Turkish Journal of Obstetrics and Gynecology最新文献

Objective: This study assessed the impact of increased initial gonadotropin doses on ovarian stimulation (OS) outcomes in unexpected hypo-responders [Patient-Oriented Strategies Encompassing Individualized Oocyte Number (POSEIDON) 1-2 group] with suboptimal mature oocyte yield, despite normal ovarian reserve markers, during their first OS cycle.

Materials and methods: Conducted at a referral infertility clinic, this observational study included women who retrieved fewer than nine oocytes during their first OS cycle despite gonadotropin doses of 150-225 international unit (IU)/day starting from cycle day two. Women who underwent a second OS cycle following unsuccessful conception were included. Gonadotropin doses were increased to 225 or 300 IU recombinant follicle-stimulating hormone (FSH) (recFSH) based on body mass index. Each patient served as her own control, with first and second OS cycles compared in terms of oocyte yield, follicular output ratio (FORT), and follicle-to-oocyte index (FOI).

Results: Among 289 unexpected hypo-responders (12% prevalence), the mean age was 34.2 years, and the mean anti-müllerian hormone level was 3.4 ng/mL. The stimulation duration was similar between cycles (11.2 days). The second OS cycle showed significant improvements in total oocytes, metaphase II oocytes, FORT, FOI, cleavage-stage embryos, and blastocysts (p<0.05).

Conclusion: Increasing gonadotropin doses in subsequent cycles improves oocyte yield and embryological outcomes in unexpected hypo-responders (POSEIDON 1-2) with normal ovarian reserve markers.

To evaluate the efficacy of secretomes in restoring ovarian function in premature ovarian insufficiency (POI) in a mouse model, researchers emphasizing their potential as a novel, cell-free therapy. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and included studies from four databases through December 2023. The bias risk was assessed using the tool for animal studies, which is Systematic Review Centre for Laboratory Animal Experimentation risk-of-bias. Outcomes, including the hormonal levels of estradiol (E2), anti-müllerian hormone (AMH), and follicle-stimulating hormone (FSH) were analyzed, with statistical comparisons made between the secretome-treated and control groups. Four studies encompassing sixty mice were included. The meta-analysis showed a significant increase in E2 levels in the secretome group [mean difference (MD)=37.45, 95% confidence interval (CI): 5.78 to 69.11; p=0.02]. No significant difference in AMH levels was observed; however, a sensitivity analysis resulted in the difference becoming statistically significant (MD=1.83, 95% CI: 0.95 to 2.71; p<0.0001). Moreover, the analysis revealed a significant reduction in FSH levels in the secretome group (MD=-36.80, 95% CI: -61.91 to -11.69; p=0.004) even after the sensitivity analysis. Our findings demonstrated enhanced outcomes with secretome therapy in the management of POI. Further research, particularly involving human subjects, is necessary to validate these findings.

The use of machine learning (ML) in biomarker analysis for predicting Down syndrome exemplifies an innovative strategy that enhances diagnostic accuracy and enables early detection. Recent studies demonstrate the effectiveness of ML algorithms in identifying genetic variations and expression patterns associated with Down syndrome by comparing genomic data from affected individuals and their typically developing peers. This review examines how ML and biomarker analysis improve prenatal screening for Down syndrome. Advancements show that integrating maternal serum markers, nuchal translucency measurements, and ultrasonographic images with algorithms, such as random forests and deep learning convolutional neural networks, raises detection rates to above 85% while keeping false positive rates low. Moreover, non-invasive prenatal testing with soft ultrasound markers has increased diagnostic sensitivity and specificity, marking a significant shift in prenatal care. The review highlights the importance of implementing robust screening protocols that utilize ultrasound biomarkers, along with developing personalized screening tools through advanced statistical methods. It also explores the potential of combining genetic and epigenetic biomarkers with ML to further improve diagnostic accuracy and understanding of Down syndrome pathophysiology. The findings stress the need for ongoing research to optimize algorithms, validate their effectiveness across diverse populations, and incorporate these cutting-edge approaches into routine clinical practice. Ultimately, blending advanced imaging techniques with ML shows promise for enhancing prenatal care outcomes and aiding informed decision-making for expectant parents.

Objective: Controlled ovarian hyperstimulation plays a critical role in in vitro fertilization (IVF) success. However, premature luteinization and variations in oocyte yield can impact IVF outcomes. This comparative study aims to investigate the effects of gonadotropin releasing hormone antagonist (GNRHant) and oral progestin-primed protocol on the oocyte count over the punctured follicle number in the same patient group undergoing consecutive IVF cycles.

Materials and methods: Forty-nine patients undergoing IVF were enrolled in this comparative study. Each participant underwent two consecutive IVF cycles. In the first cycle, GNRHant protocol was used. In the second cycle, the OPP protocol was used. The number of punctured follicles and oocytes retrieved was recorded and compared between the two cycles for each patient.

Results: The ratio of oocyte count per punctured follicle number was higher in the OPP group compared to the GNRHant group, without clinical significance (p>0.05). In the OPP, the ratio of oocytes retrieved over the punctured follicle number was 0.90±0.28; in the GNRHant group, it was recorded as 0.94±0.36, and the differences between the ratios were statistically insignificant.

Conclusion: Oocyte yield is a critical determinant of IVF success, and it can be influenced by various factors, including premature luteinization and follicular development. The use of GNRHant and OPP is known to prevent premature luteinization and improve follicular synchronization. This study demonstrates that neither of the protocols is superior in the success of oocyte retrieval over the punctured follicle count. Further research with larger sample sizes and randomized controlled trials is warranted to validate these results, and optimize clinical application of this combined protocol in IVF treatments.

Although the removal of the adnexa technically removes more tissue, it may require less fine manipulation and dissection than cystectomy. Secondary to this, we sought to measure the effectiveness and safety of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopy (CLS). We search six databases to find studies comparing LESS and CLS for ovarian lesions where removal of the entire ovary, with or without the fallopian tube, is necessary. Criteria used for study eligibility: both controlled trials and observational studies were included in this analysis. Study appraisal and synthesis methods: we used the Cochrane risk of bias assessment tool for the randomized clinical trials and the national heart, lung, and blood quality assessment tools for the observational studies. The statistical analysis was done using the review manager software. LESS showed a significantly longer operative time [mean difference (MD)=2.96 (-1.97, 7.90), p=0.24], but with moderate heterogeneity. Estimated blood loss was significantly lower for LESS [MD=-18.62 (-33.83, -3.42), p=0.02]. The length of patient hospital stay was comparable [MD=-0.02 (-0.50, 0.47), p=0.95]. Visual analog scale (VAS) pain scores at 24 hours [MD=0.23 (-0.09, 0.56), p=0.16] and 6 hours postoperatively [MD=0.15 (-0.04, 0.33), p=0.12] were similar. The LESS group required less postoperative analgesia [risk ratios (RR)=0.47 (0.32, 0.68), p=0.001]. The change in hemoglobin was comparable [MD=-0.11 (-0.26, 0.03), p=0.14]. Perioperative complications were higher in the LESS group [RR=2.236 (1.031, 4.851), p=0.04]. Compared with CLS, LESS required more operative time but resulted in significantly less blood loss and lower postoperative analgesic use. Hospital stays and VAS pain scores were similar. LESS had a higher incidence of perioperative complications, which questions the feasibility of its use in some situations.

Objective: To evaluate the effect of para-aortic lymphadenectomy on blood pressure changes in endometrial cancer patients.

Materials and methods: This retrospective study included patients with endometrial cancer treated surgically between 2017 and 2023. Patients undergoing para-aortic lymphadenectomy, up to the renal artery, in a non-nerve-sparing fashion, were compared with those undergoing pelvic lymphadenectomy or sentinel lymph node mapping. Data collected included age, body mass index, comorbidities including hypertension, diabetes mellitus, coronary artery disease, operative time, number of lymph nodes removed, tumor size, and postoperative complications. Preoperative blood pressure was recorded during outpatient visits, and postoperative measurements were collected daily during hospitalization and at follow-up visits. Statistical analyses assessed differences in systolic and diastolic blood pressure changes, operative outcomes, and complications.

Results: A total of 264 patients were analyzed. Patients in the para-aortic group had significantly longer operative times. Tumor size was larger in the paraaortic group than in another group. Systolic blood pressure decreased significantly in the para-aortic group compared to the control group (para-aortic: -17 mmHg vs. non-para-aortic: -1.10 mmHg, p<0.05), with a similar trend for diastolic pressure (-8.00 mmHg vs. -0.80 mmHg, p<0.05). Chylous ascites (15.6% vs. 5.6%) and ileus (0% vs. 12%) were more common in the para-aortic group, along with the administration of radiotherapy and chemotherapy. Both systolic and diastolic blood pressures were significantly lower in paraaortic group, in both early and late postoperative follow-up measures (p<0.005).

Conclusion: Aortic lymphadenectomy is associated with decreased blood pressure and may have therapeutic potential for hypertensive patients, highlighting the need for prospective randomized studies to explore this effect further.

Objective: To investigate the relationship between the FOXE1 gene polyalanine tract length and premature ovarian insufficiency (POI) in the Greek population.

Materials and methods: Peripheral blood was collected from 28 women with POI and 29 healthy controls. DNA was extracted and the gene was amplified using the polymerase chain reaction (PCR) technique. The PCR product was sequenced and the number of alanine tracts and the genotypes was recorded. Statistical analysis examined differences in allele and genotype frequencies between the groups.

Results: The patients' group mean age was 31.68 years with a mean age of POI diagnosis of 25.18 years. Five alleles (8, 12, 14, 16, 17 comprising alanine residues) and seven genotypes (14/14, 14/16, 16/16, 14/17, 16/17, 8/16, 12/14) were identified. The 8-alanine allele was exclusive to patients, while the 12-alanine allele appeared only in controls. The most common genotype in the study group was 14/16 (64.29%), whereas the most common genotype in the control group was 14/14 (41.4%). No differences of statistical significance were observed in the prevalences of the allele with 14 (p=0.590) and 16 (p=0.594) residues or the genotype prevalences between the two groups (p=0.066).

Conclusion: Our preliminary findings suggest no correlation between FOXE1 polyalanine tract length and POI, but given the study's small sample size, they should be interpreted with caution. Further research is deemed necessary.

Objective: Transforming growth factor-β-activated kinase 1 binding protein 2 (TAB2) plays a vital role in inflammatory pathways. It has also been considered a potential target for the enhancement of the the antiestrogen effects. Previous evidence has indicated that TAB2 gene variants are associated with several diseases, whereas their potential correlation with endometrial cancer (EC) is unclear. This study aims to initially explore the association between TAB2 gene polymorphisms (rs237028 /AG, rs521845 T/G, and rs652921 T/C) and EC.

Materials and methods: Polymerase chain reaction-restriction fragment length polymorphism was applied to determine the genotype composition and the allele frequencies of TAB2 gene variant polymorphisms in 270 EC patients and 294 healthy controls.

Results: The G allele of rs521845 was related to the increase of EC risk [p=0.08, odds ratio (OR): 0.72, 95% confidence interval (CI): 0.56-0.91]. Moreover, EC risk was associated with rs521845 in different genetic models (p=0.017, OR: 0.63, 95% CI: 0.44-0.91 in the codominant model; p=0.0051, OR: 0.61, 95% CI: 0.43-0.87 in the dominant model). For rs237028, the percentage of AG genotype in patients with highly differentiated tumours (G1) was significantly higher than that in moderately, poorly differentiated patients (G2/G3) (p=0.031, OR: 0.77, 95% CI: 0.45-1.30).

Conclusion: Our results showed that the rs521845 polymorphism of TAB2, was associated with EC risk, suggesting that TAB2 may play a crucial role in EC prognosis.

Objective: The frequency of recurrent pregnancy loss in society is 3-5%. Experts suggest that genetics account for over 80% of unexplained recurrent pregnancy loss. Glutathione S-transferase (GST) enzymes, regulated by GST genes, facilitate the detoxification of a variety of naturally occurring metabolites as well as environmentally derived chemicals. This research aimed to investigate GST gene polymorphisms as a potential risk factor in recurrent pregnancy loss etiology in the Turkish population.

Materials and methods: This study involved 107 recurrent pregnancy loss patients who sought treatment at the Sivas Cumhuriyet University Faculty of Medicine, Department of Medical Genetics, along with a control group of 107 individuals who had a successful birth and no previous history of miscarriage. The multiplex polymerase chain reaction and restriction fragment length polymorphism techniques were employed to analyze GSTM1, GSTT1 and GSTP1 gene polymorphisms in these cases.

Results: GSTT1 null genotype (X²=4.74; p=0.029) and GSTT1/GSM1 null genotype (X²=3.333; p=0.047) were associated with statistically significant differences between the study groups. No statistical significance was detected when considering the GSTM1 null genotype (X²=3.326; p=0.068) or the GSTM1/GSTP1 and GSTT1/GSTP1 gene polymorphisms.

Conclusion: A statistically significant association was observed between the GSTT1 null genotype and the diseased group. Our research demonstrated a substantial increase in the risk of recurrent pregnancy loss in the Turkish population, specifically among individuals with the GSTM1-null genotype. No statistical correlation was found between the GSTM1 and GSTP1 gene polymorphisms and recurrent pregnancy loss. Furthermore, no statistical significance was observed when they were assessed together.

Objective: To investigate the possible ability of homocysteine (Hcy) levels in embryo culture media for estimating better invitro fertilization outcomes in endometriosis patients.

Materials and methods: Nineteen women with endometriosis who were admitted to Cerrahpaşa Medical Faculty, Department of Obstetrics and Gynecology, Infertility Outpatient Clinic with the diagnosis of infertility were included in the study. The results of intracytoplasmic sperm injection treatments were recorded and Hcy levels in the embryo culture were evaluated. The results were compared with those of the control patients without endometriosis, who had previously been admitted to our clinic for assisted reproductive technology.

Results: Mean Hcy levels in the culture media of the endometriosis group and non-endometriosis group were 4.31±0.48 µmol/L and 4.15±1.44 µmol/L, respectively (p>0.05). Pregnancy was achieved in 3 patients in the endometriosis group, while 13 pregnancies were obtained in the non-endometriosis group (p>0.05). When all cases were evaluated, the mean value of Hcy in the culture medium was found to be 3.60±0.84 µmol/L in the patients with a pregnancy and 4.21±0.84 µmol/L in the group that failed to achieve a pregnancy, and this difference was statistically significant (p<0.05).

Conclusion: Difference between mean Hcy levels in the culture media of the endometriosis group and non-endometriosis group was statistically non-significant. Further studies with larger groups are needed for evaluating the association of Hcy with infertility in endometriosis patients. Mean Hcy levels in the group of patients who succeeded in conceiving were statistically higher than the group of patients who failed to conceive. It may be suggested that Hcy levels in the embryo culture media can predict the achievement of a pregnancy independently from some conditions which may adversely affect the embryo quality, such as endometriosis.