Objective: The objective of the study was to evaluate the relationship among polyp site, number, diameter, and symptomatology in endometrial polyps in reproductive and postmenopausal women.Study design: One hundred fifty-five subjects with endometrial polyps were evaluated retrospectively. Sociodemographic characteristics, endometrial thickness, polyp number, diameter, and site were reviewed, and their relations with abnormal uterine bleeding were tested.Results: A total of 36.1% of the patients in the postmenopausal group and 44.4% of the patients in the reproductive-aged group were asymptomatic. In addition, 37.3% of polyps in the reproductive-aged and 29.2% in the postmenopausal group were multiple. Polyp number, diameter, and site were not different among the 2 groups (P = .282, P = .469, and P = .485, respectively). When patients were evaluated as a whole, symptomatology was not related with polyp number, diameter, and site (P = .677, P = .334, and P = .699, respectively).Conclusion: Many endometrial polyps are asymptomatic and multiple in nature. Polyp site, number, and diameter do not correlate with symptomatology. (c) 2006 Mosby, Inc. All rights reserved.

OBJECTIVE:To assess the effects of smoking on total sperm count, progressive sperm motility and sperm morphology among couples attending an infertility clinic.METHODS:A total of 223 sperm samples (126 smokers and 97 nonsmokers) from men attending an infertility clinic for routine infertility workup were compared on the basis of standard semen analysis.RESULTS:Cigarette smoking is negatively correlated with progressive motile sperm count (r = -0.1464, p = 0.042), but not with sperm concentration (p = 0.961), total motile sperm count (p = 0.890) and sperm morphology (p = 0.838). Furthermore, packages/ year (cumulative dose of cigarettes) did not correlate with any of the sperm parameters including sperm density (p = 0.976), total (p = 0.559) and progressive (p = 0.406) motile sperm count and sperm morphology (p = 0.449).CONCLUSIONS:Although the effect of smoking on male infertility remains inconclusive, smoking had an adverse effect on the progressive sperm motility, irrespective of total amount of cigarettes smoked per day.

OBJECTIVE:We aimed to investigate the age at menopause and possible related factors in a Turkish population.STUDY DESIGN:In a three-year period, a retrospective analysis of 541 spontaneous menopause cases were evaluated. All postmenopausal women with spontaneous cessation of menses for > or = 12 months and serum FSH levels > 40 IU/l were included in the study. Sociodemographic status, reproductive and medical history, menopausal symptoms, and previous contraceptive and hormonal therapy use were assessed based on an interview using a standardized information system. Age at menarche, parity, menopausal age of mother and sister, history of lactation, physical activity, cigarette smoking, oral contraceptive use and body mass index (BMI) were assessed.RESULTS:Menopausal age of the enrolled cases was positively correlated with mothers and sisters' ages at menopause. Postmenopausal smokers had an earlier age at menopause compared to non-smokers.CONCLUSION:Cigarette smoking results in earlier menopause in the Turkish population. Menopausal ages of mothers and sisters clearly correlated with the age at menopause.

Objective: To anticipate the factors associated with urogenital symptoms in both natural and surgical menopause.Methods: A retrospective analysis was performed comprising 267 cases with spontaneous menopause and 87 surgical menopause cases without any use of hormone replacement therapy. Sociodemographic characteristics, reproductive and medical history, urogenital scale and psychological subscale of Greene Climacteric Scale were assessed and correlated with the age of menopause, time past since last menstrual period, parity, body mass index (BMI), mode of delivery among two groups.Results: Mean age of women enrolled to the study were 46.8 +/- 0.3 years and 44.4 +/- 0.25 years, for natural and surgical menopause cases, respectively. Mean parity had no correlation with urogenital scale in two groups. However, a positive correlation was apparent between the time since last menstrual period, psychological subscore of Green Climacteric Scale and urogenital score in both women with natural and surgical menopause. BMI was negatively correlated with urogenital score among two groups (r(p) = -0.85, p = 0.04).Conclusions: Intensity and frequency of urogenital symptoms and climacteric complaints as expressed in the Greene Climacteric Scale increase during menopausal transition. Care should be taken to ameliorate the quality of life (QOL) and to confront these problems in post-menopausal women. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

The aim of our study was to evaluate severity of hirsutism, assessed via the Ferriman-Gallwey scoring system in 12 different androgen-sensitive skin areas among 65 consecutive hirsute patients with functional androgen excess (polycystic ovary syndrome and idiopathic hirsutism) from the Central Anatolian region of Turkey. Results of this descriptive study showed that the buttocks/perineum, sideburn, and neck areas greatly contributed to the total hirsutism score, rather than the upper arm, upper back, and upper abdomen.

PURPOSE OF THE INVESTIGATION:To determine the diagnostic value of serum vascular endothelial growth factor (VEGF) in the preoperative assessment of the nature of ovarian masses.MATERIALS AND METHODS:A prospective cohort study was conducted from August 2001 to September 2002 on 40 premenopausal and 23 postmenopausal patients with ovarian masses. During preoperative workup, patient age, serum Ca-125 levels, serum VEGF levels, and tumor volume based on ultrasonographic examination were determined. Laparoscopic (n=23) or laparotomic (n=39) approaches were undertaken to obtain the final pathologic result. According to the final ovarian pathology, follicular cysts, corpus luteum cysts and endometriomas were grouped as non-neoplastic ovarian masses (n=40, group I). Serous or mucinous cyctadenomas, dermoid tumors and fibromas were allocated into the neoplastic benign ovarian mass group (n=10, group II). Primary malignant ovarian neoplasms were categorized into the neoplastic-malign group (n=12, group III).RESULTS:Mean ages of cases among groups I, II and III were 39.0 +/- 2.0, 42.2 +/- 5.2 and 56.9 +/- 4.2, respectively. As age of the cases enrolled in this sudy increased, the more likely was the occurrence of neoplastic malign ovarian pathologies (p < 0.001). Among postmenopausal cases diagnosed with an ovarian mass, serum Ca-125 levels were 113.5 +/- 20 IU/ml compared to those in premenopausal cases (85.8 +/- 16.0, p = 0.05). The values for serum VEGF values among pre- and postmenopausal ovarian masses were 46.2 +/- 6.7 pg/ml and 68.2 +/- 7.9, respectively (p = 0.04). In group I, serum VEGF levels of endometriomas (56.5 +/- 1.5 pg/ml) were higher compared to those of follicular or corpus luteum cysts (30.6 +/- 2.8, p = 0.05). In contrast, tumor size appeared to be larger in non-endometriotic. non-neoplastic cysts (10.1 +/- 2.0 cm), compared to endometriomas (6.4 +/- 0.6 cm, p < 0.01). Serum VEGF levels of group III were higher than other groups (p < 0.001). With respect to the discriminating benign or malign nature of the mass, with a specific cut-off value of serum VEGF level of 68.7 pg/ml, the sensitivity, specificity, positive and negative likelihood ratios were 92.3%, 88.0%, 3.3 and 0.1, respectively. For serum Ca-125 levels, the sensitivity, specificity, positive and negative likelihood ratio with a statistically relevant cut-off value of 102 IU/ml were, 76.9%, 76.0%, 3.21 and 0.3, respectively. Area under curve (AUC) for serum VEGF and Ca-125 values were 0.938 (95% CI: 0.81-0.96) and 0.769 (95% CI: 0.64-0.86), respectively (p = 0.02). Among the postmenopausal group, AUC for serum VEGF and Ca-125 was detected as 0.902 (95% CI: 0.70-0.98) and 0.873 (95% CI: 0.66-0.91) (p = 0.14).CONCLUSION:Serum VEGF has the potential to be considered as a tumor marker with a good diagnostic relevance in differentiating the nature of ovarian masses.

Objective To report a prenatal diagnosis of Gollop Wolfgang complex. Case history This is a pregnant women of 29 years of age, G:2 P:1 Ab:0 with 23 weeks of gestation, has not any history of drug use nor infection during pregnancy. Her husband 29 years of age, has not any family history of anomaly nor medical illness of skeletal deformity as his wife. Ultrasound examination of this pregnancy at 16 weeks gestation showed pes equinovarus deformity and an absence of distal bone of right extremity. The family was informed about the problem. At the meantime ethical permission was obtained for termination of this pregnancy. At 23th weeks, after having family's consent for termination of pregnancy, careful ultrasound examination of the fetus was carried out; double distal femoral epiphysis with ipsilateral deficiency of distal bone (tibia or fibula) and pes equinovarus of the right lower extremity were diagnosed. After cervical priming and induction of labor, female fetus with 1‐1‐1 Apgar scoring at 1st, 5th and 10th minute was born. There was also hypoplastic right knee joint with bony prominence and flexion contracture at the right leg. X‐rays of whole body were taken. There was also some other deformities and absence of some small bones. Conclusion This is the first case of prenatal diagnosis of Wolfgang Complex. We showed the importance of a careful ultrasound examination of fetus in the first and second trimesters for the diagnosis of fetal malformation.

ObjectiveTo investigate correlation of an office procedure saline sonohysteroscopic analysis with an invasive procedure diagnostic hysteroscopy.InterventionDiagnostic analysis of infertile patient in Osmangazi University Reproductive Health Center.Materials and methodsIn Osmangazi University, Reproductive Health Center, saline hysterosonographic analysis of the uterus, as an office procedure is done to all seconder infertile patient and primer infertile patients who have any suspicion to have an uterine anomaly or adhesion. Also if ultrasound examination of the uterus show endometrial thickness more than 5 mm after the end of menstruation saline hysterosonographic analysis (SHG) was performed.ResultsSHG is an easy and speedy method to use in office procedure. There were 38 cases of SHG showing disturbance of uterine cavity; 28 had polyp like lesions, 7 cases of suspected synechia. There were 11 patients who had normal SHG but recurrent pregnancy loss; these patients had normal findings in hysteroscopic analysis. After endoscopic procedures, 7 cases of synechia were verified, 5 cases out of 28 had submucous myomas, the others polyps. Effectiveness of the shg according to the hysteroscopic analysis is thus excellent. Correlation between the two methods, shows us that SHG can replace diagnostic hysterocopic analysis.ConclusionIn case of doubt, diagnostic analysis of the uterine cavity, can be done by SHG; hysteroscopy is superior to the SHG by its capability of treatment (surgery).

IntroductionAdrenal androgens are one of the important determinants of sexual differentiation in fetal period. Increased circulating levels of adrenal androgens as seen in congenital adrenal hyperplasia, interact with genital skin androgen receptors and induce clitoral enlargement, fusion of labial folds and cause migration of the urethral‐vaginal perineal orifice resulting in ambiguous genitalia. We are reporting a female newborn with clitoromegaly from a nulliparous mother at term pregnancy.Case reportThe mother was followed up from 22 weeks of gestation with no signs of hyperandrogenism. Because of late application for antenatal follow up and since clitoromegaly was observed at 29 weeks of pregnancy, amniocentesis could not be done. During ultrasonographic evaluation at 29 weeks of gestation, clitoris with a size of 13 × 18 mm was detected and dexamethasone 1 × 0.5 mg orally was started to use. In reevaluation at 33 weeks of gestation clitoral size was measured as 4.8 × 6.8 mm and treatment was stopped. At 40 weeks of gestation a female neonate with 10–10 apgar scores, weighing 4040 g was delivered with caesarian section due to cephalopelvic disproportion. After delivery physical examination of the neonate revealed clitoral measurements consistent with clitoromegaly. Hyperandrogenic state of the case persists and evaluation of the newborn is going on in Pediatrics Clinic.DiscussionAlthough adrenal androgen secretion starts at 6–8 weeks of gestation and dexamethasone therapy was shown to be effective in regression of virilization if it was used as early as 6–8 weeks of gestation, our case was diagnosed later in the course of pregnancy. But when similar regimen was applied similar result was obtained. So we propose that patients with intrauterine virilization signs like clitoromegaly and ones with risk of congenital adrenal hyperplasia should take glucocorticoid therapy whenever it is determined in order to ameliorate genital ambiguity in female fetuses.