Objective:Hemoglobinopathies are among the most common inherited disorders worldwide. Given the high prevalence and carrier rates in our region, this study aimed to evaluate the obstetric, genetic, and procedure-related outcomes of pregnancies undergoing chorionic villus sampling (CVS) for prenatal diagnosis. Materials and Methods:This retrospective observational study included 1,330 pregnant women referred for hemoglobinopathy screening between January 2008 and December 2012. Data regarding gestational age, indication for CVS, placental location, number of insertions, complications, and genetic results were analyzed. Transabdominal CVS was primarily performed between 10 and 14 weeks of gestation. Results:The mean gestational age at CVS was 12.4±1.03 weeks. Late referral (≥14 weeks) was observed in 8.8% of cases. Adequate sampling was achieved with a single insertion in 88.3% of procedures. The overall complication rate was 2.6%, with a fetal loss rate of 1.8% and an incidence of chorioamnionitis of 0.07%. Multiple insertions (p=0.036) and posterior placental location (odds ratio: 2.21; 95% confidence interval: 1.11-4.38; p=0.033) were significantly associated with an increased risk of complications. Genotype analysis showed that 50.2% of fetuses were carriers, 25.4% were normal, and 21% were affected. Pregnancy termination was performed in most of the affected cases (n=266), while 11 cases resulted in live births. Hemoglobin S (HbS) was the most frequent variant (31%), followed by HbD and HbE. The most common β-thalassemia mutation was IVS-I-110 (G>A), and the most frequent α-thalassemia mutation was -α3.7 deletion. Conclusion:CVS is a reliable and effective method for early prenatal diagnosis of hemoglobinopathies. Procedure-related risks are influenced by technical factors, such as the number of insertions and placental location. Standardization of techniques and operator experience may reduce complications. In high-prevalence regions, the integration of carrier screening and early prenatal diagnosis is essential to reduce the disease burden.
Objective:To synthesize current evidence on the effects of natural compounds on oxidative stress and angiogenic biomarkers, particularly malondialdehyde (MDA), soluble fms-like tyrosine kinase-1 (sFlt-1), and placental growth factor (PlGF), in experimental models of preeclampsia. Materials and Methods:A narrative review was conducted of studies retrieved from PubMed, Scopus, ScienceDirect, and Web of Science (2016-2026). Experimental animal studies that evaluated natural compounds and reported outcomes related to MDA, sFlt-1, PlGF, or angiogenic pathways were included. Study quality was assessed descriptively using the Joanna Briggs Institute framework. Results:Nine relevant experimental studies were included in the narrative synthesis. Interventions included Astragalus spp., pomegranate juice, young kopyor coconut water, soybean tempeh extract, Cosmos caudatus extract, Nigella sativa, Puerariae lobatae Radix, and olive leaf extract. Most interventions significantly reduced MDA and sFlt-1 levels, indicating reductions in oxidative stress and anti-angiogenic activity. Several compounds increased expression of PlGF and/or vascular endothelial growth factor, suggesting improved placental angiogenesis. Beneficial effects on placental morphology, blood pressure, proteinuria, and fetal outcomes were also reported. Conclusion:Natural compounds may ameliorate oxidative stress and angiogenic imbalance in experimental models of preeclampsia by reducing MDA and sFlt-1 levels and enhancing PlGF-mediated angiogenesis. These findings support their potential as adjunctive therapies for preeclampsia, although further mechanistic studies and clinical trials are needed to confirm their efficacy and safety. As this narrative review is based exclusively on findings from experimental animal models, these results should be interpreted with caution and not be directly extrapolated to clinical practice until they are confirmed by human studies.
Objective:To evaluate whether vulvar re-antisepsis before carbon dioxide (CO2) cystoscopy after laparoscopic hysterectomy is associated with a lower incidence of postoperative urinary tract infection (UTI). Materials and Methods:This prospective observational study included 98 women who underwent laparoscopic hysterectomy between November 25, 2025, and March 1, 2026. All patients received routine preoperative abdominal and vulvovaginal preparation with 10% povidone-iodine. According to routine intraoperative practice and surgeon preference, 53 patients underwent standard antisepsis alone, and 45 received additional vulvar and periurethral re-antisepsis immediately before CO2 cystoscopy. The primary outcome was a postoperative UTI, defined according to Centers for Disease Control and Prevention/National Healthcare Safety Network criteria. Logistic regression was used to explore factors associated with postoperative UTI. The study was registered at clinicaltrials.gov (NCT07232446). Results:Postoperative UTI occurred in 8 patients (15.1%) in the standard antisepsis group and in 4 patients (8.9%) in the re-antisepsis group (p=0.538). Vulvar re-antisepsis was not associated with postoperative UTI in the exploratory multivariable model [adjusted odds ratio (OR)=0.89, 95% confidence interval (CI): 0.19-4.23; p=0.881]. Delayed catheter removal (>6 hours) was associated with postoperative UTI (adjusted OR=12.87, 95% CI: 2.13-77.62; p=0.005). Conclusion:Vulvar re-antisepsis before CO2 cystoscopy did not result in a statistically significant reduction in postoperative UTIs. Given the limited number of events and the non-randomized design, these findings should be interpreted as exploratory.
Objective:Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is associated with lower postoperative pain, reduced analgesic requirements, and faster early postoperative recovery compared with laparoscopy in patients undergoing hysterectomy for benign indications. To compare postoperative pain and early recovery outcomes between vNOTES and conventional laparoscopy in patients undergoing hysterectomy for benign gynecologic indications. Materials and Methods:This single-center retrospective cohort study included 192 patients who underwent hysterectomy between March 2021 and September 2025. Patients were grouped according to surgical approach (vNOTES vs. laparoscopy). Postoperative pain was assessed using the visual analog scale at 6 and 24 hours. Primary outcomes were pain intensity and the requirement for additional analgesia. Secondary outcomes included operative time, change in hemoglobin, time to first flatus, and length of hospital stay. Multivariable logistic regression analysis was performed to identify predictors of analgesic requirement. Results:Of 192 patients, 75 (39.1%) underwent laparoscopy and 117 (60.9%) underwent vNOTES. Baseline characteristics were similar between groups. The vNOTES group had significantly lower pain scores at 6 and 24 hours (p=0.001) and a reduced need for additional analgesia (23.9% vs. 60.0%, p=0.001). Operative time was shorter and recovery outcomes, including time to first flatus and length of hospital stay, were significantly improved in the vNOTES group (p=0.001). Surgical approach, uterine weight, and operative time were independent predictors of analgesic requirement. Conclusion:In this retrospective cohort study, vNOTES was associated with lower postoperative pain scores, reduced analgesic requirement, and earlier recovery than conventional laparoscopy. These findings should be confirmed in prospective randomized studies.
Objective:To evaluate whether adjuvant 9-valent human papillomavirus vaccination improves viral clearance and reduces recurrence after excisional treatment for high-grade cervical intraepithelial neoplasia (CIN2+). Materials and Methods:This retrospective cohort study included women aged 18 years and older who underwent loop electrosurgical excision procedure for histologically confirmed CIN2+ between December 2023 and January 2026. Women with pre-treatment human papillomavirus positivity, negative surgical margins, and available post-treatment follow-up data were included. Patients were stratified according to post-treatment vaccination status. The primary outcome was human papillomavirus clearance at 24 months. Secondary outcomes included clearance at 6 and 12 months, persistent infection, time to viral clearance, and CIN2+ recurrence. Multivariable logistic and Cox regression analyses were performed. Results:A total of 666 women were included, of whom 212 (31.8%) received adjuvant vaccination and 454 (68.2%) did not. Clearance of human papillomavirus was higher in vaccinated than in unvaccinated women at 6 months (60.8% vs. 46.3%), 12 months (78.3% vs. 58.8%), and 24 months (87.7% vs. 77.8%). Persistent infection at 24 months was lower in the vaccinated group (12.3% vs. 22.2%). CIN2+ recurrence occurred in 3.8% of vaccinated women and 11.9% of unvaccinated women. Adjuvant vaccination was independently associated with faster viral clearance (adjusted hazard ratio: 2.0, 95% confidence interval: 1.5-2.7, p<0.001). Conclusion:Adjuvant 9-valent human papillomavirus vaccination after excisional treatment was associated with higher viral clearance and lower CIN2+ recurrence.
Objective:This study investigated whether routinely used second-trimester triple screening markers (alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol) could help identify pregnancies at increased risk of gestational diabetes mellitus. In addition, several hematological inflammation indices were evaluated as potential adjunctive predictors. Materials and Methods:Medical records of 405 singleton pregnancies were retrospectively reviewed. All participants underwent triple screening during gestational weeks 15-20 and subsequently underwent oral glucose tolerance testing during gestational weeks 24-28. Patients were categorized, according to oral glucose tolerance test findings, as either having gestational diabetes or as normoglycemic controls. Receiver operating characteristic analyses were performed to assess both the isolated and combined predictive capacities of measurements of alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol. The impact of maternal body mass index on model performance was also analyzed. Results:Alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol levels showed poor discriminatory ability for identifying pregnancies complicated by gestational diabetes, both individually and in combined models. However, adding maternal body mass index to the combined biomarker model substantially improved predictive accuracy (area under the curve=0.809; p<0.001). None of the evaluated inflammatory indices demonstrated significant predictive performance for gestational diabetes mellitus. Conclusion:Routine second-trimester triple screening markers appear to have limited standalone value for predicting gestational diabetes. Nevertheless, incorporating maternal body mass index considerably enhances model performance and may improve clinical risk stratification.
Objective:To investigate the value of fasting bile acid (FBA) levels and liver enzymes [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP). Materials and Methods:This retrospective study included 296 pregnant women diagnosed with ICP between 2020 and 2025. Patients were classified as having mild (FBA 10-40 μmol/L, n=223) or severe ICP (FBA >40 μmol/L, n=73). Clinical, laboratory, and neonatal outcomes were compared; receiver operating characteristic (ROC) analysis was performed to evaluate the predictive value of FBA for meconium passage; and patients who received ursodeoxycholic acid (UDCA) therapy were compared with those who did not. Results:Compared with the mild ICP group, patients with severe ICP had earlier gestational ages at diagnosis and at delivery, and lower birth weight and neonatal pH (all p<0.05). FBA levels were significantly associated with fetal growth restriction (p=0.042), preterm birth (p=0.003), neonatal intensive care unit (NICU) admission (p<0.001), and meconium passage (p<0.001). AST was associated only with NICU admission and meconium passage, whereas ALT showed no significant association with perinatal complications. The median FBA level was significantly higher in patients with meconium passage (105 vs. 20 μmol/L; p<0.001). ROC analysis identified an FBA cut-off of 88.45 μmol/L (area under the curve=0.694), with 57.1% sensitivity and 81.3% specificity. Conclusion:FBA is the strongest predictor of adverse perinatal outcomes in ICP. AST provides complementary prognostic information, whereas ALT has limited predictive value. Clinical management should be guided by FBA-based risk stratification and individualized timing of delivery.
Objective:To compare depressive and anxiety symptoms in women with unwanted and planned pregnancies. Materials and Methods:In this cross-sectional comparative study, we enrolled 220 pregnant women who presented to the Obstetrics and Gynecology Department of Yozgat Bozok University between January 2023 and June 2025. The study group comprised 120 women with unwanted pregnancies seeking elective termination before 10 weeks of gestation. The control group included 100 women with planned pregnancies. Socio-demographic and obstetric data were collected. Depressive and anxiety symptoms were assessed using the Beck Depression Inventory and Beck Anxiety Inventory, respectively. Results:Women with unwanted pregnancies had a significantly higher prevalence of depressive symptoms than women with planned pregnancies (46.7% vs. 28.0%; p=0.004). In contrast, there was no statistically significant difference in the prevalence or severity of anxiety symptoms between the groups (p=0.450). Women in the unwanted pregnancy group were significantly older, had higher parity and lower educational attainment, and were more likely to be unmarried (all p<0.001). Following termination, 20.8% of women had no future contraceptive plans, whereas 40% intended to use an intrauterine device. Conclusion:Unwanted pregnancy culminating in a request for termination is a potent risk factor for depressive symptoms, particularly among socioeconomically vulnerable women, but not necessarily for anxiety. These findings underscore the critical need to integrate mental health screening, especially for depression, and comprehensive, patient-centered contraceptive counseling into routine antenatal and post-abortion care services. Addressing the psychosocial needs of this population is essential for mitigating adverse mental health outcomes.
Objective:Preeclampsia (PE), a significant challenge for health systems, is a hypertensive disorder of pregnancy. Some studies have suggested that long non-coding ribonucleic acids play a major role in the pathogenesis of PE by regulating the biological behaviors of maternal vascular smooth muscle cells and trophoblasts. In this study, the impact of the maternally expressed gene 3 (MEG3) rs4081134 gene polymorphism on susceptibility to PE has been evaluated. Materials and Methods:We conducted a case-control study comprising 130 PE patients and 140 normotensive pregnant women with normal gestational outcomes. Genotype analysis was performed using the polymerase chain reaction-restriction fragment length polymorphism method. Results:A significant association was evident between the AA genotype and PE risk under the recessive model, indicating that these may serve as protective factors against the development of PE. No significant relationships were detected between other genotypes, genetic models, or allelic distributions and PE risk. Additionally, among pregnant women with PE, a notable correlation was observed between newborn birth weight and the rs4081134 polymorphism in the MEG3 gene. Conclusion:We found a significant association between the AA genotype, as well as the recessive model of the MEG3 rs4081134 gene polymorphism, and PE deployment. Among women diagnosed with PE, MEG3 rs4081134 gene polymorphism was significantly associated with newborn's birth weight.
Objective:To compare follicular fluid (FF) cytokine and homocysteine profiles in women with poor ovarian response (POR) undergoing in vitro fertilization (IVF), with and without sonographic endometrioma, and to explore potential inflammatory alterations associated with endometrioma in this population. Materials and Methods:This prospective comparative study was conducted among 60 women diagnosed with POR who were undergoing IVF treatment. Participants were divided into two groups according to the presence of sonographic endometrioma: Group I included women without sonographic endometrioma (n=30) and Group II included women with sonographic endometrioma (n=30). FF samples were collected during oocyte retrieval and analyzed for inflammatory biomarkers. Concentrations of interleukin-1β (IL-1β), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23, IL-33, interferon-α2 (IFN-α2), IFN-γ, tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and homocysteine were measured using LEGENDplex multiplex assays and flow cytometry. Cytokine and homocysteine levels were compared between groups. Results:Most inflammatory cytokines, including IL-1β, IL-6, IL-8, IFN-γ, and MCP-1, showed lower levels in women with sonographic endometrioma compared with women without sonographic endometrioma. In contrast, TNF-α and IL-33 levels tended to be higher in the endometrioma group. Homocysteine levels were also lower in women with sonographic endometriomas. However, none of the observed differences reached statistical significance. Overall, the findings suggested distinct, albeit non-significant, inflammatory trends in the FF microenvironment of women with POR and sonographic endometrioma. Conclusion:Women with POR and sonographic endometrioma showed altered trends in FF inflammatory-marker profiles compared with women without sonographic endometrioma; however, these differences were not statistically significant. Since the absence of sonographic endometrioma does not exclude endometriosis, the findings should be interpreted cautiously. Larger prospective studies that include IVF and assess embryological and reproductive outcomes are required to clarify the clinical significance of FF biomarkers in women with POR and endometrioma.
Objective:The 2023 update of the International Federation of Gynecology and Obstetrics (FIGO) staging system introduced significant changes in the classification of endometrial cancer by incorporating key pathological and molecular features. This study aimed to evaluate the impact of the revised FIGO 2023 staging system on stage distribution and adjuvant treatment decisions in patients undergoing surgical management of this malignancy. Materials and Methods:This retrospective study included 220 patients who underwent surgical staging for endometrial cancer between January 2018 and December 2025. All patients were initially staged using the FIGO 2009 classification. Cases were subsequently reclassified according to the FIGO 2023 staging criteria, using the algorithm proposed for settings in which routine molecular classification is unavailable. The McNemar test was used to compare stage categories between the two staging systems, and the Wilcoxon signed-rank test was applied to evaluate the impact of stage migration on adjuvant treatment recommendations. Results:Stage migration occurred in 12.7% of patients (28/220) following the application of the FIGO 2023 criteria, predominantly due to upstaging. The most common factor associated with stage reclassification was substantial lymphovascular space invasion (LVSI). The proportion of patients managed with observation alone significantly decreased from 44.5% to 32.7% (p<0.001), while the use of pelvic radiotherapy increased from 19.1% to 28.2% (p=0.004). Similarly, the proportion of patients receiving combined chemoradiotherapy significantly increased from 11.8% to 17.3% (p=0.012). Conclusion:The implementation of the FIGO 2023 staging system has resulted in clinically meaningful stage migration and significantly impacted adjuvant treatment strategies. In particular, the recognition of substantial LVSI as a defining feature of stage IIC disease has led to more intensive adjuvant therapy in a subset of patients previously categorized as low risk.
This paper presents a comprehensive cadaveric dissection atlas detailing the retroperitoneal anatomy essential to advanced pelvic surgery. Developed by a multidisciplinary team of anatomists, gynecologists, and gynecologic oncologists, the study provides a systematic, layer-by-layer guide for navigating the pelvic avascular spaces. It details five critical surgical corridors: the presacral (retrorectal) space, the pararectal space (divided into the Latzko and Okabayashi compartments), the paravesical space (medial and lateral compartments), the prevesical (retropubic/Retzius) space, and the medial psoas space (laterovascular plane). This atlas emphasizes the use of reliable landmarks, such as the sacral promontory, the obliterated umbilical artery, and the ureter, to define anatomical boundaries and ensure safe surgical practice. The primary objective is to maintain adequate exposure after retroperitoneal entry and to perform layer-by-layer surgical dissection to identify critical anatomical structures. The superior hypogastric plexus; hypogastric nerve; pelvic splanchnic nerves; inferior hypogastric plexus with its vesical and rectal branches; the internal iliac artery with its posterior and anterior trunk branches (including the superior gluteal, iliolumbar, lateral sacral, uterine, inferior gluteal, pudendal, obturator, middle rectal, and inferior and superior vesical arteries, and the obliterated umbilical artery); the external iliac artery; and the corresponding internal and external iliac veins were discussed. Additionally, the somatic nerves, obturator nerve, lumbosacral trunk, sacral nerves, sciatic nerve, genitofemoral nerve, and femoral nerve were reviewed. The parietal fascial planes, pubocervical fascial structure, and visceral compartments were evaluated as part of the whole. Respecting fascial planes-particularly the presacral fascia-is mandatory to avoid catastrophic hemorrhage and autonomic nerve injury. These spaces serve as the "neurovascular roadmap" for complex procedures, including radical hysterectomy, nerve-sparing pelvic surgery, pelvic lymphadenectomy, and hemorrhage control. Mastery of these interconnected retroperitoneal compartments facilitates a transition from organ-based to space-oriented surgery, significantly reducing morbidity while maintaining oncologic radicality.
Objective:Premature ovarian insufficiency (POI) is defined by irregular menstrual cycles or amenorrhea before age 40 with elevated follicle-stimulating hormone (FSH) levels. We evaluated FOXL2 and BMP15 variants in Turkish women with POI and assessed the distribution of the BMP15 promoter variant c.-9C>G in a case-control setting. Materials and Methods:Seventy-five women younger than 40 years with hypergonadotropic hypogonadism, primary/secondary amenorrhea, serum FSH ≥25 mIU/mL on two occasions at least four weeks apart, a normal 46,XX karyotype, and negative FMR1 CGG repeat testing were included. Women with prior ovarian surgery, pelvic chemotherapy/radiotherapy, or endocrine or autoimmune disease were excluded. FOXL2 and BMP15 coding regions and intron-exon junctions were analyzed by Sanger sequencing. BMP15 c.-9C>G genotype frequencies were compared with 80 ethnically matched controls with normal ovarian function. Genotype-specific analyses compared CG versus CC + GG using Fisher's exact test, with odds ratios (ORs) and 95% confidence intervals (CIs). Results:No pathogenic POI-associated variants were detected in FOXL2 or BMP15. The heterozygous BMP15 c.-9C>G variant was identified in 34/75 patients; it occurred alone in 21, with c.308A>G in 12, and with c.352G>A in 1 patient. In the case-control comparison, the CG genotype was more frequent in POI than in controls (34/75, 45.3% vs. 15/80, 18.8%) and was associated with increased POI risk (OR=3.59, 95% CI: 1.74-7.40; p=0.0005). Conclusion:No pathogenic BMP15 or FOXL2 variant was identified. The BMP15 c.-9C>G variant may be associated with susceptibility to POI in this Turkish cohort, but this finding requires confirmation in larger, unrelated, well-matched populations and functional studies.
Objective:To evaluate thiol-disulfide (DS) homeostasis in women with ovarian cancer and to assess its ability to distinguish malignant ovarian tumors from benign ovarian neoplasia and healthy women. Materials and Methods:This prospective comparative study included 39 women with histopathologically confirmed ovarian cancer, 30 with benign ovarian neoplasia, and 46 age- and body mass index-matched healthy women. Serum native thiol (NT), total thiol (TT), DS, and ischemia-modified albumin (IMA) levels were measured. Thiol-DS indices were calculated as DS/NT (DNT), DS/TT (DTT), and NT/TT (NTT). Data were analyzed statistically. The study was registered at ClinicalTrials.gov (NCT05011539). Results:Compared with healthy women, the ovarian cancer group exhibited lower NT, TT, and NTT values, along with higher DS, DNT, and DTT values. When malignant and benign ovarian neoplasms were compared, NT and NTT values were lower, whereas DNT and DTT ratios were higher. IMA levels did not differ between groups. Serum CA-125 levels were positively correlated with DNT and DTT, and negatively correlated with NT, TT, and NTT. Conclusion:Thiol-DS imbalance is more pronounced in ovarian cancer than in benign ovarian neoplasia and in healthy women, suggesting that these markers may be useful adjuncts in the preoperative evaluation of adnexal masses.
Objective: To test the hypothesis that flexible progestin-primed ovarian stimulation (fPPOS) is non-inferior to the gonadotropin-releasing hormone (GnRH) antagonist protocol in terms of safety and efficacy for patients undergoing controlled ovarian hyperstimulation and preimplantation genetic testing for aneuploidy (PGT-A). Materials and Methods: This retrospective analysis included data from 548 cycles involving 367 women aged 35 to 45 years. The fPPOS and GnRH antagonist groups comprised 307 cycles (56%) and 241 cycles (44%), respectively. All participants underwent absolute blastocyst culture, trophectoderm biopsy, and PGT-A, with advanced maternal age as the sole indication. The primary outcomes were incidence of premature luteinizing hormone (LH) rise (>10 mIU/mL), cycle cancellation due to premature ovulation, and euploid blastocyst rate per injected metaphase II oocyte. Spearman's rho correlation and the generalized linear model (logit) were applied for statistical analysis. Results: The incidence of premature LH rise (8.2% versus 6.6%; p=0.302) and cycle cancellation due to premature ovulation (2% versus 0.4%; p=0.112) did not differ significantly between the fPPOS and GnRH antagonist groups. Maturation, fertilization, and blastulation rates were also similar (p>0.05). The euploid blastocyst rates per biopsy (50.12% versus 53.06%; p=0.317) and per injected metaphase II oocyte (23.84% versus 23.34%; p=0.231) were comparable between groups. Secondary outcomes, including rates of positive pregnancy tests, implantation, ongoing pregnancy, biochemical pregnancy losses, and early miscarriages, were also similar (p>0.05). Conclusion: The fPPOS protocol represents a viable alternative to the GnRH antagonist protocol for patients aged 35 years or older undergoing PGT-A.
Objective: We aimed to show that inverted microscope is a reliable and highly accurate method for evaluating oocyte nuclear maturation before cumulus-oocyte complex (COC) denudation. Materials and Methods: This single-center prospective observational study was conducted between 15 October and 15 November 2025. Non-dominant follicles with a diameter <10 mm were retrieved and evaluated under an inverted microscope to predict oocyte nuclear maturation prior to COC denudation. A total of 974 oocytes were retrieved from 59 patients; 250 COCs obtained from follicles <10 mm were analyzed. COCs were divided into three groups: (i) COCs with germinal vesicle (GV) oocytes, (ii) COCs with non-GV oocytes, and (iii) unclassified COCs. Two hours later, COCs were denuded, and the diagnostic accuracy of the inverted microscope was assessed. Results: Ninety-seven COCs were classified as GV, 127 as non-GV, and 26 as unidentified. After denudation, 94 of 97 COCs were confirmed as GV oocytes, and 124 of 127 COCs were confirmed as non-GV oocytes. The accuracy of the inverted microscope in identifying nuclear maturation for GV and non-GV oocytes was 96.91% and 97.64%, respectively. No statistically significant difference in diagnostic accuracy was observed between embryologists. Conclusion: Currently, no method can definitively determine oocyte nuclear maturation before COC denudation. This method allows the prediction of oocyte nuclear maturation before denudation with high accuracy, potentially improving in vitro maturation outcomes by preserving cumulus-oocyte communication.
Objective To compare the maturation rate and developmental potential of immature oocytes subjected to and spared from cumulus-oocyte complex (COC) denudation. Materials and Methods This single-center prospective observational study was conducted between 15 November-15-December 2025. Germinal vesicle (GV) oocytes were allocated to two groups: Group 1 included oocytesobtained from follicles >10 mm and identified as GV following denudation, whereas group 2 included immature oocytes retrieved from non-dominant follicles with diameter <10 mm, and assessed under an inverted microscope immediately after oocyte retrieval and placed into culture medium without being denuded. All immature oocytes were cultured separately in Continuous Single Culture-NX Complete medium, supplemented with gentamicin and human serum albumin, for 24 hours. COCs in group 2 were subsequently denuded and evaluated for nuclear maturation. Oocytes reaching metaphase II (MII) underwent intracytoplasmic sperm injection. The primary outcome was the MII maturation rate; secondary outcomes included 2PN formation rate and cleavage-stage embryo rate. Results A total of 885 oocytes were retrieved from 52 patients. Group 1 included 84 denuded GV oocytes, and group 2 comprised 141 non-denuded COCs. After 24 hours of culture, maturation rates in groups 1 and 2 were 3/84 (2.37%) and 52/141 (36.9%), respectively. In group 1, only one oocyte was fertilized, and the resulting embryo arrested on day 3. In group 2, the fertilization and day-3 embryo rates were 23/48 (47.9%) and 14/23 (73.4%), respectively. Conclusion Non-denuded immature oocytes demonstrated significantly higher maturation, fertilization, and embryo development rates compared with denuded oocytes.
Objective: C-kit, E-cadherin and beta-catenin adhesion molecules and proto-oncogenes are thought to be associated with molecular mechanisms related to the invasion, implantation and persistence of ectopic endometrial cells. Comparing the expression levels of these molecules in endometriomas, other types of endometriosis, and normal endometrial tissue may provide further insight into the mechanisms driving endometriosis development. The present study sought to examine the molecular pathophysiological roles of these molecules by determining their expression profiles in different types of endometriosis and in the healthy endometrium. Materials and Methods: Retrospective data from 180 cases were analyzed, comprising 60 endometriomas, 60 cases of other types of endometriosis (superficial and deep), and 60 normal proliferative endometrial tissue samples. Immunohistochemical staining for c-kit, E-cadherin, and beta-catenin was performed. The expression levels of E-cadherin and beta-catenin were quantified using the H-score method. Results: C-kit positivity was found in 9% of endometriomas and 10% of other endometriosis tissues, but was absent in normal endometrium. Betacatenin H-scores were significantly lower in endometriosis tissues compared with normal endometrial tissues (p<0.001). E-cadherin levels showed no significant difference between the groups. A post-hoc power analysis confirmed that the study was adequately powered to detect group differences in E-cadherin, indicating that the non-significant finding likely reflects a true absence of a difference. Conclusion: Increased c-kit expression, along with reduced beta-catenin expression in endometriosis samples, suggests that these molecules contribute to endometriosis pathogenesis. However, because no significant difference was found in E-cadherin expression, a definitive conclusion cannot be made regarding the involvement of E-cadherin in endometriosis development.
Objective:To assess the predictive value of hematologic and biochemical inflammatory indices for methotrexate (MTX) treatment outcomes in tubal ectopic pregnancy (TEP) and to develop machine learning (ML) models for individualized risk stratification. Materials and Methods:This retrospective cohort included 293 hemodynamically stable TEP patients who were treated with a single dose of MTX between January 2019 and December 2023. Demographic, clinical, ultrasonographic, and laboratory data were analyzed. Inflammatory indices-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), and fibrinogen-to-albumin ratio (FAR)-were calculated. Outcomes were categorized as single-dose MTX success, requirement for additional MTX, or surgery. Predictive accuracy of five supervised ML algorithms was evaluated using receiver operating characteristic analysis. Results:Single-dose MTX was successful in 65.5% of patients; 18.4% required an additional dose, and 16.0% underwent surgery. AISI had the highest predictive accuracy for surgery [area under the curve (AUC)=0.929], followed by SIRI (AUC=0.899) and FAR (AUC=0.847). NLR best predicted the need for additional MTX (AUC=0.675). Naïve Bayes achieved the highest performance for surgical prediction (accuracy=98.3%, AUC=0.998), while random forest and gradient boosting were most effective in predicting the need for additional MTX (accuracy=83.1%, AUC=0.884-0.896). Feature importance analyses consistently ranked AISI, SIRI, and FAR as top predictors. Conclusion:AISI, SIRI, and FAR are strong predictors of MTX failure and surgical intervention in TEP. Combining these biomarkers with ML models markedly improves predictive performance and supports a personalized approach to TEP management. Multicenter prospective validation is needed before clinical application.
