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This study aims to assess the impact of endometrioma on embryo quality and cycle outcome in patients who undergo assisted reproductive technology (ART) treatment due to diminished ovarian reserve (DOR). Retrospective case-control study was conducted in women ≤ 40 years of age who underwent ART treatment caused by DOR, defined according to POSEIDON criteria, at a university-based infertility clinic between January 2015 and December 2020. Three groups of patients were selected: group A included patients with an idiopathic DOR, group B included patients with endometrioma(s) who underwent ovarian cystectomy, and group C included patients with endometrioma(s) without surgical treatment. A total of 351 women with DOR were included in the final analysis. Demographic characteristics, including age and AMH, were similar between the groups. Significant differences were observed among groups on mean number of MII oocytes retrieved (1.88 ± 1.59 vs. 2.84 ± 2.89 vs. 2.78 ± 2.41, respectively; p 0.001) and mean number of embryos (1.04 ± 1.18 vs. 1.87 ± 2.01 vs. 1.66 ± 1.81, respectively; p 0.001). However, the mean number of top-quality embryos, cycle cancellation, and live birth rates were similar between the groups. Clinical pregnancy (35 (26.5%) vs. 8 (18.2%) vs. 18 (42.9%), respectively; p = 0.038) and miscarriage rates (12 (9.1%) vs. 0 vs. 8 (19.0%), respectively; p = 0.009) were higher in endometrioma group without surgery. Women with DOR appear to have similar ART cycle outcomes regardless of the etiology, in terms of live birth rates. Infertility of endometrioma patients might be related to altered endometrium rather than to decreased oocyte quality. Cystectomy for endometrioma before IVF did not seem to affect the LBR.

High levels of serum inflammatory markers are related to extended hospitalisation and more severe disease in the case of tubo-ovarian abscess (TOA). There is scarce information on the serial measurement of inflammatory markers during the postoperative follow-up period of surgically treated TOA. The present study aimed to assess the postoperative longitudinal changes in serum inflammatory markers following surgery for TOA. In this retrospective cohort study, patients who underwent surgery for TOA between January 2010 and March 2020 were reviewed. All inflammatory markers peaked within 48 hours after surgical intervention and then declined with time. The predicted mean of white blood cell count (WBC) to return to normal was 2.5 days (95% CI: 1.0-4.3), which was followed by neutrophil to lymphocyte ratio (NLR) (7.1 days, 95% CI: 4.7-10.8) and C-reactive protein (CRP) (+14 days). In conclusion, serum inflammatory markers increase in the very early post-operative period. While the normalisation period is very slow, it may not be appropriate to use CRP for evaluating the treatment success of TOA surgery. However, WBC and NLR measurements might be useful for follow-up and predicting the need for medical or surgical intervention.Impact statement

Objective: In this study we aimed to assess anorexigenic peptide levels in patients with or without polycystic ovary syndrome (PCOS) and their effects on assisted reproductive treatment (ART) outcomes. Methods: A prospective case-control study was conducted in a tertiary care university-based ART clinic. Eighty-three patients were included in the study. The PCOS group included 41 patients, and the non-PCOS group included 42 controls. The 2003 Rotterdam criteria were used for PCOS patient selection. The ART indications in the non-PCOS group were tubal factor or unexplained infertility. Venous blood samples were taken on the third day of the menstrual cycle to determine the serum anorexigenic peptide levels. The enzyme-linked immunosorbent assay method was used for laboratory analyses. Results: In the PCOS group, serum obestatin levels were significantly lower than in the control group, but serum anorexigenic peptide levels were similar in PCOS patients with or without clinical pregnancy. Ovarian hyperstimulation syndrome (OHSS) was diagnosed only in PCOS patients, and the obestatin levels of OHSS patients were significantly lower than those of other PCOS patients. Conclusions: Baseline anorexigenic peptide levels did not affect the clinical pregnancy rate in ART cycles. Obestatin may play a role in the pathophysiology of OHSS; this possibility should be confirmed in further research.

Objective: The aim of the study is to create a new model to predict successful outcome in assisted reproductive techniques. Materials and Methods: A retrospective cohort study was conducted in tertiary fertility center between 2010 and 2017. Nulliparous women younger than 45 years-old undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for the first time were included; frozen embryo transfers, canceled induction cycles, freeze-all cycles were excluded. Two prediction models were built using multivariate logistic regression with a subset of the dataset and then were internally validated using bootstrapping methods. Results: Four hundred eighty eight women were included with 136 (27.9%) live births. The basal model was built using variable age, antral follicle count (AFC), and basal luteinizing hormone (LH) levels. Age over 37 years [odds ratio (OR): 0.07, 95% confidence interval (CI): 0.00-0.36] and AFC below 5 (OR: 0.15, 95% CI: 0.02-0.53) was associated with poorer outcomes whereas an LH level above 6 mIU/mL (OR: 2.24, 95% CI: 1.27-3.94) was associated with better outcomes. Optimism adjusted area under the curve (AUC) of this model was 0.68 (95% CI: 0.62-0.74). Combined model in addition to basal model variables included the length of induction cycle, the endometrial thickness at the day of transfer, grade and count of the transferred embryo. Cycles lasting more than ten days (OR: 2.23, 95% CI: 1.17-4.42), an endometrial thickness greater than 9 mm (OR: 2.07, 95% CI: 1.00-4.53) were associated with better outcomes. Optimism adjusted AUC of this model was 0.76 (95% CI: 0.70-0.81). Calibration of both models was good according to Hosmer Lemeshow test (p=0.979 and p=0.848, respectively). Conclusion: This internally validated prediction model has good calibration and can be used predicting outcomes in first time IVF/ICSI cycles with modest sensitivity.

To assess the impact of an estrogen replacement regimen on frozen embryo transfer (FET) cycle outcome.In the present retrospective cohort study, data of infertile women undergoing FET with good-quality embryos were reviewed. The first group received 2 mg of estradiol hemihydrate (EH) once daily for 6 to 7 days, then twice daily for 4 to 5 days, and then three times a day until embryo transfer. The second group received EH twice daily for 7 to 8 days, then three times a day. The third group received EH three times a day constantly. The main outcome measure was live birth rate.In total, 394 FET cycles were included. The fixed 6-mg group required the highest estradiol hemihydrate dose. The duration of estrogen treatment was significantly longer in the first group. Maximal endometrial thickness was highest in the second group (10.2 ± 1.3 mm vs. 9.6 ± 1.4 mm vs. 8.6 ± 0.9 mm, respectively; P 0.001). The clinical pregnancy rates in the groups were 41.1%, 55.2%, and 42.2%, respectively (P = 0.035). Live birth rates were 40.8%, 50.9%, and 48.1%, respectively (P = 0.320).In FET cycles with hormone replacement therapy, a step-up 4-mg regimen provides thicker endometrium with optimal-dose estrogen in an adequate time frame. The tendency for increased clinical pregnancy and live birth rates is remarkable.

The present retrospective cohort study analysed data of couples with unexplained infertility who underwent two to three intrauterine insemination (IUI) cycles. The inclusion criteria were age 20-40 years, failure to conceive for at least two years of unprotected intercourse, ovulation, normal semen analysis, and tubal patency. Total of 578 IUI cycles of 286 couples with unexplained infertility were included in the final analyses. The mean age and duration of infertility of the study population were 28.8 ± 5.1 and 5.2 ± 3.4 years, respectively. The clinical pregnancy rate (CPR) and live birth rate (LBR) per cycle were 16.6 and 13.1%, respectively. The cumulative CPR following two to three IUI cycles was 33.5% and the cumulative LBR was 26.5% for the entire cohort. The duration of infertility was significantly shorter in women whose IUI attempt were successful (p = .036). Up to three cycles of IUI with ovarian stimulation seems as an effective first-line treatment modality in unexplained infertility.IMPACT STATEMENTWhat is already known on this subject? Cont rolled ovarian stimulation combined with intrauterine insemination (IUI) is a common infertility treatment as a low-cost, less-invasive alternative to in vitro fertilisation (IVF) and was approved as a first line treatment option for unexplained infertility However, the UK National Institute for Health and Care Excellence (NICE) guideline states that IUI is not recommended to couples with unexplained infertility, male factor and mild endometriosis, unless the couples have religious, cultural or social objections to proceed with IVF.What do the results of this study add? Up to three IUI cycles with ovarian stimulation can be considered as an effective treatment modality in unexplained infertility even in couples who could not achieve pregnancy by expectant management for two years.What are the implications of these findings for clinical practice and/or further research? The clinicians should reconsider the NICE recommendation of IVF in the light of recent studies including ours which recommend IUI together when dealing couples with unexplained infertility.

ÖzAmaç: Üremeye Yardımcı Tekniklerin uygulamalarında oosit outputunu öngörerek, daha çok oosit toplamak ve IVF başarısını arttırmak için hangi değişkenleri kullanmamız gerektiğini incelemek amacıyla çalışmamızı design ettik.Gereç ve Yöntemler: 2016-2018arasında tersiyer bir üniversitenin IVF merkezine başvuran 412 infertil hasta retrospektif olarak değerlendirildi. KOH sonucu elde edilen foliküllerden OPU ile çıkan oosit sayıları yüzdelik dilimlere ayrılarak gruplandırıldı. Gruplarda oosit outputuna etkili değişkenler analiz edilerek, maximum sayıda oosit eldesini predikte edecek testleri tespit etmeye çalıştık. Bulgular: Hastaları oosit/≥14mm folikül oranlarına göre incelediğimizde, %10,2’sinin ≤%30, %4,1’inin %31-40, %6,6’sının %41-50, %2,9’unun %51-60, %5,6’sının %61-70, %8’inin %71-80, %4,9’unun %81-90 ve %57,8’inin %91-100 grubunda olduğu tespit edilmiştir. Çalışmamıza göre, oosit/≥14mm folikül oranına etkili değişkenler kadının yaşı, basal FSH (cut off 9,5mIU/mL, sensitivite 0,706 spesifite 0,621, p=0,001) ,basal LH (cutoff5,5mIU/mL, sensitivite0,640 spesifite0,690, p, PREDICTION OF OOCYTE OUTPUT: How can we maximize the oocyte retrieving from follicles in Controlled Ovarian Hyperstimulation cycles?AbstractAim: We designed our study with the purpose of determining which variables should be used to predict oocyte output, to increase the number of collected oocytes and the success rate of IVF.Materials and Method: A total of 412 infertile patients admitted to the IVF center of a tertiary university hospital between the years 2016 and 2018 were evaluated retrospectively. The number of oocytes obtained by OPU from the follicles as the result of COH was grouped in percentiles. The variables effective on oocyte output were analyzed in the groups, and tests to predict acquisition of the maximal number of oocytes were tried to be determined. Results: When we investigated according to the oocyte/≥ 14 mm follicle ratios, we determined that 10.2% of the patients were in the ≤ 30% group, whereas 4.1% of them were in the group of 31-40 %. 6.6% of the patients were in the group of 41-50 %, 2.9% in the group of 51-60%, 5.6% in the group of 61-70 %, 8% in the group of 71-80%, 4.9% in the group of 81-90 %, and 57.8% in the group of 91-100 %. According to the results of our study, the variables effective on the oocyte/≥14 mm follicle ratio were the patient’s age, basal FSH value (cutoff 9.5mIU/mL, sensitivity 0.706, specificity 0.621, p=0.001), basal LH (cutoff 5.5mIU/mL, sensitivity 0.640 specificity 0.690, p

Objective: In frozen-thawed embryo transfer (FET) cycles, preparing a synchronous endometrium for the embryo is essential. Aim of this study is to provide individualized luteal support in hormonally replaced FET cycles, and to evaluate mid-luteal serum progesterone levels and pregnancy outcomes.Study Design: In this prospective cohort study, 30 patients were included in a university hospital in six month-period. Serum progesterone level on embryo transfer day was monitored, and if it was found to be below the lower limits defined by previous studies (10 ng/mL), additional 100 mg intramuscular micronized progesterone was administered once.Mid-luteal progesterone levels and pregnancy outcomes were recorded.Results: There was no significant difference between mid-luteal progesterone levels of the patients whose transfer day progesterone was above and below 10 ng/mL (p=0.481). Although clinical pregnancy rate tended to be higher in patients whose mid-luteal progesterone was above 10 ng/mL, it was also not statistically significant.Conclusion: This is the first study in which vaginal progesterone treatment was supported by intramuscular progesterone according to serum progesterone values for the purpose of individualized progesterone support. Significant difference was not found in pregnancy outcomes. However, further studies are required to optimize management and improve pregnancy rates in hormonally treated FET cycles.

Objective The present study aims to assess the success of controlled ovarian stimulation in intrauterine insemination cycles stimulated by recombinant-FSH and Clomiphene citrate for either mono- or bi-follicular development. Methods We assessed 870 infertile patients treated with controlled ovarian stimulation in intrauterine insemination cycles at a university-based infertility clinic between January 2012 and December 2017. We compared the cycles stimulated by clomiphene citrate and recombinant-FSH in two set-ups; mono- and bi-follicular development. The main outcome measure was the clinical pregnancy rate per cycle. Results The demographic and cycle parameters were similar between the groups, except for endometrial thickness on the day of hCG administration, which was higher in the recombinant-FSH group than the clomiphene citrate group. The overall clinical pregnancy rates in clomiphene citrate and recombinant-FSH groups were 9.8% and 10.3%, respectively (p=0.940). Regarding the entire cohort, clinical pregnancy was significantly higher in cases of bi-follicular development when compared to mono-follicular development (16.8% vs. 10.2%, respectively; p=0.009). Conclusions Clomiphene citrate and recombinant-FSH have similar success rates in terms of clinical pregnancy, in either mono-follicular development or bi-follicular development. Clomiphene citrate and recombinant-FSH cycles resulted in comparable rates of bi-follicular development, which significantly increases clinical pregnancy rate. Clomiphene citrate and recombinant-FSH have similar success rates in terms of clinical pregnancy, in either mono-follicular development or bi-follicular development.

To compare success rates and complications in women undergoing laparoscopic versus open surgical management of tubo-ovarian abscess. We further examined whether early laparoscopic intervention has any impact on pregnancy rates in a subgroup of infertile patients following frozen-thawed embryo transfer.Hospital records of 48 patients diagnosed with TOA between January 2015 and December 2020, who underwent surgical intervention or received only medical treatment were analyzed. All patients were hospitalized, and parenteral antibiotics were commenced on admission initially. Laparoscopic or open surgery was performed within 48 hours course of intravenous antibiotherapy (early intervention) or later according to the clinical findings and antibiotherapy response.Of 48 patients with TOA, 18 (37.5%) underwent laparoscopic and 30 (62.5%) underwent open surgical intervention. The median postoperative hospital stay was shorter (4.5 days vs 7.5 days, respectively; p = 0.035), and postoperative opioid analgesic requirement was lesser in the laparoscopy group compared to open surgery group (22% vs 53%, respectively; p = 0.034). Intra- and post-operative complication rates were similar between the groups. Of these 48 patients, seven were diagnosed to have TOA following oocyte retrieval, and four of these conceived with frozen thawed embryo transfer all of whom underwent laparoscopic surgery within 48 hours of diagnosis.Minimal invasive surgery should be preferred even in the presence of severely adhesive and inflammatory TOA in order to improve postoperative outcomes. Moreover, early laparoscopic intervention may be considered in infertile patients with an aim to optimize pregnancy rates in a subsequent frozen-thawed embryo transfer.

OBJECTIVE: To analyze demographic and clinical data of patients who resorted to oocyte freezing between January 2014 and December 2018. STUDY DESIGN: Patients who applied to the Reproductive Endocrinology and Infertility Unit of Ankara University School of Medicine between January 2014 and December 2018 with the request of oocyte freezing were included in this study. The files and computer records of the patients were analyzed retrospectively and sociodemographic, clinical and laboratory data were evaluated. RESULTS: A total of 46 cycles were recorded in 40 patients over a 5-year period. The main indications were low ovarian reserve and/or advanced age (68.3%) and malignancy diagnosis (31.7%). There was a significant difference between elective fertility preservation and oncofertility preservation (Onco-FP) groups in terms of the age (38.4±4.7 vs 28.4±6.1; p=0.001). There was a significant difference between two groups in favor of oncofertility group in terms of anti-Mullerian hormone level, basal follicle-stimulating hormone level, antral follicle count, trigger day estradiol (E2) level, number of obtained oocytes, MII oocytes, and frozen oocytesCONCLUSION: According to our study, the most prominent oocyte cryopreservation indication was advanced age and/or low ovarian reserve. The number of oocytes collected from patients in the Onco-FP group and thus the number of frozen oocytes was significantly higher than in the elective fertility preservation group, due to younger ages and better ovarian reserve in the Onco-FP group. Abdominal administration of the technique is particularly important for virgin patients in our country. Oocyte freezing is a fertility protection method available in a wide range of indications for reproductive-aged women.

Objective: The feasibility of a gonadotropin-releasing hormone agonist (GnRHa) trigger in normal responders is still a matter of debate. The aim of this study was to compare the number of mature oocytes, the number of good-quality embryos, and the live birth rate in normal responders triggered by GnRHa alone, GnRHa and human chorionic gonadotropin (hCG; a dual trigger), and hCG alone.Methods: A retrospective cohort study was conducted at the infertility clinic of a university hospital. Data from 200 normal responders who underwent controlled ovarian hyperstimulation and intracytoplasmic sperm injection with a GnRH antagonist protocol between January 2016 and January 2017 were reviewed. The first study group consisted of patients with cycles triggered by GnRHa alone. The second study group consisted of patients with cycles triggered by both GnRHa and low-dose hCG (a dual trigger). The control group consisted of patients with cycles triggered by hCG alone.Results: The groups were comparable in terms of demographics and cycle characteristics. The numbers of total oocytes retrieved and metaphase II oocytes were similar between the groups. The total numbers of grade A embryos were 3.2±2.9 in the GnRHa group, 4.4±3.2 in the dual-trigger group, and 2.9±2.1 in the hCG group (p=0.014). The live birth rates were 21.4%, 30.5%, and 28.2% in those groups, respectively (p=0.126).Conclusion: In normal responders, a dual-trigger approach appears superior to an hCG trigger alone with regard to the number of top-quality embryos produced. However, no clinical benefit was apparent in terms of live birth rates.

Objective(s) To assess the association between the ultrasonographic presence of adenomyosis and recurrent miscarriage (RM). Study Design A prospective matched case-control study was conducted between March 2018 and December 2018 at Ankara University Hospital. A total of 132 women were assessed with transvaginal ultrasonography for the presence of adenomyosis markers. The case group consisted of 66 women with RM. The control group consisted of 66 women without RM or any other gynaecologic conditions. The rates of ultrasonographic adenomyosis, using strict criteria, were compared between the groups. Other etiologic factors for RM were described in the case group. The primary outcome was the ultrasonographic diagnosis of adenomyosis. Results The ultrasonographic diagnosis of adenomyosis, using diagnostic criteria of at least two markers, was significantly higher in the RM group when compared to the control group (19.7% vs. 6.1%, respectively; P = 0.035). The most common ultrasonographic finding in the RM group was heterogeneous myometrium (18.2%). In the RM group, there was at least one possible risk factor (including adenomyosis) for RM in 42 women (63.6%). The prevalence of adenomyosis in nine women with unexplained RM was 13.6%. Conclusion(s) The prevalence of adenomyosis was significantly increased in women with RM compared to healthy controls. Adenomyosis and uterine anomalies were the most common risk factors associated with RM.

We aimed to assess the effect of endometrial compaction on the live birth rate in frozen-thawed embryo transfer (FET) cycles and to investigate the parameters associated with compaction. FET cycles performed in a tertiary care infertility centre between May 2013 and October 2019 were reviewed retrospectively. The decremental change of endometrial thickness between the end of oestrogen phase and ET day was defined as endometrial compaction. The primary outcome measure was endometrial compaction, and the secondary outcome was the live birth rate. Among all, 89 had endometrial compaction and 194 did not. The live birth rate was significantly higher in the compaction group (23.6

Study question What is the effect of endometrial compaction on live birth rate in frozen-thawed embryo transfer (FET) cycles? Summary answer In FET cycles with artificial endometrial preparation, the chance for live birth was significantly higher in cycles with endometrial compaction. What is known already Most studies conclude that thinner the endometrium poorer the pregnancy outcome. These studies mostly include measurements in the follicular phase. Since endometrial thickness indicates receptivity, one may expect the endometrial thickness measured on ET day to be more important to predict the outcome. However, few studies assessed endometrial thickness on ET day and unlike follicular phase studies conflicting results were obtained regarding pregnancy outcome. The change in endometrial thickness may be more valuable to predict the pregnancy outcome rather than a single measurement. Study design, size, duration Retrospective observational cohort study. 283 FET cycles in which all patients underwent artificial endometrial preparation were reviewed. Participants/materials, setting, methods: The inclusion criteria were artificial endometrial preparation, age between 20–38 years. The same protocol was applied to all patients for the endometrial preparation.The change of endometrial thickness between the end of estrogen phase and embryo transfer day was recorded. Any decrement is defined as endometrial compaction. The patients were grouped according to the changes of endometrial thicknesses as compaction and non-compaction. Main results and the role of chance Among 283 cycles, 89 had endometrial compaction and 194 did not have compaction. The clinical pregnancy, implantation and live birth rates were significantly higher in the compaction group when compared to non-compaction group (P values 0.007, 0.009, and 0.039, respectively). In order to evaluate the results according to the degree of compaction, we divided the patients into 5% compaction slices. The live birth rate was significantly higher in the 5–10% compaction group (P = 0.016). A multivariable logistic regression analysis was performed to examine the independent effects of different variables on live birth chance.In FET cycles with artificial endometrial preparation, the chance for live birth was significantly higher in cycles with endometrial compaction (OR: 2.352, 95% confidence interval {CI} 1.297–4.264, P = 0.005). A receiver operating characteristic (ROC) curve analysis was performed to evaluate whether there was a certain threshold of endometrial thickness at the end of estrogen phase for endometrial compaction to occur. The sensitivity and specificity of 9.25 mm at the end of estrogen phase calculated from the ROC curve were 76.4% and 58.8%, respectively (area under the curve: 0.701, 95% CI 0.640–0.763; P Limitations, reasons for caution The main limitations of the study were its retrospective nature, relatively small sample size and utilization of different ultrasound techniques at different measurements (using transvaginal ultrasound at the end of the estrogen phase and transabdominal ultrasound on ET day). Wider implications of the findings: Recently a cohort study they found that endometrial compaction results in better pregnancy outcomes, similar to our findings. But, this is the first study to suggest a threshold value (9.2) for endometrial thickness before the commencement of progesterone in regards to increase the chance of compaction. Trial registration number Not applicable

Study question Do progesterone elevation (PE) on trigger day and progesterone to mature oocyte index (PMOI) affect embryo quality and the chance of live birth? Summary answer The top-quality embryo rate is decreased by increasing PMOI, but it has no association with absolute serum progesterone levels. What is known already Progesterone elevation have been reported to significantly decrease pregnancy and implantation rates. The main mechanism of this adverse effect is mainly related to an asynchrony between the endometrium and the embryo. Many of the previous studies have failed to show a significant impact of PE on embryo quality and the success of subsequent frozen-thawed embryo transfer (FET) cycle. However, PMOI was suggested to be more predictive than PE of ART outcome and might be associated with embryo quality. Study design, size, duration A single-centre retrospective cohort study was conducted. All FET cycles performed in a university hospital infertility centre between January 2016 and December 2019 were reviewed. A total of 44 patients who had PE (>1.5 ng/ml) on trigger day and 134 patients who did not have PE were assessed. Participants/materials, setting, methods The study group consisted of patients who had PE (>1.5 ng/mL) during fresh COS cycle and the control group consisted of patients who did not have PE. In addition to effect of PE on subsequent FET cycle outcome, an association between PMOI and embryo quality was assessed. The threshold level to define increased PMOI (>0.12 ng/ml) was calculated as the median level of the whole study cohort. Main results and the role of chance The mean ages of the study and control groups were 30.4±5.4 years and 31.1±5.6 years, respectively (P = 0.413). Although the number of oocytes collected and MII oocytes were significantly higher in patients with PE, the total number of frozen embryos were similar between the groups. There were no significant differences concerning the outcome measures including live birth rate in the subsequent FET cycle between participants with and without PE (27.3% vs. 23.9%, respectively; P = 0.652). The rate of top-quality embryos was similar between participants with and without PE (43% vs. 52%, respectively; P = 0.370). However, the rate of top-quality embryos was significantly lower in cycles with PMOI>0.12 ng/ml than in cycles PMOI Limitations, reasons for caution The retrospective design and the small sample size derived from a single institution. Wider implications of the findings: Increased PMOI, which is associated to lower top-quality embryo rate, may in turn result in diminished cumulative live birth rate. Trial registration number Not applicable

Objective: Progestins are used as an alternative to gonadotropin releasing hormone (GnRH) antagonists to suppress premature luteinizing hormone (LH) surge and a flexible protocol has been defined recently. The aim of this study was to compare the efficacy of flexible protocols with dydrogesterone and GnRH antagonist in suppressing LH surge. Material and Methods: This retrospective, case-control study, was conducted in an infertility unit of a tertiary university hospital. A daily dose of 40 mg dydrogesterone was compared with GnRH antagonist (GnRHant) in controlled ovarian hyperstimulation cycles between July 2018 and July 2019. Dydrogesterone was started when the leading follicle was 12 mm or serum estradiol was over 300 pg/mL. A subgroup analysis of poor responder patients was also performed. Results: In total there were 105 subjects aged between 23 and 41 years, 52 in the dydrogesterone group and 53 in the GnRHant group. Duration of pituitary suppression was longer in dydrogesterone group. Premature ovulation was observed in 11.5% (6/52) and 0% in the dydrogesterone and GnRHant groups, respectively. However, collected oocyte counts and metaphase II oocyte counts were found to be similar between the groups. The six patients with premature ovulation were in poor responder subgroup. Conclusion: Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned in the same cycle. However, flexible regimen may not be appropriate in patients with diminished ovarian reserve, as advanced follicular maturation and delayed suppressive effect of oral progesterone may cause premature ovulation. Randomized controlled trials in particular patient groups are required to determine the most effective minimum dose and time of application to ensure treatment success.

Objective To assess the association between hCG day progesterone levels and subsequent frozen-thawed embryo transfer (FET) cycle outcome in infertile women with and without polycystic ovary syndrome (PCOS). Method Data of 178 women who underwent FET at a university-based infertility clinic between January 2016 and December 2019 were reviewed. The study group consisted of women who had progesterone elevation (PE) during fresh controlled ovarian stimulation (COS) cycle. A sub-group analysis was also performed in PCOS and non-PCOS patients. Results There were no differences in clinical pregnancy (47.7 % vs. 50.7 %, p = 0.729), miscarriage (15.9 % vs. 22.4 %, p = 0.359), and live birth rates (27.3 % vs. 23.9 %, p = 0.652) following FET between women with and without PE in the fresh cycle. The results remained non-significant regarding the clinical pregnancy (46.7 % vs. 53.4 %, p = 0.549), miscarriage (13.3 % vs. 27.6 %, p = 0.133), and live birth rates (26.7 % vs. 19.0 %, p = 0.408) in participants with PCOS (n = 88). Conclusion hCG day progesterone level in the fresh COS cycle does not have a significant impact on the subsequent FET cycle neither in PCOS nor in non-PCOS women.

Conventional assisted reproductive technology (ART) cycles may delay cancer treatment and compromise survival, and also increase patients’ psychological burden as a result of delayed chemotherapy. The aim of this study was to compare the success rates of random start and conventional start GnRH antagonist protocols in terms of oocyte and embryo outputs in cancer patients. Data of 111 patients with a newly diagnosed cancer who underwent ART for fertility preservation at a university-based infertility clinic between January 2010 and September 2019 were reviewed. The study group underwent random start controlled ovarian hyperstimulation (RS-COH) and the control group underwent conventional start COH (CS-COH). The main outcome measures were the number of total oocytes, MII oocytes, and embryo yield. A total of 46 patients (41.5%) underwent RS-COH and 65 (58.5%) underwent CS-COH. Baseline characteristics were similar between the groups. The most common cancer type in both groups was breast cancer (60.9% vs. 52.3%, respectively). The median duration of stimulation was significantly longer in RS-COH than in CS-COH (12 vs. 10 days; P = 0.005). The median number of MII oocytes was significantly higher in RS-COH than in CS-COH (7 vs. 5 oocytes, respectively; P = 0.020). The MII/AFC ratio was significantly higher in the RS-COH group compared to the CS-COH group (74% and 57% respectively; p = 0.02). In the linear regression analyses, RS-COH protocol did not have a significant impact on MII/AFC (standardized s coefficient − 0.514; P = 0.289 {adjusted R2 for the model = 0.779}), oocyte yield (standardized s coefficient − 0.070; P = 0.829 {adjusted R2 for the model = 0.840}), and MII rate (standardized s coefficient − 0.504; P = 0.596 {adjusted R2 for the model = 0.271}). In conclusion, RS-COH protocol is as effective as CS-COH protocols for fertility preservation in cancer patients.

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 (

Human menopausal gonadotropin (hMG) has LH activity, and it may have beneficial effects in terms of oocyte quality and endometrial receptivity similar to recombinant LH supplementation. The aim of this study was to assess the effects of hMG, and its commencement time on the outcome of assisted reproductive technology (ART) cycles of POSEIDON group 3 and 4 poor responders. Data of 558 POSEIDON group 3 and 4 poor responders who underwent ART treatment following a GnRH antagonist cycle at a university-based infertility clinic between January 2014 and December 2019 were reviewed. hMG was commenced at the early follicular phase or mid-follicular phase in the study groups. The control group did not receive hMG stimulation. Live birth rate (LBR) was the main outcome measure. The mean duration of stimulation was significantly shorter in early follicular hMG group than in mid-follicular hMG group (11.9 ± 3.6 days vs. 12.8 ± 4 days, respectively; P = 0.027). The mean numbers of oocytes retrieved and MII oocytes were comparable between the groups. The LBRs per embryo transfer in early follicular hMG, mid-follicular hMG, and control groups were 21.9%, 11.7%, and 11.6%, respectively (P = 0.035). In conclusion, there is a significant association between the commencement time of hMG and live birth chance in ART cycles of POSEIDON group 3 and 4 poor responders. Early initiation of hMG together with rFSH seems to be beneficial in this specific population.

To assess the association between operative hysteroscopy prior to assisted reproductive technology (ART) cycle and cervical insufficiency (CI) in the second trimester of pregnancy. A retrospective cohort study was conducted. The charts of all women who got pregnant following an ART cycle between January 2015 and June 2018 were reviewed. The study group consisted of pregnant women who underwent operative hysteroscopy within 6 months before conception. The control group consisted of pregnant women who did not undergo hysteroscopy or any type of cervical surgical procedure before conception. The primary outcome measure was CI during the second trimester (13–27 weeks of gestation). A total of 363 pregnancies achieved by ART cycles were assessed. After the exclusion of multiple pregnancies (n = 19), previous surgical procedures (n = 4) and first-trimester pregnancy losses (n = 80), there were 29 women in the study group and 231 women in the control group. The mean ages of the study and control groups were 31.2 ± 4.06 and 29.82 ± 4.71 years, respectively (P = 0.13). The indications for operative hysteroscopy were uterine septum (n = 19), T-shaped uterus (n = 4), endometrial polyp (n = 4), and submucosal fibroids (n = 2). The rates of CI in the study and control groups were 13.7% (4/29) and 3.4% (8/231), respectively (P = 0.012). The term delivery rates in the study and control groups were 79.3 and 91.8%, respectively (P = 0.044). Operative hysteroscopy prior to ART cycles is significantly associated with CI between 13 and 27 weeks of gestation. Further investigation with larger cohorts is urgently needed to clarify this issue.

Aim: To compare the surgical results and reproductive Performances of patients with ESHRE/ESGE (European Society for Human Reproduction and Embryology/European Society for Gynaecologic Endoscopy) class U1a and U2b uterine anomalies after hysteroscopic correction. Methods: A retrospective cohort study was conducted at a university hospital infertility clinic. Ninety-six patients with class U2b (complete septate Uterus) and 78 patients with class U1a (T-shaped Uterus) uterine anomalies who underwent hysteroscopic correction between January 2009 and December 2015 were recruited. Results: The Operation time was significantly longer in class U2b anomalies (26.5 ± 5.3 minutes) than class U1a anomalies (22.8 ± 5.8 minutes; mean difference [95% confidence interval [Cl]: 3.6 ± 0.9 [1.8–5.3]; P < .001). Six out of all complete septate patients and 3 of T-shaped patients were reoperated due to postoperative synechia or to further enlarge the cavity. There were no differences between the groups regarding intraoperative (blood loss and uterine rupture) and postoperative (bleeding and infection) complications. After surgical correction, the term delivery rates increased from 3% to 71 % (P < .001) in class U2b and from 4% to 62.1 % (P < .001) in class U1a. The chance of live birth significantly increased after hysteroscopic correction both in class U2b (odds ratio [OR] 106.1; 95% Cl, 29.1–387.1; P < .001) and class U1a (OR 35.7; 95% Cl, 11.6–109.9; P < .001). The postoperative reproductive Performances of both anomalies were similar. Conclusion: Both types of anomalies seem to have similar severity and prognosis. Patients with both types of anomalies have excellent reproductive outcome after hysteroscopic correction.

A AkAr, Yavuz Emre/0000-0003-0815-3522; Ozmen, Batuhan/0000-0002-4504-669X; Atabekoglu, Cem Somer/0000-0003-0264-0709; Berker, Bulent/0000-0001-7346-7128; Sonmezer, Murat/0000-0001-6101-1414; ates, can/0000-0003-2286-4398 WOS: 000443619200004 PubMed: 30202623 Objective: To investigate the impact of peri-implantation prednisolone use and its duration in antagonist co-treated assisted reproductive technology (ART) cycles of patients with good prognosis. Materials and Methods: Infertile patients treated with gonadotropin-releasing hormone antagonist protocol between January 2010 and June 2013 were included. The patients in group A (n=196) received no prednisolone. The patients in groups B (n=397) and C (n=371) received 5 mg oral prednisolone daily, for 4 and 12 days following embryo transfer, respectively. The main outcome parameter was live birth rate. Results: The ages of the groups were 30.1 +/- 4.6, 31.5 +/- 4.5, and 30.9 +/- 4.7 years, respectively (p=0.163). There was no statistically significant difference between the groups regarding cycle characteristics. Implantation rates were 20.7%, 24.6%, and 23.8%, respectively (p=0.163). Miscarriage rates were 1.5%, 3.5%, and 3.2%, respectively (p=0.859). Live birth rates were 28.7%, 29.3%, and 32.8%, respectively (p=0.482). Conclusion: Empiric prednisolone administration during the peri-implantation period does not seem to have beneficial effects in ART cycles of patients with good prognosis.

Objective While there's a growing data on the comparison of GnRH agonist and GnRH antagonist protocols, no clear study exists on the effects of both protocols on the same patient. The aim of the present study was to compare the success rates of protocol shift and proceeding with the same protocol after an unsuccessful intracytoplasmic sperm injection (ICSI) cycle. Materials and Methods Three hundred and forty-five normal responder patients who had a previously failed ICSI cycle between January 2011 and December 2015 were reviewed. The study (n = 73) and control (n = 93) groups in the first cohort were composed of patients whose protocol were shifted to antagonist and who proceeded with agonist. The study (n = 33) and control (n = 146) groups in the second cohort were composed of patients whose protocol were shifted to agonist and who proceeded with antagonist. Results Total dose of gonadotropins, maximum estradiol levels, and number of oocytes collected were significantly higher in agonist protocol than in antagonist protocol (P = 0.021, P = 0.013, and P = 0.003, respectively). Cycle cancellation rates were significantly lower in agonist protocol than antagonist protocol (P = 0.005). The pregnancy rates in patients who shifted to antagonist and proceeded with agonist were 57.8% and 50.8%, respectively (P = 0.399). The pregnancy rates in patients who shifted to agonist and proceeded with antagonist were 33.3% and 47.9%, respectively (P = 0.202). Conclusion Protocol shift following a failed ICSI cycle with either agonist or antagonist protocol does not affect outcome.

The present study investigated maternal and neonatal outcomes in pregnant women who used obstetric lubricant gels during active labour. This prospective randomised controlled study included 180 pregnant women. Women were randomly assigned to two groups during the first-stage of labour. Pregnant women in the obstetric gel group received standard antepartum care plus vaginal application of obstetric gel. Women in the control group received standard antepartum care without obstetric gel. Mean duration of the second stage of labour was significantly shorter in the obstetric gel group than control group (45 ± 34 min vs. 58 ± 31 min, respectively; p = .005). Mean APGAR values at 5 min were significantly higher in the obstetric gel group (9.5 ± 0.6 vs. 9.2 ± 0.7; p = .0014). Among nulliparous women, mean duration of the second stage of labour was significantly shorter in the gel group than control group (53 ± 52 min vs. 83 ± 45 min, respectively; p = .003). Using obstetric gel at the beginning of the first stage decreases the length of the second stage of labour, particularly in nulliparous women, and may be associated with an improved APGAR score at 5 min. Impact statement A limited number of studies in the literature have demonstrated that obstetric gels shorten the second stage of labour and are protective for the pelvic floor. The results of this study show that using obstetric gel shortens the second stage of labour in only nulliparous, but not multiparous women. In addition, a significant improvement in the 5 min APGAR score was seen in the neonates of women who used obstetric gel. The application of obstetric gels during the labour of nulliparous women may be a useful clinical practice and may have a widespread use in the future.

Triptorelin 0.2 mg and leuprolide 1 mg subcutaneous injections for triggering final follicular maturation were compared in patients with a high risk for ovarian hyperstimulation syndrome (OHSS). Infertile patients treated with GnRH antagonist protocol between January 2014 and March 2016 were recruited. Patients with high serum oestradiol levels on HCG day (>3000 pg/ml) indicating a risk of OHSS consisted of the study groups (A and B). Patients with serum oestradiol levels less than 3000 pg/ml consisted of the control group (C). A single injection of 0.2 mg triptorelin, 1 mg leuprolide and 10000 IU HCG were administered for final oocyte triggering in groups A (n = 63), B (n = 74) and C (n = 131), respectively. Demographic parameters were comparable between the groups. No cases of severe or moderate OHSS occurred in any group. The clinical pregnancy rates were 31.7%, 37.8% and 32.8% in groups A, B and C, respectively. Both injections had comparable efficacy in clinical outcome and OHSS risk. Regardless of preferred drug, GnRH agonist trigger for final oocyte maturation seems to be safe for patients with high OHSS risk, and can be safely used in fresh embryo transfer cycles.

Background/aim To investigate the relationship between subfertility etiologies and success rates in controlled ovarian stimulation and intrauterine insemination (COS–IUI) cycles. Materials and methods The medical records of 218 couples who applied to a university-based fertility center were analyzed retrospectively. Detailed infertility examination data and pregnancy outcomes were compared according to different subfertility etiologies. The study groups with regard to subfertility etiologies were minimal–mild endometriosis, unexplained infertility, and mild male infertility. The primary outcome measure was live birth rate. Results There were no statistically significant differences between the groups regarding demographics except for total motile sperm count. Live birth rates in the male infertility group were comparable to the endometriosis and unexpected infertility groups (6.6%, 11.9%, and 10.3%, respectively; P = 0.63). Conclusion The success rate of the mild male subfertility group following COS–IUI cycles for live birth rates was similar to those of the endometriosis and unexplained subfertility groups.

Objective:The risk of adnexal mass is less in adolescents than in reproductive age women and those patients are important regarding fertility preservation. The aim of this study was to retrospectively evaluate adoles-cents operated for adnexal masses in our clinic in a 7 year period retrospectively.Material and Methods:All patients operated for adnexal mass in Ankara University School of Medicine De-partment of Obstetrics and Gynecology between 2006 and 2012 were included in this retrospective cohort study. Data including age, presenting symptom, surgical method, pathologic diagnosis, and tumor markers are recorded.Results:Mean age of the patients was 17.8±2.5 years. The most common symptoms and signs of the patients were abdominal pain (57.6%), abdominal swelling (10.2%) ve menstral irregularities (10.2%). The sensitivity, specificity, positive predictive value and negative predictive value of preoperative evalutation with physical examination, imaging and tumor markers for malignancy were 83.3%, 92.5%, 55.5%, and 98% respectively. According to pathologic examination 40 (67.8%) patients had non-neoplastic and 19 (32.2%) patients had neolastic masses. Among neoplastic adnexal masses 5 (8.5%) were mature teratoma and 7 (11.8%) were cys-tadenoma. One (1.7%) patient had borderline serous tumor and 6 (10.2%) had germ cell tumors.Conclusion:Functional ovarian cysts are common in adolescents. Ultrasonography findings and tumor mark-ers are important in differential diagnosis of complex cysts. Less invasive surgical methods and fertility pre-serving procedures should be preferred in the management of adolescent adnexal masses.

Amac: Bu calismanin amaci transabdominal fetal reduksiyonun gebelik sonuclarina olan etkisini arastirmaktir. Gerec ve Yontem: Reduksiyon yapilan ikiz gebelikler ile spontan ikiz ve yardimci ureme teknikleri (IVF) ile olusan ikiz gebelikler karsilastirildi. Gebelik sureleri, pematur dogum ve dogum oranlari, gebelikteki komplikasyonlar, dogum agirligi, APGAR skoru, yenidogan yogun bakimda yatis orani ve dogum sekli acisindan karsilastirildi. Sonuc: 2007-2014 yillari arasinda takibi yapilan 380 ikiz dogum calismaya alindi. Perinatal sonuclar ile ilgili tum veriler uc grup arasinda karsilastirildi. Spontan ikiz gebelikler (grup 3, n=165) ve IVF ile olusan ikiz gebelikler (grup 1, n=117) ve reduksiyon sonrasi ikiz gebelik devam edenler (grup 2, n=49). Gebelik suresi, erken dogum ve gebelikle iliskili komplikasyonlar grup 1’deki hastalarda grup 2’ye gore anlamli olarak iyiydi. Bunun yani sira dogum agirligi, APGAR 1.ve 5.dakika skorlari grup 2’de grup 1’e gore daha dusuktu. Tartisma: Embriyo reduksiyonu yuksek riskli komplikasyonlari olmasina ragmen cogul gebeliklerde onerilmektedir. Embriyo reduksiyonu, IVF ile olan ikiz gebelikler spontan ikiz gebelikler ile karsilastirildiginda sonuclari daha olumsuz olarak saptanmistir.

Aim The aim of this study was to evaluate whether dual trigger with leuprolide acetate plus recombinant human chorionic gonadotropin (hCG) improves in vitro fertilization outcome in gonadotropin-releasing hormone antagonist cycles. Methods A total of 156 patients diagnosed with mild male factor, unexplained or tubal factor infertility were enrolled in the study. All subjects were allocated into one of two groups: the dual trigger group (leuprolide acetate 500 μg + recombinant hCG 250 μg) and the standard group (recombinant hCG 250 μg) according to the selected trigger method. Oocyte trigger was performed when at least three follicles >17 mm were observed. Pregnancy rate, number of collected oocytes, number of metaphase II oocytes, number of grade-A embryos, cycle cancellation rate, and ovarian hyperstimulation syndrome rate were the main outcome measures for the study. Results The mean number of grade-A embryos (1.6 ± 1.5 vs 1.1 ± 1.4, P = 0.01) and of metaphase II oocytes (7.9 ± 4.6 vs 6.3 ± 5.8, P = 0.02) was significantly higher in the dual-trigger group. Pregnancy rate was significantly higher in the dual-trigger group than in the standard group (54.8 vs 37.5%, P = 0.006). Two cases of mild ovarian hyperstimulation syndrome were observed in each group. Conclusion This novel and more physiological trigger approach using 500 μg leuprolide acetate plus 250 μg recombinant hCG may lead to an increase in the number of metaphase II oocytes, grade-A embryos, and may improve pregnancy rates.

Hereditary breast and ovarian cancer syndrome is an inherited cancer-susceptibility syndrome with multiple family members with breast cancer or ovarian cancer or both, the presence of both breast cancer and ova-rian cancer in a single individual, and early age of breast cancer onset. BRCA1 and BRCA2 tumor suppressor gene mutations are responsible for the vast majority of inheritance of breast and ovarian cancers. App-roximately 10% of ovarian cancer patients and approximately 3-5% of breast cancer patients have predomi-nating BRCA1 and BRCA2 gene mutations. Preimplantation genetic diagnosis (PGD) is an alternative to conventional prenatal diagnostic techniques such as amniocentesis and chorionic villus sampling. Prenatal diagnosis for BRCA mutation in an ongoing pregnancy and pregnancy termination brings some ethical and psychological questions together. Hence, it may be favorable to perform PGD for patients with BRCA muta-tions. Eventually, PGD may be recommended at least to the infertile patients with BRCA mutation who sho-uld already undergo in vitro ifertilization IVF (in vitro fertilization).

Atabekoglu, Cem Somer/0000-0003-0264-0709; Aytac, Rusen/0000-0002-2644-545X; A AkAr, Yavuz Emre/0000-0003-0815-3522; Berker, Bulent/0000-0001-7346-7128; Ozmen, Batuhan/0000-0002-4504-669X WOS: 000486106700017 PubMed: 31238206 Objective: To investigate the effect of different TSH (0.5-2.49 mlU/L and 2.5-4.5 mlU/L) levels on intrauterine insemination (IUI) outcomes of euthyroid unexplained subfertile patients who are negative for thyroid antibodies. Study design: In this retrospective cohort study, data of euthyroid subfertile patients who underwent IUI due to unexplained infertility at a university-based infertility clinic between January 2013 and December 2014 were reviewed. A total of 156 patients of them were categorized into two groups according to pre-conceptional TSH levels. The first study group consisted of patients with serum TSH levels 0.5-2.49 mlU/L and the second study group consisted of patients with serum TSH levels 2.5-4.5 mIU/L. The primary outcome measure was live birth rate. Results: Demographics and cycle characteristics of the study groups were similar. There were no statistically significant differences between the study groups regarding main outcome measures (live birth rate, P = 0.82; clinical pregnancy rate, P = 0.64; miscarriage rate, P = 0.57). Conclusion: Pre-conceptional TSH levels ranging between 0.5-4.5 mU/L does not appear to have a significant effect on IUI outcome of euthyroid women who are negative for thyroid antibodies. (C) 2019 Elsevier B.V. All rights reserved.

Aim The aim of this study was to assess the diagnostic accuracy of hysterosalpingography (HSG) on tubal patency (TP) and to determine whether performing laparoscopy (LS) can change the original management strategy based on HSG findings. Material and Methods Records of all infertile couples (n = 1298) treated at a university-based infertility clinic between January 2002 and June 2010 were reviewed. All patients who had both HSG and LS testing (n = 264) were included in the study. HSG was performed in an attempt to rule out tubal and/or uterine pathologies. All patients included in the study were evaluated with LS not more than 12 months after HSG. Results The validity of HSG screening for TP was calculated as 84.1%. The positive and negative predictive values of HSG were 54.6% and 98.3%, respectively. The sensitivity of HSG was higher in patients with distal tubal occlusion than in patients with proximal tubal occlusion (69.8% [44/63] vs 46.7% [28/60], respectively; P = 0.011). The rates of management plan change in patients with bilateral TP, unilateral tubal occlusion and bilateral tubal occlusion were 2.8%, 12.2% and 32.4%, respectively (P = 0.000). Conclusions Patients with both unilateral tubal occlusion and bilateral tubal occlusion on HSG should be reevaluated with LS to determine the appropriate management strategy.

Objective To assess the effects of ultrasonographically detected subchorionic hematomas on pregnancy outcomes in patients with vaginal bleeding within the first half of pregnancy. Material and methods Patients diagnosed with threatened abortion due to painless vaginal bleeding and who were followed up in an in-patient service during the first vaginal bleeding between January 2009 and December 2010 were included in this retrospective cohort study. Patients were divided into two groups according to the presence of subchorionic hematoma. Miscarriage rates and pregnancy outcomes of ongoing pregnancies were compared between the groups. Results There were no statistically significant differences between the groups regarding demographic parameters, including age, parity, previous miscarriage history, and gestational age at first vaginal bleeding. While 13 of 44 pregnancies (29.5%) with subchorionic hematoma resulted in miscarriage, 25 of 198 pregnancies (12.6%) without subchorionic hematoma resulted in miscarriage (p=.010). The gestational age at miscarriage and the duration between first vaginal bleeding and miscarriage were similar between the groups. The outcome measures of ongoing pregnancies, such as gestational week at delivery, birth weight, and delivery route, were also similar between the groups. Conclusion Ultrasonographically detected subchorionic hematoma increases the risk of miscarriage in patients with vaginal bleeding and threatened abortion during the first 20 weeks of gestation. However, it does not affect the pregnancy outcome measures of ongoing pregnancies.

To compare the effects of combined oral contraceptives (OCs) containing cyproterone acetate and drospirenone in the treatment of polycystic ovary syndrome (PCOS). Fifty-two patients with PCOS were randomized in two groups: group A (n = 26) received 0.035 mg ethinyl estradiol + 2 mg cyproterone acetate and group B (n = 26) received 0.03 mg ethinyl estradiol + 3 mg drospirenone-containing OCs for 12 months. Baseline clinical features including body mass index, waist to hip ratio (WHR), and modified Ferriman-Gallwey (mFG) score were noted. Baseline biochemical parameters included androgen profile, carbohydrate metabolism, lipid profile, and oxidative stress. The percentages of changes for all parameters were compared. The groups were comparable regarding the baseline characteristics. WHR decreased significantly from baseline (−4 % [−31 to 35]) in group B when compared to group A (0 % [−11 to 14]) (P = 0.033). The total mFG score decreased significantly from baseline (−35 % [−71 to 10]) in group A when compared to group B (−18 % [−72 to 30]) (P = 0.035). Changes in androgen hormone profile were comparable except DHEA-SO4 (−32 % [−53 to 15] in group B vs. −10 % [−49 to 63] in group A; P = 0.046). The effects of the drugs were similar regarding carbohydrate metabolism, lipid profile, and oxidative stress parameters. Cyproterone acetate containing OCs seem to be more effective to treat clinical hirsutism in patients with PCOS after 12 months of treatment.

The aim of this study was to evaluate the success rates of intrauterine insemination (IUI) in infertile women with unilateral proximal and distal tubal blockage. A total of 161 couples with unilateral tubal blockage and unexplained infertility were included. The primary outcome measure was the cumulative pregnancy rate (CPR). The CPRs after three cycles of IUI were 26.3% (10/38) in patients with unilateral tubal blockage, and 44.7% (55/123) in patients with unexplained infertility (p = 0.043). CPRs were similar in patients with proximal unilateral tubal blockage and unexplained infertility (38.1% vs 44.7%, respectively, p = 0.572). CPR was significantly lower in patients with distal unilateral tubal blockage than in patients with unexplained infertility (11.7% vs 44.7%, respectively, p = 0.01). In conclusion, IVF instead of IUI may be a more appropriate approach for distal unilateral tubal blockage patients.

Objective To investigate the relationship of the progesterone-to-estradiol (P/E 2 ) ratio on the day of hCG administration with ongoing pregnancy rates in patients with normal ovarian reserve undergoing GnRH antagonist cycles. Study design Observational cohort study including 129 women with normal ovarian reserve undergoing the GnRH antagonist protocol at the IVF unit of Ankara University School of Medicine. Receiver operating characteristics (ROC) analysis was performed to determine cut-off values for the P/E 2 ratio detrimental to IVF/ICSI-ET outcomes. The ongoing pregnancy rate was the primary outcome measure. Groups were compared using the independent-samples Student's t -test, Mann Whitney and Chi-Square tests. Multivariate logistic regression analysis was used to study the association between the variables and the P/E 2 ratio. Results The optimal cut-off value for P/E 2 ratio in GnRH antagonist cycles was 0.48; ongoing pregnancy rates and live birth rates were found to be significantly higher in patients with P/E 2 ratios ≤ 0.48 than those with > 0.48 (50% vs 22.4%, p = 0.001 and 38.5% vs 19.7%, p = 0.02, respectively). In logistic regression analysis, the P/E 2 ratio was found to be an independent predictor for pregnancy, but the sensitivity (69%), specificity (61%) and overall accuracy (67%) were low as a predictor test for cycle outcome. Conclusion Although a P/E 2 ratio ≤ 0.48 on the day of hCG administration was associated with significantly higher ongoing pregnancy and live birth rates, it has poor predictive value for cycle outcome in patients with normal ovarian reserve undergoing GnRH antagonist cycles.