OBJECTIVE: In frozen-thawed embryo transfer cycles, preparing a synchronous endometrium for the
embryo is essential. The aim of this study is to provide individualized luteal support in hormonally replaced frozen-thawed embryo transfer cycles and to evaluate mid-luteal serum progesterone levels and
pregnancy outcomes.
STUDY DESIGN: In this prospective cohort study, 30 patients were included in a university hospital in
a six month period. Serum progesterone level on embryo transfer day was monitored, and if it was found
to be below the lower limits defined by previous studies (10 ng/mL), additional 100 mg intramuscular micronized progesterone was administered once. Mid-luteal progesterone levels and pregnancy outcomes
were recorded.
RESULTS: There was no significant difference between mid-luteal progesterone levels of the patients
whose transfer day progesterone was above and below 10 ng/mL (p=0.481). Although the clinical pregnancy rate tended to be higher in patients whose mid-luteal progesterone was above 10 ng/mL, it was
also not statistically significant.
CONCLUSION: This is the first study in which vaginal progesterone treatment was supported by intramuscular progesterone according to serum progesterone values for the purpose of individualized progesterone support. A significant difference was not found in pregnancy outcomes. However, further
studies are required to optimize management and improve pregnancy rates in hormonally treated
frozen-thawed embryo transfer cycles.
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Objective: To present the reference range of the fetal thymus gland according to gestational age groups.
Methods: In this prospective study, fetal thymus size was assessed in singleton, uncomplicated pregnancies between 19 and 38 weeks of gestation in our outpatient clinic between 2019 and 2020. Based on their monthly pregnancy follow-ups, fetal thymus measurement was divided into 5 gestational age groups (Group 1: 19–22 weeks, Group 2: 23–26 weeks, Group 3: 27–30 weeks, Group 4: 31–34 weeks, and Group
5: 35–38 weeks).
Results: Fetal thymus measurements of 210 patients were performed over one year, and as a result, 184 pregnant patients were included for
assessment. Fetal thymus could be visualized at a rate of 93.5%. The 5th percentile of thymus transverse diameter, antero-posterior diameter, perimeter, thymus anterior-posterior diameter to thoracic diameter, and thymus perimeter to thoracic circumference were 11.03 mm,
5.60 mm, 32.52 mm, 0.33, and 0.32 in Group 1; 13.53 mm, 7.66 mm, 43.67 mm, 0.34, and 0.32 in Group 2; 20.43 mm, 11.22 mm, 47.72
mm, 0.33, and 0.32 in Group 3; 27 mm, 12.98 mm, 55.88 mm, 0.32, and 0.30 in Group 4; 28 mm, 13.59 mm, 63.4 mm, 0.32, and 0.30 in
Group 5; respectively. Spearman’s rho correlation coefficients for the thymic measurements were 0.879, 0.869, 0.846, 0.236, and 0.267
respectively, and all p-values were less than 0.001. As a result of linear regression analysis between thymus measurements and BPD; the equations for the optimal models are as follows: thymus transverse diameter= -3.49+0.4×BPD (mm) (r=0.826, R2
=0.682, p<0.001), thymus anterior-posterior diameter= -2.48+0.22×BPD (mm) (r=0.808, R2
=0.653, p<0.001), thymus perimeter= -14.37+1.21×BPD (mm) (r=0.814,
R2
=0.663, p<0.001), thymus anterior-posterior diameter /thoracic diameter= 0.38+7.76E-4×BPD (r=0.213, R2
=0.045, p=0.004) and thymus
perimeter/thoracic circumference= 0.35+1.02E-3×BPD (r=0.263, R2
=0.069, p<0.001). Thymus transverse diameter, anterior-posterior diameter, and perimeter increased linearly with increasing biparietal diameter (BPD).
Conclusion: We established the reference ranges of fetal thymus size. Thymus transverse diameter, antero-posterior diameter, and thymus
perimeter have a strong relationship with gestational age and are easy and reproducible. Therefore, the knowledge of reference ranges of
fetal thymus will enable the evaluation of thymic aplasia/hypoplasia
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Amaç: Gebeliğin sürdürülmesi için gerekli olan progesteron, gebeliğin 10. haftasına kadar korpus luteum ve sonras›nda plasenta tarafından üretilir. Bu çalışmanın amacı, gebeliğin 6–8 ile 12. haftasındaölçülen serum progesteron konsantrasyonları ile üçüncü trimesterdeplasental disfonksiyonu ortaya koyabilecek parametreler arasındakiilişkiyi araştırmaktır.Yöntem: Gebeliğin 6–8. haftaları ve 12. haftasında ölçülen progesteron değerleri ile gebelikte hipertansif bozukluklar, intrauterin gelişme geriliği, preterm doğum ve düşük doğum ağırlığı gibi plasentaldisfonksiyon belirtileri arasındaki ilişki değerlendirildi. Ayrıca, dahaönceki bir çalışmaya dayanarak, erken gebelik döneminde 11ng/mL’nin üzerindeki ve altındaki progesteron seviyelerine göre ikigrup oluşturuldu ve gestasyonel sonuçlar yönünden bu gruplar arasındaki farklılık incelendi.Bulgular: Gebeliğin 6–8. haftaları ve 12. haftasındaki progesteronkonsantrasyonları, plasental disfonksiyona işaret eden gebelik komplikasyonlarına sahip olan ve olmayan alt gruplar arasında anlamlı şekilde farklı değildi (tüm parametreler için p>0.05). Gebeliğin 6–8. haftalarındaki 11 ng/mL’lik progesteron eşik değeri nedeniyle üçüncütrimester komplikasyonları yönünden iki grup arasında anlaml farklılık bulunmadı.Sonuç: Bu çalışmada, birinci trimesterin erken ve geç dönemlerinde ölçülen progesteron değerlerinin üçüncü trimesterdeki plasental disfonksiyon ile ilişkili olmadığı sonucuna ulaştık. Ayrıca, gestasyonel sonucu öngörmek için daha önce önerilen eşik değeri valide etmedik. Bu nedenle, rutin birinci trimester progesteron taraması gebelik takibini yönlendirmede uygun olmayabilir.
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Amaç: ‹n vitro fertilizasyon (IVF) sonras› gebelikler, çeflitli çal›flmalarda
tutarl› flekilde gösterildi¤i üzere do¤al konsepsiyona k›-
yasla daha az olumlu sonuç ile iliflkilidir. Ancak bu sorunun ard›ndaki
etiyolojik faktörler henüz aç›klanamam›flt›r. Çal›flmam›zda,
infertilite etiyolojisinin IVF gebeliklerdeki kötü gebelik sonuçlar›
üzerinde bir rolü olup olmad›¤›n› göstermeyi amaçlad›k.
Yöntem: Bu retrospektif olgu kontrol çal›flmas›nda IVF ve spontane
tekil gebelikler incelendi. ‹nfertil hastalar, infertilite etiyolojisine
göre alt› gruba ayr›ld› (anovülasyon, erkek faktörü, tubal faktör,
endometriyoz, aç›klanamayan infertilite ve düflük over rezervi).
Preeklampsi, gestasyonel diabetes mellitus, gebeli¤in intrahepatik
kolestaz›, preterm do¤um ve do¤um a¤›rl›¤› uyuflmazl›klar›-
n›n insidans› gruplar ve alt gruplar aras›nda incelendi. Her infertilite
alt grubu için demografik veriler, transferde embriyo aflamas›
(blastokiste karfl› klevaj aflamas›) ve taze dondurulmufl embriyo
transfer durumu gibi kar›fl›kl›¤a neden olan de¤iflkenler düzeltildikten
sonra, multinomiyal lojistik regresyon analizi kullan›larak
gebelik sonuçlar› üzerindeki etki araflt›r›ld›.
Bulgular: Çal›flmaya IVF grubunda 934 hasta ve kontrol grubunda
1009 hasta dahil edildi. Advers gebelik sonuçlar› kontrol grubuna
k›yasla genel infertilite grubunda daha s›kken, kar›flt›r›c› de¤iflkenlerin
ç›kar›lmas› sonras›nda infertilite etiyolojisinin bu sonuçlar
üzerindeki do¤rudan etkisi gösterilememifltir.
Sonuç: IVF gebeliklerde, artm›fl kötü gebelik sonucu risklerinin
ço¤unun maternal özelliklerle (örne¤in yafl ve vücut kitle indeksi)
ve infertilite etiyolojisinden ziyade tedavi protokolleriyle aç›klanabildi¤
i görülmektedir. Hekimler hastalara dan›flmanl›k verirken bu
riskleri dikkate almal›d›r.
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OBJECTIVE: Placenta previa may cause massive hemorrhage at antenatal, intrapartum or postpartumperiods and is one of the leading causes of maternal morbidity and mortality. Anterior or posterior location of placenta previa can change cesarean technique and management of the operation. Aim of thisstudy is to assess factors increasing intraoperative complications in patients with placenta previa and investigate the significance of anterior placenta location apart from other factors.STUDY DESIGN: This is a retrospective cohort study which was conducted in one center including 83patients followed with placenta previa in three years’ duration. Placental location, presence, and depthof myometrial invasion, previous uterine surgery and the type of uterine incision were evaluated.Intraoperative hemorrhage, need for blood transfusion and hysterectomy, complete blood count parameters of mother and newborn were compared between the anterior and posterior placenta previa.RESULTS: Previous uterine surgery, abnormally invasive placenta and need for blood transfusion weresignificantly higher in patients with anterior placenta previa. The increasing number of previous cesareanoperations enhanced placental invasion to cesarean scar area in anterior placentation, leading to higherrates of blood transfusion, classical incision, and hysterectomy. Also, when the patients with previouscesarean or classical incision were excluded, anterior placentation differed significantly when comparedwith posterior placentation with respect to hemoglobin differences between preoperative and postoperative values.CONCLUSION: Anterior location of placenta previa increases hemorrhagic complications. Placental location, presence, and depth of invasion should be assessed and timing of delivery should be plannedwith appropriate preparation of blood products before delivery.
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Gülşen Doğan DURDAĞ ,
Gizem BEKTAŞ ,
Esengül TÜRKYILMAZ ,
Halime GÖKTEPE ,
Meltem SÖNMEZER ,
Yavuz Emre ŞÜKÜR ,
Batuhan ÖZMEN ,
Cem Somer ATABEKOĞLU ,
Bülent BERKER ,
Ruşen AYTAÇ ,
Murat SONMEZER
Objective: Progestins are used as an alternative to gonadotropin releasing hormone (GnRH) antagonists to suppress premature luteinizing hormone (LH) surge and a flexible protocol has been defined recently. The aim of this study was to compare the efficacy of flexible protocols with dydrogesterone and GnRH antagonist in suppressing LH surge. Material and Methods: This retrospective, case-control study, was conducted in an infertility unit of a tertiary university hospital. A daily dose of 40 mg dydrogesterone was compared with GnRH antagonist (GnRHant) in controlled ovarian hyperstimulation cycles between July 2018 and July 2019. Dydrogesterone was started when the leading follicle was 12 mm or serum estradiol was over 300 pg/mL. A subgroup analysis of poor responder patients was also performed. Results: In total there were 105 subjects aged between 23 and 41 years, 52 in the dydrogesterone group and 53 in the GnRHant group. Duration of pituitary suppression was longer in dydrogesterone group. Premature ovulation was observed in 11.5% (6/52) and 0% in the dydrogesterone and GnRHant groups, respectively. However, collected oocyte counts and metaphase II oocyte counts were found to be similar between the groups. The six patients with premature ovulation were in poor responder subgroup. Conclusion: Dydrogesterone can be used as an alternative to antagonist regimen in patients where embryo transfer is not planned in the same cycle. However, flexible regimen may not be appropriate in patients with diminished ovarian reserve, as advanced follicular maturation and delayed suppressive effect of oral progesterone may cause premature ovulation. Randomized controlled trials in particular patient groups are required to determine the most effective minimum dose and time of application to ensure treatment success. (J Turk Ger Gynecol Assoc 2021; 22: 293-9)
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Background/aim: To investigate the utility of preoperative serum cancer antigen 125 (CA 125) levels in type 1 endometrial carcinoma (EC) as a marker for determining poor prognostic factors and survival. Material and methods: All patients with endometrial cancer, who had been treated between 2012 and 2020, were retrospectively reviewed, and finally, 256 patients with type 1 endometrium carcinoma were included in the study. The relationship between the clinicopathological characteristics, CA 125 level, and survival rates were analyzed. The cut-off value for the preoperative serum CA 125 level was defined as 16 IU/L. Results: The median serum CA 125 levels were significantly higher in patients with deep myometrial invasion, lymph node metastasis, lymphovascular space invasion, cervical stromal and adnexal involvement, advanced stage, positive peritoneal cytology, recurrence, and adjuvant therapy requirement. Serum CA 125 cut-off values determined according to clinicopathologic factors ranged from 15.3 to 22.9 IU/L (sensitivity 61%–77%, specificity 52%–73%). The disease-specific survival rate was significantly higher in patients with CA 125 levels < 16 IU/L (P = 0.047). Conclusion: The data showed that choosing a lower threshold value for the CA 125 level (16 IU/L) instead of 35 IU/L, could be more useful in type 1 EC patients with negative prognostic factors. Key words: Cancer antigen 125 (CA 125), cut-off value, endometrial carcinoma, prognosis, survival
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OBJECTIVE: To analyze demographic and clinical data of patients who resorted to oocyte freezing between January 2014 and December 2018.
STUDY DESIGN: Patients who applied to the Reproductive Endocrinology and Infertility Unit of Ankara
University School of Medicine between January 2014 and December 2018 with the request of oocyte
freezing were included in this study. The files and computer records of the patients were analyzed retrospectively and sociodemographic, clinical and laboratory data were evaluated.
RESULTS: A total of 46 cycles were recorded in 40 patients over a 5-year period. The main indications
were low ovarian reserve and/or advanced age (68.3%) and malignancy diagnosis (31.7%). There was
a significant difference between elective fertility preservation and oncofertility preservation (Onco-FP)
groups in terms of the age (38.4±4.7 vs 28.4±6.1; p=0.001). There was a significant difference between
two groups in favor of oncofertility group in terms of anti-Mullerian hormone level, basal follicle-stimulating hormone level, antral follicle count, trigger day estradiol (E2) level, number of obtained oocytes,
MII oocytes, and frozen oocytes
CONCLUSION: According to our study, the most prominent oocyte cryopreservation indication was advanced age and/or low ovarian reserve. The number of oocytes collected from patients in the Onco-FP
group and thus the number of frozen oocytes was significantly higher than in the elective fertility preservation group, due to younger ages and better ovarian reserve in the Onco-FP group. Abdominal administration of the technique is particularly important for virgin patients in our country. Oocyte freezing is a
fertility protection method available in a wide range of indications for reproductive-aged women.
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Objective: Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes.Material and Methods: Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center.Results: Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery.Conclusion: Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures. (J Turk Ger Gynecol Assoc 2021; 22: 22-8)
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OBJECTIVE: This study investigated the cases in which the fetal ascending aorta is larger than the main pulmonary artery on the three-vessel view and aimed to determine the relationship between the larger ascending aorta and major cardiac anomalies. STUDY DESIGN: Pregnancies between 18-24 gestational weeks who underwent detailed secondtrimester screening during 2015-2019 were evaluated. Cases whose fetal ascending aorta diameter was larger than fetal main pulmonary artery diameter on the three-vessel view despite normal four-chamber view were analyzed. Prenatal and postnatal echocardiography studies were performed for each case. RESULTS: Fetal ascending aorta diameter larger than fetal main pulmonary artery diameter on the three-vessel view despite normal four-chamber view was detected in 21 fetuses in a total of 3810 pregnancies (0.55%), and 10 (47.6%) of them had major congenital heart disease. The diagnosis of Tetralogy of Fallot, double outlet right ventricle, ventricular septal defect, pulmonary valve stenosis, and moderate to severe tricuspid regurgitation were confirmed with prenatal/postnatal echocardiography studies. The highest ratio of ascending aorta/main pulmonary artery was 1.4 in a fetus with a double outlet right ventricle and pulmonary valve stenosis. CONCLUSION: The fetal ratio of ascending aorta/main pulmonary artery larger than 1 on the three-vessel view may be a sign of certain cardiac anomalies. Nevertheless, this rate is not an indicator of a serious cardiac defect in all cases. Fetal advanced echocardiography and early postnatal cardiac evaluation should be done to confirm the diagnosis.
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