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.

ObjectiveTo evaluate whether the presence and type of ultrasound markers of adenomyosis, as defined by MUSA criteria, predict IVF/ICSI outcomes, specifically live birth and pregnancy loss rates.MethodsThis single-center prospective cohort study included 314 women aged 18–39 years undergoing their first IVF/ICSI cycle between March 2018 and March 2020. All participants underwent standardized transvaginal ultrasound before treatment. Adenomyosis was diagnosed using MUSA criteria, distinguishing direct markers (myometrial cysts, hyperechogenic islands, echogenic subendometrial lines; n = 54) from indirect markers (globular enlargement, asymmetrical thickening, junctional zone irregularity; n = 22). Two multivariate logistic regression models were performed: (i) all adenomyosis patients versus controls (n = 238), and (ii) direct marker patients versus controls, adjusting for maternal age, BMI, and embryo transfer stage.ResultsAmong the adenomyosis group, 71.1% exhibited direct markers. Overall, adenomyosis was associated with reduced live birth per embryo transfer (28.9% vs 40.3%, aOR 0.61, 95% CI 0.34-1.08, p = 0.094) and significantly increased total pregnancy loss among HCG-positive patients (41.0% vs 22.6%, aOR 2.49, 95% CI 1.11-5.59, p = 0.026). When restricting analysis to direct markers, associations became substantially stronger: live birth rate was 22.2% (aOR 0.42, 95% CI 0.20-0.84, p = 0.017), representing a 58% reduction in odds, and pregnancy loss rate was 48.0% (aOR 3.77, 95% CI 1.44-10.21, p = 0.007), conferring a nearly 4-fold increased risk. Blastocyst-stage transfer independently improved live birth rates but did not compensate for the negative effect of direct markers.ConclusionDirect ultrasound markers of adenomyosis identify a high-risk reproductive phenotype with substantially reduced live birth and markedly elevated total pregnancy loss risk in IVF/ICSI cycles. The presence and type of ultrasound markers, rather than adenomyosis as a binary diagnosis, should inform patient counseling and individualized treatment planning.

To evaluate whether the timing of luteal phase support (LPS) initiation affects pregnancy outcomes in natural cycle vitrified-warmed blastocyst transfer (NC-FET) cycles. This retrospective cohort study included NC-FET cycles performed between January 2022 and December 2024 at a tertiary university fertility center. Only true natural cycles with blastocyst transfer were analyzed. Patients were divided into two groups according to the initiation of LPS: two days before embryo transfer (Group 1) or on the day of embryo transfer (Group 2). All patients received vaginal and subcutaneous progesterone for LPS. Baseline characteristics, embryo features, serum progesterone levels on transfer day, and reproductive outcomes were compared. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed to identify factors associated with clinical pregnancy. A total of 246 NC-FET cycles were analyzed (Group 1: n = 172; Group 2: n = 74). Baseline characteristics, embryo quality, and transfer parameters were comparable between groups. Serum progesterone levels on the day of transfer were significantly higher in Group 1 (32.1 ± 13.0 ng/mL) compared with Group 2 (10.3 ± 3.8 ng/mL; p = 0.001). However, total pregnancy rate (66.2

Background. Delayed umbilical cord clamping (DCC) is recommended for neonatal benefit, but maternal haematological safety concerns persist and may slow uptake. Because DCC is adopted progressively, calendar time confounds implementation-era cohorts. We estimated the association between DCC ≥ 60 seconds and early postpartum maternal haematological outcomes with explicit adjustment for calendar-time confounding. Methods. Single-centre retrospective cohort of 4,644 consecutive deliveries at ≥ 22 weeks’ gestation between 6 June 2022 and 31 December 2024 (4,632 with valid delivery dates for the calendar-adjusted analysis) at a university obstetric department in Ankara, Turkey. The exposure was DCC ≥ 60 seconds versus immediate or 30-second clamping. Calendar time was modelled as a natural cubic spline. The primary analysis used stabilised inverse-probability-of-treatment weighting (IPTW); covariate-adjusted modified Poisson regression, overlap weighting and 1:1 propensity-score matching were complementary analyses. Firth-penalised logistic regression handled the sparse transfusion outcome, and E-values addressed unmeasured confounding. The primary outcome was postpartum anaemia (venous haemoglobin < 10 g/dL at 6 hours). Results. 1,889 (40.8%) episodes received DCC; adoption rose from 10.2% in 2022 to 62.3% in 2024. On the primary analysis, DCC was not associated with postpartum anaemia (stabilised IPTW risk ratio 1.01, 95% CI 0.88–1.16; covariate-adjusted 1.00, 0.91–1.10; overlap 0.99, 0.87–1.13), postpartum haemorrhage (1.11, 0.77–1.59), haemoglobin drop ≥ 2 g/dL (0.98, 0.81–1.18) or blood transfusion (0.74, 0.24–2.25). A propensity-score-matched sensitivity analysis that did not achieve calendar-time balance (maximum standardised mean difference 0.18, versus 0.05 under IPTW) gave concordant, non-significant estimates (anaemia 0.93, 0.82–1.07). An exploratory delivery-mode interaction was observed (interaction ratio 0.78, 95% CI 0.65–0.93; p = 0.007): vaginal delivery 1.19 (1.02–1.38); caesarean delivery 0.91 (0.81–1.03). Conclusions. After calendar-time-adjusted multimethod analysis, DCC ≥ 60 seconds was not associated with worse maternal haematological outcomes overall. The delivery-mode divergence is hypothesis-generating and warrants prospective evaluation before any change in practice. Trial registration. Not applicable (observational cohort study).

Purpose:To investigate the histopathological association between chronic endometritis (CE) and adenomyosis, focusing on basal endometrial alterations and the potential involvement of tissue injury and repair (TIAR) mechanisms. Methods:This retrospective case-control study included 146 propensity score-matched hysterectomy specimens (73 adenomyosis, 73 controls). CE was diagnosed via CD38 immunohistochemical staining, identifying ≥ 5 plasma cells per high-power field. Basal endometrial thickness was measured digitally at the endo-myometrial junction. Basal endometrial loss was defined as the absence of the basal layer in at least two of three regions. Results:CE was significantly more frequent in the adenomyosis group (23.3%) than in controls (9.6%; p = 0.028). Basal endometrial loss, observed in 23.3% of cases, was strongly associated with CE (47% vs. 7.1%; p < 0.001). In patients with measurable thickness, a 0.15 mm cutoff predicted CE with AUC 0.888 (sensitivity 83.3%, specificity 86.9%). In multivariate analysis, basal endometrial loss was an independent risk factor for CE (adjusted OR 10.45, 95% CI 4.12-26.51; p < 0.001). Conclusions:CE is significantly associated with adenomyosis. Basal endometrial loss may mediate this relationship through TIAR-related mechanisms, suggesting CE as a potential therapeutic target in adenomyosis.

The optimal management strategy for large (≥ 4 cm) endometriomas prior to in vitro fertilization (IVF) remains uncertain. This study aimed to compare the cumulative live birth rate (CLBR) among three approaches: no intervention, ethanol sclerotherapy (EST), and laparoscopic cystectomy. This retrospective cohort study included 90 infertile women undergoing their first IVF cycle at a university-based infertility center between 2020 and 2023. Patients were grouped based on endometrioma management: IVF with no intervention (OMA in situ group, N = 39), IVF after EST (EST group, N = 20), or IVF after cystectomy (Cystectomy group, N = 31). The primary outcome was CLBR per initiated cycle. Secondary outcomes included oocyte and embryo yield, fertilization and implantation rates, and cycle cancellation rate. Statistical analysis included one-way ANOVA and chi-square tests, with significance set at P < 0.05. The EST group demonstrated a significantly higher CLBR (65

Ovarian tissue cryopreservation (OTC) followed by autologous transplantation is an established fertility preservation strategy, particularly for women undergoing gonadotoxic cancer treatments. However, its safety in leukemia patients remains controversial due to the risk of malignant cell contamination. We report the case of a 33-year-old woman with a history of Philadelphia chromosome–positive acute lymphoblastic leukemia (ALL) who achieved a second clinical pregnancy following repeated ovarian tissue transplantation (OTT). She underwent OTC at the age of 20 prior to myeloablative therapy. Her first OTT at age 28 resulted in a live birth. Five years later, a second OTT was performed using the remaining tissue, resulting in hormonal recovery and oocyte retrieval. Preimplantation genetic testing revealed 2 euploid embryos, and a frozen single embryo transfer resulted in a clinical pregnancy, that unfortunately ended in miscarriage at 13 weeks. No leukemia recurrence was observed during the follow-up. This is the first reported case of a second clinical pregnancy following repeated OTT in a leukemia survivor, supporting the feasibility of fertility restoration through multiple transplantations. With rigorous histological, immunohistochemical, and molecular screening where appropriate, OTT can be considered a safe and effective fertility preservation option in acute leukemia survivors.

BACKGROUND:The aim of this study is to investigate the association between uterine septum and dysmenorrhea and to assess the effect of hysteroscopic resection on the severity of dysmenorrhea. METHOD:The study group (N:50) consisted of women who underwent hysteroscopic septum resection, and the control group (N:74) consisted of women who underwent diagnostic hysteroscopy and had no significant uterine pathologies. The presence and severity of dysmenorrhea were assessed by using a 10 cm visual analog scale (VAS). The main outcome measurement was the difference between preoperative and postoperative dysmenorrhea VAS scores. RESULTS:The mean preoperative VAS score was significantly higher in the study group than the control group (4.6 ± 2.6 cm vs. 3.2 ± 2.4 cm, respectively; p = 0.023). The rates of moderate to severe dysmenorrhea were 52% in the study group and 17.5% in the control group (p = 0.025). The mean dysmenorrhea VAS score of women with uterine septum was significantly improved in postoperative 3rd and 6th months when compared to the preoperative period (3.4 ± 2.4 cm and 3.1 ± 2.3 vs. 4.6 ± 2.6 cm, respectively; P1 = 0.025 and P2 = 0.003). CONCLUSIONS:Uterine septum seems to be an etiological factor for dysmenorrhea. Although there is no significant relationship between septum depth and dysmenorrhea severity, hysteroscopic resection of the uterine septum improves dysmenorrhea in the infertile study group.

Is it safe and effective to perform controlled ovarian stimulation (COS) and oocyte retrieval (OR) in prepubertal and peripubertal patients? In this retrospective cohort study, data of 20 pre-/peripubertal patients who underwent COS and OR for the purpose of oocyte cryopreservation (OC) between 2008 and 2023 were reviewed. Following COS, all OR procedures were performed transabdominally using a vaginal ultrasound probe. Ovarian reserve was assessed by serum FSH, LH, estradiol, AMH, and antral follicle counts (AFC) in all subjects. All mature oocytes were vitrified. Mean age of the patients was 15.05 ± 1.87, mean AMH was 0.84 ± 0.8 ng/ml, mean FSH was 6.39 ± 3.95 IU/L, mean estradiol was 61.6 ± 51.9 pg/ml, mean LH was 4.69 ± 3.46 IU/L, and mean AFC was 5.5 ± 5.82. Among the patients, 12 had regular menstrual cycle, 5 had irregular menstrual cycle, whereas 3 patients still did not have their menarche yet. The indications for OC were as follows: primary ovarian insufficiency (n = 7), ovarian surgery for ovarian tumors (n = 5) or ovarian torsion (n = 1), mosaic Turner syndrome (n = 2), acute lymphoblastic leukemia (n = 1) anaplastic B-cell lymphoma (n = 1), Ewing’s sarcoma (n = 1), Noonan syndrome (n = 1), and Thalassemia (n = 1). The mean number of oocytes retrieved, MII oocytes frozen, and maturation rate were 5.11 ± 5.0, 3.92 ± 4.48, and 75.1 ± 25.6

Objective: This study aims to evaluate obstetric and neonatal outcomes in pregnancies complicated by RDs and to identify hemogram-derived biomarkers associated with adverse perinatal events. Methods: This retrospective cohort study analyzed 360 pregnancies in individuals diagnosed with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), ankylosing spondylitis (AS), Sjögren’s disease, sarcoidosis, undifferentiated connective tissue disease (UCTD), and other autoimmune conditions, followed up at the Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, between 2013 and 2018. Data on disease activity, maternal complications, neonatal outcomes, and inflammatory markers were extracted from electronic medical records. Results: Patients with SSc had the highest rates of preterm birth (57.1%) and fetal growth restriction (FGR) (42.9%), whereas those with SLE (50%) and AS (25%) exhibited the highest disease flare rates. Neonates born to mothers with SSc, SLE, and Sjögren’s disease had significantly lower Apgar scores, suggesting increased neonatal distress. NICU admission was associated with elevated neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR), with higher NLR and ELR also predicting spontaneous abortion. Monocyte-to-lymphocyte ratio (MLR) and ELR demonstrated the highest predictive value for composite adverse perinatal outcomes. Additionally, RA patients experiencing disease flares had an 87.5% cesarean section (CS) rate, significantly exceeding the general population rate. Conclusions: This study underscores the increased risk of preterm birth, FGR, and neonatal complications in RD pregnancies, particularly in SSc and SLE patients. The findings suggest that early risk assessment using hemogram-based inflammatory markers may improve perinatal management and patient stratification.

Are there serum estrogen and progesterone cut-off levels on day 12 after embryo transfer that can predict clinical pregnancy, abortion, or live birth? Yes, serum estrogen and progesterone cut-off levels on day 12 after embryo transfer can predict clinical pregnancy and live birth, but not abortion. Hormone profiles in IVF cycles are known to differ from those in natural pregnancies. Specifically, low progesterone levels resulting from impaired corpus luteum function are associated with adverse pregnancy outcomes. In fresh transfers, estrogen and progesterone levels rise to supraphysiological levels, while differences are observed in FET cycles depending on the endometrial preparation method. In clinical practice, progesterone and estrogen monitoring on hCG control day is not routinely performed, and there are limited studies evaluating their effectiveness in predicting pregnancy outcomes. There is no universally accepted cut-off value defined in the literature Our prospective cohort study analyzed 201 cycles of fresh and frozen embryo transfer over a 2-year period. Serum estrogen and progesterone levels were assessed on day 12 after transfer, following the hCG control. Patients aged 24-40 with 5 or more antral follicles were included, and those with cycle cancellation were excluded. ROC analysis was used to calculate cut-off values. Fresh transfers and FET groups were evaluated separately, with subgroup analysis performed in the FET group (true natural (NC), modified natural(mNC), and hormone replacement treatment(HRT)). Of the 201 cycles, 62 were fresh transfers and 139 were FET cycles. Among the FET cycles, 93 were HRT, 20 were mNC, and 26 were NC. In the fresh transfer group, ROC analysis for clinical pregnancy revealed an estrogen cut-off value of ≥ 424 pg/mL (92.90% sensitivity, 93.10% specificity). The progesterone cut-off was ≥44.15 ng/mL (78.90% sensitivity, 97.10% specificity). For live birth, the estrogen cut-off was ≥424 pg/mL (100% sensitivity, 84.80% specificity), and the progesterone cut-off was ≥51.3 ng/mL (75% sensitivity, 97.4% specificity). No statistically significant result was found for abortion. In the FET group, ROC analysis for clinical pregnancy showed an estrogen cut-off value of ≥ 243.5 pg/mL (78.30% sensitivity, 76.50% specificity), and the progesterone cut-off was ≥14.60 ng/mL (68.80% sensitivity, 66.30% specificity). For live birth, the estrogen cut-off was ≥227.50 pg/mL (78.90% sensitivity, 70.00% specificity), and progesterone was ≥16.25 ng/mL (70.80% sensitivity, 73.50% specificity). No statistically significant result was found for abortion. In the FET subgroup analysis, only estrogen was significant for clinical pregnancy in the HRT group, with no association found between E2 and P4 for live birth. Since the treatment protocol and progesterone support were individualized, a homogeneous patient group was not achieved. It is evident that serum estrogen and progesterone are not the only factors in clinical pregnancy and live birth outcomes, but these hormones strongly correlate with pregnancy results and provide guidance Hormonal monitoring on the hCG control day appears to be useful in predicting pregnancy progression. Larger patient cohort studies are needed to develop more robust predictive formulations. No

Objective:The aim of this retrospective cohort study was to evaluate the relationship between leading follicle size at the time of human chorionic gonadotropin (hCG) trigger and live birth rates in Patient-Oriented Strategies Encompassing Individualised Oocyte Number (POSEIDON) groups 3 and 4 undergoing assisted reproductive technology cycles using a gonadotropin releasing hormone (GnRH) antagonist protocol. The objective was to identify the optimal leading follicle size for maximizing live birth outcomes in this challenging patient population. Material and Methods:This retrospective cohort study included POSEIDON groups 3 and 4 poor responders aged 20-42 years undergoing intracytoplasmic sperm injection with GnRH antagonist protocol between January 2015 and July 2021. Patients were categorized based on the occurrence of premature ovulation. The primary outcome measures were number of oocytes retrieved, number of metaphase II (MII) oocytes, MII oocyte ratio and follicle oocyte index (FOI). These outcomes were compared across different leading follicle size categories at the time of hCG trigger. Results:Among the 294 subjects included, 47 (16.2%) had premature ovulation between the trigger and oocyte pick-up days. The mean size of the leading follicle on the day of trigger was significantly higher in the premature ovulation group (19.8±2.4 mm vs.18.7±2 mm, respectively; p<0.001). Multivariate logistic regression analyses identified baseline luteinizing hormone [odds ratio (OR) 1.144, 95% confidence interval (CI) 1.052-1.243; p=0.002], number of follicles >11 mm on the day of trigger (OR 0.580, 95% CI 0.438-0.767; p<0.001), and leading follicle size (OR 1.361, 95% CI 1.130-1.641; p=0.001) as independent predictors of premature ovulation. The FOI and MII/antral follicle count ratios peaked when the leading follicle size was between 16-17 mm. Conclusion:Individualized triggering based on leading follicle size may provide optimal oocyte retrieval after ovarian stimulation in POSEIDON expected poor responders. While a late trigger may result in premature ovulation, an early trigger may also result in less MII. Triggering when the leading follicle size is between 16.5 and 17 mm may help to prevent these negative outcomes and achieve optimal cycle outcome.

ObjectiveIn this study, we aimed to investigate whether serum NGAL, MMP-9 and the MMP-9/NGAL ratio, which are inflammatory markers used for the diagnosis and follow-up of some diseases, can be used as diagnostic and follow-up markers for the diagnosis of endometriomas in infertile patients.MethodsForty-five patients with unexplained infertility and 45 infertile patients with endometriomas were included in the study. Patients with endometriomas of at least 3 cm in size were included in the study. NGAL and MMP-9 levels in venous blood samples and the MMP-9/NGAL ratios of the unexplained infertility and endometrioma groups and the preoperative and postoperative results of the endometrioma group were compared.ResultsThe mean blood NGAL and MMP-9 levels in the endometrioma and unexplained groups were 22.0 ± 4.0 ng/ml and 25.4 ± 4.9 ng/ml and 43.7 ± 8.0 ng/ml and 39.3 ± 10.7 ng/ml, respectively, and all the results were statistically significant (p=0.001; p=0.012). The mean blood levels of NGAL and MMP-9 in endometriomas and the same patients at three months after surgery were 24.9 ± 4.9 ng/ml and 27.0 ± 4.9 ng/ml and 43.9 ± 7.3 ng/ml and 36.7 ± 8.7 ng/ml, respectively (p=0.179; p=0.006). The mean ratios of MMP-9/NGAL in the endometrioma, unexplained and postoperative groups were 2.0 ± 0.2, 1.5 ± 0.2 and 1.4 ± 0.2, respectively. All these results were significantly different between the endometrioma-unexplained group and the endometrioma-postoperative group (p=0.001; p=0.001). When we performed a ROC curve analysis for the presence of endometrioma, an MMP-9/NGAL ratio greater than 1.75 had 86.1% sensitivity and 84% specificity in indicating the presence of endometrioma (AUC=0.898). There was a positive correlation between the VAS score and the MMP-9/NGAL ratio.ConclusionsInterestingly, the NGAL blood NGAL level was lower in the endometrioma group than in the control group. The MMP-9/NGAL ratio can be useful in the diagnosis of endometrioma, and this ratio reflects the clinical findings of the disease.

OBJECTIVE:Despite recent advancements in assisted reproductive technology (ART), the effective management of patients with poor ovarian response (POR) remains a formidable challenge. While various treatment strategies and predictors of live births have been documented to provide guidance to fertility specialists in managing poor responders, research efforts have predominantly encompassed all POSEIDON groups. In this study, our objective was to analyze the factors correlated with live births (LB) within a subset of the POSEIDON groups, with a particular focus on POSEIDON groups 3 and 4.PATIENTS AND METHODS:Charts of 406 patients belonging to POSEIDON groups 3 and 4 who underwent ART treatment at a university-affiliated infertility clinic following a gonadotropin-releasing hormone (GnRH) antagonist cycle between January 2016 and December 2021 were analyzed. Clinically significant factors associated with live births were incorporated into a logistic regression model for multivariate analysis to ascertain independent predictors of LB. Additionally, a receiver operating characteristic (ROC) curve analysis was conducted to establish the optimal cut-off values.RESULTS:Live births were achieved in 48 cycles (8.7%). Female age (OR, 0.930; 95% CI: 0.874-0.991; p < 0.024), baseline serum luteinizing hormone (LH) levels (OR, 0.854; 95% CI: 0.741-0.984; p < 0.029), and dual triggers (OR, 4.004; 95% CI: 1.290-12.426; p < 0.016) were identified as independent factors associated with LB following multivariate logistic regression analysis. The optimal age cut-off was determined to be 33 years, with a sensitivity of 70.8% and specificity of 75%.CONCLUSIONS:Younger age, lower baseline serum LH levels, and dual-trigger administration appear to enhance the likelihood of live birth in POSEIDON groups 3 and 4 following treatments with the GnRH antagonist protocol.

Objective: The aim of our study is to examine the relationship between adenomyosis and chronic endometritis and to discuss its possible effects on pathogenesis. Design: Prospective analysis of previous patients’ pathology specimens Setting: A tertiary university hospital’s department of obstetrics and gynecology. Patients: Patients who underwent hysterectomy at were divided into two groups according to the presence or absence of adenomyosis. A propensity score matching analysis was performed to minimize selection bias in patient groups. A total of 146, 73 patients in each group, were included in the study. Methods: The previous specimens of the patients were re-evaluated with the CD38 immunohistochemistry staining method. A positive diagnosis of CE was made in the presence of plasma cells. In particular, basal endometrial thickness was measured in endo-myometrial transition zones. Main outcome measuresand Results: The adenomyosis group was significantly younger than the group without adenomyosis (47.14 ± 4.24 vs. 50.36 ± 7.02, p = 0.012). 17 (11.6%) patients in the adenomyosis group were diagnosed with chronic endometritis, while 7 (4.8%) patients in the control group were diagnosed with chronic endometritis, and a statistically significant difference was found (p<0.05). Basal endometrium could be measured in a total of 112 (76.7%) patients, while basal endometrial loss was observed in 34 (23.3%) patients. Chronic endometritis was found in 16 (47%) of the patients with basal endometrial loss. The baseline endometrial thickness of 112 (76.7%) of the patients could be measured, but only 8 (7.1%) of them had chronic endometritis. There was a statistically significant difference between the groups (p<0.001). In multivariate analysis, there was a statistically significant relationship between basal endometrial loss and CE. Conclusion(s): A significant relationship was observed between adenomyosis and chronic endometritis.

Objective Ovarian tissue cryopreservation (OTC) and transplantation has become a promising option for fertility preservation in women facing the risk of premature ovarian failure. We aim to report our experience with 15 patients who underwent frozen thawed ovarian tissue transplantation (OTT). Methods This retrospective cohort study included 15 women who underwent OTT in our tertiary referral center between December 2011 and June 2024. All the patients had previously undergone OTC using a slow freezing protocol with a home-made pre-prepared freezing medium including DMSO and sucrose. All patients diagnosed with acute leukemia had received consolidation chemotherapy prior to OTC before undergoing bone marrow transplantation (BMT). A medical clearance was obtained from each patient's hematologist-oncologist, and a vial of tissue was thawed to screen for the presence of residual leukemic cells. All OTT procedures were performed laparoscopically, with the ovarian cortical fragments being transplanted either into a retroperitoneal pocket (n=11), created 2 days earlier to enhance vascularization, or directly onto the menopausal ovary (n=1), or both(3). Results All 15 patients who underwent OTT regained ovarian function, as demonstrated by decreased FSH levels, increased estradiol and resumption of menstruation. Patient characteristics are shown in Table 1. No major surgical complications or adverse events were observed. The median age at OTC and OTT were 23.31± 7.9 years and 32.6 ± 1.48 years respectively. The indications were as follows; leukemia (n= 6), lymphoma (n=5), breast cancer (n=1), pineal gland tumor (n=1), thalassemia (n=1), and aplastic anemia (n=1). Mean serum AMH before OTC and following OTT was 1.37± and 0.16±0.11, respectively. Following IVF, 8 healthy live births occurred in 6 patients (Two of them was twin), summing up a pregnancy rate of 45.46% per patient (5/11) in those undergoing IVF (Patient 15 does not included). In one patient diagnosed with acute leukemia, IVF resulted in a healthy ongoing pregnancy following second OTT, and in another patient diagnosed with acute leukemia 2 euploid blastocysts were frozen in the first ovarian stimulation cycle (patient 14). In patient 15, who had 2 previous IVF cancellation due to POR, a healthy live birth occurred from the menopausal ovary following retroperitoneal OTT. Except one patient who underwent OTT very recently, no relapse was recorded in 5 patients with acute leukemia over a mean follow-up >50 months. Graft survival was > 24 months in all patients. Conclusion Transplantation of frozen thawed ovarian tissue remains a promising and established technique for fertility preservation, with prolonged graft longevity and increased pregnancy rates. We suggest that OTT may be feasible in carefully screened leukemia survivors following BMT.