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Objective: The aim of this study was to describe characteristics and outcomes of assisted reproductive technology (ART) cycles performed in 2019 in Turkey. Material and Methods: One-hundred and sixty-five ART centers in Turkey were invited to submit data. The survey was sent to center directors via e-mail with anonymous links by Qualtrics™. The survey involved questions about their patient characteristics, clinical practices, and outcomes. Results: Forty-one (24.8%) centers responded to e-mails, and data gathered from 25 centers was included in the analyses. In 25 centers, 18,127 fresh or frozen transfers were carried out during the study period, of which 7796 (43.0%) were fresh and the rest were either frozen (45.2%) or embryo transfers (ET) with preimplantation genetic testing (PGT) (11.8%). The live birth rate per ET was as 30.6%, 40.1%, and 50.7% in fresh, frozen and PGT cycles, respectively. A single embryo was transferred in 65.3% of all transfers and singleton live births comprised 86.1% of all deliveries. For cycles with intrauterine insemination, 1407 were started in 2019, and 195 clinical pregnancies, 150 live births with 19 multiple pregnancies occurred. A total of 1513 ART cycles were initiated for foreign patients. Russia (29.6%), Germany (7.4%), Iraq (4.6%), Uzbekistan (3.1%), and Syria (1.4%) were the top five countries with most patients coming to Turkey for ART. Conclusion: The survey results are in parallel with the reports of international institutions and organizations. With repeated editions, the data collected with annual surveys can be used to inform ART practices in the coming years. [ABSTRACT FROM AUTHOR]

Objective: The aim of this research was to assess the effects of previous abdominal surgery and obesity on the outcomes of total laparoscopic hysterectomy (TLH). Materials and Methods: In this retrospective cohort study, 234 women who underwent TLH for benign conditions between January 2011 and December 2016 in a university hospital were included. The study group consisted of patients who had at least 1 previous abdominal surgery and the control group had previous abdominal surgeries. In a further analysis, obese patients who underwent TLH were compared to obese patients who underwent total abdominal hysterectomy (TAH) during the same timeperiod. The main outcome parameters were duration of hospital stays and major complication rates. Results: The mean durations of hospital stays and major complication rates were similar between the patients with and without previous surgery (p = 0.372 and p = 0.099, respectively). The outcomes of 93 TLH and 146 TAH patients whose BMIs were ≥30 kg/m2 were also compared. The mean BMIs of the TLH and TAH groups were 32.8 ± 2.3 kg/m2 and 33.0 ± 2.7 kg/m2, respectively. The durations of hospital stays were significantly lower in the TLH group than in the TAH group (3.1 ± 2.0 days versus 4.2 ± 3.5 days; p = 0.006). There was a tendency for increased major complication rates in the TAH group, but this was not statistically significant. Conclusions: Having previous abdominal surgery does not seem to affect outcomes of TLH unfavorably. Laparoscopic surgery, rather than open surgery, shortens hospital stays of obese hysterectomy patients without unfavorable effects. Moreover, TLH is likely to be associated with lower major complication rates. ClinicalTrials.gov ID: NCT03738085. (J GYNECOL SURG 37:512) [ABSTRACT FROM AUTHOR]

Purpose: To report the first live birth after frozen-thawed ovarian transplantation in Turkey and the second case for an acute lymphoblastic leukemia (ALL) survivor in the world. Methods: A 19-year-old patient underwent ovarian tissue cryopreservation (OTC) before cord blood transplantation in 2010. She was diagnosed as ALL with a bone marrow biopsy revealing 90% blast ALL-L2 type, and karyotype analyses indicated reciprocal translocation at t(9;22)(q34;q11). The patient received the Berlin-Frankfurt-Munster (BFM) protocol, and complete remission was achieved before fertility preservation. Serum AMH level was measured as 1.5 ng/ml, and 12 antral follicles were counted on ultrasound. She was informed about fertility preservation options and decided to proceed with OTC, with her signed consent before cord blood transplantation in April 2011. Ovarian tissue transplantation (OTT) was performed in 2017 when the patient was menopausal with serum FSH levels > 100 IU/ml and estradiol < 20 pg/ml and hematologically in molecular remission. Detailed molecular analysis, standard histology, and immunohistochemistry demonstrated that the thawed tissue is free of malignant cells. Results: Six months following OTT, she had spontaneous menstruation with serum FSH 11 IU/ml and estradiol 53 pg/ml. Two consecutive IVF cycles yielded three top-quality embryos. Following three embryo transfer cycles, one fresh and two frozen, a healthy term live birth was achieved. Frozen-thawed-transplanted tissues were extracted during caesarean delivery upon the patient's request after a total period of 25 months in vivo, and histopathological evaluation revealed that the tissue was free of leukemic infiltration. Conclusion: The authors report the first pregnancy and live birth in Turkey and the second live birth in the world following transplantation of frozen-thawed ovarian tissue in a leukemia survivor. As the transplanted tissues were removed during caesarean delivery, histological findings prove the functionality and the malignant-free status of the transplanted tissue during the grafted period. [ABSTRACT FROM AUTHOR]

Objective: To compare medium/long-term outcomes in terms of pelvic floor function, patient reported prolapse recurrence and repeat prolapse surgery after laparoscopic sacrohysteropexy (LSHP) and vaginal hysterectomy with McCall suspension (VH&McCall) which is the most commonly performed surgical option for severe uterine prolapse from past to present.Study Design: Files of patients who underwent LSHP and VH&McCall for advanced utero-vaginal prolapse (stage 3 & 4) at the Department of Gynecology in Ankara University School of Medicine between 2008 and 2018 were reviewed (n = 517). Data of women who were followed up for at least 1-year and containing both the full-filled Patient Global Impression of Improvement (PGI-I) survey and Turkish validated Pelvic Floor Distress Inventory-20 (PFDI-20), were included.Results: A total of 132 women were included in the study; 46 women who underwent LSHP and 86 women who underwent VH&McCall. Even though the median age of the LSHP group was significantly lower than the median age of VH&McCall group (42 vs. 67 years; P<;0.001), recurrence and repeat surgery rates were found to be similar after both surgical approaches as well as the scores of PGI-I and PFDI-20. However, in women who were operated before their sixties, symptomatic recurrence was found to be significantly lower after LSHP than VH&McCall (16.2 % vs. 47.4 %, respectively; P = 0.024) as well as repeat prolapse surgery (2.7 % vs. 26.3 %, respectively; P = 0.014). PGI-I and PFDI-20 scores also suggested better pelvic floor function after LSHP significantly (p = 0.004 & p = 0.003 respectively). When adjusted for age, VH&McCall significantly increased the risk of symptomatic prolapse recurrence compared to LSHP (OR: 4.65; 95 % CI: 1.326-16.312; P = 0.016).Conclusion: LSHP and VH&McCall might seem to be surgical options for individualized management with similar pelvic floor function & recurrence in the medium/long-term follow-up, but the age adjusted risk analysis showed higher rates of symptomatic recurrence after VH&McCall. Moreover, the better outcomes after LSHP in the younger subset, revealed the need of further clarification with well-designed prospective studies. [ABSTRACT FROM AUTHOR]

Abstract: In this study, a mini pilot scale reverse osmosis (RO) system containing two spiral wound FilmTech BW30-2540 membranes was installed at a geothermal area in Izmir, Turkey. The desalination and boron removal performances of this system were investigated. The effect of such parameters as operating pressure and the number of membranes employed during the operation on desalination performance of the system was investigated. The system performance was evaluated at 12 and 15bar of operating pressures as a function of the number of membranes used. Desalination performance of brackish water reverse osmosis (BWRO) system was determined by the quality and quantity analyses of the product water. When the operating pressure was increased, a high permeate recovery, permeate flux and salt rejection were obtained with both single and double membrane configurations. The maximum boron rejection was 47% at 12bar of applied pressure while it increased to 49% at 15bar of applied pressure using a single membrane mode of operation. The lowest average boron concentration in the product water was 4.7mg/L at 15bar of applied pressure for a single membrane configuration. [Copyright &y& Elsevier]

The aim of this study was to assess the effect of laparoscopic removal of endometrioma on assisted reproductive technology (ART) outcome. A retrospective cohort study was conducted at a university hospital between January 2014 and December 2017. The ART group consisted of 26 women who underwent 44 ART cycles in the presence of ovarian endometrioma and the surgery group consisted of 53 women who underwent 58 ART cycles after laparoscopic removal of ovarian endometrioma/s. There were no statistically significant differences between the groups regarding demographic parameters and background features including cycle parameters. The live birth rates in the ART and Surgery groups per embryo transfer were 23.7 and 26.1%, respectively ( p   =  .800). The rate of cycle cancellation due to poor response and/or failed oocyte retrieval was significantly higher in the Surgery group than ART group (13.7 vs. 0%, respectively; p  = .018). In conclusion, cystectomy significantly increases the risk of cycle cancellation due to poor ovarian response, which might be catastrophic individually. However, it does not seem to affect the live birth rates.IMPACT STATEMENT What is already known on this subject? Both the presence of an endometrioma or surgical removal may have deleterious effects on fertility potential. What do the results of this study add? Our results confirm that although cystectomy has no benefit on the number of oocytes collected and live birth rate, it increases the risk of cycle cancellation significantly in assisted reproductive technology cycles following endometrioma surgery. What are the implications of these findings for clinical practice and/or further research? Postponing cystectomy until a freeze-all cycle may be the best option to maximise the number of oocytes retrieved and to maximise the ovarian response.

Objective: To identify patient and cycle parameters that relate to spontaneous reduction in multiple pregnancies following in vitro fertilization (IVF) and embryo transfer (ET)., Study Design: A retrospective cohort study was conducted in an academic infertility center. All IVF cycles between January 2007 and June 2008 were evaluated and 69 infertile women were diagnosed with multiple gestation following IVF. Multiple pregnancy was diagnosed by transvaginal sonography at 6-7 weeks gestation following embryo transfer (ET). Repeat ultrasonography undertaken in late first trimester assessed ongoing multiple pregnancy versus occurrence of spontaneous reduction. Patient and IVF cycle parameters were compared between patients experiencing spontaneous reduction (n=26, cases) compared to those where the multiple pregnancy proceeded uneventfully (n=43, controls)., Results: Spontaneous reduction (SR) was observed in almost 38% of the studied multiple gestations (n=69). Women experiencing SR were significantly older (p=.047), of a leaner body mass (p=.049), and exhibited significantly higher serum estradiol (E(2)) levels in the early follicular phase (p=.016) compared to the controls. Endometrial thickness (EMT) on the day of hCG administration related inversely (p=.017), whereas the number of embryos transferred (ET) related positively with the likelihood of SR (p=.027). On multivariate analyses, EMT and the number of ET were identified as independent predictors of SR following IVF-ET; EMT of less than 10mm was associated with a fourfold increased likelihood of SR (OR 4.18; 95% CI 1.02-17.01) whereas each additional embryo transferred doubled the risk of SR in multiple pregnancies resulting from IVF (OR 2.39; CI 1.02-5.58)., Conclusions: In multiple pregnancies conceived following IVF, occurrence of SR is relatively common. Increasing number of ET and EMT measuring <10mm are identified as independent predictors of likelihood of SR. While advancing age, body mass and baseline E(2) levels were associated with likelihood of SR, these associations disappeared on adjusted analyses. The observed relationship between EMT and SR is novel: the underlying mechanisms are unclear and merit further investigation., (Copyright © 2012. Published by Elsevier Ireland Ltd.)