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Öğe Correlation between high Choline metabolite signal in spectroscopy and sperm retrieval chance at micro-TESE(Verduci, 2022) Karakuş, Cemil; Özyurt, R.OBJECTIVE: To determine the re lationship between choline (Cho) signal intensi ty measured before micro-dissection testicular sperm extraction (micro-TESE) and sperm re trieval rates in mTESE in non-obstructive azo ospermia (NOA) patients. PATIENTS AND METHODS: A total of 20 pa tients who underwent testicular MR spectros copy were included in the study. Participants consisted of 10 patients diagnosed with NOA and 10 fertile cases with normal sperm counts. Both groups of participants underwent bilater al testis MR spectroscopy. Ten patients in the NOA group underwent mTESE after spectros copy. The signal intensities of Cho, creatine (Cr), lactate, and lipids were analyzed and com pared with the results of fertile control. Cho sig nal intensity detected before mTESE in the NOA group and sperm retrieval rates were compared. RESULTS: Sperm was found in 5 of 10 patients who underwent mTESE. No sperm was found in five NOA cases. The main metabolites detected in NOA cases with sperm in mTESE were Cho and Cr. Cho and Cr signals were found to be signifi cantly lower in NOA cases where no sperm could be found in mTESE. Cho and Cr signal intensities of the fertile group were similar to NOA patients with sperm in mTESE but were significantly high er than those with NOA without sperm. While the cut-off value of Cho was 1.24 ppm (AUC 0.665, p = 0.01 [95% CI: 0.722–1.00]) the cut-off value of Cr was 1.18 ppm (AUC 0.887, p = 0.02 [95% CI]): 0.620–1.00]) for positive sperm retrieval. CONCLUSIONS: Detection of high Cho metab olite in the spectra before TESE in NOA patients increases sperm retrieval rates in mTESEÖğe Cytogenetic Analysis Of Early Pregnancy Loss After Assisted Reproduction Treatment Using İntracytoplasmic Sperm İnjection(Medica sp, 2021) Hocaoğlu Emre, Fatma Sinem; Kamar, Aret; Turktekin, Nurettin; Özyurt, Ramazan; Karakuş, Cemil; Sarıbal, DevrimObjectives: To evaluate the incidence of numerical chromosomal abnormalities in the patients with early pregnancy loss (EPL) following in vitro fertilization, and evaluate the role of different confounders of the risk of chromosomal abnormality- related pregnancy loss. Material and methods: A retrospective chart review of all patients from our in vitro fertilization (IVF) center who conceived using assisted reproduction techniques between April 2017 and 2019, who experienced a subsequent early pregnancy loss, and whose abortus materials were successfully karyotyped were included. Results: Of the 243 patients experienced an early loss, the overall rate of chromosomal abnormality was 46.75%. The overall rate of aneuploidy in our patient group was 88.8% (64/72), whereas 6.94% (5/72) of the abnormal karyotypes were polyploid. The most common type of trisomy was Trisomy 16 (20.0%; 11/55) followed by Trisomy 15 (14.5%; 8/55). Univariate and multivariate analyses showed that maternal age (< 35 years) and the total number of retrieved oocytes per cycle (? 5) were risk factors for a chromosomal abnormality (< 0.001; < 0.05, respectively). The adjusted OR of karyotypic abnormalities was 0.45 for the antagonist cycle type (p < 0.05), and 0.58 for frozen embryo transfer (p < 0.05). Conclusions: Karyotypic abnormality is one of the main reasons for pregnancy loss following an IVF procedure. Although the pregnancy rates increased as a result of novel technologies, the ratio of EPL is still high. The implementation of preimplantation genetic screening techniques might lower the incidence of EPL due to chromosomal abnormalities, thus decreasing the burden on the physicians and the patients.Öğe Follicular Fluid 25-Hydroxyvitamin D Levels Determine Fertility Outcome in Patients with Polycystic Ovary Syndrome(ELSEVIER TAIWAN, 2022) Karakuş, Cemil; Özyurt, RamazanObjective: To determine the possible relationship between follicular fluid 25-hydroxyvitamin D [25(OH) D] levels and fertility outcome of women who underwent IVF/ICSI with the diagnosis of lean polycystic ovary syndrome. Materials and methods: Thirty patients who were diagnosed with PCOS according to the Rotterdam criteria and decided on IVF/ICSI were included in the study. Thirty patients who were scheduled for IVF/ ICSI for reasons other than PCOS and matched in terms of age and BMI were taken as the control group (non-PCOS). According to BMI values, patients in both PCOS and non-PCOS groups were lean. Women in both groups were aged 21e35 years with a normal BMI (18.5e24.9 kg/m2) and first IVF/ICSI attempt. Both groups of patients were followed up using the antagonist protocol. Vit D levels were measured in serum and follicular fluid (FF) samples taken on the day of oocyte collection. The correlation between FF vit D levels, the number of total oocytes, MII oocytes and 2 PN zygotes, HOMA-IR, hormonal and de mographic parameters, clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate were evaluated. Results: At the time of oocyte retrieval women with PCOS had similar serum Vitamin D compared to non PCOS women (21.8 (12.6e24.8) ng/ml vs 22.3 (11.5e25.1) ng/ml, p < 0.54). In FF, assessed on the day of oocyte retrieval, the concentration of Vitamin D was similar in women with PCOS when compared to non-PCOS women (11.2 (9.2e14.4) ng/ml vs 13.3 (11.1e17.4) ng/ml, p < 0.06). For both groups, Vitamin D levels were lower in FF compared to serum vit D. A positive correlation was found between serum and FF Vitamin D concentrations in the full cohort. A positive and significant correlation was found between FF vit D levels and the number of total oocyte (r ¼ 0.344, p < 0.04) and MII oocyte (r ¼ 0.404, p < 0.02) in the PCOS group. The number of total oocyte, MII oocyte and 2 PN zygotes of the PCOS group were signifi cantly higher than the non-PCOS group. Positive pregnancy test rate, clinical pregnancy and live birth rates were similar in both groups. The miscarriage rates in the non-PCOS group were significantly higher than in the PCOS group. A positive and significant correlation was also found between FF vit D levels and positive pregnancy test (r ¼ 0.566, p < 0.03) and CPR (r ¼ 0.605, p < 0.02) in PCOS group. There was no correlation between FF-vit D levels and live birth and miscarriage rates in neither the PCOS nor the non PCOS group. Conclusions: Both serum and FF 25-hydroxyvitamin D level of women with PCOS at the time of oocyte retrieval are similar to non-PCOS controls. While FF 25-hydroxyvitamin D levels correlate with total and MII oocyte counts, positive pregnancy test and CPR, it does not correlate with miscarriage and live birth rates.Öğe Laparoscopic Ovarian Drilling Improve Endometrial Receptivity by Increasing Production of Endometrial Metabolites(Cordus, 2022) Karakuş, CemilObjective: Laparoscopic ovarian drilling normalizes ovulation by reducing cortical thickening, lowering androgen production, and regulating luteinizing hormone pulse frequency. On the other hand, the effect of laparoscopic ovarian drilling on the endo metrium is unknown. This study was planned to investigate the changes in the functional markers of choline, creatine, lac tate, and lipid metabolites of the endometrium before and after laparoscopic ovarian drilling in women with polycystic ovary syndrome. Methods: Twenty women diagnosed with clomiphene-resistant polycystic ovary syndrome who did not ovulate successfully despite the administration of clomiphene citrate or aromatase inhibitor were included in the study. Patients were offered Assisted Reproductive Technology (ART) or laparoscopic ovarian drilling options. Patients who accepted laparoscopic ovarian drilling formed the study group. Endometrial MR spectroscopy was applied to the participants in the mid-luteal phase before laparoscopic ovarian drilling. Choline, creatine, lactate, and lipid metabolites of all patients were measured and denominated parts per million. The second MR spectroscopy was performed 2 months after the first MR spectroscopy, and the changes in endometrial metabolites after laparoscopic ovarian drilling were recorded. Twenty patients who did not have clinical and labo ratory findings of polycystic ovary syndrome and were matched for age and body mass index were accepted as the control group. The patients in this group were selected from fertile women with at least 2 children. MR spectroscopy was performed in the mid-luteal phase in fertile women. The obtained results were compared within and between groups and the possible effects of laparoscopic ovarian drilling on metabolite synthesis were tried to be determined. Results: During MR spectroscopy examination main endometrial metabolites choline, creatine, lactate, and lipid were detected in the polycystic ovary syndrome group. The most prominent metabolite peak before and after laparoscopic ovarian drilling was recorded as choline and creatine. There was a significant increase in choline and creatine peaks after laparoscopic ovarian drilling compared to the values before laparoscopic ovarian drilling. There was no significant increase in lactate and lipid signals before and after laparoscopic ovarian drilling. The choline and creatine metabolite levels of the women with polycystic ovary syndrome before laparoscopic ovarian drilling were significantly lower than those of the fertile women. The choline and creatine metabolite levels of the women with polycystic ovary syndrome after m laparoscopic ovarian drilling were similar to those of the fertile women. There was no significant difference between lactate and lipid signals before and after laparoscopic ovarian drilling. Conclusion: Laparoscopic ovarian drilling improves polycystic ovary syndrome-related subfertility by increasing endometrial choline and creatine metabolite levels to those of fertile women.
