Murat Arslan

The objective of this study was to evaluate predictive value of cervical volume and length measurement for preterm delivery in low-risk pregnancies by transvaginal ultrasound. Two hundred fifty pregnant women were underwent ultrasound examination at 22 weeks of gestation by transvaginal route. Cervical length, width, and anteroposterior diameters were measured and cervical volume was calculated. All subjects were observed until term. Predictive values of cervical length and cervical volume were calculated and compared with predict preterm delivery. Preterm delivery occurred in 18 patients (7.2%). Mean cervical length and volume were statistically different between term and preterm delivered patients ( P = 0.001). Areas under curves were 0.913 for cervical volume and 0.923 for cervical length; this difference was not statistically significant ( P = 0.289). Sensitivity of cervical volume was 73.3% for 32-mL cut-off value with 12.85% false-positive rate and cervical length had 80% sensitivity at the 33.15-mm cut-off value with 12.7% false-positive rate. Cervical volume measurement by two-dimensional ultrasound did not add any benefit compared with the cervical length measurement for prediction of preterm delivery.

The objective of this study was to examine maternal and fetal endothelin-1 (ET-1) in pregnancies complicated with intrauterine growth restriction (IUGR) and to correlate these data with umbilical artery Doppler flow velocity waveforms (FVW). Higher mean maternal (13.8 +/- 6.4 vs 9.2 +/- 3.4 pmol/L, p < 0.05) and fetal (18.5 +/- 9.6 vs 11.7 +/- 6.9 pmol/L, p < 0.05) ET-1 levels were found in pregnancies complicated with IUGR than in controls. Fetal ET-1 level was related to birth weight percentile for gestational week. Maternal and fetal ET-1 concentrations were not related to umbilical artery Doppler flow S/D ratio, PI and RI. Maternal or fetal ET-1 concentrations were also not related to umbilical artery pH, PO2 and PCO2. Pregnancy-induced hypertension was significantly associated with an elevated fetal and maternal ET-1 concentration. In conclusion, increased production and secretion of ET-1 may play a role in the pathophysiology of idiopathic IUGR. Over-production of ET-1 in IUGR is not associated with increased placental resistance as reflected in abnormal umbilical artery Doppler FVW.

To investigate the relation between ultrasound-based ovarian volume and antral follicle counts and hormonal parameters of ovarian reserve in a group of women with normal reproductive health. Prospective study. One hundred eight women with at least one previous pregnancy reaching term were divided into three age groups (group 1 = 35-39 years, group 2 = 40-44 years, and group 3 = 45-50 years). Basal hormone measurements and transvaginal ultrasonography estimation of ovarian volume and follicle counts were performed in the early follicular phase (day 3) of the menstrual cycle. There were significant differences in FSH (P < .0001) and E2 (P < .002) levels when group I was compared to groups II and III. There was a significant decrease in mean follicle counts (MFC) between groups I and III (P < .05). The decrease in mean ovarian volume (MOV) with age was not statistically significant. Age strongly correlated with MFC (r = -.38, P < .001) and weakly with MOV (r = -.29, P < .05). However, basal FSH correlated positively with age (r = .50, P < .001) and negatively with MOV (r = -.590, P < .001) and MFC (r = -.658, P < .001). Basal E2 correlated with MOV (r = .50, P < .001) and MFC (r = .50, P…

To evaluate the relationship of endothelin 1 (ET-1) and leptin concentrations in women and newborns following a pregnancy complicated with intrauterine growth restriction (IUGR). Twenty-five women with a pregnancy complicated with IUGR at 19 different gestational ages were matched with women with uncomplicated pregnancies. Blood samples from the umbilical artery and maternal peripheral venous circulation were collected at delivery, and ET-1 and leptin levels were determined from the blood samples. Data relating to obstetric complications (e.g., pregnancy-induced hypertension), delivery (e.g. mode, birth weight, signs of intrapartum fetal distress, and Apgar scores) were also recorded. Mean maternal ET-1 (13.4+/-6.2-9.9+/-2.9 pmol/l) and mean fetal ET-1 (14.5+/-4.2-11.7+/-3.1 pmol/l) concentrations were significantly higher when women had experienced pregnancies complicated with IUGR than when they had had normal pregnancies. Mean fetal leptin concentration was significantly lower in the study group (6.8+/-2.2 ng/ml) than in the control group (10.6+/-3.6 ng/ml (P<0.05). However, fetal leptin per kilogram of fetal weight was not significantly different in the study group (3.16+/-1.18 ng/ml) than in the control group (3.23+/-0.96 ng/ml) (P>0.05, paired t-test). However, a statistically significant correlation was observed between fetal leptin concentrations per kilogram of fetal weight and fetal endothelin concentrations in pregnancies complicated with IUGR (r=0.546; P<0.05). These results suggest the intertwined roles of ET-1 and leptin in the pathophysiology of IUGR. Further studies concerning interaction between these peptides in different pregnancy conditions may provide important information about the actions of ET-1 and leptin on fetal growth.

To study the efficacy of the aromatase inhibitor letrozole as adjuvant to recombinant FSH (rFSH) in controlled ovarian hyperstimulation (COH).Prospective, randomized, and blinded clinical study.Academic tertiary institute.Forty-one patients with unexplained infertility undergoing intrauterine insemination (IUI) therapy were randomized to receive either letrozole or clomiphene citrate (CC) as adjuvants to rFSH.From day 3 to 7 of the cycle 2.5 mg/d letrozole or 100 mg/d CC were administrated. All patients received 75 IU rFSH starting on day 7 of stimulation until the day of hCG administration. Ovulation was triggered with recombinant hCG (250 μg) when the leading follicle(s) reached 18 mm in diameter. A single IUI was performed 36 hours later. The luteal phase was supplemented with micronized progesterone vaginally.Ovarian stimulation response (E2 levels and number of follicles) was our primary outcome.There were no differences in demographic characteristics between groups. Although there was a significantly lower peak serum E2 level in the group receiving letrozole + rFSH compared with CC + rFSH (914 ± 187 vs. 1,207 ± 309 pg/mL, respectively; P<.007), there were no differences in the number of mature (>16 mm) preovulatory follicles. A significantly higher endometrial thickness was observed at the time of hCG administration in patients that received letrozole (9.5 ± 1.5 mm vs. 7.3 ± 1.1 mm; P=.0001). The clinical pregnancy rate was similar between groups (23.8% vs. 20%, respectively).The aromatase inhibitor letrozole appears to constitute a good alternative to CC in patients with unexplained infertility undergoing gonadotropin-stimulated COH cycles combined with IUI therapy.

The hemizona assay (HZA) is an established functional test that examines in vitro sperm–zona pellucida binding capacity with high predictive power for fertilization outcome in IVF. The objective of this study was to evaluate the value of the HZA as a predictor of pregnancy in patients undergoing controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI).Prospective clinical study.Academic center.Eighty-two couples with unexplained or male factor infertility that underwent 313 IUI cycles.Basic semen analysis and HZA were performed within three months of starting COH/IUI therapy.Hemizona index (HZI) and clinical pregnancy.Overall, patients with an HZI of <30 had a significantly lower pregnancy rate compared to patients with an HZI of ≥30 (11.1% vs. 40.6%, respectively; P<.05; relative risk for failure to conceive: 1.5 (confidence interval 1.2–1.9)). In all patients combined, and in the range of HZI 0–60, the duration of infertility (P=.000) and the HZI (P=.004) were significant determinants of conception (receiver operating characteristics (ROC) analysis). In couples with male infertility, the average path velocity and HZI were significant predictors of conception (P=.001 and P=.005, respectively, ROC analysis). The negative and positive predictive values of the HZA for pregnancy were 93% and 69%, respectively. Logistic regression analysis provided models of HZI (P=.021) and duration of infertility (P=.037) with highest predictability of conception in male factor and unexplained infertility groups, respectively.The HZA predicted pregnancy in the IUI setting with high sensitivity and negative predictive value in couples with male infertility. Results of this sperm function test are useful in counseling couples before allocating them into COH/IUI therapy.

Purpose: To investigate the effect of the cumulative exposure to estradiol (E2) during the follicular phase on IVF outcome. Methods: Patients were stimulated with recombinant FSH after GnRH agonist suppression and had a day 3-embryo transfer. Estrogen exposure was determined as the area under the curve (AUC) for serum E2 levels measured from the first day of stimulation through the day after hCG administration. Results: E2 AUC thresholds for 10th and 90th percentiles were 4704 pg/ml and 16338 pg/ml, respectively. The pregnancy and implantation rates were highest in the 10th–90th percentile group, and were statistically higher in this group than in the >90th percentile group (54.6% vs. 33.3% and 24.8% and 12.9%, respectively, for pregnancy and implantation rates, P < 0.05). Recovered mature oocytes, fertilization, and number and mean score of transferred embryos were similar. Conclusions: High cumulative E2 exposure during the follicular phase of IVF cycles has detrimental effects on implantation.