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Öğe Cinsel Yolla Bulaşan Çeşitli Patojenlerin İnfertil Çiftlerdeki Prevalansı ve İn Vitro Fertilizasyon Başarısı Üzerine Etkisi(2019) Gürsoy, Nafia Canan; Tuncay, Görkem; Karaer, Abdullah; Tecellioğlu, Ayşe Nihan; Yiğit, Hande; Yakupoğulları, Yusuf; Otlu, BarışÖz: Giriş: Cinsel yolla bulaşan infeksiyonlar kadın ve erkek genital sisteminde oluşturduğu doku hasarı ve fonksiyon kayıpları ile infertilite, ektopik gebelik ve abortus gibi sorunlara neden olabilmektedir. İnfertilite etyopatogenezinde bakteriyel ajanların rolü iyi bilinmesine karşılık, cinsel ilişki ile bulaşabilen bazı viral etkenlerin infertilite ile olan ilişkileri göreceli olarak daha az bilinmektedir. Bu çalışmada in vitro fertilizasyon (IVF) programına alınan infertil hastalarda sitomegalovirüs (CMV), insan papillomavirüs (HPV), herpes simpleks virüs (HSV 1 ve HSV 2), insan immünyetmezlik virüsü (HIV), hepatit B virüsü (HBV), hepatit C virüsü (HCV) ve Chlamydia trachomatis sıklığının araştırılması amaçlanmıştır. Materyal ve Metod: Yaklaşık bir yıllık sürede 149 infertil çiftten semen ve servikal örnekler alındı ve polimeraz zincir reaksiyonu (PCR) yöntemiyle etkenlerin varlığı araştırıldı. Bu etkenlerin IVF tedavi başarısı üzerine etkisi değerlendirildi. Bulgular: Toplam 149 IVF tedavisine alınan infertil çiftin %8.1 (12/149)’inin CMV ile infekte olduğu görülmüş, sperm örneklerinde %2 (3/149), servikal örneklerde ise %6 (9/149) oranında CMV-DNA pozitifliği saptanmıştır. Çiftlerin her ikisinde birlikte CMV infeksiyonuna rastlanmamıştır. Çiftlerin %9.4 (14/149)’ünde HPV infeksiyonu olduğu görülmüş ve bunların sperm örneklerinde %5.4 (8/149), servikal örneklerde ise %7.4 (11/149) oranında HPV-DNA varlığı gösterilmiştir. Sperm örneklerindeki onkojenik yüksek riskli HPV (HR HPV) genotip oranı %37.5 (3/8), en sık saptanan genotipler sırayla HPV 18, 35 ve 39 iken, servikal örneklerdeki HR HPV genotip oranı %63.6 (7/11), en sık saptanan genotipler ise HPV 35, 16, 18, 45 ve 53 olarak bulunmuştur. Çiftlerin her ikisinde birden %3.4 (5/149) oranında HPV-DNA pozitifliği bulunurken, HPV genotipleri için çiftler arası uyum %40 (2/5) olarak saptanmıştır. HPV veya CMV pozitifliğinin erkeklerde sperm parametreleri, IVF tedavisi ile elde edilen oosit, embriyo sayısı ve gebelik ve canlı doğum parametreleri üzerinde istatistiksel olarak anlamlı bir etkisi olmadığı görülmüştür. Çiftlere ait sperm ve servikal örneklerin hiçbirinde C. trachomatis, HSV-1/2, HBV, HCV ve HIV tespit edilmemiştir. Sonuç: İnfertil hastalarda olası etkenlerin araştırıldığı daha kapsamlı çalışmalara gereksinim vardır. Bu konudaki epidemiyolojik veri eksiğinin giderilmesi için de öncelikle IVF kliniklerine başvuran hastalar gibi ulaşılması daha kolay hasta gruplarına ve özellikle ülkemizde endemik olarak görülen bakteriyel/viral etkenlere öncelik tanınması yararlı olacaktır.Öğe Clinical and hormonal characteristics of women with various phenotypes of polycystic ovary syndrome(2020) Düz, Senem Arda; Tuncay, Görkem; Karaer, AbdullahAbstract: Aim: The goal of this study is to identify clinical and hormonal characteristics of women with various phenotypes of polycystic ovary syndrome. Material and Methods: One hundred seventy eight cases, between the ages 18-30, diagnosed with PCOS, up to Rotterdam criteria, in our clinic between February 2015 -November 2018 were recruited in this cross sectional study. Results: The number was declined 89 by using National Institutes of Health criteria, 132 up to Androgen Excess and PCOS Society criteria. 34.83% of the patients were phenotype A, 15.16% were phenotype B, 24.15% were phenotype C and 25.84% were phenotype D. When we compared the different phenotypes with each other, body mass index, fasting glucose, postprandial glucose, fasting insulin and homeostatic model assessment for insulin resistance were found to be higher in phenotype A. In addition, luteinizing hormone and luteinizing hormone to follicle stimulating hormone ratio was higher in phenotype D than in B and C. When multivariate analysis was performed, body mass index was found to be as a single statistically significant predictive factor on IR. Conclusion: Body mass index was the most effective factor on insulin resistance and the mean body mass index was significantly higher in phenotype A.Öğe Comparison of the administration of dual and standard trigger in patients undergoing IVF Treatment(2021) Yigit, Fatih; Karaer, Abdullah; Tuncay, GörkemAbstract: Aim: This study aimed to compare in vitro fertilization (IVF) outcomes in patients who were administered dual trigger due to OHSS risk in the GnRH antagonist protocol with patients who were administered standard trigger.Materials and Methods: The medical files were retrospectively scanned for all the patients who were admitted to Inonu Unıversity department of obstetrics and gynecology.While the dual trigger group was composed of patients with OHSS risk who were stimulated with GnRH antagonist and received dual trigger(hCG + GnRHa) for final oocyte maturation, the age-matched (20-40) control group consisted of patients who were administered standard trigger (10000 IU uhCG or 500 ?grrhCG and obtained oocyte counts of 500 ?gr recombinant hCG). Thetwo groups were compared in terms of the oocyte count, MII oocyte count, and pregnancy and birth outcomes.Results: There was no statistically significant difference between the two groups in terms of age, weight, height, BMI, duration of marriage, presence of previous pregnancy, number of previous parities, number of pre-existing children, number of previous abortus stories, number of smokers, duration of infertility, LH, E2, prolactin, TSH levels, infertility causes, and hCG dose endometrium thickness. The number of oocytes and MII oocytes obtained was significantly higher in the dual trigger group compared to the control group. There was no statistically significant difference between the two groups in terms of the number of pregnancies and number of deliveries. Conclusion: Although the number of oocytes and MII oocytes was higher in the dual trigger group compared to the control group, there was no significant difference in terms of the pregnancy ratios and the number of deliveries.Öğe Endometriomalı Hastaların Matür (Metafaz II) Oositlerine Ait Kümülüs Hücrelerinin Tüm Genom Ekspresyon Analizi(2017) Çiğremiş, Yılmaz; Tuncay, Görkem; Karaer, Abdullah[Abstract Not Available]Öğe Impact of serum and follicular vitamin d levels on assisted reproductive techniques outcome(SCI PRINTERS & PUBL INC, PO DRAWER 12425 8342 OLIVE BLVD, ST LOUIS, MO 63132 USA, 2018) Tuncay, Görkem; Taşkapan, ÇağatayOBJECTIVE: To compare vitamin D levels in the serum and follicular fluids of in vitro fertilization (IVF) patients with regard to their pregnancy outcomes. STUDY DESIGN: This study enrolled 170 female patients (20-44 years old) who underwent intracytoplasmic sperm injection (ICSI) cycles between February 2015 and February 2016. The serum vitamin D was isolated by centrifugation. The follicular fluid samples were centrifuged and the supernatant was evaluated after the oocyte puncture procedure. RESULTS: Fifty-six patients had clinical pregnancies and 106 did not, and we did not find any statistically significant differences between these 2 groups in their basic or cycle characteristics. The basal follicle-stimulating hormone level was significantly lower in the pregnant group (p=0.003). A significant difference was detected in the serum vitamin D, and the follicular vitamin D concentrations were higher in the pregnant group (p=0.01 and p=0.003, respectively). There was a significant linear correlation between the 25-hydroxy vitamin D levels in the serum and follicular fluid (r=0.77, p<0.001). CONCLUSION: High vitamin D levels can improve the implantation rate and IVF outcome. The serum vitamin D level should be determined prior to IVF/ICSI cycles and supplemented if an insufficiency is established.Öğe The prognostic factors for pregnancy after gonadotropin-induced controlled ovarian stimulation therapy with intrauterine insemination cycles(2018) Tuncay, GörkemTo identify the predictive determinants for pregnancy in patients who underwent controlled ovarian stimulation (COS) /intrauterine insemination (IUI). A total 458 gonadotropin-induced controlled ovarian stimulation and intrauterine insemination cycles in 361 couples using were studied between February 2014 and January 2018. The main outcome was clinical pregnancy rate, which has been analyzed according to baseline clinical characteristics (women age, length of infertility, day 3. follicle stimulating hormone, estradiol level) and variables related to intrauterine insemination cycle (number of preovulatory follicles, endometrial thickness), and sperm parameters (sperm concentration, sperm motility, sperm morphology and total motile sperm count (TMSC). The overall clinical pregnancy rate was 11.6% (53/458) per cycle. Clinical pregnancy rate per cycle was 12.0% (43/361) in the first cycle; 10.3% (9/87) in the second cycle, and 10% (1/10) in the third cycle. Among the predictive factors evaluated, more than 25x106 TMSC was also good predictor for clinical pregnancy. The TMSC in ejaculate proved to be a useful predictor of the chance for pregnancy after IUI treatment.Öğe Renal cell carcinoma diagnosed during pregnancy: A case report and literature review(SAGE PUBLICATIONS LTD, 1 OLIVERS YARD, 55 CITY ROAD, LONDON EC1Y 1SP, ENGLAND, 2018) Yılmaz, Ercan; Oğuz, Fatih; Tuncay, Görkem; Melekoğlu, Rauf; Beytur, Ali; Coşkun, Ebru İnci; Güneş, AliDiagnosing cancer during pregnancy is uncommon. Although pregnancies with concomitant malignancies have been reported, urological tumours are possibly the most rarely identified tumours during pregnancy. Renal cell carcinoma appears to be the most common urological malignancy during pregnancy. In this case report, we discuss successful management of a patient who was diagnosed with renal cell carcinoma during the antenatal period.Öğe Treatment of unruptured cornual pregnancies by local injections of methotrexate or potassium chloride under transvaginal ultrasonographic guidance(Professıonal medıcal publıcatıons, panorama centre, rm 522, 5th floor, bldg 2, raja ghazanfar alı rd, po box 8766, saddar, karachı 00000, pakıstan, 2018) Tuncay, Görkem; Karaer, Abdullah; Coşkun, Ebru İnci; Melekoğlu, RaufObjective: To demonstrate the outcome of intralesional management and show the safety of local treatment of cornual pregnancy. Methods: Eight patients were treated with local methotrexate or potassium chloride injection. All patients underwent transvaginal ultrasound examination and were diagnosed by the criteria defined by TimorTritsch. In the case of fetal heart beat observation, potassium chloride was injected; and in the case of no heart beat detection, methotrexate was used. A follicle aspiration needle was inserted directly into the gestational sac under transvaginal guidance. Results: Although it has been considered to be a risk factor, none of the patients in our study had previous ectopic pregnancy, history of infertility / in vitro fertilization, or cornual pregnancy. One of the patients had a medical history of abortion. In four cases, methotrexate was injected, and three patients received potassium chloride as a local treatment. None of the patients had any complication in the peri- or postoperative period. Conclusion: Using a local approach, the treatment agent can reach the area of the cornual pregnancy in high concentrations. Based on this case series, a local approach seems to be an effective and fertilitysparing method for treating unruptured cornual pregnancies.Öğe Value of hysteroscopy after one in vitro fertilization failure(2018) Tuncay, GörkemTo investigate the relationship between abnormal findings and the cost effectiveness of performing a hysteroscopy after one in vitro fertilization (IVF) failure. The cases of 110 patients with a normal ultrasound of the endometrial cavity and a history of one IVF treatment failure who had been referred to the Inonu University School of Medicine Department of Obstetrics and Gynecology between June 2014 and November 2017 were recruited for this study. The median age of patients was 31.7 ± 5.7 years. Intrauterine pathologies were observed in 29 (26.3%) patients, whereas 81 (73.7%) patients exhibited a normal hysteroscopy. The distribution of the pathologies was as follows: a uterine subseptum existed in 9 (8.1%) women, an intrauterine adhesion existed in 8 (7.2%) women, a cervical stenosis existed in 4 women (3.6%), an endometrial polyp existed in 4 women (3.6%), and a submucosal myoma uteri existed in 3 women (2.7%). Two abnormalities (intrauterine adhesion and cervical stenosis) existed together in one patient. A routine hysteroscopy is necessary for women with a normal ultrasound of the endometrial cavity after one IVF failure, meaning that women with a normal ultrasound should be offered a routine hysteroscopy.
