Search

Objective: The main detrimental factor in female fertility is maternal age. Clinical pregnancy and live birth rates decline gradually with age and this decline is dramatical over 40 years. In this study, we examined the in vitro fertilization/intracytoplasmic sperm injection cycle outcomes of women aged 40 years and over. Study Design: This retrospective cohort study included 336 fresh in vitro fertilization/ICSI cycles of women aged ≥40 years. Six groups, stratified by one-year intervals were composed according to age: 40 years; 41 years; 42 years; 43 years; 44 years, and ≥45 years. The primary outcomes were the clinical pregnancy and live birth rates. Results: The clinical pregnancy rate was 18.6% in 40 years old women and it decreased to 4% in women aged ≥45 years. The live birth rates in women aged 40 and 41 years (10% and 6.1% respectively) were higher than the live birth rates in women aged 42 and 43 years (4.3% and 3.8% respectively). There was no live birth in women aged 44 and over. The miscarriage rate was 46.2% at age 40 and it increased to 100% at age 44 and over. Conclusion: The clinical pregnancy and the live birth rates decreased significantly with every single year after 40 years of age. In patients between the ages of 40-43, the live birth rate is acceptable but starting an in vitro fertilization cycle beyond 43 years of age does not seem to be reasonable.

Acute renal failure (ARF) is rarely associated with pregnancy. However, it is a severe health-deteriorating problem of pregnant women without a known kidney disease. Although its incidence is relatively low in developed countries (1/20000), it is still a serious health issue in the developing world. In addition to any of the etiological factors that may result in ARF in non-pregnant women, pregnancy also increases the vulnerability of some special diseases that may result with the renal injury. In this review we aimed to summarize antepartum and postpartum causes of renal failure via summarizing two cases of renal failure.

It is important to determine the origin and malignancy risk of pelvic pathologies preoperatively and thus decide the route and extent of the surgery. In this case report, we present three cases operated for presumed adnexal masses those were intraoperatively diagnosed to be nongynecological benign masses originating from adjacent organs with a brief review of the literature. Three cases underwent surgery with a pre-operative diagnosis of adnexal mass but intraoperatively diagnosed to be mucinous cystadenoma of appendix, mesenteric cyst and gastrointestinal stromal tumor. Non-gynecological masses should be considered in the differential diagnosis of adnexal masses and centers operating on a considerable number of adnexal masses should be capable of managing rare nongenital masses that can be accidentally encountered during the operation.

OBJECTIVE: The aim of this study was to determine the possible predictors of total gonadotropin dose (TGD) required to achieve ovulation in patients with unexplained infertility or male subfertility. STUDY DESIGN: A prospective study on 230 patients (n:178 unexplained infertility, n:52 male subfertility) scheduled for controlled ovarian stimulation (COH) and intrauterine insemination (IUI) was designed to determine the association between basal follicle stimulating hormone (FSH), luteinizing hormone (LH), estrodiol (E2) levels, antral follicle count (AFC), age and body mass index (BMI) and total gonadotropin doses needed to achieve follicular growth. RESULT: Regression analysis revealed an association between basal FSH level, BMI and AFC with total gonadotropin dose (P=0.001, P=0.002, P=0.045). BMI was positively correlated with TGD (r:0.400, P=0.001). Mean BMI of patients who required a total dosage of >1500 IUs of gonadotropin was 29.7±4.8kg/ m2 where as it was 24.9±3.2kg/ m2 for patients who received

OBJECTIVE: To compare the complete evacuation rate of two different single dose misoprostol regimens in termination of missed abortion within 24 hours. STUDY DESIGN: Hundred and one women with a diagnosis of missed abortion were randomized into two groups. Women in Group I received four tablets of misoprostol (800 mg) vaginally. In Group II, two tablets of misoprostol were administered vaginally simultaneously with two tablets taken orally. Women were evaluated by transvaginal sonography after the initiation of vaginal bleeding (primary visit) or in cases with no bleeding within 24 hours after the administration. In cases that had not completed the abortion at the primary visit, a surgical evacuation was performed. Mean expulsion time, clinical outcomes, side-effects, complications and any additional interventions required were analyzed in two groups. RESULTS: There was no statistically significant difference between the two groups in terms of age, number of previous pregnancies, the complete evacuation rate at the primary visit or mean expulsion time. The complete evacuation rate within 24 hours was 18% in Group I and 14% in Group II (p=0.38). The overall complete evacuation rate was 16% (n=16). There was a statistically significant difference between the groups for mean hemoglobin values before and after treatment (0.64 vs 0.62 respectively, p

OBJECTIVE: To evaluate the endometrial changes in patients with proven ectopic pregnancies and the v alue of endometrial histopathology in diagnosis of ectopic pregnancies. STUDY DESIGN: Medical records of 71 patients with prov en ectopic pregnancies and who had endometrial curettage results were rev iewed. Ectopic pregnancy was conf irmed either at operation or at transv aginal ultrasound ev aluation with clearly visualized characteristic adnexal mass in the presence of an empty uterus and serum beta-subunit human chorionic gonadotropin level abov e the discriminatory zone. Histopathologic f indings of the endometrial curettage materials were ev aluated. RESULTS: The mean age of the patients was 30±5.9 y ears. The mean gestational age (by date of last menstrual period) at presentation was 36.9 day s. The most common symptoms at presentation were both v aginal bleeding and missed menstruation. Rev iew of the endometrial curettages revealed that the most common type of endometrium associated with ectopic pregnancy was secretory (52.2%) followed by decidual reaction (15.5%), proliferative endometrium (14.1%), Arias-Stella reaction (11.2%), and endometrial f ragments (7%). CONCLUSION: Since ectopic pregnancy is associated with v arious ty pes of endometrial histopathology, it is not valuable in the diagnosis and should be performed in selected patients f or differential diagnosis when TVUS, serial serum b-HCG levels are inconclusive.

OBJECTIVE: The aim of this study was to ev aluate indications, effectiv eness and safety of laparoscopically assisted v aginal hysterectomy f or benign adnexal or uterine pathologies. STUDY DESIGN: We rev iewed the records of 35 consecutive women who underwent laparoscopically assisted v aginal hysterectomy f or benign reasons between January 2002 and December 2004. All the patients were not suitable candidates for abdominal or vaginal hysterectomy either because of concomitant adnexal masses or lack of uterine prolapse. The exclusion criteria included prolapse, uterine or adnexal neoplasm, pelv ic inflammation, vaginal stenosis and any pathology with a uterine size of more than 14 weeks. RESULTS: Indications for laparoscopically assisted v aginal hysterectomy were leiomyoma uteri (45.7%), intractable uterine bleeding (17.1%), myoma uteri with adnexal masses (14.3%), postmenopausal (8.6%) or bilateral (8.6%) adnexal masses and tamoxifen related endometrial pathology (5.7%). Mean operating time was 149.31 minutes (range 90-210) and the mean postoperative hospital stay was 2.4 days (range 2-10). Only one bladder laceration occurred during the operations which required conv ersion to laparotomy (2.8%). CONCLUSION: Laparoscopically assisted vaginal hysterectomy was f ound as a f easible and safe approach in the surgical management of a selected group of patients with benign pathologies.