Factors Influencing Clinical Pregnancy Rates After Myomectomy Among Infertile Women: A Single Center Retrospective Study

Aim:To determine the clinical pregnancy rates after myomectomy in infertile women who underwent surgery due to myoma uteri and to investigate the clinical factors affecting outcomes.Methods:This retrospective single-centered study included infertile patients who underwent intramural and/or subserousal uterine myomectomy in the infertility clinic at our hospital between February 2012 and October 2014. Data were obtained from the hospital records and patients’ files. Age, body mass index, physical features of myomas (diameter, number, structure, and location), surgical treatment methods used and postoperative pregnancy status were recorded for each patient separately.Results:A total of 211 infertile women who met the inclusion criteria for this study and who underwent myomectomy due to myoma uteri were included. The mean myoma diameter was 7.3±4.4 cm and intramural tumors (49.8%) were the most commonly observed type. Laparoscopic myomectomy was performed in 186 patients (88.1%) and laparoscopic in 25 patients (11.9%). The clinical pregnancy rate was calculated as 19.9% (42/211), while 28.6% (12/42) of pregnancies resulted in live birth and 71.4% (30/42) in spontaneous abortion. The mean age of the pregnant and non-pregnant patients was 33.2±5.6 and 36.8±5.8 years, respectively. The mean body mass index was 25.9±3.5 and 28.8±4.8 kg/m2, respectively (p0.05).Conclusion:The most important factors for predicting pregnancy in patients who undergo surgery due to myoma and infertility are female age and body mass index. It seems that myoma diameter, number, myometrial location, uterine location and method of surgery are not significant factors in predicting pregnancy

Investigation of the relationship between the level of the insulin resistance and high molecular weight adiponectin levels(HMWA)in pcos patients

YÖK Tez ID: 352900Polikistik Over Sendromu (PKOS) `lu hastalar ileri yaşlarda Tip 2 diyabet (DM) ve koroner arter hastalığı (KAH) geliştirme riski altındadır. KAH risk faktörlerinden başlıcaları DM, insulin rezistansı, dislipidemi ve hipertansiyondur. Son zamanlarda ise Adiponektin de bu risk faktörleri arasında gösterilmektedir. İnsulin rezistansı hem tip 2 DM hem de PKOS hastalığının patogenezinde önemli rol oynamaktadır. Her ne kadar Adiponektin düzeyleri yapılan bazı çalışmalarda hem tip 2 DM hem de PKOS hastalarında anlamlı olarak düşük bulunmuş ve insulin rezistansı ile ilişkilendirilmiş ise de bunun aksine anlamlı farkın izlenmediği çalışmalar da mevcuttur. Adiponektinin yüksek (HMWA) ve düşük molekül ağırlıklı formları bulunmaktadır ve HMWA`nin düşük moleküler ağırlıklı formlara göre daha aktif form olduğu gösterilmiştir. Son dönemde PKOS`lu hastalarda HMWA ile ilgili yapılan tüm çalışmalarda adinopektindense HMWA`nin PKOS`lu hastalarda anlamlı olarak düşük olduğu gösterilmiş ve PKOS?da ortak olarak bulunan yüksek androjen seviyeleri ve santral obezite ile HMWA daki azalmanın nedeni açıklanmaya çalışılmıştır. Adinopektin salınımının regülasyonunda vücut kitle indeksi ve insulin rezistansı dışında androjenlerin de rolü olduğu ortaya konmuştur. Ancak PKOS`lu hastalarda HMWA`nin araştırıldığı çalışma sayısı oldukça azdır. Biz bu çalışmada, Roterdam kriterlerine göre PKOS tanısı almış hastalarda serumda HMWA düzeyinin insulin rezistansı ile ilişkisini ve bu ilişkiye etki eden faktörleri araştırmayı amaçladık. Bu çalışma ile PKOS`lu hastalarda HMWA nin PKOS`unun demografik özellikleri, insulin rezistansı, androjen ve lipid profili ile ilişkisi gösterilerek literatüre PKOS patogenez ve kliniğiyle ilgili yeni bilgiler sunulmuş olacaktır. Anahtar Sözcükler: Polikistik over sendromu, HMWA, yüksek molekül a÷ÕrlÕklÕ adiponektin, insulin direnci , hiperandrojenemiPatients with Polycystic Ovary Syndrome (PCOS) have the risk of developing type 2 diabetes mellitus and cardiovascular disease (CVD) in advanced age. The main risk factors for CVD are Diabetes Mellitus, insulin resistance, dyslipidemia, and hypertension. In addition to other risk factors, recently adiponectin is also accepted as a risk factor. Insulin resistance plays an important role in the pathogenesis of PCOS and also type 2 Diabetes Mellitus. In some studies Adinopectin levels are reported to be significantly lower in patients with type 2 diabetes and PCOS and it is associated with insulin resistance. In contrary to this finding other studies report no significant difference. Adiponectin has high (HMWA) and low molecular weight forms. It is shown that compared to low molecular weight forms HMWA is more active. Recently in all studies about HMWA in patients with PCOS, the results with HMWA have been shown to be more significant compared to adiponektin. The reason for the decline in HMWA is explained by the finding of high androgen levels and central obesity in PCOS. Other than the role of body mass index and insulin resistance, androgens have a role in the regulation of adiponectin secretion. However, there are relatively few studies investigating HMWA in patients with PCOS. In this study we aim to asses the relationship between serum HMWA levels and insulin resistance, and the factors affecting this relationship in patients with PCOS diagnosed according to the Rotterdam criteria. With this study, reporting the correlation of HMWA with the demographic characteristics of PCOS, insulin resistance, and androgen profile we will be able to add new insights into the pathogenesis and clinic of PCOS. Keywords: Polycystic ovary syndrome, HMWA, high molecular weight adiponectin, insulin resistance, hyperandrogenemi

Polikistik over sendromlu hastalarda yüksek moleküler ağırlıklı adiponektin (HMWA) düzeyinin insülin rezistansı ile ilişkisinin araştırılması

Tez (Tıpta Uzmanlık) -- Kırıkkale Üniversitesi89922

Effect of time intervals from the end of sperm collection to intrauterine insemination on the pregnancy rates in controlled ovarian hyperstimulation-intrauterine insemination cycles

Objective. - To analyze the effect of time intervals from the end of sperm collection to IUI on the pregnancy rates in couples who treated by COH-IUI cycles with gonadotropin due to unexplained infertility

Decreased ADAMTS-1, -9 and -20 levels in women with endometrial polyps: a possible link between extracellular matrix proteases and endometrial pathologies

A disintegrin-like and metalloproteinase domain with thrombospondin-type 1 motifs (ADAMTS) protein superfamily includes 19 secreted metalloproteases. Proteolytic substrates of ADAMTS enzymes have been linked to female reproductive function. Herein, we aimed to investigate serum ADAMTS-1, -9 and -20 levels in women with and without endometrial polyps (EPs). The study group (n = 40) consisted of women who had hysteroscopically detected and histologically confirmed EPs whereas control group (n = 40) was recruited from those women without any endometrial pathology. Data recorded for every woman were as follows: age, body mass index, gravidity and parity, number of miscarriages, smoking status and serum ADAMTS-1, -9 and -20 levels. ADAMTS-1, -9 and -20 values were measured by commercially available ELISA kits. No statistically significant differences between the groups were observed in terms of demographics. There were also no statistically significant differences between the groups with regard to ADAMTS-1 and -20 levels, although both of them were lower in the study group. However, ADAMTS-9 was significantly lower in the study group compared to the controls (p = .010). The optimal cut off value of ADAMTS-9 in predicting EPs was found to be 163.2 ng/mL with 100% sensitivity and 35% specificity. In conclusion, ADAMTS-9 protein is decreased in women with EPs.Impact statement What is already known on this subject? Endometrial polyps (EPs) are common and are generally benign gynaecologic disorders. ADAMTS enzymes comprise a zinc metalloproteinase gene family that has roles in vascular biology, inflammation and especially in the control of the function and structure of the extracellular matrix (ECM). ECM plays an important role in the pathogenesis of myomas, adenomyosis and abnormal uterine bleeding, as well as EPs. There is an interest in these proteases, especially with regard to the physiology of ovulation and implantation. They are also associated with carcinogenesis and metastasis. One of the most feared consequences of EPs is the risk of malignancy. Therefore, it is important in gynaecology practice to diagnose these endometrial abnormalities. What do the results of this study add? This is the first study performed to investigate the relationship between some ADAMTS (-1, -9 and -20) proteases and uterine polyps. Our results demonstrate novel molecular mediators contributing to EPs physiopathology. What are the implications of these findings for clinical practice and/or further research? ADAMTS-9 is defined as a tumour suppressor gene in various malignancies. Decreased ADAMTS-9 protein, which is the product of this gene, may have a role in the pathogenesis of EPs. There is a need for further research that should be done with benign–malign EPs

The importance of infertility duration and follicle size according to pregnancy success in women undergoing ovulation induction with gonadotropins and intrauterine insemination

In this study, we aimed to evaluate the effect of infertility duration and dominant follicle size measured on the day of human chorionic gonadotropin (HCG) administration on pregnancy rates in infertile women undergoing ovulation induction (OI) with gonadotropin (GND). A total of 352 patients aged 20 to 41 years who were diagnosed with unexplained infertility or polycystic ovary syndrome (PCOS) were included in this study. Patients with a history of multifollicular development or follicle stimulating hormone (FSH) value more than 12 IU/ml were excluded from the study. The demographic and clinical features of the patients were obtained from the patients’ files and hospital automation system and recorded for each woman. The demographic and clinical features of the patients were recorded. Patients were divided into two groups as live birth (group 1, n = 47) and non-live birth groups (group 2, n = 305). There were no statistically significant differences in regard to age, infertility type, follicle stimulating hormone (FSH) level, oestradiol (E2) level, antral follicle count (AFC), cycle characteristics, GND type, number of follicles, E2 level and endometrial thickness on HCG day, total GND dose, dominant follicle size (p > 0.05). Infertility duration in group 1 was 3.5 ± 2.1; in group 2, 4.7 ± 3.9 years. This difference was statistically significant (p = .014). According to this study, live birth rates after GND + IUIs(intrauterine insemination) were significantly affected by the duration of infertility. But the dominant follicle size and endometrial thickness measured on HCG day in GND and IUI cycles did not have a significant effect on pregnancy rates.IMPACT STATEMENT What is already known on the subject? It is thought that the timing of the ovarian triggering is vital for the success of intrauterine insemmination (IUI) treatment. What do the results of this study add? According to our results live birth rates after GND + IUIs were significantly affected by the duration of infertility. What are the implications of these findings for clinical practice and/or further research? It is determined that the duration of infertility is significant and patients should be encouraged to the treatment as soon as possible

Assessment of the Relationship Between Serum High Molecular Weight Adiponectin Hormone Levels and Insulin Resistance in Patients with Polycystic Ovary Syndrome

KISA, Ucler/0000-0002-8131-6810; Tokmak, Aytekin/0000-0001-5739-5689WOS: 000466544100007PubMed: 31022741The purpose of this study was to assess the rate of insulin resistance (IR) and the relationship between IR and high-molecular weight adiponectin (HMWA) in patients with polycystic ovary syndrome (PCOS). A cross sectional study involving 43 women with PCOS and 39 normal women was carried out over a period of nine months. Fasting glucose and insulin levels, lipid parameters and androgen levels were measured in all serum samples. HMWA was determined by enzyme-linked immunosorbent assay and IR was estimated using the homeostasis model assessment of insulin resistance (HOMA-IR) index. The IR was more prevalent in the PCOS group than in the controls (p = 0.002). Dehydroepiandrosterone sulfate, sex hormone binding globulin, free androgen index, total testosterone, insulin, and HOMA-IR levels were significantly higher in the PCOS group as compared to the control group (all p < 0.05). Moreover, HMWA was significantly lower and negatively correlated with the clinical and biochemical hyperandrogenism in the PCOS group. HMWA and HOMA-IR were also associated with triglyceride, body mass index, and fat mass in this group. ROC curve analyses demonstrated that the AUC, indicative of the HMWA value for discriminating PCOS with IR, was 0.725, with a confidence interval of 0.615-0.835 (p = 0.001). The serum HMWA levels are lower in patients with PCOS, which suggest that HMWA might be involved in the pathogenesis of PCOS. We also conclude that HMWA might be a strong determinant of IR in PCOS patients

UPLC-Q-TOF/MS based untargeted metabolite and lipid analysis on premature ovarian insufficiency plasma samples

© 2021 Bentham Science Publishers.Background: Metabolomics is one of the main areas to understand cellular process at molecular level by analyzing metabolites. In recent years metabolomics has emerged as a key tool to understand molecular basis of diseases, to find diagnostic and prognostic biomarkers and develop new treatment opportunities and drug molecules. Objective: In this study, untargeted metabolite and lipid analysis were performed to identify potential biomarkers on premature ovarian insufficiency plasma samples. 43 POI subject plasma samples were compared with 32 healthy subject plasma samples. Methods: Plasma samples were pooled and extracted using chloroform:methanol:water (3:3:1 v/v/v) mixture. Agilent 6530 LC/MS Q-TOF instrument equipped with ESI source was used for analysis. A C18 column (Agilent Zorbax 1.8 µM, 50 x 2.1 mm) was used for separation of the metabolites and li-pids. XCMS, an “R software” based freeware program, was used for peak picking, grouping and compar-ing the findings. Isotopologue Parameter Optimization (IPO) software was used to optimize XCMS pa-rameters. The analytical methodology and data mining process were validated according to the literature. Results: 83 metabolite peaks and 213 lipid peaks were found to be in semi-quantitatively and statisti-cally different (fold change >1.5, p <0.05) between the POI plasma samples and control subjects. Conclusion: According to the results, two groups were successfully separated through principal component analysis. Among the peaks, phenyl alanine, decanoyl-L-carnitine, 1-palmitoyl lysophosphati-dylcholine and PC(O-16:0/2:0) were identified through auto MS/MS and matched with human metabo-lome database and proposed as plasma biomarker for POI and monitoring the patients in treatment pe-riod

Evaluation of Serum Human Epididymis Protein 4 Levels in Women with Polycystic Ovary Syndrome

Aim The main purpose of this study is the determination of scrum epididymis protein 4 (HE4) levels in women diagnosed with polycystic ovary syndrome (PCOS) and comparison with non-PCOS healthy controls. Methods All consecutive women, who applied between January 2017 and June 2017 to the gynecology outpatient clinics at the Zekai Tahir Burak Women's Health Training and Research Hospital and met the study criteria, were included in this cross-sectional study. Serum human epididymis protein 4 (HE4) concentrations were measured in each woman and the mean values were compared between the PCOS and non-PCOS groups. Results A total of 90 women (45 with PCOS and 45 without PCOS) were included in the final analysis. There were no statistically significant differences between the groups in terms of age and body mass index (p >0.05). Basal scrum HE4 levels were 172.8 +/- 139.8 and 131.8 +/- 123.1 pmol/L in the PCOS and non-PCOS groups, respectively (p = 0.415). Conclusion The serum HE4 levels were found to be similar in women with and without PCOS. No significant correlation was observed between PCOS parameters and scrum HE4 levels

Does Intrauterine Insemination Timing Matter for Achieving Pregnancy During Ovulation Induction Using Gonadotropins? A Retrospective Cohort Study

Background: Intrauterine insemination (IUI) is a commonly used procedure to increase the infertile couples' chance of pregnancy. Single or double insemination and different timing choices are modifications of this intervention. The aim of this study was to elucidate the effect of the IUI procedure on clinical pregnancy rates when performed at 24 hours or 36 hours after ovulation triggered by human chorionic gonadotropin (hCG) following ovulation induction with gonadotropins. Methods: One hundred and thirteen women diagnosed with polycystic ovarian syndrome (PCOS) (as per Rotterdam's criteria) or unexplained infertility, who were treated using gonadotropins for ovulation induction and MI for increasing fertilization potential, were recruited from the medical records of the infertility clinic. Demographic features, cycle outcomes, and clinical pregnancy rates of the patients were compared based on two different timing strategies of MI (24 hours and 36 hours) following ovulation trigger using hCG. Results: Clinical pregnancy rates per cycle were 22.9% in the PCOS group and 26.9% in the unexplained group. The clinical pregnancy rates according to the timing of MI were found to be similar for PCOS patients, unlike patients with unexplained infertility whose clinical pregnancy rates were significantly better when the MI procedure was performed 24 hours following the hCG trigger. The cycle day of hCG trigger was also found to be significantly related to clinical pregnancy rate as utilizing a later hCG trigger day appeared to positively affect the odds of clinical pregnancy establishment. Conclusion: IUI performed at either 24 hours or 36 hours after ovulation triggered by hCG injection does not change clinical pregnancy rates for PCOS patients. Patients with unexplained infertility seem to benefit from earlier IUI procedures, which increases their fertility potential during ovulation induction with gonadotropins. Avoiding earlier than physiologically needed artificial-hCG triggering before IUI procedures results with better pregnancy rates. Copyright (C) 2016, the Chinese Medical Association. Published by Elsevier Taiwan LLC.Wo