Objectives: This prospective study aimed to evaluate whether β-human chorionic gonadotropin (β-hCG) levels in uterine cavity lavage fluid can serve as a diagnostic tool to differentiate ectopic pregnancy from failed intrauterine pregnancy in patients with pregnancy of unknown location (PUL). Design: This prospective interventional study was conducted at a tertiary referral center, enrolling a total of 113 hemodynamically stable patients with PUL. Materials and Methods: All enrolled patients underwent endometrial aspiration (EA), which was performed using a flexible Karman cannula to obtain tissue samples for histopathological examination. Based on histopathological results combined with clinical follow-up data, participants were subsequently categorized into two groups: those diagnosed with ectopic pregnancy and those with failed intrauterine pregnancy. Prior to performing EA, uterine lavage was performed to collect fluid samples from the endometrial cavity, and β-hCG levels were quantitatively measured in the lavage specimens. The primary outcome measure was the comparison of lavage β-hCG concentrations between the ectopic and failed intrauterine pregnancy groups, with the intent to establish a diagnostic cutoff value for clinical application. Secondary outcome measures included comparisons of serum β-hCG levels, endometrial thickness assessed via imaging, and clinical and demographic parameters between the groups. Results: After exclusion criteria and incomplete data removal, 103 patients were included in the final analysis, comprising 81 individuals diagnosed with ectopic pregnancy and 22 with failed intrauterine pregnancies. Statistical analysis showed that the mean age was significantly higher in the failed intrauterine pregnancy group versus the ectopic pregnancy group (p = 0.03), while other demographic and clinical variables did not differ significantly between the groups. β-hCG concentrations in uterine lavage fluid were lower in the ectopic group compared to the failed intrauterine pregnancy group. This difference was significant in absolute terms (mean ± SD: 122.78 ± 115.41 mIU/mL vs. 321.09 ± 495.19 mIU/mL, p = 0.008) and after normalization to total protein content in the lavage fluid (100.67 ± 208.19 mIU/mg vs. 294.32 ± 510.69 mIU/mg, p = 0.001). In contrast, serum β-hCG levels and endometrial thickness did not show statistically significant differences between the two groups. Conclusion: Lavage β-hCG appears promising as a tool for early PUL assessment by identifying the pregnancy location. This standardized methodology could expedite the diagnosis of high-risk pregnancies through a less invasive approach, thereby enhancing ectopic pregnancy management. Further research is needed to improve accuracy.

Background and Objectives: To evaluate the impact of gonadotropin-releasing hormone agonist (GnRHa) triggering compared to human chorionic gonadotropin (hCG) triggering on frozen-thawed and fresh embryo transfer outcomes in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF). Materials and Methods: This retrospective cohort study analyzed 267 IVF cycles of 261 PCOS patients treated with GnRH antagonist protocols. Patients were divided into three groups: GnRHa-triggered frozen-thawed embryo transfer (ET) (n = 126), hCG-triggered frozen-thawed ET (n = 68), and hCG-triggered fresh ET (n = 73). Baseline characteristics, stimulation parameters, and cycle outcomes were compared between groups. A binary logistic regression analysis was established to identify independent predictors of clinical pregnancy. Results: The GnRHa-triggered group had significantly higher numbers of retrieved oocytes, mature (MII) oocytes, and fertilized oocytes compared to both hCG-triggered groups (p < 0.001). The number of obtained embryos and frozen embryos (good-quality embryos) was highest in the GnRHa group (p < 0.001). However, clinical pregnancy rates were comparable between the groups with a similar number and grade of transferred embryos (32.53%, 38.23%, and 32.87%, respectively). Multivariate regression analysis revealed that the grade of the transferred embryo was a significant predictor of clinical pregnancy (p = 0.034). Conclusions: This study provides insights into different triggering strategies for final oocyte maturation in PCOS patients. GnRH-agonist-triggered frozen-thawed cycles showed comparable clinical pregnancy outcomes to those of hCG-triggered cycles, with a potentially lower OHSS risk. The findings suggest that individualized triggering approaches based on patient characteristics and OHSS risk may be beneficial for PCOS patients undergoing IVF.

OBJECTIVE:Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine and metabolic disorder characterized by hyperandrogenism, hyperinsulinemia, and insulin resistance. The prevalence of PCOS is increasing worldwide. Although the etiology of this disease is currently unknown, it is thought to be closely related to inflammation and oxidative stress. Our study aimed to compare patients have PCOS to healthy volunteers and assess the changes in oxidative stress and inflammatory parameters in these patients. METHODS:Thirty patients between the ages of 18-45 diagnosed with PCOS and 30 healthy volunteers with the same demographic characteristics were included in this study. Clinical parameters were measured using immunoassays. Oxidative stress biomarkers, total oxidant (TOS), total antioxidant (TAS), total thiol (TT), and native thiol (NT) levels were measured using photometric methods according to Erel's method. The dynamic disulfide level (DIS) and oxidative stress index (OSI) were calculated using mathematical equations. Among the inflammatory parameters, values for interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) were measured photometrically using commercially purchased kits. RESULTS:Moreover, TT and NT levels were lower in patients with PCOS compared to those in the healthy group statistically significantly (P<0.001). In addition, TAS, TOS, OSI, DIS, IL-1β, IL-6, and TNF-α levels were identified to be significantly higher in the patients with PCOS than those in the healthy group (P<0.001). CONCLUSION:Evaluation of oxidative stress and clinical parameters used in the follow-up may be beneficial for the disease.

The aim of this study is to evaluate the risk factors for empty follicle syndrome (EFS) in patients with diminished ovarian reserve (DOR) undergoing an intracytoplasmic sperm injection cycle. In this retrospective study, patients with DOR were divided into 2 groups according to the presence of empty follicles on the day of oocyte retrieval. Patient age, body mass index (BMI), anti-Müllerian hormone (AMH), baseline follicle stimulating hormone (FSH) and estradiol (E2) levels, basal antral follicle count (AFC), total gonadotropin dose, and day of stimulation were recorded as risk factors. The association between EFS and these variables was assessed using the logistic regression method and ROC curve analysis. Increased BMI, low AMH, higher baseline FSH, low baseline AFC, higher gonadotropin dose, and longer day of ovulation induction were independent risk factors for EFS in patients with DOR. ROC curve analysis showed that BMI, AMH, baseline FSH, baseline AFC, higher gonadotropin dose, and longer ovulation induction days were predictive parameters in this group. According to the current study, higher BMI, lower AMH, higher baseline FSH, lower baseline AFC, higher gonadotropin dose and longer ovulation induction days were independent risk factors for EFS in patients with reduced ovarian reserve.

The aim of this study is to evaluate the effects of obesity on clinical outcomes in diminished ovarian reserve (DOR) patients undergoing intracytoplasmic sperm injection cycles. In this retrospective observational cross-sectional study, women admitted to current clinic with DOR undergoing intracytoplasmic sperm injection were divided into 2 groups according to the obesity. Patient age, body mass index, anti-mullerian hormone, baseline follicle stimulating hormone and baseline estradiol levels, antral follicle count, total gonadotropin dose, day of stimulation, number of mature (MII) oocytes, and clinical pregnancy were evaluated. There were no statistically significant differences between groups in terms of age, anti-mullerian hormone, baseline follicle stimulating hormone, baseline estradiol levels, antral follicle count, and clinical pregnancy (P > .05). Total gonadotropin dose, the days of ovarian stimulation were higher and number of MII oocyte were less in the obese group (P < .05). Logistic regression analyses also revealed that the days of ovarian stimulation and number of MII oocyte were significant factors in the study group. ROC curve analysis showed obesity is a negatively affecting factor in DOR patients. Obesity causes more gonadotropin dose longer days of stimulation, and less number of MII oocyte. However clinical pregnancy rate is not negatively affected by obesity according to the current study.

Objective: This study aims to determine the complementary and alternative therapy (CAM) methods used among infertile women in Turkiye, the prevalence of their use and the factors affecting their use. Method: The sample of the descriptive and cross-sectional study consisted of 142 women who applied to the Assisted Reproductive Treatment Centre of a public hospital and volunteered to participate in the study. The data were collected with "Personal Information Form" and "Complementary and Alternative Medicine Approaches Scale (CAMAS)". Descriptive statistics, Mann-Whitney U, Kruskal Wallis Test were used in the evaluation of the data. Results: While the average age of the women who contributed to the study was found to be 29.77±4.83 years. When the CAM methods used by women are examined, they are mostly prayer (88.0%), prayer (namaz) (78.2%), vow (25.4%), visit to the tomb (24.6%), amulet (20.4%), black pepper (17.6%), ginseng (15.5%), astralagus (13.4%), going to a teacher and having yourself read (13.4%), shark cartilage (13.4%), turtle blood (13.4%), lead casting (4.2%), reiki (2.8%), bioenergy (2.1%) and hypnosis it was determined to be (1.4%). When the mean scores in the CAMAS subscales were examined, it was determined that the highest score was body-mind approaches (40.46±17.37). Conclusion: In line with the research findings, it was determined that the use of CAM was common among infertile women in Turkiye and the most frequently used approaches were spiritual and herbal methods. Health professionals need to evaluate infertile women about their use of CAM methods and inform women about these methods.

OBJECTIVE:The aim of this study is to evaluate the relationship between semen parameters, complete blood count, and hormone levels on the day of spermiogram. METHODS:Semen parameters of 230 patients who were examined for full blood count test and hormone levels on the day of spermiogram were included in the study. Patients were grouped according to the total motile sperm count (TMSC), semen parameters, hemogram, and hormone levels were compared between groups. RESULTS:No statistically significant difference was found between groups in neutrophil ratios, neutrophil, lymphocyte, platelet counts, neutrophile-to-lymphocyte ratio (N/L), and platelet-to-lymphocyte ratio (P/L). However, white blood cell (WBC) and lymphocyte counts were weakly positively correlated with sperm concentration (p=0.021, p=0.026), and a weakly significant positive correlation was found with WBC and neutrophil count for motility (p=0.038, p=0.004). FSH level was found to be lower in cases with TMSC >20 m than those with TMSC <5 m and 5-10 m (p=0.004, p=0.022). LH was found to be lower in cases with TMSC >20 m than those with TMSC <5 m (p=0.048). A negative correlation was found for both FSH and LH levels with sperm concentration, motility, and TMSC (p<0.001, p=0.014). CONCLUSION:In this study, a significant negative correlation was demonstrated between FSH, LH levels and sperm concentration, motility, TMSC. N/L and P/L cannot be used as predictive markers of sperm quality. The results of a significant positive correlation between WBC, neutrophil counts, and sperm parameters encourage researchers to conduct prospective randomized controlled trials with larger sample sizes and different inflammatory and hormonal markers.

The objective of this study was to assess the impact of Vitamin E (Vit E) and Vitamin C (Vit C) on markers of the oxidant-antioxidant system, ovarian follicle reserves, and the surface epithelium in autologous intraperitoneal ovarian transplantation conducted in rats. The study aimed to investigate how these antioxidants influence various aspects related to transplantation outcomes, including oxidative stress markers, the preservation of follicle reserves, and the condition of the surface epithelium. A total of 20 adult female Wistar Albino rats were included in the study and randomly assigned to four different groups. Group 1, consisting of 5 rats, served as the control group and underwent a surgical procedure where their abdomens were opened and closed without any further intervention. Group 2, also consisting of 5 rats, underwent ovarian transplantation. In Group 3, comprising 5 rats, an intraperitoneal (IP) administration of 20 mg/kg body weight (b.w.) of Vitamin E (Vit E) was given 15 min prior to ovarian transplantation. Lastly, in Group 4, which included 5 rats, an IP administration of 50 mg/kg body weight (b.w.) of Vitamin C (Vit C) was given 15 min before ovarian transplantation. Vaginal cytology was performed in order to monitor the estrus phase in the rats. Biochemically, tissue and serum malondialdehyde (MDA) levels and erythrocyte superoxide dismutase (SOD) levels were measured. Histopathologically, the number of dysplastic changes in the ovarian surface epithelium and primordial, primary, secondary, Graaffian, and atretic follicles were examined. Dysplastic changes in the surface epithelium of Group 2 were found to be significantly higher than in Group 1 and 4 (p < 0.02). In Group 2, the ovarian follicle reserves (primordial, primary, secondary, and Graaffian follicles) were significantly lower than in other groups (p < 0.02). In addition, a significant decrease in SOD levels was found in Group 2 compared to other groups (p < 0.02). The study showed that Vit E and Vit C in autologous intraperitoneal ovarian transplantation preserved the ovarian follicle reserve. Vit C was found to be more effective than Vit E.

Aim: To investigate the effects of metformin therapy on hyperandrogenism and menstrual functions in adolescent patients with polycystic ovary syndrome (PCOS) and insulin resistance (IR). Materials and Methods: In this study, 50 adolescents with PCOS were included. Hormonal and ultrasonographic assessments were done at the early follicular phase. On the day of 19-21 of the cycle, progesterone levels were measured and patients were questioned for menstrual periods. Body-mass-indexes (BMI), waist-hip ratios, and Ferriman-Gallwey scores were calculated for all patients. IR is diagnosed according to HOMA index and insulin-resistant patients were instructed to use 1500 mg/day metformin for 3 months. After treatment ended, measurements were repeated by the same researcher. Results: Mean age and BMI values were similar between groups. Although the values of BMI and waist/hip ratio decreased after treatment, the decrement didn't reach the values of the IR- group. Free testosterone levels were significantly higher in IR+ subjects compared to IR negatives and significantly decreased after treatment. Sex hormone-binding globulin levels were increased with metformin treatment and as a result, free androgen indexes were decreased. 17 OH progesterone levels were significantly higher in the IR+ group and regressed to similar levels with IR negatives after treatment. While mean levels of fasting insulin were 19.21IU/ml in the IR+ group, it regressed to 13.14IU/ml after treatment. Also fasting glucose/insulin ratios were increased as expected. Finally, a significant improvement in the treatment group was observed at menstrual irregularity. Conclusion: Consequently, this study supports the conclusion that metformin reduces hyperandrogenism and improves menstrual and ovulatory functions.

Purpose: The aim of this study was to investigate the effects of vitamin E (Vit E) and vitamin C (Vit C) on oxidant-antioxidant system markers, ovarian follicle reserves, and surface epithelium in autologous intraperitoneal ovarian transplantation in rats. Materials and Methods: 20 adult female Wistar Albino were randomly divided into four groups. Group 1 (n = 5), the control group, only had their abdomens opened and closed. Group 2 (n = 5): underwent an ovarian transplantation. Group 3 (n = 5) received 20 mg/kg of intraperitoneal (IP) Vit E 15 minutes before an ovarian transplantation. Group 4 (n = 5) received 50 mg/kg of IP Vit C that was administered 15 minutes before an ovarian transplantation.Vaginal cytology was performed to monitor the oestrus phase. Biochemically, tissue and serum malondialdehyde levels and erythrocyte superoxide dismutase (SOD) levels were measured. Histopathologically, the number dysplastic changes in the ovarian surface epithelium were examined. Results: Dysplastic changes in the surface epithelium of Group 2 were found to be significantly higher than in Group 1 and 4 (p < 0.02). In Group 2, the ovarian follicle reserves were significantly lower than in other groups (p < 0.02). In addition, a significant decrease in SOD levels was found in Group 2 compared to other groups (p < 0.02). Conclusion: The study showed that Vit E and Vit C in autologous intraperitoneal ovarian transplantation preserved the ovarian follicle reserve. Vit C was found to be more effective than Vit E.

Son yillarda dehidroepiandrosteronun dusuk over rezervli hasta grubunda infertilite tedavisine yaniti arttirdigi saptanmistir. Bu olgu serisinde, 35 yasindan buyuk ve kotu over rezervi, yuksek 3. gun FSH’si ve dusuk antral folikul sayisi ile kanitlanmis uc hastada kisa sureli dehidroepiandrosteron kullanimi ile spontan gelisen ve saglikli bicimde terme ulasan gebelik olgulari ve bu konudaki guncel literatur bilgileri gozden gecirilmektedir. Dehidroepiandrosteron ile yapilan cok genis randomize calismalar bulunmasa da literaturdeki olgu sunumlari ve burada sunulan vakalar, bu androjenin dusuk over rezervli hastalarda spontan gebelik sansini arttirdigini kanitlamaktadir. Gebeliklerin ileri anne yasina ragmen saglikli canli dogum ile sonuclanmalari da oosit kalitesini iyilestirdigi fikrini desteklemektedir.

It has been reported recently that dehydroepiandrosterone (DHEA) supplementation in older patients with low ovarian reserve increases the response to infertility treatment. Three women of age >3S years with low ovarian reserve parameters including high FSH, low AFC have been treated with DHEA for various time intervals are reported here. They conceived spontaneously after a few months of treatment which resulted in healthy newborns. Although there are not many randomized controlled trials about the value of DHEA treatment in infertile patient population, previous case reports support that DHEA increases spontaneous pregnancy rates. Considering healthy livebirths of the relatively older age of the mentioned cases, DHEA might be improving also oocyte quality as an additional impact.

Purpose: The main goal of the current study was to examine the associations between polycystic ovary syndrome (PCOS) and body dissatisfaction and eating attitudes in a sample of adolescent girls and young women. Body dissatisfaction is 1 of the strongest predictors of the development of negative outcomes such as low self-esteem, and eating disorders. In adolescent age group of patients, both hirsutism and increased body mass index, appearing with PCOS, may be the leading symptoms also resulting or contributing to body dissatisfaction and eating disorder.Materials and Methods: The sample of 94 Turkish adolescent girls and young women [PCOS (n = 42) vs non-PCOS (n = 52)] completed measures of figure rating scale, the socio-cultural attitudes toward appearance questionnaire, body esteem scale, eating attitude test, and demographics.Results and Conclusion: The results revealed that body esteem was important for predicting eating attitudes in both groups and sociocultural internalization of thinness ideal and body dissatisfaction were also significant factors in PCOS group. However, scores for major study variables (BMI, sociocultural attitudes toward awareness and internalized appearance ideals, body esteem subscales, body dissatisfaction and eating attitudes) in the PCOS group were not significantly higher than those for girls without PCOS.

Excessive response to ovarian stimulation is common among hyper-responder patients undergoing assisted reproductive technology (ART). Cycle cancellations and severe ovarian hyperstimulation syndrome (OHSS) are all detrimental consequences observed within this cohort and several approaches have been proposed to enhance outcomes. The current study is designed to evaluate whether laparoscopic ovarian diathermy (LOD) improves ART outcomes and pregnancy rates by reducing Anti-mullerian hormone (AMH) levels in a group of patients who had a history of recurrent ART failure and high response. A total of 40 hyper-responder patients with history of previous ART failure were included. Group I consisted of 22 patients that underwent LOD prior to ART. Group II consisted of 18 patients that underwent only ART. Cycle outcomes of groups were compared. Following LOD, significant reduction in AMH levels were detected in group I (4.75 ng/mL to 2.25 ng/mL). Clinical pregnancies were similar among groups (40% versus 27.8% p = 0.65). There was no cycle cancellation in Group I, whereas there were three cycle cancellations observed due to OHSS in Group II. Our results indicate that LOD might offer enhanced fertility outcomes and may reduce the likelihood of cycle cancellations in hyper-responders with previous ART failures.

Malignant melanoma diagnosed during pregnancy results in confusion about staging and management. In this case report, a 39-year-old pregnant woman, who had undergone conception via in vitro fertilisation, was diagnosed with malignant melanoma of a growing lesion on her back in the 20th week of gestation. She delivered her baby by caesarean section in the 38th week. Metastasis was not found by chest X-ray, ultrasonography and positron emission tomography after delivery. She has been disease free for 6 months postpartum. Surgical resection of malignant melanoma and postponing of the sentinel lymph node biopsy has been proposed. Risk of adverse perinatal outcomes has not been increased; but the prognosis of malignant melanoma is known to be poorer when diagnosed during pregnancy. As a conclusion, any pigmentary change in the nevi should be assessed carefully during pregnancy.

INTRODUCTION:Paraovarian or paratubal cysts (PTCs) constitute about 10 % of adnexial masses. Although they are not uncommon; they rarely cause symptoms and are usually incidentally found. Actual incidence is not known. The symptoms occur when they grow excessively, or in case of hemorrhage, rupture or torsion.METHODS:Here, literature review reporting the incidence, presentation and complications of PTCs is performed. Uncommon presentations of PTCs in three different cases, a giant PTC, torsion of PTC and borderline paratubal tumor, are also reported and discussed.RESULTS:Ultrasonography, CT or MRI may be performed in preoperative evaluation; but none of these imaging techniques have specific criteria for diagnosis. So, in most cases misdiagnosis as an ovarian mass remains to be a problem.CONCLUSION:Paratubal cysts can become extremely big before causing symptoms. Torsion is another urgent issue regarding PTCs, necessiating urgent surgery for preservation of the ovary and the tube. Although malignancy is rare, borderline paratubal tumors have been reported in the literature.