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Öğe Can in vitro maturation overcome cycles with repeated oocyte maturation arrest? A classification system for maturation arrest and a cohort study(Wiley, 2021) Hatirnaz, Safak; Basbug, Alper; Hatirnaz, Ebru; Tannus, Samer; Hatirnaz, Kaan; Bakay, Kadir; Dahan, Michael H.Objective To investigate the role of gonadotropin-stimulated and human chorionic gonadotropin (hCG) -primed in vitro oocyte maturation (IVM) in cases of repeated in vitro fertilization (IVF) failure due to various forms of oocyte maturation arrest (OMA). Methods Retrospective cohort study. Results In all, 63 women with IVF failure due to OMA were evaluated in this study. According to the Hatirnaz & Dahan classification, 11 (17.5%) women were OMA type 1, 22 (34.9%) were OMA type 2, 0 were OMA type 3, 11 (17.5%) were OMA type 4, and 19 women were OMA type 5 (30.1%). Fewer oocytes were retrieved in the IVM than in the IVF cycles. No embryos were produced from oocytes collected in the IVM cycles of women with OMA types 1, 2, and 4. In the OMA type 5 group, 9 (47.4%) day 2 embryos and 6 (31.6%) day 3 embryos were obtained. The difference between the groups was statistically significant (P = 0.001, P = 0.002, respectively). Single day 3 embryo transfer was performed for the six patients with OMA type 5 but no clinical pregnancies occurred. Conclusions Follicle-stimulating hormone-stimulated and hCG-primed IVM does not improve oocyte maturation, developmental potential, or pregnancy rates of women with OMA. Future studies directed to re-establishing normal cytoskeletal architecture and machinery, and resumption of meiosis may be beneficial for obtaining mature oocytes.Öğe A Comparative Multicentric Study on Serosal and Endometrial Myomectomy During Cesarean Section: Surgical Outcomes(Taylor & Francis Inc, 2021) Hatirnaz, Safak; Guler, Oguz; Basbug, Alper; Cetinkaya, Mehmet Bilge; Kanat-Pektas, Mine; Bakay, Kadir; Kalkan, UzeyirObjective: This multi-center study aims to determine the efficiency and safety of endometrial myomectomy (EM) for the removal of uterine fibroids during cesarean section (CS). Methods: Retrospective review of 360 women diagnosed for fibroids during pregnancy. They all delivered by CS between 2014 and 2019. The study groups included 118 women who only underwent EM, 120 women who only had subserosal myomectomy by traditional technique and 122 women with fibroids who decided to avoid cesarean myomectomy, as control group. They were analyzed and compared the surgical outcomes. Results: The EM, subserosal myomectomy and control groups were statistically (p > 0.05) similar for to age, body mass index (BMI), gravidity, parity, gestational age at delivery, indications for CS, number of excised fibroids, size of the largest myoma. Postoperative hemoglobin values and ? (?) hemoglobin concentrations were lower in SM group (10.39gr/dl vs 9.98 gr/dl vs 10.19 - 1.44 gr/dl vs 1.90 gr/dl vs 1.35; p = 0.047, p = 0.021; respectively) Hybrid fibroids were significantly more frequent in the EM group than subserosal myomectomy and control groups (respectively, 33.1% vs 23.3% vs 27.0%, p = 0.002). Surgery time was significantly longer in the subserosal myomectomy group than EM and control groups (respectively, 46.53 min vs 37.88 min vs 33.86 min, p = 0.001). Myomectomy took significantly longer time in the subserosal myomectomy than EM group (13.75 min vs 8.17 min, p = 0.001). Conclusions: Endometrial myomectomy is a feasible choice for treatment of fibroids during CS, and, basing on our results could be an alternative to traditional cesarean subserosal myomectomy.Öğe In vitro maturation with letrozole priming: Can it be a solution for patients with cancerophobia? A pilot study(Galenos Yayincilik, 2020) Hatirnaz, Safak; Hatirnaz, Ebru Saynur; Basbug, Alper; Pektas, Mine Kanat; Erol, Onur; Dahan, Michael; Tan, SeangObjective: To investigate whether letrozole priming could be used efficiently in patients undergoing in vitro maturation (IVM) as compared with follicle-stimulating hormone (FSH) priming. Materials and Methods: This is a retrospective analysis of 63 patients who underwent IVM due to the high risk of Ovarian Hyperstimulation syndrome (OHSS) (n=39), cancerophobia (n=16), and desire for IVM after failed in vitro fertilization attempts (n=8). Forty-two patients received FSH priming and 21 patients received letrozole priming. Results: The patients who had FSH or letrozole priming were statistically similar with respect to age, body mass index, duration of infertility, basal antral follicle count, serum anti-Mullerian hormone levels, and IVM indications (p>0.05 for all). When compared with the FSH priming group, the number of germinal vesicle oocytes, metaphase 11 and fertilized oocytes were significantly higher (p=0.003, p=0.001, and p=0.016, respectively), but the number of metaphase I oocytes was significantly lower in the letrozole priming group (p=0.002). The patients who received FSH and letrozole priming had statistically similar rates of implantation (33.3% vs 37.0%, p=0.709), clinical pregnancy (31.5% vs 33.3%, p=0.848), twinning (1.9% vs 3.7%, p=0.611), and live birth (24.1% vs 29.6%, p=0.682). Conclusion: Potential indications for IVM include patients with increased risk for OHSS and contraindication for hyperestrogenism. Aromatase inhibitors can be used to preserve the fertility of patients with estrogen-sensitive cancers. Letrozole priming appears to be an efficient approach in patients who undergo IVM, with likely less cost than FSH priming.Öğe Long-term obstetric, perinatal, and surgical complications in singleton pregnancies following previous cesarean myomectomy: a retrospective multicentric study(Frontiers Media Sa, 2024) Guler, Oguz; Hatirnaz, Safak; Sparic, Radmila; Basbug, Alper; Erol, Onur; Kalkan, Uzeyir; Ulubasoglu, HasanObjectives The safety of cesarean myomectomy has been proven by previous studies. Our study aimed to reveal the long-term perinatal, obstetric, and surgical outcomes of cesarean myomectomy (CM) by comparing different CM techniques. Material and methods This retrospective multicentric case-control study involved 7 hospitals and included 226 singleton pregnancies that underwent repeated cesarean section (CS) between 2015 and 2020. Among these pregnancies, 113 of 226 cases had CM (Group A), and 113 had only CS (Group B). Of the 113 cases in which CM was performed, 58 underwent endometrial myomectomy (EM) (Subgroup A1) and 55 underwent serosal myomectomy (SM) (Subgroup A2). The groups were compared in terms of obstetric, perinatal, and surgical outcomes, and fibroid recurrence, myomectomy scar healing rate, and adhesion formation were noted. Results There was no significant difference between the groups in terms of maternal age, body mass index, gravidity, parity, and fibroid diameter in previous CS (p > 0.05). In the perinatal and obstetric evaluation of the groups, there was no significant difference between the groups in terms of neonatal weight, Apgar score, fetal growth restriction, preterm premature rupture of membranes, preterm delivery, hypertension in pregnancy, and diabetes mellitus (p > 0.05). The fibroid recurrence rate was 28.3%, and the myomectomy scar good healing rate was 99.1%. There was no difference between the groups in terms of CS duration, preoperative and postoperative hemoglobin levels, perioperative blood transfusion rates, febrile morbidity, and prolonged hospitalization (p > 0.05). In terms of adhesion formation, although the adhesion rate of the SM group was higher than that of the EM group, no statistically significant difference was detected between the groups. Conclusion This study showed that in pregnancies following CM, obstetrical, perinatal, and surgical outcomes were unaffected. Obstetricians can safely use CM, either the trans-endometrial or serosal technique, as it is a safe and effective method with long-term results.Öğe Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision(Via Medica, 2021) Soyer-Caliskan, Canan; Celik, Samettin; Basbug, Alper; Hatirnaz, Safak; Guclu, Mehmet; Akbaba, Eren; Tinelli, AndreaObjectives: Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate because of repeated cesarean sections (CS). The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating the maternal fetal impact of the two methods. Retrospective multicentric cohort study. Material and methods: A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one, comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower uterine segment (LUS) incision (transverse-transverse), which was 2-3 cm above the MAP border, with the uterus in the abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus till the border of the MAP. Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative complications were investigated. Results: Total time of surgery was significantly shorter in group 1 (p < 0.05). Intraoperative blood loss was higher in group 2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 +/- 1.04 and 12.99 +/- 5.07 respectively (p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008, p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups. Conclusions: In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision.Öğe Predictive Value of Volumetric Measurements of Fetal Adrenal Glands for Preterm Birth: A Case-Control Study(Imr Press, 2024) Basbug, Alper; Yurtcu, Engin; Keyif, Betul; Kaya, Aski Ellibes; Sungur, Mehmet Ali; Goynumer, Fikret Gokhan; Hatirnaz, SafakBackground: To investigate whether fetal adrenal gland volume (AGV) and fetal zone volume (FZV), important components of the fetal adrenal gland, differ between women who have term and preterm births, and to determine whether these two parameters can be used to predict premature birth. Methods: A total of 238 pregnant women at 24-28 weeks of gestation were included in this case-control study. The fetal AGV and FZV were ultrasonographically evaluated, and corrected AGV (cAGV) and corrected FZV (cFZV) were assessed with adjustments for estimated birth weight. Receiver operating characteristic (ROC) curves were used to assess the ability of AGV, FZV, cAGV, and cFZV to predict preterm birth. Results: Ultrasound exams on 220 term fetuses and 18 preterm fetuses showed that preterm fetuses exhibited higher AGV (p = 0.039), FZV (p = 0.001), cAGV (p = 0.001), and cFVZ (p = 0.001) compared to term fetuses. Conclusions: These results demonstrated that term and preterm fetuses differ in their AGV and FZV within this study population. The data generated by 3D sonography between 24 and 28 weeks of gestation may be beneficial for predicting premature birth. However, larger prospective studies with a larger sample size of preterm births are needed to validate these findings.Öğe PROOF OF CONCEPT OF A TREATMENT FOR HUMAN OOCYTE MATURATION ARREST;TRANSVAGINAL OVARIAN NEEDLE INJURY PRECEEDING LETROZOLE PRIMING IN VITRO MATURATION(Elsevier Science Inc, 2020) Hatirnaz, Safak; Hatirnaz, Ebru; Basbug, Alper; Dahan, Michael H.; Hatirnaz, Kaan[Abstract Not Available]Öğe True empty follicle syndrome is a subtype of oocyte maturation abnormalities(Turkish Society of Obstetrics and Gynecology, 2024) Hatirnaz, Safak; Hatirnaz, Ebru Saynur; Tan, Justin; Çelik, Samettin; Soyer Calıskan, Canan; Başbuǧ, Alper; Aydin, GercekObjective: To review the outcomes of in vitro maturation (IVM) and in vitro fertilization (IVF) in women with empty follicle syndrome (EFS). The study evaluated the genetic underpinnings of EFS by analyzing mutations. Materials and Methods: This retrospective case series involving 17 women with EFS over at least 2 IVF cycles was conducted. The study also employed whole-exome sequencing to analyze the genetic mutations. The treatment approaches included letrozole-primed IVM, follicle-stimulating hormone (FSH)-human chorionic gonadotrophin (hCG)-primed IVM, and conventional IVF. Results: The average female age was 31.5±4.6 years, and the duration of infertility was 7.3±3.5 years. Four patients underwent IVF. IVM oocyte collections yielded oocytes in 12 of 13 subjects. Of these, 75% (9/12) yielded MII oocytes after 48 h of IVM media incubation. Six subjects had fertilized embryos, resulting in a 40.9% intracytoplasmic sperm injection (ICSI) fertilization rate (9 embryos/22 MII oocytes). Genetic analysis revealed mutations in seven patients. This study demonstrated the partial efficacy of letrozole-primed IVM plus growth hormone and FSH-hCG primed IVM protocols. No pregnancies or live births were recorded after IVM. One ongoing pregnancy post-IVF and one spontaneous live birth were observed. Conclusion: Inter-cycle variabilities were observed in women with oocyte maturation abnormalities (OMAs). Almost all patients with EFS had oocytes collected during IVM following IVF. These oocytes have limited potential for maturation, fertilization, and live birth, as demonstrated by the low rates observed after IVM culture and ICSI. These conditions are observed in OMAs due to defects in the oocyte machinery. The proposed flowchart provides a comprehensive classification approach for various forms of EFS. © 2024 Elsevier B.V., All rights reserved.
