Turkish Journal of Obstetrics and Gynecology最新文献

Acupuncture has been introduced as an adjuvant therapy to in vitro fertilization (IVF) cycles in many randomized controlled trials (RCTs). However, there has been a debate among trials regarding the effectiveness and safety of the procedure. To determine how effective and safe acupuncture is as an adjunct to IVF cycles for primary and secondary female infertility. We conducted a literature search for relevant RCTs and ultimately included nine studies. The main selected outcomes included the rates of clinical pregnancy, ongoing pregnancy, miscarriage, live birth, and side effects. Patients receiving acupuncture were grouped together regardless of the acupuncture points used or the protocol for the insertion of needles. We performed a subgroup analysis according to whether studies originated inside and outside China to investigate the results of the different RCTs. We pooled outcomes as a risk ratio (RR) with 95% confidence interval (CI). The analysis revealed that in China, acupuncture led to lower clinical [RR=0.80, 95% CI (0.66, 0.97), p=0.02] and ongoing [RR=0.78, 95% CI (0.63, 0.97), p=0.03] pregnancy rates than placebo. Outside China, acupuncture increased clinical pregnancy rates [RR=1.38, 95% CI (1.11, 1.71), p=0.003] and ongoing [RR=1.73, 95% CI (1.29, 2.31), p<0.001] pregnancy rates. Rates of live birth and miscarriage did not significantly differ between the arms. Regarding side effects, acupuncture groups had a significantly higher rate of puncture site itching compared to control groups [RR=1.51, 95% CI (1.12, 2.04), p=0.007]. Overall analysis does not show a statistically significant increase in clinical pregnancy rates worldwide when using acupuncture as an adjunct therapy to IVF. There were no issues regarding patient safety from any included study. Subgroup results indicated that better rates for clinical pregnancy seem to be occurring more often in RCTs performed outside China than within.

Objective: The aim was to evaluate vaginal brachytherapy (VB) after surgery in early-stage endometrial cancer.

Materials and methods: The patients with Stage I-II endometrial adeno-cancer operated between 1998 and 2018 and whose adjuvant therapies had been arranged were evaluated retrospectively.

Results: A total of 618 patients were enrolled. In 409 patients in the low-risk group, the vaginal, pelvic recurrence, and distant metastasis rates were found to be higher in the VB group. When the results of 112 patients in the intermediate-risk group were evaluated, there was no statistically significant difference between the vaginal, pelvic recurrence, and distance metastasis rates. In 89 patients in the intermediate-high risk group, vaginal recurrence rates were 0%, 4.8%, 0%, and 25% for VB, external beam radiotherapy, combination radiotherapy, and the follow-up groups, respectively (p=0.010), and pelvic recurrence rates were found to be 18.2%, 0%, 1.9% and 0% (p=0.036). Distant metastasis rates were 0%, 0%, 9.6% and 0% (p=0.229). When the overall survival in all groups was examined, no significant difference was found between the groups.

Conclusion: In conclusion, no adjuvant treatment is a proper approach for low-risk patients. Brachytherapy can be considered a suitable option for the intermediate risk group. Combined treatments instead of VB in the high-intermediate risk group would be preferred in terms of local control.

Objective: The purpose of the study was to look at the connection between newborn intensive care requirements in low-risk pregnancies and maternal blood pregnancy-associated plasma protein (PAPP-A) and free human chorionic gonadotropin (hCG) levels, which are elements of screening tests within the first trimester.

Materials and methods: In the delivery unit of our hospital, pregnant women between the years of 18 and 35 had singleton pregnancies who delivered between 37 and 41 weeks of pregnancy between July 2021 and January 2022 were split into 2 groups. One hundred eighty two pregnant women with infants who required neonatal intensive care (NICU) were enrolled in the first group, whereas 890 pregnant women with infants who did not require NICU were enrolled in the second. These two groups' maternal blood PAPP-A and free hCG levels, which are among the first trimester screening procedures, were examined. Additionally, subgroup analysis were performed in terms of cesarean section indications and NICU admission indications. Logistic regression analysis and ROC analysis were performed with related variables for estimating NICU need.

Results: The mean serum PAPP-A value was found to be 0.91±0.34 multiples of the median (MoM) in the blood taken from the infant mothers who needed NICU, while the mean serum PAPP-A value in the blood taken from infant mothers who did not need NICU was 1.12±0.59 MoM (p<0.000). The PAPP-A MoM mean of the group with Apgar 5th minute score ≥8 (1.09±0.57) was higher than the PAPP-A mean (0.84±0.27) of the Apgar 5th minute score <7 group (p=0.013). According to the results of our study, in groups with a PAPP-A value below 0.95, the possibility of increased NICU need of newborns is higher.

Conclusion: The low serum PAPP-A level, which is used as a screening test among pregnant women, demonstrates that it is successful in predicting perinatal outcomes in the low-risk pregnancy group.

Objective: This study aimed to examine the associations between follicular distribution pattern (FDP) in polycystic ovaries and menstrual disturbances in women with infertility.

Materials and methods: A retrospective review of patients was performed (n=73). Ultrasound images from cycle day 2-5 of a spontaneous or progestin induced menstrual cycle were reviewed. Ovaries were classified as polycystic ovarian morphology (PCOM) if they contained ≥12-follicles measuring 2-9 mm in diameter. Images of PCOM ovaries were classified as having a peripheral cystic pattern (PCP) with follicles arranged at the periphery of the ovary, or general cystic pattern (GCP) if follicles were dispersed heterogeneously throughout the ovarian stroma. Menstrual disturbance was assessed by questionnaire, and oligomenorrhea was defined as cycles >35 days in length.

Results: PCP was more strongly associated with menstrual irregularity that GCP. 94% of subjects with bilateral PCP-experienced oligomenorrhea compared with 65% of women with a unilateral PCP ovary [odds ratio (OR) 9; p<0.05]. 29% of women with bilateral GCP ovaries experienced menstrual disturbances, less than bilateral PCP (OR 36; p=0.002), but similar to unilateral PCP (OR 3; p=0.07). Serum testosterone and luteinizing hormone (LH) levels were significantly correlated with the ovarian FDP.

Conclusion: There is a relationship between menstrual irregularity or certain types of serum steroids and ovarian morphology. It remains unknown if morphology, testosterone or LH causes the menstrual disturbance or if they are co-initiated by an intervening factor.

Objective: Endometrial polyps are one of the most extensive pathologies in the uterus and can be detected incidentally during assisted reproductive therapy in asymptomatic women.

Materials and methods: In patients planned for in vitro fertilization or intracytoplasmic sperm injection (ICSI) treatment, embryo freezing, or cycle cancelation options are mandatory in many clinics when detected at the beginning of the cycle. In our study, in ICSI treatment, patients with a single endometrial polyp smaller than 1.5 cm, who underwent hysteroscopic polyp resection at the beginning of the cycle and underwent fresh embryo transfer without canceling the treatment (n=31), and patients with the same characteristics of endometrial polyp who underwent hysteroscopic polyp resection before the cycle (n=34) are compared within the pregnancy, abortion and live birth rates.

Results: As a result, no statistical difference was found between the two groups' pregnancy, abortion, and live birth rates.

Conclusion: Hysteroscopic resection of polyps during ovarian stimulation in ICSI treatment does not affect pregnancy and live birth rates and may eliminate the necessity of freezing.

Objective: To determine the relationship between the cumulative effect of sequential clomiphene citrate (CC) treatments in unexplained infertile women with intercycle and intracycle serum hormone changes.

Materials and methods: Patients who received CC 50 mg in the first cycle (group I, n=34) as ovulation induction and those who received CC 50 mg in the second consecutive cycle (group II, n=18) were compared. Basal (cycle days 2-5) and trigger day (the day that recombinant human chorionic gonadotropin is given) levels of gonadotropin and steroid hormones were measured.

Results: The 17OHP increase on trigger day was found to be statistically significantly higher in group II compared to the basal day (p=0.083). The testosterone (T) response on the trigger day of the patients in group II was found to be statistically significantly higher than that in group I (p=0.023). The number of selected follicles was negatively correlated with a follicle-stimulating hormone decrease and positively correlated with an estradiol increase. Endometrial thickness was positively correlated with a luteinizing hormone increase, and cycle cancelation was positively correlated with decreased estradiol.

Conclusion: Based on this study, it was concluded that the reason for the increased efficiency rate in successive cycles of CC may be the cumulative increase in T and 17OHP levels. However, this result was found not to affect the clinical pregnancy rate.

Objective: The current study assesses programmed death-1 (PD-1) receptor expression and CD3, CD4, and CD8 tumor-infiltrating lymphocytes (TILs) in high-grade serous ovarian cancer (HGSOC) and associates our results with neoadjuvant chemotherapy history and disease prognosis.

Materials and methods: We included cases diagnosed with primary HGSOC with biopsy or surgical resection materials in this study. The immunoreactivity of CD3, CD4, CD8, and PD1 was assessed immunohistochemically in tumor tissue. We analyzed TILs in two predetermined groups of high and low TIL. The relationships between clinical characteristics, PD-1, and TIL were assessed. by the χ(2) test or Fisher's Exact test. We used Kaplan-Meier survival analysis and Cox proportional hazards regression model to the connection between survival and the amounts of TIL, and PD1.

Results: Univariate analysis demonstrated that optimal debulking (p<0.001), early International Federation of Gynecology and Obstetrics stage (p=0.046), and higher scores of stromal CD8+ TIL expression (p=0.028) in tumor cells were all substantially correlated with longer disease-free survival (DFS), whereas the remaining variables analyzed, including PD-1 positivity, stromal CD3+, and CD4+ TILs, and intraepithelial CD3+, CD4+, and CD8+ TILs, were not correlated with DFS. Also, univariate analysis revealed that optimal debulking (p=0.010), and higher scores of stromal CD8+ TIL expression (p=0.021) in tumor cells were all substantially correlated with longer overall survival (OS).

Conclusion: Higher scores of stromal CD8+ TILs are substantially correlated with DFS and OS in univariate analyses, whereas scores of stromal CD3+ and CD4+ TILs, and intraepithelial CD3+, CD4+, and CD8+ TILs are not correlated with DFS and OS in both univariate and multivariate analyses. Also, we found a significant association between PD-1 positivity and the scores of stromal CD3+ TILs and intraepithelial CD8+ TILs. However, no remarkable relationship was revealed between PD-1 positivity and the survival of HGSOC cases.

Objective: Ovarian torsion decreases ovarian reserve because of ischemic and reperfusion damage it causes. In this study, we investigated the protective effect of cilostazol (CIL) on experimental ischemia (I) and ischemic-reperfusion (I/R) damage in rat ovaries with in vitro fertilization (IVF) results.

Materials and methods: Forty-eight adult female Sprague-Dawley albino rats were randomly assigned to 6 groups with 8 animals in each group: Sham (S), I, I/R, S + CIL, I + CIL and I/R + CIL. The I groups were subjected to bilateral adnexal torsion for 3 h, while the I/R and I/R + CIL groups received subsequent detorsion for 3 h. Twenty-two mg/kg of CIL was given via oral gavage 30 min before surgery on the I (I+ CIL) or reperfusion (I/R + CIL) groups. Oocytes were collected before the IVF procedure and after ovulation induction with 150-300 IU/kg pregnant mare serum gonadotropin.

Results: The metaphase oocytes reached their highest value of 4.73±0.96 in the S+ CIL group and reached their lowest value of 0.51±0.55 in the I/R group. There were statistically significant differences in the number of second-day embryos among the I, I+ CIL, and I/R and I/R+ CIL groups (p=0.000). When the groups were compared in terms of Anti-Müllerian hormone change, the highest decrease was observed in the I and I/R groups.

Conclusion: CIL pretreatment before surgery has a protective effect against I and I/R in rats with ovarian torsion.

Objective: Ceramide (CER) is a bioactive component of the mitochondrial membrane. In this study, we will investigate the clinical importance of serum CER (sCER) and follicular fluid CER (ffCER) levels in the lipid synthesis pathway and their effect on poor oocyte quality and in vitro fertilization (IVF) outcome.

Materials and methods: This cross-sectional, case-control study was conducted in the IVF unit of a maternity hospital in the capital of Turkey, Ankara. A total of 88 women undergoing their first IVF cycle were included in this study patients were divided into 2 groups according to current diagnostic criteria for their ovarian reserves. Baseline sCER levels, and ffCER concentrations retrieved on the oocyte pickup day were measured.

Results: The mean age, body mass index, and infertility duration of the patients was similar between the groups (all p>0.05). There was also no significant difference in the clinical pregnancy rates (38.6% vs. 47.7%, p=0.127). sCER (15.6±6.5 vs. 23.5±8.9) and ffCER (82.5±34.3 vs. 116.4±46.5) levels were statistically significantly lower in the low ovarian reserve (LOR) group (both p<0.001). The performed receiver operating characteristic curve analysis revealed that sCER and ffCER levels could predict both LOR and pregnancy.

Conclusion: This is the first study evaluating the sCER and ffCER levels of patients undergoing IVF treatment. CER may be used as an ovarian reserve markers and a biomarker capable of predicting IVF outcomes.

Objective: The relationship between Cystatin-C levels and inflammatory, oxidant, and antioxidant markers in polycystic ovary syndrome (PCOS) was investigated.

Materials and methods: A total of 96 participants were included in the study as PCOS (n=58) and control (n=38) groups. Tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1B), interleukin 6 (IL-6), malondialdehyde (MDA), superoxide dismutase (SOD), and Cystatin-C were evaluated by ELISA method. Relationships metabolic and endocrine parameters seen in PCOS were examined. Univariate and multivariate logistic regression analyzes were performed to identify risk factors that may affect the PCOS group. Bivariate correlations were investigated by the Spearman's correlation analysis.

Results: While Cystatin-c, TNF-α, IL-1B, IL-6, MDA were found to be higher in patients with PCOS compared with the control group, SOD was found to be lower than the control group (p<0.05). In the correlation analysis, increased Cystatin-C levels were found to be associated with high IL-6 (r=0.214, p=0.037) and low SOD levels (r=-0.280, p=0.006).

Conclusion: In our study, it was found that the increase in Cystatin-C levels was associated with an increase in IL-6 and a decrease in SOD. These results may bring up different treatment options to reduce cardiovascular risks for treating PCOS.