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The article focuses on a study for evaluation of the significance of the hepatocyte growth factor receptor oncogene expression in cervical intraepithelial neoplasia. The study reports that the overexpression of the oncogene is an important prognostic parameter for early detection of lesions in cervical epithelial cells. The research methodology consists of patients diagnosed with cervical intraepithelial neoplasias at different states of cancer progression.

Study Question: Are modifications in the embryo culture protocol needed to perform non-invasive preimplantation genetic testing for aneuploidies (niPGT-A) affecting clinical reproductive outcomes, including blastocyst development and pregnancy outcomes?, Summary Answer: The implementation of an embryo culture protocol to accommodate niPGT-A has no impact on blastocyst viability or pregnancy outcomes., What Is Known Already: The recent identification of embryo cell-free (cf) DNA in spent blastocyst media has created the possibility of simplifying PGT-A. Concerns, however, have arisen at two levels. First, the representativeness of that cfDNA to the real ploidy status of the embryo. Second, the logistical changes that need to be implemented by the IVF laboratory when performing niPGT-A and their effect on reproductive outcomes. Concordance rates of niPGT-A to invasive PGT-A have gradually improved; however, the impact of culture protocol changes is not as well understood., Study Design, Size, Duration: As part of a trial examining concordance rates of niPGT-A versus invasive PGT-A, the IVF clinics implemented a specific niPGT-A embryo culture protocol. Briefly, this involved initial culture of fertilized oocytes following each laboratory standard routine up to Day 4. On Day 4, embryos were washed and cultured individually in 10 μl of fresh media. On Day 6 or 7, blastocysts were then biopsied, vitrified, and media collected for the niPGT-A analysis. Six IVF clinics from the previously mentioned trial were enrolled in this analysis. In the concordance trial, Clinic A cultured all embryos (97 cycles and 355 embryos) up to Day 6 or 7, whereas in the remaining clinics (B-F) (379 cycles), nearly a quarter of all the blastocysts (231/985: 23.5%) were biopsied on Day 5, with the remaining blastocysts following the niPGT-A protocol (754/985: 76.5%). During the same period (April 2018-December 2020), the IVF clinics also performed standard invasive PGT-A, which involved culture of embryos up to Days 5, 6, or 7 when blastocysts were biopsied and vitrified., Participants/materials, Setting, Methods: In total, 428 (476 cycles) patients were in the niPGT-A study group. Embryos from 1392 patients underwent the standard PGT-A culture protocol and formed the control group. Clinical information was obtained and analyzed from all the patients. Statistical comparisons were performed between the study and the control groups according to the day of biopsy., Main Results and the Role of Chance: The mean age, number of oocytes, fertilization rates, and number of blastocysts biopsied were not significantly different for the study and the control group. Regarding the overall pregnancy outcomes, no significant effect was observed on clinical pregnancy rate, miscarriage rate, or ongoing pregnancy rate (≥12 weeks) in the study group compared to the control group when stratified by day of biopsy., Limitations, Reasons for Caution: The limitations are intrinsic to the retrospective nature of the study, and to the fact that the study was conducted in invasive PGT-A patients and not specifically using niPGT-A cases., Wider Implications of the Findings: This study shows that modifying current IVF laboratory protocols to adopt niPGT-A has no impact on the number of blastocysts available for transfer and overall clinical outcomes of transferred embryos. Whether removal of the invasive biopsy step leads to further improvements in pregnancy rates awaits further studies., Study Funding/competing Interest(s): This study was funded by Igenomix. C.R., L.N.-S., and D.V. are employees of Igenomix. D.S. was on the Scientific Advisory Board of Igenomix during the study., Trial Registration Number: ClinicalTrials.gov (NCT03520933)., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Assisted reproduction technology has two significant problems: low success rates and multiple pregnancies. Because of these problems, the priority in IVF clinics is to develop a potential diagnostic test that can be used to select the embryos with the ultimate developmental competence. Aneuploidy screening as embryo selection criteria will ensure that the transferred embryos are euploid and high implantation rate. We hypothesize that aneuploidy in human preimplantation embryos could be discriminated by their amino acid metabolism profile in the spent culture media. Preimplantation genetic testing for aneuploidy results and spent embryo culture medium amino acid content were analyzed for 58 couples. The next-generation sequencing technique was used and coupled with TE biopsy. Forty euploid and 71 aneuploid blastocysts were evaluated. Embryos were cultured individually until day 5 or 6 of embryo development. Spent culture medium was collected after finishing the culture. There was no statistical difference between D3 and D5 embryo morphology between euploid and aneuploid embryos ( p   >   .05). Eight amino acids, including SER, GLY, HIS, ARG, THR, ALA, PRO, and TYR, were detected in the culture medium from the blank control group, euploid group, and aneuploid group. Only TYR amino acid concentration was found significantly higher in the aneuploid group compared to the euploid group ( p   <   .003). Tyrosine amino acid levels equal to and above 76.38   µmol/L could be considered aneuploid. Aneuploid embryos demonstrate altered amino acid turnover in vitro relative to euploid counterparts. A noninvasive method of amino acid profiling will be of value as a tool for routine preimplantation embryo selection among all patient groups.

Objective: To describe surgical procedures, previous failed pregnancies, methods for overcoming pregnancy failure and, most importantly, birth of a healthy infant, in a uterus transplantation from a deceased donor., Background: Majority of uterus transplants have involved live donors, but several advantages make deceased donor transplantation a practicable option, principally by eliminating surgical risks to the live donor., Methods: Uterus transplantation from a deceased donor was performed in September 2011 in Turkey. After 5 miscarriages, perfusion computed tomography revealed an obstructed blood-outflow. To overcome this blood flow obstruction, a saphenous vein graft was anastomosed between utero-ovarian and left ovarian vein with laparotomy. Follow-up computed tomography confirmed resolution of venous congestion and a decrease in uterine volume., Results: Following vascular augmentation surgery, fetal cardiac activity were observed 28 days after the first embryo transfer attempt. Preterm premature rupture of the membranes was diagnosed at 19 weeks' gestation. Cesarean section was planned at 28 weeks' gestation due to intrauterine growth restriction and suspected preeclampsia. A healthy 760 g male baby was delivered. The baby was discharged from the neonatal intensive care unit 79 days after delivery in good condition weighing 2475 g., Conclusions: Deceased donor uterus transplantation is a reasonable approach for treating uterine factor-related infertility. In case of recurrent miscarriages, regional vascular augmentation by arterial or venous supercharging may be required to overcome regional misperfused regions determined by imaging studies., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To compare obstetric outcomes between patients with positive and negative Berlin Questionnaire results., Methods: An observational study comparing outcome between these two groups was carried out in seven hospitals, representing seven different regions of Turkey. In each center, pregnant women who were admitted for normal pregnancy follow-up or labor, were consecutively recruited in the study. Each participant completed a sleep apnea questionnaire from the Berlin Questionnaire. This questionnaire tests snoring and daytime sleepiness. Fetal outcome and pregnancy outcome are recorded from patient files., Results: A total of 465 consecutive patients who completed the Berlin Questionnaire were analyzed. Patients with a positive questionnaire had a higher BMI, pre-pregnancy medical disorder rate and cesarean rate (68% vs 51%) than the negative group. Preeclampsia and gestational diabetes were more prevalent in the positive questionnaire group than the negative questionnaire group [19 (28%) vs. 18 (5%) for preeclampsia, 8 (12) vs. 13 (3%) for gestational diabetes, respectively]. At logistic regression analysis, gravidity, gestational age at birth and a positive questionnaire were independent predictors for preeclampsia. BMI and history of maternal medical disorders were independent predictors of gestational diabetes mellitus., Conclusion: Obstructive sleep apnea may be related to preeclampsia.

Purpose of Investigation: The purpose of this study is to evaluate the significance of the c-Met / Hepatocyte Growth Factor Receptor (HGFR) expression in cervical intraepithelial neoplasia (CIN)., Materials and Methods: Twenty-one patients from two types of cervical intraepithelial neoplasias (LSIL and HSIL), diagnosed in our clinic were studied with c-Met immunohistochemistry. Of the 21 cases, five were diagnosed as LSIL and 16 as HSIL. Normal cervical mucosas from five patients were studied with c-Met as control cases., Results: Overexpression of c-Met was found in all five of LSIL specimens. C-Met overexpression was observed in 11 cases of HSIL. No c-Met overexpression was seen in any of the five control cases., Conclusion: These results revealed that c-Met oncogene overexpression is an important parameter in cervical early oncogenesis and may have a role in malignant transformation of cervical epithelial cells.

Objective: The most commonly used classification system for endometrial hyperplasia is the World Health Organization system which is based on subjective criteria. Another classification system is endometrial intraepithelial neoplasia (EIN) system which uses diagnostic criteria including cytological demarcation, crowded gland architecture, minimum size of 1 mm, and careful exclusion of mimics, and aims to identify a precancer or cancer. The objective of this study was to compare the two classification systems in terms of predicting the presence of a coexistent cancer in surgically treated patients., Methods: Biopsy and hysterectomy specimens of 49 women who were subjected to surgery with a preoperative diagnosis of endometrial hyperplasia (EH) according to the WHO system were re-evaluated retrospectively by using EIN system., Results: Among the 49 patients, 69.4% had complex atypical EH and 75.5% had EIN at biopsy specimens. EIN was detected in 94.1% of complex atypical EH, and 41.7% of non-atypical EH. Nine women (18.4%) had endometrial cancer. Among women with cancer, all had complex atypical EH or EIN. The rate of coexistent endometrial cancer was 26.5% in women with complex atypical EH and 24.3% in women with EIN., Conclusion: Diagnoses of atypical or complex atypical EH and EIN had similar sensitivities and negative predictive values in predicting the coexistent endometrial cancer. Either of these two classification systems may be used safely when an experienced pathologist is available. However, use of the objective EIN system may be preferred whenever possible to prevent diagnostic errors in centers where an experienced pathologist is not available.

Objective: To determine whether the P-selectin-von Willebrand factor (vWF) pathway is altered in patients with polycystic ovary syndrome (PCOS)., Design: Case-control study., Setting(s): Tertiary care academic medical center., Patient(s): Thirty-two normal glucose-tolerant patients with PCOS and 21 age- and body mass index-matched healthy women were prospectively enrolled. All the patients with PCOS had clinical and/or biochemical hyperandrogenism and chronic oligoanovulation, and 89% had polycystic ovaries on ultrasound., Intervention(s): None., Main Outcome Measure(s): Soluble P-selectin (sP-selectin), vWF, total T, sex hormone-binding globulin, total cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting glucose and insulin, 2-hour glucose, and homeostatic model assessment-insulin resistance., Result(s): Soluble P-selectin levels were significantly higher in patients with PCOS compared with controls (58.7 +/- 19.0 vs. 45.3 +/- 15.0 ng/mL), whereas PCOS and control groups had similar vWF levels (46.7 +/- 24.2 vs. 39.5 +/- 22.3, respectively). There was no correlation between sP-selectin and anthropometric measurements or any of the androgen, lipid, or insulin resistance parameters., Conclusion(s): Our results suggest increments in the circulating sP-selectin concentrations associated with unaltered vWF levels in PCOS. Increased sP-selectin might potentially contribute to the future risk of cardiovascular disease in patients with PCOS., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: Lymphadenectomy, in general, is a safe and well-tolerated procedure in gynecologic oncology. However, some technical difficulties may be experienced in obese women which may result in inadequate lymphadenectomy and increased complications. The purpose of this study is to retrospectively evaluate the effect of obesity on lymph node counts retrieved and complication rates observed during lymphadenectomy in gynecologic cancers., Methods: Patients with ovarian, endometrial or cervical cancers treated with initial surgery including bilateral pelvic and paraaortic lymph node dissection were grouped as non-obese and obese. These two groups were compared in terms of the number of retrieved lymph nodes and the rate of intraoperative complications directly related to lymph node dissection., Results: One hundred twenty-three patients were eligible with a mean age of 55.1 years and mean body mass index of 29.2 kg/m(2). Fifty-nine patients were obese while 64 were non-obese. Lymph node counts obtained in different stations and in total were similar among non-obese and obese patients. Rates of lymphadenectomy-related intraoperative complications including vascular, neural, intestinal, and bladder injury were also similar in non-obese and obese patients., Conclusion: The obesity does not affect the lymph node counts and intraoperative complication rates adversely in women with gynecologic cancers. Therefore, adequate lymph node dissection should not be omitted based solely upon obesity in gynecologic oncology patients.

Since insulin resistance is accepted to be a common feature of polycystic ovary syndrome (PCOS), the exact molecular mechanism(s) involved in glucose and lipid metabolism have been under investigation in the syndrome. Recently, two novel adipokines, namely visfatin and retinol-binding protein 4 (RBP4), have been suggested to play a role in insulin resistance and diabetes. This study sought to determine whether plasma concentrations of visfatin and RBP4 are altered in PCOS by comparing a total of 27 lean, normal glucose-tolerant PCOS patients with 19 age- and body mass index-matched healthy controls. The mean plasma visfatin concentrations were higher in PCOS patients than those in healthy subjects (37.9+/-18.2 versus 19.8+/-17.5, P<0.01), while RBP4 concentrations were similar between the two. Both adipokines were correlated with each other in the whole (r=0.50, P<0.01) and in PCOS (r=0.52, P<0.01) groups but not in controls. The results suggest that lean, glucose-tolerant women with PCOS have increased circulating visfatin and unaltered RBP4 concentrations compared with healthy lean women. In order to clarify overlapping effects and their potential contribution to the pathophysiology of PCOS, further studies are needed., (Copyright (c) 2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Where there is no distortion of the endo-myometrial junction, the effect of an intramural leiomyoma on reproductive performance is controversial. The current study compared the performance of patients having a single leiomyoma and intact endometrium confirmed by hysteroscopy (study group) with that of controls having intact endometrium alone in intracytoplasmic sperm injection (ICSI) cycles. A total of 61 consecutive infertile patients were retrospectively enrolled into the study group from a computerized IVF database. The control group consisted of 444 age-matched patients undergoing ICSI-embryo transfer without any endocervical or intrauterine pathology confirmed by both transvaginal ultrasonography and office hysteroscopy. The baseline characteristics, performance of ovarian stimulation and embryological data were similar between the two groups. The clinical pregnancy per embryo transfer (36 versus 38%) and implantation rate (20 versus 19%) were also comparable. Although the miscarriage rate tended to be higher in the leiomyoma group (27 versus 19%), the difference did not reach statistical significance. In conclusion, in the presence of intact endometrium, a single intramural leiomyoma does not seem to have a deleterious effect on ICSI cycles. Before ICSI is attempted, hysteroscopy may be useful for ruling out distortion of the endometrium due to leiomyoma in selected cases.

Objective: To evaluate our experience in patients with endometrial cancer found in simple hysterectomy., Methods: Forty patients treated for endometrial cancer after simple hysterectomy were evaluated, retrospectively. Twenty-one patients (Group 1) underwent surgical staging procedure while 19 patients were not subjected to complementary surgical staging procedure (Group 2)., Results: The mean age was 53.80 years. Residual disease following reoperation was found in only four patients (19.0%). The three of them who were considered Stage IC (two Grade 1, one Grade 2) were found to be Stage IIIC and one patient who was considered Stage IB (Grade 2) was found to be Stage IIIC. The overall recurrence rates in Groups 1 and 2 were 4.8% versus 10.5% (P > 0.05). The overall disease-free survival rates were 95.24% in Group 1 and 87.50% in Group 2 (P > 0.05). Considering the patients who received postoperative adjuvant radiotherapy (RT), the overall disease-free survival rates were 88.89% in Group 1 and 84.62% in Group 2 (P > 0.05)., Conclusion: We believe that complementary surgical staging may have benefit in patients with incompletely staged endometrial carcinoma excluding Stage IA G1 cases, since the recurrence rate has rising and disease-free survival estimate has decreasing tendencies in incompletely staged patients than that in complementary surgically staged ones., ((c) 2006 Wiley-Liss, Inc.)