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Objective The primary aim of this study is to investigate whether there are any minor sonographic uterine findings, not typical for adenomyosis, in endometriosis patients. The secondary objective is to determine the prevalence of sonographic features of adenomyosis in an infertile population with endometriosis. Study design The investigation was of 291 infertile women with endometriosis, either manifesting endometrioma (OMA) or diagnosed through laparoscopy, who were investigated for two‐dimensional transvaginal sonographic (2D-TVS) features of adenomyosis. These patients were grouped as either having endometriosis with adenomyosis (EwA,n = 121) or without adenomyosis (EwoA, n = 170). Additionally, patients without both endometriosis and 2D-TVS features of adenomyosis constituted the control group (n = 170). Results At least one 2D-TVS feature of adenomyosis was detected in 41.6 % (n = 121) of women with endometriosis. Asymmetrical myometrial thickening of uterine walls (57.9 %), hyperechogenic islands (47.1 %), and fan-shaped shadowing (46.9 %) were relatively more prevalent 2D-TVS findings among EwA patients. Multiple OMA (p = 0.038), OMA ≥ 4 cm (p = 0.034), and total OMA volumes were found to be higher (p = 0.004) in the EwA group. Additionally, uterine volumes were found to be 96.7 cm3, 73.0 cm3, and 64.2 cm3 in the EwA, EwoA, and control groups, respectively (EwA vs EwoA, p Conclusion A stepwise and statistically significant volume increase from the control group to the EwoA and then to the EwA group may reflect a spectrum of uterine involvement in endometriosis. This might indicate that many uterine endometriosis cases are still hidden from view, possibly demonstrating an "iceberg phenomenon".

Purpose This study analyzed the safety of myomectomy during the cesarean section (CS). Methods Pregnant women who underwent myomectomy during CS in a tertiary center between January 2015 and November 2019 were included in the study in Group A, and pregnant women who did not have myoma and who underwent only CS were included in the study in Group B. The following information was obtained from patient files in hospital archives and was then recorded and compared: age, gravidity, parity, gestational week, characteristics of the myomas (i.e., location, size, number, and type), duration of surgery, perioperative complications, need for blood transfusion, preoperative and postoperative hemoglobin (Hb) values, duration of surgery, and hospital stay duration. Results A total of 83 patients underwent CS plus myomectomy (Group A), and 80 patients (without myoma) underwent only CS (Group B).There were no statistically significant differences between the groups in terms of preoperative and postoperative Hb values or blood transfusion rates (p > 0.05). Hospitalization and surgery duration were significantly higher in the group that underwent CS myomectomy (p = 0.001 andp = 0.001, respectively). The mean myoma size was 8.3 +/- 4.1 cm in Group A. There was a statistically significant and inverse correlation between the size of the myoma and the delivery week (p = 0.035). There was a statistically significant and positive correlation between the myoma size and hospital stay (p = 0.01). Conclusion Myomectomy during CS is safe and can be applied regardless of the location, size, type, and number of myomas. However, to make myomectomy routine during CS, multi-center studies that include more cases are needed.

Objective To evaluate whether uterine artery Doppler velocimetry during peak uterine contraction is a useful marker for the prediction of preterm delivery. Methods In this prospective cohort study, 172 patients admitted with preterm (24–35 weeks of gestation) uterine contractions were evaluated by uterine artery Doppler velocimetry during peak uterine contraction and common obstetric measures including the cervical length. For uterine artery Doppler velocimetry, flow velocity waveforms during peak uterine contraction (determined visually from the tocodynamometer) were recorded during three consecutive heart cycles, and the mean uterine artery pulsatility index was calculated. Results During the peak of contraction, the uterine artery pulsatility index was significantly higher in patients who delivered within 7 days than in the patients who did not deliver (p

Amaç: Ardışık kültür ortamı ile kesintisiz tek basamaklı kültür ortamının erken dönemde embriyo kaliteleri üzerine olan etkilerini araştırarak, farklı kültür ortamlarında geliştirilmiş embriyoların olası implantasyon potansiyellerini incelemek. Gereç ve yöntem: Akdeniz Üniversitesi Tıp Fakültesi Üremeye Yardımcı Tedavi Merkezi’nde, Aralık 2014 ve Aralık 2015 tarihleri arasında, in vitro fertilizasyon tedavisi uygulanmış hastalara ait bilgiler elektronik veri tabanı kullanılarak incelendi. Ardışık basamaklı kültür medyumu uygulanan hastaların (n=144) belirlenmesinin ardından, her hasta için indeks olguya en yakın dönemde oosit toplama işlemi gerçekleştirilmiş; yaş ve metafaz-2 oosit sayıları eşleşen ancak tek basamaklı embriyo kültür medyumunun kullanıldığı hastalar (n=144) seçildi. Embriyo kaliteleri ve gebelik sonuçları gruplar arasında karşılaştırıldı. Bulgular:Gruplar arasında fertilize oosit, gelişimin 2-3. gününde yüksek kalite embriyo sayıları ile fertilize oositten yüksek kalitede klivaj embriyo gelişiminde istatistiksel olarak anlamlı fark saptanmadı (p>0.05). Ancak, hasta başına yüksek kalitede blastokist sayısının (p=0.048) ve yüksek kaliteli klivaj evresindeki embriyolardan yine yüksek kaliteli blastokist gelişim oranının (p=0.043) tek basamaklı kültür ortamında daha yüksek olduğu bulundu. Benzer şekilde, blastokist transferi yapılan olgular istatistiksel olarak tek basamaklı kültür grubunda daha fazla idi (p˂0.001). Gebelik sonuçları değerlendirildiğinde, embriyo transferi yapılan hastalarda klinik gebelik (p=0.038) oranı tek basamaklı kültür ortamında daha yüksek bulundu. Ancak implantasyon oranında gruplar arasında istatistiksel olarak anlamlı fark izlenmedi (p>0.05). Sonuç: Çalışmamız tek basamaklı medyum uygulamalarıyla ardışık medyum ile benzer oranlarda yüksek kalitede embriyo gelişimi sağlanabileceğini göstermektedir. Ayrıca, blastokist gelişim oranı artarak olası gebelik sonuçlarında iyileşme sağlanabilir. Pam Tıp Derg 2016;9(3):212-218, Purpose: The aim of this study was to investigate the effect of sequential vs. single-step media on early human embryo development and the embryos’ implantation potential. Materials and methods:This retrospective study included patients who underwent in vitro fertilization (IVF) treatment at the Akdeniz University Reproductive Centre between December 2014 and December 2015. The electronical database was screened to identify the type of culture media used for IVF. A hundred forty four women whose embryos were cultured in sequential media were retrospectively matched for age and metaphase-2 oocytes with 144 women whose embryos were cultured in single-step media. Embryo quality and pregnancy outcomes were compared between sequential and single-step media groups. Results: The number of fertilized oocytes, high quality embryos on day 2-3 and developmental rate of high quality embryos from fertilized oocytes were found to be comparable between the groups (p>0.05). However, the number of high quality blastocysts (p=0.048) and developmental rate of high quality blastocysts from high quality cleavage stage embryos (p=0.043) were significantly higher in single-step media group. Subsequently, singlestep media group had more embryos transferred at blastocyst stage (p˂0.001). Dealing with the pregnancy outcomes, clinical pregnancy per embryo transfer was found to be higher in single-step media group (p=0.038). There was no significant difference in implantation rates between the groups (p>0.05). Conclusion: We have shown that a single step culture media supports high quality embryo development equivalently to established sequential media. Moreover, higher number of blastocysts available for transfer with single step media, might result in a concurrent improve in pregnancy rates. Pam Med J 2016;9(3):212-218

Today, infertility takes a major place in gynecology practice. Non-puerperal uterine inversion is a rare event and usually accompanies submucous myoma, leiomyosarcoma, rhabdomyosarcoma, malignant mixed Mullerian tumour, and endometrial polyp. Herein, we report a 39-year-old woman who suffered from secondary infertility together with uterine inversion, which is an extremely rare co-existence.

The current study aimed to investigate the effects of luteal gonadotropin-releasing hormone (GnRH) antagonist pretreatment on the outcomes of diminished ovarian reserve (DOR) patients who were treated using a FSH/letrozole/GnRH antagonist (FLA) protocol. Thus, patients who had luteal GnRH antagonist pretreatment (AFLA) prior to stimulation were compared to patients who had the FLA protocol, only. An electronic database was used to identify patients and stimulation characteristics. Women who had a total antral follicle count (AFC) of 0.05). However, the AFLA group had significantly more metaphase-2 (MII) oocytes (p=0.009), a higher oocyte maturity rate (MII/total oocytes) (p=0.029), and a higher mature oocyte yield (MII/AFC) (p=0.020) with more cleaved embryos (p=0.036), and a significantly reduced number of canceled cycles (26.7% vs. 44.7%; p=0.048). The clinical pregnancy rate per cycle was 22.2% vs. 13.2% (p=0.195) in the AFLA and FLA groups, respectively. Interestingly, a subgroup analysis including ESHRE Bologna criteria poor responder patients showed that the luteal administration of GnRH antagonist resulted in better outcomes when compared with the FLA protocol alone. In conclusion, luteal GnRH antagonist pretreatment improves ovarian stimulation parameters and reproductive outcomes in poor ovarian reserve IVF patients.

Aim: To evaluate the effect of instant urinary catheterization on pregnancy rates in women who are on bed rest after embryo transfer (ET). Methods: This retrospective study included patients who underwent intracytoplasmic sperm injection (ICSI) treatment at the Akdeniz University Fertility Clinic between January 2015 and March 2016. All patients were advised bed rest for an hour after ET. The clinic's electronic database was screened to identify the uterine anatomy of the patients, transferred embryo quality, and urinary catheterization status. Only women with an anteverted and anteflexed uterus and cycles that resulted in high-quality blastocyst transfers were included in this analysis. Finally, 71 cycles with urinary catheterization and 81 cycles with no catheterization were analyzed. Results: The clinical (53.5 vs. 40.7%, p = 0.115) and ongoing pregnancy (43.7 vs. 35.8%, p = 0.323) rates were comparable between urinary catheterization and non-catheterization groups. Multivariate analysis by logistic regression including confounding factors revealed that urinary catheterization was independently associated with clinical pregnancy (OR 2.06, 95% CI 1.03-4.13, p = 0.041). However, no significant association was detected between catheterization and the clinically more relevant, ongoing pregnancy (OR 1.65, 95% CI 0.82-3.30, p = 0.160). Conclusion: Our preliminary findings on the use of instant urinary catheterization after ET are promising and justify further investigation in larger prospective studies.

Objective. To investigate in vitro fertilization (IVF) treatment outcomes of unilateral oocyte retrieval in patients with transvaginally inaccessible ovaries.Study Design. Ninety-two women who underwent unilateral oocyte retrieval were retrospectively matched for age, antral follicle count, and body mass index with 184 women who underwent bilateral oocyte retrieval. Each patient in bilateral oocyte retrieval group had the same number of cumulus oophorus complexes (COCs) from single ovary and had comparable number of follicles (±2) on contralateral site where follicular aspiration was performed.Results. The number of COCs, metaphase-2 oocytes, 2-pronuclei, and top-quality embryos was significantly lower in unilateral oocyte retrieval group. However, proportion of patients with an embryo transfer of at least one top-quality embryo was found to be comparable between unilateral and bilateral oocyte retrieval. Subsequently, clinical pregnancy and live birth rates were found to be similar between the groups. The ROC curve analysis revealed (AUC = 0.74, 95% CI 0.63–0.86,p=0.001) that retrieved COCs ≥ 5 from single ovary had sensitivity of 76.0% and specificity of 64.2% for occurrence of a clinical pregnancy.Conclusion. The patients with unilateral oocyte retrieval have reasonable chance of success with IVF. The retrieval of ≥5 COCs from accessible ovary might result in better treatment outcomes among these patients.

Aim: The aim of this study was to evaluate midurethral tissue characteristics in continent and stress urinary incontinent postmenopausal women by using transvaginal ultrasound gray-level histogram. Methods: Thirty-seven patients with stress urinary incontinence (SUI) and 77 patients without SUI were evaluated. Vaginal ultrasound gray-level histograms were performed by 2 gynecologists blinded to patients' SUI statuses. The mean gray-level (MGL) of ultrasound gray-level histogram, representing the echogenicity of a region of interest, was measured in the anterior and posterior midurethral wall along a vertical ultrasound beam. The difference in MGL between anterior and posterior (AP difference) midurethra was calculated. Results: The MGL value of SUI patients was found to be lower in posterior (p = 0.008) and higher in anterior midurethral region (p = 0.001) when compared with control group. In addition, the difference in MGL between anterior and posterior midurethra (AP difference) was found to be higher in SUI group (p < 0.001). Multivariate analysis by logistic regression including confounding factors revealed that AP difference was independently associated with presence of SUI (adjusted OR 1.14, 95% CI 1.08-1.20, p < 0.001). Intra- and inter-observer reproducibility was found to be high with intraclass correlation coefficient of 0.83 and 0.78, respectively. Conclusion: Postmenopausal SUI patients might have a distinct midurethral echogenicity pattern with the quantitative ultrasonography.

Background The aim of this study was to investigate the influence of body mass index (BMI) on the in vitro fertilization (IVF) treatment outcomes in a cohort of women undergoing their first IVF, using an intracytoplasmic sperm injection (ICSI). Methods This retrospective cohort study included 298 cycles from women younger than 38 years old undergoing IVF-ICSI at a university infertility clinic. The treatment cycles were divided into three groups according to the BMI of the women involved: normal weight (18.5 ≤ BMI 0.05 for each). Additionally, clinical pregnancy, spontaneous abortion, and the ongoing pregnancy rates per transfer were found to be comparable between the normal weight, overweight, and obese women (p >0.05 for each). Conclusion Obese women might require a significantly higher dose of gonadotropins and longer stimulation durations, without greatly affecting the pregnancy outcomes.

Placental abruption is defined as ‘premature separation of normally implanted placenta from uterus, generally characterised by abdominal/pelvic pain, vaginal bleeding and uterine tenderness’. It co...

Our aim was to determine the effect of cervical dilatation at non-labour caesarean section on post-operative pain and maternal morbidity. This prospective, randomised, single-blinded trial was conducted from March 2013 to February 2014. In all, 199 patients were enrolled in the study: 102 in non-dilated group and 97 in cervical dilatation group. Based on Visual Analogue Scale, there were no significant differences between the two groups on post-operative 8th, 24th and 48th hour pain scores. We observed thinner endometrial cavity thickness, shorter operation time and shorter hospitalisation duration in cervical dilatation group. However, change in haemoglobin concentrations and puerperal fever rates were found to be comparable between the groups. In conclusion, intra-operative cervical dilatation does not seem to benefit in terms of post-operative pain, change in haemoglobin concentrations or puerperal fever.

PubMedID: 24435497 Objective: This study aimed at determining if tumor-free distance (TFD) from outermost layer of cervix predicts surgicopathologic factors and outcome in surgically treated cervical cancer patients. Materials and methods: One hundred sixteen surgically treated cervical squamous cell carcinomas between 1991 and 2010 with FIGO stage IB/2A were identified and reevaluated histologically regarding the TFD. TFD was defined as the distance between outermost layer of cervix and deepest cervical stromal invasion. Depth of invasion (DOI) and TFD were expressed as continuous variables and compared with traditional surgicopathologic variables and survival to determine their prognostic significance. Results: The mean DOI was 10.3 mm and the mean TFD was 4.2 mm. The most common stage was IB1 (60 patients, 51.7%). The mean number of removed pelvic lymph nodes was 32.2 (median 30; range 8-78). Positive pelvic lymph nodes were found in 27 (23%) of the patients. Sixty-eight patients had lymphovascular space involvement (LVSI). Sixty-eight patients (59%) received postoperative radiotherapy where the following items were present: tumor diameter >4 cm, positive lymph nodes, LVSI and positive surgical margins. With the median fol-low- up of 53 months (3-219 months); 14 patients had local and 13 patients had distant metastases (5 of the patients had both at the time of recurrence). With logistic regression analysis, TFD was a predictor of pelvic lymph involvement ( p=0.028) and LVSI (p=0.008) while DOI was a predictor of LVSI (p=0.044). In Cox regression analysis, increased TFD was associated with improved disease-free survival (DFS) (p=0.007). DFS curves (for TFD cut off value 2.5 mm) according to Kaplan-Meier were found to be statistically significant (log rank test=0.002). Conclusion: The results indicate that TFD is predictive of pelvic lymph node involvement, LVSI and patient outcome in surgically treated cervical cancer patients. However, prospective measurement of TFD is still necessary to determine its value in clinical practice. © Springer-Verlag 2014.

Objective To evaluate the prognostic value of tumor budding (TB) in endometrioid (EEC) and non-endometrioid endometrial cancers (NEEC) and to determine its correlation with expression of E-cadherin. Methods Ninety-five patients with primary endometrial carcinoma were examined statistically. All patients were diagnosed, treated, and given follow-up care at Dokuz Eylul University Faculty of Medicine. Tumor budding detected by either H&E-stained sections and anticytokeratin-staining C11. The tissue block with the largest invasive front was chosen for budding counting and immunostaining. E-cadherin expression was examined by immunohistochemistry using the primary antibodies against to it. Results Tumor budding was low-grade in 73 and high-grade in 22 cases. E-cadherin expression loss was identified in 48 patients. The high-grade TB was significantly higher in patients with advanced stage and deep myometrial invasion (p=0.032 and 0.018, respectively). E-Cadherin expression was significantly lower in NEECs than EECs (p=0.032). The negative expression of E-cadherin was associated with advanced stage and poor differentiation (p=0.001 and p=0.024, respectively). We determined that tumor budding adversely correlated with the presence of E-cadherin expression but not statistically significant. Based on the results of multivariate analysis, TB has an independent impact on cumulative overall survival. We found no statistically significant difference between E-cadherin expression and survival. Conclusions TB is associated with undifferentiated tumor, advanced stage and decreased postoperative survival in endometrial cancer. It might be a valuable prognostic clinicopathologic factor which can be applicable in routine examination.

Objectives To examine the effect of copper intrauterine device (Cu-IUD) on female sexual dysfunction (FSD) subtypes. Material and methods There were 159 sexually active women (ninety Cu-IUD users and sixty-nine women with no contraception) who attended the gynecology clinic for routine gynecologic control informed about the study and asked to fill Female Sexual Function Index (FSFI) and Beck Depression Inventory questionnaires. Results The prevalence of FSD was 41.1% ( n = 37) and 37.7% ( n = 26) in Cu-IUD users and control groups, respectively ( p > 0.05). In analyses of mean overall and subgroup scores of FSFI, significantly lower scores for arousal ( p = 0.021), lubrication ( p = 0.021), orgasm ( p = 0.040), pain ( p 0.001), and overall FSFI ( p = 0.031) were noted in Cu-IUD users. When the results for FSFI domains were considered for Cu-IUD users separately, the only difference to reach statistical significance, using a Bonferroni adjustment, was found to be the pain domain. Finally, we determined that Cu-IUD status made the strongest unique contribution to explaining the dependent variable pain in multiple logistic regression model (β = −0.26, p = 0.001). Conclusion Cu-IUD users have increased sexual pain compared to women with no contraception, which in turn possibly causes decreased sexual arousal, lubrication, and orgasm in these women.