Normal over rezervi olan ve long protokol uygulanan İVF hastalarında rekombinant fsh ve yüksek derecede saflaştırılmış hmg kullanımının gebelik sonuçlarına etkisinin karşılaştırılması]

Objective: Gonadotropins used in controlled ovarian stimulation have been increasing in number. Beside the recombinant preparations such as rec-FSH, rec-LH and h-hMG human-derived preparations have entered the market. We decided to compare the effects of rec-FSH and HP-hMG with GnRHa on embryo quality and pregnancy outcome in women undergoing an IVF cycle. Material and Methods: In this study, data of 87 patients who had applied to our center from 2007 to 2008 and who had met all inclusion criteria, were analyzed. The patients underwent controlled ovarian hyperstimulation with HP-hMG, rec-FSH following down-regulation with a GnRHa in a long protocol, selected according to determined criteria and acquired embryo via IVF transfer. Results: Of the 87 patients, 44 were stimulated with rec-FSH and 43 with HP-hMG. Distribution of infertility causes was similar between the groups. Duration of gonadotropin administration (p=0.677, Student's t-test) and the total dose of gonadotropin received (p=0.392, Student's t-test) were similar between the two groups. The fertilization rate of the rec- FSH group was significantly higher than the HP-hMG group (p=0.001, Mann-Whitney U test). No significant differences were observed between the study groups in biochemical, clinical and ongoing pregnancy parameters. Conclusion: The higher oocyte yield with rec- FSH does not result in higher quality embryos. LH activity in combination with FSH activity positively affected the oocyte and embryo maturation. Therefore, when we consider the clinical and ongoing pregnancy rates there is no inferiority of HP-hMG in controlled ovarian stimulation

The Relationship Between Endometrial Thickness and Histopathological Results in Patients with Postmenopausal Vaginal Bleeding

Amaç: Postmenopozal kanamalı kadınlarda transvajinal ultrasonografi (TVUSG) ile ölçülen endometrial kalınlık değerleri ile endometrial örnekleme sonuçları arasındaki ilişkiyi ve anormal endometrial patolojileri tespitinde transvajinal ultrasonografinin değerini araştırmak. Gereç ve Yöntemler: Postmenopozal kanaması olan 279 hastanın TVUSG ile ölçülen endometrial kalınlıkları ve sonrasında yapılmış olan endometrial örnekleme sonuçları retrospektifolarak incelendi ve karşılaştırıldı. Bulgular: En sık karşılaşılan normal endometrial histopatoloji sonucu endometrial hücre (n=7I), anormal histopatoloji sonucu ise endometrialpolip (n=40) idi. Endometrium kanseri tanısı alan hastaların %73 'ü (n=]9) 60 yaş ve üstündeydi. Endometrial kalınlık değeri mm olan hastaların (n=68) hiçbirinde endometrial hiperplazi veya endometrium kanseri yoktu, olguda endometrial polip saptanırken 5mm endometrial kalınlığa sahip olguların (n=49) hiçbirinde anormal endometrial histopatoloji saptanmadı. mm endometrial kalınlık eşik değerinin sensitivitesi %100, spesifitesi 24. iken mm eşik değerinin sensitivitesi %95.I spesifitesi ise 33.8 olarak hesaplandı. Gereksiz endometrial örnekleme oranı 5mm eşik değeri için 7.8, 6mm eşik değeri için 23 idi. Sonuç: Endometrium kanseri görülme riski yüksek olan postmenopozal kanamalı hastalarda anormal endometrialpatolojiye sahip olguları tespit etmek, morbidite ve mortalite riski olan endometrial örneklemenin gereksiz uygulanmasının önüne geçilebilecek olması nedeniyle endometrial örnekleme kararının verilmesinde VUSG 'nin kolay uygulanabilen, etkili bir klinik araç olduğunu düşünmekteyiz.Objective: investigate the relationship between endometrial thickness detected by transvaginal ultrasonography and the predictive value ofTVUSG in detecting abnormal endometrial pathology in patients with postmenopausal bleeding. Materials and Methods: Endometrial thickness was measured by VUSG and endometrial sampling results of 279 patients with postmenopausal bleeding were assessed and compared retrospectively. Results: The most common encountered normal and abnormal endometrial histopathology results were endometrial cell (n=71) and endometrial polyp (n=40) respectively. 73% (n=19) of the patients with endometrial cancer was above 60 years. There was no endometrial cancer and hyperplasia in the patients with 6mm (n=68) endometrial thickness but endometrial polyps were detected. There was no abnormal endometrial histopathology among the patients with 5mm (n=49) endometrial thickness. cut-of levelfor endometrial thickness of 6mm had sensitivity of 95.1% and specificity of 33.8% while mm cutoflevel had sensitivity of] 00% and specificity of24. 7%. Conclusion: We concluded that VUSG is an effective tool to detect abnormal endometrial pathology andprevent the unnecessary endometrial sampling which has morbidity and mortality risk in the patient with postmenopausal bleeding who has high risk for endometrial cancer