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Bulent Urman

Koç University, Obstetrics and Gynecology, Faculty Member

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Analysis of factors determining the number of embryos to be transferred after IVF treatment in Turkey, TSRM survey

Turkish Journal of Obstetrics and Gynecology, 2008

OBJECTIVE: To assess the factors that determine the number of embryos to be transferred after ass... more OBJECTIVE: To assess the factors that determine the number of embryos to be transferred after assisted reproduction treatment in Turkey, and compare the number of embryos transferred to that in other European countries. MATERIALS-METHODS: An electronic questionnaire that sought for clinicians' preferences for the number of embryos to be transferred under several scenarios was posted on the Turkish Society of Reproductive Medicine (TSRM) web site. Effects of woman's age, embryo quality, outcome of previous ART treatments, and the presence of primary or secondary infertility on the choice of number of embryos to be transferred was assessed with trend analysis. RESULTS: The number of embryos to be transferred increased linearly with women's age, and increased in the presence of poor prognostic factors such as poor embryo quality and recurrent implantation failure. Respondents chose to transfer less embryos to secondary infertile women. While the clinicians chose to transfer...

Luteal phase support for assisted reproduction treatment cycles - Physicians` preferences in Turkey - A TSRM Survey

Turkish Journal of Obstetrics and Gynecology, 2010

Objective: To assess the luteal phase support practices after assisted reproduction treatment in ... more Objective: To assess the luteal phase support practices after assisted reproduction treatment in Turkey. Materials and Methods: An electronic questionnaire that sought for clinicians' preferences for luteal phase support for assisted reproduction cycles was posted on the Turkish Society of Reproductive Medicine (TSRM) web site. Results: The majority of participants prefer to support the luteal phase regardless of the type of gonadotropin releasing hormone analogue used for pituitary suppression. LPS is started between day of oocyte collection and embryo transfer. Progesterone vaginal gel seems to be the most commonly used agent for LPS. Almost half of participants think estogen should be used as an adjuvant to progesterone. Most participants reported continuing LPS until completion of the first trimester of pregnancy. Conclusions: Current practice of LPS in Turkey seems to be guided with available evidence. However, opinions on controversial aspects of LPS are various, which is ...

Reply: Every established treatment had been experimental at the beginning

Human Reproduction, 2020

Do endometriomas grow during ovarian stimulation for assisted reproduction? A three-dimensional volume analysis before and after ovarian stimulation

Reproductive biomedicine online, 2018

Whether endometriomas grow because of supraphysiological oestradiol levels attained during ovaria... more Whether endometriomas grow because of supraphysiological oestradiol levels attained during ovarian stimulation for assisted reproduction techniques is a concern. In this prospective study, 25 women with 28 endometriomas underwent three-dimensional ultrasound using sono-automated volume calculation software. Endometrioma volume was measured on the first day of gonadotrophin injection (V1) and the day of ovulation trigger (V2). Nine (36%) women were stimulated in a gonadotrophin releasing hormone antagonist protocol (GnRH), 13 (52%) in a long, and three (12%) in an ultra-long GnRH agonist protocol. Mean duration of stimulation was 10.3 days with median total gonadotrophin dose of 4500 IU/day. Median number of cumulus oocyte complexes was five, and metaphase-two oocytes was four. None of the endometriomas were punctured during oocyte retrieval. Median V1 was 22.2 ml (12-30 ml) and median V2 was 24.99 ml (11.2-37.4 ml) with P = 0.001. Twenty-three out of 28 endometriomas (82%) grew to s...

Ovarian and Uterine Functions in Female Survivors of Childhood Cancers

The oncologist, Jan 20, 2017

Adult survivors of childhood cancers are more prone to developing poor reproductive and obstetric... more Adult survivors of childhood cancers are more prone to developing poor reproductive and obstetrical outcomes than their siblings and the general population as a result of previous exposure to chemotherapy and radiation during childhood. Chemotherapy drugs exert cytotoxic effects systemically and therefore can damage the ovaries, leading to infertility, premature ovarian failure, and, to a lesser extent, spontaneous abortions. They have very limited or no deleterious effects on the uterus that can be recognized clinically. By contrast, radiation is detrimental to both the ovaries and the uterus, thereby causing a greater magnitude of adverse effects on the female reproductive function. These include infertility, premature ovarian failure, miscarriage, fetal growth restrictions, perinatal deaths, preterm births, delivery of small-for-gestational-age infants, preeclampsia, and abnormal placentation. Regrettably, the majority of these adverse outcomes arise from radiation-induced uterin...

Thrombophilia and assisted reproduction technology—any detrimental impact or unnecessary overuse?

Journal of Assisted Reproduction and Genetics, 2016

FSH Stimulation promotes progesterone synthesis and output from human granulosa cells without luteinization

Human Reproduction, 2017

Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 2017

The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound gui... more The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound guidance for excision of symptomatic deep intramural myomas that are not otherwise visible at laparoscopy. Seventeen patients with symptomatic deep intramural myomas who underwent laparoscopic myomectomy with intraoperative endoscopic ultrasound guidance were followed up and reported. All myomas were removed successfully. The endometrium was breached in one patient. All patients were relieved of their symptoms and three patients presenting with infertility conceived. There were no short- or long-term complications associated with the procedure. One patient who had multiple myomas necessitated intravenous iron treatment prior to discharge. Laparoscopic removal of small symptomatic deep intramural myomas is facilitated by the use of intraoperative endoscopic ultrasound that enables exact localisation and correct placement of the serosal incision. Impact statement What is already known on this...

Which is worse? Comparison of ART outcome between women with primary or recurrent endometriomas

Human reproduction (Oxford, England), Jan 12, 2017

Are live birth rates (LBR) different after ART cycles between women with primary or recurrent end... more Are live birth rates (LBR) different after ART cycles between women with primary or recurrent endometrioma? Women with recurrent endometrioma have similar LBR as compared to patients with primary endometrioma. Recurrence rate can be as high as 29% after endometrioma excision. Prior studies on management of endometrioma before ART involve primary endometriomas. There is limited information regarding the prognosis of women with recurrent endometriomas. A multicenter retrospective cohort study, including 76 women with primary and 82 women with recurrent endometriomas treated at the participating centers over a 6-year period. Women with endometrioma who underwent ART at three academic ART centers. Couples with another indication for ART were excluded. Female age, median number of prior failed ART cycles, proportion of patients with bilateral endometrioma (28 versus 28.9%), ovarian stimulation protocols, and total gonadotropin consumption were similar between the study groups. Numbers of...

Short and long term outcomes of children conceived with assisted reproductive technology

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

Despite their wide and global use, possible short and long-term effects of fertility treatments o... more Despite their wide and global use, possible short and long-term effects of fertility treatments on children is not well-established. In this review, birth defects and perinatal complications and their relationship with assisted reproductive technology (ART), along with long-term effects of ART on cardiovascular system, metabolism, behavior, cognitive skills, and childhood cancers are discussed. Children conceived through ART are at increased risk for birth defects and perinatal complications such as preterm delivery, low birth weight and small for gestational age. Parental characteristics, underlying infertility etiology and ART procedures themselves may contribute to this. The long-term effects of ART are difficult to establish. Studies so far report that ART children have normal social, emotional, cognitive, and motor functions. Likewise, despite some minor inconsistencies in some studies, they do not seem to be at increased risk for childhood cancers. However, there are a number of studies that imply vascular system may be adversely affected by ART and its possible consequences should be further investigated with follow up studies. Large scale studies with long-term follow up periods are required to determine the effects of ART on conceived children.

Parasitic Myomas and an Adenomyoma Obstructing the Ureter After Power Morcellation of Myomas and Endometriotic Nodule Resection

Journal of Obstetrics and Gynaecology Canada, 2016

The use of power morcellation (PM) in abdominal and pelvic surgery has been discouraged and even ... more The use of power morcellation (PM) in abdominal and pelvic surgery has been discouraged and even banned in some institutions because of the risk of spreading malignant cells, although some authorities maintain that PM can be an appropriate tool for selected patients deemed to be at low risk of malignancy. A 42-year-old woman developed parasitic myomas and an adenomyoma obstructing the right ureter after laparoscopic excision of multiple myomas and deep infiltrating endometriosis using PM. Laparoscopic excision of the parasitic myomas and removal of the adenomyoma relieved the obstruction of the ureter. Although there is reasonable concern about the use of PM spreading malignant disease, benign disease can also be spread by PM and can cause significant complications. Use of PM should be restricted as much as possible.

A biphasic basal body temperature record during pregnancy

Acta Europaea Fertilitatis, 1989

A case of biphasic temperature record is reported during the course of an ectopic pregnancy. Poss... more

Adhesions after Ovarian Drilling and Intercede

Fertility and Sterility, 1994

Midtubal occlusion: etiology, management, and outcome

Fertility and Sterility, 1992

To assess the significance of pathological midtubal occlusion in infertility. Retrospective descr... more To assess the significance of pathological midtubal occlusion in infertility. Retrospective descriptive case review. Tertiary referral center. Sixteen women, 26 to 38 years of age presenting with infertility and diagnosed as having midtubal occlusion. Assessment of the etiology of the occlusive disease and yield of microsurgical tubotubal anastomosis. Histologic examination of occluded tubal segment and fertility outcome subsequent to anastomosis. Occlusion was because of tuberculous salpingitis (n = 6), resolved tubal pregnancy (n = 3), endometriosis (n = 2), chronic inflammatory reaction (n = 1), tubal cyst (n = 1), intratubal adhesions (n = 1), infant hernia repair (n = 1), and calcification (n = 1). Of eight women (including the patient with tuberculous salpingitis) who underwent tubal anastomosis only for midtubal occlusion, three had subsequent term deliveries, two had tubal pregnancies, and three women did not conceive. Midtubal occlusion of the tube because of an infectious process is rare. Excluding tuberculous salpingitis, microsurgical anastomosis yields satisfactory fertility, albeit with significant risk of ectopic pregnancy.

Polikistik Over Sendromlu Kadınlarda Non-IVF Ovülasyon İndüksiyonu

Turkiye Klinikleri Journal of Surgical Medical Sciences, 2007

Does the use of gonadotropin-releasing hormone antagonists in natural IVF cycles for poor responder patients cause more harm than benefit?

Human Fertility, 2016

Poor ovarian response to controlled ovarian stimulation (COS) is one of the most critical factors... more Poor ovarian response to controlled ovarian stimulation (COS) is one of the most critical factors that substantially limits the success of assisted reproduction techniques (ARTs). Natural and modified natural cycle IVF are two options that could be considered as a last resort. Blocking gonadotropin-releasing hormone (GnRH) actions in the endometrium via GnRH receptor antagonism may have a negative impact on endometrial receptivity. We analysed IVF outcomes in 142 natural (n = 30) or modified natural (n = 112) IVF cycles performed in 82 women retrospectively. A significantly lower proportion of natural cycles reached follicular aspiration compared to modified natural cycles (56.7% vs. 85.7%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, the difference between the numbers of IVF cycles ending in embryo transfer (26.7% vs. 44.6%) was not statistically significant between natural cycle and modified natural IVF cycles. Clinical pregnancy (6.7% vs. 7.1%) and live birth rates per initiated cycle (6.7% vs. 5.4%) were similar between the two groups. Notably, the implantation rate was slightly lower in modified natural cycles (16% vs. 25%, p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). There was a trend towards higher clinical pregnancy (25% vs. 16%) and live birth (25% vs. 12%) rates per embryo transfer in natural cycles compared to modified natural cycles, but the differences did not reach statistical significance.

Laparoscopic Repair of Cesarean Scar Defect “isthmocele”

Journal of Minimally Invasive Gynecology, 2016

DEBATE CONTINUED What next for preimplantation genetic screening? A clinician's perspective

Preimplantation genetic screening (PGS) is a technique that has been introduced into clinical pra... more Preimplantation genetic screening (PGS) is a technique that has been introduced into clinical practice to screen and eliminate aneuploid embryos from transfer with the intention to improve implantation rates and decrease pregnancy wastage. Although practiced widely throughout the world, PGS unfortunately has been adopted without being subjected to rigorous scientific validation. Data from recent randomized trials have shed doubt on the efficacy of the procedure when used in women with advanced age, one of the target populations for PGS. Other purported indications for the application of this complicated technique such as recurrent implantation failure and recurrent spontaneous abortion have not been subjected to randomized controlled trials. For the best interest of patients, we feel it is timely for a debate regarding the efficacy and safety of PGS.

Fertility outcome following tubal pregnancy

Acta Europaea fertilitatis

This study was undertaken to analyze the factors associated with fertility outcome following tuba... more This study was undertaken to analyze the factors associated with fertility outcome following tubal pregnancy. Eighty-six patients were analyzed in this regard. The chances of a favourable outcome (intrauterine pregnancy) decreased and an unfavorable outcome (repeated tubal pregnancy or no pregnancy) increased with a history of previous tubal pregnancy and also with an absent or diseased contralateral tube at the time of surgery. History of infertility, prior reconstructive tubal surgery, status of the ipsilateral tube at the time of surgery, the treatment modality (laparoscopy vs laparotomy) or the surgical approach (conservative vs radical) did not significantly affect fertility outcome.

Comparing two embryo transfer catheters. Use of a trial transfer to determine the catheter applied

The Journal of reproductive medicine, 2000

To analyze the performance of two different embryo transfer catheters (Wallace and Frydman) in an... more To analyze the performance of two different embryo transfer catheters (Wallace and Frydman) in an in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) program. Four hundred twenty-eight IVF or ICSI embryo transfer cycles were analyzed. A trial transfer was performed before the initiation of controlled ovarian hyperstimulation to determine the choice of embryo transfer catheter, Wallace or Frydman. Actual transfer was undertaken with the catheter chosen from the trial transfer. During actual embryo transfer, 214 (93.5%) of the intended 229 Wallace transfers were successful, and in 15 transfers the Frydman catheter was used. Of the intended 199 Frydman transfers, all were successful. Clinical pregnancy rate, implantation rate per embryo and ectopic pregnancy rate per transfer for the Wallace catheter were 41.6%, 16% and 0.9%, respectively. Respective rates for the Frydman catheter were 36.0%, 14.4% and 0.9% (P > .05 for all variables). Trial catheterization prevente...

Analysis of factors determining the number of embryos to be transferred after IVF treatment in Turkey, TSRM survey

Turkish Journal of Obstetrics and Gynecology, 2008

OBJECTIVE: To assess the factors that determine the number of embryos to be transferred after ass... more OBJECTIVE: To assess the factors that determine the number of embryos to be transferred after assisted reproduction treatment in Turkey, and compare the number of embryos transferred to that in other European countries. MATERIALS-METHODS: An electronic questionnaire that sought for clinicians' preferences for the number of embryos to be transferred under several scenarios was posted on the Turkish Society of Reproductive Medicine (TSRM) web site. Effects of woman's age, embryo quality, outcome of previous ART treatments, and the presence of primary or secondary infertility on the choice of number of embryos to be transferred was assessed with trend analysis. RESULTS: The number of embryos to be transferred increased linearly with women's age, and increased in the presence of poor prognostic factors such as poor embryo quality and recurrent implantation failure. Respondents chose to transfer less embryos to secondary infertile women. While the clinicians chose to transfer...

Luteal phase support for assisted reproduction treatment cycles - Physicians` preferences in Turkey - A TSRM Survey

Turkish Journal of Obstetrics and Gynecology, 2010

Objective: To assess the luteal phase support practices after assisted reproduction treatment in ... more Objective: To assess the luteal phase support practices after assisted reproduction treatment in Turkey. Materials and Methods: An electronic questionnaire that sought for clinicians' preferences for luteal phase support for assisted reproduction cycles was posted on the Turkish Society of Reproductive Medicine (TSRM) web site. Results: The majority of participants prefer to support the luteal phase regardless of the type of gonadotropin releasing hormone analogue used for pituitary suppression. LPS is started between day of oocyte collection and embryo transfer. Progesterone vaginal gel seems to be the most commonly used agent for LPS. Almost half of participants think estogen should be used as an adjuvant to progesterone. Most participants reported continuing LPS until completion of the first trimester of pregnancy. Conclusions: Current practice of LPS in Turkey seems to be guided with available evidence. However, opinions on controversial aspects of LPS are various, which is ...

Reply: Every established treatment had been experimental at the beginning

Human Reproduction, 2020

Do endometriomas grow during ovarian stimulation for assisted reproduction? A three-dimensional volume analysis before and after ovarian stimulation

Reproductive biomedicine online, 2018

Whether endometriomas grow because of supraphysiological oestradiol levels attained during ovaria... more Whether endometriomas grow because of supraphysiological oestradiol levels attained during ovarian stimulation for assisted reproduction techniques is a concern. In this prospective study, 25 women with 28 endometriomas underwent three-dimensional ultrasound using sono-automated volume calculation software. Endometrioma volume was measured on the first day of gonadotrophin injection (V1) and the day of ovulation trigger (V2). Nine (36%) women were stimulated in a gonadotrophin releasing hormone antagonist protocol (GnRH), 13 (52%) in a long, and three (12%) in an ultra-long GnRH agonist protocol. Mean duration of stimulation was 10.3 days with median total gonadotrophin dose of 4500 IU/day. Median number of cumulus oocyte complexes was five, and metaphase-two oocytes was four. None of the endometriomas were punctured during oocyte retrieval. Median V1 was 22.2 ml (12-30 ml) and median V2 was 24.99 ml (11.2-37.4 ml) with P = 0.001. Twenty-three out of 28 endometriomas (82%) grew to s...

Ovarian and Uterine Functions in Female Survivors of Childhood Cancers

The oncologist, Jan 20, 2017

Adult survivors of childhood cancers are more prone to developing poor reproductive and obstetric... more Adult survivors of childhood cancers are more prone to developing poor reproductive and obstetrical outcomes than their siblings and the general population as a result of previous exposure to chemotherapy and radiation during childhood. Chemotherapy drugs exert cytotoxic effects systemically and therefore can damage the ovaries, leading to infertility, premature ovarian failure, and, to a lesser extent, spontaneous abortions. They have very limited or no deleterious effects on the uterus that can be recognized clinically. By contrast, radiation is detrimental to both the ovaries and the uterus, thereby causing a greater magnitude of adverse effects on the female reproductive function. These include infertility, premature ovarian failure, miscarriage, fetal growth restrictions, perinatal deaths, preterm births, delivery of small-for-gestational-age infants, preeclampsia, and abnormal placentation. Regrettably, the majority of these adverse outcomes arise from radiation-induced uterin...

Thrombophilia and assisted reproduction technology—any detrimental impact or unnecessary overuse?

Journal of Assisted Reproduction and Genetics, 2016

FSH Stimulation promotes progesterone synthesis and output from human granulosa cells without luteinization

Human Reproduction, 2017

Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 2017

The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound gui... more The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound guidance for excision of symptomatic deep intramural myomas that are not otherwise visible at laparoscopy. Seventeen patients with symptomatic deep intramural myomas who underwent laparoscopic myomectomy with intraoperative endoscopic ultrasound guidance were followed up and reported. All myomas were removed successfully. The endometrium was breached in one patient. All patients were relieved of their symptoms and three patients presenting with infertility conceived. There were no short- or long-term complications associated with the procedure. One patient who had multiple myomas necessitated intravenous iron treatment prior to discharge. Laparoscopic removal of small symptomatic deep intramural myomas is facilitated by the use of intraoperative endoscopic ultrasound that enables exact localisation and correct placement of the serosal incision. Impact statement What is already known on this...

Which is worse? Comparison of ART outcome between women with primary or recurrent endometriomas

Human reproduction (Oxford, England), Jan 12, 2017

Are live birth rates (LBR) different after ART cycles between women with primary or recurrent end... more Are live birth rates (LBR) different after ART cycles between women with primary or recurrent endometrioma? Women with recurrent endometrioma have similar LBR as compared to patients with primary endometrioma. Recurrence rate can be as high as 29% after endometrioma excision. Prior studies on management of endometrioma before ART involve primary endometriomas. There is limited information regarding the prognosis of women with recurrent endometriomas. A multicenter retrospective cohort study, including 76 women with primary and 82 women with recurrent endometriomas treated at the participating centers over a 6-year period. Women with endometrioma who underwent ART at three academic ART centers. Couples with another indication for ART were excluded. Female age, median number of prior failed ART cycles, proportion of patients with bilateral endometrioma (28 versus 28.9%), ovarian stimulation protocols, and total gonadotropin consumption were similar between the study groups. Numbers of...

Short and long term outcomes of children conceived with assisted reproductive technology

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016

Despite their wide and global use, possible short and long-term effects of fertility treatments o... more Despite their wide and global use, possible short and long-term effects of fertility treatments on children is not well-established. In this review, birth defects and perinatal complications and their relationship with assisted reproductive technology (ART), along with long-term effects of ART on cardiovascular system, metabolism, behavior, cognitive skills, and childhood cancers are discussed. Children conceived through ART are at increased risk for birth defects and perinatal complications such as preterm delivery, low birth weight and small for gestational age. Parental characteristics, underlying infertility etiology and ART procedures themselves may contribute to this. The long-term effects of ART are difficult to establish. Studies so far report that ART children have normal social, emotional, cognitive, and motor functions. Likewise, despite some minor inconsistencies in some studies, they do not seem to be at increased risk for childhood cancers. However, there are a number of studies that imply vascular system may be adversely affected by ART and its possible consequences should be further investigated with follow up studies. Large scale studies with long-term follow up periods are required to determine the effects of ART on conceived children.

Parasitic Myomas and an Adenomyoma Obstructing the Ureter After Power Morcellation of Myomas and Endometriotic Nodule Resection

Journal of Obstetrics and Gynaecology Canada, 2016

The use of power morcellation (PM) in abdominal and pelvic surgery has been discouraged and even ... more The use of power morcellation (PM) in abdominal and pelvic surgery has been discouraged and even banned in some institutions because of the risk of spreading malignant cells, although some authorities maintain that PM can be an appropriate tool for selected patients deemed to be at low risk of malignancy. A 42-year-old woman developed parasitic myomas and an adenomyoma obstructing the right ureter after laparoscopic excision of multiple myomas and deep infiltrating endometriosis using PM. Laparoscopic excision of the parasitic myomas and removal of the adenomyoma relieved the obstruction of the ureter. Although there is reasonable concern about the use of PM spreading malignant disease, benign disease can also be spread by PM and can cause significant complications. Use of PM should be restricted as much as possible.

A biphasic basal body temperature record during pregnancy

Acta Europaea Fertilitatis, 1989

A case of biphasic temperature record is reported during the course of an ectopic pregnancy. Poss... more

Adhesions after Ovarian Drilling and Intercede

Fertility and Sterility, 1994

Midtubal occlusion: etiology, management, and outcome

Fertility and Sterility, 1992

To assess the significance of pathological midtubal occlusion in infertility. Retrospective descr... more To assess the significance of pathological midtubal occlusion in infertility. Retrospective descriptive case review. Tertiary referral center. Sixteen women, 26 to 38 years of age presenting with infertility and diagnosed as having midtubal occlusion. Assessment of the etiology of the occlusive disease and yield of microsurgical tubotubal anastomosis. Histologic examination of occluded tubal segment and fertility outcome subsequent to anastomosis. Occlusion was because of tuberculous salpingitis (n = 6), resolved tubal pregnancy (n = 3), endometriosis (n = 2), chronic inflammatory reaction (n = 1), tubal cyst (n = 1), intratubal adhesions (n = 1), infant hernia repair (n = 1), and calcification (n = 1). Of eight women (including the patient with tuberculous salpingitis) who underwent tubal anastomosis only for midtubal occlusion, three had subsequent term deliveries, two had tubal pregnancies, and three women did not conceive. Midtubal occlusion of the tube because of an infectious process is rare. Excluding tuberculous salpingitis, microsurgical anastomosis yields satisfactory fertility, albeit with significant risk of ectopic pregnancy.

Polikistik Over Sendromlu Kadınlarda Non-IVF Ovülasyon İndüksiyonu

Turkiye Klinikleri Journal of Surgical Medical Sciences, 2007

Does the use of gonadotropin-releasing hormone antagonists in natural IVF cycles for poor responder patients cause more harm than benefit?

Human Fertility, 2016

Poor ovarian response to controlled ovarian stimulation (COS) is one of the most critical factors... more Poor ovarian response to controlled ovarian stimulation (COS) is one of the most critical factors that substantially limits the success of assisted reproduction techniques (ARTs). Natural and modified natural cycle IVF are two options that could be considered as a last resort. Blocking gonadotropin-releasing hormone (GnRH) actions in the endometrium via GnRH receptor antagonism may have a negative impact on endometrial receptivity. We analysed IVF outcomes in 142 natural (n = 30) or modified natural (n = 112) IVF cycles performed in 82 women retrospectively. A significantly lower proportion of natural cycles reached follicular aspiration compared to modified natural cycles (56.7% vs. 85.7%, p &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). However, the difference between the numbers of IVF cycles ending in embryo transfer (26.7% vs. 44.6%) was not statistically significant between natural cycle and modified natural IVF cycles. Clinical pregnancy (6.7% vs. 7.1%) and live birth rates per initiated cycle (6.7% vs. 5.4%) were similar between the two groups. Notably, the implantation rate was slightly lower in modified natural cycles (16% vs. 25%, p &amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). There was a trend towards higher clinical pregnancy (25% vs. 16%) and live birth (25% vs. 12%) rates per embryo transfer in natural cycles compared to modified natural cycles, but the differences did not reach statistical significance.

Laparoscopic Repair of Cesarean Scar Defect “isthmocele”

Journal of Minimally Invasive Gynecology, 2016

DEBATE CONTINUED What next for preimplantation genetic screening? A clinician's perspective

Preimplantation genetic screening (PGS) is a technique that has been introduced into clinical pra... more Preimplantation genetic screening (PGS) is a technique that has been introduced into clinical practice to screen and eliminate aneuploid embryos from transfer with the intention to improve implantation rates and decrease pregnancy wastage. Although practiced widely throughout the world, PGS unfortunately has been adopted without being subjected to rigorous scientific validation. Data from recent randomized trials have shed doubt on the efficacy of the procedure when used in women with advanced age, one of the target populations for PGS. Other purported indications for the application of this complicated technique such as recurrent implantation failure and recurrent spontaneous abortion have not been subjected to randomized controlled trials. For the best interest of patients, we feel it is timely for a debate regarding the efficacy and safety of PGS.

Fertility outcome following tubal pregnancy

Acta Europaea fertilitatis

This study was undertaken to analyze the factors associated with fertility outcome following tuba... more This study was undertaken to analyze the factors associated with fertility outcome following tubal pregnancy. Eighty-six patients were analyzed in this regard. The chances of a favourable outcome (intrauterine pregnancy) decreased and an unfavorable outcome (repeated tubal pregnancy or no pregnancy) increased with a history of previous tubal pregnancy and also with an absent or diseased contralateral tube at the time of surgery. History of infertility, prior reconstructive tubal surgery, status of the ipsilateral tube at the time of surgery, the treatment modality (laparoscopy vs laparotomy) or the surgical approach (conservative vs radical) did not significantly affect fertility outcome.

Comparing two embryo transfer catheters. Use of a trial transfer to determine the catheter applied

The Journal of reproductive medicine, 2000

To analyze the performance of two different embryo transfer catheters (Wallace and Frydman) in an... more To analyze the performance of two different embryo transfer catheters (Wallace and Frydman) in an in vitro fertilization (IVF)-intracytoplasmic sperm injection (ICSI) program. Four hundred twenty-eight IVF or ICSI embryo transfer cycles were analyzed. A trial transfer was performed before the initiation of controlled ovarian hyperstimulation to determine the choice of embryo transfer catheter, Wallace or Frydman. Actual transfer was undertaken with the catheter chosen from the trial transfer. During actual embryo transfer, 214 (93.5%) of the intended 229 Wallace transfers were successful, and in 15 transfers the Frydman catheter was used. Of the intended 199 Frydman transfers, all were successful. Clinical pregnancy rate, implantation rate per embryo and ectopic pregnancy rate per transfer for the Wallace catheter were 41.6%, 16% and 0.9%, respectively. Respective rates for the Frydman catheter were 36.0%, 14.4% and 0.9% (P > .05 for all variables). Trial catheterization prevente...