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    Noninvasive assessment of classic and high PPROM using cervicovaginal podocalyxin and nephrin: Findings from a prospective observational study
    (Lippincott Williams & Wilkins, 2025) Kali, Zercan; Karli, Pervin; Karabulut, Umran; Cagiran, Fatma Tanilir; Kirici, Pinar; Ege, Serhat
    This study assesses the diagnostic and prognostic value of cervicovaginal amniotic fluid (CVAF) podocalyxin (PDX) and nephrin levels in pregnancies with classic and high preterm premature rupture of membranes (PPROM), focusing on neonatal outcomes. This prospective study included 144 singleton pregnancies between 22 and 34 weeks, classified as classic PPROM (n = 74), high PPROM (n = 32), and controls (n = 38). CVAF and serum samples were analyzed using enzyme-linked immunosorbent assay to quantify PDX and nephrin levels. Receiver operating characteristic curves evaluated diagnostic performance. Logistic regression identified predictors of respiratory distress syndrome and bronchopulmonary dysplasia. CVAF PDX and nephrin levels were significantly higher in the classic PPROM group (35.05 +/- 5.55 and 12.88 +/- 3.85 ng/mL, respectively) compared to high PPROM and control groups. Receiver operating characteristic analysis demonstrated excellent diagnostic performance for distinguishing classic PPROM, with area under the curve values of 0.92 (95% confidence interval [CI]: 0.88-0.96) for PDX and 0.93 (95% CI: 0.89-0.97) for nephrin. In multivariable logistic regression, elevated PDX was independently associated with bronchopulmonary dysplasia (odds ratio = 1.32, 95% CI: 1.10-1.59), while elevated nephrin predicted respiratory distress syndrome (odds ratio = 1.18, 95% CI: 1.02-1.36). These findings support their utility as noninvasive biomarkers for both diagnosis and risk stratification in PPROM. CVAF PDX and nephrin demonstrated significant diagnostic and prognostic value in differentiating PPROM subtypes and may be useful for neonatal risk stratification. These findings suggest that CVAF PDX and nephrin levels may serve as noninvasive tools for early identification of high-risk PPROM cases, potentially guiding timely intervention and targeted neonatal care.
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    PTX3 as a key modulator of functional ovarian response in PCOS: evaluation alongside TSG-6 and ITI
    (Bmc, 2025) Kali, Zercan; Karabulut, Umran; Memur, Tuba; Cagiran, Fatma Tanilir; Mavral, Nihal; Kirici, Pinar
    ObjectiveTo investigate the relationship between follicular fluid pentraxin 3 (PTX-3) levels and ovarian response, embryo quality, and insulin resistance (IR) in patients with polycystic ovary syndrome (PCOS) undergoing IVF/ICSI.MethodsA total of 130 women were enrolled and categorized into three groups: lean PCOS (n = 43), overweight PCOS (n = 42), and unexplained infertility (UEI, n = 45). Patients with endocrine disorders, chronic inflammatory diseases, or recent hormonal therapy (within 3 months) were excluded. Follicular fluid (FF) and serum PTX-3 levels were measured using ELISA. Subgroup analyses were performed according to BMI and HOMA-IR status. Correlations between FF PTX-3 and clinical, hormonal, and embryological parameters were assessed. ROC curve analysis and multivariate linear regression were used to evaluate the diagnostic and predictive value of FF biomarkers for follicular output rate (FORT).ResultsFF PTX-3 levels were significantly higher in both lean (23.31 +/- 1.33 ng/mL) and overweight PCOS patients (12.54 +/- 1.05 ng/mL) compared to UEI controls (7.01 +/- 0.54 ng/mL; p = 0.029). Notably, PTX-3 remained elevated in lean PCOS despite a lower BMI, supporting its role in intrinsic ovarian inflammation. FF PTX-3 showed significant positive correlations with total testosterone (r = 0.580), AFC (r = 0.598), and oocyte count (r = 0.532), but was inversely associated with high-quality embryo number (r = - 0.482), 2PN count (r = - 0.312), and FORT (r = - 0.418). ROC analysis demonstrated moderate diagnostic performance of PTX-3 for predicting suboptimal FORT (AUC = 0.77; cut-off: 20.4 ng/mL). In multivariate analysis, FF PTX-3 (beta = - 0.65, p = 0.001), TSG-6 (beta = - 0.42), and ITI (beta = - 0.37) were independent negative predictors of FORT, while AFC was positively associated.ConclusionElevated follicular PTX-3 levels are linked to hyperandrogenism and ovarian reserve in PCOS, but may impair embryo quality and functional follicular response. PTX-3 may serve as a potential biomarker of ovarian inflammation and compromised oocyte competence, independent of BMI or systemic insulin resistance.
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    The role of prokineticins in recurrent implantation failure
    (Elsevier Masson, Corp Off, 2020) Karaer, Abdullah; Tuncay, Gorkem; Uysal, Onur; Sevimli, Tugba Semerci; Sahin, Nurhan; Karabulut, Umran; Sariboyaci, Ayla Eker
    The aim of the present study was to investigate the expression patterns of prokineticins (PROK) and prokineticin receptors (PROKR) in the endometrium of women with recurrent implantation failure (RIF). Fifteen (15) women with RIF and 15 fertile controls were enrolled in this study. Endometrial samples were taken from study participants with an endometrial biopsy cannula during the implantation window. Real time polymerase chain reaction and immunohistochemistry were used to determine PROK/PROKR mRNA expression and protein localization, respectively. PROK1 mRNA levels were 6.09 times higher compared to endometrial samples obtained from women with RIF than in samples obtained from fertile controls, whereas PROKR1 mRNA levels were 2.46 times lower in endometrial samples obtained from women with RIF than in samples from fertile controls. In addition, decreased PROKR1 was supported by immunohistochemistry analysis at protein level. There was no statistically significant difference between women with RIF and fertile controls regarding PROK2 and PROKR2 levels. Altered expression of the PROK1/PROKR1 system could be one of the numerous abnormalities in the endometrium of women with RIF. (C) 2020 Elsevier Masson SAS. All rights reserved.
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    Stress in couples undergoing assisted reproductive technology
    (Springer Heidelberg, 2020) Tuncay, Gorkem; Yildiz, Sedat; Karaer, Abdullah; Reyhani, Ismail; Ozgocer, Tuba; Ucar, Cihat; Karabulut, Umran
    Purpose To determine the associations between pre-treatment self-reported stress level, salivary cortisol levels, and clinical pregnancy outcome in couples undergoing assisted reproductive technology treatment (ART). Study design Seventy-five couples (150 patients) undergoing ART treatment were enrolled in this study. Psychological variables were assessed using the Perceived Stress Scale, Beck Anxiety Inventory, State-Trait Anxiety Inventory, and Beck Depression Inventory. Salivary cortisol levels were obtained from each couple prior to commencing gonadotropin treatment at several times (upon waking and at 15, 30, and 60 min after waking). Results There was no statistically significant association between the self-reported stress levels and the ART treatment outcome in couples. Women with a successful outcome after ART treatment had higher median salivary cortisol levels than women who had an unsuccessful result [24.7 (19.9-63.1) vs. 20.7 (10.4-30.4), respectively]. There was no statistically significant difference in the median salivary cortisol levels of men in relation to ART treatment outcome. Salivary cortisol levels of the couples were not correlated. Conclusions Women who had higher median salivary cortisol levels in the pre-treatment period had a higher clinical pregnancy rate. This result suggests that moderately increased activity of the hypothalamic-pituitary-adrenal axis during ART treatment might be associated with successful conception.