ICSI for selected oocytes within a batch--save for the 2nd time around? Intracytoplasmic sperm injection.
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Cytoplasm↗
Biomedical subjects
H Yarali
Publications and source records attributed to H Yarali.
Follicle-stimulating hormone levels on cycle day 3 to predict ovarian response in women undergoing controlled ovarian hyperstimulation for in vitro fertilization using a flare-up protocol.
OBJECTIVE: To determine whether cycle day 3 serum FSH levels predict poor ovarian response and cycle cancellation in women undergoing controlled ovarian hyperstimulation (COH) for IVF. DESIGN: Prospective case series. SETTING: University hospital IVF program. PATIENT(S): The study includes outcomes of 637 initial cycles of IVF. INTERVENTION(S): Controlled ovarian hyperstimulation was undertaken with a short, flare-up GnRH agonist and hMG protocol. The relation of cycle day 3 FSH levels with various cycle characteristics and outcomes was determined. MAIN OUTCOME MEASURE(S): The accuracy of cycle day 3 FSH levels in predicting poor ovarian response and cycle cancellation was evaluated. Receiver operating characteristic curves were constructed to determine the optimum cutoff value for the cycle day 3 serum FSH level that best predicted poor ovarian response and cycle cancellation. RESULT(S): A cycle day 3 serum FSH level > or = 13 mIU/mL (conversion factor to SI unit, 1.00) was associated with a high likelihood of poor ovarian response and cycle cancellation. The sensitivity, specificity, and positive likelihood ratio of an FSH level of 13 mIU/mL in predicting cycle cancellation were 52%, 91%, and 6.04, respectively. CONCLUSION(S): Cycle day 3 FSH screening appears to be a fairly accurate predictor of poor ovarian response and cycle cancellation in women undergoing COH using a short, flare-up GnRH agonist and hMG protocol.
Adult↗
Results of in vitro fertilization and embryo transfer in women with infertility due to genital tuberculosis.
OBJECTIVE: To determine the results of IVF-ET in women with infertility due to genital tuberculosis. DESIGN: Retrospective case-control study. SETTING: In vitro fertilization and ET unit of a university hospital. PATIENTS: Forty-four cycles of IVF-ET were undertaken in 24 women with genital tuberculosis and the results were compared with 366 cycles in 274 nontuberculous tubal factor couples. INTERVENTIONS: All women with genital tuberculosis were evaluated with hysteroscopy, endometrial biopsy, and acid fast bacilli stain before treatment with IVF-ET. RESULTS: Subjects with genital tuberculosis had higher basal FSH levels, required more exogenous gonadotropins for controlled ovarian hyperstimulation, reached lower peak E2 levels, and yielded fewer oocytes and embryos when compared with tubal factor patients. Furthermore, in women with genital tuberculosis, clinical pregnancy rate per cycle was lower and spontaneous abortion rate was higher. CONCLUSIONS: Women with genital tuberculosis appear to represent a less favorable subset within other tubal factor patients when treated with IVF-ET.
Adult↗
Adhesion formation and reformation after laparoscopic removal of ovarian endometriomas.
STUDY OBJECTIVE: To evaluate the extent of adhesion formation after laparoscopic removal of endometriomas. DESIGN: Prospective case series. SETTING: A university hospital. PATIENTS: Nineteen infertile women with ovarian endometriomas. INTERVENTIONS: All patients underwent laparoscopic cystectomy with total stripping of the cyst capsule when possible. A second-look laparoscopy was performed after 3 months of postoperative treatment with a gonadotropin-releasing hormone analog. MEASUREMENTS AND MAIN RESULTS: The extent of adhesion reformation was dependent on the extent and severity of adhesions at initial laparoscopy. One (5.2%) woman had a residual ovarian endometrioma at second-look laparoscopy. De novo adhesion formation was not seen. Nine women (42.8%) conceived during the postoperative follow-up period (range 11-22 mo). CONCLUSIONS: Laparoscopic removal of endometriomas is effective in eradicating the disease. Adhesions at second-look laparoscopy depend on adhesions at the initial laparoscopy. Crude pregnancy rates are satisfactory in infertile women.
Adult↗
Pregnancy Outcome, and Adhesion Formation and Reformation after Laparoscopic Cystectomy of Ovarian Endmetriomas
Unilateral or bilateral cystectomy for endometriomas was performed in 90 infertile women. Using a multipuncture technique, a cortical incision was made on the medial aspect of the ovary with sharp-tipped unipolar coagulation. Cystectomy was performed by stripping the cyst capsule from the normal ovarian cortex with the aid of atraumatic grasping forceps. If the capsule removal was incomplete due to technical difficulties, the remaining capsular fragments were vaporized with the carbon dioxide laser. Endometriosis implants elsewhere in the pelvis were vaporized and adhesions, if present, were lysed. The ovarian cortex was closed with a few interrupted 6-0 polyglactin sutures using extracorporeal knot technique. A second-look laparoscopy was performed in 25 patients to evaluate adhesion formation, reformation, postoperative crude pregnancy rates, and factors that would predict conception.
Journal Article↗
Uterine rupture following hysteroscopic lysis of synechiae due to tuberculosis and uterine perforation.
A patient with genital tuberculosis who conceived with in-vitro fertilization and embryo transfer following hysteroscopic synechiolysis complicated by a fundal uterine perforation subsequently presented with uterine rupture at 36 weeks gestation. Immediate Caesarean section and repair of the ruptured uterus were performed. Women with a history of uterine perforation should be counselled regarding the risk of uterine rupture during their subsequent pregnancies.
Adult↗
A new type of CO2 laser avoids power density loss due to absorption and the blooming effect by the CO2 gas environment.
The aim of this study was to compare the acute tissue effects of a standard CO2 laser (Ultrapulse 5000) with a new design (Ultrapulse 5000L) that utilizes a different carbon isotope (C13) in the rat uterine horn model. Following laparotomy, measured laser injuries were effected with the Ultrapulse 5000 or Ultrapulse 5000L lasers via a laparoscope using CO2 or air for insufflation. Serial sections of the lesions were, thereafter, obtained to evaluate depth and width of total injury, width of defect and thermal damage zone. When CO2 was used as the insufflating gas, Ultrapulse 5000L laser was associated with significantly deeper lesions compared to the Ultrapulse 5000 system for the two tested pulsed energy levels (P < 0.0001). The width of total injury and thermal damage zone were significantly less with the former laser compared to the latter. The width of the defect was, however, significantly larger with the Ultrapulse 5000L laser for the 200 millijoule pulsed energy level, whereas it was comparable for the 75 millijoule level. When air was used as the insufflation gas, all four parameters of tissue injury were comparable between the two types of laser (P > 0.05). The adverse effects on the CO2 laser beam and the resultant altered tissue effects that occur in a regular CO2 environment are avoided by the use of the Ultrapulse 5000L or an air environment.
Air↗
Diagnosis of early tubal pregnancy by salpingoscopy.
Salpingoscopy was performed to diagnose any early tubal pregnancy that could not be identified at laparoscopy. The procedure may prove to be a valuable tool in such cases not only for diagnosis but also as a guide to proper endoscopic treatment by determining the site of the gestation.
Adult↗
The results of in vitro fertilization-embryo transfer in couples with unexplained infertility failing to conceive with superovulation and intrauterine insemination.
OBJECTIVE: To determine the results of IVF-ET in couples with long-standing unexplained infertility who had failed to conceive with four to six cycles of superovulation and IUI. DESIGN: Retrospective case control series. SETTING: University IVF-ET center. PATIENTS: One hundred seventeen couples with unexplained infertility who had failed to conceive with superovulation and IUI underwent 157 cycles of IVF-ET. Results were compared with 194 tubal factor couples subjected to 250 IVF-ET cycles within the same time period. RESULTS: Total fertilization failure events were more common (20.4% versus 7.6%) and tended to be repetitive in couples with unexplained infertility. When total fertilization failure events were excluded, fertilization rates (57.8% versus 60.9%) and cumulative clinical pregnancy rates over three cycles (55.4% versus 46.5%) were similar in unexplained infertility and tubal disease groups. CONCLUSIONS: Couples with unexplained infertility failing to conceive with superovulation and IUI have a favorable outcome when treated subsequently with IVF-ET. Conception rates similar to couples with tubal disease may be expected despite a higher incidence of total fertilization failure events.
Adult↗
Salpingoscopic findings in women with occlusive and nonocclusive salpingitis isthmica nodosa.
STUDY OBJECTIVE: To characterize ampullary endosalpingeal findings in women with occlusive or nonocclusive salpingitis isthmica nodosa. DESIGN: Prospective case study. SETTING: Obstetrics and Gynecology Department of a University Hospital. PATIENTS: Twenty women (38 tubes) with occlusive or nonocclusive salpingitis isthmica nodosa were studied. INTERVENTIONS: Salpingoscopy was performed during diagnostic laparoscopy in 20 women (38 tubes) with hysterosalpingographic evidence of salpingitis isthmica nodosa. MAIN OUTCOME MEASURES: Salpingoscopic findings were recorded and the patients were managed accordingly. RESULTS: Of the 38 tubes 10 appeared radiographically and laparoscopically normal. Two tubes were occluded distally. Of the 26 tubes with occlusive or nonocclusive salpingitis isthmica nodosa, 5 (19.2%) showed varying degrees of endosalpingeal abnormality. Patients with abnormal salpingoscopy were regarded as having bipolar tubal disease and were referred for assisted conception. The remaining patients were scheduled for microsurgical tubal reconstruction. CONCLUSIONS: One in five patients with proximal tubal disease may have ampullary endosalpingeal damage of varying degrees. However, the significance of this finding in relation to subsequent management strategies and fertility outcome is yet to be characterized.
Adult↗
Results of Second-Look Laparoscopy Following Removal of Endometriomata
Despite widespread use of operative laparoscopy for removal of endometriomata, there are inadequate data regarding subsequent adhesion formation. We performed second look laparoscopy (SLL) within 6 months of laparoscopic endometriosis cystectomy in 21 infertile women. Mean age and mean duration of infertility were 30.5 ± 4.4 and 7.1 ± 4.9 years respectively. Cysts were removed with the following technique: incision of the ovarian cortex, cystoscopy (biopsy when necessary), and total stripping of the cyst capsule. All patients received postoperative suppressive therapy for 3 months. Total AFS score decreased significantly in all patients (34.1 ± 14.7 vs 12.3 ± 10.7; P<0.001). The adhesion score assessed at SLL improved in 3 (14.3%) remained the same in 13 (61.9%) and worsened in 5 (23.8%). Mean adhesion score at SLL was significantly less compared with adhesion score during cystectomy (7.1 ± 5.2 vs 8.7 ± 6.4; P=0.038). None of the patients had de novo adhesions. Adhesion scores were similar in women where ovarian cortical defect was left open or suture closed. Of the 21 women, 4 (19%) conceived within six months of SLL. In conclusion, laparoscopic removal of ovarian endometriomata was not associated with increased adhesion formation at SLL. Adhesions at SLL were mainly dependent upon adhesions at laparoscopic cystectomy.
Journal Article↗
Colour Doppler hysterosalpingosonography: a simple and potentially useful method to evaluate fallopian tubal patency.
The diagnostic efficacy of colour Doppler hysterosalpingosonography to evaluate Fallopian tubal patency was studied in 17 women. Of the 17 women, 12 were infertile and the remaining five were fertile and requested elective tubal ligation. Colour Doppler sonography was performed using the transabdominal approach 1-4 weeks after diagnostic laparoscopy during infertility work-up in the former, and 1-2 weeks after bilateral isthmic tubal ligation in the latter group. Sterile saline was used as the contrast agent. Laparoscopic chromopertubation was considered as the gold standard. The sensitivity and specificity of colour Doppler sonography were found to be 93 and 83%, respectively. A kappa value of 0.73 reflected good clinical agreement between the two techniques. Colour Doppler hysterosalpingosonography is concluded to be a relatively accurate and simple procedure to test tubal patency. The other advantages include absence of radiation and avoidance of potential allergic reactions to iodinated contrast agents employed for hysterosalpingography. However, the inability to delineate the inner architecture of the genital canal and to determine the exact location of tubal obstruction, when present, remain the disadvantages of this technique.
Color↗
Evaluation of the sites of ectopic pregnancies subsequent to reconstructive tubal surgery.
The sites of ectopic pregnancies in women who underwent various types of reconstructive tubal surgery were analysed and compared to the controls. Overall, ectopic pregnancies subsequent to all types of tubal surgeries were more often implanted proximally compared to the control population.
Fallopian Tubes↗
Laparoscopic treatment of polycystic ovarian disease.
There has been a recent surge of interest in laparoscopic treatment of polycystic ovarian disease (PCOD) that is unresponsive to first-line ovulation-inducing agents. Laparoscopic treatment options include multiple ovarian punch biopsy, ovarian electrocauterization and laser vaporization or photo-coagulation. These procedures are relatively easy to perform, devoid of major complications, and yield satisfactory ovulation and conception rates. Adhesion formation, however, is a potential complication following such procedures. Furthermore, women subjected to laparoscopic destructive ovarian procedures also need to be critically assessed regarding other long-term risks, such as premature ovarian failure. Laparoscopic treatment of PCOD, at present, should be viewed as experimental awaiting further trials assessing its long-term safety.
Electrocoagulation↗
Hyaluronic acid membrane for reducing adhesion formation and reformation in the rat uterine horn.
The efficacy of hyaluronic acid (HA) membrane in preventing or reducing intraperitoneal adhesion formation and reformation was evaluated in the rat uterine horn. Forty-seven Wistar rats were employed. Following a measured laser injury on the right uterine horn of each rat, HA membrane was applied to cover the site of injury in 20 (HA membrane group). No membrane was applied in another 20 (control group). The type and extent of adhesions were assessed at relaparotomy. Following microsurgical adhesiolysis at second-look laparotomy, the same animals were randomized to the HA membrane and control groups. The type and extent of adhesion reformation were evaluated at third-look laparotomy. Following a similar injury on the right uterine horn in another seven rats, HA membrane was applied on both uterine horns. A repeat laparotomy was performed three hours later to assess the status of the membrane. The type and extent of adhesion formation and reformation were comparable between the HA membrane and control groups. The HA membrane did not remain on the uterine horn and gelled rapidly. Hyaluronic acid membrane was ineffective in reducing adhesion formation and reformation in the rat uterine horn.
Animals↗
Fluid accumulation in the uterine cavity due to obstruction of the endocervical canal in a patient undergoing in vitro fertilization and embryo transfer.
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Adult↗
The ascites in the ovarian hyperstimulation syndrome does not originate from the ovary.
OBJECTIVE: To evaluate the direct ovarian contribution to ascites formation in the ovarian hyperstimulation syndrome (OHSS) in a rabbit model. DESIGN: Prospective experimental study. SETTING: Research center of a university teaching hospital. PARTICIPANTS: New Zealand White rabbits. INTERVENTIONS: Both ovaries of the rabbits in the experimental group were enclosed within a pouch developed from the surrounding peritoneum and mesosalpinx by microsurgery. Animals in the control group did not undergo any surgical intervention. Ovarian hyperstimulation was induced by alternate day equine chorionic gonadotropin and intermittent human chorionic gonadotropin (hCG). MAIN OUTCOME MEASURES: Degree of ascites formation and the morphological and endocrinologic signs of ovarian hyperstimulation. RESULTS: The serial plasma estradiol and progesterone levels, ovarian weights, and ascites response were not statistically different between the two groups. CONCLUSIONS: Isolation of both ovaries from the peritoneal cavity does not prevent ascites formation in the OHSS. Increased transudation across extraovarian serosal surfaces contributes to ascites formation in OHSS.
Animals↗
Pelvic-peritoneal tuberculosis with elevated serum and peritoneal fluid Ca-125 levels. A report of two cases.
We report 2 patients with pelvic-peritoneal tuberculosis and elevated serum and peritoneal fluid levels of Ca-125. The first was a young and infertile women who had cul-de-sac nodularity and dysmenorrhea. The other was postmenopausal and presented with weight loss and ascites. While a preoperative diagnosis of endometriosis was made in the former, intraperitoneal malignancy was considered in the latter. The diagnosis of pelvic-peritoneal tuberculosis was reached by laparoscopic-directed biopsy in both patients. Serum levels of Ca-125 returned to normal limits following antituberculous drug treatment.
Adnexal Diseases↗