Objective: To compare the visual appearance of the ovaries with two dimensional and three dimensional (3D) ultrasound (US) modalities in unselected women of reproductive age and to evaluate whether 3D changes the likelihood of polycystic ovary syndrome (PCOS) diagnosis. Methods: This cross-sectional study was conducted in patients diagnosed within an unselected population of women (n = 115). The primary outcome measures were antral follicle count (AFC) and ovarian volume (OV), assessed using two different sonographic modalities. The agreement of these two sonographic modalities was tested using a Bland-Altman plot. Results: Whereas the mean AFC with both sonographic modalities was 10.3 +/- 4.8 vs. 11.2 +/- 5.5 (p = 0.61), the OV estimated were 7.5 +/- 3.0 vs. 9.6 +/- 4.0 (p < 0.001) mL respectively. The mean bias, representing the upper and lower limits of agreement between the modalities for estimation of AFC, was - 0.17 (-8.45 to 8.11). The respective figure for OV was -1.99 mL (-7.72 to 3.75). Therefore, 3D revealed OV values that were 22.5% larger and identified 2 additional cases of PCOS according to the Rotterdam criteria. Conclusion: 3D US yields larger OV values and classifies slightly more women as having PCOS. Although concerns related to the diagnosis of PCOM mainly focus on AFC, those findings also underscore the reliability of OV as a diagnostic parameter for the syndrome. These findings suggest that the imaging modality should be considered when interpreting ovarian measurements and applying diagnostic criteria.

OBJECTIVE: Aim of this study is determining the influence of luteal long GnRH agonist and GnRH antagonist protocols on IVF/ICSI cycle outcome in group of patients considered “normal responder” and influence of luteal long GnRH agonist, microdose flare-up agonist and GnRH antagonist protocols on IVF/ICSI cycle outcome in a group of patients considered “poor responder”. STUDY DESIGN: This was a retrospective analysis performed in the Hacettepe University School of Medicine IVF Center, Ankara, from January 2005 to December 2007. Normal responders (first arm) were stimulated either with luteal long GnRH analogues, (193 patients and 300 cycles) or with GnRH antagonists (215 patients and 300 cycles). Poor responders (second arm) were stimulated either with luteal long GnRH analogues, (20 patients and 32 cycles), with GnRH antagonists (21 patients and 45 cycles) or microdose flare-up protocol (27 patients and 74 cycles). RESULTS: In the first arm; the clinical pregnancy, implantation and multiple pregnancy rates were comparable between the two groups in the first arm. In the second arm; clinical pregnancy, implantation and multiple pregnancy rates were comparable between three groups. CONCLUSION: There is insufficient evidence to recommend GnRH agonist or GnRH antagonist protocols for patients considered “normal’ and ‘poor responder’.

Adnexal torsion causes venous and lymphatic blockade complicated by congestion. Adnexal torsion is seldom in pregnancy, occuring approximately 1 in 5000 pregnancies, more frequently in the first trimester. Acute abdominal pain and abdominal disturbances are challenging issues during pregnancy for the diagnosis. The clinical symptoms are non-specific. Colour and power Doppler sonography may be useful for the early diagnosis. Adnexal torsion is generally due to ovarian stimulation treatment or ovarian masses in pregnancy. The correct diagnosis of maternal ovarian torsion might be delayed or underestimated in the second half of gestation because the increased dimensions of the uterus could blockade the abdominal palpation and make the sonography inefficient. Laparoscopy should be preferable for the adnexal torsion suspicion. But as the gestational age increases laparotomy should be a choice because of the risk of injury to the uterus related to the enlarged volume by the fetus.

Backgrounds: What is not clear as yet is not only the etiology, but also the management of osseous metaplasia. We describe an infertile patient with osseous metaplasia and subsequent pregnancy after treatment and review the literature from infertility perspective. Method: We presented a 30-year-old woman with 8 years of secondary infertility who conceived spontaneously after removal of osseous tissue by operative hysteroscopy (HS) following one failed in vitro fertilization cycle. The current literature regarding the osseous metaplasia and fertility potential after removal of osseous tissue was also systematically reviewed in which 21 reports (n = 64 women) were eligible. Results: The available data suggest that restoration of endometrial cavity with HS or curettage provides a spontaneous pregnancy rate of 54.2% within 12 months. Conclusion: According to the available data, irrespective from the duration of subfertility, spontaneous pregnancy should be expected for at least 1 year following the ‘complete' restoration of endometrial cavity. In that context, further infertility treatments such as assisted reproduction cycles should be postponed, unless there is another reason for infertility.

Background/Aims: To analyze whether the presence of endometriosis per se is associated with inferior pregnancy rates in women undergoing in vitro fertilization (IVF). Methods: Between July 2005 and November 2012, a total of 485 patients with endometriosis under the age of 38 years undergoing their first IVF attempt at our center were included; 72 patients had minimal-mild disease and the remaining 413 patients had moderate-severe disease. 131 patients with laparoscopically confirmed tubal factor infertility not harboring endometriosis and hydrosalpinx under the age of 38 years undergoing their first IVF attempt at our center served as the control group. Results: The bilateral antral follicle count and controlled ovarian hyperstimulation response were diminished in the moderate-severe group. However, the implantation, clinical pregnancy, miscarriage and live birth rates were comparable among the three groups. The recurrence of endometrioma following pre-IVF cystectomy was not associated with inferior pregnancy rates. Female age, bilateral antral follicle count and number of embryos transferred were noted to be significant independent predictors of live birth. Conclusion: We conclude that neither the presence nor the extent of endometriosis have any detrimental effect on IVF pregnancy rates.

Pelvic organ prolapse (POP) is defined as the descent of pelvic organs from normal position due to pelvic floor dysfunction. A woman has a 11% life time risk of undergoing surgery for POP. A case of laparoscopic sacrohysteropexy, a uterus preserving surgical procedure for the treatment of uterine prolapse is presented and 6 month follow up outcomes are reported. A 26 year-old woman presented with complaints of a mass bulging out of her vagina and pressure feeling in her pelvis. Her pelvic examination revealed second degree uterine prolapse with no prolapse of anterior and posterior vaginal walls. She underwent laparoscopic sacrohysteropexy. On her follow up at first and sixth months postoperatively, she had remained asymptomatic. Her pelvic examination revealed no uterine prolapse. Laparoscopic sacrohysteropexy is an effective, safe and conservative procedure for the treatment of uterine prolapse.

AimThe aim of this study is to determine the effect of a mandatory single embryo transfer (SET) policy on pregnancy rates and multiple pregnancy rates in intracytoplasmic sperm injection (ICSI) cycles.MethodsOne hundred and twenty-eight patients (154 cycles) underwent ICSI before the Turkish Ministry of Health's legislation, 55 patients (69 cycles) underwent ICSI after the legislation (day-3 embryo transfers only) and 35 patients (39 cycles) who underwent ICSI after the legislation (day-5 embryo transfers only).ResultsGroups were comparable regarding the women's mean age and body mass index. The number of embryos transferred (2.70.5 vs 1.0 +/- 0.0 vs 1.0 +/- 0.0) was significantly higher in group I, compared to group II and group III. Clinical pregnancy per embryo transfer (40.8% vs 15.1% vs 36.1%) and live birth rate (37.7% vs 13.2% vs 30.6%) were significantly lower in group II when compared to group I and group III. Multiple pregnancy rates (39.6% vs 0.0%, vs 0.0%) were significantly higher in group I when compared to group II and III. Implantation rates were significantly higher in group III when compared to group I and group II. Miscarriage rates were comparable among the groups.ConclusionThe mandatory SET policy caused a dramatic decrease of multiple pregnancy rates. Mandatory SET with only day-3 embryo transfers decreased the pregnancy rates but this detrimental effect was not seen in cycles with day-5 embryo transfers.

The use of cabergoline and coasting are both effective in reducing the risk of ovarian hyperstimulation syndrome (OHSS). Our aim was to compare the effectiveness of cabergoline with coasting to prevent moderate–severe OHSS.

Purpose To investigate the relationship between hyaluronan binding (HB) assay and pregnancy rates in intrauterine insemination (IUI) cycles. Methods This prospective cohort study was done in Hacettepe University, a tertiary care center for reproductive medicine. Seventy-one consecutive couples who suffered from unexplained infertility and underwent controlled ovarian hyperstimulation (COH) and IUI were enrolled into the study. Results From the 71 IUI patients, the clinical pregnancy rate was 14.1 % (10 of 71). HB ratio from the overall patient number was 48.6 ± 25.9. The mean HB ratio in pregnant and non-pregnant groups was comparable (50.2 ± 25.2 vs. 48.3 ± 26.2, respectively, p > 0.05). Conclusions Hyaluronan binding assay does not predict pregnancy rates in IUI cycles in couples with unexplained infertility.

What is the prevalence, phenotype and metabolic features of polycystic ovary syndrome (PCOS) in the same population according to three different diagnostic criteria?The prevalence of PCOS under National Institutes of Health (NIH), Rotterdam and Androgen Excess and PCOS (AE-PCOS) Society criteria was 6.1, 19.9 and 15.3, respectively. PCOS carried a 2-fold increased risk of metabolic syndrome regardless of the diagnostic criteria used.The prevalence rates of PCOS differ depending on the diagnostic criteria used to define the syndrome. The current paper gives the prevalence rates of the component and composite phenotypes of PCOS in the same population and reports similar rates of metabolic syndrome in women with PCOS under contrasting diagnostic criteria.In this cross-sectional study, 392 women between the ages of 18 and 45 years were analyzed.When the prevalence of PCOS according to NIH was set to 8 with a precision of 2.2 and confidence interval of 95, the sample size required for a prevalence survey was found to be 400 subjects. The study was carried out in the General Directorate of Mineral Research and Exploration, a government-based institute, in which the largest number of female staff (n 527) are employed within a single institute in Ankara, Turkey. The study was performed between 7 December 2009 and 30 April 2010. All female subjects between the ages of 18 and 45 years were invited to participate. Women older than 45 or younger than 18 years, post-menopausal women, women with a history of hysterectomy or bilateral oopherectomy and pregnant women were excluded. Totally, 392 of the employees were recruited for the final analyses.The prevalence of PCOS under NIH, Rotterdam and AE-PCOS Society criteria were 6.1, 19.9 and 15.3, respectively. While the prevalence of metabolic syndrome was 6.1 in the whole study group, within the patients diagnosed as PCOS according to NIH, Rotterdam and AE-PCOS Society criteria, it was 12.5, 10.3 and 10.0, respectively.Even though we have included women working at a single institution with a high response rate for the participation, we cannot exclude potential selection bias due to undetermined differences between our sample and background community. We might have underestimated actual prevalence of metabolic syndrome in PCOS due to lack of oral glucose tolerance test 2 h glucose data.Current results can be generalized to Caucasian populations and may present variations in other populations according to race and ethnicity.This work was, in part, sponsored by Merck Serono.Not applicable.

Background: Our aim was to determine the effect of single endometriomas ≤3 cm in diameter per se on ovarian reserve in intracytoplasmic sperm injection (ICSI) cycles. Methods: We enrolled 19 consecutive infertile patients (29 cycles) who had unilateral single endometriomas ≤3 cm in diameter and who underwent ICSI. Results: The mean age of the patients was 33.3 ± 4.9 years. The mean diameter of endometriomas was 21.8 ± 4.9 mm. Left- and right-sided endometriomas were 34.5 and 65.5%, respectively. The number of oocytes retrieved from ovaries with endometriomas and contralateral normal ovaries was comparable (5.9 ± 4.3 vs. 5.4 ± 3.8). Conclusion: Endometriomas ≤3 cm in diameter per se did not have a deleterious effect on ovarian reserve in ICSI cycles.

The aim of this study was to review the application of Vecchietti’s principles to laparoscopy for the creation af neovagina in patients diagnosed with Rokitansky syndrome, the functional and psychological outcomes. A functioning neovagina was performed in both of the subjects. The subjects which are sexually active noted satisfactory intercourse with significant improvements in self-confidence, self-esteem and general well-being in first 6 months follow-up.

Background: To analyze the influence of oral contraceptive pill (OCP) pretreatment in intracytoplasmic sperm injection cycles among normoresponders in whom leuprolide acetate is preferred for that kind of gonadotropin-releasing hormone agonist. Methods: Between March 2001 and January 2010, a total of 821 cycles were pretreated with OCP in luteal-long leuprolide acetate in the IVF Center, Faculty of Medicine, University of Hacettepe. Of these, a total of 169 consecutive patients were selected for the final analyses according to the selection criteria (OCP group) and compared with 349 age-matched controls (Control group). The normoresponders were defined by the presence of 6–15 antral follicles in both ovaries. Results: Female age, body mass index, duration of infertility and antral follicle count were similar among both groups. Although the total dose of FSH used and duration of stimulation were similar, the maximal serum estradiol concentrations were higher in the OCP group than in the Control group (2,630.3 ± 1,568.0 vs. 2,166.5 ± 1,259.7 pg/ml, p = 0.001). The mean numbers of metaphase-II oocytes were 11.0 ± 6.2 versus 9.4 ± 5.2 in the OCP and Control groups, respectively (p = 0.004). The mean number of available day 3 embryos having ≧7 blastomeres was also higher in the OCP group (4.4 ± 3.3 vs. 3.5 ± 3.1, p = 0.013). However, the embryo transfer cancellation rate was noted to be higher in the OCP group, which is mainly due to fertilization failure and arrest during embryogenesis (6.5 vs. 2.9%, p = 0.049). The clinical pregnancy (36.7 vs. 38.3%) and implantation rates (21.8 vs. 20.6%) were comparable. Conclusion: These findings suggest that although pretreatment with an OCP might exaggerate ovarian response, the pregnancy rate does not fluctuate in leuprolide acetate cycles among normoresponders.

Retroperitoneal hemorrhage following ruptured renal angiomyolipoma is usually managed surgically or by embolization. But when the same episode occurs in pregnancy, surgery which predisposes to preterm delivery and its subsequent sequelae, the unknown influences of radiation exposure on the fetus makes the management of such cases very challenging. A 21‐year‐old woman was seen in the emergency unit at the 25th week of her pregnancy with complaints of sudden onset left flank pain radiating to the back, nausea and hematuria. Abdominal magnetic resonance imaging (MRI) revealed masses consistent with angiomyolipoma in the upper pole of the left kidney with evidence of recent bleeding and the center of the right kidney measuring 11.5 × 9.5 cm and 3.5 cm, respectively. The patient received three units of red blood cell concentrate due to fall in hematocrit level resulting in hemodynamically stable condition until term. At term, an infant weighing 3510 g was delivered through elective cesarean section. To avoid iatrogenic preterm delivery and unnecessary fetal exposure to radiation, conservative management of ruptured angiomyolipoma in pregnancy may be considered as a treatment option in hemodynamically stable patients.