The effects of supraphysiological oestrogen levels on ventricular repolarisation parameters

Background: The frequency of arrhythmic death developing without a structural cardiac disease is higher in women. Also, female sex is an independent risk factor regarding development of torsades de pointes. Several studies have been conducted on the physiological and therapeutic effects of sex hormones on the cardiac conduction system. Aim: In this study we aim to examine the effect of hormonal changes, especially supraphysiological E2 level changes occurring during in vitro fertilisation treatment, on ventricular repolarisation parameters. Methods: The study included female patients aged between 23 and 39 years, who were administered controlled ovarian hyperstimulation treatment. Patients’ electrocardiograms and blood samples were obtained and analysed before and after the ovarian hyperstimulation treatment. Results: Mean QTc intervals before ovarian hyperstimulation were 411.9 ± 23.7 ms. Measurements during oestradiol peak were calculated as 420.7 ± 23.3 ms, and the QTc interval increase was significant (p = 0.007). Corrected QT dispersion averages were not significant before or after hyperstimulation (53 ± 17 ms vs. 54.5 ± 18.2 ms, respectively, p > 0.05). Tp-e, J-T peak, and PR dispersion changes were not significant after the ovarian hyperstimulation therapy. Conclusions: Supraphysiological oestradiol levels that occur during controlled ovarian hyperstimulation cause prolongation of QTc intervals, but not to a pathological level. Although this prolongation is not significant in healthy individuals, it might increase ventricular arrhythmia risk in patients with congenital long QT syndrome and in patients taking medication that prolongs QT

Twin Pregnancy Complicated By Interlocking: A Case Report

Management of labor in multiple pregnancies is one of the most attracting subjects of obstetrics. Presentation of twin pairs is the major determinant of the route of deliv ery. In the past how to deliv er breech v ertex twin pairs was a conf licting decision. Anesthesia, technical difficulties and antibiotic options restricted the use of cesarean section. Under such circumstances ev en sacrif ication of one of the babies could be acceptable and thus mortality and morbidity was high. Recently we pref er the abdominal route f or delivery of breech vertex twins. Maternal morbidity is only slightly increased in cesarean sections when compared to vaginal deliv ery with the innovations of today. We now present a case of breech vertex twins which were interlocked during v aginal deliv ery and the f irst twin could be deliv ered up to the scapulas. The delivery of the first breech twin could be completed only after the abdominal deliv ery of the second v ertex twin. The babies both did very well in contrast to their difficult deliv ery. This condition presented a chance for us to rev iew the management of deliv ery of breech v ertex twin pairs in the literature and to present our own clinical experience

The effects of different gonadotropin releasing hormone analogues in IVF cycles

Objective: To compare Triptorelin, Leuprolide acetate and Nafarelin sodium in women undergoing controlled ovarian hyperstimulation for in vitro fertilization cycles. Settings: Zeynep Kamil Women and Children's Hospital Reproductive Endocrinology - Infertility - IVFCenter. Material and Methods: Sixty patients were haphazardly distributed for each GnRH-a group. GnRH-a was administrated, starting on the 21st day of menstrual cycles for the long protocol: Triptorelin (Decapeptyl, 0.1 mg) as 0.1 mg/day SC, leuprolide (Lucrine, 5 mg flacon) as 0.5 mg/day SC and nafarelin (Synarel, 2 mg/mi nasal spray) as 200 micrograms to each nostril with a daily total dosage of 800 micrograms. The responses from each group were compared on the basis of duration of stimulation, total dosage of gonadotropin, E2 values on day 5, the down regulation duration, cyst formation, E2 values on the 1st day of stimulation and HCG, progesterone values and endometrial thickness on the HCG day, the number oocytes picked up, fertilization rates, the number of transferred embryos, pregnancy and implantation ratios. Results: Evaluating Triptorelin (T), Leuprolide (LA) and Nafarelin (NA) groups respectively, E2 values on the 1st day of menstrual cycles, measured to confirm the down regulation for each GnRH-a, were 24.67 pg/ml, 21.23 pg/ml, 29.62 pg/ml (p<0.05); the total gonadotropin usage (ampoules) were 47.15 ± 12.97, 39.45 ± 13.97, 36.72 ± 13.14 (p<0.05); the number of retrieved oocytes were 9,89 ± 5,98, 10,50 ± 3,69 and 9,19 ± 5,31 (p>0,05); the fertilization rates were 89%, 100% and 100% (p>0.05). The implantation and pregnancy rates, the two major parameters of the study were 5% and 15% in T, 16.5% and 40% in LA, 14.8% and 38.8% in NA groups respectively (p>0,05). Conclusions: Even though the success rates in Triptorelin group were somewhat lower, the results of every GnRH-a group were statistically similar; but to reach the same outcome we had to use more gonadotropins in this former group. Cost-effectivity analysis of the three GnRH-a makes Leuprolide and Nafarelin better choices than Triptorelin. However, we must state that our study has two major limitations to give a concrete conclusion, namely the study was not randomized and the number of patients was very small

Assessment of the relationship of basal serum anti-mullerian hormone levels with oocyte quality and pregnancy outcomes in patients undergoing ICSI

Background: Anti-Mullerian hormone (AMH) is constantly secreted during menstrual cycles and may offer several advantages over traditional biomarkers of ovarian reserve. Objective: To assess the relationship of anti-Mullerian hormone (AMH) values, which are used to evaluate ovary reserves, with oocyte and embryo quality and with ART outcomes in patients undergoing intra-cytoplasmic sperm injection (ICSI). Materials and Methods: This cross sectional study was performed using 50 women undergoing ICSI in IVF center of Zeynep Kamil Women's and Children's Hospital, İstanbul, Turkey. All patients received the long protocol. Follicle-stimulating hormone, luteinizing hormone, estradiol, and AMH levels were measured and antral follicle counts were obtained on the 3rd day of menstruation. A cut-off value based on the number of oocytes was determined for AMH, and women were evaluated after being divided into two groups as bad responders and good responders, according to their AMH levels. Results: Twelve (27.3%) women were in bad responders group and 32 (72.7%) women were in good responders group. AMH measurements were statistically significantly different between the two groups (p<0.01). Based on this significance, the researchers used ROC analysis to estimate a cut-off point for AMH. The researchers detected the good responders with an AMH level 1.90 or above, with 87.50% sensitivity, 66.67% specificity, 87.50% positive prediction, and 66.67% negative prediction (AUC=0.777, p<0.01). Conclusion: Basal AMH levels can be used as an indicator to determine the ovarian response in women undergoing ICSI. AMH can be used to predict the number of mature oocytes that can be collected during treatment and the number of oocytes that can be fertilized. However, AMH is not a valuable tool to evaluate oocyte quality, the development of high-quality embryos, or pregnancy conception

Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome

Background: Estradiol (E2) is required for follicular development and play an important role in embryo implantation. Objective: The aim of this study was to assess the impact of serum E2 levels on the day of hCG administration in IVF-ICSI patients who are performed controlled ovarian hyperstimulation (COH).Materials and Methods: A total of 203 women who were undergone one time IVF cyclus were evaluated in this cross sectional study. All the patients were treated either with long protocol or with microdose flare protocol. The patients were categorized into five groups according to the serum E2 levels on the day of hCG administration.Results: The mean number of the retrieved oocytes was (NRO) 10.6±6.7, mean fertilization rate was 55.7±24.8, and implantation rate was 9.0±19.2. Of 203 patients, 43 (21%) patients were pregnant. When the overall results are examined, the number of the retrieved oocytes and the number of transferred embryos were better in patients with serum E2 levels >4000 pg/ml and these values were statistically significant. There were no statistical difference in patients 37 years or older. In women ≤36 years old, the IVF-ICSI outcomes were better in patients with serum E2 levels >4000 pg/ml.Conclusion: In spite of the lack of high quality evidence to support a positive association between serum E2 levels and IVF-ICSI outcomes, this study shows that high E2 levels during COH might be associated with an increased potential of pregnancy depending on better ovarian response. When the overall results are examined, the best scores were in patients with serum E2 levels >4000 pg/ml

INVESTIGATION OF FACTORS AFFECTING THE SUCCESS RATES OF IN VITRO FERTILIZATION FOLLOWED BY A FAILED CYCLE

Objective: Our aim was to compare the success of the treatment modalities used in in vitro fertilization protocols by comparing the cycles of same patients with failed and successful results to determine the factors affecting the success

Anisotropic Tunability of Vibrational Modes in Black Phosphorus Under Uniaxial Compressive/Tensile Strain

Abstract Strain engineering is a powerful strategy for tuning the optical, electrical, vibrational properties of 2D nanomaterials. In this work, a four‐point bending apparatus is constructed to apply both compressive and tensile strain on 2D anisotropic black phosphorus flake. Further polarized Raman spectroscopy is used to study the vibrational modes of black phosphorus flakes under uniaxial strain applied along various crystalline orientations. Here, a strong anisotropic blue/redshift of A1g, B2g, and A2g modes is found under compressive/tensile strain, respectively. Interestingly, mode A1g exhibits the maximum/minimum shift while mode B2g and mode A2g present the minimum/maximum shift when the strain is applied along armchair/zigzag direction. Density functional theory calculations are carried out to investigate the anisotropic strain response mechanism, finding that the strain‐induced regulation of the P─P bond angle, bond length, and especially interlayer interaction has a giant influence on the Raman shift

Coagulation tests at trigger day in patients with Factor V Leiden Mutation to predict implantation failure

Objectives: The aim of this study was to assess the predictive value of coagulation tests at trigger day in patients with isolated factor V Leiden mutation who underwent intracytoplasmic sperm injection cycle (ICSI). Study Design:  Ninety women with isolated factor V Leiden mutation underwent ICSI cycles with an indication of unexplained infertility. In all participants antagonist protocol was used for ovarian hyperstimulation and coagulation tests including activated partial thromboplastin time (APTT), partial thromboplastin time (PT), international normalized ratio (INR), serum fibrinogen and D-dimer levels at trigger day were determined to predict successful implantation. All the clinical parameters specific for the treatment and some patient characteristics were recorded for each participants. Results: There was no significant difference between groups with and without succesfull implantation in terms of age, body mass index, basal hormone levels (follicle stimulating hormone, estradiol, progesterone at day 3 and antimullerian hormone) (P > 0.05). Estradiol and progestrone levels at trigger day were comparable between groups  (P > 0.05). Groups had similar endometrial thickness at embryo transfer day (P > 0.05). Some ovarian stimulation characteristics including initial gonadotropin dose, number of follicles > 17 mm, number of oocytes harvested and number of embryos were similar between groups (P > 0.05). Although there was no significant difference between groups with regard to APTT and PT levels, INR level were significantly lower while D-dimer levels and fibrinogen were significantly higher in cases without implantation (P < 0.05). Conclusion: D-dimer, fibrinogen and INR levels were significant predictors for successful implantation in women with isolated factor V Leiden who underwent ovulation hyperstimulation

Antral Folikül Sayi{dotless}si{dotless}ni{dotless}n in Vitro Fertilizasyon Sonuçlari Üzerine Etkisi]

Aim: The aim of this study is to evaluate the effects of number and size of antral follicles on ovarian reserve and subsequently in vitro fertilization (IVF) outcome. Material and Method: 44 patients treated with IVF in the Infertility Clinic of Zeynep Kamil Women's and Children Disease Education and Research Hospital (Istanbul, Turkey) were prospectively included in this study. On the third day of menstrual bleeding, transvaginal ultrasound was performed. Antral follicle count (AFC) and antral follicle (AF) size were recorded in these patients. Group I as AF > 5mm and Group II as AF 5 mm). Under the area of ROC curve estimations for ovarian response revealed that antral follicle (AF) > 5 mm had the largest area 0.675 +/- 0.083 (0.517-0.808). Discussion: There might be an association between AF that is larger than 5 mm in size and number of retrieved mature oocytes. Since AFC, is a routine screening test in any IVF center, we believe paying closer attention to the measurement of AFC that are larger than 5 mm in size might help clinicians to achieve more successful outcomes in terms of on embryo quality and pregnancy outcome in women undergoing an in vitro fertilization