Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Remedies for Recurrent Implantation Failure(2014) Zeyneloglu, Hulusi Bulent; Onalan, Gogsen; https://orcid.org/0000-0002-0289-2642; 24919029; B-6487-2009; GZG-9810-2022In vitro fertilization (IVF) is expensive, time consuming, and the most successful treatment of fertility; however, in general the cumulative chance of having a live birth with the treatment is still around 40%. Many couples still remain unsuccessful after several IVF attempts, causing deep impact on quality of life, and each failed cycle causing a financial burden. Several adjuvant therapies have been used along with IVF to increase the pregnancy rates for women with repeated implantation failure. Testing of adjuvant therapies in properly conducted randomized controlled trials is rarely done so that potential benefits and risks are unlikely to be clearly presented to patients and clinicians. In this review, we assessed the effects of adjuvants, such as growth hormone, androgens, and glucocorticoids to enhance oocyte number and quality; sildenafil, low-dose aspirin, heparin, corticosteroids, granulocyte colony-stimulating factor, endometrial injury, intrauterine injection of human chorionic gonadotropin, and intrauterine administration of autologous peripheral blood mononuclear cells to improve poor endometrial response; antioxidants, complementary and alternative medicine modalities, such as Chinese herbal medicine and acupuncture; and assisted hatching and preimplantation genetic screening to correct embryonic factors.Item The relationship between thyroid autoimmunity and poor response to ovarian stimulation in in vitro fertilization women with infertility(2022) Akdulum, Munire Funda Cevher; Erdem, Mehmet; Barut, Gunel; Demirdag, Erhan; Iyidir, oezlem Turhan; Guler, Ismail; Erdem, Ahmet; 35971933Introduction: Thyroid autoimmunity (TAI) is the most common autoimmune disorder. Patients with TAI are usually euthyroid, and the pres-ence of anti-thyroid peroxidase (anti-TPO) in patients with or without thyroid dysfunction is associated with infertility, recurrent em-bryo implantation failure, and early pregnancy loss. We aimed to investigate the relationship between low ovarian reserve, pregnancy outcomes, and TAI. Material and methods: This retrospective cohort study was conducted in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients between 2010 and 2018. All patients (n = 1400) for whom thyroid autoantibody testing was requested were detected. A study group was formed from patients with anti-TPO positivity (n = 363). The control group (n = 555) comprised euthyroid anti-TPO negative patients matched to the study group regarding age and body mass index (BMI). Results: Mean serum TSH value was 2.35 +/- 1.70 mIU/mL in anti-TPO-positive patients and 1.81 +/- 1.2 mIU/mL in controls, and the dif-ference was significant (p < 0.05). Total dose of gonadotropins used in ovulation induction in anti-TPO-positive and control patients were 3000 IU and 2700 IU, respectively, and the difference was statistically significant (p < 0.05). The number of metaphase 2 oocytes was significantly lower in the anti-TPO-positive group (p < 0.05). Embryo transfer number and embryo grade were significantly lower in the anti-TPO-positive group (p < 0.01). Poor ovarian response was significantly higher in anti-TPO-positive patients (40%) as compared to anti-TPO-negative controls (30%) (p < 0.01). Clinical pregnancy rate was significantly lower in the anti-TPO-positive group (29.2%), as compared to the antibody-negative group (38.4%) (p < 0.01). Conclusions: There are controversial data regarding the impact of antithyroid antibodies on ovarian reserve and pregnancy outcome after IVF treatment. The results of this study indicate that there was a relationship between TAI and poor ovarian response, and that TAI adversely affects IVF outcomes. Further investigations are required to explore the mechanism behind these effects. (Endokrynol Pol 2022; 73 (4): 699-705)Item Extended culture of cleavage-stage embryos in vitrified-thawed cycles may be an alternative to frozen and thawed blastocysts during in vitro fertilization(2021) Aytac, Pinar C.; Kilicdag, Esra B.; 34308730Aim We compared the clinical outcomes of vitrified-thawed cycles during in vitro fertilization (IVF) for frozen and thawed blastocysts compared to cleavage-stage embryos that were frozen, thawed and extended culture to the blastocyst stage. Material and methods Between January 2014 and December 2016, 908 frozen-thawed cycles were included in the study. After removing cycles that met exclusion criteria, clinical outcomes for 355 cleavage-stage embryos with extended blastocyst culture (Group I) were compared with 279 frozen and thawed blastocysts (Group II). Results Cryo-survival rate of the two groups were similar (96.7% versus 95.0%). Implantation rates (28.9% versus 22.4%, p = .04) and clinical pregnancy rates (37.2% versus 27.9%, p = .03) were higher in Group I. Pregnancy, live birth and abortus rates were similar in both groups. Although overall abortus rates were similar in both groups, abortus rates before 12 weeks of gestation were higher in Group I, and chemical abortus rates were higher in Group II (p = .03, p = .04). Weeks of gestation at birth and birth weight were similar in both groups. Conclusions The use of extended blastocyst culture of cleavage-stage embryos was not inferior to frozen and thawed blastocysts. Freezing at the cleavage-stage can provide similar cryo-survival rates than blastocyst vitrification. Vitrifying surplus or all embryos for storage at the cleavage-stage allows higher implantation and clinical pregnancy rates. But after abortus, live birth rates were similar in both groups.Item Psychological domain of quality of life, depression and anxiety levels inin vitrofertilization/intracytoplasmic sperm injection cycles of women with endometriosis: a prospective stud(2020) Ceran, M. U.; Yilmaz, N.; Ugurlu, E. N.; Erkal, N.; Ozgu-Erdinc, A. S.; Tasci, Y.; Gulerman, H. C.; Engin-Ustun, Y.; 0000-0003-1923-2373; 32635772Objective To evaluate the psychological domain of quality of life (PDQoL), anxiety and depression levels of infertile women with endometriosis versus non endometriosis who applied for Assisted Reproductive Technologies (ART). Method This prospective case-control study compromised a total of 105 women who applied for IVF/ICSI program. Ninety-three women were divided into two groups as endometriosis (n = 37) and non-endometriosis (n = 56) after 12 patients who refused to participate in the study were excluded. The WHOQOL-BREF questionnaire, Beck Depression and Anxiety Inventory scales were used to determine the psychological stress levels. Results A significant difference was found between the endometriosis and non-endometriosis groups regarding depression scores, while no significant difference was reported with respect to PDQoL and anxiety (p < 0.01,p = 0.897 andp = 0.058, respectively). A weak but significant correlation was observed between depression and endometriosis (CC: 0.435,p < 0.01). Though anxiety scores were found to be higher in endometriosis group this can not reach statistical significance (p = 0.058). Impact of PDQoL, depression and anxiety scores on pregnancy outcomes were found to be insignificant. Conclusion Women with endometriosis seem to be more susceptible to depression and anxiety than women without endometriosis. Although infertility treatment outcomes are not found to be significantly affected, the impact of depression and anxiety over ART treatment success merit further research.Item Granulocyte colony-stimulating factor for intracytoplasmic sperm injection patients with repeated implantation failure: which route is best?dagger(2019) Zeyneloglu, Hulusi Bulent; Tohma, Yusuf Aytac; Onalan, Gogsen; Moran, Utkun; 0000-0002-0289-2642; 0000-0001-9418-4733; 31496328; B-6487-2009The aim of this study was to assess whether the dual administration of granulocyte colony-stimulating factor (G-CSF) increases the effect of only systemic administration in patients with RIF. This retrospective study included 111 infertile normoresponder cases with two or more unsuccessful in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) treatments, despite the transfer of good quality embryos. Patients were divided into three groups according to using G-CSF and administration route; Group 1 included patients who received subcutaneous (SC) G-CSF only (n = 38), Group 2 comprised patients who received both intrauterine (IU) and SC G-CSF (n = 39), the control group included patients who did not receive G-CSF who were matched by age (n = 34). The IU route of G-CSF was employed on ovulation triggering day. G-CSF was administered via an IU insemination catheter. SC injection was started on the day of oocyte retrieval and administered for 15 days at 100,000 IU/kg. Foetal cardiac activity (clinical pregnancy) was present in 50 patients (46.2%) after embryo transfer, with 20 patients included in SC group (Group 1) (52.6%), 25 in SC + IU group (Group 2) (64.1%) and 8 (23.5%) in control group and significant difference was observed between groups (p: .001). Pregnancy resulted in live birth in 43 patients (39.8%), with 13 patients belonging in Group 1 (34.2%), 25 in Group 2 (61.5%) and 8 (23.5%) in control group; significant differences were observed between groups (p: .001). In conclusion, our results showed that dual administration of G-CSF was significantly more effective that the SC only method.Impact statement What is already known on this subject? A number of studies reported the possible benefits of granulocyte colony-stimulating factor (G-CSF) administration in recurrent implantation failure (RIF) and recurrent pregnancy loss patients; however, it is unclear which administration route is better. What do the results of this study add? Our results showed that G-CSF is a promising and safe agent for increasing live birth rates in patients with RIF. Additionally, dual administration is considered the better method than SC only administration.Item GnRH agonist versus HCG triggering in different IVF/ICSI cycles of same patients: a retrospective study(2019) Yilmaz, Nafiye; Ceran, Mehmet Ufuk; Ugurlu, Evin Nil; Gulerman, Hacer Cavidan; Engin Ustun, Yaprak; 0000-0003-1923-2373; 31791167The aim of this study was to assess Gonadotropin Releasing Hormone agonist (GnRHa) trigger results of fresh in vitro fertilisation (IVF), Intracytoplasmic Sperm Injection (ICSI) cycles in high-responder patients. Thirty-six high-responder patients, undergoing GnRH antagonist protocol combined with GnRHa trigger for final oocyte maturation, were included. All cycles were autologous fresh transfer cycles. Fifteen of 36 patients had previous IVF/ICSI cycles triggered with human chorionic gonadotropin (hCG) and both cycles of these patients were compared. The mean fertilisation rate, blastocyst development and clinical pregnancy rates were 67%, 44.4% and 44.4%, respectively. The hCG and GnRHa trigger cycles of the same patients were compared as two groups (n: 15). 2PN oocyte counts were significantly higher in agonist trigger cycles (p .048). There were no differences in terms of M2 oocyte count and fertilisation rate. The blastocyst formation and clinical pregnancy rates for hCG and GnRHa trigger cycles were 33.3-66.7% and 13.3-46.7%, respectively. These results were found to be 2-fold and 3.5-fold higher, but not statistically significant. GnRHa trigger in combination with LPS is a good option for final oocyte maturation due to its good pregnancy outcomes and virtually eliminating OHSS risks.IMPACT STATEMENT What is already known on this subject? Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of Ovarian Hyperstimulation Syndrome (OHSS) on IVF cycles using antagonist protocol. What do the results of this study add? The main strength of this study is the comparison of different triggers in different cycles of the same patients. GnRHa trigger in combination with Luteal Phase Support (LPS) is a good option for final oocyte maturation due to its good pregnancy outcomes and virtually eliminating OHSS risks.