The impact of endometriosis on fertility

Although the prevalence of endometriosis in infertile women seemed to be nearly 50%, all women with endometriosis are not infertile..

The impact of sweeping the membranes on cervical length and labor: a randomized clinical trial

Objectives: The aim of the study was to investigate to what extent sweeping of the membranes contributes to cervical shortening and if cervical shortening is related to the time to onset of labor and duration of the active phase of labor. Methods: This prospective randomized clinical trial was performed at Baskent University between February and March 2011. Women were randomly assigned to receive membrane sweeping (Sweeping Group) (n=69) or no membrane sweeping (Control Group) (n=71). Cervical length was measured (cervix1) in both groups by examiner 1 and the Bishop Score was determined in the control group and sweeping was performed in the sweeping group by examiner 2. Two days later the patients had another cervical length measurement (cervix 2) by examiner 1, blinded to the group and results of the examiner 2. t test, Mann-Whitney U test and Chi-square test were used for statistical analyses. Results: Cervix 1 was 27.4}8.4 mm and 29.6}8.9 mm (p= 0.14), cervix 2 was 23.3}8.8 mm and 23.8}8.5mm (p= 0.28) and cervical shortening was 5}4 mm and 5}4mm (p= 0.446), time to onset of labor was 6.3}4.6 and 5.7}4.1 (p= 0.38) and duration of labor was 5.8} 2.89 and 5.7} 2.4 (p= 0.82) for the sweeping and the control groups, respectively. Conclusions: Sweeping of the membranes does not reduce cervical length and does not shorten time to onset of labor and duration of the active phase of labor. NCT01309308: Sweeping the Membranes, Cervical Length and Duration of Labor

A novel approach for congenital absence of the uterine cervix: Office hysteroscopic versapoint canalization using real-time trans-abdominal sonography guidance

Herein, we report a novel technique for cervical agenesis via office hysteroscopy using Versapoint using real-time trans-abdominal sonography guidance. Fourteen days after the canalization procedure, a second hysteroscopy was performed to remove the silicone catheter and insert a Cupper T380a intrauterine device, which aimed to prevent a neocervical canal occlusion. This is the first case report of a patient with congenital cervical agenesis undergoing canalization with Versapoint in an office hysteroscopy; laparoscopy was not performed for assistance

Przegląd chorób układu krążenia w ciąży

Abstract With recent advances in prenatal care, the incidence of direct causes of maternal death has declined and indirect causes have gained significant importance. Thromboembolism, hypertension and cardiovascular diseases are the most common indirect causes of maternal death. Acute myocardial infarction, stroke, venous thromboembolism, peripartum cardiomyopathy, aortic dissection and amniotic fluid emboli are responsible for the majority of the maternal deaths from cardiovascular causes. The issue of pregnancy of heart transplant – and Turner syndrome – patients requires extensive research. Obstetricians should possess good knowledge of cardiovascular complications of pregnancy because a high index of suspicion and early diagnosis, together with timely and appropriate interventions may save the life of the fetus and the mother.Streszczenie W związku z rozwojem medycyny, częstość występowania bezpośrednich przyczyn zgonów matek, np. krwotoków, znacząco się zmniejszyła. Jednak obserwuje się wzrost śmiertelności matek spowodowanych innymi, niebezpośrednimi przyczynami takimi jak: choroba zakrzepowo-zatorowa, nadciśnienie indukowane ciążą oraz choroby układu sercowo-naczyniowego. Zawał mięśnia sercowego, udar mózgu, zakrzepica żylna, kardiomiopatia okołoporodowa, tętniak rozwarstwiający aorty oraz zator płynem owodniowym są odpowiedzialne za większość przypadków śmiertelności matczynej wywołanej chorobami układu sercowo-naczyniowego. Na szczególną uwagę zasługują coraz częściej pojawiające się pacjentki po transplantacji serca oraz ciężarne z zespołem Turnera. Położnicy powinni posiadać rozległą wiedzę dotyczącą chorób układu krążenia i możliwych ich powikłań podczas ciąży, ponieważ wczesna diagnoza oraz właściwa interwencja mogą uratować życie płodu i matki

A novel approach using a minimal number of injections during the IVF/ICSI cycle: Luteal half-dose depot GnRH agonist following corifollitropin alfa versus the corifollitropin alfa with a GnRH-antagonist cycle

Objective: Corifollitropin alfa is a good choice for assisted reproductive technology (ART) cycles because fewer injections are needed than with other agents. In this retrospective cohort, we analyzed luteal injected half-dose depot gonadotropin hormone-releasing hormone (GnRH) agonist cycles in women who received corifollitropin alfa and those who underwent a conventional corifollitropin alfa cycle with a GnRH antagonist. Material and Methods: In this retrospective cohort, we analyzed luteal injected half-dose depot GnRH agonist cycles in women who received corifollitropin alfa and those who underwent a conventional corifollitropin alfa cycle with a GnRH antagonist at the Division of Reproductive Endocrinology and IVF Unit, Obstetrics and Gynecology Department, Baskent University School of Medicine, Adana, Turkey, from March 2014 to August 2015. The patient's baseline characteristics were similar between the two groups. Forty-five patients underwent the long protocol, in which a half-dose of depot GnRH agonist was administered on day 21 of the preceding cycle. Forty-nine patients underwent the GnRH-antagonist protocol. Corifollitropin alfa was administered on the menstrual cycle day 3. Results: The mean ages of the two groups were similar (32.77+/-5.55 vs. 34.2+/-4.51 years ["for the long-and antagonist-protocol groups, respectively"]). The total number of retrieved oocytes, the fertilization rate, and the number of transferred embryos were similar between the two groups. The only significant difference between the two protocols was the number of injections during the controlled ovarian stimulation (COH) cycle, which included the depot-agonist injection in the long-protocol group (4.46+/-1.64 vs. 5.71+/-2.51, p=0.006). The clinical pregnancy and implantation rates were similar in the two protocols (16/45 [35.6%] vs. 16/49 [32.7%] for the intention to treat and 32.5+/-6.82% vs. 36.25+/-8.58%, respectively). Conclusion: Our results show that ART cycles could be performed with fewer injections using corifollitropin alfa and a half-dose of depot GnRH agonist

Pasireotide: A new option for treatment of acromegaly

Acromegaly is characterized by excess production of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Although surgery is the first treatment option, somatostatin receptor analogs (SSRAs) can be used in selected cases which surgery is contraindicated. A patient who has been diagnosed as acromegaly was admitted to our hospital. Hypophyseal adenomectomy had been performed one year ago. The patient was taking lanreotide for 6 months and disease was not under control. She had loss of vision. Although she had a residual tumor, second surgery couldnt be performed due to the location of tumor. The patient was followed for 6 years. Radiotherapy and other medical treatment options were tried but none of them were successful. At the end of six years, pasireotide was started. At the third month of treatment, biochemical control was achieved. Pasireotide may be a treatment option for some patients with acromegaly that are inadequately controlled by first generation SSRAs. [Med-Science 2020; 9(2.000): 518-21

A case report of the cascade filtration system: A safe and effective method for low-density lipoprotein apheresis during pregnancy

PubMedID: 18937724Women with familial hypercholesterolemia (FH) should be treated effectively during pregnancy, as elevated low-density lipoprotein cholesterol (LDL-C) levels may result in life-threatening consequences. Hydroxymethylglutaryl- coenzyme A reductase inhibitors are contraindicated during pregnancy, therefore LDL apheresis should be considered in the management of such pregnant cases. There are five different methods of selective LDL apheresis: heparin-induced extracorporeal LDL precipitation, double filtration plasmapheresis, direct adsorption of lipoproteins, dextran sulfate adsorption, and LDL immunoadsorption. The cascade filtration system is another modern and effective method for the extracorporeal elimination of LDL-C, although it is not as selective as the methods mentioned above. Herein, we present the case of a pregnant woman with heterozygous FH and extremely elevated LDL-C levels who has been successfully treated with the cascade filtration system until delivery. As far as we can ascertain, LDL apheresis with the cascade filtration system during pregnancy has not yet been reported in the literature. © 2008 The Authors

Miliary tuberculosis in a pregnant woman who is on hemodialysis: Case report

Miliary tuberculosis is rare during pregnancy. A 34-ye ar-old multipara woman on hemodialysis for chronic renal failure presented with fever and cough. Although the chest X-ray was suggestive of tuberculosis, the skin test and the sputum smear were negative and the patient was initially treated for bacterial pneumonia. Mycobacterium tuberculosis was detected in blood culture 4 days later. The patient was put on anti-tuberculosis treatment and continued hemodialysis. She was followed up weekly and the pregnancy was uneventful until she was admitted with preterm labor at the 27th week. She responded to tocolytic treatment initially. After the induction of pulmonary maturity, to colysis was discontinued and the patient delivered an 860-gram female baby who did well after a long time in neonatal intensive care unit. Copyright © 2010 by Türkiye Klinikleri

The combination of dehydroepiandrosterone, transdermal testosterone, and growth hormone as an adjuvant therapy in assisted reproductive technology cycles in patients aged below 40 years with diminished ovarian reserve

Objective: To evaluate to the efficacy of testosterone, dehydroepiandrosterone (DHEA) and growth hormone (GH) supplementations in patients with diminished ovarian reserve (DOR) in assisted reproductive technology (ART) cycles. Materials and Methods: A retrospective cohort including 33 women with 81 ART cycles were aged and ovarian reserve matched 52 women with 102 conventional in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) protocol. Administration of DHEA for 12 weeks and transdermal testosterone for 4 weeks as pretreatment adjuvant and luteal start GH in DOR patient treatment arm compared to conventional IVF/ICSI cycles. Results: The number of follicles > 14 mm, number of oocytes, number of metaphase 2 oocytes and fertilisation rate were significantly higher in ISIK protocol (IP). The clinical pregnancy rate (CPR) per embryo transfer of the IP was 38.2% (13/34). The cancellation rate of cycles decreased significantly from 54.5 % (24/44) to 8.1% (3/37) with the IP, while the OPR was 35.3% (12/34). Conclusions: Our study has shown that even the poorest responders could achieve clinical pregnancy after inducing ovarian folliculogenesis with a combination of transdermal testosterone, DHEA

Hepatogenous photosensitization in Akkaraman lambs: special emphasis to oxidative stress and thrombocytopenia

WOS: 000334986200007In this study, a total of 24 Akkaraman lambs with clinical signs that are reminiscent of photosensitization composed the experimental group (Group I). Additional 10 healthy lambs were included as controls (Group II). We were aimed to make definitive diagnosis of photosensitization, which can be confused with blue tongue, big head and sunburns and to establish etiology as primary or hepatogenous. In total blood analyses, the leukocyte count was higher, but thrombocyte count was lower (thrombocytopenia) in Group I compared to Group II. The lower MCV indicates presence of a case of microcytosis. Furthermore, affected lambs had significantly higher levels of phylloerythrin, gamma-glutamyl transpeptidase, aspartate aminotransferase, alkaline phosphatase, cholesterol and serum urea nitrogen. Histopathological lesions included periaciner necrosis, periportal fibrosis and biliary duct hyperplasy. The grazing field, where the lambs had been grazing, was very rich in Tribulus terrestris, a hepatotoxic plant. Based on the increased levels of phylloerythrin, gamma-glutamyl transpeptidase, aspartate aminotransferase and alkaline phosphatase as well as pathological findings in liver, the cases were diagnosed as hepatogenous photosensitization. In addition, presence of Tribulus terrestris in the grazing pasture strongly supported the diagnosis. Increased levels of serum malondialdehyde in affected lambs showed an ongoing oxidative stress. In addition, thrombocytopenia in such cases should be considered as a risk factor for disseminated intravascular coagulation (DIC). Thus in addition to a semptomatical treatment protocol, use of antioxidants, anticoagulants, and liver protective agents shoud be taken into consideration in hepatogenous photosensitization in lambs