Research question Can artificial intelligence (AI) models accurately predict variables that affect clinical pregnancy rates in single-euploid embryo transfer cycles? Design This retrospective cohort study was conducted at Sisli Memorial Hospital, Assisted Reproductive Technology (ART), and Reproductive Genetics Centre between October 2011 and February 2023. It involved 4300 frozen-thawed single euploid embryo transfer cycles. Twenty-six variables, including clinical, demographic, and embryological characteristics, were investigated, which may affect clinical pregnancy outcomes in single euploid embryo transfers. This dataset was evaluated using various machine learning (ML) methods, including AdaBoost, Random Forest, XGBoost, LightGBM, and ExtraTree. Model performance and comparative effectiveness were assessed using 5-fold cross-validation, F1-score, recall, and the area under the receiver operating characteristic curve (AUROC). Furthermore, the SHapley Additive exPlanations (SHAP) values were used to analyse the direction and magnitude of the factors influencing clinical pregnancy. Results Using various ML algorithms, seven key factors influencing clinical pregnancy rates were identified based on their level of importance. These factors included the number of previous cycles, anti-Müllerian hormone (AMH) levels, endometrial thickness, post-thaw embryo grade, maternal age, number of frozen embryos, and endometrial preparation method. XGBoost demonstrated promising performance in predicting clinical pregnancy, achieving a sensitivity of approximately 0.74 and a specificity of 0.70. Additionally, the AUROC value of 0.78 further highlighted the superiority of the XGBoost algorithm compared to the other methods Conclusion ML algorithms have successfully identified factors influencing clinical pregnancy in euploid embryo transfer cycles. Understanding these factors could potentially assist physicians in optimising in vitro fertilisation (IVF) treatments and customising patient treatment regimens.

First-trimester pregnancy losses are commonly attributed to chromosomal abnormalities. The causes of pregnancy loss following transfer of a euploid embryo are not fully elucidated. The aim of this study was to evaluate clinical and embryological parameters for pregnancy failure following the transfer of a single euploid embryo. Pregnancy outcomes of single euploid embryo transfers from a single centre between January 2017 and March 2020 were retrospectively evaluated. Several clinical and embryological parameters were evaluated in consideration to pregnancy outcomes; total pregnancy loss and live birth (LB). Endometrial preparation type, number of previous frozen embryo transfer cycles, history of recurrent pregnancy loss, higher body mass index, presence of endometriosis and/or adenomyosis and embryo quality were found to be significantly different between two groups. Morphokinetic parameter analysis of 523 euploid embryos using time-lapse imaging did not show any statistical differences between the two groups; however, a significantly higher rate of uneven blastomeres in the cleavage stage was observed in the total pregnancy loss group. Evaluation of clinical and embryological data can reveal possible factors associated with pregnancy loss that can facilitate improved patient consultation. Feasible interventions can potentially increase the chance of achieving an LB. Lay Abstract Like natural pregnancies, not all pregnancies following fertility treatment go to term. The most common reason for these losses is that these embryos lack the genetic constitution compatible with live birth. Combined with fertility treatment, genetic tests can evaluate the genetic ability of embryos to go to term. Monitoring the outcome of pregnancies resulting from such embryos can help us identify whether and which conditions specific to treatment can lead to pregnancy loss. The analysis identified four parameters associated with embryo loss: Embryo quality and division patterns, existence of previous treatment and treatment type.

Introduction: Endometriosis is an estrogen-dependent chronic inflammatory disease that is defined by the presence of endometrial-like tissue outside of the uterus. The most common localization is the ovaries, and endometriosis in this location is then called an endometrioma. According to the European Society of Human Reproduction and Embryology (ESHRE) (2022) guidelines, the most commonly prescribed treatments for endometriosis include drugs that alter the hormonal milieu. Dienogest is a new generation of progestin used in the treatment of endometriosis. The aim of this study was to assess the effect of Dienogest treatment on endometrioma size and endometriosis-related pain symptoms over a six-month follow-up period.Methods: This prospective observational study was conducted at a tertiary clinic in Turkey between March 2020 and March 2021. Here, 64 patients aged 17-49 years with unilateral or bilateral endometriomas without any hormone-dependent cancers and any medical conditions contraindicating the onset of hormonal treatment, such as active venous thromboembolism, previous or current cardiovascular disease, diabetes with cardiovascular complications, current severe liver disease, and not being pregnant, were included. Endometrioma sizes were determined by transvaginal ultrasonography (TVUS). Dysmenorrhea and dyspareunia symptoms were evaluated using the visual analogue scale (VAS). Patients received Dienogest 2 mg/day continuously for six months. At the three-and six-month follow-ups, the patients were re-evaluated.Results: The mean endometrioma size decreased significantly from an initial measurement of 44.0 +/- 13 mm to 39.5 +/- 15 mm at three months and to 34.4 +/- 18 mm at the six-month follow-up. The mean dysmenorrhea VAS scores before treatment, at the three-month follow-up, and at the six-month follow-up were 6.9 +/- 2.6, 4.3 +/- 2.8, and 3.8 +/- 2.7, respectively. Dysmenorrhea VAS scores decreased significantly over the first three months (p<0.01). Similarly, the mean VAS score for dyspareunia decreased at three and six months compared with the pretreatment value (p<0.01).Conclusion: This study shows that dienogest treatment reduced the symptoms of dysmenorrhea and dyspareunia and the size of endometriomas. However, the main significant decrease in dysmenorrhea and dyspareunia symptoms was noted in the first three months, making it a good treatment option, especially in young patients with a fertility wish.

Abstract Objectives We aim to investigate the utility of middle cerebral artery peak systolic velocity (MCA PSV) Doppler in determining the perinatal mortality and morbidity in serial Doppler measurements from the time of diagnosis to the delivery of complicated cases with fetal growth restriction (FGR). Methods At 24–38 weeks of gestation, 65 pregnant women diagnosed with FGR were included in the study. The fetal biometry measurements, MCA pulsatility index (PI), and MCA PSV Doppler evaluation of the cases formed at the diagnosis and the delivery were recorded. Gestational weeks, birth weights, APGAR scores, cord pH values, NICU (neonatal intensive care unit) admission, NICU duration of stay, and perinatal morbidity parameters such as RDS (respiratory distress syndrome), BPD (bronchopulmonary dysplasia), NEC (necrotizing enterocolitis), sepsis and perinatal mortality were compared. The patients were divided into two groups: early and late-onset fetal growth restriction. Perinatal morbidity and mortality were accepted as adverse perinatal outcomes. Results MCA PSV above the 95th percentile at the diagnosis and delivery time was seen at a significantly higher rate with adverse perinatal outcomes. Conclusions This study shows that evaluating MCA PSV with Doppler can be a helpful diagnostic method for early diagnosis of restriction and hypoxic fetuses. Also, it may be used in clinics as a noninvasive method to predict neonatal prognosis.

Abstract Study question Does adding subcutaneous progesterone to vaginal administration affect pregnancy outcomes in young patients undergoing modified natural-frozen embryo transfer (mNC-FTET) with top-good quality, single blastocyst ? Summary answer Adding subcutaneous progesterone supplementation to vaginal administration after frozen-thawed embryo transfer in modified natural cycles does not improve live birth rates. What is known already Vaginal progesterone supplementation during frozen-thawed embryo transfer in modified natural cycles during luteal phase may increase the rate of live birth rate and decrease the rate of miscarriage. Study design, size, duration 245 participants were included in this retrospective cohort study conducted at a single IVF center between November 2020and January 2022.The primary outcome was the live birth rate; secondary outcomes included pregnancy, clinical pregnancy and biochemical and clinical abortion rates. Participants/materials, setting, methods 245 women aged 20-35 years in mNC-FTET cycles with a single top-good quality blastocyst embryo transfer were included. Patients with fibroids, synechiae, recurrent implantation failure, recurrent pregnancy loss were excluded. After thawing embryos were evaluated for quality, hCG(Ovitrelle-Merck) triggered; 129 patients received 200 mg vaginal progesterone (Lutinus-Merck)(group I), while 116 received 200 mg. vaginal and 25 mg subcutaneous progesterone (Progestan-Dex-Kocak Pharma) (group II). The main outcome was live birth rate(LBR), secondary outcome was miscarriage rate. Main results and the role of chance Baseline demographics and background characteristics were similar in the study groups. The live birth rate in group I is 86 of 106 (66.6%) compared 74 of 116 (63.7%) in group II (odds ratio 1,135, 95% confidence interval [CI]: 0.670-0.922, P = 0.637). There were 106 pregnant patients out of 129 in group I (82.17%) and 93 pregnant patients out of 116 in group II (odds ratio 0.877, 95 CI: 0.462-1,666, P = 0.68). The clinical pregnancy rate is 95 out of 129 patients (73.6%) in group I and 90 out of 116 patients in group II (odds ratio of 0.807, 95% confidence interval [CI]: 0.449-1.45, P = 0.474). The rate of biochemical abortion in group II was 10 of 129 patients (7.75%) and 4 of 116 (3.45%) (odds ratio 2.35, 95 CI: 0.717–7.718, P = 0.687). The clinical abortion rate was 6 of 129 patients (4.6%) and 6 of 116 patients (5.17%) in group II (odds ratio 2.35, 95 CI: 0.717-7.718; P = 0.687). According to primary and secondary outcomes, there were no significant differences between the groups. Limitations, reasons for caution To avoid bias, patients older than 35 years were excluded. Subcutaneous progesterone may be beneficial for older patients undergoing euploid embryo transfer. To reduce confounding factors, the number of patients was limited. Wider implications of the findings For luteal phase support, both vaginal and subcutaneous progesterone supplementation did not increase live birth rates following frozen-thawed embryo transfer in modified natural cycles in young patients. Trial registration number not applicable

Abstract Study question Does modified natural endometrial preparation in single euploid frozen-thawed embryo transfer (FET) cycles affect chance of pregnancy and risk of miscarriage compared to artificial? Summary answer The rate of clinical pregnancy and live birth increases while the rate of miscarriage decreases in modified natural FET cycles compared to artificial FET cycles. What is known already Corpus luteum produces growth factors, angiogenic factors and vasoactive substances as well as hormones. These substances play role for initial placentation. Early maternal endocrine milieu resulting exogenous estrogen and progesterone could damage placentation, which may in turn cause miscarriage. High estradiol levels might also be responsible for decreased pregnancy rates (Wu et al 2021). Study design, size, duration This retrospective, single center study evaluated 1890 frozen single euploid embryo transfer cycles in women between 20-43 years old from January 2017 to September 2021. The study is based on data obtained from Istanbul Memorial Hospital, ART and Reproductive Genetics Center. FET cycles were analyzed in two groups according to different endometrial preparation protocol. Group A (n = 1335): modified natural FET cycles (mNat/FET) and Group B (n = 555): artificial FET cycles (AC-FET). Participants/materials, setting, methods Only good prognosis patients with ages between 20-43 years old were included. Exclusion criterias were women age 44 and above, recurrent abortion history, BMI>35 kg/m 2, endometrial factor, uterin factor (adenomyosis, mullerian anomaly) history. NGS was used to study trophoectoderm biopsy material in all cases. Patients demographics, cycle characteristics and pregnancy outcomes were analyzed. Main results and the role of chance We analyzed the effect of endometrial preparation methods on pregnancy outcomes between the two groups after excluding confounding factors in single euploid embryo transfer cycles. There were no significant differences in patient demographics and cycle characteristics such as age, body-mass index, infertility duration, previous IVF attempts, AMH level, daily gonadotropin dosage used, number of oocytes obtained, mature oocytes and fertilized oocytes between the two groups. There was no significant difference between the morphologic grading of the transferred embryos in both groups. However, all pregnancy outcomes were statistically significantly different in two groups. In group A, biochemical pregnancy rate (76.9% vs. 73.9%, p:0.04), clinical pregnancy rate (71% vs. 65.7%, p < 0.01), live birth rate (65.4% vs. 50.5%, p < 0.01) were significantly higher than in group B. Also, biochemical pregnancy loss rate (7.7% vs. 11%, p:0.01), clinical pregnancy loss rate (6.7% vs. 21%, p < 0.01), second trimester pregnancy loss rate (0.8% vs. 1.5%, p:0.04) were significantly lower compared to group B. Limitations, reasons for caution The limitation of our study include the fact that this was a retrospective analysis. Prospective randomised studies are necessary to evaluate the differences between the two groups according to pregnancy outcomes. Wider implications of the findings This study shows that pregnancy outcomes are better in patients undergoing mNat/FET even after controlling for confounding factors when comparing mNat/FET and AC-FET in single euploid FET cycles. As a result, in appropriate patients, mNat/FET with higher pregnancy rate and live birth rate should be preferred as much as feasible. Trial registration number Not applicable

Abstract Study question What are the factors affecting the rates of live birth in frozen-thawed euploid embryo transfer cycles? Summary answer Some demographic characteristics, frozen embryo transfer (FET) cycle parameters, and embryo characteristics of patients affect live birth rates in euploid embryo transfer cycles. What is known already The aim of assisted reproductive techniques (ART) is to achieve live birth as soon as possible. Preimplantation genetic testing (PGT) is an embryo selection technique recommended to shorten the live birth time. In addition, PGT reduces the number of failed ART cycles by eliminating embryos with chromosomal abnormalities that will not implant or will cause miscarriage. Despite these, the live birth rate after euploid embryo transfer cycles is still not at the expected level. Study design, size, duration This retrospective cohort study was conducted between January 2011 and May 2021 at the IVF and Reproductive Genetics Centre, Memorial Sisli Hospital, Istanbul, Turkey. The study involved a total of 2783 frozen-thawed euploid embryo transfer cycles. Participants/materials, setting, methods 2873 euploid FET cycles were analysed in the study to determine factors affecting live birth rates. 30 parameters thought to affect live birth were identified and analysed by logistic regression analysis on the effects of live birth. These parameters include patients' demographics, fresh cycle and FET cycle characteristics, and embryo-related parameters on live birth effects in euploid embryo transfer cycles. Main results and the role of chance 53% of 2783 euploid embryo transfer cycles have resulted in a live birth. The birth rate was 0,5 times less in the group with a body mass index (BMI) of higher than 29 compared to the group with a BMI of less than 25 (p < 0.05). In cycles in which embryos of good-to-moderate-to-poor quality were transferred, the chance of live birth was lower than in cycles in which embryos of top quality were transferred (OR:0.837 OR:0.515 OR:0.528, respectively). The live birth rate was higher in cases where endometrial preparation was performed in natural cycles than in artificial cycles (OR:1.67, p < 0.05). Embryo transfers without separate blastomeres had a higher live birth rate than embryo transfers with separate blastomeres (OR:1.416, p < 0.006). The live birth rate was 0.7 times lower in the group that did not undergo embryo re-expansion 4 hours after thawing (p < 0.04). Embryo transfer on the sixth day was associated with a lower live birth rate than embryo transfer on the fifth day. (OR:0.6, p < 0.02). The group with a history of recurrent implantation failure (RIF) had a lower live birth rate than the group without a history of RIF (OR:0.5) Limitations, reasons for caution This study is a retrospective study. Wider implications of the findings In euploid embryo transfer cycles, clinicians and embryologists must know the parameters affecting live birth to guide treatment and select the embryo to be transferred first. In addition, the patient should be informed and guided about these factors. Trial registration number Not applicable

AIM:We aimed to investigate the association between the serum concentrations of Vitamin A and Vitamin C and the severity of the COVID-19.  Methods: Fifty-three consecutive PCR (+) COVID-19 patients admitted to a dedicated ward were enrolled in this study. Blood samples for serum Vitamin A and C measurements were drawn from all participants upon admission. All subjects underwent thoracic CT imaging prior to hospitalization. CT severity score (CT-SS) was then calculated for determining the extent of pulmonary involvement. A group of healthy volunteers, in whom COVID-19 was ruled out, were assigned to the control group (n=26). These groups were compared by demographic features and serum vitamin A and C levels. The relationship between serum concentrations of these vitamins and pre-defined outcome measures, CT-SS and length of hospitalization (LOH), was also assessed.  Results: In COVID-19 patients, serum Vitamin A (ng/ml, 494±96 vs. 698±93; p<0.001) and Vitamin C (ng/ml, 2961 [1991-31718] vs. 3953 [1385-8779]; p=0.007) levels were significantly lower with respect to healthy controls. According to the results of correlation analyses, there was a significant negative association between Vitamin A level and outcome measures (LOH, r=-0.293; p=0.009 and CT-SS, r=-0.289; p=0.010). The negative correlations between Vitamin C level and those measures were even more prominent (LOH, r=-0.478; p<0.001 and CT-SS, r=-0.734: p<0.001).CONCLUSION:COVID-19 patients had lower baseline serum Vitamin A and Vitamin C levels as compared to healthy controls. In subjects with COVID-19, Vitamin A and Vitamin C levels were negatively correlated with CT-SS and LOH.

Objective: This study aimed to define the approach to pregnant women with coronavirus disease-2019 (COVID-19) and to determine the maternal and neonatal consequences of the disease. Material and Methods: Maternal and neonatal outcomes of COVID-19 pregnant women are illustrated by looking at the following parameters: Real-time reverse transcription polymerase chain reaction test, complete blood count, D-dimer and ferritin concentration, lymphocyte count, aspartate aminotransferase, C-reactive protein, and alanine aminotransferase level, neonatal umbilical blood gas analysis, admission to the neonatal intensive care unit (NICU), and lung computed tomography images. Results: Forty-three trimester pregnant women with a diagnosis of COVID-19 were included in the study. The most common complaint at admission was cough (50%), and the most common accompanying finding was shortness of breath and fever. The delivery method was 34 patients cesarean section and 6 patients vaginal delivery. Two neonates were admitted to the NICU due to respiratory distress. There were no maternal or infant deaths. The patients were hospitalized for approximately 5 days. Conclusion: To sum up, our study is a preliminary study and there is a need for studies involving a much larger number of patients in terms of clinical features and follow-up treatment of pregnant women with COVID-19. In this regard, long-term patient follow-up results will be extremely important.

PURPOSE:Can the risk factors that cause first trimester pregnancy loss in good-quality frozen-thawed embryo transfer (FET) cycles be predicted using machine learning algorithms? METHODS:This is a retrospective cohort study conducted at Sisli Memorial Hospital, ART and Reproductive Genetics Center, between January 2011 and May 2021. A total of 3805 good-quality FET cycles were included in the study. First trimester pregnancy loss rates were evaluated according to female age, paternal age, body mass index (BMI), diagnosis of infertility, endometrial preparation protocols (natural/artificial), embryo quality (top/good), presence of polycystic ovarian syndrome (PCOS), history of recurrent pregnancy loss (RPL), recurrent implantation failure (RIF), severe male infertility, adenomyosis and endometriosis. RESULTS:The first trimester pregnancy loss rate was 18.2% (693/ 3805). The presence of RPL increased first trimester pregnancy loss (OR = 7.729, 95%CI = 5.908-10.142, P = 0.000). BMI, which is > 30, increased first trimester pregnancy loss compared to < 25 (OR = 1.418, 95%CI = 1.025-1.950, P = 0.033). Endometrial preparation with artificial cycle increased first trimester pregnancy loss compared to natural cycle (OR = 2.101, 95%CI = 1.630-2.723, P = 0.000). Female age, which is 35-37, increased first trimester pregnancy loss compared to < 30 (OR = 1.617, 95%CI = 1.120-2.316, P = 0.018), and female age, which is > 37, increased first trimester pregnancy loss compared to < 30 (OR = 2.286, 95%CI = 1.146-4,38, P = 0.016). The presence of PCOS increased first trimester pregnancy loss (OR = 1.693, 95%CI = 1.198-2.390, P = 0.002). The number of previous IVF cycles, which is > 3, increased first trimester pregnancy loss compared to < 3 (OR = 2.182, 95%CI = 1.708-2.790, P = 0.000). CONCLUSIONS:History of RPL, RIF, advanced female age, presence of PCOS, and high BMI (> 30 kg/m2) were the factors that increased first trimester pregnancy loss.

INTRODUCTION:Data regarding the role of the enhanced recovery after surgery (ERAS) protocol in improving postoperative outcomes and postoperative compliance in patients undergoing gynecological surgery, in particular, minor laparoscopic and hysteroscopic gynecological procedures, are limited.AIM:To investigate the impact of the ERAS protocol on time to ambulation, length of stay (LOS), readmissions and postoperative complications in patients undergoing minor gynecological surgical procedures.MATERIAL AND METHODS:A total of 104 patients undergoing minor laparoscopic and hysteroscopic gynecological procedures were randomized to the ERAS protocol or conventional care. Time to defecation, ambulation, and solid food intake, bleeding and LOS were recorded for each patient.RESULTS:The amount of intravenous fluid administered in the perioperative (p < 0.001) and postoperative period (p < 0.001) was significantly higher in the conventional care group than in the ERAS group. In addition, time to first defecation (p < 0.001), time to eating solid food (p < 0.001), and time to ambulation (p = 0.008) were shorter in the ERAS group compared to the conventional care group. Length of stay was also significantly shorter in the ERAS group than in the conventional care group (p < 0.001).CONCLUSIONS:Implementation of ERAS protocols provides shorter LOS, less fluid intake, early return of bowel function and early mobilization without an increase in complication rate in women undergoing minor laparoscopic or hysteroscopic gynecologic surgery.

Objectives: Data concerning the usefulness of pleth variability index (PVI)-based goal-directed fluid management (GDFM) in gynecologic surgery is limited. This study purposed to compare the impact of PVI-based GDFM to conventional fluid management (CFM) on intraoperative hemodynamics and lactate levels in subjects undergoing gynecologic surgery. Methods: This randomized and controlled trial was conducted on 70 patients undergoing elective gynecologic surgery. Subjects were randomly assigned to CFM or GDFM. Hemodynamic data and results of the arterial blood gas analysis, and total amount of the fluid infused were recorded throughout the surgery at 1-h intervals. Results: The amount of the total fluids was significantly higher in the CFM group compared to that of the GDFM group (p<0.001). Mean arterial pressure recorded at the 2nd h of the surgery was significantly lower in the CFM group compared to that of the GDFM group (p=0.047). While there were no significant differences between the baseline and the 2nd h lactate levels in the GDFM group, the lactate level significantly increased from baseline to the 2nd h in the CFM group (p=0.010). Conclusion: Implementation of PVI-based GDFM provides better intraoperative hemodynamic stability and lower lactate levels compared to the CFM in subjects undergoing gynecologic surgery.

Abstract Study question Do the presence of necrotic foci and/or the presence of separate blastomeres and the blastocoele expansion degree affect pregnancy outcomes of frozen-thawed euploid embryo transfer cycles? Summary answer Significant correlations were observed between pregnancy outcomes and the degree of blastocoele expansion, the presence of necrotic foci or separate blastomeres in the euploid embryo. What is known already Implantation failure and pregnancy losses may occur despite the selection of a healthy euploid embryo for transfer and the elimination of other risk factors. Blastocyst morphology is known to affect pregnancy outcomes, but the effect of necrotic foci and/or separate blastomeres in the embryo on pregnancy outcomes needs further investigation. Study design, size, duration This is a retrospective cohort study and was conducted at ART and Reproductive Genetics Centre, Memorial, Sisli Hospital, Istanbul, Turkey between January 2017 and September 2021. A total of 2758 frozen-thawed euploid embryo transfer cycles were included in the study. Participants/materials, setting, methods After thawing, the embryos were divided into groups according to their morphological grades, whether there were necrotic foci and whether there were separate blastomeres, and were evaluated in terms of pregnancy outcomes. Blastocysts were graded by using Gardner and Schoolcraft’s grading system. Ongoing pregnancy was defined as a pregnancy that had reached 20 weeks. Miscarriage was defined as a pregnancy loss occurring before the 20th gestational week. Main results and the role of chance Our data showed that the presence of necrotic foci in the inner cell mass or trophectoderm reduced the ongoing pregnancy rates and increased the miscarriage rates. The ongoing pregnancy rate was lower (41.0%, vs 60.0%, p < 0.001) and the miscarriage rate was higher (27.3% vs 19.8%, p < 0.05) in the group with necrotic foci than in the group without necrotic foci. The presence of separate blastomeres decreased the ongoing pregnancy rates (50.3% in the group with separate blastomeres, 61.8% in the group without separate blastomeres) (p < 0.001) and increased the miscarriage rates (25.3% in the group with separate blastomeres, 18.8% in the group without separate blastomeres) (p > 0.004). The ongoing pregnancy rates for blastocoele expansion degrees of 2, 3, 4, 5, and 6 were 39.5%, 38.3%, 59.3%, 59.8%, and 61.4%, respectively and the miscarriage rates for blastocoele expansion degrees of 2, 3, 4, 5, and 6 were 35%, 33.3%, 21%, 21.2%, 18.4%, respectively. Embryos with degrees of expansion grade ≤ 3 had lower ongoing pregnancy rates and higher miscarriage rates than those with degrees of expansion > 3 (p < 0.01). Limitations, reasons for caution Retrospective study. Wider implications of the findings When choosing the embryo to be transferred in cases with more than one euploid embryo, the selection should be made by considering the blastocoele expansion degrees and the presence of necrotic foci and separate blastomeres in the embryo. Trial registration number not applicable

OBJECTIVE Considerable amount of women undergoing dilatation and curettage (D&C) are subject to preoperative anxiety. We hypothesized that the implementation of video-based multimedia information (MMI) before the D&C might facilitate patients' education and provide clear information regarding the procedure. This study aimed to compare the impact of video-based MMI and conventional written information on anxiety, pain severity, and satisfaction in patients undergoing D&C. METHODS Seventy four women scheduled for D&C for abnormal uterine bleeding were enrolled in this prospective randomized study. Subjects were assigned to receive a video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after the application of the MMI or written information. All patients underwent D&C by the same gynecologist. Following D&C, patient satisfaction and procedural pain were ranked using a Likert scale and Visual Analogue Scale. RESULTS Post-informational STAI-S score was significantly lower than the pre-informational STAI-S score in the video group (p<0.001), whereas no significant change occurred in STAI-S score in the control group (p=0.210). The satisfaction rate of the patients receiving MMI before the D&C was significantly higher than the satisfaction rate of the controls (75% vs. 50%, p=0.027). CONCLUSION Implementation of MMI before the D&C procedure is associated with less anxiety, less severe postoperative pain and improved patients satisfaction, compared to the conventional written information.

A cause for recurrent pregnancy loss (RPL) is identified in less than 50% of couples. In cases of unexplained RPL, empirical treatments are often offered, including preimplantation genetic testing (PGT). Here in this retrospective cohort study, the aim was to define the factors that cause pregnancy loss after a euploid embryo transfer in the patients with unexplained RPL. The pregnancy results of all single euploid embryos tested with next generation sequencing (NGS) in Istanbul Memorial Hospital between January 2017 and March 2020 were evaluated. Only the cases that have the diagnosis of unexplained RPL and the cases below the age of 43 were included. RPL was defined as two or more pregnancy losses occurring before 20 weeks of gestation. Exclusion criteria were: inversion/translocation carriers, mullerian anomalies and fibroids distorting endometrial cavity, patients with acquired thrombophilia and endocrine abnormalities. The pregnancy outcomes; namely, biochemical pregnancy loss (BPL), clinical pregnancy loss (CPL), total pregnancy loss (TPL) and live birth (LB) were analyzed according to clinical and embryological factors including maternal age, body mass index (BMI), type of endometrial preparation for frozen embryo transfer (FET), the presence of polycystic ovarian syndrome (PCOS), presence of severe male factor (SMF), the presence of endometriosis or adenomyosis, and the morphological grading of the embryo according to Gardner's scoring system. Top quality blastocysts (TQ) included 3-4-5-6 AA; good quality (GQ) blastocysts comprised 3-4-5-6BB, AB or BA. Blastocysts of inferior quality were designated as medium and poor quality (MQ-PQ). The transfer of 448 single euploid embryos resulted in 310 pregnancies. The overall pregnancy rate was 69.2%, the rates of BPL, CPL and TPL were 11.9%, 15.7% and 25.8% respectively. The live birth rate was 51.3%. The CPL and TPL were higher in the group that had a BMI value of 25 or higher and in the group of patients that had an embryo transfer with MQ-PQ embryos. The CPL and TPL were also higher in the patients that had an endometrial preparation for FET with estrogen replacement instead of a natural cycle (25.0% and 33.1% vs 8.6% and 20.2%, p>0.05). The presence of PCOS, SMF and endometriosis or adenomyosis did not have any significant effect on pregnancy loss rates. In patients with an unexplained RPL history, the chance of a live birth after a euploid embryo transfer is significantly affected by various clinical parameters; including BMI, embryo quality and type of endometrial preparation for FET.

The aim of the study is to determine factors that cause first-trimester pregnancy loss in frozen-thawed embryo transfer (FET) cycles. This is a retrospective cohort study conducted at Sisli Memorial Hospital, ART and Reproductive Genetics Center,Istanbul, between January 2016-January 2021. A total of 2460 clinical pregnancy cycles were analyzed in the study. FET cycles with preimplantation genetic testing (PGT), and ectopic pregnancies were excluded from the study. First-trimester pregnancy loss rates were evaluated according to different parameters; female age, body mass index (BMI), diagnosis of infertility, endometrial preparation protocols (natural vs artificial), embryo grade, presence of polycystic ovarian syndrome (PCOS), the history of recurrent pregnancy loss (RPL), recurrent implantation failure (RIF) and severe male infertility. Multivariable logistic regression analyses was used to identify of risk factors first-trimester pregnancy losses. The overall pregnancy loss rate in the first trimester was 17.6% (433/2460). Advenced female age, high BMI, presence of PCOS, RPL, moderate -poor grade embryo transfer and endometrial preparation in the artificial cycle significantly increased clinical pregnancy loss rates (p<0.05) (Table 1). On the other hand, the first-trimester pregnancy loss rate was not affected by the presence of severe male factor, presence of RIF, the diagnosis of infertility (p>0.05). Age>35 years old, BMI> 30 kg/m2, presence of PCOS, history of RPL, and endometrial preparation protocol with artificial cycle were the factors that increased first trimester pregnancy loss.

Objective: To identify changing trends in peripartum hysterectomy (PH), both elective. cesarean hysterectomy and emergency cesarean hysterectomy, at a single training and research hospital over the last 17 years in Istanbul, Turkey. Materials and methods: A retrospective cohort study was performed between January 2001 and September 2017. The records of all patients who had PH at Kanuni Sultan S & uuml;leyman Training and Research Hospital were analyzed. Results: There were 243 cases of PH during the study period. A total of 266,386 births occurred, of which 60.1% were vaginal deliveries and 39.8% were cesarean sections. The incidence of PH increased from 0.67 per 1000 deliveries to 1.14 per 1000 deliveries during 2001-2008 and 2009-2017, respectively, with an overall incidence of 0.91 per 1000 deliveries during the 17 years. The main indication for PH changed significantly during this time from uterine atony (57.1%) to placenta accreta spectrum (85%). About 37% of women who underwent PH had at least one previous cesarean delivery during 2001-2008, whereas that percentage increased to 95.4% during 2009-2017. Conclusion: Placenta accreta spectrum was the leading cause of PH and was associated with significant maternal morbidity and mortality. (c) 2021 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The aim of the study is to determine factors that cause first-trimester pregnancy loss in frozen-thawed embryo transfer (FET) cycles. This is a retrospective cohort study conducted at Sisli Memorial Hospital, ART and Reproductive Genetics Center,Istanbul, between January 2016-January 2021. A total of 2460 clinical pregnancy cycles were analyzed in the study. FET cycles with preimplantation genetic testing (PGT), and ectopic pregnancies were excluded from the study. First-trimester pregnancy loss rates were evaluated according to different parameters; female age, body mass index (BMI), diagnosis of infertility, endometrial preparation protocols (natural vs artificial), embryo grade, presence of polycystic ovarian syndrome (PCOS), the history of recurrent pregnancy loss (RPL), recurrent implantation failure (RIF) and severe male infertility. Multivariable logistic regression analysis was used to identify of risk factors first-trimester pregnancy losses. The overall pregnancy loss rate in the first trimester was 17.6% (433/2460). Advenced female age, high BMI, presence of PCOS, RPL, moderate -poor grade embryo transfer and endometrial preparation in the artificial cycle significantly increased clinical pregnancy loss rates (p<0.05) (Table 1). On the other hand, the first-trimester pregnancy loss rate was not affected by the presence of severe male factor, presence of RIF, the diagnosis of infertility (p>0.05). Age>35 years old, BMI> 30 kg/m2, presence of PCOS, history of RPL, and endometrial preparation protocol with artificial cycle were the factors that increased first trimester pregnancy loss.

Introduction: Use of multimedia tools has been shown to improve patient comprehension, reduce pre-procedural anxiety, and increase patient satisfaction in various surgical settings. Aim: To investigate the impact of video-based multimedia information (MMI) on the anxiety levels of patients undergoing office hysteroscopy (OH). Material and methods: All consecutive women aged 18-65 years and scheduled for diagnostic OH were enrolled in this prospective randomized study. Subjects were assigned to receive video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after application of the MMI or written information. All patients underwent a standardized transvaginal hysteroscopy procedure by the same gynecologist. Following the hysteroscopy, patient satisfaction and procedural pain were ranked using a Likert scale and visual analogue scale. Results: Fifty-two patients were randomized to receive a video-based MMI, and 52 patients were randomized to receive written information. Post-information STAI-S score was significantly lower in the MMI group than that of the written information group (45.0 +/- 8.0 vs. 49.4 +/- 8.4, p < 0.001, 95% CI for the difference: 1.36-7.79). Moreover, the satisfaction rate of the video group was significantly higher than the satisfaction rate of the controls (92.3% vs. 63.5%, p < 0.001). VAS score of procedural pain was similar for the two groups. Conclusions: A video-based MMI before OH might be preferred to conventional information methods in order to reduce the pre-procedural anxiety and to increase patients' satisfaction.