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Objective: The aim of our study was to evaluate sonographic endometrial thickness succeeding the estrogen-only stage and on the day when embryo transfer (ET) occurred in artificial frozen embryo transfer (FET) cycles to delve into the effect of endometrial compaction (EC) on clinical pregnancy rate (CPR). Patients and Methods: In the first group endometrial thickness diminished when ET occurred when compared to the end of the estrogen-only phase (n:37). Endometrial thickness increased/did not alter for the second group (n:70). Demographic characteristics were recorded and the following were studied: in vitro fertilization (IVF) treatment indications, hormone levels, total antral follicle count, duration of infertility, embryo quality, embryo-fundus distance, endometrial thickness at the end of estrogen-only phase and on ET day, luteal support, CPR. Results: No significant difference occurred in CPRs (n:107). ET, on day 5 was higher in the first group (p<0.05). Regression analysis revealed EC was 8.000 times higher in those with ET day 5 than those with 3. CONCLUSION: Endometrial compaction is non-relevant to the rate of clinical pregnancy. The day of ET affected the presence of EC. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In this study, we aimed to evaluate whether the demographic and stimulation characteristics, treatment results, and pregnancy outcomes of infertile couples who applied to our assisted reproductive technology center vary according to the calendar year. STUDY DESIGN: The original files of 949 patients who underwent assisted reproductive technology treatment were analyzed between January 2012 and December 2017. Assisted reproductive technology cycles were classified according to year and also basal parameters and assisted reproductive technology outcomes were compared by year. RESULTS: Female age, infertility period, baseline follicle-stimulating hormone, luteinizing hormone, estradiol levels, duration of stimulation, total gonadotropin dose required, peak E2 level, and endometrial thickness on human chorionic gonadotropin administration day were statistically significant between the groups (p<0.05). While a statistically significant difference was observed in fertilization rate (p<0.05), the following were comparable between the groups (p>0.05): number of retrieved and MII oocytes, two pronuclei, day of transfer, embryo transfer technique, single vs. multiple embryo transfer, rates of the Grade-I embryo, biochemical and clinical pregnancy, live birth, ectopic pregnancy, and miscarriage. CONCLUSION: Infertile women of reproductive age benefit from assisted reproductive technology when trying to become pregnant. Factors that could adversely affect assisted reproductive technology, such as advanced age, have a negative impact on the treatment's success. These repercussions should be taken into account by infertile couples who consider delaying pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the impact of adjuvant treatments, factors influencing recurrence, and survival data in patients with 2023 International Federation of Gynecology and Obstetrics (FIGO) stage IIB endometrial cancer., Methods: A retrospective analysis was conducted on patients with endometrial cancer who underwent surgery between 2005 and 2022 at seven different centers in Turkey. Demographic, clinicopathological, and survival data were collected and analyzed., Results: Among 7323 patients, 565 (7.7%) were classified as 2023 FIGO stage IIB based on pathological results. Of 565 patients, 214 were followed without receiving adjuvant treatment, while 335 (95.4%) received adjuvant radiotherapy, and 16 (4.6%) received radiotherapy and chemotherapy. The locoregional recurrence rate was higher in patients with a tumor size >4 cm (p=0.038) and myometrial invasion >50% (p=0.045). In patients with distant metastasis, the recurrence rate was lower in those with myometrial invasion <50% compared with myometrial invasion ≥50% (p=0.031). The impact of adjuvant treatment on endometrial cancer patients revealed no significant differences for both disease free survival (p=0.85) and overall survival (p=0.54). Subgroup analyses showed that in patients with deep myometrial invasion, adjuvant treatment was associated with a significant increase in overall survival (p=0.044), but there was no effect on disease-free survival (p=0.12)., Conclusions: Patients with stage IIB endometrial cancer with myometrial invasion ≥50% were more likely to have locoregional and distant metastases. Adjuvant radiotherapy or chemoradiotherapy did not demonstrate an overall survival benefit in these patients., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Sonoelastography is an imaging technique that measures tissue strain quantitatively. This study aims to investigate whether the strain rate of endometrium measured by elastography can predict pregnancy after intrauterine insemination (IUI). Methods: This study examined 197 gonadotropin‐stimulated IUI cycles of 148 women diagnosed with unexplained infertility from February 2019 to November 2020. Endometrial thickness, pattern, and strain rate were measured by transvaginal ultrasonography immediately before the insemination. The endometrium and the parametrial tissue were selected for regions of interest, and the strain rate was calculated. The measurements were analyzed concerning the IUI outcome. Results: Of the 197 IUI cycles, the pregnancy rate was 15.20% (n = 30), and ongoing pregnancy rate was 12.2% (n = 24). The mean strain rates were not different between pregnant and nonpregnant groups (2.68 ± 1.28 vs. 2.81 ± 1.32, p = 0.651). Strain rate was not predictive for pregnancy, shown by receiver operating characteristic curve analysis; the area under the curve was 0.526 (95% CI 0.413–0.639; p = 0.649). Pregnancy rates were significantly affected by the women's age and the inseminated sperm count. In multiple logistic regression analysis, the other parameters, including body mass index, anti‐Müllerian hormone, endometrial thickness, endometrial strain rate, and echogenic endometrial pattern, did not significantly change the odds ratio of pregnancy. Conclusion: The endometrial strain rate does not significantly affect the pregnancy rates in gonadotropin stimulated IUI cycles. It appears that strain rate does not predict IUI outcome. More research is needed to evaluate the usefulness of sonoelastography in infertility treatments. [ABSTRACT FROM AUTHOR]

Background: To investigate the incidence of nodular and diffuse adenomyosis, concomitant pathologies and also to compare the demographic and clinic differences among patients with adenomyosis and their surgery indications. Methods: This retrospective study was conducted in Tepecik Research Hospital, Izmir, Turkey between 2014 and 2016. Patients were divided into two groups of nodular and diffuse adenomyosis. The following variables were evaluated for both groups: age, gravidity, parity, menopausal status, indication for hysterectomy, ultrasonographic parameters, gynecological symptoms (abnormal uterine bleeding [AUB], pelvic pain and pelvic pressure, postmenopausal vaginal bleeding), preoperative and postoperative histopathological assessment, and coexisting pathologies. Results: Of the total 3457 cases of hysterectomies, 755 (95% CI: 20.4-23.1) were confirmed with adenomyosis. There were 217 (95% CI: 23.9-30.0) postmenopausal women. Adenomyosis was most commonly detected in patients in the age of 40 to 50 (57.6%). The most common symptoms were AUB (n: 336) (95% CI: 40.9-48.0), pelvic pain or pressure (n:139) (18.4%), and postmenopausal vaginal bleeding (n: 119) (95% CI: 13.1-18,4). Seventy-four (95% CI: 7.9-11.9) of the patients had nodular and 681(95% CI: 88.0-92.3) had diffuse adenomyosis. Demographic data, age, parity, gravidity, endometrial thickness, and menopausal status were similar between the groups. AUB was more frequently detected in nodular adenomyosis (56.8%). Myoma uteri was the main hysterectomy indication in both groups. In addition, treatment-resistant AUB for nodular adenomyosis and endometrial pathologies for diffuse adenomyosis were the most frequent indications for hysterectomy after myoma uteri. Conclusion: The most common form of adenomyosis was the diffuse form. Endometrial pathologies were more frequently associated with diffuse adenomyosis. Asymptomatic and incidental adenomyosis were more common with the diffuse form. AUB was more frequently detected with nodular adenomyosis. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to evaluate the results of the laparotomies due to gynecological pathologies in breast cancer patients and to assess the distribution of gynecological pathologies and the clinical and laboratory findings contributing to the diagnosis. Methods: This study was conducted between years 2002 and 2011 at Hacettepe University Hospital. We obtained information about 86 consecutive breast cancer patients, including age, time of diagnosis and pathology of breast cancer, hormone receptor status, history of endocrine therapy, presenting symptoms, ultrasonography findings, CA 125 levels, endometrial biopsy results, type of gynecological surgery and pathology results. Data were analyzed with the use of SPSS software. Results: Twenty‐one (24.4%) out of 86 patients had endometrial pathology, and 24 (27.9%) had adnexal pathology. Fourteen patients (16.2%) had malignant pathology, and of them, 11 had ovarian cancer 3 had endometrial cancer. There were five abnormal cytological findings: 2 ASCUS, 1 LSIL, 1 ASC‐H and 1 adenocarcinoma. The patient with the cytology report of adenocarcinoma had the final diagnosis of endometrial cancer. Of the patients, 67 (77.9%) used tamoxifen, whereas 19 (22.1%) did not. Thirty‐three patients (38.4%) with gynecological pathologies were detected incidentally during routine follow‐up of breast cancer. Conclusion: This study supports the increase of the gynecological pathology incidence in breast cancer patients and the recommendation of close gynecological follow‐up in these patients. Asymptomatic patients might also develop genital cancer. The ultrasonographic appearance of the adnexal masses or endometrial thickness and any abnormal vaginal bleeding or high CA 125 levels are important parameters for evaluating breast cancer patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the complaints of premenopausal and postmenopausal geriatric patient who admitted to gynecology outpatient clinic. Methods: 25 Premenopausal and 25postmenopuasal geriatric patients who admitted to outpatient clinic of gynecology in Sakarya Private Konak Hospital were evaluated retrospectively regarding diagnosis, gravida and parity situations, surgical operations, systemic disorders and ultrasonographic mesaurement of endometrial thickness and copmpared to each other. Results: Frequency of common complatints of admitted patients was 20% vaginitis, 16% irregular menstrual bleeding, 14% postmenopausal bleeding. 76% of patients had no systemic disorder. 6% of patients had diabetes mellitus and 18% had hypertention. Rate of having comorbidity in postmenopausal geriatric group was 44% and that of premenopausal group was 4%. According to our findings the frequecy of diseases in postmenopausal geriatric group was 12% uterine prolapse, 24% cytocel, 20% urinary incontinance 4% vasomotor symptoms 12% vaginitis and 28% posmenopausal bleeding and in premenopausal group 28% vaginitis, 16% uterine myoma, 32% irregular menstrual bleeding, 8% dysmenorrhea, 12% and 4% subcutaneus endometriosis. We stated endometrioid adenocarcinoma as the results of endometrial samplings of 2 patients who had postmenopusal bleeding and these patients were referred to gynecologic oncology clinic. Conclusion: Despite all gynecologic problems could be seen in geriatric age group, diseases such as atrofic symptoms due to hypoostrogenemy, vasomotor symptoms, pelvic organ prolapse and urinary incontinance is frequently seen in these women. Both for women heatlh and geriatric women care performing gynocologic evaluation regarding these, would be benefical in terms of early disgnosis and treatment of the diseaeses. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy and safety of levonorgestrel-releasing intrauterine system (LNG-IUS) in the long-term treatment of heavy menstrual blood loss in women unrelated to intrauterine pathology.Methods: One hundred and six parous women aged 33-48 years with recurrent heavy menstrual bleeding (HMB) participated in this study. The women were followed up for 24 months and were assessed for intensity of bleeding both for pre- and post-insertion periods. An LNG-IUS was inserted in each patient within 7 days of the start of menstrual flow. The women were followed up at 1, 3, 6, 12, 18, and 24 months following the insertion of the intrauterine device.Results: One hundred and two women completed the follow-up period and had a significant reduction in the amount of menstrual blood loss. The LNG-IUS was well tolerated by all women. Pre-treatment of the use of the LNG-IUS, endometrial biopsy patterns for irregular proliferative endometrium and for atypical simple hyperplasia were 34/106 (32.08%) and 61/106 (57.55%) respectively and after treatment no abnormal pathologic findings were determined (p < 0.001).Conclusion: Our findings indicate that the LNG-IUS is effective for significantly reducing the amount of menstrual blood loss in women with HMB. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of body mass index (BMI) in women with premenopausal heavy menstrual bleeding (HMB) to identify patients who should undergo endometrial biopsy.Methods: This prospective cohort study included 1120 premenopausal women who presented to the Gynecology Clinic, Bakirkoy Dr. Sadi Konuk Training and Research Hospital in Istanbul, Turkey, due to HMB and who underwent endometrial sampling. The abnormal endometrial histopathological results were analyzed by separating patients into groups of all abnormal findings (hyperplasia without atypia + hyperplasia with atypia + carcinoma) and hyperplasia with atypia + carcinoma. Sensitivity and specificity of the abnormal histopathological results were calculated in both groups using BMI cut-off values as 25, 30 and 35 and age cut-offs as 40 and 45 years.Results: The rate of hyperplasia with atypia and carcinoma was sevenfold higher in women with a BMI ≥30 compared to those with a BMI ≤30 (95 % CI 2.4-17.9). In the analyses, BMI was a stronger risk factor in women younger than 45 years of age. The risk of endometrial carcinoma and atypical hyperplasia was twofold higher in patients older than 45 years when compared with patients younger than 45 years (95 % CI 1.1-5.1).Conclusions: All women with a BMI ≥30 and presenting premenopausal HMB should undergo endometrial biopsy regardless of age. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the diagnostic value of endometrial thickness measurement on sonography in predicting endometrial pathologies in postmenopausal women with vaginal bleeding and in those with asymptomatic thickened endometrium.Methods: Six hundred two postmenopausal women with vaginal bleeding or asymptomatic thickened endometrium were evaluated in this study. Two hundred seventy-four women with postmenopausal bleeding regardless of endometrial thickness (group 1: symptomatic) and 328 women with an incidental finding of thickened endometrium (≥5 mm) without bleeding (group 2: asymptomatic) underwent endometrial biopsy for histopathologic examination. The receiver operating characteristics curves of endometrial thickness measurement for prediction of endometrial pathologies were analyzed.Results: Endometrial carcinoma was detected in eight women (2.9%) in group 1 and in three (0.9%) in group 2. The best cutoff point for endometrial thickness in predicting endometrial carcinoma in group 1 was 8.2 mm, which provided 75% sensitivity (95% confidence interval [CI], 40.9-92.9%) and 74% specificity (95% CI, 68-78.5%); area under the receiver operating characteristics curve (AUC), 0.88; 95% CI, 0.76-1.00%; p = 0.0001. In group 2, the AUC was 0.76 (95% CI, 0.46-1.00; p = 0.114); the evidence was inconclusive as to the relationship between endometrial thickness and malignancy. For the prediction of polyps, the AUCs of endometrial thickness were 0.77 for group 1 (95% CI, 0.71-0.83%; p = 0.0001) and 0.61 for group 2 (95% CI, 0.54-0.67%; p = 0.002).Conclusions: Sonographically determined endometrial thickness measurement shows high diagnostic performance for detection of endometrial cancer in symptomatic postmenopausal women at the optimal cutoff thickness of approximately 8 mm, although the evidence supporting the use of sonography for predicting malignancy in asymptomatic women is inconclusive. For polyp detection, this technique shows moderate diagnostic ability in symptomatic women, but its predictive value is low in asymptomatic women. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:339-346, 2016. [ABSTRACT FROM AUTHOR]

Objective: To compare classic terminology and the PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory disorders, endometrium, iatrogenic, and not classified) classification system among women who underwent surgery for abnormal uterine bleeding (AUB), and to subclassify the components of the PALM group for future studies.Methods: In a retrospective study, data were obtained for nonpregnant women aged 18-55years who underwent hysterectomy, myomectomy, or polypectomy for AUB at a center in Turkey in 2014. The patients were retrospectively classified according to the PALM-COEIN system, and the two terminologies were compared.Results: A total of 471 women were included. The term "hypermenorrhea" covered 15 different pathology combinations, "menorrhagia" nine, "metrorrhagia" 14, and "menometrorrhagia" 18. Of 92 patients with polyp, 5 (5.4%) had two polyps and 1 (1.1%) had three. Of 146 patients with adenomyosis, 131 (89.7%) had diffuse adenomyosis and 12 (8.2%) had adenomyoma. Of 309 patients with myoma uteri, 108 (34.9%) had submucous myoma and 201 (65.1%) had other types of myoma.Conclusion: Classic terminology for AUB is insufficient and confusing with respect to etiologic pathologies among nonpregnant women of reproductive age. Widespread adoption of the PALM-COEIN system for AUB classification will facilitate more meaningful communication among both clinicians and investigators, and clarify the populations that should be evaluated in clinical trials, thereby enhancing communication with patients. [ABSTRACT FROM AUTHOR]

Purpose: Endometrium carcinoma (EC) is the fourth common cancer among women worldwide and the incidence is increasing. It is important to define the EC earlier for survival of the patients.Methods: Women who had endometrial hyperplasia (EH) and EC in postmenopausal and premenopausal period were included to participate in this study. MN assay has been performed to participants for detection of the genetic damages and DNA instability.Results: MN ratio was significantly higher in EC group compared to other two groups (EH and control groups) (p < 0.001). On the other hand, there was no significant difference among these groups with regard to number of gravidity and presence of a family history of cancer (p > 0.05). MN frequency and NDI were significantly correlated with the age in endometrial hyperplasia without atypia, endometrial cancer and control groups (r 0.546, p < 0.001; r 0.320, p 0.024; r 0.396, p 0.003, respectively). Similarly, MN frequency and NDI were significantly correlated with BMI in three groups (r 0.287, p 0.044; r 0.467, p 0.001; r 0.473, p 0.001, respectively).Conclusions: MN scoring in pre-neoplastic conditions of the endometrium can be used as adjunct in endometrium cancer screening. By using MN assay, discrimination may be possible among endometrial cancer, endometrial precancerous lesions and pathologically normal patients. This is an easy, simple, reliable, reproducible objective test and can be used in routine patient examination. [ABSTRACT FROM AUTHOR]

Aim The present study aims to determine how transvaginal ultrasonography and histopathological examination findings are correlated in a cohort of premenopausal and postmenopausal Turkish women with abnormal uterine bleeding. Methods This is a retrospective review of 350 Turkish women who underwent transvaginal ultrasonography and suction curettage as a result of abnormal uterine bleeding. Results Sonographic appearance of the endometrium was normal in 244 patients (69.7%), while homogeneous thickening was detected in 47 patients (13.4%) and cystic thickening in 21 patients (6.0%). A sonographic diagnosis of endometrial polyp was made in 38 patients (10.9%). Histopathological analysis of endometrial samplings revealed proliferative endometrium (36%), secretory endometrium (24.6%), decidualization (10.9%), endometrial polyp (8.3%), endometritis (6.8%), endometrial hyperplasia (4.6%), irregular shedding (3.7%), atrophic endometrium (3.1%), endometrial cancer (1.1%) and placental retention (0.9%). The sonographic and histopathological findings correlated significantly (χ2 = 122 768, P = 0.001; r = 0.215, P = 0.001). Approximately 51% of the women with homogeneous endometrial thickening had proliferative endometrium. Only 44.7% of the women with ultrasonographically visualized endometrial polyps had histopathologically diagnosed endometrial polyps. Nearly 57% of the women with cystic endometrial thickening had proliferative endometrium. Conclusion If there is no facility for hysteroscopy or hysteroscopy-guided endometrial biopsy for women with abnormal uterine bleeding, transvaginal ultrasonography findings can be efficiently used to make a preliminary diagnosis and, thus, notify the pathologists. [ABSTRACT FROM AUTHOR]

Background The aim of the present study was to evaluate the significance of endometrial sampling in asymptomatic, bleeding-free postmenopausal women who have endometrial thickness greater or equal to 5 mm. Methods A retrospective review was conducted of all women who underwent transvaginal ultrasonography between January 2000 and March 2009 in a menopause clinic, who were found to have an endometrial thickness of at least 5 mm and who were subjected to endometrial sampling. Results Five hundred and thirty asymptomatic postmenopausal women underwent ultrasonographic evaluation with subsequent endometrial sampling. The mean endometrial stripe thickness was 8.7 mm (range: 6-26). Five cases of adenocarcinoma (0.9%) and 65 (12.2%) cases of simple/complex atypical hyperplasia were diagnosed. Conclusions In this study, 106 investigations were performed to detect one case of adenocarcinoma. Although this is a high number per case detection of endometrial adenocarcinoma, considering the rising incidence of endometrial cancer, large prospective trials with surrogate criteria for asymptomatic women are needed to investigate the importance of thickened endometrial stripe in postmenopausal women. [ABSTRACT FROM AUTHOR]

To assess the effect of local injury to the endometrium for implantation, pregnancy and live birth rates in ICSI-ET cycles with recurrent implantation failure. The study was prospectively designed and performed in a university hospital. A group of 100 women, who failed to conceive during one or more cycles of IVF and embryo transfer (ET), was treated with a long protocol for controlled ovarian hyperstimulation. The IVF treatment and ET were preceded by repeated endometrial biopsies, in a randomly selected 50 of a total of 100 women. Age of the women, days of stimulation, total dose of gonadotropins, E2 concentrations and endometrial thickness on hCG day, total MII stage oocytes, the total number of high quality embryos for transfer, the day of transfer and the number of embryos transferred were similar for both groups. Transfer of a similar number of embryos (138 and 141 in the experimental and control patients, respectively) resulted in rates of implantation (34.67 % vs. 30.88 %; p= 0,1384) clinical pregnancy (60 % vs. 34 %; p= 0.009), and live births per ET (44 % vs. 24 %; p= 0.03), which were higher in the experimental group as compared to controls. These results suggest that IVF treatment that is preceded by local injury to the endometrium improved the rates of embryo implantation, clinical pregnancy, and live births in asiste reproductive technique. [ABSTRACT FROM AUTHOR]

Background: This study investigated the effects of serum estradiol (E2) and progesterone levels on preovulatory endometrial thickness and echogenicity in controlled ovarian hyperstimulation (COH) cycles for in vitro fertilization (IVF). Materials and Methods: In this retrospective study, we evaluated the data of 241 in vitro fertilization- embryo transfer cycles. Cycles were classified into three groups according to endometrial thickness measured on the day of human chorionic gonadotropin (hCG) administration as: i. ≤8 mm, ii. 8-14 mm, and iii. ≥14 mm. Echogenic patterns were described as trilaminar, isoechogenic, and hyperechogenic. Serum E2 and progesterone levels were evaluated on the day of hCG administration. Data were analyzed using χ2 test, Student's t test and analysis of variance (ANOVA). Results: Serum E2 levels increased in parallel with endometrial thickness, although differences among the three groups were insignificant. There was no correlation between serum progesterone levels and endometrial thickness. There was no significant difference in the steroid hormone concentrations between the echogenic patterns. Conclusion: Serum steroid hormone levels on the day of hCG administration do not affect the ultrasound appearance of the endometrium in COH cycles. [ABSTRACT FROM AUTHOR]

Aim: A biopsy is often taken as part of the preoperative workup, regardless of the indication for hysterectomy. Some authors believe that dilatation and curettage is a poor diagnostic procedure for intrauterine pathologies, but dilatation and curettage has been the method of choice for obtaining an endometrial sample. The aim of this study was to investigate the concordance between endometrial histopathological diagnoses from preoperative dilatation and curettage and hysterectomy specimens. The differences between premenopausal and postmenopausal women were also investigated. Methods: Histopathological results for dilatation and curettage specimens from 645 women (401 premenopausal and 244 postmenopausal) who underwent a hysterectomy between 2003 and 2009 were analyzed retrospectively. Results: High sensitivity (87.8%), specificity (100%), positive (100%) and negative (98.7%) predictive values, and accuracy (98.8%) were observed for all malignant endometrial pathologies obtained at dilatation and curettage. In postmenopausal women, eight malignancies were missed when the preoperative diagnosis from the dilatation and curettage sample indicated inadequate tissue or premalignant lesions. For premenopausal women, we found only two missed malignancies. The accuracy was 99.5% and 96.8% for malignant pathologies diagnosed from curettage material for pre- and postmenopausal women, respectively. Conclusions: Dilatation and curettage remains the 'gold standard' for diagnosing endometrial pathologies, especially malignancies. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to detect endometrial leptin expression in proliferative and secretory phases and then to compare the results with that of hyperplastic endometrium. Material and Methods: Seventeen proliferative, 23 secretory phase and 18 hyperplastic endometrial tissues diagnosed in our hospital between 2002 and 2007 were included in the study. These samples were stained with leptin antibody using an immunohistochemical method. Endometrial glandular and surface epithelium and stroma were evaluated for staining distribution and intensity. Conclusion: Staining intensity seen in early proliferative phase samples (2.33±0.51) increased significantly throughout the middle (2.40±0.54) and late phases (2.83±0.40) (p<0.05). Early secretory phase samples had the least staining intensity (1.42±0.53), while it increased significantly in later periods (2.38±0.51) (p<0.05). There was no difference in staining intensity among proliferative, secretory and hyperplastic tissues (p>0.05). Conclusion: Although endometrial leptin expression was observed in a differential manner throughout the whole menstrual period, no difference was seen in endometrial hyperplasia. We consider that leptin does not play a role in hyperplastic transformation of the endometrium. [ABSTRACT FROM AUTHOR]

Endometrial thickness is one of the parameters contributing to the outcome of assisted reproduction treatment. The aim of the current study was to investigate the pregnancy rate and the outcome when the endometrial thickness was <7 mm during a treatment cycle. Treatments conducted between January 2000 and December 2004 at the German Hospital in Istanbul were reviewed retrospectively. A total of 175 embryo transfer cycles with an endometrial thickness of <7 mm on the day of oocyte retrieval were assessed. The 175 oocyte retrieval-embryo transfer cycles resulted in 53 pregnancies (30%), of which 11% were biochemical pregnancies, 26% were miscarriages and 58% were delivered. The clinical pregnancy rate was 26%, miscarriage rate was 31% and live birth rate was 17%. However, the results were quite good when the patient age was <35 years or the number of oocytes retrieved was over five or the number of available embryos to transfer was three or more. In conclusion, when the endometrial thickness is <7 mm during an treatment cycle, the couple should be informed about the chance of pregnancy and the outcome. In a young normoresponder woman with at least three embryos available for transfer, transfer could be carried out, otherwise embryo freezing should be recommended. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the changes in follicular development, serum hormonal levels, and endometrium in the pre-implantation period of rats by using recombinant FSH (rFSH) without human chorionic gonadotropin (hCG). Thirty female rats were studied in six groups of five specimens. Two groups determined as controls (groups 1 and 2). Two groups received constant doses of rFSH (groups 3 and 4) and other two decreasing doses (groups 5 and 6). One of the paired groups was mated. Uterus, ovaries, and blood samples were taken from non-mated groups (groups 1, 3, and 5) at the proestrus period and from mated groups (groups 2, 4, and 6) in the pre-implantation period. In non-mated groups antral follicles and corpus luteum periodicum and in mated groups antral follicles, corpus luteum periodicum, and corpus luteum graviditatis were increased in rFSH groups, especially in decreasing dose groups. Estradiol (E2) levels were increased and progesterone (P)/E2 ratio was significantly decreased in decreasing dose groups. Endometrium surface epithelium was columnar, irregular, and folded in rFSH groups. Endometrium glandular epithelium was cuboidal in all groups. In decreasing dose groups endometrial stroma was smooth and fibroblastic. Mitotic indices of endometrium surface, glandular epithelium, and stroma were significantly decreased in rFSH groups. Primary follicles and P levels showed no change. It seems likely that decreasing doses of rFSH might be used in order to improve follicular development, although it has negative effects with E2 on endometrium in the pre-implantation period of rats. [ABSTRACT FROM AUTHOR]

Recurrent implantation failure (RIF) is diagnosed when good-quality embryos repeatedly fail to implant after transfer in several in vitro fertilization (IVF) treatment cycles. Different expression profiles in maternal mRNAs could be referring to many diseases including RIF. This study aimed to reveal significantly dysregulated selected genes expression between healthy fertile women and RIF patients in the implantation window days of the natural menstrual cycle. MME, WWC1, TNC, and FOXP3 genes were chosen as target genes regarding their possible relations with the implantation process. Pathways with these genes were identified and the relationship between these pathways and RIF was investigated. In this study, the endometrial biopsy samples were collected in the secretory phase (cycle day 20-24) of the menstrual cycle from RIF patients (n = 34) and healthy fertile controls (n = 34). After "Pathway and network-oriented GWAS analysis" (PANOGA) and "Kyoto Encyclopedia of Genes and Genomes" (KEGG) pathway analysis; "Membrane Metalloendopeptidase" (MME), "WW and C2 Domain Containing 1" (WWC1), "Tenascin C" (TNC) and "Forkhead Box P3" (FOXP3) genes were chosen as target genes by regarding their possible relation with implantation process. Detection of differences in mRNA expressions between the control group and RIF patients has been performed with the droplet digital PCR (ddPCR) method. Results of the study showed that MME and WWC1 genes expression levels are significantly (p < 0,05) up-regulated 4.9 and 5.2 times respectively and TNC gene expression level is significantly (p < 0,05) down-regulated 9 times in the RIF samples compared to the control group. However, no statistically significant difference was observed between the patient group and the control group in the expression of the FOXP3 gene (p < 0.05). Changes are observed in the expression of the renin-angiotensin system pathway in which the MME gene is involved in the implantation process. The increase in MME gene expression can be speculated to cause implantation failure by restricting the invasion of trophoblast cells. Increasing WWC1 gene expression in the Hippo signaling pathway inhibits "Yes-associated protein 1" (YAP) expression, which is a transcriptional cofactor. Inhibition of YAP protein expression may impair the implantation process by causing the failure of endometrial decidualization. The TNC gene is located in the focal adhesion pathway and this pathway reduces cell adhesion on the endometrial surface to facilitate the attachment of the embryo to the endometrium. The reason for implantation failure might be that the intercellular connections are not suitable for implantation as a result of decreased expression of the focal adhesion pathway in which the TNC gene is effective. Considering the relations between the pathways of the target genes and the implantation process, changes in the expression of target genes might be a cause of RIF., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: Uterine perfusion, particularly the endometrial blood flow, may have an important role in endometrial receptivity. In order to assess the contribution of sub endometrial blood flow in the etiopathogenesis of unexplained infertility mid luteal- peri-implantation period spiral artery transvaginal color Doppler parameters were measured and compared with fertile controls. Material and Methods: Forty-two consecutive patients admitted to Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Obstetric and Gynecology with the diagnosis of unexplained infertility after standard diagnostic work up constituted the study group and they were compared with a fertile control group admitted to hospital with non specific gynecological complaints or for check-up in the same period. Mid luteal transvaginal color Doppler ultrasonography was applied to each patient by the same radiologist who was blind to the diagnosis of the particular patient and, RI (resistance index) and PI (pulsatility index) values were calculated. Results: There were no significant differences between the two groups, in respect to age, body mass index, basal hormonal and mid luteal progesterone levels (p>0.05). For the fertile control group, mid luteal-peri-implantation phase endometrial spiral artery mean RI values were calculated as 0.48±0.08 SD and mean PI values as 0.65±0.18 SD. For the study group, mean RI values were calculated as 0.54±0.07 SD, PI values were calculated as 0.80±0.16 SD. The differences for RI (p=0.009) and PI (p=0.004) were statistically significant. Conclusion: According to Doppler parameters, unexplained infertility patients have high impedance blood flow in spiral arteries which means that peri-implantation blood flow in these patient is lower than fertile controls. These findings suggest that endometrial perfusion may have an important contribution to etiopathogenesis of unexplained infertility. [ABSTRACT FROM AUTHOR]

Endometrial carcinoma is the most commonly encountered gynecological cancer in women worldwide and is also one of the popular models of the hormone-dependent carcinomas. This study was aimed to evaluate and compare the concentrations of five paraben molecules (methylparaben, ethylparaben, N-propylparaben, benzylparaben, isobutylparaben + N-butylparaben) in the endometrial and myometrial tissue samples of patients diagnosed with endometrial carcinoma and benign gynecologic diseases. A total of 88 patients were included in the study and chemical analysis was performed on 176 tissue samples. The study group comprised of 33 patients with endometrial carcinoma and 6 patients with endometrial intraepithelial neoplasia. The control group comprised of 49 patients. One endometrial and one myometrial tissue samples were collected from each patient. The analyses were performed using ultrahigh-performance liquid chromatography and tandem mass spectrometry (UHPLC-MS/MS). At least one type of paraben molecule was detected in 23.07% (9/39) of the patients in the study group, and in 2.04% (1/49) of the patients in the control group; this difference between the groups was statistically significant (p = .002). N-Propylparaben and isobutyl + N-butylparaben were the most frequently detected (in 7/10 of the samples) paraben molecules in the study. Tumor characteristics (tumor diameter, myometrial invasion, architectural grade, nuclear grade, lymphovascular space invasion, and tumor stage) were comparable between the two groups of endometrial carcinoma (paraben-detected and paraben-undetected groups). In conclusion, paraben molecules were more frequently detected in the endometrial carcinoma tissue samples than in the normal endometrium.

Objective: To evaluate the effect of embryo flash position and movement of the air bubbles at 1 and 60 minutes after ET on clinical pregnancy rates (PRs).Design: Prospective clinical trial.Setting: University fertility clinic.Patient(s): A total of 230 fresh ultrasound-guided ETs performed by a single physician (C.F.) at the IVF center of Yeditepe University Hospital between September 2016 and February 2017 were included.Intervention(s): Transabdominal ultrasonographic guidance at ET.Main Outcome Measure(s): Clinical PRs.Result(s): There was no significant difference in terms of clinical PRs between women with embryo flash located >15 mm and <15 mm from the fundus at 1 or 60 minutes (P=.6 and P=.7, respectively). The PRs in women with embryo flash located <15 mm and >15 mm from the fundus were 47% and 60%, respectively (P=.6). The clinical intrauterine PRs were 69.5%, 38.5%, and 19.1% in fundal, static, and cervical, respectively. The highest PR was in fundal when compared with others (P<.01). The clinical PR appears to be associated with the embryo flash movement/migration and the PR was dramatically reduced when the embryo migrated from its original position toward the cervix at 60 minutes.Conclusion(s): We concluded that clinical PR appears to be associated with the embryo flash movement/migration at 60 minutes after ET and embryo flash movement toward the fundus is associated with higher clinical PRs. Further well-designed randomized controlled trials are required to optimize ET technique in the future. [ABSTRACT FROM AUTHOR]

Objective: Intrauterine device (IUD) is a widely used long-acting contraceptive method; however, the side-effects related to IUD may lead to method discontinuation. The aim of this study is to evaluate the relation between the most common side-effects of IUD use; mainly dysmenorrhea, menorrhaghia, pelvic cramping and the relation of these complications with the position of the IUD device within the cavity and uterine dimensions evaluated by transvaginal ultrasonography., Material and Method: Two hundred and eighty-four patients who had Cu-T380A IUD insertion at the Family Planning Clinic of a tertiary health center were evaluated at insertion and 6 and 12 weeks after the insertion. Demographic characteristics, medical history, symptoms and findings of the gynecological examination were recorded. Transvaginal ultrasonographic measurement of the uterine dimensions, the distance between the tip of the Cu-IUD and the fundus, myometrium and endometrium were measured to evaluate the displacement of the IUD. The relationship between the symptoms and IUD displacement diagnosed by ultrasonographic examination were investigated., Results: Two hundred and sixty-seven patients were followed-up for 12 weeks as the remaining 16 had partial or complete IUD expulsion. A statistically significantly shorter uterine length was measured in patients who complained of menorrhagia in comparison to the ones without this complaint (54.27 ± 6.11 vs 60.25 ± 10.52 mm, p = 0.02) while uterine length was similar in patients with or without dysmenorrhea at 12 weeks (59.60 ± 10.25 vs 60.33 ± 10.68 mm, p = 0.71). The distances between the tip of the IUD and the endometrium, myometrium and the uterine fundus, were statistically and significantly longer in patients who experienced pelvic cramping at 3rd month, showing a downward movement of the IUD. (Endometrium; 0.29 ± 0.72 vs 0.45 ± 0.35 mm, p = 0.02, Myometrium; 1.25 ± 1.39 vs 2.38 ± 2.26 mm p < 0.05, Fundus; 1.68 ± 2.39 vs 2.92 ± 1.78 mm, p < 0.05)., Conclusion: A shorter uterine cavity length seems to be a predictor of menorrhagia in patients with Cu-T 380A IUD. Patients experiencing pelvic cramping with IUD are more susceptible for IUD expulsion as the downward movement of IUD is more prominent in these patients.