BACKGROUND: Chromosomal abnormalities are a significant cause of miscarriages. Carriers of balanced chromosome rearrangement are often at risk of recurrent pregnancy loss (RPL), as they are more likely to produce gametes with unbalanced chromosome rearrangements. OBJECTIVE: This study evaluated the chromosomal abnormalities detected in couples with history of primary recurrent pregnancy loss. DESIGN: Retrospective, cross-sectional study SETTING: Single center, tertiary healthcare center in Turkey PATIENTS AND METHODS: This study reviewed conventional cytogenetic/molecular cytogenetic analysis data of 4030 patients (2015 couples) who visited the clinic from 2008–2024. MAIN OUTCOME MEASURES: Chromosomal abnormalities in patients diagnosed with primary recurrent pregnancy loss and genetic testing results of spontaneously achieved pregnancies in 16 patients with a balanced chromosomal rearrangement. SAMPLE SIZE: 4030 individuals (2015 couples) RESULTS: Majority of couples had a history of two spontaneous miscarriages (59.4%), followed by couples with 3 miscarriages (28.1%), 4 miscarriages (7.5%), and 5 or more miscarriages (4.91%). Chromosomal abnormality was detected in 133 (3.3%) cases. Among the revealed abnormalities, 130 (97.7%) were structural chromosome anomalies, while only 3 (2.3%) numerical chromosome anomalies were observed, including sex chromosome aneuploidy in 2 cases and mosaic karyotype in one case. Among the detected 130 structural chromosome abnormalities, reciprocal translocations (86 cases, 66.2%) were most frequently observed, followed by Robertsonian translocations in 26 cases (20.0%), inversion in 11 cases (8.5%), marker chromosome in 5 cases (3.8%), and derivative chromosomes in 2 cases (1.5%). Products of conception (conceptus materials) were analyzed from 16 spontaneously conceived pregnancies in individuals identified as carriers of chromosomal rearrangements. Although reciprocal translocations involving acrocentric chromosomes are typically expected to result in 3:1 meiotic segregation, adjacent-1 segregation was observed in two female individuals carrying the translocation t(9;15)(p22;q23). This finding is likely due to the limited genetic content of the translocated segments. Additionally, a novel complex three-way translocation, t(5;7;13)(p12;p12;p11), was identified for the first time. CONCLUSION: Cytogenetic and molecular analyses are crucial components in the etiological investigations of couples with RPL. LIMITATIONS: Retrospective design

Introduction: Infertile women may have difficulty coping with the stress caused by assisted reproductive methods.Aim: It was aimed to investigate the effect of chewing gum on stress levels in women with unexplained infertility.Method: Sixty - one women receiving in - vitro fertilization treatment in the tertiary care center were included in the study. A randomized controlled experimental design was established in the study. The group chewing gum for five minutes at least two times a day was called "Experimental Group - 1", the group chewing gum for 20 minutes at least two times a day was called "Experimental Group - 2", and the group not chewing gum was called "Control Group". Reproductive information and stress level data of infertile women were collected with the Descriptive Information Form and Fertility Problem Inventory.Results: No statistically significant difference was found in comparing Fertility Problem Inventory total scores between the groups (p gt; 0.005). However, a statistically signifiant difference was found between the mean values of the denial of life without children, which was a subscale of the Fertility Problem Inventory score according to time in the Experimental Group - 2 group (p lt;0.005).Conclusion: We believe that the positive effect of chewing gum on coping with stress may be an alternative intervention that may contribute positively to coping with the infertility treatment process and should be supported by other interventions.

Un caso raro de una nueva entidad de malformación mülleriana que imita un hemiútero con cavidad rudimentaria no comunicante: masa uterina cavitada accesoria.

Purpose To assess the impact of serum progesterone level and the progesterone/estradiol ratio on determining the appropriate day of embryo transfer in fresh IVF/ICSI cycles without premature progesterone elevation. Methods This was a retrospective cohort study in a university teaching hospital. Only fresh embryo transfer cycles in the GnRH-antagonist protocol without elevated trigger-day progesterone levels ( n = 508) were analyzed after taking into consideration the exclusion criteria. The main outcome measure was to determine the association between below and above of the cut-off values of serum progesterone level and P/E 2 ratio regarding clinical pregnancy, ongoing pregnancy and live birth rates. These rates were assessed with the use of percentile and logistic regression analyses according to the threshold levels of serum progesterone levels < 0.85 ng/mL versus ≥ 0.85 ng/mL on the day of hCG administration. Results The clinical pregnancy rates were significantly lower in fresh cycles with P levels ≥ 0.85 ng/mL on the day of hCG administration than in cycles with P levels < 0.85 ng/mL for the cleavage-stage embryo transfers (26.7% vs. 47.5%, p = 0.001). Blastocyst-stage embryo transfer improved pregnancy results although the P levels were ≥ 0.85 ng/mL (53.8% vs. 51.4%, p > 0.05). The adjusted odds ratio of P levels < 0.85 ng/mL revealed significant differences in only cleavage-stage embryo transfer cycles (aOR = 0.424, p = 0.016). Conclusion Although serum progesterone levels are below the accepted cut-off level of 1.5 ng/mL, there may be reduced pregnancy outcomes in fresh embryo transfer cycles. A threshold level such as 0.85 ng/mL may ensure the decision to replace the cleavage stage with the blastocyst-stage embryo transfer in fresh cycles without premature progesterone elevation.

Aim: To assess the predictive value of serum progesterone/estradiol (P/E-2) and serum progesterone/follicle (P/F) ratios on the reproductive outcomes of women without elevated trigger-day progesterone levels undergoing GnRH-antagonist IVF (in vitro fertilization)/ICSI (intracytoplasmic sperm injection) cycles. Materials and methods: This was a retrospective cohort study in a university teaching hospital conducted between January 2017 and December 2019. Couples who underwent assisted reproduction cycles were evaluated. Initially, 978 cycles were evaluated and only GnRH antagonist cycles (n = 505) without elevated trigger-day progesterone levels were analyzed after respecting exclusion criteria. Results: A total of 505 cycles were analyzed after the exclusion criteria were met. The clinical pregnancy rate, ongoing pregnancy rate, and live birth rate were 45.5%, 30.9%, and 27.8%, respectively. Cutoff values of P/E-2 and P/F ratios that were discriminative for achieving or not achieving clinical pregnancy were 0.36 and 0.17, respectively. The clinical pregnancy rates were found to be significantly different between below and above P/E-2 cutoff values (49.8% vs. 40.1%, respectively, p = .031), while there were no significant differences between below and above P/F cutoff values regarding the pregnancy outcomes. Conclusion: The P/E-2 and P/F ratios were found to be more efficient and reliable markers than serum progesterone level alone in predicting the reproductive outcomes of assisted reproduction cycles without a premature rise in serum progesterone levels. A P/E-2 ratio <= 0.36 and a P/F ratio <= 0.17 significantly improved the cycle outcomes.

Background The influence of thyroid autoimmunity in in–vitro fertilization/intracytoplasmic sperm injection (ICSI) cycles is still a controversial issue. Although some women are euthyroid, some studies found thyroid dysfunction and thyroid autoimmunity increased the incidence of infertility. We aimed to evaluate the impact of anti-thyroid antibodies on the cycle parameters, embryo quality, and pregnancy outcomes in women who underwent ICSI cycles. Results Fertilization rate was significantly higher in anti-thyroid antibody-negative patients than in anti-thyroid antibody-positive patients (97.1 ± 10.5 vs. 91.5 ± 19.8, respectively, p = 0.003). Clinical pregnancy, miscarriage, and ongoing pregnancy rates were not different among study groups. The presence of top-quality embryo was lower in anti-thyroid antibody-positive patients but it did not reach any statistical significance (56.5% vs. 67.8%, p = 0.09). In the subgroup analysis, there were no significant differences except for the miscarriage rate according to the TSH threshold. Conclusion The clinical pregnancy and ongoing pregnancy were not affected by the positivity of anti-thyroid antibodies. We showed that thyroid autoimmunity may have an impact on fertilization rate and embryo quality in patients undergoing ICSI cycles. Miscarriage rate also increases with thyroid autoimmunity and TSH levels above 2.5 μIU/L.

Aim This study evaluated the level of fear and anxiety related to the COVID-19 outbreak, in infertile women whose ART cycles were delayed due to the pandemic. Materials and methods An online survey was sent to women whose ART cycles were postponed due to the COVID-19 outbreak between April and May 2020. The study population were 101 participants. The main outcome measure is to determine the levels of fear and anxiety in infertile women by using the Spielberger State-Trait Anxiety Inventory (STAI-T and STAI-S) and Fear of COVID-19 scale (FCV-19S). The relationship of the COVID-19 outbreak with the willingness to go ahead with the desire for pregnancy was also assessed. Results The state-anxiety levels were significantly higher in women above 35 years (45.0 +/- 5.2 vs. 42.2 +/- 4.5,p = 0.006). Women with diminished ovarian reserve had a higher state-anxiety compared to other causes, but were not found to be significant (44.7 +/- 5.2 vs. 42.5 +/- 5.0,p = 0.173). Women who thought that the possibility of not being able to get pregnant was more important than being infected with the COVID-19 had higher anxiety levels than women who thought just the opposite. The diminished ovarian reserve and high duration of infertility were found to be significantly associated with higher anxiety levels (OR = 2.5,p < 0.05). The diminished ovarian reserve and previous ART failure significantly predicted the presence of clinical state-anxiety. Conclusion The state-anxiety was found to be higher in women whose cycles were postponed due to the outbreak and the presence of diminished ovarian reserve also significantly affected anxiety levels. Further research is needed to assess whether COVID-19 will have any impact on ART treatments in the next few years.

Amaç: Gonadotropin stimülasyonuna over yanıtını değerlendirmek için birçok parametre bulunmaktadır. Basal LH seviyeleri FSH seviyelerine ek olarak over yanıtında önerilmektedir. Bu çalışma ile GnRH-antagonist IVF (in-vitro fertilizasyon) siklusu uygulanan hastalarda bazal LH seviyelerinin siklus ve gebelik sonuçları ile ilişkisini değerlendirmek amaçlanmıştır. Yöntemler: Retrospektif kohort çalışmaya FSH değeri 10 IU/L’den daha düşük olan 317 siklus dahil edilmiştir. Bazal hormonal bulgular (FSH, LH, estradiol) ovaryan stimülasyon başlamadan önce kaydedildi. Hastalara GnRH-antagonist protokol ve rekombinant FSH tedavisi uygulandı. Hastalar; LH değeri için belirlenmiş olan eşik değerlere göre kategorize edilmişlerdir (Grup 1: LH <4,1 IU/L ve Grup 2: LH 4,1). Elde edilen toplam oosit sayısı, matür oosit sayısı, implantasyon oranı, klinik gebelik ve devam eden gebelik oranı çalışma grupları arasında analiz edilerek karşılaştırıldı.Bulgular: Grup 2 hastalarda, Grup 1 ile karşılaştırıldığında daha fazla oosit sayısı ve matür oosit sayısı tespit edilmiştir (P=0,006 ve P=0,03). İstatistiksel olarak anlamlı olmasa dahi, yüksek LH seviyelerinde daha yüksek gebelik oranları lehine bir eğilim saptandı. Klinik gebelik ve devam eden gebelik oranları Grup 1’de daha düşüktü ancak bu farklılık istatistiksel olarak anlamlı değildi (Klinik ve devam eden gebelik için sırasıyla %38,3’e karşı %48,5, P=0,162 ve %29,4’e karşı %34,0, P=0,535). Bazal LH seviyeleri oosit sayısı ile pozitif olarak korele olarak saptandı ve düşük FSH seviyeleri ile kombinasyonu da daha fazla oosit sayısı ve pik östrojen düzeyleri ile ilişkili bulundu.Sonuç: Artmış bazal LH seviyeleri toplam elde edilen oosit sayısı gibi siklus sonuçları üzerinde faydalı etki sağlayabilir. Bununla birlikte klinik gebelik oranları LH seviyesi eşik değerinin altında ve üstünde olanlar arasında benzer olarak tespit edildi.

Luteal phase deficiency as a result of multifollicular development which produces supraphysiological progesterone and estradiol levels and benefit of luteal phase support have been proven in assisted reproductive technique (ART) treatment. But, there were some controversial results in intrauterine insemination (IUI) cycles whether luteal phase support (LPS) with progesterone have an impact on pregnancy outcome. To assess the efficacy of vaginal progesterone gel in the gonadotropin-induced IUI cycles, this retrospective data analysis compared the luteal phase support and control group in terms of clinical pregnancy (CPR) and live birth rates (LBR). In subgroup analysis, multifollicular and monofollicular growth were analyzed separately. In total, after exclusion criteria, 380 IUI cycles were analyzed, cycles were grouped as LPS(+) and LPS(-) with 190 and 190 cycles, respectively. CPR and LBR were comparable between groups (11.6% vs. 10.5, p = .74 and 8.9% vs. 8.4%, p = .75 respectively). Although multifollicular growth demonstrated higher pregnancy outcomes than monofollicular growth, intermediate follicles (14-16 mm) had a positive impact on pregnancy outcome in monofollicular growth like multifollicular subgroup. We found no difference in CPR and LBR according to the luteal phase vaginal progesterone gel. Nevertheless, multifollicular cycles and also monofollicular growth cycles with two and more intermediate follicles may have benefit LPS in gonadotropin-induced IUI cycles.

Objective: Hysteroscopic myomectomy is the gold standard method for treatment of submucous fibroids. Hysteroscopic myomectomy techniques for removal of submucous fibroids still have controversies. In this study we aimed to describe usefulness of ultrasound guidance in hysteroscopic myomectomy for a safe and effective removal of submucous G1 and G2 fibroids.Study design: This is a multicentre study. 64 symptomatic patients with submucous fibroid underwent ultrasound guided hysteroscopic myomectomy. First we excised intrauterine dome of fibroid until reaching the level of cavity wall by the method of resectoscopic (electrosurgical resection using a loop electrode) slicing. Next remnant intramural node was squeezed by uterine contractions induced. After we had excised the intrauterine dome of fibroid by slicing method, we formed cavitation for the intramural part (newly raised myoma dome). The cavity was filled with distension solution and we evaluated the margins of the uterus and the margins of the myoma by sonographically. Then the myoma was excised under ultrasonographic guidance by transabdominal probe. We obtained a regular uterine cavity.Results: Mean operation time was 42 +/- 7 min. Mean Mannitol volume was 4.3 +/- 1.7 I and the mean intraoperational fluid deficit was 500 ml. Not in any case uterine perforation was occurred. All fibroids removed totally. In 8 (19%) cases intrauterine synechiae detected and all these synechiaes were incised by a scissor during hysteroscopy.Conclusion: There is still no single technique proven to be unequivocally superior to the others for treating fibroids with intramural development (G1-G2). Ultrasound guided hysteroscopy seems to be an effective and safe method for resection of G1 and G2 fibroids. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

The role of apolipoprotein E (Apo E) gene polymorphisms in the etiology of recurrent pregnancy loss (RPL) is not clearly understood. We evaluated this polymorphism in unexplained pregnancy losses in a group of Turkish women. In our prospective case-control study, 45 well-characterized RPL cases were examined for their Apo E genotypes, based on restriction fragment length polymorphism analysis of polymerase chain reaction (PCR)-amplified fragments. The observed genotypes were compared with those obtained from equal number matched controls. We observed similar Apo E genotypes and E2, E3 and E4 allele frequency distribution among RPL patients and controls. The allele frequencies obtained in patients and controls, respectively, were as follows: E2=8 (9%) and 12 (13.4%) (P=0.342), E3=66 (73.3%) and 60 (66.6%) (P=0.328) and E4=16 (17.7%) and 18 (20%) (P=0.703). Our data did not support the association of Apo E gene polymorphisms with RPL as reported by previous studies. We endorse adequate characterization of RPL cases and adequate sample size prior to addressing such studies.

OBJECTIVE:To assess the apoptosis rate in eutopic and ectopic endometrial stromal and glandular cells, normal peritoneum and adhesions in women with endometriosis.METHODS:A total number of 97 women with (n:60) and without (n:37) histopathologically confirmed endometriosis who underwent laparoscopy or laparotomy in the early follicular phase of the menstrual cycles for pain and infertility were included in this study. Stage I/II and stage III/IV were categorized as early staged and late-staged endometriosis. The endometrial samples were obtained with a Novack cannula from the corpus of the uterus. Normal-looking peritoneum, peritoneal implants and adhesions were sampled and fixed in formaldehyde for immunohistochemical staining with Bcl-2 and Bax. Tissue samples were fixed in formaldehyde for the assessment of apoptosis via terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) and M30 cytoDEATH antibody.RESULTS:The intensity of Bax staining of normal-looking peritoneum in early staged endometriosis was higher, compared to women with late-staged and women without endometriosis (P = 0.03). However, degree of Bcl-2 staining did not differ among early and late-staged endometriosis and women without endometriosis (P = 0.1). In terms of Bcl-2 and Bax staining in the stromal and glandular parts of the eutopic endometria, no significant differences were detected among three groups. In cases with early- and late-staged endometriosis the intensity of Bax and Bcl-2 stainings did not differ in both stromal and glandular parts of ectopic endometria. Number of cells with positive apoptotic signals assessed via TUNEL (P = 1.0) and M30 cytoDEATH antibody (P = 0.59) in normal-looking peritoneum did not differ between three groups. In addition, no difference in term of numbers of apoptotic cells obtained from adhesions was observed between three groups (for TUNEL, P = 0.29, for M30, P = 0.19).CONCLUSIONS:Apoptosis patterns did not differ in the eutopic and ectopic endometria as well as adhesions of women with or without endometriosis.

To investigate the level of cytokines and immune cells in the peripheral blood (PB) and peritoneal fluid (PF) of different stages of endometriosis.

Objectives: This prospective cohort study was an attempt to evaluate the lipid profile changes among two groups of surgically menopausal women, using daily 0.625 mg oral CEE and weekly 3.9 mg TTS estrogen patch.Materials and Methods: Of 127 women associated with surgical menopause, 83 (63.5%) cases recieved CEE (group I) and 44 (34.7%) women administrated weekly 3.9 mg. TTS estrogen patch (group II). Age, body mass index (BMI), baseline systolic and diastolic blood pressures of all cases were recorded. Total cholesterol (TC), LDL, HDL and triglycerides (TG) levels were determined before and 6 months after treatment.Results: Man age, BMI, initial systolic and diastolic blood pressures were similar among both groups. TC (227 +/- 5.9 mg/dl) and TG levels (119 +/- 11.9 mg/dl) were higher in group II, prior to hormone therapy. When lipid levels were compared before and 6months after treatment in each group, HDL levels was significantly increased in group I (p=0.01), whilst among group II, plasma HDL (p=0.08) level was increased and TG (p=0.002) level was decreased. Based on delta (_) values of each lipid parameter changes, only TG level decrease remained statistically significant in group II (p=0.03).Conclusion: Transdermal hormone therapy seems to be superior to the oral forms in improving the lipid profiles. Hence individualization of hormone therapy is essential in monitoring those women with surgical menopause.

Objective: To compare the effects of hormone therapy on serum lipids in postmenopausal women.Materials and Methods: A retrospective study in 173 healthy postmenopausal women enrolled for this study. Participants had received 2 mg 17 beta-estradiol (E2) and 1 mg norethisterone acetate (E2/NETA) (n=21), 0.625 mg conjugated equine estrogen (CEE) and 2.5 mg medroxyprogesterone acetate (MPA) (n=38), 0.625 mg conjugated equine estrogen and 5 mg medroxyprogesterone acetate (n=39) and 2.5 mg tibolone (n=75). From the medical records, fasting serum lipid samples were evaluated before and after 6 months of treatment.Results: Total cholesterol decreased significantly only in E2/NETA group (p< 0.05). Mean levels of LDL decreased significantly in E2/NETA (p< 0.05) and CEE/2.5 mg MPA (p< 0.05). There was a significant increase of HDL within the CEE/5 mg MPA group (p< 0.01), whereas in the other groups increase of HDL was not found to be significant. Triglycerides decreased in all groups although the differences were not significant. When percentage of lipid profile changes among four groups were compared, only percentage of changes in LDL was significant between E2/NETA and tibolone groups.Discussion: Different hormone therapy regimes have different effects on lipid profile and none of them seem to be ideal. While many other factors are important for the cardiovascular system, changing of lipid profile may have an important role; so that when prescribing hormone therapy, lipid profile should be evaluated and monitored thereafter.

It is well known that an effective freezing technique is crucial for small numbers of human sperm using empty zona pellucida as straws. However, this method still has problems. The goal of this stu...

Objective: The objective of the study was to evaluate the relationship among polyp site, number, diameter, and symptomatology in endometrial polyps in reproductive and postmenopausal women.Study design: One hundred fifty-five subjects with endometrial polyps were evaluated retrospectively. Sociodemographic characteristics, endometrial thickness, polyp number, diameter, and site were reviewed, and their relations with abnormal uterine bleeding were tested.Results: A total of 36.1% of the patients in the postmenopausal group and 44.4% of the patients in the reproductive-aged group were asymptomatic. In addition, 37.3% of polyps in the reproductive-aged and 29.2% in the postmenopausal group were multiple. Polyp number, diameter, and site were not different among the 2 groups (P = .282, P = .469, and P = .485, respectively). When patients were evaluated as a whole, symptomatology was not related with polyp number, diameter, and site (P = .677, P = .334, and P = .699, respectively).Conclusion: Many endometrial polyps are asymptomatic and multiple in nature. Polyp site, number, and diameter do not correlate with symptomatology. (c) 2006 Mosby, Inc. All rights reserved.