OBJECTIVE: The main detrimental factor in female fertility is maternal age. Clinical pregnancy and live
birth rates decline gradually with age and this decline is dramatical over 40 years. In this study, we examined the in vitro fertilization/intracytoplasmic sperm injection cycle outcomes of women aged 40 years
and over.
STUDY DESIGN: This retrospective cohort study included 336 fresh in vitro fertilization/ICSI cycles of
women aged ≥40 years. Six groups, stratified by one-year intervals were composed according to age:
40 years; 41 years; 42 years; 43 years; 44 years, and ≥45 years. The primary outcomes were the clinical pregnancy and live birth rates.
RESULTS: The clinical pregnancy rate was 18.6% in 40 years old women and it decreased to 4% in
women aged ≥45 years. The live birth rates in women aged 40 and 41 years (10% and 6.1% respectively) were higher than the live birth rates in women aged 42 and 43 years (4.3% and 3.8% respectively). There was no live birth in women aged 44 and over. The miscarriage rate was 46.2% at age 40
and it increased to 100% at age 44 and over.
CONCLUSION: The clinical pregnancy and the live birth rates decreased significantly with every single
year after 40 years of age. In patients between the ages of 40-43, the live birth rate is acceptable but
starting an in vitro fertilization cycle beyond 43 years of age does not seem to be reasonable.
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Aims: Urinary incontinence (UI) is a common condition in women and might affect women’s
physical and psychological health in different aspects. This study evaluated the effects of UI on
the quality of life (QoL) and sexual function in women of reproductive age.
Methods: In this prospective case-control study, sexually active and premenopausal women
who were admitted to the urogynecology outpatient clinic of our hospital with UI were included.
Women without UI complaints were selected for the control group. All the women were asked
to fill the Urogenital Distress Inventory-6 (UDI-6), the Incontinence Impact Questionnaire-7
(IIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12
(PISQ-12).
Results: There were 64 women [median age: 42 (12)] in the UI group and 58 women [median
age: 40 (11)] in the control group. Although the median age was similar in the two groups,
the UI group had significantly more gravidas [3 (1) vs. 2 (1); p<0.00] and parity [2.5 (1) vs. 2
(1); p<0.001], body mass index [27.9 (7.2) vs. 24.9 (5.1); p=0.002], and Pelvic Organ ProlapseQuantification [0 (0) vs. 0 (0); p=0.03] levels. The most common UI type was mixed UI (64.1%)
followed by the stress (20.3%) and urge UI (15.6%). The UI group had significantly higher
scores in both the subscale and total scores in IIQ-7 and UDI-6 questionnaires (p<0.001). For
the PSIQ-12 questionnaire, the behavioral-emotive subscale did not differ between the two
groups, while physical and partner subscales and the total score were significantly lower in the
UI group (p<0.001).
Conclusions: This study showed that UI had a negative impact on QoL and sexual function in
women o
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Para-aortic lymph nodes are exclusively important for the staging of gynecologic malignancies. This surgical education video describes the stepby-step technique for para-aortic lymphadenectomy with anatomic landmarks in a cadaver.
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Objectives: This study aims to compare the fracture risk calculated with Fracture Risk Assessment Tool (FRAX®) in patients with natural
and surgical menopause.
Patients and methods: Between April 2019 and July 2019, 285 postmenopausal patients (mean age 57.3 years; range, 40 to 78 years) who
were admitted to the menopause clinic were enrolled in this prospective cross-sectional study. Of these, 220 were in natural menopause and
65 were in surgical menopause. Demographic data, medical history, and International Physical Activity Questionnaire scores were collected
through face-to-face interviews with the patients. Femoral neck and lumbar vertebrae (L1-L4) T-scores were evaluated using dual-energy
X-ray absorptiometry. Fragility fracture risk was assessed using FRAX®.
Results: The groups were similar in terms of age, body mass index, duration of menopause, smoking, alcohol use, and history of fracture
(p>0.05). The risk of major osteoporotic fracture and hip fracture calculated without adding bone mineral density (BMD) was similar
between groups (p=0.417 and p=0.234). The risk of hip fracture calculated with the addition of BMD was higher in natural menopause
patients (p=0.023). Lumbar vertebrae T-scores were similar between two groups regardless of age; femoral neck T-scores were higher in
surgical menopause (T-score=-0.8) than natural menopause group (T-score=-1.25) aged under 60 years, whereas this difference disappeared
after 60 years of age.
Conclusion: In our study, the fracture risk and the severity of osteoporosis were not different in surgical menopausal patients compared to
the natural menopausal patients. Hip fracture risk calculated using BMD was lower in patients under 50 years of age in surgical menopausal
patients. However, the fracture risks were similar in both groups after 50 years of age.
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Objective: The aim of this study was to assess the diagnostic values of new biochemical markers that may be an alternative to the oral glucose tolerance test (OGTT) and determine the differences in these markers among three groups of women with varying degrees of glucose homeostasis dysregulation. Material and Methods: This was a prospective study. All women were screened with 50 gram (g) oral glucose and a 100 g OGTT for gestational diabetes mellitus (GDM). The patients were divided into three groups depending on the result of the tests: no evidence of glucose metabolism abnormality (controls); impaired glucose tolerance (IGT); and GDM. All three groups were evaluated for serum human advanced glycation endproducts (AGEs) concentrations, carboxymethyl lysine (CML) concentration and receptor for advanced glycation end-product concentrations (RAGE/AGER), body mass index (BMI), age, fasting glucose levels, obstetrical parameters and gestational age. Results: The study included 180 women divided into 59 (32.8%) GDM, 50 (27.8%) IGT and 71 (39.4%) controls. Age was similar among the three groups. Whereas fasting glucose levels and BMI in the three groups was significantly different, AGEs, CML, RAGE/AGER levels were found as significantly different between the groups (p<0.001). Conclusion: In this study the use of AGEs, CML, and RAGE/AGER concentrations for the diagnosis and screening of gestational diabetes was investigated. It was found that advanced glycation products were significantly elevated in pregnancies with both IGT and GDM. These biochemical markers of glucose homeostasis dysregulation may have potential for GDM screening in the future. (J Turk Ger Gynecol Assoc 2021; 22: 127-31)
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ABS TRACT Objective: The objective of this study was to evaluate the efficacy, safety, and tolerability of Gynomax® XL vaginal ovule in the treatment of bacterial vaginosis (BV), candidal vulvovaginitis (CVV), trichomonal vaginitis (TV), and mixed vaginal infections (MVI). Material and Methods: A total of 98 women diagnosed clinically with BV, CVV, TV, or MVI have completed this study. Patients were given Gynomax® XL for 3 consecutive days, and approximately 10 (+/-5) days after the treatment, a follow-up visit was conducted. In addition to the clinical examinations, vaginal swab samples were collected in both visits for microbiological tests. Results: Based on the clinical diagnosis of the investigators, most of the patients had MVIs (54.1%), followed by BV (24.5%) and CVV (20.4%) at the baseline visit. One (1.0%) patient was diagnosed as having TV. According to the microbiologic examination results, 44 (44.9%) patients had BV, 20 (20.4%) had CVV, and 13 (13.3%) had MVIs. According to the clinical findings, overall complete recovery (CR) was observed in 76.5% of the patients and according to the microbiologic findings, overall CR was observed in 85.7% of the patients. Microbiologic results evaluated by each diagnostic criterion showed that CR was detected in 93.2%, 85.0%, and 61.5% of the patients with BV, CVV, and MVIs, respectively. There were no serious or non-serious adverse events leading to patient withdrawal or treatment discontinuation during this study. Conclusion: Gynomax® XL vaginal ovules administered once daily for three consecutive days provide effective and safe treatment in patients with BV, CVV, and MVIs.
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Objective: To evaluate the obstetric outcomes of fetuses with cystic hygroma other than karyotype abnormalities and structural malformations.Material and Methods: We conducted a retrospective study based on the review of medical records of pregnant women in whomultrasonographic diagnosis of fetal cystic hygroma was established in the first trimester from January 2014 to October 2018. All patients wereoffered genetic counselling and prenatal invasive diagnostic procedures to obtain fetal karyotype. For ongoing pregnancies fetal echocardiographyand detailed second trimester sonographic anomaly screening was performed by a perinatologist/pediatric cardiologist. The demographiccharacteristics of the women and the results of the karyotype analysis were obtained from the database of our hospital and correlated with theobstetric outcomes.Results: Within a five-year period, there were 106 cases of fetal cystic hygroma. Of those, fetal cardiac malformations were detected in fourand micrognathia in one fetus. Eighty-five women underwent fetal invasive procedures and karyotype abnormalities were detected in 52 of thecases. Fetal outcomes of 33 cases with normal karyotype and 21 cases in whom karyotyping analysis were not performed due to patient refusalwere enrolled into the study. Obstetric outcomes of 21 women who refused karyotyping consisted of 13 livebirths, seven missed abortions, andone fetal death, whereas those of 33 women with normal karyotype were; 12 livebirths, 12 missed abortions, two hydrops fetalis, and five fetaldeaths. Nineteen of 33 fetuses with a normal karyotype and eight of 21 fetuses in whom karyotyping was not performed were terminated.Conclusion: The presence of cystic hygroma carries a high risk for fetal karyotype abnormalities and cardiac malformations. The postnataloutcomes of the fetuses with cystic hygroma appeared to be correlated with the absence of structural malformations and karyotype abnormalities.(J Turk Ger Gynecol Assoc 2020; 21: 107-10)
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Objective There is a role of inflammatory processes on the pathophysiology of rheumatic heart valve disease (RHVD). The neutrophil-lymphocyte ratio (NLR) as an inflammatorymarker is associated with some clinical situations in pregnancy. In this study, we aimed to investigate the predictive role of NLR in pregnant women with NLR.Materials and MethodsFirst-trimester pregnant women, who were referred to cardiology outpatient clinic and diagnosed with RHVD (n=24) were enrolled in this study and age-matched healthypregnant women (n=24) were taken as control groups. The two groups were compared in terms of clinical characteristics, echocardiographic findings, and NLR. The roleof NLO in predicting RKKH has been examined.Results Groups were similar in terms of demographic features. NLR was higher in pregnant women with RHVD than the control group (3.68 ±1.74 vs. 2.68±1.14, p=0.00239). NLR(OR: 0,597, p= 0,037, 95% CI: 0,343-0,921) and neutrophil count (OR: 0,609, p= 0.013, 95% CI: 0,390-0,863) were possible independent predictors of RHVD.Conclusion NLR was significantly higher among pregnant women with RHVD. As it is not possible to provide routine cardiac check-up to all pregnant women; markers for specificrisk groups need to be defined to reduce the risks associated with heart diseases during pregnancy. According to these findings, pregnant women with high NLR may needextra attention in terms of CVD like RHVD. Further studies with large patient groups are needed to define the predictive value of NLR.
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Amaç: Postmenopozal kadınlarda serum lipid düzeyleri ve kemik mineralyoğunluğu arasında herhangi bir ilişki olup olmadığını araştırmak.Gereç ve Yöntemler: Bu retrospektif çalışmaya 1 yıllık zaman zarfında kemik mineral yoğunluğu ölçümü yaptıran postmenopozal kadınlar dahil edildi. Kemik mineral yoğunluğu ölçümlerine göre T skor değerleri -1 üzerindeolan kadınlar kontrol grubunu, -2,5 altında olanlar ise osteoporoz grubunuoluşturdu. Lipid profili olarak serum trigliserit (TG), total kolesterol (TK),yüksek yoğunluklu lipoprotein (HDL) ve düşük yoğunluklu lipoprotein (LDL)düzeyleri incelendi.Bulgular: 248 tane kadın çalışma grubunu oluşturdu. Bunların 108 (%43.5)tanesi osteoporoz grubunda yer alırken, 140 (%56.5) tanesi kontrol grubunu yer aldı. Osteopoproz grubundaki kadınların ortalama yaşı, menopozsüresi, TK, HDL, LDL düzeyleri kontrol grubundaki kadınların ortalama değerlerine göre anlamlı derecede daha fazlaydı. Çalışma grubunda, lumbarve femur total kemik mineral yoğunluğu değerleri ile kadın yaşı, menopozsüresi, TK, HDL, LDL değerleri arasında anlamlı şekilde ters yönde ilişki vardı. Ancak lineer regresyon modelinde yaş, menopoz süresi ve HDLdüzeyi, hem vertebra total hem de femur total kemik mineral yoğunluğuile ilişkili anlamlı bağımsız faktörler olarak bulundu. TK ve LDL düzeyi iseistatistiksel olarak anlamlı değildi.Sonuç: Yüksek HDL seviyesi postmenopozal kadınlarda azalmış kemikmineral yoğunluğu ile ilişkilidir ve bu ilişki kadın yaşı ve menopoz süresinden etkilenmez.
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A global public health problem with a high rate spread and transmission, Coronavirus outbreak has become the most talkedabout matter throughout the world. We are severely affected by the nations with vast numbers of deaths; it was hard to predict sucha colossal pandemic with terrifying consequences. Elective surgeries are limited, but situations requiring an urgent gynaecological orobstetric surgical approach must still be performed during the COVID-19 pandemic. Concerns regarding surgical safety and the risk ofviral transmission during surgery are of great importance. In this review, we aimed to summarize the concepts related to laparoscopicgynecological surgery during COVID-19 pandemic in the light of current literature.
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