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Öğe A novel biochemical marker-OKL38- with its apoptotic and antioxidant properties for the development of PCOS and its related clinical implications(Taylor & Francis Ltd, 2020) Yetkin Yıldırım, Gonca; Tola, Esra Nur; Dağ, İsmailAim: To investigate the role of serum OKL38 levels in the development of polycystic ovary syndrome (PCOS) and clinical implications related to PCOS. Method: PCOS (n = 33) and ovulatory controls (n = 48) were recruited for the study. Anthropometric measurements were recorded, and blood samples for hormonal and biochemical parameters including serum OKL38 levels were obtained. The potential role of OKL38 on the development of PCOS, metabolic syndrome and cardiovascular disease (CVD) were investigated. Framingham risk score (FRS) was used for the determination of CVD risk. Results: Mean Ferriman-Gallway (FG) score, insulin, low-density lipoprotein (LDL), total cholesterol (TC) levels, and the homeostasis model assessment of insulin resistance index (HOMA-IR) were significantly increased (p < .05) in women with PCOS compared to controls. PCOS group had lower mean OKL38 level compared to controls (p < .0001) and OKL38 was negatively predictive for the diagnosis of PCOS after adjustment of variables that were significantly different between two groups. A negative association between OKL38 and metabolic syndrome in PCOS women was evident after adjustment for age, obesity, and abdominal obesity. OKL38 level was also negatively correlated with body mass index, waist-to-hip-ratio, fat composition, serum TC, LDL, free testosterone levels, FRS, and FG scores. Conclusion: OKL38 may have a partial role in the etiopathogenesis of PCOS and may protect development of metabolic syndrome and CVD in women with PCOS.Öğe Dondurulmuş-çözdürülmüş embriyo transferlerinde farklı naturel (naturel, modifiye naturel, stimule edilmiş modifiye naturel) siklus sonuçlarının karşılaştırılması(Türkiye Klinikleri Yayınevi, 2022) Özmen, Sevinç; Tola, Esra NurAmaç: Çalışmamızın amacı naturel siklus ile dondurulmuş-çözdürülmüş embriyo transferi (DÇET) uygulanan hastalarda kullanılan 3 farklı naturel siklus yöntemi- nin klinik sonuçlarını karşılaştırmaktır. Gereç ve Yöntemler: Bu retrospektif çalışma Medipol Mega Hastanesi İn vitro Fertilizasyon (IVF) Ünitesinde yapıldı. Na- turel siklus ile DÇET yapılan 35 yaş ve altı 271 kadın retrospektif olarak çalışmaya alındı. Vakalar DÇET siklusu hazırlama protokolüne göre 3 gruba ayrıldı: Spontan ovulasyona kadar sadece izlem yap ılan grup naturel DÇET (n-DÇET, n=155), spontan folikül geli şimi takip edilip ovulasyon için human koryonik gonadotropin (hCG) yapılan grup modifiye naturel DÇET (mn-DÇET, n=81), aromataz inhibitörü ile ovulasyon indüksiyonu yapılıp ovulasyonu tetiklemek için hCG yapılan grup stimule edilmiş modifiye naturel DÇET (s-DÇET, n=35) grubu. Çalışmaya alınan vakaların hepsi dondurulmuş iyi kalite blastokiste sahipti. Gruplar arası implantasyon (pozitif gebelik testi), klinik gebelik (ultrasonda fetal kalp atımı), abort (20. gestasyonel haftadan önce gebelik terminasyonu) ve canlı doğum oranları karşılaştırıldı. Bulgular: Naturel DÇET, modifiye naturel DÇET ve stimule edilmi ş modifiye naturel DÇET grupları arasında siklus iptali, implantasyon, abortus ve canl ı doğum oranları arasında anlamlı olarak fark izlenmedi. Sonuç: n-DÇET, mn-DÇET ve s-DÇET grupları arasında IVF başarısı benzerdir. Naturel siklusla DÇET yapılacak vakalarda menstrual siklusu düzenli ise mn-DÇET, siklusu düzenszi grupta ise s-DÇET yap ılması daha az maliyetli ve klinisyen ve hasta aç ısından daha az zaman alıcı gibi durmaktadır.Öğe İleri anne yaşı olan vakalarda anöploidi için preimplantasyon genetik tanı (Pgt-A) yapılması canlı doğum oranını arttırır mı?(Üreme Tıbbı, Cerrahi Eğitim, Araştırma ve Uygulama Vakfı, 2022) Özmen, Sevinç; Tola, Esra NurAmaç: Anöploidi nedeniyle embriyolara preimplantasyon genetik tarama (PGT-A) yapılmasının in vitro fertilizasyon (IVF) başarısını artırabi- leceği öne sürülmüştür. Ancak PGT-A’ nın invazif bir işlem olması ve embriyoya zarar verilebileceği kaygısı bazı klinisyenlerde bu işlemi yapma konusunda çekingen davranmaya yol açar. Buradan yola çıkarak ileri yaş olup IVF başarısının iyi beklendiği normal overyan rezervli ve iyi ka- lite blastokist transferi yap ılan kadınlarda PGT-A’ nın canlı doğum üzerine etkisini ara ştırdık. Gereç ve Yöntemler: ?37 yaş ve dondurulmuş iyi kalite blastokist transferine giden 85 vaka retrospektif olarak çal ışmaya dahil edildi. Vakalar blastların dondurulma nedenine göre iki gruba ayrıldı: PGT-A nedeniyle embriyosu dondurulmuş grup PGT-A grubu (n=27) ve PGT-A dışı herhangi bir nedenle embriyosu dondurulmuş grup non-PGT-A grubu (n=58) olarak adlandırıldı. Gruplar arası implantasyon (embriyo transferinden 9 gün sonra kanda pozitif gebelik testi), klinik gebelik (embriyo transferinden 6 hafta sonra ultrasonda fetal kalp at ımı), biyokimyasal gebelik (kanda gebelik testi pozitif çıkıp sonrasında ge- rileyen vakalar), klinik abort (20. gebelik haftadan önce gebelik terminasyonu) ve canlı doğum oranları (20, gebelik haftasından sonra canlı bebek doğumu) karşılaştırıldı. Bulgular: Her iki grup demografik özellikler açısından benzerdi. Non-PGT-A grubunda transfer edilen embriyo say ısı önemli ölçüde daha fazla olmasına rağmen çoğul gebelik oranı her iki grupta benzerdi. Gruplar arası implantasyon, klinik gebelik, biyokimyasal gebelik ve canlı doğum oranları benzerdi (p>0,05). Klinik abort non-PGT-A grubunda (24,2%) PGT-A grubuna (0) göre (p=0,04) daha yüksekti. Sonuç: İleri yaş, iyi over rezervi olan ve iyi kalite blastokiste sahip kadınlarda anöploidi taraması için PGT-A yapmak klinik abort oranlarını azalt- masına rağmen canlı doğum oranlarını etkilememektedir.Öğe Intracytoplasmic sperm injection cycle success in patients under 35 years old with diminished ovarian reserve plus severe male factor(Wiley, 2023) Özmen, Sevinç; Tola, Esra Nur; Karahasanoğlu, AyşeObjective We aimed to evaluate intracytoplasmic sperm injection (ICSI) outcomes in young patients with diminished ovarian reserve (DOR) plus severe male factor (SMF) compared with age-matched controls with DOR. Study design A total of 189 infertile women under 35 years with DOR undergoing ICSI procedures were included retrospectively. Participants whose partners' sperm analysis was normal considered as the DOR group (n = 154) and whose partners' had SMF considered as the DOR + SMF group (n = 35). The two groups were compared regarding cycle characteristics and pregnancy outcomes. Results Demographic features except infertility duration were similar between two groups. The duration of infertility was significantly longer in the DOR + SMF group compared to the DOR group (p = 0.02). Ovarian stimulation characteristics, oocyte retrieval parameters, fertilization rate, quality of embryos, embryo cancellation rate, and development up to blastocyst stage were found similar between two groups. Implantation, clinical pregnancy, abortion, and live birth rate, multiple pregnancy rate per cycle were distributed homogenously between the DOR and DOR + SMF groups. Regarding perinatal and neonatal outcomes of groups, fetal height and weight were significantly lower in DOR + SMF group than in DOR group (p = 0.001 and 0.01, respectively). Gestational week at delivery was lower in the DOR + SMF group compared to the DOR group (p < 0.0001). Conclusion Fetal anthropometric measures were lower regarding to preterm delivery in the DOR + SMF group than the DOR group. Large sample-sized studies should be performed to explain the decreased gestational week at the time of delivery in the DOR + SMF group.Öğe Obstetrics and perinatal outcomes between elective single versus double blastocyst transfer in women younger than 35 years: A cross-sectional study(Elsevier Masson s.r.l., 2023) Özmen, Sevinç; Tola, Esra Nur; Karahasanoğlu, AyşeIntroduction: Clinicians have a positive attitude towards multiple embryo transfer in in vitro fertilization (IVF) cycles, considering increased live birth rates compared to single embryo transfer. We aimed to evaluate obstetric and perinatal outcomes among young women who became clinically pregnant after single & double blastocyst transfer.Material-method: 545 women under 35 years who became clinically pregnant after fresh blastocyst transfer was evaluated retrospectively. The participants were divided1according to the transferred embryo number the elective single blastocyst transfer group (eSBT) (n=112) and the double blastocyst transfer group (DBT group) (n=433). Obstetric and perinatal outcomes were recorded. Results: Live birth and abortion rates per pregnancy and per gestational sac, having a fetus with congenital anomaly per pregnancy and per neonate, and gestational complications were comparable between the groups. Multiple pregnancy, Cesarean section, and admission to neonatal intensive care unit (NICU) and hospitalization day in NICU per neonate were higher in the DBT group than in the eSBT group. Mean gestational week, birth weight, birth height decreased with the embryo transfer number. Conclusion: DBT transfer appears to be associated with increased multiple pregnancies, Cesarean section, prematurity, decreased fetal anthropometric measurements, and admission to NICU without an increase in live birth and abortion rates. Therefore, it will be easier for clinicians to choose eSBT by providing young couples undergoing IVF treatment with detailed information about multiple pregnancies and prematurity.Öğe The association between age-related infertility and deoxyribonucleic acid (DNA) integrity parameters of granulosa cells and lymphocytes(Taylor & Francis Inc, 2022) Tola, Esra Nur; Aslan Koşar, Pınar; Nal Şahin, Esra; Sancer, OkanThis study aimed to investigate the association between deoxyribonucleic acid (DNA) integrity parameters and advanced maternal age (AMA)-related infertility. The granulosa cells and the lymphocytes obtained from 119 infertile women were recruited. Patients were divided into two groups: the AMA group (>= 35 years, n = 26) and the non-AMA group (<35 years, n = 93). The tail length, tail moment and tail DNA percentage were evaluated as the DNA integrity parameters using comet assay. Infertility duration (p=.001), luteinising hormone (p=.01) and progesterone levels (p<.0001) were higher and smoking was more prevalent in the AMA group (p=.001). AMA group was stimulated with higher gonadotropin doses (p=.04) and had decreased anti-mullerian hormone levels (p<.0001). All of DNA integrity parameters were distributed homogenously between the groups; however, the tail length of lymphocytes was higher (p=.02) in the AMA group. Fertilisation was lower (p=.02), oocyte quality was tended to be poor (p=.03) and blastocyst transfer was lower in the AMA group (p=.03). Embryo quality was distributed homogenously between the groups. Implantation, clinical pregnancy and live birth rates were similar between the groups. Impact Statement What is already known on this subject? Advanced maternal age (AMA)-related infertility is associated with diminished ovarian reserve and alteration in follicular environment resulting in poor oocyte quality; however, the exact pathophysiologic mechanism is not clear. What do the results of this study add? Tail length, tail deoxyribonucleic acid (DNA) percentage, tail moment of granulosa cells were nonsignificantly higher in the AMA group compared to younger patients. All of the DNA integrity parameters of lymphocytes were nonsignificantly higher; however, only tail length of lymphocytes was statistically higher in the AMA group than the non-AMA group. A positive correlation was observed between DNA integrity parameters of lymphocytes and body mass index. There were no correlations between DNA integrity parameters of granulosa cells and lymphocyte and infertility duration, gonadotropin dose, duration of ovarian stimulation, oocyte score, embryo score, basal hormone levels and anti-mullerian hormone levels. What are the implications of these findings for clinical practice and/or further research? Our findings offer new insight for further understanding the role of granulosa cells in mediating the poor reproductive outcome of ageing patients. Understanding the mechanisms of ovarian ageing and poor oocyte quality in women with AMA may help to identify specific targets for improving oocyte quality with ageing.Öğe The association between gestational diabetes mellitus and DNA damage in umbilical cord leukocytes and placental samples(Taylor & Francis Ltd, 2022) Tola, Esra Nur; Bucak, Mevlüt; Togay, Atahan; Aslan Koşar, PınarObjective(s): To evaluate the relation between gestational diabetes mellitus (GDM) and maternal and/or fetal DNA integrity. Method: 59 pregnant women were classified into two groups on the basis of 75 g oral glucose tolerance test (OGTT) and glycemic profile (GP): Control group (OGTT and GP normal, n = 29) and GDM group (abnormal 75 g OGTT, n = 30). The umbilical cord blood and placental samples obtained from the maternal side were collected at the time of delivery. Alkaline comet assay was performed for the determination of DNA damage. The trial was approved with the protocol number 72867572.050.01.04-299082. Result(s): Body mass index (BMI), weight gain during pregnancy, glycemic means and fetal weight were increased in GDM group compared control group (p = .01, .0001, .04, and .01, respectively). In the GDM group, the number of large-for-gestational-age (LGA) infants was significantly higher compared to the nondiabetic group (p = .04). Tail DNA percentages in placental samples were higher in the GDM group compared to controls (p = .01); however, DNA integrity in umbilical cord leukocytes was similar between the groups (p = 0.1). In contrast to umbilical cord DNA damage, placental DNA damage showed positive correlation with maternal glycemia in the whole group and within each group. The positive association of placental DNA damage and GDM remained after adjusting for age, BMI, smoking, glycemia, gestational age at delivery, fetal weight at delivery, and delivery type (p = .01). Conclusion(s): Placental DNA damage is associated with GDM and placental cells seem to be more vulnerable to DNA damage compared to fetal blood cells.Öğe The association between preterm delivery and postpartum bleeding in otherwise uncomplicated pregnancies(Galenos Publishing House, 2022) Kılınçdemir Turgut, Ümran; Tola, Esra Nur; Sezik, MekinObjective: The primary aim was to investigate whether preterm delivery was an independent risk factor for blood or blood products transfusion in the intrapartum or postpartum period, considered as a proxy for severe obstetric bleeding. Material and Methods: Throughout a 9-month-period, 216 uncomplicated singleton deliveries were included in a cross-sectional study after exclusion of severe maternal and fetal morbidity, such as chorioamnionitis, and use of medications including tocolytics. Maternal and neonatal data were evaluated and compared across preterm (between 24 0/7-36 6/7 weeks’ gestation) and term (between 37 0/7-41 6/7 weeks’ gestation) deliveries. Primary and secondary outcomes were requirement for blood or blood products transfusion until discharge and change in hemoglobin value and hematocrit from baseline to postpartum hour 6, respectively. Logistic regression models were constructed to evaluate the effect of preterm delivery on the primary outcome. Results: There were 90 (41.7%) preterm deliveries with an overall cesarean section rate of 77.8%. Preterm delivery was not an independent risk factor for the primary outcome, when route of delivery, maternal body-mass index, antenatal steroid administration, and baseline (admission) platelet and leukocyte counts were controlled for [adjusted risk ratio, 2.46; 95% confidence interval (CI), 0.69-8.77; p=0.16]. Subgroup analysis, including cesarean deliveries, revealed a similar result (adjusted risk ratio, 1.65; 95% CI, 0.42-6.48; p=0.47). Secondary outcomes, including decrease in mean or percent values of hemoglobin and hematocrit measurements, were also similar across preterm and term groups, both after vaginal and cesarean delivery (for all comparisons, p>0.05). Conclusion: Preterm delivery is not independently associated with increased requirement for blood transfusions or decreased hemoglobin and hematocrit values following otherwise uncomplicated vaginal or cesarean delivery of singletons.Öğe The association of type D personality and premenstruel syndrome(Süleyman Demirel University, 2022) Yıldırım Baş, Funda; Tola, Esra Nur; Çankaya, Başak AslıObjective Type D personality, defined as the presence of two personality characters -negative affectivity (NA) and social inhibition (SI), is associated with various disorders. The aim of our study was to investigate the association between Type D personality and premenstruel syndrome (PMS). Material and Methods A total of 286 female (86 with PMS and 200 control) were recruited for the study. The mean age of the participants was 21.28 ± 0.12 years. Data were obtained from the Premenstrual Syndrome Scale, Beck Depression Inventory (BDI-21) and Type D Personality Scale (DS14). SPSS 22 (Statistical Package for Social Sciences) program was used to evaluate the data. Statistical significance level was accepted as p<0.05. T test was used to compare continuous variables, chi-square test was used to compare categorical data, and pearson correlation test was used to determine the relationships between continuous variables. Results Depression and Type D personality were found to be significantly more common in the PMS group than in the control group (p<0.0001). Type D personality was positively correlation with PMS and BDI-21 (r=0.434, p<0.0001; OD (r=0.621, p<0.0001). Conclusion A positive relationship was found between PMS and depression and Type D personality. Prospective studies with a large number of patients are needed to better understand the underlying mechanisms.Öğe The role of oxidant status on the etiopathogenesis of unexplained infertility and intracytoplasmic sperm injection - embryo transfer success: A case-control study(Taylor & Francis Inc, 2022) Şentürk, Raziye; Tola, Esra Nur; Bozkurt, Mustafa; Kumbul Doğuç, DuyguThe present study aims to evaluate the role of follicular fluid (FF) and serum (s) total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) on the etiopathogenesis of unexplained infertility (UI) and intracytoplasmic sperm injection-embryo transfer (ICSI-ET) success. Twenty UI patients and 20 controls with male factor undergoing an ICSI-ET cycle were recruited. FF samples aspirated from mature follicles and blood samples collected just before the oocyte retrieval were stored until analysis. Embriyo quality and implantation, clinical pregnancy and living birth rates were evaluated. FF-TOS and FF-OSI of the UI patients were higher than the control group. s-TOS and s-OSI were significantly increased in the UI group compared to the control group. However, only s-TOS was positively associated with UI diagnosis after age-adjustment. FF-OSI was negatively associated with embryo quality in the UI group (but not in the whole group) after age-adjustment. No significant effect of TAS, TOS, and OSI on implantation, clinical pregnancy and live birth rate was observed. In conclusion, especially s-TOS can have a partial role in the etiopathogenesis of UI. High FF-OSI can decrease the quality of embryo in patients with UI.Impact statement What is already known? Total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI), which is the ratio of TOS to TAS, provide a broad overview of redox status. What do the results of this study add? An elevated serum TOS (s-TOS) was associated with UI after age-adjustment. Follicular fluid OSI (FF-OSI) was negatively associated with embryo quality and embryo score in the UI group (but not in the whole group) after age-adjustment. No significant effect of TAS, TOS, and OSI was observed on implantation, clinical pregnancy, and live birth rate. What are the implications of these findings for clinical practice and/or further research? Evaluation of FF-OSI in women with unexplained infertility can be considered to predict embryo quality. Further studies that evaluate antioxidant agents to decrease oxidative stress in UI and its' clinical implications are warranted.
