This study was planned to test whether follicular fluid (FF) levels of patatin-like phospholipase domain containing 3-gene (PNPLA3:adiponutrin), preptin, kisspeptin, and amylin change in polycystic ovarian syndrome (PCOS). A total of 40 infertile volunteers undergoing IVF/ICSI were included in the study. They were divided into two groups as PCOS (n=20) and control group without PCOS (n=20). The controls were recruited from subjects with a poor ovarian response. The PCOS and control participants were matched according to their body mass index (BMI). Each group of participants underwent ovarian stimulation with GnRH antagonist protocol. Blood and FF samples of one dominant follicle were obtained from each subject during the oocyte pick-up. FF and serum levels of PNPLA3, preptin, kisspeptin and amylin were measured through ELISA. Amylin and adiponutrin median values were not different according to study groups (p>0.05). FF-preptin median values in the control group were similar to the serum preptin values of control and PCOS groups (Z=0.970, p=1.000 and Z=2.631, p=0.051, respectively). Medians of the serum preptin in control and PCOS groups were the same (Z=1.649; p=0.595). FF-preptin median values of PCOS group were significantly lower than the preptin median values of the control group. Serum preptin levels were positively correlated with HOMA-IR, but not with pregnancy rates and the number of retrieved oocytes. Serum kisspeptin levels were negatively correlated with the number of retrieved oocytes and pregnancy rates. While amylin and adiponutrin have no role in the folliculogenesis, kisspeptin and preptin work together for regulating follicle developmental capacity in PCOS.

Embryos have evolved a remarkable capacity to find implantation site. The impressive navigation ability of natural blastocysts may rely on highly sensitive signals arising from embryos and specialized signal processing strategies in the endometrium. Navigation capabilities may be compromised in ICSI embryos because of altered biochemical signaling. The design and delivery of artificial blastocyst (AB) carrying strong chemical signals may allow ICSI embryos to more easily locate to and be retained in the implantation zone. ICSI embryos will attach easily to the implantation zone after it is found by the AB. Co-transfer of the AB together with the ICSI embryo may overcome potential difficulties in implantation due to impaired embryo-maternal communication in cases with implantation failure.

The aim of this study was to investigate whether the expression levels of endometrial NFκB p65 differ between normal weight and overweight PCOS women and to compare them with BMI-matched control subjects without PCOS. The study group comprised 20 normal weight (BMI: 18.5-24.9 kg/m2) and 15 overweight PCOS women (BMI: 25-29.9 kg/m2) with infertility. Healthy fertile women without PCOS were recruited as the control group. The patients in the normal weight PCOS group and control group were age and BMI-matched. Endometrial samples were obtained during the mid-luteal phase for immunohistochemical staining. The H-Score method was used to evaluate NF-κB p65 (Rel A) expression. Both normal and overweight PCOS women demonstrated significantly higher endometrial NF-κB p65 expression than the women without PCOS. The H-scores of endometrial NF-κB p65 expression were similar in both groups of PCOS women. NF-κB p65 was positively correlated with serum insulin, HOMA-IR and total testosterone levels in PCOS women. By leading to pathological inflammation, an increase in NF-κB p65 expression in the endometrium of normal and overweight PCOS women may contribute to PCOS-related subfertility. Impact statement What is already known on this subject: Although the pathogenesis of PCOS has not yet been clarified, low-grade chronic inflammation is gradually being established as an important pathogenetic factor. Increased levels of inflammatory cytokines such as IL-6 and TNF-α have been reported in women with PCOS. Causes of pathological endometrial inflammation may arise from either a local endometrial disease or linked to diseases which are located in a distant reproductive tissue. Nevertheless, possible role of endometrial NF-κB, basic cellular regulatory of inflammation, in the pathophysiology of PCOS related implantation defect has not been elucidated yet. What do the results of this study add: This study provides first and novel insights into the relationship between PCOS related infertility and pathological endometrial inflammation. We demonstrated that there is a close association between PCOS and pathological endometrial inflammation. Moreover, we clearly showed that pathological endometrial inflammation occurs in both normal and overweight women with PCOS. Further, endometrial NF-κB p65 (Rel A) expression were found to be positively correlated with serum insulin levels and hyperandrogenism in overweight PCOS women. What are the implications of these findings for clinical practice: If we can analyse pathological endometrial inflammation by measuring endometrial NF-κB p65 (Rel A) expression, treatment could be directed towards eliminating the source of pathological endometrial inflammation.

Objective: Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections). Study Design: Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. Results: Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50-79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results. Conclusion: The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options.

Objective: To investigate whether serum levels of estradiol affect reproductive outcomes of normoresponder women undergoing fresh embryo transfer (ET) versus frozen-thawed ET (FET). Material and Methods: Two hundred fifty-five normoresponder women underwent fresh ET in their first or second in vitro fertilization cycle. Ninety-two women with negative pregnacy test results underwent FET. Clinical and ongoing pregnancy rates, implantation, and live birth rates of women undergoing fresh ET versus FET were compared. Results: One hundred forty-seven (57.65%) out of the 255 normoresponder women receiving FET had positive beta-human chorionic gonadotrophin (hCG) results. The remaining 108 women had negative beta-hCG results. The clinical pregnancy rates of the fresh ET group were found as 55.69% (n=142). Ninety-two of the 108 women with failed pregnancies underwent FET; 72.83% had positive beta-hCG results (n=67), and 70.65% had clinical pregnancy (n=65). Both biochemical and clinical pregnancy rates of women undergoing FET increased significantly (p<0.012 and p<0.013, respectively). Ongoing pregnancy (60.87% vs. 52.94%) and live birth rates (59.87% vs. 48.63%) were similar in both fresh and FET groups. Serum E2 levels of women who failed to conceive were significantly higher than those women did conceive. Serum progesterone levels of women who conceived versus those that did not were similar. Conclusion: The detrimental effect of high serum estradiol levels on endometrial receptivity could be prevented by FET.

AIM:The present study aimed to determine the levels of total cholesterol, triglycerides (TG), low-density lipoproteins (LDL), high-density lipoproteins (HDL), and vitamins B1 and B2 in intrahepatic cholestasis of pregnancy (ICP) patients, and to evaluate if these were involved in the pathophysiology of the disease.METHODS:The prospective randomized study included 35 pregnant patients who were admitted to the Gynecology and Obstetrics Polyclinic, Faculty of Medicine at Dicle University and who were diagnosed with ICP (Group 1), and 40 healthy pregnant women who were admitted in the same period and who had no systemic diseases that might complicate the pregnancy during the pregnancy follow-up (Group 2). Serum lipid levels and vitamins B1 and B2 were determined and compared, and statistical comparisons of the groups were made.RESULTS:There was no difference between the TG levels of the two groups (P=0.631). Total cholesterol, LDL, HDL, and vitamin B1 and B2 levels were higher in Group 1 than in Group 2 (P=0.001, P=0.001, P=0.001, P=0.001, and P=0.032, respectively).CONCLUSIONS:Increased levels of vitamins B1 and B2 may indicate a need for increased energy metabolism at the fetus. So we believe that new studies are required, which will be supported by the placental analyses of the pyruvate and lactate levels in maternal blood at delivery and fetal cord blood in order to develop a better understanding on the fetal effects of energy metabolism.

The aim of this study was to determine whether endometrioma resection alters most commonly defined endometrial metabolites, lactate (Lac), N-acetylaspartate (NAA), creatine 1 (Cr1), creatine 2 (Cr2), and choline (Cho) during the window of implantation. Twenty patients with uni- or bilateral endometrioma and 7 patients having nonendometriotic benign ovarian cyst were included. Midluteal phase magnetic resonance spectroscopy analysis of eutopic endometrium was performed before surgery. Second spectrum of endometrium was obtained 3 to 5 months after laparoscopic endometrioma resection. Pre- and postoperative endometrial peaks of Lac, NAA, Cr, and Cho were measured in units and denominated in parts per million (ppm). Compared to preoperative peak values, significantly decreased NAA, Lac, and Cr1 signals were noted in patients undergoing endometrioma surgery. Nearly 5-fold decline in the NAA signal occurred after endometrioma surgery (1.94 ± 3.24 vs 0.37 ± 0.55). Likewise, 2.5-fold decline in Lac signals was noted after endometrioma resection (2.81 ± 2.64 vs 1.06 ± 1.88). Both uni- and bilateral endometrioma affected endometrium signals the same. The peak intensity of Cho, Cr1, Cr2, NAA, and Lac did not alter significantly after nonendometriotic cyst surgery. Endometrioma surgery straightens endometrial NAA, Lac, and Cr1 peaks, suggesting improvement in endometrial receptivity.

Objective: The study was planned to investigate whether DHEA supplementation had an impact on endometrial receptivity in women who were poor responders (POR). Material and Methods: Twenty-eight POR women who were undergoing hysteroscopy and five fertile control subjects were included. The POR women were equally subdivided into two separate groups as patients who were currently using DHEA and those who were not. Endometrial samples of the subjects were obtained during hysteroscopy at the late follicular phase. Expression levels of endometrial HOXA-10, HOXA-11, and LIF mRNA were measured with the using real-time polymerase chain reaction. Spontaneous clinical pregnancy rates were also noted. Results: Compared with POR women who were not given DHEA, upregulated endometrial HOXA-10 (7.33-fold) and HOXA-11 (2.39-fold) mRNA expression were detected in POR women on DHEA. The increase in HOXA-10 mRNA was significant (p<0.03). The fold increase in HOXA-11 mRNA was found as 2.39, which indicated a positive upregulation. However, this fold increment was insignificant (p<0.45). An insignificant increase in spontaneous clinical pregnancy rates in POR women on DHEA (53.3%) was observed compared with POR women who were not given DHEA (43.8%). Conclusion: Oral DHEA supplementation in POR upregulates endometrial HOXA-10 mRNA expression, which is known to positively modulate endometrial receptivity.

As with other organs endometrial functions are altered with the advancing age. Age related decrease in reproductive functions leads to decline in the number of oocytes retrieved and the synthesis of endometrial receptivity molecules. Despite the significant improvement in assisted reproductive technologies we do not have so many options to enhance endometrial receptivity. Due to lack of drugs having endometrium receptivity enhancement properties, oocyte donation seems to be the only solution for women with implantation failure. The euploid oocytes come from young and healthy donors may overcome age associated endometrial receptivity defect. Nevertheless, many reasons restrict us from using oocyte donation in women with implantation failure. We, therefore, hypothesized that by mimicking a young blastocyst's effect on endometrium, the transfer of genuine embryos and implantation-promoting compounds together might be the new treatment option for infertile women with recurrent implantation failure. Artificial beads, MI or GV oocytes, and empty zona can be used as a container for intrauterine replacement of implantation-promoting compounds.

Objective The aim of this study was to assess the changes of follicular fluid (FF) and serum levels of cerebellin precursor protein 1 (cbln1) and betatrophin in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with a gonadotropin-releasing hormone (GnRH) antagonist protocol. Methods Twenty infertile women with PCOS and 20 control women diagnosed as poor responders undergoing ovarian stimulation with a GnRH antagonist were included. Blood samples were obtained during ovum pick-up. Follicular fluid from a dominant follicle was collected from the subjects. Using enzyme-linked immunosorbent assays, FF and serum levels of cbln1 and betatrophin were measured in both groups of participants. Metabolic and hormonal parameters were also determined and correlated with each other. Results Both groups of women had similar serum and FF betatrophin levels (55.0±8.9 ng/mL vs. 53.1±10.3 ng/mL, p=0.11). The serum and FF betatrophin levels of poor responders were found to be similar (49.9±5.9 ng/mL vs. 48.9±10.7 ng/mL, p=0.22). Conversely, the FF cbln1 levels of PCOS women were found to be significantly higher than the serum cbln1 levels (589.1±147.6 ng/L vs. 531.7±74.3 ng/L, p<0.02). The FF cbln1 levels of control participants without PCOS were significantly higher than their serum cbln1 levels (599.3±211.5 ng/L vs. 525.3±87.0 ng/L, p=0.01). Positive correlations were detected among body mass index, insulin resistance, serum insulin, total testosterone, and betatrophin levels in the PCOS group. Conclusion Follicular fluid betatrophin and cbln1 concentrations may play a pivotal role on follicular growth in PCOS subjects undergoing IVF/ICSI with an antagonist protocol.

BACKGROUND: Bartholin's abscess is a gynecological pathology commonly observed in the reproductive period. The etiology attributes this pathology to a wide range of factors. Even though there is more than one treatment option, there has yet to emerge a consensus regarding the ideal method. The present study aims to present patients operated on due to the presence of Bartholin's abscess.METHODS: The data pertaining to 15 patients that had applied to our clinic with various complaints and had been subject to silver nitrate treatment upon the diagnosis of Bartholin's abscess (group 1) and to 21 patients that had been subject to surgical excision after the same diagnosis (group 2) were reviewed retrospectively. The review was followed by the recording of age, gravidity, parity, presenting symptoms, mass sizes and locations, operative durations, and observed complications of the patients. The data thus compiled were evaluated through statistical analyses.RESULTS: In the specified timeframe, 36 patients were observed to have been operated upon, 15 patients to have been subject to silver nitrate treatment (group 1) and 21 patients to have been subject to surgical excision (group 2). all operated patients were in the reproductive period. Mass locations tended to be in the right side in both groups (93.3% and 90.5%). No statistically significant difference was observed between the operated groups in mass sizes (P=0.892). The operative durations were significantly shorter among patients in Group 1 (P=0.001). Any increase in mass size and operative duration was observed to increase the risk of complications.CONCLUSIONS: increased mass size and extended operative duration are the two most important risk factors in the emergence of complications. it should be kept in mind that an effective course of treatment can be secured with minimum side effects through the performance of the operation in the shortest duration possible and with the use of suitable techniques. We are of the opinion that appropriate results can be achieved upon the consideration of minimally invasive treatment modalities in all aspects.

In this article we aimed to describe the clinical findings in a patient with subhepatic right ovary and mullerian duct anomalies who was successfully treated with in vitro fertilization (IVF) due to male factor infertility. Ovarian maldescent is a rare condition, and ovary localization can be seen up to the subhepatic region. This unusual ovarian localization suggests ovarian maldescent can be anywhere between the liver and pelvic brim When required, transabdominal ultrasound-guided oocyte retrieval and IVF can be performed successfully.

The aim of this study was to investigate potential therapeutic efficiency of ozone therapy in the treatment of experimental endometriosis in rats. Fifteen rats were divided into three groups, which were labeled as the (1) sham control, (2) the ozone (treated with intraperitoneal ozone-oxygen mixture) and (3) the GnRH-agonist (given single dose (1 mg) leuprolide acetate depot formulation) group. Endometrial implant activity of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-1 beta (IL-1 beta), IL-6, tumor necrosis factor-alpha (TNF-alpha), and vasculary endothelial growth factor (VEGF) were measured after ozone-therapy. Furthermore, peritoneal fluid activity of SOD, MDA, and TNF-alpha were also measured before and after ozone-therapy. Serum AMH levels of the rats those were given ozone-therapy and control groups were measured. The rats given ozone-therapy showed significantly reduced endometriotic implant volumes. After ozone-therapy, a significant increase in activity of SOD in peritoneal fluid was detected. Conversely, implant levels of SOD in rats given ozone therapy was found to be significantly decreased. Both peritoneal fluid and implant levels of MDA were significantly decreased after ozone-therapy. Implant levels of TNF-alpha, IL-1 beta, and IL-6 were significantly increased following ozone-therapy. VEGF levels of implant was found to be unchanged after ozone-therapy. Serum AMH levels of animals were given ozone-therapy and control groups were similar. The number of both primordial and preantral follicles were significantly decreased after ozone-therapy. However, the number of atretic follicles were similar in ozone-therapy and control groups. Repeated administration of ozone-oxygen therapy in non-toxic doses inhibits growth of endometrial implants.

Regardless of the anatomical locations, some benign gynecological disorders (BGDs) such as peritoneal endometriosis, ovarian endometrioma, adenomyosis, uterine leiomyomas, endometrial polyps, uterine septum, and hydrosalpinges may lead to implantation failure. Despite progress in medical therapies, surgery remains a mainstay of BGDs treatment. Although our knowledge of endometrial receptivity after BGDs surgery is limited, it has allowed for significant improvement in the treatment of female subfertility. Many researchers studied on pregnancy outcome following BGDs surgery, but they did not investigate the possible impact of surgery on endometrial receptivity. They, therefore, concluded that pregnancy rates improved after BGDs surgery based on clinical observations. Many of these clinicians believe that surgical resection of BGDs leads to removal of local mechanical effect over the endometrium. Moreover, they accept that BGDs surgery may inhibit the detrimental signaling and secretion of some molecules from the BGDSs into the endometrium that may lead to favorable effect on the endometrium. However, so far, data from randomized controlled trials or systematic review or meta-analyses to answer the question whether surgical treatment of BGDs can improve endometrial receptivity are lacking. The purpose of this systematic review was to evaluate the results of available publications dealing with the impact of reproductive surgery for BGDs on endometrial receptivity.

The aim of this study was to explore the inter-relationship between polycystic ovary syndrome and gestational diabetes mellitus, and demonstrate maternal and fetal outcomes. This was a case-control study in 1360 pregnant women who received a diagnosis of gestational diabetes mellitus between 24 and 28 weeks of gestational age. Among all diagnosed with gestational diabetes mellitus, 150 pregnant women had received a polycystic ovary syndrome, and 160 women who did not have polycystic ovary syndrome were designated as controls. The incidence of pregnancy-induced hypertension was 26.3% and 12% in the case and control groups, respectively. Preeclampsia was seen at an incidence of 12% and 6% in case and in control groups, respectively. The difference in neonatal hypoglycemia between the two groups was statistically significant, with an incidence of 17% and 5% in the case and in control groups, respectively. This study demonstrated that the presence of polycystic ovary syndrome along with gestational diabetes mellitus increases the risk of pregnancy induced hypertension by 2.4 fold, preeclampsia by 2 fold and neonatal hypoglycemia by 3.2 fold, compared to gestational diabetes mellitus alone.

OBJECTIVE: Uterine myomas are the most common benign pelvic tumours observed during the reproductive period.Increased risks of haemorrhage and postoperative morbidity lead professionals to avoid myomectomy at the time of Cesarean (C-section). The present study retrospectively analysed the data of patients who had undergone C-section only and those that had undergone C-section and simultaneous myomectomy. STUDY DESIGN: The data of 42 patients (Group 1) who had underwent caesarean myomectomy and of 50 patients underwent C-section only (Group 2) out of 92 patients that had been taken into C-section on the basis of obstetric indications were retrospectively analysed in this study. The relevant patient data were recorded with the inclusion of demographic data, gestational week, and preoperative and postoperative laboratory findings. Types, locations and sizes (the largest diameter) of individual myomas were identified and noted. RESULTS: The mean diameter of myomas was 66.3±30.2 mm. Ten patients that had underwent caesarean myomectomy (23.8%) developed a need for intensive care. No statistically significant difference was found in laboratory parameters between Group 1 and Group 2. CONCLUSION: Caesarean myomectomy, when performed by experienced obstetricians, does not lead to a significant increase in maternal morbidity and mortality. Although the short-term effects of this procedure are known, there is a need for the conduct of more comprehensive studies to establish its longterm effects on fertility or how it will affect the next pregnancy processes.

Behçet sendromu (BS) nadir görülen, vaskülit ile karakterize kronik, inflamatuar, tekrarlayan, multisistemik bir hastalıktır. BS, tekrarlayan oral ve genital aftlar, artrit, göz lezyonları, kutanöz lezyonlar, gastrointestinal sistem ve merkezi sinir sistemi tutulumuyla karakterize otoimmün bir hastalıktır. Behçet sendromunda genital tutulum farklı serilerde %60-90 olarak rapor edilmiştir. Genital bölgede en sık tutulum vulvada labium majuslarda görülmektedir. Daha sonra azalan sıklıkta vajen ve servikste rapor edilmiştir. Fakat şu ana kadar histerektomize bir hastada vajinal cuffta herhangi bir tutulum bildirilmemiştir. Biz bu makalede daha önceden BS olduğu bilinen hastada ilk defa görülen nadir bir vajinal cuff ülseri tanımladık. Bu olgu BS'ye bağlı genital ülserin vaginal cuff da görülmesi bakımından literatürde ilk olup bu anlamda literatüre katkı sağlayacağını ve vajinal lezyonların ayırıcı tanısında göz önüne alınması gerektiğini düşünüyoruz. Behçet Syndrome (BS) is a rare chronic, inflammatory, recurrent and multisystemic disease that is characterised by vasculitis throughout the body. BS is an autoimmune disease that affects the neurological and gastrointestinal systems that is characterized by reoccurring oral and genital aphthosis, arthritis, eye and cutaneous lesions. In BS, genital lesions have been reported at rates of 60-90% in different series. Lesions are observed most commonly on the vulva labium majora, followed by the vagina and uterine cervix in descending order. However, no previous study has reported a lesion on the vaginal cuff of a patient who has undergone total hysterectomy. In this study, for the first time, we defined a rare vaginal cuff ulcer in a patient previously diagnosed with BS. This case study will be the first in literature and contribute to it by revealing the appearance of a genital ulcer on the vaginal cuff caused by BS. Moreover, we think that it should be considered in the differential diagnosis of vaginal lesions.

Background We aimed to present the relationship between premature progesterone elevation (PPE) and clinical outcomes in high-responder patients who had a coasting period of <4 days in length due to their high risk of developing ovarian hyperstimulation syndrome (OHSS) and who were treated with a long-acting gonadotropin-releasing hormone agonist (GnRH-agonist) protocol in in vitro fertilization-embryo transfer (IVF-ET) cycles. Material/Methods This retrospective study was conducted at the University Hospital Assisted Reproductive Technology Center. The outcomes of 101 patients undergoing IVF- intracytoplasmic sperm injection (ICSI) cycles who showed a high response to COH (estradiol >4000 pg/ml and/or >20 follicles each ≥10 mm in diameter and at least 20% ≥15 mm) and who were coasted for <4 days were evaluated. Number of oocytes, 2 pronuclei (PN) embryos, implantation rate, and live birth rate were measured. Results The incidence of PPE was 32.6%. Compared with those without PPE, patients with PPE had a higher number of oocytes retrieved. Total mature and fertilized oocytes and the mean number of embryos transferred were not significantly different between groups. Live birth rates (41.9% vs. 38.7%) and implantation rates (26.5% vs. 23%) were also not significantly divergent in the PPE and non-PPE groups, respectively. Conclusions P concentrations ≥1.3 ng/ml on the day of human chorionic gonadotropin (hCG) administration, designated in this study as PPE, does not appear to be related to adverse effects in terms of clinical outcomes in high-responder patients undergoing coasting <4 days due to their high risk of developing OHSS treated with a long-acting GnRH-a protocol in IVF-embryo transfer cycles.