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Öğe Comparison of GnRH agonist and antagonist protocols among patients with mild-moderate endometriosis and endometrioma: a novel clinical approach.(Elsevier Science Inc, 2005) Pabuçcu, Recai; Önalan, Göğşen; Selam, Belgin; Ceyhan, Temel; Akar, Münire; Önalan, ReşideDifferent IVF protocols individualized according to various stages of endometriosis and according to management of endometrioma may be essential for the improvement of clinical outcomes in IVF programs.Öğe Current approach to endometriosis(Gulhane Askeri Tip Akademisi, 2005) Selam, BelginEndometriosis is defined as the presence of endometrial tissue outside the uterus. It is mostly localized to the pelvic viscera and the peritoneum in women during the reproductive period. Endometriosis is observed in a wide spectrum of clinical presentations such as minimal lesions, adhesions involving bladder, ureter, bowel, and massive endometriomas distorting the tuboovarian anatomy. Pelvic pain and infertility are frequently observed in patients with endometriosis. The present review summarizes the pathogenesis and diagnosis of endometriosis, pelvic pain and infertility related to endometriosis and their current therapeutic approach. © Gülhane Askeri Tip Akademisi 2005.Öğe Mood scores in relation to hormone replacement therapies during menopause: a prospective randomized trial(Tohoku Univ Medical Press, 2005) Önalan, Göğşen; Önalan, Reşide; Selam, Belgin; Akar, Münire; Günenç, Ziya; Topçuoğlu, AtaThere is lack of studies in literature about the long-term effects of hormone replacement therapies and cholesterol levels on mood scores in menopause. In the present study we have investigated whether serum lipid levels affect mood scores in menopause and evaluated the long-term effects of the combined hormone replacement regimens (HRT) on depressive symptoms in postmenopausal women. In this prospective-randomized, placebo-controlled, double-blind study, 286 women in menopause were divided into four groups according to therapeutic regimens they received; 1) Conjugated equine estrogen (CEE) of 0.625 mg plus medroxyprogesterone acetate (MPA) of 2.5 mg (n = 79), 2) CEE (0.625 mg) plus MPA of 5 mg (n = 77), 3) tibolone of 2.5 mg (a selective tissue estrogenic activity regulator) (n = 76), and 4) Calcium (Ca) of 1,000 mg (n = 54). Beck Depression Inventory (BDI), and serum levels of lipoprotein lipids were assessed before and after 12-months of treatment with oral continuous HRT and Ca supplementation. BDI scores in the study groups were not correlated with lipid profiles. We compared two subgroups of patients with initial BDI scores 0-14 (normal mood scores) in order to asses for the possible relation between the lipid profile and mood. Following treatment, first subgroup had increased scores to 15-30 (mildly depressed women, n = 27) and the second subgroup preserved BDI scores of 0-14 (normal mood scores, n = 23). Serum levels of total cholesterol, high-density lipoprotein, low-density lipoprotein and body mass index were found to be similar between these two groups. BDI scores decreased significantly in all HRT groups after 12 months of treatment, compared to Ca group (p < 0.05). We did not observe any correlation between BDI scores and lipid profiles before and following continuous HRT or Ca supplementation. Continuous combined hormone replacement regimens, CEE + MPA and tibolone, have superior long-tenn effects on mood scores in menopause and should be considered during the decision process for use of HRT due to menopausal symptoms.Öğe Research on medical ethics and embriyo(2005) Cinci, Mehmet; Selam, Belgin; Ataç, Adnan; Akar, Münire ErmanResearch with spare embryos achieved by assisted reproductive techniques and remained following embryo transfer has been a subject of debate regarding the ethical issues all over the world. Current developments in science have introduced new approaches for research of assisted reproductive techniques including stem cell, human somatic cell nuclear transfer (cloning) and preimplantation genetic diagnosis which have increased the extent of controversy on ethical dilemma. Current study summarizes the purpose of embryo research, cryopreservation of embryo and regulations of embryo research in different countries. It also mentions the current ethical approach for stem cell research, cloning and preimplantation genetic diagnosis. Finally it explains the present regulations for the ethics of these issues in Turkey concluding with the recommendations that may be useful for the future applications.Öğe Serum and follicular fluid levels of soluble Fas and soluble Fas ligand in IVF cycles(Elsevier, 2006) Önalan, Göğşen; Selam, Belgin; Önalan, Reşide; Ceyhan, Temel; Cıncık, Mehmet; Pabuçcu, RecaiObjective: To determine follicular fluid (FF) and serum levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in patients undergoing IVF cycles. S Study Design: A prospective comparative study among patients with endometriosis (n = 12), infertility due to male factor (11 = 12) and poor responders (n = 32) undergoing IVF cycles in Centrum IVF Clinic. Individual FF and serum samples were collected from patients during transvaginal ultrasonography-guided follicle aspiration. Patients were classified as poor responder patients undergoing IVF cycles with GnRHa, triptorelin and GnRH antagonist, cetrotide, patients with endometriosis and patients with infertility due to male factor. sFas, sFasL levels in both FF and serum samples and their correlations with clinical outcomes of IVF were measured in each study group. Results: Serum and FF levels of sFas, sFasL were similar in the poor responder and male factor groups. There were no differences between the serum and FF levels of both sFas and sFasL among poor responder patients receiving either GnRH agonist or antagonist therapies. Serum levels of sFas were significantly lower in the endometriosis group compared to the male factor group. Serum and FF levels of sFas, sFasL were similar among patients with or without clinical pregnancy. Conclusion: sFas and sFasL are detected in both serum and follicular fluid samples from IVF cycles, their levels are similar between poor responder and male factor groups as well as between GnRH agonist and antagonist treatment groups. These soluble apoptotic factors may not be predictive for the outcomes of IVF. Decreased serum levels of sFas, suggests increased apoptosis in endometriosis.Öğe Serum and follicular fluid levels of soluble Fas, soluble Fas ligand and apoptosis of luteinized granulosa cells in PCOS patients undergoing IVF(Oxford Univ Press, 2005) Önalan, Göğşen; Selam, Belgin; Baran, Yusuf; Cıncık, Mehmet; Önalan, Reşide; Gündüz, Ufuk; Ural, Ali UğurBACKGROUND: There are limited data about the levels of soluble apoptotic factors and their modulation with therapeutic regimens in IVF cycles. The aim of the current study was to determine follicular fluid, and serum levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in PCOS patients undergoing IVF/ICSI cycles; also to investigate the effects of metformin on these factors and on apoptosis of luteinized granulosa cells. METHODS: We investigated the serum and follicular fluid levels of sFas and sFasL in patients with PCOS (n=28) and compared them with those of the patients with infertility due to male factor (n=12) undergoing IVF cycles. Effects of metformin therapy on these parameters and apoptosis of luteinized granulosa cells were also investigated among the patients with PCOS. RESULTS: Serum levels of sFas were significantly lower in the PCOS group compared to those in women with infertility due to male factor. Metformin therapy in PCOS patients preceding IVF cycles increased serum levels of sFas and decreased follicular fluid levels of sFasL compared to those on placebo. Follicular fluid from PCOS patients demonstrated luteinized granulosa cell DNA fragmentation in agarose gel, whereas a similar pattern was not observed among PCOS patients undergoing metformin therapy. CONCLUSION: Decreased serum levels of sFas and luteinized granulosa cell DNA fragmentation is observed in patients with PCOS undergoing IVF cycles. Metformin therapy preceding IVF demonstrates an antiapoptotic effect with increased serum levels of sFas, decreased follicular fluid levels of sFasL and prevention of luteinized granulosa cell DNA fragmentation.Öğe Successful treatment of cervical stenosis with hysteroscopic canalization before embryo transfer in patients undergoing IVF: a case series(Elsevier Science Inc, 2005) Pabuçcu, Recai; Ceyhan, Seyit Temel; Önalan, Göğşen; Göktolga, Ümit; Ercan, Cihangir Mutlu; Selam, BelginThe course of the transfer catheter through the cervical canal is one of the most important issues for a successful embryo transfer (ET) during in vitro fertilization (IVF) cycles. Technically difficult ETs due to cervical stenosis are associated with reduced chance of pregnancy after assisted reproductive procedures. In the current case series, we report on three patients with cervical stenosis who underwent IVF-ET cycles. These three patients, in whom ET was classified as "difficult," failed to conceive with previous ET attempts. An intervention to create a cervical tract was performed with operative hysteroscopy under general anesthesia before transcervical ET. After the hysteroscopic shaving procedure, we observed quite an improvement in access to the endometrial cavity during ET procedure. These patients had significantly easier ET procedures compared with previous attempts and achieved clinical pregnancies. Hysteroscopic revision of the cervical canal results in easier ET and improves pregnancy rates in patients with cervical stenosis and histories of difficult ET.
