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PURPOSE: To compare the effect of two different sperm preparation techniques, including swim-up and gradient methods on sperm deoxyribonucleic acid (DNA) fragmentation status of semen samples from unexplained and mild male factor subfertile patients undergoing intrauterine insemination (IUI). DESIGN: A prospective randomized study was conducted in 65 subfertile patients, including 34 unexplained and 31 male factor infertility to compare basal and post-procedure DNA fragmentation rates in swim-up and gradient techniques. Sperm DNA fragmentation rates were evaluated by a sperm chromatin dispersion (SCD) test in two portions of each sample of semen that was prepared with either swim-up or gradient techniques. Sperm motility and morphology were also assessed based on WHO 2010 criteria. RESULTS: Swim-up but not gradient method yielded a statistically significant reduction in the DNA fragmented sperm rate after preparation as compared to basal rates, in the semen samples of both unexplained (41.85 ± 22.04 vs. 28.58 ± 21.93, p

BACKGROUND/AIM The aim of the study was to compare the luteal estradiol patch/GnRH antagonists priming protocol (LPP) with the standard GnRH antagonist protocol in poor ovarian responders (PORs) in terms of the outcomes of in vitro fertilization (IVF) treatment. MATERIALS AND METHODS IVF outcomes of 265 cycles in 265 patients (106 in the LPP group, 159 in the standard GnRH antagonist group) were evaluated retrospectively. RESULTS Mean length of stimulation (11.4 ± 2.7 vs. 10.0 ± 2.7 days; P < 0.05) and the total gonadotropin dose (3403 ± 1060 vs. 2984 ± 1112) used were significantly greater in the LPP group than in the standard GnRH antagonist protocol group. The mean number of oocytes retrieved (3.5 ± 2.6 vs. 3.7 ± 2.8), the number of mature oocytes (2.8 ± 2.2 vs. 2.6 ± 2.2), fertilization rates (65% vs. 62%), the number of embryos transferred (1.6 ± 0.6 vs. 1.7 ± 0.6), and implantation rates (16% vs. 13%) were similar. The cancellation rate did not significantly differ between the groups (9.4% vs. 13.2%). There were no significant differences in the clinical pregnancy (11.3% vs. 13.2%) or live birth rates per patient (3.8% vs. 9.4%) and clinical pregnancy (18.8% vs. 22.6%) or live birth rates per embryo transfer (6.3% vs. 12.9%) between the groups. CONCLUSION LPP does not improve IVF outcomes when compared with the standard GnRH antagonist protocol in PORs.

Objectives: The aim of the study was to measure advanced oxidation protein products (AOPPs) as markers for oxidative stress to evaluate cardiovascular risk in pre- and postmenopausal women and to compare the results with malondialde­hyde (MDA) levels. Material and methods: Twenty premenopausal women and 84 naturally postmenopausal patients were enrolled in the study. AOPP and MDA plasma levels were measured. The postmenopausal group was further subdivided into two groups: postmenopausal age of 40–49 and of 50–59 years. AOPP and MDA levels were compared between premenopausal, 40–49 and 50–59 year old menopausal women. Results: Plasma AOPP and MDA levels in postmenopausal women were increased when compared with their premeno­pausal peers (123.83 ± 55.51 μmol/L vs. 61.59 ± 16.42 μmol/L and 6.50 ± 1.05 μmol/L vs. 5.98 ± 0.77 μmol/L; respectively). Mean plasma AOPP levels in the two menopausal age groups were both significantly higher from the premenopausal group (118.64 ± 59.1 μmol/L vs. 61.59 ± 16.42 μmol/L and 132.31 ± 48.97 μmol/L vs. 61.59 ± 16.42 μmol/L; respectively). No significant difference was found in mean AOPP levels between postmenopausal subjects of 40–49 and 50–59 years age (118.64 ± 59.12 μmol/L vs. 132.31 ± 48.97 μmol/L). Mean plasma MDA levels of each of two postmenopausal age groups were both significantly higher from the premenopausal group (6.50 ± 1.04 μmol/L vs. 5.98 ± 0.77 μmol/L and 6.50 ± 1.10 μmol/L vs. 5.98 ± 0.77 μmol/L; respectively). However, no statistically significant difference between the two postmenopausal age groups (6.50 ± 1.04 μmol/L vs . 6.50 ± 1.10 μmol/L) was found. Conclusions: AOPP and MDA levels are elevated in postmenopausal women as compared to their premenopausal peers, suggesting they can be used as markers for cardiovascular risk in postmenopausal women.

In this study, our objective was to evaluate the impact of testicular histopathology on the outcome of intracytoplasmic sperm injection (ICSI) cycles of patients with nonobstructive azoospermia and correlate with clinical and hormonal parameters. For this purpose, 271 patients with nonobstructive azospermia (NOA) who underwent testicular sperm extraction (TESE) for ICSI cycles were retrospectively evaluated for sperm retrieval, fertilisation, embryo cleavage, clinical pregnancy and live birth rates among different testicular histology groups. We also correlated hormonal and clinical factors with histological findings. Sperm retrieval and fertilisation rates (FR) were found to be significantly different among all testicular histological groups of NOA except for embryo cleavage, clinical pregnancy and live birth rates. Furthermore, serum follicle stimulating hormone (FSH) level was the most significant variable to predict sperm recovery on TESE. Separate analyses within each testicular histological group revealed that higher FSH was also associated with lower pregnancy rates in only maturation arrest group. In conclusion, testicular histology significantly influences sperm retrieval and FRs but not pregnancy and live birth rates in nonobstructive azoospermia. However, FSH is the best predictor of a successful TESE.

Our objective was to assess the role of laparoscopic removal of ovarian endometriomas and ablation of peritoneal endometriosis on the outcome of intracytoplasmic sperm injection (ICSI) - Embryo Transfer cycles by comparing with the results of patients with untreated endometriomas and tubal factor without underlying endometriosis confirmed by laparoscopy. For this purpose, between 2002 and 2015, outcomes of 257 ICSI cycles of 150 patients, including 91 cycles of 48 patients in minimal endometriosis, 57 cycles of 25 patients in endometrioma removal, 65 cycles of 53 patients in non-operated endometrioma, and 44 cycles of 24 patients in tubal factor groups were retrospectively analyzed. Basal ovarian reserve was significantly lower, mean starting and total gonadotropin consumption was significantly higher, and mean serum E2 on the day of hCG injection, number of dominant follicles, number of retrieved total, and MII oocytes were all significantly lower in the endometrioma cystectomy group. Fertilization and embryo cleavage rates were also significantly the lowest in the endometrioma cystectomy group, whereas clinical pregnancy and live birth rates were comparable among all groups. The number of transferred embryos and duration of infertility were the most significant predictors of clinical pregnancy and live birth. Basal antral follicle count was also significant in predicting live birth.

Endometriyozis degisik fenotipleri olan bir hastaliktir. Semptomatik olgularda progesterona direnc ve duzensiz sitokin uretimi, hem ektopik hem otopik endometriyumda gorulebilir. En azindan bazi hastalarda, bu durumun kronik enflamasyon ve antikor otoreaksiyonu ile ilintisi mevcuttur. Immunolojik faktorler de endometrial hucrelerin olusmasinda neden olabilir. Immunolojik degisimler arasinda peritoneal makrofajlarin sayisinda ve aktivitesinde artis, antikorlarin artan dolasimi, azalan T-hucre reaksiyonu, azalan naturel killer hucre sitotoksisitesi ve sitokin aginda diger degisimler sayilabilir. Bu derlemede amac, endometriyozis ve otoimmun hastaliklar arasindaki olasi iliskiyi irdelemek ve endometriyozis etyopatogenezinde enflamasyonun oynadigi potansiyel role isik tutmaktir.

Intrahepatic cholestasis of pregnancy (ICP) is an uncommon disorder, which generally occurs in the second and third trimester of pregnancy with symptoms of pruritus. The cause of ICP is unknown but genetic, hormonal and environmental factors contribute to its pathogenesis. The aetiology of ICP is unclear but elevation in oestrogen levels thought to cause ICP is typically seen in the third trimester of pregnancy, and for this reason it is not usually considered in the differential diagnosis of pruritus and liver function disorders in the first trimester of the pregnancy. We present two cases of pregnancy after IVF treatment diagnosed with ICP following the development of OHSS, deteriorating liver function tests and severe pruritus.

In this study, we aimed to determine whether anti-Müllerian hormone (AMH) levels vary between fertile and infertile populations and compare them with basal follicle-stimulating hormone (FSH) levels and antral follicle count (AFC). This was a prospective study that included 177 primarily infertile patients who underwent IVF treatment and 162 healthy fertile patients admitted to our clinic for benign diseases. FSH and AMH levels and the AFC of the infertile and fertile populations were compared between the age categories30, 30-39 and ≥40. Correlations between AMH, basal FSH, and AFC with age were evaluated. AFC and AMH levels did not differ between the fertile and infertile groups in all age categories. AMH was inversely correlated with age in both the fertile and infertile populations. However, AFC revealed a stronger correlation with age in both the fertile and infertile populations compared with basal FSH and AMH. Age was positively correlated with basal FSH and inversely correlated with AMH and AFC. In conclusion, there was no significant difference between the fertile and infertile populations in terms of AMH or AFC. The decrease in ovarian reserve in infertile patients is directly related to age, not infertility.

Objective To ascertain the incidence of premature progesterone P rise and its impact on outcomes in controlled ovarian hyperstimulation and intrauterine insemination (COH–IUI) cycles, and also to identify variables related with premature P rise. Study design Four hundred sixty cycles of 460 couples with unexplained infertility having COH–IUI treatment with a starting dose of 75 IU recombinant FSH enrolled in this prospective study. Serum P levels were determined on the day of hCG trigger. Premature P rise was defined as progesterone ≥1 ng/mL. The primary outcome measure was live birth per cycle with regard to P levels of ≥1 ng/mL and ≥1.5 ng/mL. Secondary outcome measures were cycle characteristics associated with P rise. Results The incidence of premature P rise was 22.0%. P levels on hCG day were significantly lower in cycles with live birth as compared to cycles without live birth 0.49 ± 0.51 vs. 0.73 ± 0.82 ng/mL. Live birth rates were significantly lower in cycles with hCG day P levels ≥1.0 ng/mL (%7.9 vs. %22.6) and ≥1.5 ng/mL (%6.4 vs. %20.8). Among age, number of dominant follicles, estradiol, LH and P levels on the day of hCG trigger, it was found that P levels was the only significant variable to predict live birth on multivariate analysis. The number of dominant follicles on hCG day and premature LH surge were the only significant variables related with premature P rise. Conclusion Premature P is a frequent feature of COH–IUI cycles and associated with decreased live birth rates.

To ascertain the association between basal progesterone (P) levels and the occurrence of preovulatory progesterone rise (PPR) and clinical pregnancy rates (CPRs) in ICSI cycles with GnRH antagonists.Serum P levels of 464 patients were measured on day 2 and day of hCG of cycles. Cycles with basal P levels1.6ng/mL were cancelled. All embryos were cryopreserved in cycles with P levels≥2ng/mL on the day of hCG. The primary outcome measures were the incidence of PPR (P1.5ng/mL) and CPR with regard to basal P.Basal P levels were significantly higher in cycles with PPR than in those without PPR (0.63±0.31 vs. 0.48±0.28ng/mL). Area under the curve for basal P according to ROC analysis to discriminate between elevated and normal P levels on the day of hCG was 0.65 (0.58-0.71 95% CI, p0.01). The cut-off value for basal P levels that best discriminates between cycles with and without PPR was 0.65ng/mL. Cycles with basal P levels above 0.65ng/mL had a significantly higher incidence of PPR (30.9% vs. 13.5%) but similar clinical and cumulative pregnancy rates (38.8% vs. 31.1% and 41.7% vs. 32.6%, respectively) in comparison to cycles with basal P levels below 0.65ng/mL. In multivariate regression analysis, basal P levels, LH level on the first day of antagonist administration, and estradiol levels on the day of hCG trigger were the variables that predicted PPR.Basal P levels were associated with increased incidence of PPR but not with CPR.

To determine the impact of sperm morphology on success of intrauterine insemination (IUI) in unexplained and male subfertility.Basal and post-wash normal percentage of sperm with normal morphology was assessed prospectively in 412 couples with 530 IUI cycles who underwent ovarian hyperstimulation with gonadotropins. The primary outcome was live birth per cycle. Receiver operating characteristics (ROC) curves were used to determine the effectiveness of sperm morphology to predict live birth in IUI cycles.Normal sperm morphology (%) after preparation was higher in patients with live birth (5.4 ± 4.5 vs 4.3 ± 4.1; respectively, p.05) in study population. In male subfertile group, normal sperm morphology before and after sperm preparation was higher in patients with live birth (1.3 ± 1.4 vs 0.6 ± 0.9; p0.001 and 4.6 ± 4.4 vs 1.9 ± 2.2; p0.01, respectively). However, both basal and post-wash normal sperm morphology (%) were similar in patients with and without live birth in unexplained group. The best cut-off value for normal sperm morphology (%) to predict live birth was 4.5% in male subfertile group with a sensitivity of 50.6% and specificity of 61.7%.Morphological evaluation is not a reliable parameter alone for predicting pregnancy outcome in unexplained infertility. In male subfertility, post-wash normal sperm morphology percentage higher than 4.5 increases the probability of live birth.

This study investigates the effects of anticoagulant therapy on pregnancy outcomes in 204 patients with thrombophilia and previous poor obstetric outcomes. Patients with poor obstetric history (pre-eclampsia, intrauterine growth retardation, fetal death, placental abruption, recurrent pregnancy loss) and having hereditary thrombophilia were included in this study. Poor obstetric outcomes were observed more frequently in patients who had not taken anticogulant therapy compared with treated group. Live birth rate, gestational age at birth and Apgar scores were significantly higher in the treated group when compared with the untreated group. There were no significant differences in terms of birthweight, mode of delivery and admission rates to the neonatal intensive care unit (NICU). Low-molecular-weight heparin (LMWH) plus acetylsalicylic acid (ASA) had higher gestational age at birth, Apgar scores, live birth rate and a lower abortion rates when compared with controls; in contrast, no significant difference was observed in terms of birthweight, mode of delivery, obstetric complications and admission rates to NICU. There were no significant differences between control group and both LMWH only and ASA only groups in terms of gestational age at birth, Apgar scores, birthweight, mode of delivery, obstetric complications and admission rates to NICU. Only LMWH group had higher live birth rate as compared with control group. The use of only ASA did not seem to affect the perinatal complication rates and outcomes. In conclusion, anticoagulant therapy with both LMWH and ASA seems to provide better obstetric outcomes in pregnant women with thrombophilia and previous poor obstetric outcomes. Blood Coagul Fibrinolysis 26: 267-273 Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

Aim: We aimed to investigate possibility of different ovarian volume threshold and to study diagnostic thresholds for polycystic ovary in Turkish women, since the literature on this subject is very limited. Material and Method: Clinical study carried out Namik Kemal University School of Medicine, Tekirdag, Turkey.This case-control study included 132 patients with polycystic ovary syndrome (PCOS), diagnosed according to Rotterdam criteria and 75 controls. Comparison of ovarian volumes between PCOS patients and control group. Results: We found a mean ovarian volume of 9.44 ± 4.3 cm3 in PCOS cases and 7.63 ± 3.66 cm3 in control cases. The area under curve (AUC) for mean ovarian volume (MOV) was 0.633. The analysis showed that setting the threshold of MOV at 8.2 cm3 offered the best compromise between specificity (61.3%) and sensitivity (53.8%). Discussion: Optimum threshold of ovarian volume to distinguish the PCOS from normal women and the mean ovarian volume in Turkish PCOS patients remain beneath the criteria by Rotterdam.

To compare the efficacy of intrauterine insemination (IUI) cycles undergoing ovarian hyperstimulation with recombinant FSH (rFSH) or clomiphene citrate (CC) in couples with unexplained and male subfertility.Two hundred and nineteen subfertile couples were enrolled in this randomized prospective study. Patients were randomly assigned to receive 75IU rFSH or 100mg CC for two cycles. Cycles with more than four dominant follicles and/or serum E2 levels higher than 1500pg/ml were cancelled. Primary outcomes were live birth rates per patient and per cycle, secondary outcomes were clinical and multiple pregnancy rates.One hundred and nine women received rFSH and 110 received CC. Both cumulative clinical pregnancy and live birth rates per patient were significantly higher in gonadotropin group (43.1% and 37.6%) as compared to CC group (28.2% and 20%) (p0.05 and p0.01, respectively). Live birth rate per cycle were significantly higher in gonadotropin group (24.3%) in comparison with CC group (13.8%) (p0.05). However, clinical pregnancy rate per cycle was not different between groups (28.4% vs 20%) (p0.05). There was no significant difference between gonadotropin and CC group groups in terms of multiple pregnancy rates (10.4% vs 12.5%, p0.05). Continuous variables were compared with Student's t test. Categorical variables were compared with Chi square test.rFSH has significantly higher cumulative clinical pregnancy and live birth rates when compared to CC with similar multiple pregnancy rates in subfertile patients undergoing IUI.

To compare the efficacy of gradient and swim-up semen preparation techniques on pregnancy rates in couples undergoing intrauterine insemination (IUI) cycles with low dose gonadotropin stimulation with the diagnosis of unexplained or mild male subfertility.Two hundred and twenty three couples were randomized into swim up or gradient technique groups for sperm preperation. The clinical and on going pregnancy rates per cycle and per patient were evaluated.Both clinical and ongoing pregnancy rates per cycle were significantly higher in the "gradient" group (19% and 16.9%) in comparision with the "swim up" group (9.7% and 6.9%) (p 0.05). Clinical pregnancy and on-going pregnancy rates per patient were higher in the "gradient" group (26.1% and 23.4%) when compared to the "swim up" group (15.2% and 10.7%), (p 0.05). In the subgroup of 191 unexplained subfertile couples with 290 cycles; the "gradient" group also revealed significantly higher clinical and ongoing pregnancy rates per cycle (21.6% and 17.9%) when compared with the "swim up" group (10.3% and 7.1%) (p 0.05). In total of 48 treatment cycles upon 32 couples with mild male factor subfertility no significant difference were found between the two sperm preparation techniques in terms of clinical (% 5.3 vs %6.9, p 0.05) and ongoing (% 5.3 vs %6.9, p 0.05) pregnancy rates per cycle.The gradient technique significantly improves clinical outcome in IUI cycles of unexplained subfertile couples when compared to swim up technique. In male subfertile patients, both techniques yield similar clinical outcomes.

Background and Objectives: The aim of this study was to compare the in vitro fertilization (IVF) outcomes of long gonadotropin-releasing hormone agonist (GnRH-a) and GnRH-antagonist (GnRH-ant) protocols in endometriosis patients who have undergone laparoscopic endometrioma resection surgery. To our knowledge, there is no study in the current literature that compares the effectiveness of long GnRH-a and GnRH-ant protocols in management of IVF cycles in endometriosis patients who underwent laparoscopic endometrioma resection surgery. Methods: Eighty-six patients with stage III to IV endometriosis who had undergone laparoscopic resection surgery for endometrioma were divided into 2 groups: those who had ovarian stimulation with a long GnRH-a protocol (n = 44), and those who had ovarian stimulation with a GnRHant protocol (n = 42). Results: The number of follicles on human chorionic gonadotropin injection day, duration of hyperstimulation, number of retrieved metaphase II oocytes, and total number of grade 1 embryos were statically significantly higher in the long GnRH-a protocol. There were no significant differences in positive beta-human chorionic gonadotropin pregnancy rates (25% vs 21.4%; P = .269) and ongoing pregnancy rates per patient (20.5% vs 19.1%; P = .302) between the 2 protocols. Conclusions: Long GnRH-a and GnRH-ant protocols both present similar IVF outcomes in patients with endometriosis who have undergone laparoscopic endometrioma resection surgery. A long GnRH-a protocol may lead to a higher number of embryos that can be cryopreserved, providing the possibility of additional embryo transfers without having to go through the process of ovarian stimulation again. Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [33502] An earlier version of this research was presented at the 29th Annual Meeting of the European Society of Human Reproduction and Embryology in London, 2013. This was made possible by funding from the Scientific Research Projects Coordination Unit of Istanbul University (#33502).

Objectives To evaluate the predictive value of uterine artery Doppler characteristics in predicting copper intrauterine device (IUD)-induced side effects such as dysmenorrhoea and menorrhagia, and worsening of dyspareunia. Methods One hundred and twenty regularly menstruating women were enrolled in the study. All underwent transvaginal uterine artery Doppler analysis in the early follicular phase, on two occasions: before insertion of the IUD, and six months after insertion. Pre- and post-insertion resistance (RI) and pulsatility (PI) indices of the uterine arteries were measured. Doppler parameters were compared between subjects experiencing an increase in IUD-mediated side effects and those reporting no change. Results RI and PI of all participants before and after IUD insertion were not signifi cantly different (0.75 � 0.06 vs. 0.74 � 0.09, p � 0.49; 1.81 � 0.55 vs. 1.83 � 0.70, p � 0.7, respec- tively). No signifi cant difference was found in the comparison of pre- and post-insertion PI and RI values of women who had increased- and those who experienced no change in dysmenorrhoea, dyspareunia and duration/amount of menstruation. Conclusions No major changes in uterine blood fl ow were observed in women experienc- ing increased menstrual bleeding, dyspareunia or dysmenorrhoea after insertion of a copper IUD. The occurrence of these effects cannot be predicted by prior Doppler fl ow analysis.

Amac: Elazig Egitim ve Arastirma Hastanesi’nde 2009 - 2012 yillari arasinda yapilan vajinal dogum ile sezaryen dogum oranlarini ve sezaryen endikasyonlari incelemek, sezaryen oranlarinin artisi bilgisiyle Turkiye gercegine katki saglamak ve sezaryen oranlarinin azaltilabilmesi icin cozum yollari aramaktir. Yontemler: Calismaya 01.01.2009 ile 31.12.2012 tarihleri arasinda Elazig Egitim ve Arastirma Hastanesi Kadin Hastaliklari ve Dogum Bolumu’nde dogum yapmis hastalar dahil edilmistir. Hastalarin demografik ozellikleri, gravida ve parite durumu, dogum haftasi, dogum sekli, sezaryen endikasyonlari, dogum agirliklari, yenidogan cinsiyetleri hastane kayitlarindan retrospektif olarak tarandi. Yillara gore sezaryen oranlari ve sezaryen endikasyonlari belirlendi. Bulgular: 2009-2012 yillari arasinda gerceklesen 13874 dogumun %55.6’si (n=7720) normal spontan vajinal dogum, %44.4’u (n= 6154) ise sezaryen ile dogum gerceklesmistir. Tum dogumlar icindeki sezaryen endikasyonlari incelendiginde; 2391 (%17.2) hastanin mukerrer sezaryen, 387 (%2.7) hastanin makat prezentasyon, 1067 (%7.6) hastanin bas-pelvis uygunsuzlugu ve 1125 (%8.1) hastanin fetal distress, 279 (%2) hastanin makrozomi, kalan hastalarin ise diger nedenler (plasenta dekolmani, kordon sarkmasi, cogul gebelik, preeklampsi) ile sezaryene alindigi tespit edilmistir. Yillara gore sezaryen istatistigi incelendiginde; 2009 yilinda %41.6 (n=1491) hastaya, 2010 yilinda %45,7 (n=1739) hastaya, 2011 yilinda %43 (n=1499) hastaya ve 2012 yilinda %43.7 (n=1225) hastaya sezaryen ile dogum uygulandigi saptanmistir. Sonuc: Sezaryen oranlarimizdaki artis dunyadaki ve Turkiye’deki artis oranlariyla paralellik gostermektedir. Artmis sezaryen oranlarinin azaltilmasi hekim, hasta ve saglik politikalari belirleyicilerinin isbirligi ile multidisipliner bir yaklasim gerektiren stratejilere ihtiyac duymaktadir. Normal 0 false false false TR X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normal Tablo"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

To determine the predictive value of serum anti-müllerian hormone (AMH) concentrations and antral follicle counts (AFC), on ovarian response and live birth rates after IVF and compare with age and basal FSH.Basal levels of AMH, FSH and antral follicle count were measured in 192 patients prior to IVF treatment. The predictive value of these parameters were evaluated in terms of retrieved oocyte number and live birth rates.Poor responders in IVF were older, had lower AFC and AMH but higher basal FSH levels. In multivariate analysis AFC was the best and only independent parameter among other parameters and AMH was better than age and basal FSH to predict poor response to ovarian stimulation. Addition of AMH, basal FSH, age and total gonadotropin dose to AFC did not improve its prognostic reliability. Area under curve (AUC) for each parameter according to ROC analysis also revealed that AFC performed better in poor response prediction compared with AMH, basal FSH and age. The cut-off point for mean AMH and AFC in discriminating the best between poor and normal ovarian response cycles was 0.94 ng/mL (with a sensitivity of 70% and a specificity of 86%) and 5.5 (with a sensitivity of 91% and a specificity of 91%), respectively. However, age was the only independent predictor of live birth in IVF as compared to hormonal and ultrasound indices of ovarian reserve.AFC is better than AMH to predict poor ovarian response. Although AMH and AFC could be used to predict ovarian response they had limited value in live birth prediction. The only significant predictor of the probability of achieving a live birth was age.

Aciklanamayan infertilite, kovansiyonel tetkiklerle sebebi tespit edilemeyen ve infertil ciftlerin %15’inde gorulen bir durumdur. Nedeni tespit edilemedigi icin tedavisinde kullanilan yontemler nedeni ortadan kaldirmaktan cok ampirik olarak fertilite oranlarini artirmaya yoneliktir. Bu amacla; bekleme tedavisi, klomifen sitrat, gonadotropin ile ovaryen hiperstimulasyon, intrasevikal inseminasyon, intrauterine inseminasyon ve in vitro fertilizasyon gibi tedavi yontemleri gunumuze kadar tek baslarina veya kombine olarak kullanilmaktadir. Bu derlemedeki amac, literaturde mevcut tedavi yontemlerinin etkinligini gostererek, aciklamayan infertilite tedavisinde uygun tedavi stratejileri gelistirmeye yardimci olmaktir.

Diminished ovarian reserve is a more common occurrence as more women postpone childbearing in modern societies due to social and demographic trends. Diminished ovarian reserve is one of the primary reasons for poor ART outcome. Due to high costs, side effects and heavy burden on patients on ART treatments, patient selection and counseling for prognosis is an important aspect before starting ART. Proper prediction of ovarian reserve before initiation of the treatment can decrease cycle cancellations, help clinicians to establish alternative treatment options (i.e.oocyte donation) for poor prognosis patients. However, indicators of ovarian reserve are not fully successful in predicting the outcome of the treatment. In this review, our aim was to discuss the efficacy of ovarian reserve tests on predicting poor ovarian response and treatment outcome in ART patients.Günümüzde modern toplumlarda kadınların evliliklerini çeşitli nedenlerle geciktirmesi nedeniyle düşük over rezervi ile daha sık karşılaşılmaktadır. ART tedavisi sırasında düşük over reservi başarıyı azaltan başlıca nedenlerden birisidir. Tedavilerin maliyeti, yan etkileri, hasta açısından zorlukları göz önüne alındığında uygun hasta seçimi ve uygun prognoz belirlenmesinin oldukça önemli olduğu görülmektedir. Tedavi öncesi ovaryen yanıtın öngörülmesi ile yetersiz ovaryen yanıt nedeniyle siklus iptalleri azaltılabilmekte; aynı zamanda hekime uygun tedavi stratejileri geliştirme ve kötü prognozlu hastaları alternatif yöntemlere (oosit donasyonu) yöneltmeyi sağlayabilmektedir. Günümüzde bu amaçla kullanılan birçok belirteç mevcuttur. Ancak bu belirteçler tedaviye verilen yanıt hakkında fikir verse de hiç birisi tek başına tedavi başarısını göstermede tam güvenilir değildir. Bu derlemede ART tedavisi alan hastalarda kötü ovaryen yanıtı ve başarıyı ön görmede kullanılan over rezerv testlerinin etkinliği tartışılmaktadır.