Journal of the Turkish German Gynecological Association最新文献

The Coronavirus disease-19 (COVID-19) pandemic was declared in March 2020 by the World Health Organization. The severe acute respiratory syndrome-coronavirus-2 virus enters host cells through angiotensin-converting enzyme 2 receptors and transmembrane serine protease type II that are expressed in pulmonary alveoli, as well as in hepatocytes, endothelium, ovaries, uterus, vagina, thyroid, and other tissues. In addition to viral injury, the COVID-19 pandemic, through protective measures such as social isolation and lockdown, has promoted a scenario of psychosocial stress, especially in women. In this context of isolation, anxiety, fear, and mental distress, there is dysregulation of the hypothalamic-pituitary-adrenal axis and subsequent gonadal side effects. Furthermore, studies report an association between COVID-19 and temporary menstrual cycle alterations such, as increased cycle duration, decreased cycle duration, increased menstrual flow, dysmenorrhea, and amenorrhea. Regarding COVID-19 vaccination, menstrual irregularities have been observed in about half of the women, predominantly with a decrease in cycle duration and increased menstrual flow, but without fertility sequelae. The aim of this study was to review the most up-to-date information on the relationship between the COVID-19 pandemic and menstrual irregularities.

Objective: To determine factors affecting obstetric outcomes in pregnancies after conization by loop electrosurgical excision procedure (LEEP) or cold-knife conization (CKC) due to cervical intraepithelial neoplasia.

Material and methods: The maternal and clinical characteristics and obstetric outcomes of CKC, LEEP and control groups were evaluated and compared. Risk factors for adverse pregnancy outcomes were evaluated using multiple logistic regression analyses.

Results: The incidence of preterm delivery, preterm premature rupture of membranes (PPROM), low APGAR scores, fetal mortality, and late-period spontaneous abortus was highest in patients who underwent CKC (p<0.05). Cone depth of CKC was greater than LEEP (p=0.025). Cervical length (CL) at pregnancy was CKC < LEEP < controls (p=0.003). Shorter CL at pregnancy and time from conization to pregnancy (t-CP) was correlated with a high incidence of preterm delivery and PPROM (p<0.05). To predict preterm delivery, t-CP <14 months had 63.16% sensitivity and 77.42% specificity [area under the curve (AUC): 0.714, 95% confidence interval (CI): (0.603-0.809); p=0.005], and CL at pregnancy <31 mm had 65% sensitivity and 71.78% specificity [AUC: 0.731, 95% CI: (0.675-0.782); p<0.001]. To predict PPROM, t-CP <15 months had 85.71% sensitivity and 65.22% specificity [AUC: 0.730, 95% CI: (0.603-0.809); p=0.024], and CL <32 mm had 72.73% sensitivity and 61.89% spcificity [AUC: 0.685, 95% CI: (0.675-0.782); p=0.007].

Conclusion: Compared with CKC, LEEP has shorter cone depth and fewer adverse pregnancy outcomes. The t-CP <14 months was a risk for preterm delivery and <15 months was a risk for PPROM. CL at pregnancy <31 mm was a risk for preterm delivery and <32 mm was a risk for PPROM.

Objective: Polycystic ovary syndrome (PCOS) is prevalent among reproductive-aged women and is categorized by hormonal imbalances, irregular menstrual cycles, and challenges with fertility. PCOS affects approximately 3.6% of women globally, with prevalence varying by region. The luteinizing hormone/choriogonadotropin receptor (LHCGR) gene, which encodes the LHCGR, has been implicated in PCOS pathophysiology. This study investigated the association between the LHCGR gene polymorphism rs2293275 and PCOS through a meta-analysis.

Material and methods: An extensive literature review was carried out using Embase, PubMed, and Google Scholar databases to identify research studies exploring the association between LHCGR gene variants and PCOS. The review was conducted based on the PRISMA checklist. Eligible case-control studies from 2016 to 2024 were chosen based on predefined criteria. Quantitative data analysis was performed using MetaGenyo software, employing a significance threshold of p<0.05. Odds ratios (OR) and confidence intervals (CI) were calculated to evaluate the relationships. G*Power 3.1 software was employed for statistical power analysis to assess the study's strength. The meta-analysis explored the link between LHCGR gene variant rs2293275 and PCOS across diverse ethnic groups and genetic models.

Results: Analyzing data from 10 studies involving 1,431 PCOS cases and 1,317 controls, the findings revealed no significant associations in most genetic models: allele (OR: 0.89, 95% CI: 0.54-1.49), dominant (OR: 0.74, 95% CI: 0.47-1.18), recessive (OR: 0.80, 95% CI: 0.41-1.57), and over-dominant (OR: 1.13, 95% CI: 0.69-1.85). Subgroup analyses by ethnicity (Arabs, Asians, Caucasians) consistently showed no significant correlations, except a protective effect in Caucasians (OR: 0.57, 95% CI: 0.34-0.95) in the AA vs. aa comparison. Sensitivity analyses confirmed robustness, and there was no indication of publication bias. Power analysis validated adequate sample sizes, and protein-protein interaction networks underscored biological relevance.

Conclusion: The meta-analysis concluded that no significant connection was observed between the LHCGR gene variant rs2293275 and the risk of PCOS among different populations. This suggests a complexity in PCOS etiology and indicating that LHCGR may not be a significant genetic marker for PCOS. Future research should explore other genetic and environmental factors contributing to PCOS, emphasizing the importance of genetic and ethnic variability in such studies.

Objective: Contraception use and follow-up visit data from before and in two periods during the coronavirus disease-2019 (COVID-19) pandemic were compared to investigate change in behavior.

Material and methods: A retrospective study of women aged 18-49 years from New York City during three one-year time periods: pre-COVID-19 pandemic [(COV-PRE); n=4,261], early COVID-19 pandemic when the COVID-19 vaccine was not available [(COV-VACNO); n=3,365], and later COVID-19 pandemic when the COVID-19 vaccine was available [(COV-VACAV); n=4,170].

Results: There were higher odds of implant use [odds ratio (OR): 1.42, 95% confidence interval (CI): 1.05, 1.93, p=0.02] during COV-VACNO. There were lower odds for any contraception (OR: 0.88, 95% CI: 0.79, 0.98, p<0.001) or intrauterine device (IUD) (OR: 0.73, 95% CI: 0.61, 0.86, p<0.001) use during COV-VACAV. No differences occurred for bilateral tubal ligation, pill, patch, injection, medical elective abortion, or surgical elective abortion. There was a greater percentage of follow-up visits for any contraception (p=0.02) and IUD (p=0.02) use during COV-VACNO and COV-VACAV than COV-PRE.

Conclusion: When COVID-19 vaccines were unavailable, there were higher odds for use of implants. Once COVID-19 vaccines were available, there were lower odds for any contraception and IUD use. These findings highlight changes in behavior in terms of contraceptive concerns and preferences during a public health crisis that should be planned for by healthcare providers.

Objective: The question of whether severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection influences ovarian function and oocyte quality has arisen as angiotensin converting enzyme-2 receptors, which facilitates viral infection, are found on reproductive system tissues, including the vagina, placenta, uterus, and ovaries. The primary objective of this prospective study was to evaluate the impact of SARS-CoV-2, on ovarian function, with a focus on anti-Mullerian hormone (AMH) and acute phase reactant levels in patients well after recovery from coronavirus disease-2019 (COVID-19).

Material and methods: This prospective cohort study was conducted in the department of obstetrics and gynecology at a single center between October 2020 and June 2021. In order to investigate the impact of COVID-19 on ovarian reserve, 34 non-pregnant women of reproductive age (24-38 years) with COVID-19 polymerase chain reaction positivity were included.

Results: The difference between AMH levels measured 6 months after COVID-19 infection and baseline AMH levels was -0.31±0.80 ng/dL on average and -0.25 (-2.1-1.3) ng/dL on median. Significant correlations were observed between the change in AMH levels and white blood cell levels (r=-0.434, p=0.010), lymphocyte levels (r=-0.361, p=0.036), C-reactive protein levels (r=0.542, p=0.001), ferritin levels (r=0.570, p=0.001) and procalcitonin levels (r=0.598, p=0.001).

Conclusion: We believe this is the first study to examine whether there is a correlation between the late results of COVID-19 and ovarian function. In this cohort, AMH values decreased 6-months after recovery from COVID-19 and a correlation was found between measures of disease severity and the magnitude of decrease in AMH. However, the study was underpowered and future larger studies are required to validate these findings.

Leptin is a hormone produced from adipose tissue, targeting the hypothalamus and regulating energy expenditure, adipose tissue mass, and reproductive function. Leptin concentration reflects body weight and the amount of energy stored, as well as the level of reproductive hormones and male fertility. In this review, the aim was to focus on leptin signaling mechanisms and the significant influence of leptin on the male reproductive system and to summarize the current knowledge of clinical and experimental studies. The PubMed database was searched for studies on leptin and the male reproductive system to summarize the mechanism of leptin in the male reproductive system. Studies have shown that obesity-related, high leptin levels or leptin resistance negatively affects male reproductive functions. Leptin directly affects the testis by binding to the hypothalamic-pituitary-gonadal axis and the receptors of testicular cells, and thus the location of leptin receptors plays a key role in the regulation of the male reproductive system with the negative feedback mechanism between adipose tissue and hypothalamus. Based on the current evidence, leptin may totally inhibit male reproduction, and investigation of this role of leptin has established a potential interaction between obesity and male infertility. The mechanism of leptin in the male reproductive system should be further investigated and possible treatments for subfertility should be evaluated, supported by better understanding of leptin and associated signaling mechanisms.

Objective: The aim of this study was to investigate the developmental potential of immature oocytes and evaluate whether unstimulated in vitro maturation (IVM) could serve as a treatment option for women with oocyte maturation abnormalities (OMAs).

Material and methods: This cohort study was conducted between September 2019 and December 2022, and included women who underwent unstimulated, non-human chorionic gonadotropin (hCG) priming IVM. Oocytes were incubated with IVM medium for 26-48 hours and evaluated to compare their maturation profiles with the immature oocytes retrieved from the same patients in their previous in vitro fertilization cycles.

Results: Among the twelve women in the study, eleven (91.6%) underwent whole exome sequencing analysis. Of these, 18 variants were identified in 10 individuals, excluding case 1, who had no previous mutation analysis. Of the mutations identified, 9 (50%) were located in FSHR, 5 (27.8%) in TUBB8, 1 (5.6%) in ZP1, 1 (5.6%) in SLFN14, 1 (5.6%) in AR, and 1 (5.6%) in STEAP3. Apart from one woman with resistant ovary syndrome (ROS), none treated with unstimulated IVM had oocyte maturation. Remarkably, the only patient to achieve oocyte maturation in an unstimulated IVM cycle was case 11, who had ROS and a single FSHR variant.

Conclusion: Unstimulated, non-hCG primed IVM does not appear to be effective in the treatment of OMAs, perhaps with the exception of women with ROS. However, this study led our team to develop novel treatment options based on physiological mechanisms for some subtypes and supraphysiological approach for other subtypes of OMAs.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder that impacts women before reaching menopause. In addition to notable features (irregular ovulation, elevated androgen levels, and the existence of numerous ovarian cysts), individuals with PCOS frequently encounter diverse metabolic, cardiovascular, and psychological conditions. The onset of PCOS is influenced by a combination of factors, and various genetic variations are believed to play a significant role in its progression. The objective of the current study was to explore the link between genetic variations in the candidate genes thyroid-adenoma-associated (THADA) gene and insulin receptor (INSR) and susceptibility to developing PCOS. We conducted an extensive search across various databases, including Google Scholar, PubMed, Science Direct, Scopus, and EMBASE, to compile relevant case-control studies and literature reviews for subsequent statistical analysis. In the present study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, a guideline for Systematic Reviews and Meta-Analysis. While a previous meta-analysis explored the correlation between INSR rs1799817 and THADA rs13429458 and their association with susceptibility to PCOS, our current study did not integrate any findings from these prior investigations. Our research encompassed articles published between 2017 and 2023, and we employed MetaGenyo software to assess the collected data. Statistical power analysis was performed using G*Power 3.1 software. Odds ratios and their corresponding 95% confidence intervals were calculated for each genetic model. Fifteen studies that met the criteria were analyzed. Out of these, ten studies, involving 1,189 cases and 1,005 controls, examined the INSR rs1799817 gene polymorphism, while five studies, including 783 cases and 553 controls, investigated the THADA rs13429458 gene polymorphism. The meta-analysis results indicated that there was no statistically significant association between the INSR rs1799817 gene polymorphism and the risk of PCOS (p>0.05). In contrast, the THADA rs13429458 gene polymorphism showed a significant association with PCOS risk under the over-dominant model (p<0.05). The present meta-analysis demonstrated a notable association between the THADA rs13429458 gene polymorphism and the likelihood of developing PCOS. Further rigorous studies with expanded sample sizes and diverse ethnic representation will be important to comprehensively evaluate and validate these findings.

Objective: Our aim was to show that anti-Mullerian hormone (AMH) may be used as a quantitative marker of ovarian reserve in Turkish girls aged 18 years and younger and establish the reference values for AMH in Turkish girls.

Material and methods: This retrospective study included girls between 8-18 years old, without premature ovarian failure or without genetic factors resulting in ovarian dysgenesis. Blood specimens were collected after overnight fasting early in the morning during the early follicular phase. Measurement of serum levels of gonadotropins and AMH was done. Mean serum AMH levels of different age groups and best fitting curve representing AMH percentiles (10^th, 25^th, 50^th, 75^th, 90^th) were calculated.

Results: In total 785 girls with a mean age of 16.16±1.90 years were included, divided into seven age groups. The mean serum AMH level for the total cohort was 5.20±4.19 ng/mL. There was a significant difference between the mean values of AMH in age groups as follows: ≤12 and 17-≤18 (p=0.011). The best fitting curves for AMH percentiles were 4^th order polynomial functions. There was a significant correlation between AMH and age and follicle stimulating hormone levels (r=0.148, p<0.001 and r=-0.092, p=0.010).

Conclusion: Our results reflect the real-life data for serum AMH values in Turkish girls. Our nomogram may be useful for counseling adolescents about their ovarian reserve and diagnosing other gynecological diseases. A longitudinal study is necessary for improving the predictive value of AMH values in girls aged 18 and younger.