Objective: Uterine perfusion, particularly the endometrial blood flow, may have an important role in endometrial receptivity. In order to assess the contribution of sub endometrial blood flow in the etiopathogenesis of unexplained infertility mid luteal-peri-implantation period spiral artery transvaginal color Doppler parameters were measured and compared with fertile controls. Material and Methods: Forty-two consecutive patients admitted toIzmir Katip Celebi University Ataturk Training and Research Hospital, Department of Obstetric and Gynecology with the diagnosis of unexplained infertility after standard diagnostic work up constituted the study group and they were compared with a fertile control group admitted to hospital with non specific gynecological complaints or for check-up in the same period. Mid luteal transvaginal color Doppler ultrasonography was applied to each patient by the same radiologist who was blind to the diagnosis of the particular patient and, RI (resistance index) and PI (pulsatility index) values were calculated.Results: There were no significant differences between the two groups, in respect to age, body mass index, basal hormonal and mid luteal progesterone levels (p>0.05). For the fertile control group, mid luteal-peri-implantation phase endometrial spiral artery mean RI values were calculated as 0.48±0.08 SD and mean PI values as 0.65±0.18 SD. For the study group, mean RI values were calculated as 0.54±0.07 SD, PI values were calculated as 0.80±0.16 SD. The differences for RI (p=0.009) and PI (p=0.004) were statistically significant. Conclusion:According to Doppler parameters, unexplained infertility patients have high impedance blood flow in spiral arteries which means that peri-implantation blood flow in these patient is lower than fertile controls. These findings suggest that endometrial perfusion may have an important contribution to etiopathogenesis of unexplained infertility. (J Turkish-German Gynecol Assoc 2012; 13: 169-71) Key words: Unexplained infertility, endometrial blood flow, endometrial receptivity, transvaginal ultrasonograhy, colored Doppler Received: 13 June, 2012 Accepted: 21 July, 2012 Amaç: Endometrial kan akımının, endometrial implantasyonda önemli rol oynadığı düşünülmektedir. Biz çalışmamızda subendometrial kan akımının açıklanamayan infertilitedeki önemini belirleyebilmek için mid-luteal-periimplantasyon dönemindeki kan akımını TVUSG doppler ile ölçerek fertil kontrol grubu ile karşılaş-tırdık. Gereç ve Yöntemler: Çalışmamıza İzmir Katip Çelebi ÜniversitesiAtatürk Eğitim ve Araştırma Hastanesi, Kadın Hastalıkları ve Doğum Kliniği'ne infertilite nedeni ile başvurmuş ve yapılan tetkikler sonucunda açıklanamayan infertilite olarak tanı almış 42 hasta ile fertilite dışındaki jinekolojik şikayetler ile başvurmuş fertil hastaların midluteal dönemindeki endometrial kan akımı değerlendirildi. Ölçüm-ler; rezistans indeksi ve pulsatilite indeksi, hastaların hangi gruba ait olduğunu bilmeyen tek radyolog tarafından yapıldı. Abstract ÖzetOriginal Investigation ...
Background: To determine the cut-off values of the preoperative risk of malignancy index (RMI) used in differentiating benign or malignant adnexal masses and to determine their significance in differential diagnosis by comparison of different systems. Materials and Methods: 191 operated women were assessed retrospectively. RMI of 1, 2, 3 and 4; cut-off values for an effective benign or malignant differentiation together with sensitivity, specificity, negative and positive predictive values were calculated. Results: Cut-off value for RMI 1 was found to be 250; there was significant (p<0.001) compatibility at this level with sensitivity of 60%, positive predictive value (PPV) of 75%, specificity of 93%, negative predictive value (NPV) of 88% and an overall compliance rate of 85%. When RMI 2 and 3 was obtained with a cut-off value of 200, there was significant (p<0.001) compatibility at this level for RMI 2 with sensitivity of 67%, PPV of 67%, specificity of 89%, NPV of 89%, histopathologic correlation of 84% while RMI 3 had significant (p<0.001) compatibility at the same level with sensitivity of 63%, PPV of 69%, specificity of 91%, NPV of 88% and a histopathologic correlation of 84%. Significant (p<0.001) compatibility for RMI 4 with a sensitivity of 67%, PPV of 73%, specificity of 92%, NPV of 89% and a histopathologic correlation of 86% was obtained at the cut-off level 400. Conclusions: RMI have a significant predictability in differentiating benign and malignant adnexal masses, thus can effectively be used in clinical practice.
Objective. The purpose of this study was to evaluate the relationship between clomiphene citrate (CC) plus metformin treatment and endometrial glycodelin expression and to then correlate this relationship with pregnancy outcomes. Material and Methods. A total of 30 patients diagnosed with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria constituted our study group. All had been admitted to the gynecology outpatient clinic between June 1, 2011, and January 1, 2012, for infertility treatment. Our control group consisted of 20 patients admitted for routine Pap smear control. They had no history of infertility and were not using contraceptives and they were actively attempting pregnancy. Midluteal progesterone measurement and pipelle endometrial biopsies were performed with both groups. For PCOS patients, metformin treatment was initiated right after the biopsy and CC was added in the second menstrual cycle. Pipelle endometrial biopsies were repeated. Histological dating and immunohistochemistry for glycodelin were performed by a single pathologist who was blinded to the patients' clinical data. Result(s). The posttreatment ovulation rate in the study group was 93.3%. No pregnancies were achieved in either group when glycodelin expression was not present, even in the presence of ovulation. When glycodelin expression was high in PCOS group, the pregnancy rate was 60% and all pregnancies ended in live births. In weak expression group, however, three out of four pregnancies ended as early pregnancy losses. Conclusion(s). Endometrial glycodelin expression is an important predictor of pregnancy outcomes in both PCOS and fertile groups.
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