Gynecology Obstetrics & Reproductive Medicine

Embryo Ploidy and Ovarian Response in Gonadotropin-Releasing Hormone Antagonist Versus Progestin-Primed Ovarian Stimulation Protocols with Recombinant Luteinizing Hormone: A Within-Patient Study

2026-07-26T00:46:24+03:00

OBJECTIVE: To compare embryo ploidy rates and ovarian response outcomes between gonadotropin-releasing hormone (GnRH) antagonist and progestin-primed ovarian stimulation (PPOS) cycles with recombinant luteinizing hormone (rLH) administered from stimulation onset.

STUDY DESIGN: This retrospective within-patient cohort study included 41 women undergoing in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A) at a single center. Each patient completed both GnRH antagonist and PPOS cycles with rLH supplementation initiated on stimulation day 1. Cycles using GnRH agonists, urinary LH, random-start approaches, or with major gonadotropin dose discrepancies were excluded. The primary outcome was euploidy rate per biopsied blastocyst. Secondary outcomes included gonadotropin consumption, numbers of retrieved and mature oocytes, fertilization, blastulation, and euploidy per metaphase II (MII) oocyte. Paired t-tests or Wilcoxon signed-rank tests were used as appropriate. Statistical significance was set at p <0.05.

RESULTS: In total, 175 blastocysts were biopsied (86 antagonists; 89 PPOS). Euploidy rates per biopsied embryo were comparable (32.36% vs 33.72%). No significant differences were observed in oocyte yield, MII oocytes, fertilization, or blastulation rates. Gonadotropin consumption was significantly higher in antagonist cycles (p = 0.013), while hormonal profiles at trigger were comparable.

CONCLUSION: When rLH supplementation is standardized, PPOS and antagonist protocols yield comparable embryo ploidy and similar ovarian response in IVF-PGT-A cycles. PPOS remains an effective alternative, particularly in freeze-all strategies. Larger prospective studies are needed to clarify the benefit of rLH across stimulation protocols.

Cigarette Smoking Disrupts Sperm Nuclear Maturation, Epigenetic Regulation, and CatSper-Mediated Calcium Signaling

2026-03-22T00:22:56+03:00

OBJECTIVE: The CatSper (cation channel of sperm) channel is the principal pH-sensitive and low-voltage-activated cation channel that regulates Ca²⁺ influx required for sperm hyperactivation. Exposure to cigarette smoke is known to affect semen parameters and sperm DNA integrity adversely. This study aimed to investigate the effects of cigarette smoking on semen analysis results, sperm DNA fragmentation, chromatin condensation, global DNA methylation, and CatSper4 immunoreactivity.

STUDY DESIGN: In this case-control study, 50 men who presented for infertility evaluation between November 2019 and November 2021 were divided into two groups: non-smokers (n=25) and those who smoked approximately one pack of cigarettes per day (n=25). Twenty of these cases were normospermic and 30 oligospermic. Semen analysis was performed according to the World Health Organization 2010 criteria. Sperm DNA fragmentation was assessed by acridine orange staining, chromatin condensation by aniline blue staining, global DNA methylation by 5-methylcytosine (5-mC) ELISA assay, and CatSper4 expression by immunofluorescence staining.

RESULTS: In normospermic men, no statistically significant smoking-related differences were observed in conventional semen parameters, DNA fragmentation, chromatin condensation, or CatSper4 positivity. In oligospermic men, smoking was associated with significantly higher sperm DNA fragmentation and significantly lower chromatin condensation and CatSper4 positivity. In contrast, sperm concentration, motility, and normal morphology did not differ significantly between smokers and non-smokers. Global DNA methylation levels were significantly higher in smokers than in non-smokers (1.81±0.52 vs. 1.11±0.35, respectively; p=0.0012).

CONCLUSION: Cigarette smoking may impair male fertility potential primarily through alterations in sperm DNA integrity, chromatin maturation, global DNA methylation, and CatSper4-related calcium signaling, particularly in oligospermic men. Larger-scale studies using individual-level datasets are required to confirm these findings and clarify their clinical significance.

Systemic Thiol-Disulfide Homeostasis and Contemporaneous Menstrual Pain Intensity in Primary Dysmenorrhea: A Prospective Observational Study

2026-05-22T20:28:43+03:00

OBJECTIVE: Primary dysmenorrhea (PD) is associated with prostaglandin-mediated uterine hypercontractility, transient ischemia, inflammation, and oxidative stress. Whether systemic redox biomarkers reflect menstrual pain intensity at a specific clinical time point remains uncertain. This study evaluated the associations of thiol-disulfide homeostasis parameters and ischemia-modified albumin (IMA) with contemporaneous menstrual pain intensity among women with PD.

STUDY DESIGN: This cross-sectional study included 98 women with PD. Pain intensity was assessed immediately before venous blood sampling during menstrual days 1-4 using a 10-cm Visual Analog Scale (VAS). The primary analysis examined continuous contemporaneous VAS scores. A secondary exploratory analysis classified pain as mild (>0 to 3), moderate (>3 to 6), severe (>6 to 8), or very severe (>8 to 10). Native thiol, total thiol, disulfide, thiol-disulfide ratios, and IMA were evaluated.

RESULTS: Spearman correlation coefficients between contemporaneous VAS score and the measured biomarkers ranged from -0.10 to 0.10. All bootstrap 95% confidence intervals included zero, with outermost limits of approximately -0.29 and 0.29. Menstrual sampling-day-adjusted analyses and the sensitivity analysis using the retrospective worst-pain score yielded concordant findings. In the secondary categorical analysis, no significant differences were observed for native thiol (p=0.9913), total thiol (p=0.9805), disulfide (p=0.3098), the thiol-disulfide ratios (p=0.4704-0.5095), or ischemia-modified albumin (p=0.8986). All Holm-adjusted p values were 1.000.

CONCLUSION: Systemic thiol-disulfide homeostasis parameters and unadjusted IMA were not associated with contemporaneous menstrual pain intensity in this cohort. A single systemic measurement may not adequately represent the localized, dynamic, and centrally modulated mechanisms underlying menstrual pain. Future studies are needed to improve diagnostic and therapeutic strategies for PD.

In Search for an Effective Conservative Surgery for Diffuse Adenomyosis in a Resource-Constrained Setting: Outcome of Open Double-Flap Adenomyomectomy in Infertile Women

2026-05-31T19:57:31+03:00

OBJECTIVES: Adenomyosis is a common cause of pelvic pain, menorrhagia, and infertility in women of reproductive age. There remains a need for an effective fertility-sparing surgical option for managing diffuse adenomyosis. This study evaluated the clinical and reproductive outcomes of open double-flap adenomyomectomy in infertile women in a resource-poor setting.

STUDY DESIGN: This prospective observational cohort study was conducted between July 2024 and December 2025. Twenty-four infertile women with diffuse adenomyosis underwent open double-flap adenomyomectomy and were followed up for 12 months. Clinical and postoperative outcomes were analyzed. The severity of menorrhagia and dysmenorrhea was assessed using a Visual Analog scale (VAS) serially over 12 months postoperatively. Reproductive outcomes were also evaluated in women who subsequently had assisted reproductive treatment.

RESULTS: The mean age of the women studied was 40.9±5.6 years, while the average duration of infertility was 7.4±3.4 years. The mean uterine size was 17.3±2.5 weeks. Mean blood loss was 285±222.9 ml, and 29.2% of the women required blood transfusion. The average duration of surgery was 135.9±75.6 minutes. One woman (4.2%) developed postoperative pelvic abscess. Appreciable improvement in menorrhagia and dysmenorrhea was observed, as demonstrated by declining VAS scores during follow-up. Nine women underwent in vitro fertilization, of whom 3 achieved pregnancy.

CONCLUSION: Double-flap open adenomyomectomy may result in symptom relief and appreciable fertility outcomes in women with diffuse adenomyosis. The procedure appears safe, with low complication

Clinical and Reproductive Outcomes After Hysteroscopic Repair of Isthmocele

2026-04-22T14:45:57+03:00

OBJECTIVE: The growing global prevalence of cesarean delivery has increased the incidence of long-term scar complications, among which isthmocele represents a clinically relevant yet often under-recognized entity. This defect, characterized by incomplete myometrial healing at the cesarean incision site, has been associated with abnormal uterine bleeding, pelvic pain, and secondary infertility. Although hysteroscopic correction has emerged as a minimally invasive treatment option, data on its long-term clinical and reproductive outcomes remain limited.

STUDY DESIGN: This multicenter retrospective cohort included 96 women diagnosed with isthmocele who underwent hysteroscopic repair across three hospitals in Turkey. Demographic, hematologic, and surgical data were extracted from institutional records. Primary outcomes were symptom resolution, fertility outcomes, complications, and reoperation rates; secondary measures included operative time, hospital stay, and perioperative morbidity.

RESULTS: The mean patient age was 34.7 years. Preoperative mean hemoglobin was 11.6 g/dL and ferritin 81.4 ng/mL. Complete symptom resolution was achieved in 69.8% of patients, and 25.0% of the total cohort conceived post-surgery. However, this proportion could not be restricted to women who had expressed a desire for pregnancy (see Limitations). The reoperation rate was 36.5%. A mean interval of 3.56 years was recorded among patients with persistent or recurrent symptoms, although these two groups could not be distinguished in this retrospective dataset (see Limitations). No major intraoperative or postoperative complications were observed, and minor complications occurred in 3.1% of cases.

CONCLUSION: Hysteroscopic repair of isthmocele was associated with substantial symptomatic improvement and a low complication profile. Fertility outcomes require cautious interpretation given limitations in linking pregnancy intention to conception at the patient level. Individualized patient selection - informed by residual myometrial thickness where available and by reproductive goals - appears important, although this retrospective, single-arm design cannot directly test that recommendation.

Postoperative Arterial Thromboembolism Causing Acute Limb Ischemia and Amputation Following Gynecologic Oncology Malignancy Surgery: Presentation of Two Cases

2026-02-24T12:32:14+03:00

This case report presents two rare cases and aims to highlight arterial thromboembolism (ATE) as a rare but potentially devastating complication following gynecologic oncology surgery. Chronic kidney disease (CKD) has been demonstrated to heighten susceptibility to thrombotic events through a variety of mechanisms, including endothelial dysfunction, uremia-associated platelet activation, impaired fibrinolysis, and systemic inflammation. In addition, other systemic and perioperative risk factors-including advanced age, malignancy-associated hypercoagulability, smoking history, hypertension, atherosclerosis, sepsis, and perioperative hemodynamic instability-may also contribute to the development of arterial thromboembolism. This report presents two rare cases of early postoperative ATE leading to acute limb ischemia, amputation, and death in patients with advanced ovarian malignancy and concomitant CKD.
In the first instance, a 51-year-old female patient was diagnosed with end-stage CKD and required long-term dialysis. She subsequently underwent a surgical procedure for high-grade serous ovarian carcinoma. Severe postoperative ATE manifested on postoperative day 1, rapidly progressing to extensive ischemia. Despite escalating treatment from prophylactic to therapeutic anticoagulation and vasodilator therapy, the patient's condition continued to deteriorate, ultimately resulting in the need for amputation. The patient succumbed on postoperative day 35 due to complications from sepsis and multi-organ failure. In the second case, a 71-year-old woman with advanced-stage CKD (non-dialysis-dependent) underwent primary cytoreductive surgery for ovarian mucinous carcinoma. Bilateral lower-extremity arterial thrombosis developed on postoperative day 2, with absent distal perfusion. Despite aggressive anticoagulation and prostacyclin therapy, thigh-level amputation was necessary, and the patient succumbed on postoperative day 18 due to multi-organ failure.
These cases suggest that CKD may increase susceptibility to postoperative arterial thromboembolism and may be an important predisposing factor rather than an independent causal risk factor. ATE development in this setting is likely multifactorial and should not be interpreted as a direct cause-effect relationship based on two cases. In this high-risk population, ATE may progress rapidly and remain refractory to medical therapy. Early postoperative peripheral perfusion monitoring and multidisciplinary management are essential.

Evidence-Based Clinical Recommendations For The Use Of Antenatal Corticosteroids

2026-05-12T20:19:46+03:00

Antenatal corticosteroid (ACS) therapy is one of the most effective evidence-based interventions for improving neonatal survival and reducing major short-term morbidities associated with prematurity in pregnancies at risk of preterm birth. However, the clinical benefit of ACS largely depends on accurate patient selection, appropriate gestational age, and the reliable prediction of delivery timing. The most pronounced benefit is achieved when delivery occurs within 1-7 days after the initial dose; outside this window, efficacy decreases and the risk of unnecessary fetal exposure increases. Current evidence strongly supports the administration of ACS in pregnancies between 24+0 and 33+6 weeks of gestation with a high risk of preterm birth within the following seven days. Within this gestational window, ACS significantly reduces neonatal mortality as well as major morbidities such as respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. In contrast, the 22+0–23+6 weeks of gestation represent the most sensitive period for the use of ACS, and administration should be considered only in selected cases in which delivery is expected imminently and aggressive neonatal care is planned, within a shared decision-making process. The administration of ACS is not recommended in pregnancies below 22+0 weeks of gestation. The use of ACS in the late preterm period (34+0-36+6 weeks of gestation) remains controversial, and no survival benefit has been demonstrated. Although ACS may modestly reduce the need for respiratory support during this period, it increases the risk of neonatal hypoglycemia, and uncertainties persist regarding long-term neurodevelopmental outcomes. Therefore, ACS should not be used routinely but should be considered only in selected cases where a clear potential benefit is evident. There is insufficient evidence to support the use of prophylactic ACS prior to planned cesarean delivery at ≥37 weeks of gestation. Although repeated courses of ACS may provide short-term respiratory benefits, their use should be carefully limited due to concerns regarding fetal growth and potential long-term effects associated with increased exposure. Overall, ACS should be administered using a targeted, selective, and individualized approach.

Development of Gestational Age-Specific Nomograms for Fetal Splenic Artery Doppler Parameters Between 18 and 40 Weeks of Gestation

2026-08-19T20:01:07+03:00

OBJECTIVE: To characterize the gestational age-related behavior of fetal splenic artery (SA) Doppler parameters and to establish appropriate reference models for the systolic/diastolic (S/D) ratio, pulsatility index (PI), peak systolic velocity (PSV), and time-averaged maximum velocity (TAMV) in normal singleton pregnancies between 18 and 40 weeks of gestation.

STUDY DESIGN: This prospective observational cross-sectional study included 103 normal singleton pregnancies undergoing routine obstetric ultrasonographic examination between 18 and 40 weeks of gestation. SA Doppler waveforms were obtained using a standardized technique, and the S/D ratio, PI, PSV, and TAMV were recorded. We modeled the relationship between gestational age and each parameter using linear and quadratic regression analysis and derived gestational age-specific Z-score equations and percentile reference values (5th, 10th, 50th, 90th, and 95th). Gestational age-specific modeling was applied to PSV and TAMV; PI, which showed no gestational age dependence, was reported as a single pooled reference interval, and S/D, which could not be adequately modeled parametrically, was reported descriptively. Correlations between SA Doppler parameters and gestational age, fetal biometric parameters, and umbilical artery (UA) Doppler indices were assessed using Spearman correlation analysis.

RESULTS: SA PSV and TAMV increased significantly with advancing gestational age (PSV=−5.651+1.587×GA, R²=0.399, p<0.001; TAMV=−10.900+0.929×GA, R²=0.401, p<0.001), whereas the SA S/D ratio and PI showed no significant association with gestational age. SA PSV and TAMV correlated positively with abdominal circumference and estimated fetal weight (r=0.632-0.674, all p<0.001) and negatively with UA Doppler indices. In contrast, SA S/D correlated positively with the UA S/D ratio (r=0.405, p=0.006).

CONCLUSION: This study provides gestational age-specific nomograms and Z-score equations for SA PSV and TAMV, a pooled reference interval for SA PI, and descriptive values for SA S/D in normal pregnancy. These reference values may serve as a normative foundation for future research examining SA hemodynamics in relation to fetal growth, anemia, and pancreatic development.

Longitudinal Assessment of Fetal Ductus Arteriosus Morphometry: Establishing Gestational Age-Specific Reference Values

2026-08-19T20:40:50+03:00

OBJECTIVES: To longitudinally evaluate fetal ductus arteriosus (DA) morphometric changes and establish normative reference values between 18 and 36 weeks of gestation.

STUDY DESIGN: This prospective cohort study included 29 pregnant women with structurally normal singleton fetuses and confirmed gestational ages. Each participant underwent serial standardized ultrasound examinations to evaluate DA length and proximal, mid, and distal diameters. We defined weekly growth trends using regression analyses and assessed correlations with fetal biometric parameters.

RESULTS: Due to missed examinations caused by intermittent withdrawals, a total of 99 prenatal and 29 postnatal ultrasound examinations were performed longitudinally. DA length increased linearly at approximately 0.63 mm/week (R²=0.813). Proximal, mid, and distal diameters showed significant linear increases of 0.28 mm/week, 0.32 mm/week, and 0.16 mm/week, respectively (R²=0.769, 0.681, and 0.541). DA length correlated strongly with fetal abdominal circumference (R²=0.855). We established reference percentile tables and normative curves for DA dimensions across gestational ages (18-36 weeks).

CONCLUSIONS: This longitudinal study provides comprehensive reference values for fetal DA morphometric assessment between 18-36 gestational weeks. These nomograms support clinicians in identifying deviations suggestive of DA constriction, especially relevant given the expanded indications for maternal indomethacin administration. Further multicentre studies involving diverse populations are required to enhance the generalizability and clinical applicability of these reference standards.

Anemia and Postpartum Depression: The Role of Anemia Phenotype

2026-05-23T17:26:04+03:00

Objective: To evaluate the relationship between anemia and postpartum depressive symptoms in term pregnant women and to examine whether different anemia phenotypes and hematological parameters are associated with postpartum depressive symptoms.

Study Design: This retrospective observational study included 326 term pregnant women who delivered at Torbalı State Hospital between January and December 2025. Hematological parameters were obtained from the complete blood count performed at hospital admission before labor or cesarean section. Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at the routine postpartum follow-up visit at 4–6 weeks postpartum. Participants were grouped according to EPDS score as <10 and ≥10. Univariate and multivariable logistic regression analyses were performed to identify factors associated with EPDS ≥10.

Results: Anemia was present in 112 women (34.4%). The median EPDS score was 1.0 (IQR: 0.0–4.0), and 32 women (9.8%) had EPDS scores ≥10. Women with EPDS scores ≥10 had significantly lower hemoglobin levels and higher RDW values than those with EPDS scores <10. Anemia was significantly more frequent among women with EPDS ≥10 (84.4% vs. 28.9%, p<0.001). EPDS score showed a significant negative correlation with hemoglobin level (ρ=-0.221, p<0.001). After adjustment for potential confounders, anemia remained an independent predictor of EPDS ≥10 (adjusted OR 13.95, 95% CI 5.06-38.44, p<0.001).

Conclusion: Anemia was strongly and independently associated with postpartum depressive symptoms in term pregnant women. Evaluation of anemia phenotypes suggests that this relationship may extend beyond simple iron deficiency and may reflect more complex underlying biological mechanisms.

Perinatal and Neonatal Outcomes of Grand Multiparous Refugee Women Under the Age of Thirty-Five: A Comparative Study

2026-05-31T20:03:40+03:00

OBJECTIVES: To compare maternal and neonatal outcomes between grand multiparous Syrian refugee women younger than 35 years and Türkiye citizens.

STUDY DESIGN: In this retrospective cohort study we screened electronic birth records according to predefined eligibility criteria. Of 313 potentially eligible women, 16 were excluded because their patient files could not be accessed, leaving 297 grand multiparous women aged 18–34 years (150 Türkiye citizens and 147 Syrian refugees) who delivered at Adiyaman University Faculty of Medicine Education and Research Hospital. Women aged <18 or ≥35 years, those with multiple pregnancies, and refugees with Türkiye citizenship were excluded. We compared groups and used multivariable logistic regression; adjusted models for neonatal intensive care unit (NICU) admission, cesarean delivery, and gestational diabetes mellitus (GDM) included maternal age, parity, and gestational age at delivery.

RESULTS: NICU admission was more frequent among Syrian refugee neonates (16.3% vs. 8.7%, p=0.046) and remained associated with refugee status after adjustment (adjusted odds ratio 2.42, 95% CI 1.11-5.26; p=0.026). Cesarean delivery, blood transfusion, 5-minute Apgar score <7, and diagnosed GDM did not differ significantly. Missing GDM data were substantially more frequent among Syrian refugees (57.1% vs. 4.7%).

CONCLUSION: Syrian refugee status was independently associated with higher NICU admission in this age-restricted grand-multiparous cohort, identifying neonatal intensive care requirement as the principal observed difference. This focused comparison highlights a clinically relevant neonatal disparity; nonsignificant differences in other outcomes do not establish equivalence or comparable healthcare access.