10),i(9)(q10). Design: Case report. Setting: Reference hospital. Patient(s): Infertile oligoastenozoospermic man with complementary isochromosome 46,XY, i(9)(p10),i(9)(q10). Intervention(s): Peripheral blood lymphocytes obtained for karyotyping, and florescence in situ hybridization (FISH) analysis for gonadal mosaicism in ejaculated spermatozoa. Main Outcome Measure(s): Physical examination, semen analysis, GBG banding, and FISH procedure. Result(s): The semen analysis revealed oligoasthenoteratozoospermia. The lymphocytic karyotype detected a complementary isochromosome 46,XY, i(9)(p10),i(9)(q10), and the FISH procedure showed abnormal sperm. Conclusion(s): This the first report of oligoasthenoteratozoospermia associated with complementary isochromosome 46,XY, i(9)(p10),i(9)(q10). [Copyright &y& Elsevier]

Objective: To report a case of cervical dysgenesis presenting with hematometra. Design: Case report. Setting: Teaching and research hospital. Patient(s): A 12-year-old girl presented with primary amenorrhea. At laparoscopic examination she was found to have a ball-shaped enlarged uterus without any type of connection to the upper normal-appearing cervix. Intervention(s): Conservative surgery with end-to-end anastomosis of the upper blunt end of the cervix to the lower part of the uterus was performed. Main Outcome Measure(s): Preserve fertility and/or maintain cyclic menstrual cycles. Result(s): After having normal menses for 3 months, the patient was admitted again with occlusion at the anastomosis site. Hematometra was drained and hysteroscopic and laparoscopic observations proved a normal-appearing uterus, endocervical canal, and cervix. Conclusion(s): Conservative surgical treatment with intact cervical and uterine segments, with an end-to-end cervicouterine anastomosis is a feasible and effective option in patients with cervical transverse fragmentation. [ABSTRACT FROM AUTHOR]

Cryopreservation at the ART (artificial reproductive techniques) improved cumulative birth rate, decreased the risk of OHSS (ovarian hyperstimulation syndrome). And also, it is usefull in cases who are not convenient for fresh embryo transfer. Vitrification is most suitable method for cryopreservation due to high survival rate than other metods[1, 2]. The duration of storage time of the vitrified embriyos is challenging area. The use of cryoprotectants at higher concentraton and the contact of liquid nitrogen may affect to embryos undesirably by longer time[3]. In this study, we evaluate the embryo degeneration rate, abortion and stillbirth, birth anomaly and birth weight after the transfer of vitrified embryos that stored at different storage period an behalf of pregnancy. Patients who underwent FET cycle embryo transfer at ART clinic at Ankara Etlik Zubeyde Hanim Women's Hospital were retrospectively analyzed between 2013 and 2022. Patients with age >39 or BMI ≥40 or uterine anomaly were excluded. Embryos on Day 3 and 5 were graded according to Istanbul concensus criteria before vitrification. Only grade 1 and grade 2 embryos were vitirified. The vitrification procedure was performed according to instruction of the manufacturer (Vitrolife, RapidVit and RapidWarm Omni). HRT (hormone replacement therapy) was performed for endometrial preparation. Patients were divided into three groups according to the storage period of transferred embriyos. Group 1, 0-1 years; Group 2, 1-3 years; Group 3, 3-5 years. Statistical analyzes were performed with SPSS version 25.0 program. The Kruskal Wallis Test was used for non-normally distributed variables. Relationships between categorical variables were examined with the Fisher-Freeman-Halton Exact Test. Cases where the p-value was below 0.05 were considered as statistically significant results. The eligible total of 91 patients included the study were grouped according to embryo storage period (71 women in group 1; 15 women in group 2; and, 5 women in group 3). No significant difference was observed according to the variable levels of maternal age, BMI, degenerated/warmed embriyos ratio (embryo degeneration rate at thawing), clinical pregnancy, live birth gestational age, birth weight between groups (p>0.05). No neonatal defects were observed in infants According to our results, storage time of the vitrified embriyos in the liquid nitrogen were not affect the clinical outcomes of the ART. The limitation of this study is retrospective and the number of patients less. As a conclusion, prolonged storage time of the vitrified embryos does not affect the clinical outcome of te ARTs, and further studies are needed. [ABSTRACT FROM AUTHOR]

Embryo quality is important for success in In Vitro Fertilization (IVF) cycles. Previous studies have shown that the pregnancy rate is lower in poor-quality embryo transfers. Additionally, a higher abortion rate has been observed in these types of embryo transfers. The aim of this study is to investigate pregnancy and birth outcomes in IVF cycles with G1 (first grade)/good quality and G2 (second grade)/fair quality fresh and single embryo transfers. This retrospective study was included 936 fresh IVF treatment cycles that performed between 2014 to 2022 at IVF Center of Etlik Zubeyde Hanim Hospital. The number of transfered embryos was 542 in Group 1 (G1) and 394 in Group 2 (G2). The rate of pregnancies, abortus, live births, pregnancy outcomes and prenatal complications were analyzed. The demographic characteristics of the study group, including the age of females and males, body mass index (BMI; kg/m2), gonadotrophine dose, embryo transfer day (D3 or D5), the number of retrieved oocytes, and fertilized oocytes, were recorded. Additionally, causes of infertility, such as male infertility, poor ovarian reserve, endometriosis, tubal factor infertility, unexplained infertility were also included. Women with polycystic ovarian syndrome, hypertension, diabetes mellitus, and patients over 39 years of age were excluded. Embryos were graded according to the İstanbul Consensus Workshop. The clinical features of the patients were compared according to the embryo quality. As a result of the analysis, the measurement level of total oocyte count was significantly higher in the Group 1 (G1 embryo-11.6±6.51) compared to the Group 2 (G2 embryo-10.32±6.21) (p=0.003). The number of mature oocytes was higher in the Group 1 (8.93±4.93) than in the Group 2 (8.02±5.06) (p=0.008). And also the number of fertilized oocytes was higher in the Group 1 (5.13±3.39) compared to the Group 2 (4.37±3.20) (p=0.001). (table1) Biochemical pregnancy rate was almost same between Group 1 and Group 2 while the clinical pregnancy rate was higher in the Group 1 (41.51%) than Group 2 (31.73%) (p<0.05). The number of individuals who did not achieve pregnancy after IVF treatment was found to be higher in Group 2 (p<0.05). Abortus rate was higher in Group 2. (table 1) Based on our findings, we demonstrated that the clinical pregnancy and live birth rates were significantly higher in G1 embryo transfers compared to G2 embryo transfers. Additionally, the number of collected oocytes, MII oocyte rate, and fertilization rate were also higher in the G1 embryo transfer group. Pregnancy complications and rates of healthy infants were similar in both groups. However, the miscarriage rate was higher in the G2 embryo transfer group. There was no difference between the groups in terms of maternal age. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months. Design: Prospective, randomized, controlled study. Setting: The reproductive endocrinology unit of a tertiary, research and education hospital. Patient(s): Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study. Intervention(s): The patients were treated with either LNG-IUS (n = 20) or GnRH-a (n = 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks. Main Outcome Measure(s): Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP). Result(s): The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction. Conclusion(s): Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aimed to assess the possible effects of etonogestrel implant (Implanon®, Organon, Oss, The Netherlands) on total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and Hb levels in a sample of Turkish population. Study Design: Healthy women of childbearing potential who had applied to our Family Planning Clinic for a contraceptive method and had chosen to have an Implanon insertion after thorough counseling about all family planning methods and screening for eligibility for Implanon use were enrolled in the study. Serum concentrations of TC, TG, HDL-C, LDL-C, AST, ALT and Hb levels were tested before and at 3 and 6 months after insertion. Baseline mean parameters were compared with mean parameters at 3 and 6 months for statistical significance using paired-samples t test. Results: Eighty-two women eligible for the study were included. Mean age of the patients was 27.5±4.8 years. When compared to the baseline values, there was a statistically significant decrease in the TC (p<.001), HDL-C (p<.001) and TG (p=.006) at the end of the third month, while there was a significant increase in Hb values (p=.01). The decrease in TC (p=.001) and HDL-C (p<.001) and increase in Hb value (p=.03) persisted by the end of sixth month while the decrease in TG was transient. A statistically significant increase in mean ALT level was observed at 6 months (p=.03). Conclusion: The effect of Implanon on liver functions and lipid metabolism does not lead to unhealthy alterations. Increase in Hb can be attributed to the high frequency of amenorrhea in patients. [Copyright &y& Elsevier]

Abstract: Objective: The objective was to determine whether the interleukin-6 (IL-6) level in umbilical cord blood can be used for the prediction of histologic chorioamnionitis, funisitis, fetal membrane cultures and neonatal infection. Study design: A case–control study was conducted on 30 controls (control group) and on 40 women with term premature rupture of the membranes (PROM group). The interleukin-6 concentration of cord blood was measured. Fetal membranes and newborn blood were cultured. Placentas were examined for histologic chorioamnionitis and funisitis. Receiver operator curve analysis was used to obtain a cut-off value of interleukin-6 concentration for predicting histological and clinical infection. Results: The mean interleukin-6 level in cord blood was significantly higher in the PROM group (p =0.01). Histological chorioamnionitis and positive placental cultures were significantly higher in the PROM group (p =0.006 and 0.02, respectively). The PROM group had seven (17.5%) cases of funisitis and positive newborn blood cultures while neither was observed in the control group. A cord blood interleukin-6 level >29pg/ml was found to have 84% sensitivity and 72.5% specificity for predicting positive placental cultures and 74.1% sensitivity and 76.7% specificity for identifying cases of histologic chorioamnionitis. For predicting funisitis and positive newborn cord blood cultures a cord blood interleukin-6 level >39pg/ml has 100% sensitivity and 81% specificity. Conclusion: Cord blood interleukin-6 level can be a tool for the evaluation of the extent of maternal–fetal infection and guides proper planning of the treatment. [Copyright &y& Elsevier]

Abstract: The objective of this prospective randomized placebo-controlled study was to determine the effectiveness of 400 μg oral and 400 μg vaginal misoprostol administration for cervical priming 3 h prior to manual vacuum aspiration (MVA) under local anesthesia for voluntary termination of pregnancy before 10 weeks of gestation in comparison with placebo oral or placebo vaginal administration (n=40 in each group). Postmedication cervical dilatation was similar in the oral (mean, 6.6±1.5) and vaginal (mean, 7.2±0.8) misoprostol groups but significantly higher compared with the oral (mean, 3.4±0.2) and vaginal (mean, 3.6±1.9) placebo groups. Duration of the procedure was also significantly shorter in the misoprostol groups in comparison with their placebo counterparts. Preoperative bleeding and side effects were more common in the misoprostol groups, but none required medical intervention. Intraoperative bleeding was less in the vaginal misoprostol group compared with the placebo groups. There was no significant difference in terms of visual analogue scores during the procedure, patient satisfaction, days of postoperative bleeding and rate of postoperative complications among the groups. Cervical priming with misoprostol administered orally or vaginally 3 h before MVA for termination of pregnancy under local anesthesia facilitates the procedure by decreasing the need for cervical dilatation and by shortening its duration without improving patients'' pain perception and satisfaction mainly due to side effects. [Copyright &y& Elsevier]