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Objective: The aim of this study was to investigate if adipose-derived stromal vascular fraction (SVF) treatment has any protective effect on ovarian function in rats with cyclophosphamide (CP) induced ovarian damage., Design: This was an experimental animal study., Participants/materials, Setting, Methods: 25 mature cycling Wistar-Albino rats were randomized into four groups (n = 5 per group). Rats in groups 1 and 2 received single dose of intraperitoneal (i.p.) 1 mL/kg sodium chloride 0.9% (NaCl). Groups 3 and 4 received single dose of 75 mg/kg i.p. CP. On seventh day, SVF was prepared from adipose tissues of 5 additional rats and groups 1 and 3 received 0.9% NaCl i.p. injections while groups 2 and 4 received 0.2 mL i.p. injections of SVF. On day 21 all rats were euthanized, and serum anti-mullerian hormone (AMH) levels, primordial, primary, secondary, antral, and atretic follicle counts, AMH positive staining follicle counts along with AMH staining intensity of the follicles were evaluated., Results: Among two CP induced ovarian damaged groups, SVF treated group showed significantly higher secondary and antral follicle and lower atretic follicle counts, significantly higher mean serum AMH levels, AMH positive antral follicle count and higher intensity of AMH positive follicle scores for primary, secondary, and antral follicles when compared to untreated group. Moreover, group 1 showed no significant difference for all parameters except antral follicle count and AMH positive staining intensity scores for antral follicles when compared to group 4., Limitations: This study was conducted on experimental rat model., Conclusion: Our study demonstrated a significant protective effect of SVF against CP-induced ovarian damage which reveals the apparent need for further investigation of its precise mechanisms of action as it may provide a new treatment approach for women with premature ovarian failure., (© 2024 S. Karger AG, Basel.)

Objectives: We investigated the potential of glutathione to protect ovarian function in rats exposed to cyclophosphamide by measuring serum anti-Mullerian hormone (AMH) levels, follicle counts, and related parameters., Design: Forty-two adult female Sprague-Dawley rats were randomly divided into six groups and treated with various combinations of cyclophosphamide, glutathione, and sodium chloride. On day 21, the rats were anesthetized, and their ovaries were removed for examination., Participants/materials, Setting, Methods: Histopathological examination, serum AMH concentrations, follicle counts, AMH-positive staining of follicle percentages were analyzed. Statistical analysis was performed using a one-way analysis of variance and Tukey's test, with significance set at p < 0.05. Secondary measures encompassed histopathological examination and percentages of AMH-positive staining of follicles., Results: Significant differences were observed in follicle counts, AMH-positive follicle parameters, and serum AMH concentrations among the six groups. Group 2 (treated with cyclophosphamide) had the lowest primordial, primary, secondary, and antral follicle counts and the highest atretic count. Group 6, treated with cyclophosphamide and 200 mg/kg glutathione, showed improved follicle counts compared to those in group 2. Reducing the glutathione dose to 100 mg/kg was ineffective., Limitations: This was an experimental animal investigation with a comparatively modest sample size. Experimental studies should be conducted to determine the optimal dosage and duration of glutathione therapy. Information gathered from an experimental animal model may not yield precisely similar outcomes in humans; therefore, additional investigations are necessary to examine the impact of glutathione on women experiencing POI., Conclusions: The anti-oxidative protective effect of directly administered glutathione was demonstrated for the first time. Low-dose glutathione was ineffective, whereas a high dose yielded significant ovarian protection against cyclophosphamide. Our findings provide valuable insights for supplementing clinical trials on the protective effects of glutathione against ovarian damage., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Research Question: Can cannabidiol (CBD) be used in the treatment of endometriosis for its anti-inflammatory, antioxidative and antiangiogenic effects?, Design: Endometrial implants were surgically induced in 36 female Wistar albino rats. After confirmation of endometriotic foci, the rats were randomized into four groups. In the leuprolide acetate group, rats were given a single 1 mg/kg s.c. leuprolide acetate injection. The other groups were 5 mg/kg CBD (CBD5), saline solution and 20 mg/kg CBD (CBD20); daily i.p. injections were administered for 7 days. After 21 days, the rats were euthanised, and total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) measurements in blood and peritoneal fluid samples, and immunohistochemical staining for TNF-α, IL-6 and vascular endothelial growth factor (VEGF) of endometriotic tissues were evaluated., Results: Significant reductions in the endometriotic implant surface area (P = 0.0213), serum TOS (P = 0.0491), OSI (P = 0.0056), IL-6 (P = 0.0236), TNF-α (P = 0.0083) and peritoneal fluid OSI (P = 0.0401), IL-6 (P = 0.0205) and TNF-α (P = 0.0045) concentrations were observed in the CBD5 group when compared with the saline solution group. Compared with the saline solution group, increased TAS concentrations in serum (P = 0.0012) and peritoneal fluid (P = 0.0145) were found in the CBD5 group. The CBD5 and leuprolide acetate groups were similar regarding inflammatory and oxidative stress parameters of serum and peritoneal fluid samples. The CBD5 group showed significantly lower mean intensity in both surface epithelium and stromal cells for VEGF (both P = 0.002) and only in surface epithelium cells for IL-6 (P = 0.0108), when compared with the leuprolide acetate group., Conclusion: Due to its anti-inflammatory, antioxidative and antiangiogenic effects, CBD might be a therapeutic agent candidate for endometriosis., (Copyright © 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Purpose: Endometriosis affects the quality of life, sleep, and sexual life of patients due to pain. This study compared the scores of endometriosis patients in these three areas before and after surgery., Methods: Patients between the ages of 18 and 60 with a prediagnosis of endometriosis were enrolled. Postoperative histopathological diagnosis of endometriosis was confirmed in all patients. This study included 56 patients who completed pre- and postoperative (three months) evaluation of quality scale questionnaires: a visual analog scale for pelvic pain, the Pittsburgh Sleep Quality Index, Morningness-Eveningness Questionnaire, Endometriosis Health Profile-30 Questionnaire, and Female Sexual Function Index were administered prior to and 3 months after each patient's surgery., Results: Among the 56 female patients included in this study, statistically significant improvement was observed in pain scores, quality of life, sexual function, and sleep of all patients regardless of endometriosis stage., Conclusion: Endometriosis is a disease that progresses, with increasing pain scores; it has negative effects on the quality of life, sexual function, and sleep of patients. Surgical or medical treatment can be performed considering the complaints and fertility status of the patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Our study's primary objective was to examine the effects of four different prophylactic protocols on the prevention of postpartum hemorrhage following vaginal birth, including carbetocin only, oxytocin only, and a combination of carbetocin or oxytocin with tranexamic acid., Design: A multicentric randomized controlled trial., Participants/materials, Setting, and Methods: This multicentric center prospective randomized controlled trial was conducted at the Department of Obstetrics and Gynecology of Bezmialem University and Van Health Teaching and Research Hospital from August 2022 to January 2023. The collected data included age, gravidity, parity, gestational age at birth, duration of delivery stages, prepartum hemoglobin and hematocrit concentrations, changes in hemoglobin and hematocrit concentrations, intrapartum blood loss, estimated blood loss after 2 h of vaginal delivery, Apgar scores at 1 and 5 min, birth weight, and neonatal intensive care unit (NICU) admission. Intrapartum blood loss was objectively measured in milliliters using a postpartum drape with a calibrated bag. The amount of bleeding was measured by subtracting the empty weight of the pads placed under the patient in the patient's bed within 2 h after delivery. Group I: carbetocin 100 μg/mL (n = 75), group II: oxytocin 5 IU/mL (n = 75), group III: carbetocin and tranexamic acid 50 mg/mL (n = 75), group IV: oxytocin and tranexamic acid (n = 75)., Results: The hemoglobin concentration decrease significantly differed between groups (1.03 ± 1.04, 1.3 ± 0.85, 1.4 ± 0.85, 1.41 ± 0.87, respectively; p < 0.001). Group 4 has the highest decrease in hemoglobin and hematocrit concentrations. When we investigated the subgroup differences, the decrease in hemoglobin concentration was significantly higher in group 2 than group 1 (1.30 ± 0.85 vs. 1.03 ± 1.04; p = 0.023), in group 2 than group 3 (1.3 ± 0.85 vs. 1.04 ± 0.9; p = 0.013), and in group 4 than group 3 (1.41 ± 0.87 vs. 1.04 ± 0.9; p < 0.001). The decrease in hematocrit level was significantly different between groups (3.07 ± 3.23, 3.55 ± 2.44, 2.13 ± 3.09, 4.25 ± 2.52; p < 0.001, respectively). No significant differences were observed in terms of mean blood loss between the four groups (277.19 ± 208.10, 294.13 ± 198.64, 274.33 ± 199.57, and 283.97 ± 178.11; p = 0.445, respectively). Furthermore, there was no significant difference between the groups in the rate of need for blood transfusion (1.3%, 5.4%, 4%, and 4%, respectively; p = 0.6)., Limitations: The most important limitation of the study is a relatively small number of participants., Conclusion: In conclusion, our findings suggest that carbetocin may be more successful than oxytocin and oxytocin plus tranexamic acid regimens in terms of postpartum hemoglobin reduction, and there is no difference in terms of the need for blood transfusion when it is used for postpartum hemorrhage prophylaxis after vaginal delivery., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Purpose: To assess sleep disturbances, levels of anxiety, depression and fatigue in women with premature ovarian insufficiency (POI)., Materials and Methods: The study included 62 women with POI and 62 age-matched controls. Women in both groups completed questionnaires. Pittsburgh Sleep Quality Index, Insomnia severity index, Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale and Fatigue Severity Scale were used., Results: We found poor sleep quality, higher levels of insomnia in women with POI than in controls. Depression was much more prevalent and severe in POI women. Total anxiety score, the severity of anxiety and fatigue did not differ significantly between the groups. According to the multivariable logistic regression analysis, being married and having POI were associated with worse quality of sleep, and having more children was associated with an increase in depression levels in the whole cohort. Backward analysis showed that when POI status was taken as a reference, married women were at 6.5 fold increased risk of poor sleep quality., Conclusions: Women with premature ovarian failure are more likely to suffer from poor sleep quality, insomnia and depression than healthy women.

Objective: Recent randomized controlled trials have demonstrated an association between uterine closure technique at the time of cesarean delivery and short- and long-term operative outcomes with varied results. This systematic review and meta-analysis aimed to examine types of suture material used for cesarean delivery., Data Sources: Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid, and ClinicalTrials.gov were searched from inception of each database to October 2021., Study Eligibility Criteria: All randomized controlled trials that compared types of suture materials used for hysterotomy closure during low-transverse cesarean delivery at ≥24 weeks' gestation and examined maternal outcomes were included for this review. The primary outcome was estimated blood loss. Secondary outcomes included additional surgical complications., Methods: Results were summarized as mean difference or risk ratio with associated 95% confidence intervals. The quality of studies was evaluated with the Cochrane Handbook for Systematic Reviews of Interventions for judging risk of bias. Heterogeneity was measured using I-squared (Higgins I 2 )., Results: This review included 7 randomized controlled trials, of which 3 compared multifilament with barbed suture (136 vs 136 participants), 3 compared multifilament with conventional monofilament suture (245 vs 244 participants), and 1 trial compared multifilament with chromic suture (4590 vs 4595 participants). Primary analysis showed no difference in estimated blood loss between the multifilament and the barbed suture group (mean difference, 46.2 mL; 95% confidence interval, -13.6 to 105.9), nor in change in hemoglobin concentration between the multifilament and the conventional monofilament group (mean difference, -0.1%; 95% confidence interval, -0.5 to 0.3). Secondary outcomes showed a reduction in operative time with barbed vs multifilament suture (mean difference, 1.9 minutes; 95% confidence interval, 0.03-3.8). Analysis also demonstrated an increased uterine scar thickness with use of conventional monofilament vs multifilament suture (mean difference, -1.05 mm; 95% confidence interval, -1.9 to -0.2)., Conclusion: This meta-analysis does not support a specific type of suture material for uterine closure at cesarean delivery because of insufficient data. Although barbed suture was associated with an overall decrease in operative time, and use of conventional monofilament suture was associated with an increase in uterine scar thickness, the clinical utility of these differences is not clear. Further adequate randomized controlled trials are warranted for evaluation of different suture materials for hysterotomy closure., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Research Question: What is the efficacy and possible positive effect of additional rescue subcutaneous (s.c.) progesterone therapy for restoration of progesterone concentration on embryo transfer day and pregnancy rates during programmed artificial frozen embryo transfer (FET) cycles with vaginal progesterone tablet plus i.m. progesterone?, Design: Multicentre prospective cohort study (NCT04769401) including a total of 238 programmed artificial FET between February 2021 and September 2021. Patients were divided into ≥10 ng/ml and <10 ng/ml according to serum progesterone concentrations on embryo transfer day; 25 mg of s.c. progesterone was added to patients with <10 ng/ml; blood samples were taken 2 days later. The primary outcome was the ongoing pregnancy rate., Results: The proportion of patients having ≥10 ng/ml serum progesterone concentrations on embryo transfer day was 70.7%. There was no statistically significant difference with regard to cumulative pregnancy rate, ongoing pregnancy rate and miscarriage between the groups (55.4% versus 61.5%, P = 0.4; 78.2% versus 72.5% per pregnancy, P = 0.5; 21.8% versus 27.5%, P = 0.5, respectively, ≥10 ng/ml and <10 ng/ml). Eighty-three per cent of patients with low serum progesterone concentrations on embryo transfer day reached an adequate progesterone concentration with rescue s.c. progesterone treatment; 90% of pregnancy rates in patients with serum progesterone concentrations <10 ng/ml on embryo transfer day were in patients who reached adequate serum progesterone concentrations with daily rescue s.c. progesterone treatment., Conclusions: The measurement of serum progesterone concentrations on embryo transfer day may create the opportunity for rescue progesterone administration on that day for patients who fail to reach adequate serum progesterone concentrations, achieving similar pregnancy rates without cancellation of the cycle., (Copyright © 2022 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to investigate the reproductive profiles, metabolic parameters and cardiometabolic risk assessed by surrogate indexes in women with adenomyosis. Ninety-six premenopausal women who were diagnosed with adenomyosis by transvaginal ultrasound and 97 age-body mass index (BMI) matched controls with normal ultrasound during routine examination were included. Women with adenomyosis were more likely to have higher gravidity and had more abortions than women without adenomyosis. Regarding the individual metabolic syndrome components, the adenomyosis group was more likely to have higher prevalence of hypertension, low HDL-C and central obesity. No significant difference was found between the groups in terms of visceral adiposity index, lipid accumulation product and fatty liver index. Only higher blood pressure (BP) remained statistically significant after adjustment for confounding factors in multivariate analysis. Women with adenomyosis had remarkably high risk of hypertension. It may be advisable to monitor their BP closely.Impact Statement What is already known on this subject? The only anthropometric characteristic assessed in women in relation to adenomyosis is body mass index (BMI). A case-control study showed that women who are obese are more likely to have adenomyosis. The gravidity, number of spontaneous abortions and previous uterine surgeries such as dilatation and curettage (D&C) and caesarean section were found significantly associated with adenomyosis. What do the results of this study add? A remarkable finding of our study was the increased incidence of higher systolic BP in women with adenomyosis. No difference was observed in adiposity indices between women with and without adenomyosis. Higher prevalence of central obesity and lower HDL-C levels were seen in women with adenomyosis. What are the implications of these findings for clinical practice and/or further research? The study identifies that adenomyosis is associated with an increased risk of hypertension, and women with adenomyosis may be monitored closely for blood pressure changes. Our report also provides novel information about the metabolic risk profiles associated with adenomyosis.

Background  Imaging plays an important role in the evaluation of prostate cancer patients. In recent years, much attention has been focused on gallium 68 prostate-specific membrane antigen positron emission tomography-computed tomography ( 68 Ga PSMA PET-CT) in prostate cancer patients and has been widely used for staging, restaging, and therapy response for these patients. The aim of this study was to report 68 Ga PSMA PET-CT in other cancers and benign processes incidentally detected on 68 Ga PSMA PET-CT in patients with prostate cancer. Materials and Methods  A total of 600 68 Ga PSMA PET-CT scans were performed for initial staging, restaging, detection of suspected recurrence, and therapy response in prostate cancer patients between December 2018 and June 2020. A total of 38 patients with histopathologically proven prostate cancer were included in the current study with other malignancies and benign processes. Mainly histopathology in most of cases and clinical and radiological follow-up in few cases after PET/CT scanning served as the standard of reference. Results  A total of 38 patients (age range: 52-85 years; mean age: 68.6) with prostate cancer final histopathology results were included in the study. A total of 51 lesion sites were evaluated in 38 patients. Forty-one lesion regions of these 51 regions were based on histopathological diagnosis, whereas 10 of them were based on clinical follow-up and conventional radiological follow-up as differential criteria. Thirty of 51 lesion regions were evaluated as malignant and 21 were benign lesions. The most common 68 Ga PSMA ligand avid malignancy was lung adenocarcinoma (6/38). Conclusions  Prostate-specific membrane antigen (PSMA) is a cell surface glycoprotein and mainly expressed in prostate epithelium. 68 Ga PSMA PET-CT imaging is very sensitive and specific imaging modality in prostate cancer patients. However, other malignancies and some benign processes may also have 68 Ga PSMA ligand avidity and some prostate cancer metastases may imitate other malignancies., Competing Interests: Conflict of Interest None declared., (World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

In this prospective study, seventy-six patients (PCOS group; n = 36, multifollicular ovary group; n = 40) were evaluated by 2-D and 3-D ultrasonography. VOCAL programme, echogenicity, number of follicles and blood flow parameters were evaluated. The patients with PCOS had a higher total ovarian volume, mean stromal volume and stromal echogenicity (18.6 ± 4.75 to 10.2 ± 3.4 p  < .01; 12.23 ± 2.53 to 5.02 ± 2.44 p  = .02; score 1:28 to 10 p  < .01, respectively). There was no statistically significant difference in terms of mean RI and PI values between the groups ( p  > .05). 3 D power Doppler parameters included VI, FI, and VFI values of the patients with PCOS were higher when compared to those of the patients with multifollicular ovary (3.82 ± 2.65 to 1.78 ± 1.2, p  < .01; 50.76 ± 4.45 to 40.6 ± 3.64, p  = .03; and 2.34 ± 1.02 to 1.12 ± 0.65, p  = .02, respectively). Our results revealed that total ovarian volume, stromal volume and echogenicity; VFI, VI, and FI could be useful for differential diagnosis in women with PCOS and multifollicular ovaries.Impact statement What is already known on this subject? Ultrasonography is considered the new diagnostic tool for PCOS. Enlarged ovaries with multiple small follicles peripherally located around increased ovarian stroma with increased stromal echogenicity are the sonographic features of polycystic ovaries. What do the results of this study add? 3-D Doppler ultrasonography may be more specific in the determination of multifollicular and polycystic ovaries when compared to RI and PI in 2-D Doppler ultrasonography. Moreover, 3-D power Doppler ultrasonography could be useful for differential diagnosis in women with PCOS and multifollicular ovaries. What are the implications of these findings for clinical practice and/or further research? In clinical practice, the differentiation of multifollicular ovaries and polycystic ovaries (PCO) is difficult with the use of 2-D sonography alone. Therefore, 3-D ultrasound and power Doppler may also be used in addition to 2-D ultrasound for the differentiation of multifollicular ovaries and PCO.

Purpose: This study aimed to compare the effects of two different suture materials, monofilament synthetic absorbable sutures versus multifilament synthetic absorbable sutures, on healing the uterine scar after a cesarean delivery., Methods: A total of 95 women between the ages of 18 and 40 who had undergone a primary cesarean section (CS) after the 38 th week of gestation. In Group I (n=48), continuous double-layer unlocked closure of the low transverse uterine incision was performed using monofilament synthetic absorbable sutures. In Group II (n=47), continuous double-layer unlocked closure of the low transverse uterine incision was performed using multifilament synthetic absorbable sutures. Six months after the operation, the integrity of the cesarean scar at the uterine incision site was assessed using hydrosonography. The healing ratio and the thickness of the residual myometrium covering the defect were calculated as markers of uterine scar healing., Results: No statistically significant differences were observed between the groups with regard to the preoperative hemoglobin concentrations, the change in the hemoglobin concentrations, operating time, and the number of intraoperative additional hemostatic uterine sutures. Mean thickness of the residual myometrium covering the defect was thicker in the monofilament suture group in comparison to the multifilament suture group (7.76±2.11 vs. 5.96±1.69, respectively; p<0.01). The mean healing ratio was significantly higher in the monofilament suture group in comparison to the multifilament suture group (0.76±0.13 vs. 0.60±0.12, respectively; p<0.01) CONCLUSION: Continuous double-layer unlocked closure of the uterine incision at cesarean delivery using monofilament synthetic absorbable sutures decreases the risk of CS scar defect., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Aim: To identify which positive prognostic parameters contribute to successful treatment outcomes and the probability of pregnancy by analyzing the results of infertile couples underwent ovulation stimulation (OS) and intra-uterine insemination (IUI) in our clinic., Methods: Five hundred and nineteen couples who underwent OS-IUI treatment because of a mild-moderate male factor, unexplained infertility, or anovulation were retrospectively analyzed. The data collected included patient demographics, cycle characteristic, sperm parameters and pregnancy rates. The main outcome measure was pregnancy rate (PR)., Results: Our overall PR was 17.72% (n = 92). In women who did not achieve pregnancy, age, BMI and duration of infertility were significantly higher (P < 0.001, P < 0.001 and P = 0.03, respectively). The IUI indications of higher PR were unexplained infertility (P = 0.018) and primary infertility (P = 0.003). AFC was significantly lower and the total dosage of gonadotropins was significantly higher in women who did not achieve pregnancy (P = 0.001 and P = 0.017, respectively). The number of progressive motile spermatozoa inseminated and the morphology were significantly higher in women who did not achieve pregnancy (P = 0.056 and P = 0.001, respectively). Female age ≤ 30 (OR = 0.87; 95% CI: 0.81-0.95; P < 0.01), BMI ≤23.3 kg/m 2 (OR = 0.87; 95% CI: 0.80-0.95; P = 0.002) and AFC > 9 (OR = 1.07; 95% CI: 1-1.15; P = 0.034) increase the pregnancy., Conclusion: Younger women, especially those with unexplained infertility, primary infertility, shorter duration of infertility, normal ovarian reserve, higher motile spermatozoa inseminated and sperm morphology, could benefit from OS-IUI., (© 2020 Japan Society of Obstetrics and Gynecology.)

Aim: To evaluate the clinical outcome of assisted reproductive technology (ART) cycles in couple with male infertility, where the spermatozoa were selected using either a conventional gradient-density centrifugation technique or microfluidic sperm sorting., Methods: A total of 181 patients who underwent in vitro fertilization (IVF) because of male factor infertility at the IVF center of Bezmialem and Yeditepe University Hospital were included in this study. All patients were divided into two groups according to the sperm selection method: group I (n = 91): microfluidic sperm-sorting chip; group II (n = 90): density-gradient centrifugation. Data collected included male and female age, type of infertility, duration of infertility, previous IVF attempts, smoking, antral follicle count, total dosage of gonadotropins, maximum estradiol levels, duration of stimulations, endometrial thickness on human chorionic gonadotropin day, total number of oocytes retrieved, number of mature oocytes retrieved, number of pronuclear (PN), sperm parameters, clinical PR and ongoing PR., Results: There was no statistically significant difference in clinical PR and ongoing PR between groups (49.5% vs 40%, P = 0.2; 44% vs 36.7%, P = 0.3; respectively). The improvement in pregnancy rate was more prominent in patients where the female partner's age is higher than 35 (P = 0.09) and men have a total motile sperm count between 1 and 5 million (P < 0.01)., Conclusion: Microfluidic devices, "labs-on-a-chip," are a disposable, easy to use, and inexpensive method for sperm sorting. Our results show that IVF success rates might improve with the use of a microfluidic sperm-sorting chip for sperm selection in male infertility., (© 2020 Japan Society of Obstetrics and Gynecology.)

Purpose: The aim of our study was to evaluate the positive effect of starting an IV oxytocin infusion early before uterine incision on intraoperative blood loss., Methods: A total of 101 women between 18-40 years who underwent a primary elective cesarean section (CS) were included in this randomized controlled trial. The patients were divided into two groups. In Group I (n=51), oxytocin infusion was administered immediately after incision of the visceral peritoneum during CS. In Group II (n=50), infusion was administered immediately after clamping the umbilical cord. The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean reduction in hemoglobin and hematocrit levels, need for additional uterotonics and hemostatic uterine sutures, blood transfusion, post-operative pain score, and additional surgical procedures., Results: There were statistical significant differences either in the change of the hemoglobin concentration (1.27±0.75 vs.1.74±0.81; p<0.01) or in the change of hematocrit concentration (3.89±2.24 vs. 5.41±2.93; p<0.01). Intraoperative blood loss was significantly lower in Group I when compared to Group II (475.86±150.11 vs. 605.1±203.2; p<0.01)., Conclusions: Our findings suggest that the starting IV oxytocin infusion early before uterine incision reduces intraoperative blood loss. This could be effective to replace starting IV oxytocin infusion late after umbilical cord clamping or delivery of the placenta., Einleitung: Das Ziel unserer Studie war es. die positive Wirkung der beginnenden IV Oxytocin-Infusion früh vor der Uterusinzision auf den intraoperativen Blutverlust zu bewerten., Material Und Methodik: In diese randomisierte kontrollierte Studie wurden insgesamt 101 Frauen zwischen 18 und 40 Jahren eingeschlossen, die sich einem primären elektiven Kaiserschnitt unterzogen hatten. Die Patienten wurden in 2 Gruppen eingeteilt. Gruppe I (n=51); Die Oxytocin-Infusion wurde unmittelbar nach der Inzision des viszeralen Peritoneums während der CS verabreicht. Gruppe II (n=50); Die Infusion wurde unmittelbar nach dem Klemmen der Nabelschnur verabreicht. Das primäre Ergebnis war das mittlere Blutverlustvolumen während der CS. Zu den sekundären Ergebnissen gehörte die mittlere Verringerung der Hämoglobin- und Hämatokritwerte, Bedarf an zusätzlichen Uterotonika und hämostatischen Uterusnähten, Bluttransfusion, postoperativer Schmerzscore und zusätzliche chirurgische Eingriffe., Ergebnisse: Es gab statistisch signifikante Unterschiede zwischen der Änderung der Hämoglobinkonzentration 1,27±0,75 vs.1,74±0,81; p<0,01) oder der Änderung der Hämatokritkonzentration(3,89±2,24 vs. 5,41±2,93; p<0,01). Der intraoperative Blutverlust war in Gruppe I im Vergleich zu Gruppe II signifikant geringer (475,86±150,11 vs. 605,1±203,2; p<0,01)., Diskussion: Unsere Ergebnisse legen nahe, dass die beginnende intravenöse Oxytocin-Infusion früh vor der Uterusinzision den intraoperativen Blutverlust verringert. Dies könnte wirksam sein, um eine beginnende intravenöse Oxytocin-Infusion zu einem späten Zeitpunkt nach dem Klemmen der Nabelschnur oder der Abgabe der Plazenta zu ersetzen., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Purpose: We evaluated the protective effect of PRP on ovarian function in female rats with cyclophosphamide (Cy)-induced ovarian damage., Methods: Thirty-two adult female Sprague-Dawley rats were randomly divided into four groups. Group 1 (control-sodium chloride 0.9%; 1 mL/kg, single-dose ip injection), group 2 (Cy); 75 mg/kg, single-dose ip injection and sodium chloride 0.9% (1 mL/kg, single-dose ip injection), group 3 Cy plus PRP, Cy (75 mg/kg, single-dose and PRP (200 μl, single-dose) ip injection), group 4 (PRP, 200 μl, single-dose ip injection). Primordial, antral, and atretic follicle counts; serum anti-Müllerian hormone (AMH) levels; AMH-positive granulosa cells; and gene expression analysis of Ddx4 were assessed., Results: Serum AMH levels were significantly lower in group 2 compared to groups 1, 3, and 4 (p < 0.01, p < 0.01, and p = 0.04, respectively). A significant difference was found in the primordial, primary, secondary, antral, and atretic follicle counts between all groups (p < 0.01). There was a statistically significant difference in AMH-positive staining primary, secondary, and antral follicles count between the groups (p < 0.01). There was a statistically significant difference in primary, secondary, and antral AMH positive staining follicle intensity score between the groups (p < 0.01). Ddx4 expression in group 4 was highest compared to other groups., Conclusion: Our study may provide evidence that PRP could protect ovarian function against ovarian damage induced by Cy. It could lead to improved primordial, primary, secondary, and antral follicle numbers.

The aim of this study was to investigate the clinical, endocrine, metabolic features and prevalence of metabolic syndrome (MBS) in Turkish adolescents with polycystic ovary syndrome (PCOS) and the differences in metabolic parameters between adolescent PCOS with or without the presence of polycystic ovaries (PCO) on ultrasound. Subjects (n = 77) were classified into two groups: oligomenorrhea (O) and clinical and/or biochemical hyperandrogenism (HA) (n = 38), without PCO and O + HA with PCO (n = 39). The control group consisted of 33 age-matched adolescents. Adolescents with PCOS had a significantly higher body mass index (BMI), waist circumference and levels of LH, LH/FSH ratio, triglyceride, insulin, HOMA-IR, free androgen index and lower levels of SHBG and FSH. After adjustment for BMI, LH, LH: FSH ratio remained significantly higher. Adolescents with PCOS had a higher prevalence of MBS. No significant differences in lipid profiles, insulin levels and insulin sensitivity in both the PCOS groups were seen. HDL-C levels were lower in the O + HA + PCO group compared to the controls. BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS. Impact statement Many studies have investigated the effect of PCOS on metabolic and cardiovascular risks. It is thought that PCOS increases metabolic and cardiovascular risks. Increase in metabolic and cardiovascular risks associated with PCOS may be handled with early diagnosis and early intervention of PCOS in adolescents, although the diagnosis of PCOS in adolescents could be hard because of the features of PCOS overlapping normal pubertal physiological events. However, early identification of adolescent girls with PCOS may provide opportunities for prevention of well-known health risks associated with this syndrome and reduction of long-term health consequences of PCOS by reducing androgen levels and improving metabolic profile. Our results also support that BMI may be the major contributing factor in the development of metabolic abnormalities in adolescents with PCOS.

Purpose of Review: Endometriosis is a disease of adolescents and reproductive-aged women characterized by the presence of endometrial tissue outside the uterine cavity and commonly associated with chronic pelvic pain and infertility. Here we review the epidemiology of endometriosis as well as potential biomarkers for detection and with the goal of highlighting risk factors that could be used in combination with biomarkers to identify and treat women with endometriosis earlier.., Recent Findings: Early age at menarche, shorter menstrual length, and taller height are associated with a higher risk of endometriosis while parity, higher body mass index (BMI) and smoking are associated with decreased risk. Endometriosis often presents as infertility or continued pelvic pain despite treatment with analgesics and cyclic oral contraceptive pills., Summary: Despite a range of symptoms, diagnosis of endometriosis is often delayed due to lack of non-invasive, definitive and consistent biomarkers for diagnosis of endometriosis. Hormone therapy and analgesics are used for treatment of symptomatic endometriosis. However, the efficacy of these treatments are limited as endometriosis often recurs. In this review, we describe potential diagnostic biomarkers and risk factors that may be used as early non-invasive in vitro tools for identification of endometriosis to minimize diagnostic delay and improve reproductive health of patients., Competing Interests: Conflict of Interest Parveen Parasar, Pinar Ozcan, and Kathryn L. Terry declare that they have no conflict of interest.

It is imperative to have evidence-based guidelines for cesarean delivery. The aim of this meta-analysis was to evaluate the effectiveness of a cephalad-caudad compared to transverse blunt expansion of the uterine incision to reduce blood loss in women who underwent low-segment transverse cesarean delivery. We therefore performed a systematic search in electronic databases from their inception until March 2016. We included all randomized trials comparing cephalad-caudad versus transverse (control group) blunt expansion of the uterine incision in women who underwent a low transverse cesarean delivery. The primary outcome was postpartum blood loss, defined as the mean amount of blood loss (mL). Two trials (921 women) were analyzed. After the transverse uterine incision in the lower uterine segment with the scalpel, the uterine incision was then bluntly expanded by the designated method. Blunt expansion of the primary incision was derived by placing the index fingers of the operating surgeon into the incision and pulling the fingers apart laterally (transverse group) or cephalad (cephalad-caudad group). Women who were randomized in the cephalad-caudad group had lower: mean of postpartum blood loss, hemoglobin drop and hematocrit drop 24h after cesarean, unintended extension, uterine vessels injury, blood loss >1500mL and need for additional stitches. There was no statistically significant difference in the incidence of blood loss >1000mL, in the operating time and in post-operative pain. In conclusion, expansion of the uterine incision with fingers in a cephalad-caudad direction is associated with better maternal outcomes and, therefore, should be preferred to transverse expansion during a cesarean delivery., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Aim: The objective of the analysis was to determine the characteristics that distinguish women with adenomyosis and leiomyomas from those with leiomyoma only from a sample who underwent hysterectomy for benign uterine diseases., Methods: This retrospective study was based on the analysis of medical records of 75 women with both adenomyosis and uterine leiomyomas and 218 women with leiomyomas only, diagnosed by histologic analysis of uterine specimens., Results: Results of multivariate logistic regression analyses showed that women with both adenomyosis and leiomyomas had a higher gravity (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.01-1.33) and more frequent pelvic pain (OR 0.38, 95% CI 0.21-0.7) compared with women with leiomyomas only. Postmenopausal bleeding was commonly reported in women with adenomyosis and leiomyomas. No significant difference was observed between the two groups in terms of menorrhagia and metrorrhagia and the preoperative diagnosis of prolapse., Conclusions: The presence of concomitant adenomyosis may cause different clinical symptomatology., (© 2015 Japan Society of Obstetrics and Gynecology.)

Objective: To assess serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester and to determine the factors affecting deficiency levels and its association with pregnancy outcomes., Methods: Serum 25(OH)D concentrations were measured at 11-14 weeks' gestation in 229 singleton pregnancies using liquid chromatography-tandem mass spectrometry., Results: The median serum 25(OH)D concentration was 10.8 ng/mL and 45.9% of women had severe vitamin D deficiency with concentrations of <10 ng/mL. Logistic regression analysis revealed that covered dressing style, lack of multivitamin intake, season of blood sampling (November-April) were factors associated with 25(OH)D deficiency. There was a negative correlation between 25(OH)D levels and gestational age at sampling. Low 25(OH)D levels were not associated with adverse pregnancy outcomes. Higher rate of cesarean section (CS) was noted in women with 25(OH)D ≥10 ng/mL compared to those with 25(OH)D < 10mg/ml (p= 0.01)., Conclusion: A high prevalence of vitamin D deficiency was observed in early pregnancy which was related to dress code, use of multi-vitamins and season at sampling. Low 25(OH)D levels were not related with adverse pregnancy outcomes. Women with severe vitamin D deficiency were more likely to deliver vaginally.

Objective: To determine which type of blunt expansion of a low transverse uterine incision during operative delivery is associated with decreased blood loss and intra- and post-operative morbidity for a caesarean section (CS)., Methods: The prospective randomised-controlled trial was conducted at the Department of Obstetrics and Gynecology, Bezmialem University Hospital. The patients were randomly assigned to a group that received a cephalad-caudad (n = 55) or transverse (n = 57) blunt expansion of the low transverse uterine incision. Intra- and post-operative morbidity at caesarean delivery in short-term including blood loss, operating time, post-operative pain with the faces pain rating scale, and post-operative morbidity were analysed., Results: The changes in both haemoglobin (p < 0.01) and haematocrit (p < 0.01) from the pre-operative to post-operative values, estimates of blood loss (p < 0.01) were significantly lower in cephalad-caudad group and the post-operative haematocrit concentrations (p = 0.02) were significantly greater in cephalad-caudad group when compared with the transverse group. The damage of parametrial and uterine vessels into lateral edges were recorded in 11 (19.6%) patients in transverse group and 7 (12.9%) patients in cephalad-caudad group and there is no statistical significance between groups in terms of these parameters (p > 0.05, 95% CI 0.19, 1.63)., Conclusion: Our findings suggest that cephalad-caudad blunt expansion of the low transverse uterine incision decreases blood loss compared to transverse blunt dissection.

Background: Laparoscopic approach has become the standard procedure for living donor nephrectomy in many transplant centers. Because the conventional approach results in cosmetic problems and pain during laparoscopic live donor nephrectomy, transvaginal extraction of an intact kidney has been recently introduced as a minimally invasive technique. Here, we aimed to investigate whether transvaginal extraction of an intact kidney during laparoscopic live donor nephrectomy is associated with decreased postoperative pain, nausea and vomiting, and morphine consumption., Material and Methods: This prospective data analysis included a total of 27 female donors who underwent laparoscopic removal of a single kidney for living donor nephrectomy through conventional or transvaginal route. Data collected included age, body mass index, ASA scores, histocompatibility, additional medical disorders, peri- and postoperative complications, postoperative pain scores with visual analogue pain scores (VAS), length of postoperative stay, morphine consumption, degree of nausea and vomiting, level of sedation, and pruritus., Results: No significant differences between the transvaginal and conventional groups were observed in VAS scores and morphine consumption at postoperative 1, 3, 6, 12, and 24 hours. Although not reaching statistical significance, according to analysis of morphine consumption, there was a trend toward decreasing analgesic requirements in the transvaginal group at postoperative 12 and 24 hours. There were no significant differences between the groups in terms of degree of nausea or vomiting, or length of postoperative hospital stay., Conclusions: We suggest that with a more desirable cosmetic result, transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy (TVNALDN) is a suitable new minimally invasive laparoscopic technique associated with reduced postoperative pain and analgesic requirements in select women.

Objective: To determine the effects of captopril on experimentally induced endometriosis in a rat model., Study Design: Twenty-four adult, mature female Wistar-Albino rats in which endometriotic implants were induced by transplanting autologous uterine tissue to ectopic sites on the peritoneum. After the endometriotic implants were formed surgically, the 24 rats were randomly divided into three groups. Group 1 (captopril group, eight rats) were given 50 mg kg(-1)d(-1) of oral captopril for 21 d. Group 2 (leuprolide acetate group, eight rats) were given a single 1 mg kg(-1) subcutaneous injection of leuprolide acetate. Group 3 (control) were given no medication and served as controls (eight rats). The surface area of the endometriotic implants and the score of histologic analysis. Also, VEGF and MCP-1 levels in peritoneal fluids and bloods were analyzed., Results: At the beginning of the medical treatment, the mean surface areas of the endometriotic implants were comparable in all three groups. At the end of the treatment the mean implant surface area in the captopril group and leuprolide acetate group was less than that in the control group. Mean histopathological examination score for the implants post treatment was lower in the captopril and leuprolide acetate groups. Peritoneal fluids VEGF level in the captopril and leuprolide acetate groups was lower than that in the control group. The post-treatment MCP-1 level was also lower in the captopril and leuprolide acetate groups than in the control group. The serum VEGF and MCP-1 levels post treatment were significantly lower in the captopril and leuprolide acetate groups than in the control group., Conclusion: Administration of captopril reduced the size and progression of endometriotic lesions in a rat model., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: To evaluate the effect of markedly elevated 50-g glucose loading test (GLT) (>or=200 mg/dL) and equivocal 100-g GLT (one abnormal value) results on maternal and perinatal outcomes., Methods: Retrospective analysis of 2029 singleton pregnancies screened for gestational diabetes mellitus (GDM). Maternal and perinatal outcomes in five different groups with different degrees of glucose intolerance were compared. First group consisted of patients with normal 50-g test, second group was formed by patients with abnormal 50-g glucose test but a normal 100-g test. Third group included patients with one abnormal value after 100-g test. Patients in the fourth group were diagnosed to have GDM after an abnormal 100-g test. Patients in the fifth group had a value >or=200 mg/dL after 50-g test and were diagnosed to have GDM., Results: Macrosomia and large for gestational age incidence were highest in the group with one elevated glucose tolerance test (GTT) value. Hospitalisation rates, hypoglycemia, hyperbilirubinemia and polycythemia were more common in neonates born to mothers with one elevated GTT value and to mothers with a GLT > 200 mg/dL., Conclusion: Adverse maternal and perinatal outcomes in patients with one elevated GTT value and in patients with a GLT value > 200 mg/dL warrant close glucose monitoring and treatment in these groups even in the absence of a diagnostic abnormal GTT.