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    Comparison of ovulation induction treatments in intrauterine insemination; A retrospective study in a tertiary center
    (2020) Ege, Serhat
    Aim: In this study, were compared of different ovarian stimulation drugs used in intrauterine insemination ( IUI) cycles. Material and Methods: The records of 3420 infertile patients who presented to the outpatient clinic were retrospectively analyzed. The patients were evaluated into three groups ( n=421). 170 patients who received letrozole treatment were included in group 1, 50 patients who received Clomiphene citrate (CC) treatment were included in group 2, and 201 patients who received gonadotropins treatment were included in group 3.Results: The mean numbers of follicles were in IUI cycles stimulated with the use of letrozole (1.5± 0.6), CC (1.6 ± 0.6), and gonadotropins (1.6 ± 0.7). After stimulation with letrozole, CC and gonadotropins, pregnancy rates were 13(7.6%), 6(12%) and 19(9.4%); Abortion rates were 2(1.1%), 1(2%) and 3(1.4%). Multiple pregnancy occurred in, 1/170 (0.58%), 1/50 (2%) and 2/201 (0.99%) in the letrozole, CC and gonadotropins groups.Conclusion: After stimulation with treatment protocols; pregnancy rates, abortion rates, and multiple pregnancy rates were similar.The question that this study set out to answer was of effectiveness. Different ovarian stimulation protocols used in IUI programs, clinical opportunities, experience of the person, does affect the results of the study.
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    Comparison of pregnancy outcomes in CC resistance PCOS patients undergoing CC plus letrozole and intra uterine insemination treatment with different follicular diameters
    (2020) Ege, Serhat
    Aim: Using Clomiphene citrate (CC) plus letrozole combination to determine the effect of follicular diameter on pregnancy outcomes in CC resistance Polycystic ovary syndrome (PCOS) patients during intra uterine insemination cycles. Material and Methods: The records of infertile patients who presented to the outpatient clinic were retrospectively analysed. PCOS was diagnosed in 536 (23%) patients, 71 (18%) of whom had CC-resistant PCOS using CC plus letrozole. The patients were divided into two groups; follicular diameter 17-19 mm (group 1, n = 31) and 20-22 mm (group 2, n = 40).Results: The pregnancy rate in group 1 was 20% (6/30), the abortion rate was 17% (1/6), and the multiple pregnancy rate was 17% (1/6). In group 2, the pregnancy rate was 17% (7/41), the abortion rate was 14% (1/7) and the multiple pregnancy rate was 14% (1/7). There was no statistically significant between-group difference in the pregnancy (p =0.3), abortion (p = 0.8) or multiple pregnancy rates (p =0.8).Conclusion: In PCOS patients with CC plus letrozole and intra uterine insemination ovulation induction, pregnancy rate is not related to follicular size between 17-22 mm on hCG day. Although there was no direct relationship between follicular size and endometrial thickness, it was found that delaying HCG was not significant for better results.
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    Comparison of total laparoscopic hysterectomy and abdominal hysterectomy; A retrospective study in a tertiary center southeastern Turkey
    (2020) Erdem, Selami; Ege, Serhat
    Aim: This study aimed to compare the morbidities of abdominal and laparoscopic hysterectomies to determine the most appropriate hysterectomy method and to identify possible risks when planning surgery. Material and Methods: The records of 50 patients who underwent abdominal hysterectomy (group 1) and 213 patients who underwent total laparoscopic hysterectomy (group 2) between January 2017 and March 2018 in our obstetrics and gynecology clinic were reviewed retrospectively. Results: In patients included in our study, the analgesic requirement was found to be significantly higher in Group 1 than in Group 2 (4.62±1.41 and 4.02±1.54, respectively). While the mean hospital stays in group 1 was significantly higher than in group 2 (2.56 ± 1.24 days, 2.07 ± 0.76 days, respectively), the mean operation time was higher in group 2 than in group 1 (96.70 ± 40.85 min and 141.29 ± 42.35 min, respectively). The postoperative hematoma and urethral injury is seen in group 2 were significantly higher than group 1 (p=0.04 and p=0.04, respectively).Conclusion: The advantages of laparoscopic hysterectomy were shorter duration of hospitalization and less analgesic needs, while the disadvantage of this method was the longer duration of surgery, greater the risk of urinary system complications, and the need for a turn to laparotomy. Therefore, when planning laparoscopy, peri-operative preparations should be made in terms of long surgical time and management of possible complications.
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    Controlled ovarian hyperstimulation with gonadotropins for Clomiphene Citrate resistant Polycystic ovary syndrome leads to a higher risk of ovarian hyperstimulation syndrome
    (2021) Ege, Serhat
    Ovarian hyperstimulation syndrome (OHSS) caused by controlled ovarian hyperstimulation ,although usually regressing spontaneously, may occasionally occur with clomiphene citrate, typically with gonadotropin, which sometimes results in serious complications. 25-year-old patient was followed up in our hospital due to OHSS. Since our patient was Clomiphene Citrate (CC) resistant Polycystic ovary syndrome (PCOS), follitropin alpha was started. Firstly, treatment started from 75 IU rFSH. Increased to 150 IU on day 15, if no improvement in the ovaries. Due to the development of two 18 mm follicles on the 21 st day and the E2 value being 773 pg/mL, human chorionic gonadotropin (hCG) was applied and insemination was performed. Patients with CC resistant PCOS represent a challenge for reproductive medicine. We propose a calculated low-dose stimulation strategy with step- up according to ovarian response in gonadotropins protocols. If the treatment period is extended and the dose is increased; Even if the follow-up values are normal, the patient should be closely monitored to avoid OHSS.