The incidence of metabolic syndrome in adolescents with different phenotypes of PCOS

Objectives: To evaluate the incidence of metabolic syndrome in Turkish adolescents with different phenotypes of polycystic ovary syndrome (PCOS). Material and methods: This cross-sectional study was performed on the Youth Center clinic of a tertiary referral hospital in Turkey. Adolescents with PCOS (n = 144) were classified into four phenotype groups according to the presence of oligo/anovulation (O), hyperandrogenism (H), and polycystic ovarian morphology (P) as follows: Phenotype A (O + H + P), Phenotype B (H + O), Phenotype C (H + P), Phenotype D (O + P). The adolescents gave early follicular phase blood samples for endocrine and metabolic tests. The incidence and the presence of parameters of metabolic syndrome were assessed among the four groups. Results: In total, 54.9% of the adolescents with PCOS were overweight and 25.7% had metabolic syndrome. The incidence of metabolic syndrome in Phenotypes A-D were as follows: 39.5%, 20.5%, 26.5%, and 15.2%, respectively. Although body mass index was higher in the Phenotype A group, insulin resistance was similar in all of the phenotype groups. The most common dyslipidemia was low HDL-C levels and this was present in more than half of the adolescents with PCOS. Both body mass index and total testosterone levels were significantly higher in adolescents with metabolic syndrome in comparison to those without metabolic syndrome. Conclusions: Although low HDL-C levels and insulin resistance are common PCOS findings in adolescents, the metabolic profile seems to be worse in Phenotype A than the other phenotypes. Therefore, screening programs should evaluate patients based on the known risk factors and phenotypes for adolescents with PCOS

Mean Platelet Volume, Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Severe Preeclampsia

Objectives: The aim of the study was to compare the changes in the values of leukocytes, neutrophils, lymphocytes, mean platelet volume (MPV), and systemic inflammatory response (SIR) markers (neutrophil-lymphocyte ratio/platelet-lymphocyte ratio) in patients with severe preeclampsia (PE) of healthy pregnant and non-pregnant women. Material and methods: Hematological parameters including MPV, and SIR markers [neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR)] were compered between the between three groups comprising of women with severe PE, healthy pregnant women and healthy non-pregnant women. Results: MPV and PLR did not show statistically significant differences between the three groups (p=0.081, p=0.098). NLR showed a statistically significant difference between the three groups (p=0.000). NLR values of patients with severe PE were statistically significantly higher than healthy non-pregnant women (p=0.000). No statistically significant difference was found between patients with severe PE and healthy pregnant women (p=0.721). The cut-off value of the leukocyte number for severe PE was 7.6 x 103/ml, with 76.7% sensitivity and 60.6% specificity. The cut-off value of neutrophil number was 6.4 x 103/ml for the group with severe PE, with 76.7% sensitivity and 69% specificity. Conclusions: Our results showed that MPV level did not differ among patients with severe PE, healthy pregnant women and non-pregnant women. NLR cannot be used to identify patients with severe PE. PLR measured before termination of pregnancy is not an effective marker for severe PE, either

Helicobacter pylori Seropositivity and Stool Antigen in Patients With Hyperemesis Gravidarum

The objective of this paper is to investigate whether Helicobacter pylori is an etiologic factor in hyperemesis gravidarum. Thirty one patients with hyperemesis gravidarum and twenty nine pregnant controls without hyperemesis gravidarum were included in this prospective study. All pregnant women were examined both for Helicobacter pylori serum immunoglobulin G antibodies (HpIgG Ab), showing chronic infection, and Helicobacter pylori stool antigens (HpSA), showing active gastrointestinal colonization. Chi-square and Student t tests were used accordingly for statistical analysis. Helicobacter pylori seropositivity was 67.7% in the patients with hyperemesis gravidarum and 79.3% in the control group (χ(2) = 1.02, P = .31). HpSA was detected in 22.6% of patients with hyperemesis gravidarum, whereas 6.9% of patients in the control group. The difference was not statistically significant (χ(2) = 2.89, P = .08). In this study, no relation was found between Helicobacter pylori and hyperemesis gravidarum. The low social status of women in both groups could be one of the reasons for the high prevalence of Hp infection

Clinical symptoms and diagnostic tools that are related to infertility and hydrosalpinx formation in women with advanced stage endometriosis complicated by endometrioma

Objectives: The study included patients suffering from stage III-IV endometriosis complicated by an endometrioma (OMA). We investigated the association between age, presence of dysmenorrhea/dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility, as well as the risk of intraoperative detection of hydrosalpinx that was not suspected on pre-operative assessment. Materials and Methods: The study included patients with stage III-IV endometriosis complicated by OMA who underwent a laparoscopic or open surgery due to pre-diagnosis of infertility or adnexal mass. Results: Dysmenorrhea had statistically significant association with infertility (p=0.031). There was no statistically significant relation between age, dyspareunia, preoperative CA 125 level, size of OMA on ultrasonographic exam and infertility (p=0. 203, p=0.561, p=0.561 and p=0.668, respectively). No statistically significant relation was found between age, CA 125 level, dysmenorrhea, dyspareunia and detection of an unilateral/bilateral hydrosalpinx, that was not suspected on pre-operative assessment (p=0.179, p=0.295, p=0.895, p=0.424, respectively). There was an association between OMA size (p=0.023) and detection of unilateral/bilateral hydrosalpinx. Conclusions: Patients who desire to have children but suffer from severe dysmenorrhea must be preoperatively informed about the possibility of having stage III-IV endometriosis. Infertile patients who are about to undergo an operation, especially due to a large OMA, may turn out to have hydrosalpinx. These patients should be informed preoperatively about the possibility of having salpingectomy or the proximal tubal surgery for improving fertility

The effect of anxiety and depression scores of couples who underwent assisted reproductive techniques on the pregnancy outcomes.

Objective: The aim of this study was to determine the effect of anxiety and depression scores of couples who underwent Assisted Reproductive Techniques (ART) on pregnancy outcomes. Method: This study was conducted as a prospective and comparative study with 217 couples. The study data was collected by using a semi-structured questionnaire and the Turkish version of the State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). The questionnaire, STAI and BDI were applied to couples who initiated ART treatment. Couples\u2019 state anxiety scores were re-evaluated after embryo transfer (ET). Results: A significant relationship was found between the depression score of women and pregnancy outcome (p < 0.05). It was determined that anxiety scores for both men and women were higher before the ART procedure, but their anxiety scores decreased after ET (p < 0.05). Spouses of women with a negative pregnancy outcome had higher trait and state anxiety mean scores (p > 0.05) and lower depression scores (p <0.05) than spouses of women with a positive pregnancy outcome. Conclusion: Study results indicated that the anxiety and depression scores of couples who had achieved a positive pregnancy result were lower than for couples with a negative result. The results of this study will contribute to the health professionals especially to the nurses who spend the most time with couples in providing consulting services and supporting psychological status of couples during ART process in Turkey

The effect of hCG day progesterone in 1318 cycles on pregnancy outcomes: ongoing discussion

Objectives: To investigate the effect of human chorionic gonadotropin day progesterone (hCG-P) level on pregnancy outcomes in in vitro fertilization (IVF) cycles. Material and methods: This study is an analysis of a cohort of 1318 fresh IVF- embryo transfer cycles, including 579 agonists and 739 antagonists, performed at a single IVF center between 2007 and 2018. For fresh cycles, we performed Receiver Operating Characteristic analysis (ROC) to calculate the threshold value of hCG-P, which affects pregnancy outcomes. We divided patients below and above the determined threshold value into two groups, then, correlation analysis and we performed logistic regression analysis. Results: According to ROC curve analysis of hCG-P,AUC was 0.537 (95% CI: 0.510–0.564, p < 0.05) for LBR, and the threshold value for P was 0.78. The hCG-P threshold value of 0.78 proved to be significant in relation to BMI, type of drug used during induction, the hCG day E2, the total number of oocytes, the number of oocytes and the subsequent pregnancy outcome between the two groups (p < 0.05). However, the model we built, which accounted for hCG-P, total number of oocytes, age, BMI, induction protocol, total dose of gonadotropin used in induction did not prove significant in terms of its effect on LBR. Conclusions: The threshold value of hCG-P that we found to have an effect on LBR was quite low compared with the P-value generally recommended in the literature. Therefore, further studies are needed to determine an accurate P-value that reduces success in managing fresh cycles

The Complete Evacuation Rate of Two Different Single Dose Misoprostol Regimens for Termination of Missed Abortion

OBJECTIVE: To compare the complete evacuation rate of two different single dose misoprostol regimens in termination of missed abortion within 24 hours. STUDY DESIGN: Hundred and one women with a diagnosis of missed abortion were randomized into two groups. Women in Group I received four tablets of misoprostol (800 mg) vaginally. In Group II, two tablets of misoprostol were administered vaginally simultaneously with two tablets taken orally. Women were evaluated by transvaginal sonography after the initiation of vaginal bleeding (primary visit) or in cases with no bleeding within 24 hours after the administration. In cases that had not completed the abortion at the primary visit, a surgical evacuation was performed. Mean expulsion time, clinical outcomes, side-effects, complications and any additional interventions required were analyzed in two groups. RESULTS: There was no statistically significant difference between the two groups in terms of age, number of previous pregnancies, the complete evacuation rate at the primary visit or mean expulsion time. The complete evacuation rate within 24 hours was 18% in Group I and 14% in Group II (p=0.38). The overall complete evacuation rate was 16% (n=16). There was a statistically significant difference between the groups for mean hemoglobin values before and after treatment (0.64 vs 0.62 respectively, p<0.05). CONCLUSION: With a single dose misoprostol regimen regardless of the route of administration, overall complete evacuation rate was low at the first follow-up visit

Predictors of Total Gonadotropin Dose Required for Follicular Growth in Controlled Ovarian Stimulation with Intrauterin Insemination Cycles in Patients with Unexplained Infertility or Male Subfertility

OBJECTIVE: The aim of this study was to determine the possible predictors of total gonadotropin dose (TGD) required to achieve ovulation in patients with unexplained infertility or male subfertility. STUDY DESIGN: A prospective study on 230 patients (n:178 unexplained infertility, n:52 male subfertility) scheduled for controlled ovarian stimulation (COH) and intrauterine insemination (IUI) was designed to determine the association between basal follicle stimulating hormone (FSH), luteinizing hormone (LH), estrodiol (E2) levels, antral follicle count (AFC), age and body mass index (BMI) and total gonadotropin doses needed to achieve follicular growth. RESULT: Regression analysis revealed an association between basal FSH level, BMI and AFC with total gonadotropin dose (P=0.001, P=0.002, P=0.045). BMI was positively correlated with TGD (r:0.400, P=0.001). Mean BMI of patients who required a total dosage of >1500 IUs of gonadotropin was 29.7±4.8kg/ m2 where as it was 24.9±3.2kg/ m2 for patients who received <1500 IU to achieve follicle growth (P=0.001). CONCLUSION: Our study results imply that basal BMI is the essential parameter in determining the total dose of gonadotropin used to achieve follicular growth