Background and Objectives: Evidence on the impact of adherence to the Mediterranean diet alone—without supplementation—on serum and follicular fluid fatty acid profiles and assisted reproduction outcomes remains limited. This study evaluated the effects of a pre-treatment Mediterranean diet intervention on these parameters. Materials and Methods: In this prospective, non-randomized controlled trial, 32 women undergoing infertility treatment were allocated to a Mediterranean diet intervention group (n = 16) or a control group (n = 16). The intervention lasted 12 weeks, and adherence was assessed using validated dietary indices. Serum and follicular fluid fatty acid profiles were analyzed, and implantation and pregnancy outcomes were recorded. Results: The diet group showed increased ω-6 and ω-3 intake with decreased LA/ALA and ω-6/ω-3 ratios. In the control group, serum EPA + DHA levels declined, whereas in the diet group serum LA/ALA decreased. Follicular fluid in the intervention group had lower EPA + DHA and ω-6 ratios. Diet adherence correlated positively with MII oocytes (r = 0.797) and pronuclei (r = 0.741). No significant associations were found between follicular fluid fatty acids and IVF outcomes. A total of four implantation events were observed (intervention: n = 3; control: n = 1). Two of the implantations in the intervention group resulted in live births, while the remaining implantation events did not result in live birth. Conclusions: A Mediterranean diet-aligned dietary intervention may induce favorable changes in blood and follicular fluid parameters; however, the underlying metabolic mechanisms warrant further investigation. Three implantations were observed in the intervention group and one in the control group; given the low number of events, comparisons of live birth outcomes should be interpreted with caution. Overall, the findings regarding ART outcomes and clinical translation remain exploratory due to the limited sample size. Well-designed randomized controlled trials in which ART and clinical endpoints are defined as primary outcomes are needed.

Objective: The aim of this study was to evaluate the effects of polycystic ovary syndrome (PCOS) and accompanying obesity on various metabolic and biochemical parameters, particularly body composition, insulin resistance (IR), lipid profile, and inflammatory markers. Methods: The aim of this study was to evaluate the effects of polycystic ovary syndrome (PCOS) and accompanying obesity on various metabolic and biochemical parameters, particularly body composition, insulin resistance (IR), lipid profile, and inflammatory markers. A total of 120 women aged 18–40 years were included in the study: 40 obese patients with PCOS, 40 normal-weight (non-obese) patients with PCOS, and 40 healthy controls. The diagnosis of PCOS was established according to the Rotterdam criteria. Participants were classified based on body mass index (BMI) as obese (BMI ≥30 kg/m2) or non-obese (BMI <25 kg/m2). Body composition was assessed using bioelectrical impedance analysis. Serum fasting glucose, insulin, glycated hemoglobin (HbA1c), lipid profile, C-reactive protein (CRP), alanine aminotransferase, aspartate aminotransferase, anti-Müllerian hormone (AMH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and progesterone were analyzed. IR was calculated using the homeostatic model assessment of IR (HOMA-IR) method. Statistical comparisons between groups were performed using the Kruskal–Wallis test followed by Dunn’s post-hoc analyses. Results: Body weight, BMI, total fat mass, and body fat percentage were significantly higher in the obese PCOS group than in the other groups, whereas body water percentage and high-density lipoprotein (HDL) cholesterol levels were significantly lower (p < 0.001). Fasting insulin levels and HOMA-IR were significantly higher in the obese PCOS group than in both the control group and the non-obese PCOS group (p < 0.001). Additionally, HbA1c levels were higher in the obese PCOS group compared with both the control group (p < 0.001) and the non-obese PCOS group (p < 0.01). Similarly, triglyceride (TG), CRP, and ALT levels were higher in the obese PCOS group than in the other groups. AMH levels were higher in the non-obese PCOS group than in the control group. In contrast, no statistically significant differences were found among the groups in LH levels, FSH levels, the LH/FSH ratio, or progesterone levels. Correlation analyses showed that BMI and fat mass were positively associated with indicators of IR and with levels of TG, CRP, and ALT, and negatively associated with HDL cholesterol and body water percentage. Conclusion: The severity of metabolic impairment in PCOS is closely associated with obesity and increased fat mass. Obesity is one of the main determinants of IR, dyslipidemia, and inflammation. Therefore, improving body composition is of great importance in the management of PCOS to reduce metabolic risk.

Objective: To compare the diagnostic accuracy and concordance of three-dimensional/four-dimensional (3D/4D) ultrasonography and magnetic resonance imaging (MRI) in detecting Müllerian duct anomalies (MDAs) and to evaluate their impact on surgical decision-making. Methods: This prospective observational study included 32 patients who presented to the infertility or gynecology outpatient clinics at Gazi University Hospital between November 2016 and November 2017. All patients underwent both 3D/4D transvaginal ultrasonography (Voluson E6, GE Healthcare) and pelvic MRI (3T Verio, Siemens). Diagnoses were classified according to the American Society of Reproductive Medicine (ASRM, 1988) criteria. Concordance between the two imaging modalities was evaluated using the kappa (κ) statistic. Results: Of the 32 enrolled patients, 25 completed both imaging studies. Overall concordance between 3D/4D ultrasonography and MRI was 40% (κ = 0.266, p < 0.001), indicating low-to-moderate agreement. The most common diagnosis with 3D/4D ultrasonography was septate uterus (56%), compared with 20% by MRI. Among 13 patients who underwent surgery, 12 were correctly diagnosed as having septate uterus by 3D/4D ultrasonography (positive predictive value, 92.3%), while MRI correctly identified four (30.8%). Surgical decisions were based on 3D/4D ultrasonography in 69.2% of discordant cases and on MRI in 30.8%. Conclusion: Although MRI remains the reference standard for evaluating MDAs, 3D/4D ultrasonography demonstrated strong clinical value in guiding surgical management and offered advantages of accessibility, real-time assessment, and lower cost. We recommend that 3D/4D ultrasonography be performed by the operating gynecologist prior to surgical planning. Larger randomized studies are warranted to validate these findings.

Objective:To investigate patient characteristics and outcomes of assisted reproductive technology (ART) cycles conducted in Türkiye during the coronavirus disease-2019 (COVID-19) pandemic (2020-2021). Material and Methods:ART centers in Türkiye were invited to participate in this survey. The questionnaire focused on patient demographics and performance outcomes and was sent to center directors via anonymous Qualtrics™ links. Results:The survey was sent to 167 centers and data were collected from 15 centers in 2020 and 24 centers in 2021. The clinical pregnancy rate from intrauterine insemination (IUI) procedures remained similar, with 15.1% in 2020 (1,245 IUI cycles) and 14.5% in 2021 (2,023 IUI cycles), while successful delivery rates were 12.5% and 11.5%, respectively. For ART treatments, the clinical pregnancy rate from fresh embryo transfers increased from 45.1% in 2020 (3,119 transfers) to 50.4% in 2021 (8832 transfers), with similar live birth rates, 34.2% vs. 34.4%. Frozen embryo transfers resulted in clinical pregnancy rates of 47.8% in 2020 (2,498 transfers) and 51.9% in 2021 (12,015 transfers), with live birth rates rising from 39.8% to 42.7%. Preimplantation genetic testing cycles resulted in clinical pregnancy rates of 64.2% in 2020 (271 transfers) and 60.8% in 2021 (2,102 transfers), with live birth rates of 53.5% and 48.2%, respectively. Regarding techniques for fertility preservation in females, 11 prepubertal and 61 postpubertal ovarian tissue cryopreservation procedures were reported, alongside 1,346 cycles performed within the same period. In males, 144 post-pubertal testicular tissue, 871 epididymal and 2,480 ejaculated sperm cryopreservations were reported. During the two years, six ovarian tissue transplantations followed by ART were performed, with 96 women using cryopreserved oocytes. In addition, 40 testicular tissue, 298 epididymal, and 238 ejaculated sperm samples were used for ART purposes. Conclusion:This survey provides a comprehensive overview of ART practices in Türkiye for 2020 and 2021, establishing a long-term, nationallevel analysis while highlighting the challenges posed by the COVID-19 pandemic. The longitudinal analysis established a foundation for future annual reports and offers critical insights into emerging trends over these two years.

Objective: To evaluate whether ovarian volume is correlated with hormonal status and frequent symptoms in menopausal period. Methods: Sixty-two postmenopausal women who applied for routine yearly gynecological control included. After measurement of ovarian volumes by using Virtual Organ Computer-aided Analysis volume analysis, hormonal levels, and evaluation of symptoms with standardized menopause-specific quality of life questionnaire, comparisons and correlation analysis were performed. Results: When the time of menopausal period increases the ovarian volume decreased (p=0.026), and earlier menopause age correlated with lower ovarian volume (p=0.014). Although the results did not reach statistically significance, a negative correlation between ovarian volumes and follicle stimulating hormone levels and a positive correlation between ovarian volumes and Estradiol levels were found (p=0.46, p=0.26). There was no correlation between ovarian volume analyses with hormonal status and menopausal symptoms. Conclusion: Both the severity and type of menopausal symptoms and hormonal status do not relate with ovarian volume after the menopause. This finding may be useful to decide to perform oophorectomy or not at the time of hysterectomy in menopausal ages.

Objective:The aim of this study was to describe characteristics and outcomes of assisted reproductive technology (ART) cycles performed in 2019 in Turkey. Material and Methods:One-hundred and sixty-five ART centers in Turkey were invited to submit data.The survey was sent to center directors via e-mail with anonymous links by Qualtrics™.The survey involved questions about their patient characteristics, clinical practices, and outcomes.Results: Forty-one (24.8%) centers responded to e-mails, and data gathered from 25 centers was included in the analyses.In 25 centers, 18,127 fresh or frozen transfers were carried out during the study period, of which 7796 (43.0%) were fresh and the rest were either frozen (45.2%) or embryo transfers (ET) with preimplantation genetic testing (PGT) (11.8%).The live birth rate per ET was as 30.6%, 40.1%, and 50.7% in fresh, frozen and PGT cycles, respectively.A single embryo was transferred in 65.3% of all transfers and singleton live births comprised 86.1% of all deliveries.For cycles with intrauterine insemination, 1407 were started in 2019, and 195 clinical pregnancies, 150 live births with 19 multiple pregnancies occurred.A total of 1513 ART cycles were initiated for foreign patients.Russia (29.6%), Germany (7.4%), Iraq (4.6%), Uzbekistan (3.1%), and Syria (1.4%) were the top five countries with most patients coming to Turkey for ART. Conclusion:The survey results are in parallel with the reports of international institutions and organizations.With repeated editions, the data collected with annual surveys can be used to inform ART practices in the coming years.(

Objective To determine the effect of follicular phase estrogen priming in IVF cycles. Materials and Methods This retrospective cohort study was conducted in a university based IVF clinic between 2017-2021. Five hundred and fifty-one cycles were analyzed where study (116) and control (435) groups treated with GnRH antagonist fixed protocol while study group received additional 6mg/day of estrogen starting from the 1st day of cycle until the hCG trigger and clomiphene citrate for 5-15 days. Only one cycle of each patient were included to the study so number of patients and cycles were equal. Primary outcomes were clinical pregnancy rate, live birth rate and gonadotropin consumption. Secondary outcomes were abortion rate, chemical pregnancy rate, ectopic pregnancy rate, multiple pregnancy rate and intrapartum exitus rate. Results Mean BMI was significantly higher in study group whilst all the remaining demographic properties were similar. Basal serum FSH levels (8.54 - 10.01, p=0.03), AFC (8.54 - 10.01, p=0.03), total gonadotropin consumption (1611.76 -2975.81, p=0.00) and ovarian stimulation duration (7.40 - 9.4, p=0.00) were significantly lower in study group while maximum serum LH level (10.12 -3.42, p = 0.00) and Pg level (1.52 - 1.00, p = 0.015) were statistically higher. Number of collected oocytes, M1 and M2 oocytes were similar for both groups where M2 oocyte rate (71.3% - 75.0%, p = 0.04) was significantly higher in the control group. Post IVF results (number of ICSI, PN, cleavage, blast, transferred embryo, frozen embryo, fertilization rate, FORT and FOI) were similar for both groups. Single/twin pregnancy, single/twin birth, chemical pregnancy, ectopic pregnancy, abortion and intrapartum exitus rates were similar. Clinical pregnancy (29.4 -23.4, p< 0.01), single pregnancy (21.8-16.4, p< 0.01), total live birth (20.2 -14.8, p< 0.01) and single live birth (17.6 - 12.5, p< 0.01) rates represented an increasing trend in the study group with a p value < 0.01. Conclusion This research supports the possibility of follicular phase estrogen priming in IVF cycles to increase the clinical pregnancy rates compared to conventional OS protocols while decreasing the gonadotropin consumption as it decreases financial burden of IVF cycles on patients and healthcare system.

Objectives To evaluate relationship between, male AMH, serum markers, and semen parameters in severe male factor in vitro fertilization (IVF) treatment. Methods Between July 2022-June 2023, sixty-nine azopermia(n=44), severe oligospermia (n=25) and thirthy-two normospermia control patients (n=32) who met the inclusion criteria who underwent IVF treatment is analyzed. A prospective normal distributed epidemiological study, analyzed retrospectively. Results The mean AMH levels in all 3 groups azoospermia (n=44), severe oligospermia (n=25), combined of two (n=69), by comparing control group (n=32) were similar 5,3±3,8SD, 5,3±3,8SD, 5,3±3,5SD, 6,5±3,2SD ng/ml respectively. AMH distribution over the years by age were in all male factor infertility cases were already elevated and do not changed by years, only normal cases AMH decreased at trend by years (p=0,07). At ROC analyses of AMH in azospermia by controls; significant threshold value is ≤4,58 ng/ml (p=0,02). Also in combined group same threshold value was significant for AMH≤3,81 ng/ml (p=0,02). Mean FSH mIU/ml levels were in all 3 groups significantly higher than controls 15.1 ±11.8 SD, 7.08±5.9SD, 12.2±10.7SD and 3.6±1.5SD (p=0,001). FSH distribution over the years by age were in severe oligospermic, combined and control group significantly decreased by age. Azospermics FSH were already elevated, didn't changed by time. At ROC analyses of FSH by controls revealed 3 groups thereshold value >5,59 mIU/ml (p=0,001). Conclusion AMH can not be used to predict a man's reproductive potential and is not associated with abnormal semen analysis results. The distrubituon of AMH over the years is found to be meaningless. Conversely FSH is closely related to abnormal semen. Linear increase of FSH levels over the years is observed significantly in men with azoospermia, severe oligospermia, combined group compared to normozoospermia. But when ROC curve analysis is performed AMH and FSH significantly predicts at thereshold levels the azospermia compared to normals.

To investigate whether the DNA methylation profiles of GNAS(20q13.32), MEST(7q32.2), MESTIT1(7q32.2), IGF2(11p15.5), H19 (7q32.2), and CEP41(7q32.2) genes are related to the transcriptomic and epigenomic etiology of male infertility. The DNA methylation levels of spermatozoa were obtained from fertile (n = 30), oligozoospermic (n = 30), and men with normal sperm count (n = 30). The methylation status of each CpG site was categorized as hypermethylated or hypomethylated. Expression levels of target gene transcripts were determined using real-time PCR. The oligozoospermia showed a higher frequency of hypermethylation at GNASAS 1st, 3rd, and 5th CpG dinucleotides (66.7

PurposeTo evaluate the impact of serum LH levels prior to progestin administration on the outcomes of programmed frozen-thawed embryo transfer (FET) cycles.MethodsRetrospective cohort study was conducted to compare the treatment outcomes between four groups based on the 25 percentiles of serum LH levels before progestin administration in 596 cycles of 518 patients undergoing artificial endometrial preparation protocols for FET. Primary outcome measures were ongoing and live birth rates. Secondary outcome measures were the pregnancy rates, clinical pregnancy rates, and pregnancy loss rates.ResultsThe trends in clinical pregnancy (CPR) and live birth rates (LBR) increased from the first to the fourth quartile (Q1 to Q4) of serum LH levels prior to progestin administration (37,0% to 48,3%, p = 0.042, and 22.6% to 39.5%, respectively, p = 0.003). Pregnancy loss rates (PLR) were higher in group Q1, although the difference was not statistically significant. Based on a multivariate logistic regression analysis, a low serum LH level before progestin initiation was found to be the most significant predictor associated with a negative effect on live birth (OR: 0,421, 95% CI 0,178 – 0,994, p=0,048). The day of estrogen initiation was significantly correlated with serum LH levels and quartiles of serum LH levels before progestin administration (r=0,200, p=0,015 and r=0,215, p=0,009, respectively).ConclusionThe serum LH level prior to progestin administration significantly affects pregnancy and live birth rates in patients undergoing an artificial endometrial preparation protocol for FET. LH monitoring should be incorporated into the follow-up, in addition to assessing endometrial thickness and morphology in artificial FET cycles.

Fetal ovarian torsion is quite a rare event during the antenatal period and usually seen because of an ovarian cyst complication. In this case report, we present a case of fetal ovarian torsion without any ovarian cyst or underlying detectable causes. A 27-year-old primigravid woman with no significant past medical history had a routine prenatal ultrasound at 30 weeks' gestation. The ultrasound showed abdominal ascites and a 47×42-cm intraabdominal solid diffuse mass at the left side under the stomach. Doppler examination showed no blood flow on the mass. Paracentesis was performed, cytological examination reported no abnormality. Based on these findings, the diagnosis was thought to be fetal ovarian torsion. There is lack of consistent recommendations to guide the prenatal and the postnatal management of cases with in-utero diagnosis of ovarian torsion. A "wait-and-see" policy is usually preferred, as in our case.

Objectives: Platelet-rich plasma (PRP) is obtained by centrifuging the platelet-rich portion of the patient's own blood. The objective of our study is to retrospectively examine the impact of intraovarian PRP injection on infertile women with diminished ovarian reserve, specifically focusing on the oocyte count, oocyte quality, and endometrial thinning. Methods: A retrospective assessment was conducted on cases who had intraovarian PRP injection at the in vitro fertilization (IVF) unit of the Obstetrics and Gynecology Department of Gazi University School of Medicine hospital. The review encompasses the period from 1 January 2015 to 30 June 2020. The endometrial thickness, follicle count of greater than 14 millimeters, estradiol levels, follicle-stimulating hormone (FSH) levels, and antral follicle count were assessed during the menstrual cycle both prior to and within a period of 1-6 months following the PRP procedure. Twenty nonpregnant patients who had IVF before and 4-6 months after PRP were admitted to the post-PRP IVF cycle. The quantification of oocytes and M2 oocytes was conducted both prior to and subsequent to PRP treatment. Results: Among 120 cases, only 60 cases who fulfilled inclusion criteria were analyzed. The basal endometrial thickness, basal follicle number (>14 mm), estradiol value, oocyte count, and M2 oocyte count exhibited a statistically significant increase following the administration of PRP injection (p<0.001). The basal FSH value exhibited a notable drop following the administration of PRP injection, with a statistically significant difference (p=0.002). In the pregnant group, the number of oocytes obtained with oocyte pick-up (OPU) increased by 300%, and in the nonpregnant group, the increase was 125% only. The number of M2 oocytes obtained with OPU increased by 250% in the pregnant group, while it was 93% in the nonpregnant group. Conclusion: Ultimately, the affordability of PRP production and its considerable theoretical efficacy have the potential to substantially decrease the expenses associated with assisted reproductive technology procedures. In the present scenario, the administration of an intraovarian PRP injection may be contemplated as a therapeutic intervention for women exhibiting diminished ovarian reserve.

Objective: To evaluate whether hCG day serum LH levels have an impact on IVF outcomes in patients undergoing GnRH antagonist protocols. Methods: This retrospective cohort study was carried out in a private IVF clinic from September 2017 to January 2021. A total of 971 completed IVF cycles with GnRH antagonists were evaluated. Three groups with different LH levels were analysed according to hCG day serum LH concentrations: Group 1: LH >= 10 mIU/ml, Group 2: LH = 1.2-10 mIU/ml, and Group 3: LH <1.2 mIU/ml. Results: Total dose of gonadotropin consumption was significantly higher, and the number of MII oocytes retrieved was significantly lower in group 3 than others (p<0.001). The maturation rates and implantation rates were significantly lower in group 3 compared to other groups (p<0.05, p<0.05, respectively). Clinical pregnancy (CPR) and live birth rates (LBR) per cycle were significantly lower in group 3 (6.2%, 6.2%, respectively) compared to group 1 (41.3%, 35.3, respectively) and group 2 (38.7%, 31.4%, respectively) (p<0.001, p<0.001, respectively). CPR and LBR per embryo transfer were also significantly lower in group 3 than others (p=0.003, p=0.029, respectively). Multivariate logistic regression analysis revealed that female age, number of MII oocytes retrieved, and serum hCG day LH levels were the significant variables in predicting live birth. Conclusion: Higher hCG day LH levels result in poor pregnancy outcomes, especially in older poor responders, and GnRH antagonists seem ineffective in these patients. However, lower hCG day LH levels may not affect IVF outcomes in antagonist cycles.

Introduction: Thyroid autoimmunity (TAI) is the most common autoimmune disorder. Patients with TAI are usually euthyroid, and the presence of anti-thyroid peroxidase (anti-TPO) in patients with or without thyroid dysfunction is associated with infertility, recurrent embryo implantation failure, and early pregnancy loss. We aimed to investigate the relationship between low ovarian reserve, pregnancy outcomes, and TAI. Material and methods: This retrospective cohort study was conducted in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients between 2010 and 2018. All patients (n = 1400) for whom thyroid autoantibody testing was requested were detected. A study group was formed from patients with anti-TPO positivity (n = 363). The control group (n = 555) comprised euthyroid anti-TPO negative patients matched to the study group regarding age and body mass index (BMI). Results: Mean serum TSH value was 2.35 ± 1.70 mIU/mL in anti-TPO-positive patients and 1.81 ± 1.2 mIU/mL in controls, and the difference was significant (p < 0.05). Total dose of gonadotropins used in ovulation induction in anti-TPO-positive and control patients were 3000 IU and 2700 IU, respectively, and the difference was statistically significant (p < 0.05). The number of metaphase 2 oocytes was significantly lower in the anti-TPO-positive group (p < 0.05). Embryo transfer number and embryo grade were significantly lower in the anti-TPO-positive group (p < 0.01). Poor ovarian response was significantly higher in anti-TPO-positive patients (40%) as compared to anti-TPO-negative controls (30%) (p < 0.01). Clinical pregnancy rate was significantly lower in the anti-TPO-positive group (29.2%), as compared to the antibody-negative group (38.4%) (p < 0.01). Conclusions: There are controversial data regarding the impact of antithyroid antibodies on ovarian reserve and pregnancy outcome after IVF treatment. The results of this study indicate that there was a relationship between TAI and poor ovarian response, and that TAI adversely affects IVF outcomes. Further investigations are required to explore the mechanism behind these effects.