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Postoperative adhesions can cause serious complications, including intestinal obstruction, chronic abdominopelvic pain, and infertility in women. Here we investigate the effects of disulfiram on the postoperative adhesion model. Female Wistar rats were used (n = 72). The animals were separated into six groups (12 rats per group): group 1 (control), group 2 (300 mg/kg disulfiram administered for 3 days preoperatively), group 3 (50 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 4 (300 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 5 (50 mg/kg disulfiram administered 14 days postoperatively only), and group 6 (300 mg/kg disulfiram administered 14 days postoperatively only). A histopathologic examination was performed. Immunohistochemical stainings for matrix metalloproteinase-2 and 9 (MMP-2, and MMP-9) and vascular endothelial growth factor (VEGF) were evaluated. The macroscopic adhesion scores were significantly lower in the disulfiram groups (groups 3, 4, and 6) compared to the control group (p < 0.05). Inflammation scores were lower in all groups receiving disulfiram, but only reached statistical significance in group 4 (p < 0.05). In the immunohistochemical evaluation of the groups, MMP-9 was significantly lower in group 5 than group 4 (p < 0.05). There was no significant difference between the groups for MMP-2 and VEGF. We found that disulfiram reduced postoperative adhesion formation. Disulfiram becomes more effective (by directly reducing inflammation) when initiated during the preoperative period at high doses.

Background/aim To evaluate the effects of hysterectomy on rat ovaries and the possible protective role of peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist-rosiglitazone against ovarian reserve decrement. Materials and methods Forty-five adult Wistar albino rats were randomly divided into three groups. Hysterectomy was performed (n = 15) in group 1 [H]; 1 mg/kg/day PPAR-γ agonist/rosiglitazone was used for 50 days after hysterectomy (n = 15) in group 2 [H + R]; a sham operation was performed (n = 15) in group 3 [control, C]. Blood samples were collected for anti-Müllerian hormone (AMH) evaluation in all groups and simultaneous ovarian Doppler examination was performed in [H] and [H + R] groups before and after (50 days) hysterectomy. All animals were sacrificed to obtain ovaries for histological examination. Results AMH levels were found to be significantly decreased at postoperative day 50 in all groups (P < 0.05). Histopathologic analysis showed that primary, preantral, and antral follicle counts were significantly higher in the [H] group as compared to the [C] and [H + R] groups (P < 0.05). There was no significant difference between the [C] and [H + R] groups in terms of follicle numbers (P > 0.05). In the ovarian Doppler blood flow analysis, all parameters were significantly decreased in group [H] (P < 0.05), but not in the [H + R] group (P > 0.05) on postoperative day 50. Conclusion Hysterectomy affects the histopathological structure of rat ovaries and PPAR-γ agonist-rosiglitazone improves the ovarian Doppler blood flow parameters.

Objective Endometriosis is a chronic inflammatory disease pathologically defined as the presence of endometrial-like tissue outside the uterine cavity. It is one of the most important diseases affecting women of reproductive age. The process of endometriotic implant growth is mediated by many complex interactions of immunologic, hormonal, genetic, and environmental mediators. Vitamin C (ascorbic acid), besides playing a role in preventing invasion and metastasis, is an antioxidant having anti-inflammatory and -angiogenic effects. In this study, we aimed to investigate the effect of vitamin C on the prevention and regression of endometriotic implants in a rat model of endometriosis. Materials and Methods This was a prospective, comparative, experimental animal study. After endometriotic implants were induced simultaneously, rats were divided into three groups. Group A was given 500 mg/kg of intravenous vitamin C every 2 days, starting immediately after implantation ( n = 11). All rats had a second operation 21 days after the initial one and had the lesion volumes measured. Group B was given 500 mg/kg of intravenous vitamin C every 2 days, starting 21 days after this operation ( n = 11). All rats were sacrificed 21 days after the third operation. Implant volume, weight measurements, and histopathological evaluation of the lesions were carried out. Group A received vitamin C throughout the study, while Group C ( n = 11) was not given any medication. The findings in the three groups were compared. Results At the second laparotomy after the induction, Group A had the smallest implant volume with a statistically significant difference compared to Group B ( p = 0.012). The end-of-study volumes of endometriotic implants of group B were significantly smaller than the first volumes ( p Conclusion Intravenous vitamin C treatment might have a suppressive effect on the prevention of endometriotic implant induction and regression of endometriotic implant volumes.

Objective: Assisted reproduction techniques have become widespread worldwide. Considering their costs, physicians endeavor to improve pregnancy rates. Infections are one of the disrupting problems in this arena. We aimed to investigate the effects of screening for vaginal infection on pregnancy rates in intracytoplasmic sperm injection cycles. Materials and Methods: One hundred twenty patients randomized into two groups for this study. Patients were screened for vaginal infections in group 1, and no screening was performed in group 2. The assisted reproduction outcomes were investigated and compared between the two groups. Results: There was no significant difference between ages, or durations and causes of infertility of patients who conceived and of those who did conceive. Forty-five patients in group 1, and 40 patients in group 2 reached the embryo transfer stage. The rates of conception were 23.5% (n=4) in culture-positive patients (n=17), and 42.9% (n=12) in culture-negative patients (n=28) in group 1. There was no significant difference among patients who were not screened, screen-positive, and screen-negative, in terms of pregnancy rates. None of the patients had Neisseria gonorrhoeae or Trichomonas vaginalis. Bacterial vaginosis was detected in 13 patients, and both bacterial vaginosis and Chlamydia trachomatis were detected in 4 patients. Three of 4 patients who conceived screen-positive and 8 of 12 patients who conceived screen-negative delivered healthily at term. Conclusion: No significant difference was found between patients who were sampled for culture and patients who were not sampled in terms of pregnancy rates. Also, no difference was found between the patients who were culture-negative and patients who were treated with antimicrobials after a culture positive result. Further larger studies are warranted to clarify this issue. PRECIS: No significant difference was found between patients who were sampled for culture and those who were not sampled in terms of pregnancy rates in intracytoplasmic sperm injection cycles.

Introduction Microdissection testicular sperm extraction (microTESE) is considered the gold standard method for surgical sperm retrieval among patients with non-obstructive azoospermia (NOA). Aim This study aimed to evaluate the correlation between histopathological findings after failed microTESE procedure and outcomes of the "second-look" procedure and to provide insight into the most common histopathological patterns after testicular biopsy within our population. Methods The retrospective study included 33 selected patients with NOA, who had undergone unsuccessful sperm retrieval. The diagnosis of NOA was made after the assessment of the patient's history data, a physical examination, semen analysis, the hormonal profile, and genetic studies. After negative sperm retrieval, histopathological report has been analyzed for "second-look" microTESE attempt. Results Five testicular histopathological patterns were found: hypospermatogenesis (9,1%), Sertoli cell-only syndrome (43%), germ cell maturation arrest (15%), seminiferous tubule hyalinization (15%), mixed pattern (21%). Y-microdeletions were detected in 5 patients, of which 3 patients showed AZFc region deletions. Only 3 patients (9,1%) underwent a "second-look" procedure after the evaluation of histopathological reports. After the stimulation therapy and "second-look" procedure, we had a positive outcome in a single patient (33,3%). Mean FSH value in patients with confirmed spermatogenesis was 17.26±3.11IU/l, while mean FSH value in patients without presence or germ cell statistically significantly exceeded and was 24.28±4.71IU/L (p=0.038). Conclusion Histopathological reports following the microTESE procedure are obligatory for the proper selection of patients who are candidates for the "second-look" microTESE attempt. Patients with Sertoli cell-only syndrome and hypospermatogenesis particularly can benefit from the "second-look" procedure.

Aim: Ovarian reserve is one of the most important prognostic factors to predict probability of pregnancy in in vitro fertilization (IVF) cycles. Poor ovarian response is associated with high cycle cancellation rate and diminished pregnancy rates. Therefore, the management of women who demonstrate an inadequate response to controlled ovarian hyperstimulation (COH) are a challenge to treat with IVF. Methods: A hundred consecutive infertile women, defined as poor responder, were recruited to this study. It was conducted at the assisted reproductive technology (ART) unit of the Ankara Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital during the period September 2009 to September 2011. All patients in Group 1(n=50) were treated by using flexible gonadotropin releasing hormone (GNRH) antagonist protocol and in Group 2 (n=50) were treated by using GnRH microdose flare-up protocol. Exogenous gonadotropin (Gonal F, Serono, Istanbul, Turkey) was initiated on the second day of menstruation in all patients in Group 1(n=50) and GnRH antagonist (0.25 mg, Cetrotide; Serono, Geneva, Switzerland) was started when the leading follicle reached 12 mm in mean diameter and were continued until the day of hCG administration. Results: Total dosage of gonadotropins was significantly higher in group 2 (2625 IU in group 1 vs 4050 IU in group 2; p

Dirican, Enver/0000-0001-6230-1229; Gode, Funda/0000-0002-9371-6942; Dirican, Enver/0000-0001-6230-1229 WOS: 000411999200002 PubMed: 29949336 Objectives: The aim of this study was to evaluate the relationship between in vitro fertilization (IVF) cycle outcomes, serum and follicular fluid (FF) levels of leptin and ghrelin. Material and methods: Forty-four women who underwent intracytoplasmic sperm injection cycles (ICSI) were enrolled in the study. On the third day (D3) of the menstrual cycle, venous blood samples were drawn for serum measurements of leptin and ghrelin. The follicular fluid (FF) and the corresponding oocyte were obtained from a single dominant preovulatory follicle at the time of oocyte pick-up. The FF and D3 serum leptin and ghrelin concentrations were measured by enzyme-linked immunosorbent assay. The relationship between pregnancy rate and serum, follicular fluid levels of leptin and ghrelin were analyzed. Results: Of the 44 cases included, nineteen achieved clinical pregnancy (43.18%). Follicular fluid ghrelin levels were significantly lower in the pregnant group than non-pregnant group (p < 0.05) With respect to FF leptin, there was no statistically significant differences between the pregnant and non-pregnant women (p > 0.05). There was no statistically significant difference in D3 serum ghrelin between pregnant and non-pregnant groups (p > 0.05). However, D3 serum leptin levels were significantly lower in pregnant women than non-pregnant women (p < 0.05). Conclusions: Lower ghrelin levels in the follicular fluid were associated with higher pregnancy rates. Also, D3 serum leptin levels were inversely correlated with clinical pregnancy rates. These findings support the potential role of these molecules on IVF outcomes.

Introduction: To present results of MicroTese procedure in treatment of male infertility in patients with azoospermia at Bahçeci BIH IVF Center during two-year period of 2013-2014. Methods: In the stated time-period, 55 MicroTese surgeries were performed. In 52.7% of the cases, sperm cells were isolated after MicroTese surgery, and in 47.3% of the cases, there was a negative outcome of the procedure. Obtained sperm cells were subjected to cryopreservation. Furthermore, ICSI procedure was performed by use of the obtained sperm cells. Results: Of 29 positive MicroTese surgeries, 21 (72.4%) resulted in clinical pregnancies. Biggest percentage of negative MicroTese procedures happened in patients with cryptorchidism and orchidopexy. Conclusion: MicroTese is the most precise and successful method of retrieving sperm cells surgically in men with azoospermia. Our results are within scope of results in referent world centers.

The aim of this study was to investigate the possible therapeutic effects of Doxycycline (Dox) on endometriotic lesions in an experimental rat model. Thirty-seven female Wistar albino rats with surgically induced endometriosis were randomized and divided into four groups. The rats were administered 5 mg/kg/day oral Dox in Group 1 (low-dose Dox group, n=9), 20 mg/kg/day oral Dox in Group 2 (high-dose Dox group, n=10) and 1 mg/kg single dose, subcutaneous leuprolide acetate in Group 3 (leuprolide acetate group, n=9). The rats in Group 4 (control group, n=9) were given no medication. The rats received medication for three weeks and were then sacrificed to evaluate the morphological and histological features of the implants. Matrix metalloproteinase (MMP)-9 immunoreactivity of the implants was also evaluated. The size of the endometriotic implants decreased in Groups 1-3 but statistically significant differences were not observed among the groups. The mean surface area of the endometriotic implants decreased from 69.3 +/- 30.8 to 52.1 +/- 27.0 mm(2) in Group 1 (P>0.05), from 60.2 +/- 18.9 to 38.6 +/- 28.7 mm(2) in Group 2 (P>0.05) and from 58.1 +/- 33.1 to 26 +/- 9.0 mm(2) in Group 3 (P=0.03). The epithelial MMP-9 immunohistochemical score was significantly higher in Group 1 and lower in Group 3 when compared with the control group (Group 4) (P=0.042 and P=0.014, respectively). When the stromal MMP-9 immunohistochemical and histopathological scores of the endometriotic implants were compared, no statistically significant differences were found among the groups. Although there was no statistically significant difference, Dox reduced the endometriotic implant area in the rat endometriosis model. Further studies are required to investigate the potential efficacy of Dox in endometriosis due to its widespread use and tolerability.

Tapisiz, Omer/0000-0002-7128-8086 WOS: 000348826200002 PubMed: 25462212 Objective: Montelukast, a selective antagonist of Type 1 cysteinyl leukotriene receptors (CysLT(1)Rs), antagonizes the proinflammatory and proasthmatic activities of CysLT(1)Rs. We investigated the effect of montelukast on a surgically induced endometriosis rat model. Study design: Thirty-two sexually mature, cycling, female Wistar-Albino rats, in which endometriotic implants were surgically induced, were randomly divided into three groups. Group I [Montelukast (M), 10 rats)] was given 1.6 mg/kg/day of oral montelukast sodium. Group II [Leuprolide acetate (L), 11 rats] was given 1 mg/kg single dose of s.c.leuprolide acetate. Group III [Control (C), 11 rats] received saline solution through an orogastric tube and served as controls. After a 3-weeks medication, the rats were sacrificed to investigate the endometriotic implants for size and morphological and histological characteristics, including immunoreactivity of MMP-2 and VEGF. Results: The mean area of implants decreased from 48.2 +/- 24.7 to 293 +/- 15.8 mm(2) in Group I (M) (P = 0.008) and from 62 +/- 32.1 to 39.9 +/- 18.1 mm(2) in Group II(L) (P = 0.003). In Group III (C), the mean area increased from 41.1 +/- 31.1 to 60.4 +/- 37.1 mm(2) (P = 0.025). Histopathological analysis showed statistically significant lower scores in rats treated with montelukast compared to leuprolide and controls. MMP H scores were not different between the groups in both epithelial and stromal MMP-2 immunostaining. VEGF H scores were statistically lower in Group I (M) in epithelial VEGF immunostaining when compared to Group II(L) and Group III (C) (P = 0.006). Conclusion(s): Montelukast may effectively cause a significant decrease in the area of endometriotic implants. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Introduction: Heterotropic pregnancy is a condition of the co-existence of different gestations. With the widespread use of assisted reproductive techniques its incidence is increasing. Case: A 30-year-old woman, gravida 2 para 1,with spontaneous pregnancy at 7 weeks and 6 days gestational age according to the last menstruation, applied to our emergency department with abdominal pain and vaginal bleeding.The medical history includes a caesarean surgery, intrauterin device (IUD) usage and a procedure of intrauterine insemination (IUI) following the ovulation induction by clomiphene citrate resulting with unsuccessful pregnancy. he patient who got pregnant spontaneously and had a single five-weeks intrauterine pregnancy at the application.The patient was diagnosed with ruptured heterotropic pregnancy and treated with laparoscopic salpingectomy.Upon the consent and request of the family, intrauterine pregnancy was evacuated.No complications occurred in the postoperative period. was reported consistent with heterotropic pregnancy. Conclusion: Regardless of the presence of any risk factors in pregnant women diagnosed with intrauterine pregnancy, adnexa and pelvic structures should be examined in detail.. The detection of intrauterine pregnancy in the ultrasonography does not eliminate heterotropic pregnancy. Early diagnosis before development of complications has a life saving importance.

To evaluate umbilical cord blood ischemia-modified albumin (IMA) levels in cases of fetal distress (FD) and to explore fetal blood IMA levels regarding the route of delivery.Umbilical cord and maternal serum IMA concentrations were assessed in term 40 cases with cesarean section (CS) due to FD, 76 cases with elective repeat CS and 85 cases with noncomplicated vaginal delivery.The maternal and umbilical cord IMA levels were significantly lower in vaginal deliveries when compared with CS cases either in FD or previous CS groups (p = 0.02). Although no statistically significant difference was found in IMA levels of CS groups (previous CS vs. FD), cord blood IMA levels tend to be higher in FD group. Neither demographic characteristics nor fetal outcome parameters were found to have any correlation with maternal IMA levels. However, umbilical cord IMA levels were found to be negatively correlated with 1th min Apgar scores (r = -0.143, p = 0.043).IMA seems to be responsive to hypoxic FD showing the highest levels in cases with severe fetal hypoxia. Higher levels of IMA in cases with elective repeat CS might indicate acute transient hypoxia and possible myocardial ischemia in these cases.

To evaluate the efficacy of estradiol supplementation starting on the day of human chorionic gonadotrophin (hCG) in patients with thin endometrium in intracytoplasmic sperm injection (ICSI) cycles.A total of 117 consecutive patients with the endometrial thickness on the hCG day ≤ 8 mm were reviewed. Estradiol supplementation was given in 57 patients and the remaining 60 patients were accepted as control group. Estradiol supplemented (ES) group received estradiol hemihydrate 4 mg/day started on the day of hCG. Luteal phase was supported using the vaginal progesterone gel in both groups. Clinical pregnancy rate, implantation rate, miscarriage rate, endometrial thickness on the day of oocyte pick-up and on the day of embryo transferred were accepted as main outcome measures.There were no statistical differences in terms of clinical pregnancy rate (28.1% vs. 23.3%), implantation rate (16% vs. 10.4%), miscarriage rate (21% vs. 31.6%), endometrial thickness on the oocyte pick-up day (8.5 ± 1.8 vs. 8.4 ± 1.4, mm) and embryo transferred day (9.6 ± 2.9 vs. 10.3 ± 2.4, mm) in the ES group vs. control group.Estradiol supplementation starting on the hCG day for the patients with thin endometrium does not provide any benefit on the pregnancy outcome in ICSI cycles.

The aim of this study was to evaluate the level of asymmetrical dimethylarginine (ADMA) levels before gonadotrophine treatment and on the day of oocytes retrieval in order to determine whether ADMA can be used as a predictive marker for implantation success in in vitro fertilization (IVF) cycles. Forty-four unexplained infertile patients were included in the study. Controlled ovarian hyperstimulation was performed using the recombinant follicle-stimulating hormone (FSH) with the standard long protocol for all patients. ADMA and E2 were measured at the beginning of the ovulation induction and on oocyte retrieval day. The primary outcome was the difference in ADMA levels in implantation positive and implantation negative women. At the beginning of the ovulation induction, the mean ADMA levels were 1553 μmol/L and 1.464 μmol/L in the implantation positive and negative groups, respectively. There was no statistically significant difference between groups (p: 0.90). On the day of oocyte retrieval, the mean ADMA levels were 1173 μmol/L and 1170 μmol/L in the implantation positive and negative groups, respectively. There was no statistically significant difference between groups (p: 0.97). In conclusion, ADMA levels before gonadotrophine treatment and the day of oocytes retrieval cannot be used as a predictive marker for implantation success in IVF cycles.

SUMMARY Infertility is defined as the time of one year of unprotected intercourse without conception and affects approximately 15% of the couples. Data available over the years reveal that pathology is found among 55% of cases in women, 35% of cases in men and the remaining 10% of cases are defined as unexplained infertility. Male infertility is commonly due to deficiencies in the semen and semen quality is used as a surrogate measure of male fecundity. A semen analysis evaluates certain characteristics of a male's semen and the sperm contained in the semen. It should be the first laboratory investigation for men while evaluating a couple's infertility. Here, we tried to review the semen analysis as a very important laboratory investigation in evaluating the infertile couples with all points in the light of last published World Health Organization (WHO) criteria.

The factors behind the empty zona pellucida (EZP) formation and its relationship with in vitro fertilization (IVF) outcomes were analyzed. A total of 104 patients who underwent IVF treatment and collected oocytes including EZP were enrolled in this study. EZP index (EZPI = the ratio of number of EZP to number of cumulus-oocyte complex (COC)) was used for the statistical analysis. Patients were grouped as Group 1 when EZPI ≤ 0.17 (n = 57) and Group 2 when EZPI0.17 (n = 47). Type-2 EZP, a variation or an advanced type of oocyte degeneration, is tested. Woman age, basal hormone levels, and total gonadotropin dose were significantly higher in Group 2 compared to Group 1. Total antral follicle count was significantly low in Group 2. Total number of mature oocytes, oocyte quality index, the number of fertilized oocytes, and the numbers of Grade 1 embryos were significantly low in Group 2. On the linear regression analysis, using gonadotropin releasing hormone antagonist protocol (B = 0.086, p = 0.030), the number of ≥17 mm follicle (B = 0.015, p = 0.047), peak serum level of estradiol (B = -3.625; p = 0.014), number of fertilized oocytes (B = -0.02, p = 0.0001) and the day-2 embryo score (B = -0,044, p = 0.001) significantly affected EZPI. An increment of the EZPI may be revealed decreased oocyte quality, and it is also related to the poor ovarian response.

Aim: To investigate the coexistence of endometriosis and uterine septum patients whose complaints are abortion and infertility. Methods: Ninety-two patients with a uterine septum and 191 patients who had undergone diagnostic laparoscopy for infertility were reviewed. The incidence of endometriosis in patients with a uterine septum was compared with patients with a normal uterine cavity; then the incidence of endometriosis was compared in association with having a preoperative diagnosis of presumed unexplained infertility in women with a partial or complete uterine septum. Results: There was no significant difference between the patients who had a uterine septum and those with a normal cavity in terms of the incidence of endometriosis (P = 0.39). Also, the incidence of endometriosis was not significantly different in patients who had a complete or partial uterine septum (P = 0.49). Endometriosis was observed in 8.7% of the patients who were presumed to have unexplained infertility in the complete uterine septum group and in 18.8% of the patients in the partial uterine septum group; but the difference was not statistically significant when complete and partial uterine septum groups were compared according to the type of infertility (partial uterine septum group, P = 0.13; complete uterine septum group, P = 0.28). Conclusion: An increased incidence of endometriosis was not observed in patients with a septate uterus. The reason for infertility in women with a partial uterine septum may be related to endometriosis.

SUMMARY Objective: The compliance rate between the hysterosalpingography (HSG) and laparoscopy (L/S) results in patients who diagnosed tubal occlusion on the HSG was investigated. Also, the incidence of endometriosis was evaluated in the study population. Material and methods: Medical records of 139 women who were underwent L/S for the investigation of the tubal occlusion were reviewed retrospectively. The concordance rate between the HSG and L/S was investigated. The incidence of endometriosis in patients with no tubal pathology was compared with patients with unilaterally and bilaterally tubal occlusion. Results: Mean age of the women was 31.8±5.7years, mean BMI was measured as 24.6±4.6 kg/m2, and gravida 0 (05), mean infertility period was 30.7±3.7 months. Tubal occlusion was confirmed after the L/S in 38.8% of the patients (n=38) who has unilaterally tubal occlusion on the HSG. However, 58.8% (n=20) of the patients who were diagnosed as bilaterally tubal occlusion on the HSG was confirmed with the L/S. The misdiagnosis rate of the HSG was significantly high in women with unilaterally tubal occlusions compared with bilaterally tubal occlusions [(respectively, 61.2%, 51.2%) (p:0.001)]. Endometriosis was observed in 28.4% of the patients who had patent tubes and in 13.9% of the patients in the unilaterally tubal occlusion group and and in 22.7% of the patients in the bilaterally tubal occlusion group. But the difference was not statistically significant when groups were compared according to the rate of endometriosis (p=0.24). Conclusion: HSG is the first step diagnostic test for the assessment of the fallopian tubes. Although L/S is more invasive technique than HSG, L/S with chromopertubation is the gold standard test for identifying periadnexal adhesive disease and endometriosis.

Simulation training constitutes the transition from the theoretical training to the practice on the process of medical education. Simulation training provides people an opportunity to learn their work, develop skills and repeat the application prior to the actual application. Until 2004, the process of obstetric simulation training has focused on acquisition of training procedural skills on obstetrics such as amniocentesis, conducting breech birth, managing shoulder dystocia, and managing obstetrics emergencies and trauma. Later on, obstetric simulation mainly focused on team work and team performance. Therefore, the identification of clinical errors, the reduction in clinical risks and the improvement of clinical outcomes were mainly investigated. Generaly used gynecologic simulators include gynecological examination, suture techniques, the implementation of intrauterine and subcutaneous contraceptives, laparoscopy and hysteroscopy, and placement of periurethral sling. The aim of this article is to provide an overview on simulators and simulation training within obstetrics and gyneacology.

Background/Aims. Since the assessments of the morphology of oocytes, zygotes and/or embryos are of crucial importance to select the best candidate for pregnancy, many morphological evaluation tools have been proposed. Although embryo scoring, particularly cleavage and blastocyst stages, is more convincing due to successful results, zygote scoring still have a bias as different outcomes. In the current study, we designed a prospective study to test the reliability of zygote scoring by focusing on zygote evaluation techniques and its relation with embryo development and embryo selection for transfer.Methods. A total of 1215 mature oocytes from 139 couples were evaluated for the study.Results. There is no correlation between published zygote scoring technique and embryo development.Conclusions. We conclude that the inconsistency of data obtained from zygote scoring might be caused by the static nature of pronuclear stage embryos and thus pronuclear scoring seems to be unreliable evaluation technique for embr...

Objectives The aim of this study was to assess the predictive value of serum progesterone levels in early pregnancy prognosis in spontaneous dichorionic-diamniotic twin gestations. Study design This study was carried out among 38 spontaneous dichorionic-diamniotic twin gestations between January 2003 and June 2005 in the Department of Obstetrics and Gynaecology at the Gulhane Military Medical Academy. Serum progesterone levels were measured at 7 and 10 weeks’ gestation and pregnancies were followed until 14 gestational weeks by ultrasound examination. Results We found that a progesterone level of 58 nmol/l in the 7th gestational week and of 51 ng/ml at 10 gestational weeks has a predictive value for viable intrauterine twin pregnancies with 83% sensitivity and 69% specificity and 83% sensitivity and 84% specificity, respectively. Conclusion Progesterone levels in the early gestational weeks may be a biochemical marker for the prediction of a twin pregnancy outcome and may reduce the number of ultrasound examinations.

Summary: Objective: The diagnosis and management of a fetal neck mass encountered during routine antenatal ultrasound screening, and later diagnosed definitely as a intrauterine fetal goiter, is discussed in this case report. Case Report: A 28-year-old primigravida at 36 weeks' gestation with normal vital findings, normal laboratory values, and no history of pathologic findings was examined in our outpatient Department for the first time. Her previous antenatal visits were done in secondary maternal care units. The ultrasound screening revealed polyhydramnios (amniotic fluid index, 21 cm), a homogeneous solid mass of 3.67 × 7.88 cm on the anterior of the fetal neck, and fetal abdominal ascites. Other fetal organs appeared normal. Maternal thyroid panel was in the normal range. The fetus was delivered abdominally at 38 weeks' gestation and diagnosed with defective thyroid hormone biosynthesis. With appropriate treatment, the size of the thyroid gland was observed to decrease. Conclusion: The early diagnosis and appropriate treatment of intrauterine fetal goiter is crucial, owing to the potential mental and motor outcomes of this disease. Key Words: diagnosis, intrauterine fetal goiter, treatment

To evaluate the anticipated and perceived pain and determine the factors contributing to pain perception in women undergoing midtrimester amniocentesis.A visual analog scale was used to quantify pain in this prospective study of 64 women undergoing amniocentesis in the same clinical setting. The analysis was done using the paired-samples t test, analysis of variance, the Kruskal-Wallis test, the Mann-Whitney U test, and Pearson correlation analysis.The postprocedural pain scores were significantly less than the preprocedural pain scores (P0.01). Parity, a previous amniocentesis, the indication for amniocentesis, and the previous loss of a child were factors contributing to pain scores. No correlations were found between pain score and maternal age, week of pregnancy at the time of the procedure, parity, or having lost a child.The perceived pain was less than the anticipated pain, and the factors contributing to pain should be kept in mind when counseling patients undergoing midtrimester amniocentesis.

OBJECTIVE: To find out the diagnostic accuracy of transvaginal sonography (TVS) and saline infusion sonography (SIS) by comparing the results with hysteroscopy (HSC) and hystological reports obtained by endometrial biopsies in pre and postmenopausal women with abnormal uterine bleeding (AUB). Design: Prospective study Setting: women presenting with abnormal uterine bleeeding as an outpatient procedure, in Gülhane Military Medical Faculty, between June 01, 2004 – August 01, 2005. Patients: 38 premenopausal and 6 postmenopausal patients Interventions: TVS and SIS was performed at the same seance and they underwent hysteroscopy and hysteroscopic biopsy one week later. Main outcome measures: The findings at TVS and SIS were compared with the hysteroscopic views and histologic findings. The sensitivity and spesifity ratios of all three methods were calculated in defining the endometrial and intracavitary pathologies. RESULTS: The sensitivity ratios of TVS and SIS in defining endometrial pathologies was 36.4% and 33.8% respectively and the sensitivity of hysteroscopy was lower. (%28.6, p=0.24) In the comparison of spesifity ratios sonohysterography had a higher ratio than others. (TVS vs SIS, p=0.08; HSC vs SIS, p=0.07) As a result; in outpatient group, hysteroscopy gives not much more information than SIS. The detection rate of focal intrauterine pathology (polyp/submucous myoma) using conventional TVS was significantly lower than sonohysterography. (sensitivity ratios; 46.5% and 97.1% respectively; p=0.0009) The sensitivity ratios of hysteroscopy (100%) and SIS (97.1) was similar. (p=0.98) CONCLUSIONS: Sonohysterography is a current, trustable method which can replace office hysteroscopy in the diagnosis and evaluation of cases presenting with AUB especially in outpatient group.

PURPOSE: To evaluate the effects of hormone replacement therapy (HRT) on refractive status, corneal topography, and aberrations of the eye in postmenopausal women. METHODS: Thirty-six healthy postmenopausal women (72 eyes) were included in the study. All patients received HRT that consisted of 0.625 mg/day conjugated estrogen and 5 mg/day medroxyprogesterone acetate in a continuous combined regimen. Schirmer Il test and tear film break-up time (BUT) were performed on all patients at the time of enrollment and 6 months after initiation of HRT. Refractive status, corneal topography, and wavefront aberrations were evaluated with the NIDEK Optical Path Difference-Scan before and 6 months after HRT was initiated. RESULTS: Mean patient age was 50.8+2.6 years (range: 47 to 57 years). The mean duration of menopause was 2.7+0.8 years (range: 1.4 to 3.5 years). The Schirmer Il test and tear film BUT measurements were significantly lower after HRT (P.05). CONCLUSIONS: Hormone replacement therapy in postmenopausal women does not significantly affect refractive status, corneal topography, and wavefront aberrations of the eye at 6-month follow-up. [J Refract Surg. 2007;23:567-572.]

The aim of this study was to investigate the effect of clarithromycin in rat endometriosis and its association with matrix metalloproteinase-9 (MMP-9) expression. After surgical induction of endometriosis, 27 rats were randomised into three groups. Size of endometriotic implants were evalutated and rats in group I (n = 9) were given 100 mg/kg/day of oral clarithromycin, rats in group II (n = 9) were given single 1 mg/kg s.c. injection of leuprolide acetate and rats in group III (n = 9) were not given any medication for 21 days. At the end of 21 days of medication, remaining 23 rats were sacrificed to evaluate morphological and histological features of implants. There was a significant difference between the groups in implant volumes (p = 0.004) before and after medication. Regression of implants were significantly higher in groups I and II than that in control group (p = 0.009 and p = 0.011, respectively). After medication, in group I the implant volume decreased from 62 (12-166) mm(3) to 26 (3-87) mm(3) (p = 0.012) and in group II the volume decreased from 224 (76-1135) mm(3) to 62 (26-101) mm(3) (p = 0.028). There was a significant difference between groups in histopathological score (p = 0.024). The epithelial immunohistochemical score of MMP-9 was significantly lower in group II than that in control group (p = 0.014). In conclusion, clarithromycin regresses endometriotic implants in rats, but not via MMP-9.

To investigate if there is any association between the serum folate and vitamin B12 status and the depressive symptoms in postmenopausal women. Materials and methods: The study included 95 postmenopausal women. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess their depressive symptoms. The investigated women were classified into 2 groups based on the existence of depressive symptoms. These 2 groups were compared in terms of folic acid and vitamin B12 levels. Results: Among 95 cases, 27 postmenopausal women scored 16 or more on the CES-D scale and were classified as the depressive group (Group 1), and 68 postmenopausal women scored 15 or less and were classified as the nondepressive group (Group 2). The serum levels of folate were 11.5 ± 5.4 ng/mL in group 1 and 12.3 ± 5.3 ng/mL in group 2. The concentrations of vitamin B12 were 456.2 ± 343.4 pg/mL in group 1 and 446.5 ± 165.1 pg/mL in group 2. The folate and vitamin B12 levels did not significantly correlate to the frequency of depressive symptoms (P = 0.52 and P = 0.24, respectively). Conclusion: In this study, no correlation was detected between serum folate and vitamin B12 levels and depressive symptoms in postmenopausal women. Supplementation of folic acid and vitamin B12 for postmenopausal women does not seem to be an effective intervention to reduce depressive symptoms.

Background/Aim: There are controversies about the routine use of oronasopharyngeal suction (ONPS) in healthy infants. This study aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term infants delivered by cesarean section. Methods: 140 term, healthy newborns of uncomplicated pregnancies were prospectively randomized to one of two groups according to the use of ONPS procedure. Differences in oxygen saturation levels, heart rates, and Apgar scores were determined. Results: The mean SaO2 values through the 2nd and 6th min of life were significantly higher in the no suction group (p < 0.001). The maximum time to reach SaO2 of ≧92% (6 vs. 11 min) and ≧86% (5 vs. 8 min) saturation were shorter in the no suction group than in the ONPS group. The mean heart rates were consistently and significantly lower in the no suction group during the first 6 min except the second one. All neonates without suction had an Apgar score of 10 at the 5th min, while the mean ± SD for ONPS group was 9.34 ± 0.48 (p < 0.001). Conclusion: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section.

This prospective randomised controlled trial aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal term and vaginally born infants and was performed at a Turkish tertiary hospital from June 2003 to January 2004. A total of 140 newborns were enrolled in the trial (n = 70 per group). The no suction group showed lower mean heart rates through the 3rd and 6th minutes and higher SaO/2 values through the first 6 mins of life (P < 0.001). The maximum time to reach SaO/2 of = 92% (6 vs. 11 min) and = 86% (5 vs. 8 min) were shorter in the no suction group (P < 0.001). (authors)

In the present study, we investigated the impact of metformin therapy on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in patients with polycystic ovary syndrome (PCOS). Metformin does not lead to any improvement in IVF/ICSI outcomes among patients with PCOS.

Objective To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation (COH) improves intracytoplasmic sperm injection (ICSI) outcomes. Design Prospective study. Setting University hospital. Patient(s) A prospective analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups: aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery (n = 41) (group 1); nonaspirated endometriomas (n = 40) (group 2); history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH (n = 44) (group 3); and tubal factor infertility (n = 46) (control group 4). Intervention(s) Aspiration of endometriomas. Main outcome measure(s) Clinical parameters, characteristics of COH, and ICSI results were analyzed. Result(s) We observed higher levels of E 2 on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas. When we compared all endometriomas and tubal factor (control) groups, we observed a lower number of total follicles (>17 mm) and metaphase II (MII) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group. Implantation and clinical pregnancy rates were similar among all groups. Conclusion(s) In the current study, all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility. We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles >17 mm, the number of MII oocytes retrieved, the implantation rates, or the clinical pregnancy rates. Resection of small endometriomas (1–6 cm) may not present any additional benefits to the IVF-ICSI cycle outcomes.

Objective: To present spontaneous resolution of isolated fetal ascites diagnosed at antenatal period. Case: A 30-year-old, G3, P2 patient admitted to our perinatology clinic in 26th week of pregnancy with a diagnosis of severe, isolated fetal ascites without any other anomalies revealed by ultrasound examination. The workup for Parvovirus B19, cytomegalovirus, toxoplasmosis, herpes simplex, rubella, hepatitis A, B, C and infectious markers were negative. Fetal karyotyping was reported as normal. As the persistence of fetal ascites was seen at 32 and 34 weeks gestation, a complete resolution of the ascites was detected at 36 weeks’ gestation. A normal 4,200 grams male infant was vaginally delivered at 39 weeks gestation. Conclusion: Isolated fetal ascites is a rare ultrasound finding and diagnosis is to be confirmed with exclusion of related fetal anomalies, immunologic and nonimmunologic causes. Parents should be counseled about other rare concomitant and undetectable anomalies despite detailed evaluation. Ultrasonografik izlemde spontan remisyona

Dichorionic twin pregnancy discordant for fetal anencephaly is a serious condition that threatens the normal co-twin's life by causing polyhydramniosis, preterm labor and sudden death of one or both of the fetuses. We report a case of dichorionic twin pregnancy discordant for fetal anencephaly delivered at the 32(nd) week of gestation because of preterm labor and nonreassuring fetal monitoring. The aim of this case report is to summarize management options in this situation.Fetal anensefali ile komplike dikoryonik ikiz gebelik polihidramnioz, preterm eylem ve bir ya da iki fetusun birden ani ölümü şeklinde sonuçlara yol açabilen potansiyel tehlikeli bir durumdur. Bu çalışmada 32. gebelik haftasında preterm eylem ve güven vermeyen fetal kalp hızı patterni nedeni ile doğum yapan fetuslardan birinin anensefal olduğu dikoryonik ikiz gebelik olgusu sunulmuş ve tedavi seçenekleri tartışılmıştır.

Introduction Main categorisation of azospermic is in two grups: nonobstructive azoospermia (NOA) and obstructive azoospermia (OA). We had evaluation of prognostic factors and determinants in sperm retrieval procedures in azoospermic patients. Methods Retrospective evaluation observed 21 selected patients with NOA and OA azoospermia, after that complete history, physical examination with ultarsound volume of testis and hormonal profile. Hormonal profile included: follicle stimulating hormone (FSH), luteinizing hormone (LH), testosteron (T) and prolactin (P) serum levels. Also karyotype and Y-deletion analysis were done and analyzed. Results 9 OA patients (42,9%) were undergone for TESE operation and 12 NOA patients (57,1%) for Micro-TESE operation. All TESE procedures were positive (100%). Micro-TESE in 12 selected NOA patients, 5 patients (41,6%) were positive and 7 patients (58,4%) negative. Patients testicular size, serum FSH and testosterone level showed correlation in success of sperm retrieval procedures. Conclusion TESE is elected procedure for obstructive azospermia (OA). Micro-TESE is appropriate sperm retrieval procedurec for patients with non-obstructive azoospermia (NOA) and correlate with high FSH and small volume of testis.

Objective To assess the rate of insulin resistance (IR) and the relationship between IR and high molecular weight (HMW) adiponectin in normal weight adolescents with polycystic ovary syndrome (PCOS) and a maternal history of PCOS. Design Case-controlled study. Setting Adolescent clinic of a teaching and research hospital. Patient(s) Forty normal weight adolescents with PCOS and a maternal history of PCOS and 40 normo-ovulatory age- and body mass index (BMI)-matched controls. Intervention(s) A 75-g oral glucose tolerance test (OGTT) was performed for each participant. Main Outcome Measure(s) Homeostasis model assessment of IR and HMW adiponectin. Result(s) There were no statistically significant differences between the PCOS and control groups in terms of fasting glucose, fasting insulin, and lipid parameters. Although total and free T were significantly higher, HMW adiponectin levels were significantly lower in the PCOS group compared with the control group. When the PCOS group was compared according to the IR, the HMW adiponectin level was significantly lower in the adolescents with PCOS and IR. The adolescents with PCOS and biochemical hyperandrogenemia had significantly lower HMW adiponectin levels and significantly higher homeostasis model assessment of IR score compared with the adolescents with PCOS and normoandrogenemia. Conclusion(s) The adolescents with PCOS had a significantly increased rate of IR without clinical findings of metabolic disorders or obesity. The HMW adiponectin levels were negatively correlated with IR.

OBJECTIVE: To evaluate whether endometrial pathologies could be occur due to hormonal theraphy in patients with recurrent Invitrofertilization (IVF) failure and to report our hysteroscopy findings. Design: Retrospective Setting: All of the patients were primary infertile. Hysterosalpingraphy was normal, intracavitary pathology was not seen before IVF cycles. All of the data were obtained from patient’s chart. Patients: One hundred and fourty five patients who have two IVF failure Interventions: Office hysteroscopy was performed before third cycle. Main Outcome Measures: Hysteroscopic findings and endometrial biopsy results RESULTS: Of the 145 patients, 37 ( 25,5 %) have intrauterin pathologies, 23 were endometrial polip (15.8 %), 14 were intrauterine adhesion ( 9.7 %). 108 were normal ( 74,5 %) CONCLUSIONS: in patients with recurrent IVF-ET failures. Hormonal theraphies and embryo transfer procedure could be induce endometrial pathologies. In patients who wasn’t seen intrauterine pathology before IVF-ET cycles, Office hysteroscopy could identify new developing intrauterine pathologies.

Isolated torsion of fallopian tubes should be considered even at premenarcheal ages in cases of acute pelvic pain and prompt surgery can preserve the tube and thus fertility. It is an uncommon emergency event and a difficult condition to evaluate clinically. This report focuses on a 12-year-old premenarcheal girl who presented with acute pelvic pain of 2 days. Pelvic ultrasound showed an adnexal mass on the left side. Laparoscopy was performed and an isolated tubal torsion was discovered. The tube was necrotic and salpingectomy was performed. The appendix appeared to be hyperemic and erectile. Appendectomy was also performed to rule out appendicitis. Its our recommendation that in the differential diagnosis of acute lower abdominal pain of girls isolated torsion of the fallopian tubes should be considered. Also preservation of the tube and fertility should be possible with prompt surgical intervention. (authors)

The course of the transfer catheter through the cervical canal is one of the most important issues for a successful embryo transfer (ET) during in vitro fertilization (IVF) cycles. Technically difficult ETs due to cervical stenosis are associated with reduced chance of pregnancy after assisted reproductive procedures. In the current case series, we report on three patients with cervical stenosis who underwent IVF-ET cycles. These three patients, in whom ET was classified as "difficult," failed to conceive with previous ET attempts. An intervention to create a cervical tract was performed with operative hysteroscopy under general anesthesia before transcervical ET. After the hysteroscopic shaving procedure, we observed quite an improvement in access to the endometrial cavity during ET procedure. These patients had significantly easier ET procedures compared with previous attempts and achieved clinical pregnancies. Hysteroscopic revision of the cervical canal results in easier ET and improves pregnancy rates in patients with cervical stenosis and histories of difficult ET.

International-Federation-of-Fertility-Societies 21st World Congress on Fertility and Sterility / 69th Annual Meeting of the American-Society-for-Reproductive-Medicine -- OCT 12-17, 2013 -- Boston, MA WOS: 000342554501238 … Int Federat Fertil Soc, Amer Soc Reprod Med

Background: The aim of this study was to evaluate the link between romantic relationship and/or sexual activity of adolescents, and family structure. Methods: Medical records of 1087 adolescent girls were evaluated for age, statute (student, working, out-of-school), incidence of romantic relationship and sexual activity, and family structures. Results: Teenager students had significantly less romantic relationships and experience of sexual intercourse than other groups. Parent-adolescent communication was negatively correlated with absence of romantic relationship and sexual intercourse. Conclusion: Adolescents who have left school and are working constitute a population having higher romantic relationships and sexual intercourse experiences compared with the student adolescents. Good relationships with parents were associated with less risky sexual behavior. Close relationships with school delay the onset of sexual activity.

The aim of the presented study is to determine the effect of different sperm parameters on the pregnancy rate of intrauterine insemination (IUI) cycles in women with favourable fertility characteristics treated for infertility. Medical records of 212 infertile couples who had undergone a total of 253 cycles were reviewed retrospectively. Inclusion criteria for women were age35 years, antral follicle count5, FSH15 IU/ml, and at least one patent tube documented by HSG or laparoscopy. Clinical pregnancy rates were achieved as 15.8% per cycle, and 18.8% per couple. Woman's age, partner's age, total number of motile sperm (TMS) and motility, significantly influenced pregnancy rate. Pregnancy rate was the highest when women were aged25 and TMS10 × 10(6). Partner's age significantly affected the pregnancy rate per cycle in women aged30 years and TMS10 × 10(6). Woman's age (OR: 5.4 95% CI: 1.2-24.3) and TMS (OR: 0.06 95% CI: 0.003-0.89) were predictor variables as regards to pregnancy. Pregnancy rate was the highest in IUI cycles when woman was25 years old, TMS was10 × 10(6), and morphology was4%. Male age was found to be another determining factor for IUI success, even if they had a normal spermiogram.

To compare the efficacy on the cycle performance of 375 versus 450 IU/day gonadotrophin on the microdose flare-up protocol in poor responders.A total of 91 poor responder patients who were treated with the microdose flare-up protocol were enrolled in this study. Group 1 (n = 40) was stimulated with 375 IU/day gonadotrophin. Group 2 (n = 51) was stimulated with 450 IU/day gonadotrophin. Main outcome measurements were accepted as the results of controlled ovarian hyperstimulation, implantation, clinical pregnancy, and live birth rates.Baseline characteristics are similar between the two groups. Higher number of oocyte cumulus complexes and lower total gonadotrophin requirement were noted in Group 1 compared with Group 2. Number of metaphase II oocytes and implantation rates were similar between the groups. A trend toward higher clinical pregnancy and live birth rate was observed in Group 1 but these results did not reach statistical significance.Total gonadotrophin costs are lower using the 375 IU/day gonadotrophin compared to the 450 IU/day in poor responders. Additional 75 IU/day does not give any improvement neither embryology nor pregnancy outcomes.

The aim of this study was to assess whether the desire to escape the psychological condition created by infertility (to have a baby) affected risk-taking behavior, with the possible relationship between ovarian cancer and infertility as the “accepted risk” to overcome infertility. 229 infertile and 204 fertile women who were patients at the Gulhane Military Medical Academy were administered a semistructured questionnaire. Increased ovarian cancer risk was accepted by 67.2% of the infertile women in order to have baby. There was no significant relation between the woman's age, duration of infertility, knowledge of the preventability and curability of ovarian cancer, or acceptable risk. These results indicate the importance to Turkish women of overcoming infertility.

Severe ovarian hyperstimulation syndrome (OHSS) is a serious and potentially fatal complication of ovarian stimulation. A 29-year-old nulligravid patient with anovulatory infertility was treated with in vitro fertilization. Six days after embryo transfer, the patient presented with complaint of abdominal bloating, nausea, vomiting and shortness of breath. Severe late-onset OHSS, with massive ascites and pleural effusion, was diagnosed. Posterior colpotomy was performed under general anesthesia, a Foley catheter was inserted into the posterior cul-de-sac, and bilateral chest drainage tubes were left for continuous drainage. In total, 13.2 liters of ascites and 6.1 liters of pleural fluid were drained in 8 days. Continuous drainage of ascites and pleural effusion improved the patient's comfort without need for repeated transvaginal and thoracic aspirations.

Aim: The efficacy of commencement of recombinant follicle-stimulating hormone (recFSH) during the luteal phase in the long-protocol gonadotropin-releasing hormone (GnRH) agonist regimen in poor responders was compared with the conventional protocol in a prospective, randomized, controlled study. Methods: Forty-two women who responded poorly to previous conventional controlled ovarian hyperstimulation were included in the study. Recombinant FSH (150 IU) was started simultaneously with the GnRH agonist long protocol in the study group. The control group was started recFSH on Day 2 of menstruation in the long-protocol GnRH agonist regimen. The number of metaphase (M) II oocytes, the number of embryos transferred, and the pregnancy rate were analyzed as main outcome measures. Results: Patients in the study group had a higher number of MII oocytes compared with the control group (6.8 vs 3.2, respectively; P