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Objective: In frozen-thawed embryo transfer (FET) cycles, preparing a synchronous endometrium for the embryo is essential. Aim of this study is to provide individualized luteal support in hormonally replaced FET cycles, and to evaluate mid-luteal serum progesterone levels and pregnancy outcomes.Study Design: In this prospective cohort study, 30 patients were included in a university hospital in six month-period. Serum progesterone level on embryo transfer day was monitored, and if it was found to be below the lower limits defined by previous studies (10 ng/mL), additional 100 mg intramuscular micronized progesterone was administered once.Mid-luteal progesterone levels and pregnancy outcomes were recorded.Results: There was no significant difference between mid-luteal progesterone levels of the patients whose transfer day progesterone was above and below 10 ng/mL (p=0.481). Although clinical pregnancy rate tended to be higher in patients whose mid-luteal progesterone was above 10 ng/mL, it was also not statistically significant.Conclusion: This is the first study in which vaginal progesterone treatment was supported by intramuscular progesterone according to serum progesterone values for the purpose of individualized progesterone support. Significant difference was not found in pregnancy outcomes. However, further studies are required to optimize management and improve pregnancy rates in hormonally treated FET cycles.

OBJECTIVE: To analyze demographic and clinical data of patients who resorted to oocyte freezing between January 2014 and December 2018. STUDY DESIGN: Patients who applied to the Reproductive Endocrinology and Infertility Unit of Ankara University School of Medicine between January 2014 and December 2018 with the request of oocyte freezing were included in this study. The files and computer records of the patients were analyzed retrospectively and sociodemographic, clinical and laboratory data were evaluated. RESULTS: A total of 46 cycles were recorded in 40 patients over a 5-year period. The main indications were low ovarian reserve and/or advanced age (68.3%) and malignancy diagnosis (31.7%). There was a significant difference between elective fertility preservation and oncofertility preservation (Onco-FP) groups in terms of the age (38.4±4.7 vs 28.4±6.1; p=0.001). There was a significant difference between two groups in favor of oncofertility group in terms of anti-Mullerian hormone level, basal follicle-stimulating hormone level, antral follicle count, trigger day estradiol (E2) level, number of obtained oocytes, MII oocytes, and frozen oocytesCONCLUSION: According to our study, the most prominent oocyte cryopreservation indication was advanced age and/or low ovarian reserve. The number of oocytes collected from patients in the Onco-FP group and thus the number of frozen oocytes was significantly higher than in the elective fertility preservation group, due to younger ages and better ovarian reserve in the Onco-FP group. Abdominal administration of the technique is particularly important for virgin patients in our country. Oocyte freezing is a fertility protection method available in a wide range of indications for reproductive-aged women.

Objective: Progestins are used as an alternative to gonadotropin releasing hormone (GnRH) antagonists to suppress premature luteinizing hormone (LH) surge and a flexible protocol has been defined recently. The aim of this study was to compare the efficacy of flexible protocols with dydrogesterone and GnRH antagonist in suppressing LH surge. Material and Methods: This retrospective, case-control study, was conducted in an infertility unit of a tertiary university hospital. A daily dose of 40 mg dydrogesterone was compared with GnRH antagonist (GnRHant) in controlled ovarian hyperstimulation cycles between July 2018 and July 2019. Dydrogesterone was started when the leading follicle was 12 mm or serum estradiol was over 300 pg/mL. A subgroup analysis of poor responder patients was also performed. Results: In total there were 105 subjects aged between 23 and 41 years, 52 in the dydrogesterone group and 53 in the GnRHant group. Duration of pituitary suppression was longer in dydrogesterone group. Premature ovulation was observed in 11.5% (6/52) and 0% in the dydrogesterone and GnRHant groups, respectively. However, collected oocyte counts and metaphase II oocyte counts were found to be similar between the groups. The six patients with premature ovulation were in poor responder subgroup. Conclusion: Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned in the same cycle. However, flexible regimen may not be appropriate in patients with diminished ovarian reserve, as advanced follicular maturation and delayed suppressive effect of oral progesterone may cause premature ovulation. Randomized controlled trials in particular patient groups are required to determine the most effective minimum dose and time of application to ensure treatment success.

Despite the wide utilization of gonadotropin-releasing hormone analogs, progesterone elevation (P4E) in the late follicular phase occurs in 5 to 30% of all ovarian stimulation (OS) cycles. Although the detrimental effect of P4E on pregnancy rates in fresh in vitro fertilization cycles is valid in all subsets of cases, higher levels of P4 and a longer duration of P4E may be needed in patients with a hyper-ovarian response in order for a negative impact on pregnancy rates to occur. Available preclinical and clinical data suggest that aggressive OS with high doses of follicle-stimulating hormone might increase 3β-hydroxy steroid dehydrogenase and 17β-hydroxy steroid dehydrogenase enzyme activity in human granulosa cells, which leads to high P4 production and hence a higher amount of leakage to the systemic circulation due to a lack of 17α-hydroxylase enzyme expression in human species. High P4 concentrations appear to alter gene expression in the endometrium; however, caution is necessary regarding its potential effect on oocyte/embryo quality with respect to the role of inherent follicular disruption in some women. In terms of the mechanism of overproduction in P4 synthesis, the main preventive strategy should be avoiding aggressive stimulation. Unfortunately, there is lack of large-scale randomized controlled trials for other approaches, including deferred embryo transfer in the thaw cycle. Since there is a significant inter-assay variability for P4 measurement, it may be wise to recommend that every center should define their own P4E and the level needed for harm to occur based on their own assays and datasets before deciding the best approach.

Objective: The aim of the study is to evaluate the possible effects of the various conditions especially bimanual examination on the adequacy of pap smear test.Study Design: Presented here is a prospective controlled clinical trial carried out at Ankara Atatürk Training and Research Hospital between November 2013 and March 2014. Total of 1771 patients seen at the gynecology outpatient clinic were included in the study. The technique described by the American Society of Cytopathology Criteria 2000 for the preparation of the specimen was followed. Updated Bethesda system 2014 was used for reporting the results.Results: Number of subjects in smear before examination group was 1194 and in the smear after examination group was 577. Two percent (n=36 subjects) of the cervicovaginal report was inadequate. When other clinical conditions were not taken into consideration, the likelihood ratio for inadequate smear in the smear after examination group was 2.64 compared to smear before examination group (p=0,004). Conclusions: In some conditions cervicovaginal smear sampling may be carried out after bimanual vaginal examination instead of missing the chance to screen the women. However, the patients have to be informed that cervicovaginal smear result might be inadequate so that a repeat test has to be carried out.

OBJECTIVE: We aimed to evaluate the alteration of dynamic thiol/disulfide homeostasis which basically shows the oxidative stress in body in pregnant women with gestational diabetes mellitus (GDM) by using a newly developed and automated analysis method. STUDY DESIGN: Study population consisted of body mass index and gestational age-matched pregnant women. Patients were subdivided into 3 groups based on their response to glucose challenge test (GCT) and oral glucose tolerance test (OGTT) results: (1) control group (normal GCT test results n= 87); (2) Impaired glucose tolerance (IGT) group ( n= 37); (3) GDM group (n=25). Maternal serum thiol and disulphide levels were compared among three groups. RESULTS: Maternal serum thiol values were found decreased and maternal serum disulphide levels were increased in GDM groups were compared to control and IGT groups (Thiols for controls: 398.19±30.49 µmol/L, for IGT group 395.92±35.52 µmol/L, and for GDM group 371.89±41.14 µmol/L p= 0.002). Disulphides for controls; 17.47±4.38 µmol/L, for IGT; 19.27±3.34 µmol/L, for GDM group; 25.46±4.21 µmol/L, (p=0.001). Disulphide/thiol ratio was found to be increased in GDM group comparing to other groups (Disulphide/thiol ratio: 0.044±0.012 for controls, 0.049±0.009 for IGT group, 0.068±0.0103 for GDM group p=0.001) CONCLUSION: Thiol- disulphide balance has shifted to the oxidative side in pregnant women with GDM. So blood glucose regulation is extremely crucial for reducing the oxidative stress which may lead to damages to vital organs of a mother or possibly to development of a fetus in women with GDM.

Background/Aims: This study aims to examine the differences in plasma thiol-disulphide levels that are related to oxidative stress among obese and nonobese women with polycystic ovary syndrome (PCOS) and their age/body mass index (BMI)-matched healthy controls. Methods: The participants were divided into 4 groups based on BMI (nonobese and obese). Serum thiol and disulphide levels were compared among groups. Results: Serum thiols were found higher in the obese PCOS group than those in the obese control group in the study (thiol: 407.33 ± 46.25 vs. 365.67 ± 67.03 µmol/l, p = 0.014). Disulphide levels were observed to be decreased in the obese PCOS group relative to its control (21.39 ± 1.33 vs. 23.53 ± 8.47 µmol/l, p = 0.021). Serum thiol levels were found to be higher in the nonobese PCOS group compared to nonobese controls (thiol: 434.7 ± 46.92 vs. 422.94 ± 46.61 µmol/l, p = 0.031). Significant differences of disulphide levels between the nonobese PCOS group and the nonobese control group were observed (18.07 ± 1.93 vs. 20.68 ± 3.79 µmol/l, p = 0.027). Conclusion: High antioxidant levels in women with PCOS may be related to either mechanisms involving anovulation, multiple follicular development, and apoptosis or to their compensatory system against oxidative load arising from obesity and overweightness.

Objective The aim of the study is to evaluate alterations in intracellular and extracellular antioxidant enzymes activities and serum oxidative stress markers in patients with endometriosis. Study design The current prospective study consisted of 31 female patients with endometriosis and 27 healthy controls. Serum total thiol, native thiol, disulphide, catalase, myeloperoxidase, and ceruloplasmin concentrations were measured. Laboratory and clinical data of all participants were recorded to compare the differences between the study and the control groups. Results Serum native thiol and total thiol levels in the study group were significantly lower than those in the control group [( p = 0.009, p = 0.03, respectively)]. Serum catalase levels are significantly higher in patients with endometriosis comparing to the control group ( p = 0.009). Conclusions The finding that significant differences in serum total thiol, native thiol, and catalase levels observed in endometriotic patients supports that oxidative stress carries weigh in the pathophysiological aspects of endometriosis. Also significantly low levels of extracellular antioxidants and significantly high levels of intracellular antioxidants in endometriotic patients may arise from differences of free radicals in endometriosis and the activity levels of endometriosis. These non-invasive serum markers might give us an opportunity to monitor the disease's progress during the treatment.

Multiple sclerosis (MS) is an autoimmune disorder characterized by chronic inflammation in the central nerves system. Because the disease predominantly affects women of reproductive ages, having knowledge about contraception options for MS patients can make clinicians provide better counseling. Although most contraceptive methods are generally accepted as safe and effective in MS patients, recent studies have raised questions about their potential adverse effects on the disease. The use of contraceptive methods to avoid unintended pregnancies is crucial in MS patients, particularly during the relapse phase of the disease or the time when the disease is not completely under control. This review investigates the contraception options and their effects on female MS patients. Providing appropriate contraception options to multiple sclerosis patients will be one of the most challenging issues for clinicians to deal with. Recent studies have raised questions that the use of hormonal contraceptives may at least partly contribute to the rise in incidence of MS in women. This review investigates the contraception options and their effects on female MS patients.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized with the congenital ab- sence of uterus and vagina. Uterus may be rudimentary. Coexistence of a myomauteri with MRKH syndrome is possible. The case presented in this study is the eighteenth report in the literature. Moreover, it is the fi rst one with coexistent skeletal system anomalies, left pelvic renal ectopia, and leiomyoma of the rudimentary uterus. Coexistence of a uterine leiomyoma and MRKH syndrome is very rare. However, if a patient with MRKH syndrome presents with a pelvic mass, the possibility of a leiomyoma should be considered. The review of the english written medical literature revealed that the coexistence of a uterine leiomyoma and MRKH syndrome is very rare. However, if a patient with MRKH syndrome present with a pelvic mass, the possibility of a leiomyoma should be considered.

Amaç: Gestasyonel diabetes mellitus (GDM) ile ilgili en iyi tarama ve tanı yönteminin ne olduğu konusundaki tartışmalar devam etmektedir. Gebelerin gestasyonel diabetes mellitus tarama testleri ile ilgili farkındalığı ve bunu etkileyen faktörlerle ilgili çalışmalar sınırlı sayıdadır. Bu çalışma gebelerin glikoz yükleme testleri konusundaki bilgi düzeyleri, bu testleri yaptırma konusundaki tutum ve davranışları ve bu testleri yaptırma konusundaki son kararlarını etkileyen faktörleri araştırmak için yapılmıştır.Materyal ve Metot: Bu çalışma Şubat 2015 ve Nisan 2015 arasında gebelik takibi için gebe polikliniğimize başvuran gebeler arasında yürütülen bir anket çalışmasıdır. Çalışmaya katılan gebelere 14 soruluk anket uygulanmıştır.Bulgular: Çalışmaya toplam 476 gebe katılmıştır. Katılan gebelerin ortalama yaşı 27,7(17-42) yıl idi. İyi bilgi düzeyine sahip olma ile bu gebelikte glikoz testini yaptırma veya testi yaptırmayı düşünme arasında istatistiksel anlamlı farklılık tespit edilmiştir (p, Objectives: Debates continue about the best screening and diagnostic method for Gestational Diabetes Mellitus (GDM). However, the number of the studies investigating the awareness and related behaviors of pregnant women about gestational diabetes mellitus screening tests are limited in the literature. This study was planned to investigate the levels of knowledge about the glucose challenge tests, attitudes towards agreeing to these tests and facts affecting their final decisions about having these tests done or not of pregnant women.Materials and Methods: This study is a survey, conducted among pregnant women admitted to our obstetric outpatient clinic for pregnancy follow-up, between February 2015 and April 2015. A fourteen items long questionnaire was administered to pregnant women who participated in the study.Results: A total of 476 pregnant women participated in the study. The average age of the participating women was determined to be 27.7 (17-42) years. We found a statistically significant difference between having good knowledge and having the glucose challenge test done or considering to have it done in the current pregnancy (p

The aim of this study was to analyze the expression of microfibril-associated protein 2 (MFAP2), microfibril-associated protein 5 (MFAP5) and nuclear localized factor 2 (NLF2) genes in patients with repeated IVF failure and compare with fertile population. Total RNA was isolated from 38 patients (repeated implantation failure, group 1, n=22: fertile patients, group 2, n=16). mRNA expression levels were measured quantitatively using real-time polymerase chain reaction. Our results showed that mRNA expression of NLF2 significantly decreased in the infertility group as compared to control group (P=0.023). In addition a marked decrease was observed in the expression of MFAP2 in women with repeated implantation failure. In conclusion, NLF2 gene expression levels and differences in MFAP2 and MFAP5 gene expressions (albeit being insignificant) between infertile group and control group draw attention to a genetic basis under implantation failure. (C) 2012 Elsevier B.V. All rights reserved.

To determine the prevalence and factors associated with diastasis recti abdominis (DRA) MATERIAL AND METHODS: Between January 2011 and May 2011, we examined 95 patients, aged between 19-24, for the presence of DRA during an ultrasonographic exploration in Mus Obstetrics and Gynecology Hospital, Mus, Turkey DRA was graded by the number of fingerbreadths between the medial edges of the bellies of the rectus abdominis muscle, 3-4 cm above the umbilicus. The exclusion criteria included urogynecologic problems since childhood, excessive protrusion of the vagina due to loss of support, pregnancy obesity less than 6 months postpartum. The relationship between DRA and parity previous abdominal surgery pelvic relaxation as well as type of parity was assessed.Positive correlation was found between parity and DRA (r = 0.77; p0.001). Although there was no significant difference between DRA and the type of delivery among primiparous patients (p = 0.556), DRA increased significantly in the second cesarean section patients (p = 0.004). In this trial, cystocele and rectocele were established in 57% and 43% of patients with DRA, while descensus uteri was present in 10 (52%) patients.Increased parity and recurrent abdominal surgery seem to increase the risk of DRA. However; the importance of DRA in the young women remains unknown.

As genomic imprinting plays a critical role in the development of the placenta, the aim of this study was to detect whether the expression levels of the imprinted genes IGF2 and H19 in the endometrium differ between infertile and fertile women.Total RNA was extracted from 30 (15 unexplained infertile and 15 fertile) women's endometrial tissue. cDNA was synthesized from total RNAs of each sample. IGF2 and H19 mRNA expression levels were measured quantitatively using the Real Time PCR method. In order to determine the allelic expression of IGF2 and H19, genomic DNA was extracted from endometrial tissues.When compared with the control group, increased mRNA expression of IGF2 was detected (1.5-fold change, P=0.015) in the unexplained infertility group. In contrast, H19 expression was lower in the infertility group as compared to the control group (4-fold change, P0.0001). Restriction analysis of cDNA-derived PCR product showed that all patients and controls indicated monoallelic expression of IGF2 and H19.Our results showed that altered expression of these imprinted genes might affect implantation and that their timely and appropriate activation is important for proper functioning. To understand the molecular epigenetic basis of implantation and placental development, genomic imprinted genes should be further investigated.

Objective To evaluate the association between glycemic levels with glucose loading test during pregnancy and maternal and perinatal outcomes. Methods Retrospective analysis of 2059 singleton pregnancies screened for gestational diabetes mellitus at Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology between January 2004 and December 2006 was conducted. Sensitivity and specificity of the 50 g glucose loading test was calculated for different cut-off values in our population. Maternal and perinatal outcomes in different groups with different results after screening test were compared. Results An increase in cut-off value from 140 to 145 mg/dl seems to be associated with a significant increase in specificity along with a tolerable decrease in sensitivity. A cut-off value of 147.5 mg/dl is associated with a higher specificity and a slightly lower sensitivity. However, the cut-off value 150 mg/dl seems to be associated with a significant decrease in sensitivity. As for the upper limit, a cut-off value of 180 mg/dl is associated with a 90% specificity and a cut-off value of 200 mg/dl is associated with a 99% specificity. A 100% specificity could be reached only after a cut-off value of 221 mg/dl. A GLT value of 180 mg/dl or higher was found to be associated with poor maternal and fetal outcomes, regardless of the result obtained after the diagnostic test. Conclusion Results obtained after 50 g GLT should be evaluated separately for each patient and the diagnostic test which is time-consuming, uncomfortable and expensive can be omitted up to a cut-off value of 147.5 mg/dl, especially for those patients with no risk factors. Besides, a GLT value of 180 mg/dl or higher proves the diagnostic test unnecessary as these patients are associated with unfavorable perinatal and fetal outcomes.