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    Comparison of the effects of ovarian cauterization and gonadotropin-releasing hormone agonist and oral contraceptive therapy combination on endocrine-changes in women with polycystic ovary disease
    (Amer Soc Reproductive Medicine, 1996) Taskin, O; Yalcinoglu, AI; Kafkasli, A; Burak, F; Ozekici, U
    Objective: To study the effects of laparoscopic ovarian cauterization and combination of long-acting GnRH agonist (GnRH-a) and oral contraceptive (OC) therapy on endocrine changes in women with clomiphene citrate (CC)-resistant polycystic ovary disease (PCOD). Design: Prospective, randomized. Setting: University-based infertility clinic. Patients: Seventeen women with CC-resistant PCOD were included randomly in the study to either laparoscopic ovarian cautery or GnRH-a and OC therapy for 3 months. Main Outcome Measures: Serum concentrations of LH, FSH, androstenedione (A), T, and sex hormone-binding globulin (SHBG) were determined before each therapeutic approach and during the follicular phase of first menstrual cycle after the cessation of each treatment. Results: The mean. serum concentrations and the clinical profiles were similar in both groups. Both groups showed significant changes in LH, FSH, A, T, and SHBG compared with pretreatment levels. There were no significant differences in the final concentrations of LH, FSH, and A between the two study groups after each treatment, whereas T and SHBG levels were significantly different in the goserelin and OC group. The decrease in LH and increase in SHBG serum concentrations were greater in the goserelin and CC-treated women [-59% and +5.9% versus -70% and +13.5%, respectively]. Although the SHBG concentration increased in both groups, the serum SHBG concentration of the goserelin and OC group was significantly higher than the other group. Conclusion: Both therapeutic modalities revealed similar effects on the endocrine profiles in women with CC-resistant PCOD. Considering the invasiveness, cost, and potential complications of laparoscopic ovarian cauterization, noninvasive medical treatment with GnRH-a and OC combination may be more effective in restoring the optimal follicular environment in women with PCOD.
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    Effectiveness of tibolone on hypoestrogenic symptoms induced by goserelin treatment in patients with endometriosis
    (Amer Soc Reproductive Medicine, 1997) Taskin, O; Uryan, I; Yalcinoglu, AI; Buhur, A; Kucuk, S; Burak, F
    Objective: To investigate the efficacy and safety of tibolone on hypoestrogenic vasomotor symptoms and bone parameters in patients treated with goserelin acetate. Design: Prospective, randomized placebo controlled double-blind study. Setting: Human volunteers in a university-based fertility clinic. Patient(s): Twenty-nine women of mean age 29.2 +/- 4.8 years with mild to severe endometriosis undergoing 6 months of treatment with 3.6 mg goserelin acetate in an SC depot formulation were studied. Intervention(s): The patients were allocated randomly to either 2.5 mg/d tibolone (n = 15) or an iran pill (n = 14) in a double-blinded fashion beginning in the third cycle. Main Outcome Measure(s): Frequency and severity of hot flushes, sweating, irritability, loss of libido, nervousness, and sleeplessness were assessed by the patients using 0 to 6 point scoring system and compared. Samples of urine were obtained for calcium and creatinine (Ca:Cr) ratios at the start of treatment and monthly there after. The vasomotor scoring for each symptom and Ca:Cr ratios before the treatment and at the end of 6th month were analyzed by parametric: and nonparametric tests. Result(s): The mean age, weight, vasomotor scores, pelvic scores, and urine Ca:Cf ratios were similar in both placebo and tibolone group (28.7 +/- 4.8 versus 27.6 +/- 6.3 years, 50.9 +/- 5,3 versus 53.1 +/- 7.1 Bg, 4.7 +/- 1,1 versus 4.2 +/- 0.8, and 0.056 +/- 0.008 versus 0.059 +/- 0.006, respectively). The decreases in vasomotor scoring as regards to hot flushing, sweating, and other associated symptoms were statistically significant in tibolone group compared with placebo (10.4 +/- 1.6 versus 24.6 +/- 4.9). During the study significant reductions in urine Ca:Cr ratio was obtained in the tibolone patients compared with placebo (0.031 +/- 0.006 versus 0.0055 +/- 0.007). The incidence of side effects (weight change, vaginal bleeding) was low and did not differ from the placebo group. Conclusion(s): Considering the beneficial effects of tibolone on vasomotor symptoms and bone loss, our data suggest that this synthetic steroid is an effective and safe option in relieving symptoms induced by GnRH-analogue.
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    The effects of episiotomy and Kegel exercises on postpartum pelvic relaxation: A prospective controlled study
    (Mary Ann Liebert Inc Publ, 1996) Taskin, O; Wheeler, JM; Yalcinoglu, AI; Coksenim, S
    To evaluate the effects of episiotomy and Kegel exercises on symptoms and signs indicating postpartum pelvic relaxation, we prospectively studied 100 primigravidas consecutively enrolled from a homogeneous patient population. A control group was defined as the first 20 women requiring cesarean section prior to labor for accepted indications. The remaining four groups of 20 women each were treated as follows: no episiotomy or Kegel, episiotomy but no Kegel, episiotomy plus postpartum Kegel, and episiotomy plus antepartum Kegel. Research outcomes included the incidence and severity of pelvic relaxation determined by physicians blinded to group assignment and complaints of stress urinary incontinence. Fisher's exact tests were used for comparisons. Episiotomy alone was associated with decreased incidence of cystocele and rectocele, but there was no effect on degree of defects that occurred. Episiotomy plus antepartum Kegel produced no significant difference compared with cesarean controls for any defect of pelvic relaxation and, furthermore, was the only vaginal delivery group producing no third-degree defects. This study supports the use of episiotomy in most primigravidas and further suggests that teaching of Kegel exercises be included in antepartum patient instruction.