Endocrinology and reproductive medicine

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Endocrinology And Reproductive Medicine - Oral Presentations

OraI-E&RM-001 Study of effective factors on IUD discontinuation in women in Ardebil Health Centers, 2003,

Mardi A 1, Dr. Rahimi G 1, Dr. Amani M 1, Mashoufi M 1, KHeirkhah M 2 1 Medical Faculty-Ardebil University of Medical Sciences-lran 2 Nursing Faculty-Ardebil University of Medical Sciences-lran

and infertile groups. The postthaw percentage of annexin V positive and necrotic cells increased significantly when compared with prefreeze values in both fertile and infertile groups. CONCLUSIONS: It is concluded that cryopreservation-thawing can damage membrane integrity of sperm in fertile and infertile men. KEY WORDS: infertile men, sperm membrane, vitrification

INTRODUCTION: The crisis of population is one of the most important problems of the world.lUD is one of the important methods for contraception in Ardebil and about 12.75 per- cent of women use it, but some of them don't bear it until the end of period. METHODS: This study was a descriptive-causative research. All of the women who referred to health centers to take out the IUD during the first semester of year about 271 women have been selected and studied. RESULTS: This research indicated the effective factors of IUD discontinuation were: Medical factors 70.5% ( hyper bleeding and spotting, abdominal pain and backache, infec- tion, cervix ulcers and perforation, rejection) and common factors 29.5% (tending to pregnancy, social and family factors).The most of those who were under 25 years old, with two children and low education, had medium or high bleeding in monthly period. DISCUSSION: The results showed hyper bleeding in first year of using and tending to pregnancy in the following years were two important reasons to discontinuation .so it sounds that the health providers must be careful in choosing people who refer to use IUD and give them enough informa- tion about it.Key words:lUD-discontinuation-contraception. KEY WORDS: IUD, discontinuation, contraception

OraI-E&RM-002 The effect of vitrification on sperm membrane damage in fertile and infertile men

Ghaffari Novin M 1, Pierovi T 2, Soleimani Rad j3 1 Department of Reproductive Endocrinology and Embryology, Reproductive Biology and Biotechnology, Infertility Center, Tehran, Iran 2 Department of Histology, Urimia University of Medical Sciences 3 Infertility Center, Tabriz University of Medical Sciences, Tabriz, Iran

OBJECTIVES: The objective of this study was to investigate sperm membrane damage during cryopreservation-thawing by the assessment of membrane integrity with annexin V binding. METHODS: Semen samples were obtained from twenty infertile and ten fertile men after a minimum of 3 days of sexual abstinences. After seminal liquefaction, a routine semen analysis was performed using Semen Analyzer Quality to determine sperm concentration and motility according to world Health Organization specifications. This was immediately followed by the assessment of membrane integrity with annexin V binding. A portion of each sample was immediately cryopreserved by vitrification method and thawed after two weeks. Postthaw analyses of concentration and motility, annexin V binding were also examined as above. The results were analyses by paired t-test. RESULTS: Annexin V binding (live sperm with membrane damage) was detected in the prefreeze samples of fertile

OraI -E&RM-003 Effect of ovarian stromal destruction immediately before gonadotropin treatment in PCOS patients on the outcome of Assisted Reproduction Treatment

Vanlioglu F, Karaman Y, Bingol B Department of infertility-lVF, Metropofitan Hospital, Istanbul, Turkey

OBJECTIVES: To evaluate the responce to controlled ovarian hyperstimulation during ART in patients with PCOS patients who underwent ovarian stromal destruction immediately before starting gonadotropin treatment. METHODS: One hundred-eighty-nine patients with PCOS underwent ART due to male factor infertility. Daily leuprolide acetate was administared starting from the 21st day of the preceeding cycle.Ovarian stromal damage were performed on both ovaries by a 17 gauge oocytes pick-up needle immediately before starting gonadotropin treatment(Group I; n=98). The day after this procedure ovulation induction was commenced using gonadotropins together with tapering leuprolide acetate dose. When the leading follicle reached 20 mm in diameter, hCG 10.000 IU was administrated. Oocyte pick-up was performed after 36 hours. 91 cases with no ovarian stromal damage performed served as the control group (Group II; n=91). RESULTS: The mean oocte, metaphase-II count, estradiol level on day of hCG, severe OHSS rate were found to be significantly different between groups I and I1. Number of transferred embryos and clinical pregnancy rates did not dif- fer in between the two groups. CONCLUSIONS: Performing ovarian stromal damage through the vaginal route before starting gonadotropin treatment in down-regulated patients with PCOS may be used as an alternative method to lower the severe OHSS and abortion risks. KEY WORDS: PCOS, asssisted reproduction, infertility, ovarian stromal destruction

Comparison of Group I and Group II

Group I Group II p value

Oocyte (mean• metaphasell(mean -+sd) No,of transferred embryos (mean_+ sd) Estradiol day of hCG Clinical pregnancy (%) Severe OHSS (%) Abortion (%)

(n=98) (n=91 ) 18• 23• P<0.05 16-+3 15-+1 P<0.05 2_+1.1 2_+1.3 NS

2110-+270 3420_+640 P<0.01 54 47 NS 1 (1/98) 9.8(9/91 ) P<0.01 7.4(4/54) 21.4(9/42) P<0.01

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Endocrinology And Reproductive Medicine - Oral Presentations

OraI-E&RM-004 Fert i l i ty Outcome Of Myomec tomy in Infertile Patients

Tavmergen E 1 , Akdogan A 2, AKman A 1, Levi R 2, Tavmergen Goker EN 1

Department of Obstetrics and Gynecology, Eye University Medicine Faculty, Izmir, Turkey 2 Eye University Family Planning and Infertility Research and Treatment Center, Izmir, Turkey

OBJECTIVES: To determine the results of surgical interven- tions performed for myomectomy in infertile patients. METHODS: 128 infertile women having myomas were operated during the years 2000-2004. Myomectomies were performed, by laparoscopic, hysteroscopic or laparotomic way according to their Iocalisation and size. Expectant management, IUl or, ART were performed and the results were evaluated. RESULTS: The mean age, infertility period was as following, 35_+4 years, 7,6_+5,7 years. Myomectomy was performed by laparatomy in 44, by laparoscopy in 72 and, by hysteroscopy in 12 patients. The mean diameter and size of the myomas removed by laparatomy, laparoscopy and hysteroscopy were following as consequetively 5,27+_2,27, 3,63+_1,43, 2,08+_1,16 cm and 3,00+_3,07, 1,84+_2,24, 1,16+_0,38. To follow-up was unavaible for 16 (12,5%) patients. The postoperative results according to the treatment modalities are shown in Table. The avarage duration between operation and pregnancy was 15+_14 months. Of the women who con- ceived 14 (50%) delivered at term while 3 delivered before 36 week (PROM), 7(25%)resulted with abortus and, 4 (14,3%)the follow up was not performed in our center. CONCLUSIONS: High pregnancy results after myomectomy with expected management afterwards seem as a good treatment modality in infertile patients with no other infertility cause. KEY WORDS: infertility, myomectomy, pregnancy

Table. Results

Laparatomy laparoscopy hysteroscopy total/ total/ totaL/ pregnant pregnant pregnant

spontaneously 6/4 9/7 1/0 I UI 1/0 12/2 2/1 ART" 37/1 51/11 9/2

OraI-E&RM-005 LevonorgestreI-Releasing Intrauterine System In The Treatment Of Menorrhagia And The Value Of Endometrial Thickness In Prediction Of Intermenstrual Spotting

Ates U, Seyhan A, Atmaca U, Ortakuz S, Ata B, Akar S, Usta T, Ozdemir B, Sidal B Department of obstetrics and gynecology, vakif gureba research and training hospital, istanbul, turkey

OBJECTIVES: The levonorgestrel releasing intrauterine system (LNG-IUS) is effective treatment for menorrhagia. The objective of this study was to evaluate efficacy of LNG-

IUS in menstrual disturbance and predict intermenstrual spotting according to endometrial thickness. METHODS: 46 women with menorrhagia were enrolled into the study. Group I (n=28) included patients with endometrial thickness less than 5 mm and Group I1(n=28) included patients with endometrial thickness =-5 mm. The patients were followed at 1 month, 3 months and 6 months after the insertion of the LNG-IUS. RESULTS: Compared with the baseline,both treatment groups presented significant increases in serum haemoglobin at 6 months 12,9+_0,7 in Group I and 12,6+_0,6 in group I1. Intermenstrual spotting at the first month of LNG- IUS in Group I and II were 6,6+_0,9 and 14+_3,4 days respectively. Following 3 months Group I experienced 2,0+1,2 days of spotting whereas Group II had 8,4+_2,8 days. There had been obvious reduction in the spotting in the 6th month (0,4_+0,1 and 3,2_+2,0 days in group I and II respectively. CONCLUSIONS: Patients with thinner endometrium (<5 mm) experienced less intermenstrual spotting. We believe that full curettage should be applied to all patients to achieve thin and regular endometrium which will result in better respond to the LNG-IUS, less spotting and higher patient compliance. KEY WORDS: levonorgestrel, intrauterine device, menorrhagia, endometrial thickness

OraI-E&RM-006 The change of social groups of women in donor insemination program through the years.

Yoldemir T 1, Gee A 2, Sutherland p2, Bowman M 2, Fraser I S 2 1 Medistanbul Clinic Women 2 Fertility Unit in Royal Prince Alfred Hospital, University of Sydney, Australia

OBJECTIVES: To determine the change of social groups of women through the years, enrolled in our donor insemination program. METHODS: A retrospective analysis of women treated with intracervical insemination using unknown donor sperm at RPAH.SIVF Fertility Unit in Royal Prince Alfred Hospital, University of Sydney, Australia the years 1994 and 2001 was done. The pregnancy rates and outcomes in single, lesbian and heterosexual women after donor sperm insemination were compared. RESULTS: The cumulative clinical and ongoing pregnancy rates after third cycle were 18.49, 7.84, 21.74 and 15.48, 5.88, 17.39 for heterosexual, single and lesbian women, respectively. The rates were 17.91, 8.99, 17.65 and 14.47, 5.61, 11.76 after the sixth cycle and 17.42, 9.61, 14.29 and 13.76, 5.77, 9.52 after the ninth cycle of treatment, respectively. CONCLUSIONS: Lesbian women and heterosexual women had decrease in pregnancy rates as the cycle numbers increased; however single women had lower rates than the other two, most probably due to the older age they started treatment. Comprehensive work-up should be done before the sixth cycle to each group and decision for advanced fertility therapies must be made. KEY WORDS: donor insemination, infertility, pregnancy

Endocr ino logy A n d Reproduct ive Medic ine - Oral- , P o s t e r P r e s e n t a t i o n s

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OraI-E&RM-007 Comparison of Metabolic and Endocrine Effects of Metformin and Metformin plus Cycl ic Medroxyprogesterone Acetate (MPA) Treatment in Patients with Polycystic Ovary Syndrome: A Prospective Randomized Study

Haydardedeoglu B, Bagis T, Kilicdag EB, Simsek E, Asian E, Zeyneloglu HB Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey

OBJECTIVES: The aim of this study is to determine the metabolic and endocrine effects of cyclic MPA, which used with metformin concamitantly, and compare the results with metformin monotherapy in PCOS patients. METHODS: Thirty-five women were randomized to two groups: 15 women in group 1 received 850 mg of metformin twice daily for 3 months. In group 2, 20 women received 850 mg of metformin twice daily plus cyclic MPA 5 mg twice daily for 3 months. RESULTS: Total cholesterol levels decreased from 176.7_+35.7 mg/dl to 163.4+30.7 mg/dl in metformin+MPA group (p=0.002) but this levels did not change significantly in metformin group (p=0.159). Fasting glucose and insulin levels and HOMA levels did not change significantly at the study period in both groups. While homocystein levels re- mained unchanged in metformin+MPA group, levels increased significantly in metformin group (8.92-+1.9 IJmol/I to 11.2-+3.3 IJmol/I, p=0.002). CONCLUSIONS: According to the results of this study, we could not find any harmfull effects of cyclic MPA plus metformin treatment on metabolic parameters and insulin resistance in patients with PCOS during three months. Although it is difficult to explain the mechanism, MPA may ameliorate uneventful effects of metformin on homocystein levels. KEY WORDS: Polycystic Ovary Syndrome, progesterone, metformin, metabolic effect

Poster-E&RM-001 When should laparoscopy be performed for evaluation of primary and secondary infertile women? Initially or finally?

Kahyaoglu S 1 , Turgay 12, Ertas 5 2, Yilmaz B 2, Var m 2, Batioglu S 2 1 Gn.Dr.Tevfik Saglam Cad. Emlakbankasi Evleri C3/32 Etlik/ANKARA 2 Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey

OBJECTIVES: Determining the objective management strategy for infertile patients who will benefit from diagnostic laparoscopy, when to offer them this procedure and establish- ment of any possible remaining differences between primary and secondary infertiles. METHODS: 191 infertile women were retrospectively reviewed from April 2001 to April 2003 who underwent diagnostic laparoscopy for investigation of infertility. Preoperative and postoperative treatment strategies were compared. The correlation between hysterosalpingography and laparoscopy findings were identified.The results were assessed by using statistical software SPSS version 10,0 for Windows.

RESULTS: 106 patients were primary and 85 were secondary infertile. The mean ages of primary and secondary infertile patients were 27 and 29 respectively. %60 of primary and %69 of secondary infertile patients had pelvic patolo- gies.Treatment strategy of 29 (%43) 67 primary infertile patients and 27 (%49) with infertility related risk factors have changed after laparoscopy. CONCLUSIONS: Diagnostic laparoscopy changes the treatment strategies of both primary and secondary infertile patients regardless of preoperative hysterosalpingography results. Diagnostic laparoscopy; ready for operative procedu- res especially for secondary infertiles; must be performed initially to all infertile patients unresponsive to previous infertility treatments with or without abnormal hysterosalpingography. KEY WORDS: diagnostic laparoscopy, infertility

Poster -E&RM-002 Tubal endometriosis as an insidious risk factor for implantation in an assisted reproductive technique procedure: a case report

Turgay 11, Kahyaoglu S 2, Ertas E 2, Muftuoglu K 2, Batioglu S 2 1 Gn.Dr. Tevfik Saglam Cad. Emlakbankasi Evleri C3/32 Etlik/ANKARA 2 Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey

In recent years, due to growing importance of asisted reproductive techniques (ART), bilateral tubal pregnancy has been reported more frequently. Endometriosis can probably be added to recently established risk factors for ectopic pregnancy. ART patients have a higher incidence of endometriosis. The possible relationship between these two conditi- ons remains to be proven. CASE: A 33 years old Turkish woman with 18 years of primary infertility was admitted to ART procedure. 4 embryos, 2 grade 1 and 2 grade 2, were transferred to uterine cavity without any difficulty with soft transfer catheter 3 days after fertilization by intracytoplasmic sperm injection. 20 days after embryo transfer she was admitted to emergency department complaining of pelvic pain and vaginal bleeding. Du- ring laparoscopic examination, bilateral tubal ampullary ectopic pregnancies diametered 20-30 milimeters were diagnosed. Bilateral salpingectomy was performed and pathological examination confirmed bilateral tubal ectopic pregnancy containing endometriotic implants. DISCUSSION: Tubal mucosal environment with endometriotic implants resembling original uterine endometrium can be a risk factor for implantation of transferred embryos. Alt- hough increasing evidence is needed, bilateral tubal closure or salpingectomy must be considered for patients with endometriosis before ART. KEY WORDS: tubal endometriozis, assisted reproductive techniques, primary infertility

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E n d o c r i n o l o g y A n d R e p r o d u c t i v e M e d i c i n e - P o s t e r P r e s e n t a t i o n s

Poster -E&RM-003 Swyer syndrome with SRY+ Y chromosome and rudimentary internal genitalia: a case report

Kahyaoglu S ~, Turgay 12, Ertas 5 2, Batioglu S 2 1 Gn. Dr. Tevfik Saglam Caddesi Emlakbankasi Evleri C3 Blok No: 32 Etlik/Ankara 06020 2 Zekai Tahir Burak Women's Health and Research Hospital, Ankara, Turkey

INTRODUCTION: Swyer syndrome is characterized with normal female internal genitalia and infantile female external genitalia suggesting disappeared leydig cell function.Various genetical abnormalities of gonadal dysgenesis may cause different sexual phenotypes. Hypoplastic uterus, an unlikely finding for this syndrome suggesting some insufficient function of antim011erian hormone prenatally, is demonstrated in this case. CASE: A 20 years old virgin patient was first seen before 2 years complaining with primary amenorrhea. She had infantile seeming female external genitalia with adequate vagina for sexual intercourse. Laboratory studies showed elevated gonadotrophines and low estrogen levels. Chromosome analysis with fluorescence in situ hybridization (FISH) method revealed 46 XY; and molecular investigation was undertaken to determine mutation in SRY through DNA se- quencing. SRY mutations were absent. When she was seen one year after we performed ultrasonographic examination because of no menstrual outflow. Pelvic ultrasonography revealed hypoplastic uterus (26x12 mm) with a rudimentary cervix. DISCUSSION: Normal structure of the SRY gene does not exclude possibility of Swyer Syndrome (SS) existence. Dif- ferent mutations on Y chromosome effecting the function of SRY at different intrauterine period may result with different internal and external genitalia structures. KEY WORDS: Swyer syndrome, internal genitalia, leydig cell

Pos te r -E&RM-004 Heterotopic pregnancy following ovulation induction by clomiphene citrate and timed intercourse: a case report

Tekcan C, Naki M M, Uysal A, Gezin K, YL~cel N, Kanadikirik F Department of Obstetrics and Gynecology, GSztepe Research and Training Hospital, Istanbul, Turkey

We report a combined intra-uterine and unruptured tubal pregnancy following ovulation induction by Clomiphene Ci- trate (CC) and timed intercourse. The diagnosis of heterotopic pregnancy is the major problem until occurence of tubal rupture. Because heterotopic pregnancy is a life threatening condition, the diagnosis should be made as soon as possible. In a spontaneous conception, heterotopic pregnancy is a rare event. The risk of heterotopic pregnancy significantly increases after ovulation induction. Clomiphene itself could be associated with a high heterotopic pregnancy rate. We present a case with normally developing intra-uterine single- ton pregnancy after succesfully managed by salpingectomy of syncronous tubal pregnancy following ovulation induction by CC and a review of the literature. KEY WORDS: heterotopic pregnancy, ovulation induction, clomiphene citrate

Poster -E&RM-005 Does addition of human chorionic gonadotrophin (hCG) to clomiphene citrate (CC) ovulation induction therapy improve pregnancy outcomes

Yilmaz B 1, Kelekci S 1, Savan K 2, Kalyoncu S 1, Gokturk U 1, Oral H ~, Mollamahmutoglu L ~ i Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey 2 Suleymaniye Maternity Hospital, Istanbul, Turkey

OBJECTIVES: TO investigate if addition of hCG to CC therapy affects the pregnancy outcomes in women with WHO Class II anovulation. METHODS: In this prospective, randomized, multicentric study 125 patients (for 125 cycles) were randomized initially to one of two treatment groups. In both group A and B: CC of 50 mg was given on days 5-9 of the menstrual cycle; natural intercourse was advised for alternate days 5 days after the last dose of clomiphene citrate. In group B, once a leading follicle of >18 mm was noted, hCG (10 000 IU) was given intramuscularly. Main outcome measures were ovulation, pregnancy, fertilization, implantation, twin and abortion rates. RESULTS: There were no statistically significant differences between treatment group A and B regarding pregnancy outcomes (Table 1). CONCLUSIONS: Addition of hCG to CC ovulation induction therapy does not improve pregnancy outcomes during natural intercourse advised cycles in women with WHO Class II anovulation. KEY WORDS: clomiphene citrate, ovulation induction, human chorionic gonadotropin

Table I Comparison of main outcome measures between groups

Group A Group B Totals n (%) n (%) n (%)

Ovulation rate 49/65 (75.4) 50/60 (83.0) 99/125 (79.2) Pregnancy rate 23*/65 (35.4) 21"/60 (35.0) 44/125 (35.2 Clinical 181/65 (27.6) 201-/60 (33.3) 38/125 (30.4) pregnancy rate Implantation rate 18/52:1: (34.6) 20/55:1: (36.3) 38/107 (35.5) Fertilization rate 23/52 (44.2) 21/55 (38.2) 44/107 (41.1) Twin rate 1/65 (1.5) 2/60 (3.3) 3/125 (2.4) Abortion rate 6w (26. 1) 4w (19.1) 10/44 (22.7)

Note: All P values were not statistically significant, * Number of pregnancy 2 weeks after ovulation, 1 Number of pregnancy at 7 weeks gestation by US scan, :1: Number of collapsed (ovulated) follicles by US scan, w Detected che- mically but not by US scan at 7 weeks gestation

E n d o c r i n o l o g y A n d R e p r o d u c t i v e M e d i c i n e - Pos te r P r e s e n t a t i o n s

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Poster -E&RM-006 Effects of addition of human chorionic gonadotrophin (hCG) to c lomiphene ci trate (CC) ovulation induction therapy on luteal function

Yilmaz B~, Kelekci S 1, Savan K 2, Kalyoncu S ~, Ertas IE~, Gokturk U ~, Oral H 1, Mollamahmutoglu L 1 l Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey 2 Suleymaniye Maternity Hospital, Istanbul, Turkey

OBJECTIVES: To evaluate the possible effects of addition of hCG to CC therapy on luteal function in women with WHO Class II anovulation. METHODS: In this randomized prospective multicentric study 125 women with WHO class II anovulation received 50 mg of clomiphene citrate alone in group A (n=65) or 50 mg of clomiphene citrate plus hCG in group B (n=60) in a total of 125 cycles during natural intercourse advised cycles. RESULTS: There were no statistically significant differences between group A and B regarding midluteal progesterone levels(9.3_+3.6 and 9.7_+4.8 ng/ml, p=0.693) but luteal phase length of ovulated patients was significantly longer (p<0.01) in group A (14.3_+1.1) than group B (11.3_+1.1). CONCLUSIONS: Addition of hCG to to CC therapy does not affect midluteal serum progesteron level but increases luteal phase length in women with WHO Class II anovulation. KEY WORDS: hCG, clomiphene citrate, ovulation induction, luteal function

Poster -E&RM-007 The Effect of Midluteal Estradiol Concentration on the Rates of Pregnancy and Implantation

Kahveci S, Dogan M, Mollamahmutoglu L, Isik A, Batioglu S IVF Clinic, Dr.Zekai Tahir Burak Education and Research Hospital, Ankara, Turkey

OBJECTIVES: The aim of this study is to investigate the effect of changes in midluteal estradio[ (E2) concentrations on pregnancy (PR) and implantation rates (IR). METHODS: 228 patients were enrolled in the study.For peak estradiol, blood was withdrawn seven days after hCG. For five groups stratified according to midluteal E2 concentrations, pregnancy and implantation rates were calculated separately. RESULTS: Overall 65 continuing pregnancy were obtained (28.5%).1n the comparison between groups, no statistically significant difference was found with regard to age, FSH values, peak E2 values, the number of oocytes harvested; the number of embryos transferred, and mid luteal E2 values. Midluteal E2 values were significantly lower than those on hCG day (p<0.0001). Although the difference was not statistically significant, when midluteal estradiol concentrations were over 1000 pg/ml, implantation and pregnancy rates were established to be higher. When the rates of viable continuing pregnancy and implantation rates were compared between groups, there was no statistically significant differences between the values. Ac- cording to the ratio of peak E2/midluteal E2,no statistically significant difference was present between PR and IR values. CONCLUSIONS: Midluteal estradiol measurements can be a valuable method in predicting ART results. In order to a definite conclusion, larger prospective randomized studies are required. KEY WORDS: midluteal estradiol concentration, pregnancy, implantation

Poster-E&RM-008 Influence of high dose methotrexate therapy on the primordial follicles of the mouse ovary

Saygili U 1, Gol M 1, Koyuncuoglu M 2, Uslu T 1, Erten 01 Department of Obstetrics and Gynecology, Dokuz Eylul

University Hospital, Izmir, Turkey 2 Department of Pathology, Dokuz Eylul University Hospital, Izmir, Turkey

OBJECTIVES: To measure directly the primordial follicle loss following exposure to high dose MTX. METHODS: In this cross - sectional, randomized, animal study, nine inbred Balb/c mice aged 7-8 weeks in the study group were administered 5 gr/kg methotrexate as a single agent intrapedtoneally, whereas nine mice in the control group received saline. Total number of primordial follicles remaining in both ovaries were counted. RESULTS: In the high dose methotrexate group, the mean number of primordial follicles (mean _ SD) was significantly lower (202_+38) than the control group (327_+81.7; p=0.002). CONCLUSIONS: High dose methotrexate causes damage to the primordial follicles of the ovaries of mice. Physicians should consider the toxic effects of high dose methotrexate on the ovary when using this agent in their young aged patients. KEY WORDS: high dose methotrexate, primordial follicule, mouse ovary

Poster-E&RM-009 Unique Congenital Mullerian Anomaly: A Case Report

Ciftci B, Biri A, Bozkurt N, Karabacak O, Himmetoglu O Department of Obstetrics and Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey

OBJECTIVES: We report a patient with a unique congenital Mullerian anomaly; cervical duplication with a longitudinal vaginal septum, uterine septum, and a normal extrauterine morphology with associated endometriosis. CASE: The patient was a 38-year-old woman who presented to obstetrician and gynecologist for dysparoneou, and 1- year history of infertility. On pelvic examination, a longitudinal vaginal septum and two cervices were present. Transva- ginal ultrasound, revealed a septate uterus with 3-cm cystic mass in the right ovary. Laparoscopy showed a normal ext- ra-uterine morphology, fallopian tubes and ovaries, chromo- pertubation performed through both cervices demonstrated a fill and spill from the both fallopian tubes. Magnetic reso- nance imaging displayed a normal outer uterine contour with a complete uterine septum, two endometrial cavities, and cervices. DISCUSSION: There are two theories on direction of the fusion of the Mullerian ducts; one of which suggests caudo- cranial direction and the other bilateral direction. Present case, is in the favor of bidirection; Multerian duct fusion could start at the isthmic area and then proceed simultaneously through a bi-directional manner. Cervix duplication and vaginal septum suggests a lack of caudal fusion, while the normal extrauterine morphology and septate uterus might show the successful fusion but a lack of resorption superiorly. KEY WORDS: Mullerian anomaly, cervical duplication, laparoscopy

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Poster -E&RM-010 Effect of vitrification on fertilizing capacity of spermatozoa in fert i le and infert i le men

Amir Jannati N 1, Ghaffari Novin M 1, Pierovi T 2, Soleimani Rad j3

Department of Reproductive Endocrinology and Embryology, Reproductive Biology and Biotechnology, Infertility Center, Tehran, Iran 2 Department of Histology, Urimia University of Medical Sciences, Urimia, Iran 3 Infertility Center, Tabriz University of Medical Sciences, Tabriz, Iran

OBJECTIVES: The aim of the present study was to evaluate the effect of vitrification on acrosome reaction and motility of sperm in fertile and infertile men. Semen samples were collected from ten fertile and twenty infertile men after a minimum of 3 days of sexual abstinence. METHODS: After seminal liquefaction, a routine semen analysis was performed using Semen Analyzer Quality to determine sperm concentration and motility according to World Health Organization specifications. This was immediately followed by the evaluation of acrosome quality by tri- ple staining technique. The remainder of each sample was immediately cryopreserved by vitrification method and thawed after two weeks. Analyses of concentration, motility and acrosome quality were performed after thawing and the results were statistically analysed by paired t-test. RESULTS: After vitrification, the percentage of live spermatozoa with intact acrosome was significantly decreased from 33.37_+4.07 to 9.87_+2.97 (p<0.002) in fertile and from 26_+3.64 to 11.16_+1.82 (p<0.001) in infertile groups. The percentage of sperm progressive motility (a+b) were significantly decreased from 60 and 35 to 40 and 20 in fertile and infertile groups after vitrification, respectively. CONCLUSIONS: It is concluded that vitrification impairs fertilizing capacity of sperm in fertile and infertile men. KEY WORDS: infertile men, vitrification, spermatozoa, fertilizing capacity

Poster-E&RM-011 Some effects of artificial extracellular matrix on function and morphology of human endometrial epithelial cells in vitro.

Nouri M 1, Ghaffari Novin M 2 Infertility Center, Tabriz University of Medical Sciences,

Tabriz, Iran 2 Department of Reproductive Endocrinology and Embryology, Reproductive Biology and Biotechnology, Infertility Center, Tehran, Iran

OBJECTIVES: We have examined effects of artificial ECM (Matrigel) on the function and morphology of human endometrial epithelial cells using molecular techniques and elec- tron microscopy. METHODS: Endometrial samples were removed, with infor- med patient consent and Ethics Committee approval, from 17 previously fertile women undergoing total abdominal hysterectomy. The tissue was dissociated and centrifuged to provide an epithelial-rich suspension which was cultured either on plastic or seeded into Matrigel to produce polarized cells.

RESULTS: Cells on plastic were undifferentiated, flattened and squamous but cells in polarized cultured were well-developed, tall, columnar and similar to secretory phase cells in vivo. The amount of total RNA in cells grown on Matrigel (23+1.5 pg/cell) was more than double that in cells grown on plastic (9.1 +1.4 pg/cell). CONCLUSIONS: These results suggest that ECM plays an important role in function and morphology of human endometrial epithelial cells in vitro. KEY WORDS: extracellular matrix, endometrial epithelial cells, endometrium

Poster -E&RM-012 The Effects of Melatonin Deprivation on Vaginal Squamous Cell Maturation of Pinealectomized Rats

Hascalik S 1, Celik 01, Parlakpinar H 2, Mizrak B 3, Ozsahin M 1 i Department of Obstetric and Gynecology, Inonu University Medical Faculty, Malatya, Turkey 2 Department of Pharmacology, Inonu University Medical Faculty, Malatya, Turkey 3 Department of Pathology, Inonu University Medical Faculty, Malatya, Turkey

OBJECTIVES: Using Papanicolau method, the present study investigated the effects of pinealectomy on the vaginal epithelial maturation. MATERIALS AND METHODS: Twenty-one pinealectomized rats were randomly assigned into 3 groups with seven rats in each group. The groups consisted of sham-operated, pinealectomized only, pinealectomized animals treated with melatonin. Melatonin administration started at the 60 th days following pinealectomy and continued for 21 days. At the end of the entire course, smears were obtained from each rats. Smears were stained with usual Papanicolau method, and observed with a light microscope by an experienced cytopathologist. Cy- tological grading was made according to the extend of parabasal, intermediate, superficial and anuclear squamous cells. RESULTS: Pinealectomized rats had higher scores for superficial and anuclear cells when compared to sham operated and pinealectomy plus melatonin group. Melatonin group had lower scores for superficial and anuclear cells than those of pinealectomized group. All of three groups had same scores for intermediate, and parabasal cells. CONCLUSIONS: The results of the our study suggest that the pinealectomy improved the vaginal stratification. KEY WORDS: pinealectomy, rat, vaginal epithelial maturation

Poster -E&RM-013 The Effects Of IL-6, Leptin And LIF Serum Levels On Successful Pregnancy Outcome In ART-Patients

Onder C, Gezginc K, Colakoglu M Department of Gynecology and Obstetrics, Selcuk University Faculty of Meram Medicine, Konya, Turkey

OBJECTIVES: To evaluate the effects of of Leptin, IL-6 and LIF on endometrial receptivity and succesful pregnancy outcome.

E n d o c r i n o l o g y A n d R e p r o d u c t i v e M e d i c i n e - Pos te r P resen ta t i ons

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METHODS: Fourty infertile patients, in whom IVF-ET therapy was undertaken were included. Patients were divided into two groups. The first group consisted of 20 achieved pregnancy cases, and the second group consisted of 20 pregnancy failed cases. Their serum samples were obtained at the date of ovum pick-up, and on the 7th and 12th day of embryo transfer and were evaluated for the serum levels of IL-6, LIF and Leptin. RESULTS: During the implantation period an increase in serum leptin levels and a decrease in serum IL-6 levels were detected. The changes of serum leptin, IL-6 and LIF levels were not of significantly associated with successful pregnancy outcome. CONCLUSIONS: Although high serum leptin levels and, low serum IL-6 levels in the implantation date, they are not obli- gatory indicators of succesful pregnancy outcome. In the early stages of pregnancy there seems to be an increase in serum leptin levels and a decrease in serum IL-6 levels. Se- rum LIF levels in ART patients are not associated with a succesful pregnancy outcome. Key Words: IVF-ET, Preg- nancy, IL-6, Leptin, LIE KEY WORDS: IVF-ET, Pregnancy, IL-6, Leptin, LIE

CASE: Three cases diagnosed between 2001-2005 are presented below. CASE 1: A 25 years old girl who had dysmenorea occuring for 4 years and bilateral low abdominal pain was referred. Uterus didelphys and hematocolpometra were found out by USG, in addition to this right renal agenesis was present in MRI. Two uteruses, the right one which is bigger than the other, was observed at laparoscopy, in the same session longitudinal septum resection was performed. CASE 2: A 19 year old girl who was complaining of dysmenorea was referred. Laparotomy was performed to the patient whose hematocolpometra was observed by USG. He- matometra was drained and two halves were connected to each other. Right renal agenesis was observed at USG examination later on. CASE 3:An18 years old patient, who complained of abdominal distention and dysmenorea had been diagnosed of hematocolpometra by USG. Uterine anomaly had been diagnosed, right renal agenesis was detected with IVP. After laparoscopic surgery, oblique septum was resected. CONCLUSIONS: Appropriate evaluation of these cases result in correct diagnosis and treatment. KEY WORDS: Uterus didelphys, renal agenesis, hemivagina

Poster-E&RM-014 Genital tuberculosis in infertile patients

Demir SC, Cetin MT, Kadayifci O, GQzel AB Cukurova University Faculty of Medicine Department of Obstetrics and Gynecology Balcali Adana

OBJECTIVES: The aim of this study is to emphasize the importance of genital tuberculosis in infertility METHODS: One hundred and eighteen patie'nts had laparotomy with various indications who applied to the Infertility Unit of Obstetrics and Gynecology Outpatients Clinic of the University of Cukurova in a period between 1 Jan 1984 to 1 Jan 1999. RESULTS: Genital Tuberculosis has been diagnosed inci- dentally in the 16 out of 118 patients. 11 of them had primary and 5 of them had secondary infertility. The incidence of genital tuberculosis was 13.5%. The mean age of the patients was 27.8. CONCLUSIONS: Since nowadays genital tuberculosis is neglected it seems that atypical forms of Tuberculosis will be reborn both in developed and also in developing coun- tries because of imigration. KEY WORDS: Genital tuberculosis, infertility, diagnosis

Poster-E&RM-015 Uterus Didelphys Associated with Obstructed Hemivagina and ipsilateral Renal Agenesis: Three Cases

Polat I, Yildirim G, Ozdemir A, Tekirdag All I Istanbul Bakirk6y Dogumevi, Kadin ve Cocuk Hastaliklari Egitim ve Arastirma HastanesL Istanbul

BACKGROUND: Uterus didelphys associated with obstructed hemivagina and ipsilateral renal agenesis is rarely seen. After the appereance of first symtoms and signs doctors who referred these patients misdiagnosed this syndrome in 100% of the cases.

Poster-E&RM-016 Cerebral Artery Hemodynamics In PCOS

Kizkin S 1, Engin-Ustun y2, Ustun y2, Ozcan C 1, Serbest S 2, Ozisik HI 1 1 Department of Neurology, Inonu University Medical Faculty, Malatya, Turkey 2 Department of Obstetrics and Gynecology, Inonu University Medical Faculty, Malatya, Turkey

OBJECTIVES: The aim of the present study was to investigate haemodynamic changes in the medial cerebral artery (MCA) and also internal carotid artery (ICA) in young women with PCOS and PCO. METHODS: 28 PCOS patients, 16 PCO patients, and 24 healthy control subjects were included in the study. The blood flow rate, pulsatility index (PI) and back pressure of both medial and internal carotid arteries were determined with transcranial Doppler and the groups were compared. RESULTS: There was no significant difference between the groups as to the bilateral MCA and ICA blood flow rate (Vmean), PI and back pressure. CONCLUSIONS: Our results do not indicate whether the risk of cerebrovascular events will increase in middle and advanced ages in PCOS patients but show that changes in cerebral hemodynamics are not among the problems cau- sed by PCOS at an early stage. KEY WORDS: PCOS, cerebral blood flow, doppler

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Poster-E&RM-017 Efficacy of GnRH Agonists and Antagonists Usage in Patients for ART Short Protocol Compared: Serum and Folliculer Leptins Levels and Pregnancy Outcomes

Ergenoglu M 1 , Akdogan A 2, Goker ENT 1 , Levi R 2, Tavmergen E 1 1 Department of Obstetrics and Gynecology, Ege University Medicine Faculty, Izmir, Turkey 2 Ege University Family Planning and Infertility Research and Treatment Center, lzmir, Turkey

OBJECTIVES: To determine serum and folliculer leptin levels in patients using GnRH agonist and antagonist in ART short protocol cycles and evaluate pregnancy outcomes. METHODS: Patients randomly selected to join asisted reproductive technology cycles during February 2004-July 2004 were enrolled in this study.Groupl consisted of 21 patients receiving rFSH+GnRH agonists where as Groupll consisted of 34 patients who received rFSH+GnRH antagonists. During the ovulation induction period 5 serum samples collected (day 2, day 5 or antagonist starting day, hCG day, oocyte pickup day, and twelve day after embriyo transfer).Folli- culer fluid samples were collected to be evaluated for leptin, estradiol, prolactin and LH. RESULTS: There were no difference in age, basal FSH, basal LH and Basal E2 between groups. Leptin levels also showed no difference between the two groups and in pregnant and nonpregnant group. Pregnant women in groupll showed lower basal leptin levels than groupl. The difference of leptin levels in follicular fluid and serum values did not correlate with pregnancy. A relation between BMI and leptin was detected in groupl. CONCLUSIONS: Our results have shown that both analo- gues and antagonists have similar efficacy and effect in poor responder women. Leptin levels in either groups, whether pregnant or nonpregnant, were not significantly different. This results show need for more studies of leptin in infertility. KEY WORDS: GnRH agonist, GnRH antagonist, ART, Lep- tin

Table. Results

group I group It Mann Whitney U test (p<0,05)

Age 32,9• 34,3• 0,158 BMI 24,0• 25,2_+4,3 0,382 Gonadotropin 3178,5 3327,9 0,573

• • dosage Induction day 8,7• 8,0• Oocyte number 11,2• 7,4_+5,7 Transferred 2,6• 2,3• embrios Endometrium 11,1• 10,8• thickness Pregnancy rate 7 (%33) 17(%50) (percentage)

0,056 0,020* 0,278

0,391

Chi-square test p=0,176

Poster -E&RM-018 The ef fect o f mef fo rmin therapy on insulin resistance in patients with policystic ovary syndrome

Uckuyu A 1, Ozcimen E E t, Nisanoglu 01, Onal C t, Zeyneloglu H g 2, Akgun S 3 1 Department of Gyneacology and Obstetrics, Baskent University, Konya, Turkey 2 Department of Gyneacology and Obstetrics, Baskent University, Ankara, Turkey 3 Department of Public Health, Baskent University, Ankara, Turkey

OBJECTIVES: Polycystic ovary syndrome (PCOS) is characterized by chronic anovulation and hyperandrogenism. Some patients with this syndrome display insulin resistance. Insulin sensitizing drugs such as metformin are used to treat PCOS in recent years.In this study metformin's effect on insulin resistance was evaluated. METHODS: In 24 patients with PCOS, fasting blood glucose, insulin were measured and body mass index (BMI), HOMA-IR (homeostasis model assessment insulin resistance) were calculated before and after 1.7 gr metformin therapy.Wilcoxon and Mann Whitney U test were used in stati- stics. RESULTS: The mean age of the patients was 26.5_+6.7 years. Fasting blood glucose was same before and after the therapy. Insulin concentrations were lower after the therapy, but not statistically significant (p>0.05).Before the therapy in obese patients basal fasting insulin and HOMA-IR were higher (p<0.05) than nonobese ones. After the therapy, insulin concentrations were decreased more in obese group. HOMA - IR index, which was higher than 2.5, was decreased more by the metformin therapy (p<0.05). CONCLUSIONS: Our data suggest that obese patients respond better than nonobese patients to 1.7 gr/day metformin regimen. BMI was the parameter to affect HOMA-IR. KEY WORDS: PCOS, metformin, insulin resistance

Poster -E&RM-019 Effects Of Profound Teratospermia On ICSI Results

Koc S, Cebi Z, SSnmez S, Yasar L, KL~pelioglu L, Bilecan S, AygCm M, Zebitay AG SOleymaniye Maternity and Women's Disease Research and Teaching Hospital, IstanbuI, Assisted Reproductive Techniques Unit

OBJECTIVES: To asses the intracytoplasmic sperm injection (ICSI) results in couples with profound teratospermia(Kruger's strict criteria of zero) and teratospermia(Kru- ger's strict criteria of 1-4%). METHODS: Retrospective analysis of 49 choosen icsi cycles during 29 month period. Patients with diminished ovarian reserve (DOR), polycystic ovary (PCO), older than 38 years and men whose spermia were extracted by invasive methods,men with globozoospermia and total immotile spermia were excluded from the study.After ovarian down regulation(teuprolide acetate),controlled ovarian hyperstimulation was started with r.fsh in all cases.Group1 oocytes were injected with sperms called profound teratospermia and group 2 were injected with teratospermic sperms. Embryo transfer


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was performed 3 days after transvaginal aspiration. The main aim was to asses the differences between two groups inrespect of fertilization,implantation,clinical pragnancy rates. RESULTS: In the group1 and group 2, fertilization, implantation,clinical pragnancy rates were: 73.9%, 15.32%, 41.9% and:72.31%, 15.24%, 43.0% respectively. There were no statistical difference between the two groups; P=0.635 P=0.881, P=0.878. CONCLUSIONS: This is one of the leading studies which compares the icsi result of profound teratospermia with teratospermia.Our results suggest that Kruger's strict criteria is not enough to predict the icsi results and more complex sperm selection citeria should be used to predict it. KEY WORDS: teratospermia, ICSl, Kruger's criteria

Poster -E&RM-020 Beck Depression Inventory Scores (BDI) in Patients with PCOS

Dursun E, s 0., Bozdag G., Yarali H. Department of Obstetrics&Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

OBJECTIVES: Patients with polycystic ovary syndrome (PCOS) may have an increased risk of the depressive disorders due to associated health problems and imbalance of the gonadal hormones. Objective was to compare the depression scores in patients with PCOS and controls. METHODS: Forty consecutive patients with PCOS and re- gularly cycling controls (n=30) were compared in respect to presenting symptoms, BMI, BDI scores, educational levels, socio-economic status, and biochemical parameters. Mood score test (Beck Depression Inventory) was recorded on specially designed forms. Patients with past or current history of psychiatric problems, cognitive dysfunction, co-existent medical problems including, uncontrolled diabetes, and car- diac problems and aged over 40 were excluded. RESULTS: The mean age (29.6• vs. 25.8_+6.1 y), BMI (22.4_+3.4 vs. 23.0_+2.9) and socio-economic status of the PCOS and control groups were comparable. The mean BDI score of the PCOS group was significantly higher compared to the controls (15.7_+8.9 vs. 4.1_+4.3, p <0.001). The rate of BDI scores greater than 10 and 20, implying severity of the depressive disorder, were significantly higher in the PCOS group (p<0.001). Higher educational level correlated posi- tively with higher depression score. CONCLUSIONS: Patients with PCOS may be prone to increased risk of depressive disorders. KEY WORDS: polycystic ovary syndrome, depression, mood score test

Poster-E&RM-021 Inguinal Endometrioma: A Case Report

Demlrcl F 1, Mun S 1, Eraydm E 1, Sadlk S 1, Sipahl C 1, Bayol 0 2 1 Aegean Social Security and Maternity Teaching Hospital, Izmir, Turkey 2 Department of Pathology, Tepecik Social Security and Teaching Hospital, Izmir, Turkey

Endometriosis is defined as the presence of endometrial tissue (glands and stroma) actively growing and functioning

outside the uterus. The most frequent sites of implantation are the pelvic viscera and the peritoneum. Inguinal and peri- ostal regions are rare sites for endometrial implantation. Cli- nical presentations of perostal endometrioma are tender inguinal nodule and cyclical pain. The best choice of treatment is complete excision. In this case report, clinical and pathological features of an inguinal region endometrioma that invased periosteum of bone were presented and discussed. KEY WORDS: inguinal endometrioma, case report

Poster -E&RM-022 Clinical Pregnancy Rates In Controlled Ovarian Hyperstimulation: impact of GnRH agonist v.s. antagonist

Sarikaya S, Garipoglu Dalgin E, Delilbasi L, Gursoy R Department of IVF, GOven Hospital, Ankara, Turkey

OBJECTIVES: GnRH antagonists are an encouraging alternative to agonist treatment. They have been introduced in IVF to prevent premature LH surge. The retrospective study was performed to assess the effects of GnRH agonist versus antagonists on clinical pregnancy rates. METHODS: 400 cycles were reviewed retrospectively. In 305 cycles agonists were used whereas antagonists in 95.Clinical pregnancy was defined as the presence of gesta- tional sac in ultrasonography. RESULTS: The overall (n=400) mean age was 31+4.9 (21- 43) years.Mean age in the leuprolide acetate treatment group (n=305) was 30.2+4.6 (21-43) years,whereas in the cetrorelix treatment(n=95)was 33.4+4.8(21-43)years. The mean duration of infertility for the subjects treated with either leuprolide acetate or cetrorelix was 7.6 and 9.4 years respectively. The total mean number of oocytes per attempt was 11.4 and 7.8 for the agonist and antagonist groups, whereas the number of metaphasell oocytes was 9.1 and 5.9, fertilization rates of agonist and antagonist treated subjects were 78.8% and 75%, implantation rates were 55.1% and 30.5% respectively. Miscarriage rates per clinical pregnancy were 11.8% and 5.3%, the ongoing pregnancy rates per attempt were 49.3% and 26.7% respectively. CONCLUSIONS: The overall results of this retrospective study shows that there is a statistically significant reduction in the clinical ongoing pregnancy rate in the GnRH antogonist.The increasing experience in the use of these drugs is likely to lead to optimization of the antogonist protocol. KEY WORDS: pregnancy, controlled ovarian hyperstimulation, GnRH agonists, GnRH antagonists

Poster-E&RM-023 Hysteroscopic Balloon Technique For Correction Of Complete Uterine Septum

Ustun Y, Engin-Ustun Y, Meydanli MM, Atmaca R, Kafkasli A Department of Gynecology and Obstetrics, In6nO University Medical Faculty, Malatya, Turkey

CASE: A 25-year-old nulliparous woman with a presenting complaint of dyspareunia and desire for fertility was referred for evaluation. A Iongitidunal vaginal septum and septate uterus with double cervix was diagnosed by combined hys-

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teroscopy and laparoscopy. After the excision of the complete Iongitidunal vaginal septum, corporal part of a complete uterine septum was hysteroscopically perforated using elec- trocautery by the help of a balloon introduced into the second cavity and then incised with no problems. The septum was spared below the internal cervical os. KEY WORDS: Septate uterus, double cervix, hysteroscopy

Poster -E&RM-024 Effects Of Ovulation Induction In The Pre-implantation Period Of Rats

C a n d a M T 1 , Kucuk M 1, Bagriyanik HA 2, Ozyurt 0 2, Canda m 3 i Department of Obstetrics and Gynecology Trakya University Medical Faculty, Edirne, Turkey 2 Department of Histology and Embriology Dokuz Eylul University Medical Faculty, Izmir, Turkey 3 Department of Pathology Dokuz Eylul University Medical Faculty, Izmir, Turkey

OBJECTIVES: Our aim is to evaluate the ovarial, endometrial and hormonal changes in the pre-implantation period of rats by using recombinant follicle stimulating hormon (rFSH;Puregon | N.V. Organon, Oss, Holland). METHODS: Female rats of a Wistar strain studied under six groups, rFSH is given in decreasing (16,8,4 IU) and constant doses (16 IU) consequent three days in the diestrus period. Two groups received placebo. One of the pair groups was mated with male rats. 48 hours after mating uterus, ovaries and blood samples were taken. Statistical analysis was performed. RESULTS: Antral follicles, corpus luteum, corpus luteum graviditatis and estradiol levels were increased in all rFSH groups, more significantly in decreasing group (P=0.002, P=0.014, P=0,01 and P=0.00, respectively). No difference was observed in progesterone levels in all groups. For four rhFSH groups, endometrium surface epithelium converted from cuboidal to columnar and mitotic indexes of endometrium surface, glandular epithelium and stroma were decreased. Endometrial stromal decidual reaction was evident in constant and control groups but not in decreasing group. CONCLUSIONS: rhFSH had a directly negative effect on endometrium surface and glandular epithelium especially in decreasing group, rFSH had a negative impact on stroma with estradiol. All these alterations may have bad influence on the pre-implantation period. KEY WORDS: ovulation induction, rat, preimplantation, recombinant FSH

Comparison of the endometrial morphology in the preimplantation period of control and rFSH groups

Group 1 Group 2 Group 3 Group 4 Group 5 Group 6

Endometrial Smooth Smoo th Folded Folded F o l d e d Folded Profile Surface Cuboidal Cuboidal Columnar Columnar Columnar Columnar epithelium Glandular Cuboidal Cuboidal Cuboidal Cuboidal Cuboidal Cuboidal epithelium Stromal Cells Desi- Desi- Desi- Desi- Fibro- Fibro-

dualised dualised dual ised dual ised blastie blastic

Group 1: Control, not mated Group 2: Control, mated Group 3: Constant dose, not mated Group 4: Constant dose, mated Group 5: Decreasing dose, not mated Group 6: Decrea- sing dose, mated

Poster -E&RM-025 The comparison of therapeutic efficacies of two preoperatively-administered gonadotropin releasing hormone analogs on symptomatic uterine leiomyomas

GL3ven MA KSU, Faculty of Medicine, Department of Obstetrics and Gynecology, Kahramanmras/TURKEY

OBJECTIVES: The aim was to determine the therapeutic efficacies of two different gonadotropin-releasing hormone analogs in patients with symptomatic uterine leiomyoma. METHODS: Twenty women with symptomatic uterine leiomyomas awaiting elective surgical treatment (either myomectomy or hysterectomy) were randomly divided into two groups. Nine patients received gosereline acetata 3.6mg subcutaneously and 11 patients triptoreline acetate 3.75mg intramusculary every four weeks for a period of 12 weeks beginning on one of the first three days of the menstrual cycle. Changes in myoma volume were ascertained by magnetic resonans imaging or computed tomography. Hormo- ne profiles were obtained for both groups before and after completion of therapy. RESULTS: Leiomyoma volume decreased in the triptoreline acetate group from 121r mm 3 to 41_+40 mm 3 (P=0.003) and in the gosereline acetata group from 239+352 mm 3 to 98_+146 mm 3 (p=0.008) after the therapy. The post-therapy FSH level was significantly lower in the triptoreline acetate group (5.6_+1.9 versus 9.2_+4.2, p=0.007). CONCLUSIONS: GnRH-analogs are an effective therapeutic tool for reduction of myoma size. Two pre-operative GnRH- analogs shows similar results, in terms of uterine shrinkage. KEY WORDS: uterine leiomyoma, gonadotropin-releasing hormone analogs, efficacy

Poster-E&RM-026 Effect of Implanot~ on serum lipids and liver function tests

Tamsoy S, Kaymak O, Ozkale D, Okyay R E, Neslihanoglu R, Kalyoncu S, Batioglu S, Mollamahmutoglu L Zekai Tahir Burak Mother Health Training and Research Hospital, Ankara, TURKEY

OBJECTIVES: The effects of Implanon | on serum lipids and liver function tests over a 6-month period was assessed in this study. METHODS: A total of 36 healthy volunteers were enrolled in the study. Serum concentrations of total cholesterol (TC), tri- glycerides (TG), high-density lipoprotein cholesterol (HDL- C), low-density lipoprotein cholesterol (LDL-C), very low- density lipoprotein cholesterol (VLDL-C), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were tested before and at 6 months after insertion. RESULTS: Mean age of the patients was 25,64+4.4 years. Mean changes in TC, TG and HDL-C levels were statistically significant. Baseline mean TC,TG and HDL-C levels were 164, 14-92,5 and 54,07 mg/dl and decreased to 155,12 and 84,5, and 49,8 mg/dl 6 months later, respectively, which were statistically significant (p=0.001). There were no statistically significant difference between the mean baseline levels of LDL-C ve VLDL-C. There were no statistically signifi-

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cant difference between the mean baseline levels and at 6 months levels of AST and ALT (15,64-17,64 mg/dl and 14,07-16,21 mg/dl respectively.) CONCLUSIONS: The adverse effect of Implanon | on serum lipid profile is to lower the serum levels of HDL-C. No adverse effects on liver function tests were determined. KEY WORDS: implanon, serum lipids, liver function

Poster -E&RM-027 An ongoing pregnancy after frozen thawed embryo transfer in a patient with Klinefel ter Syndrome

Yarali H, Bozdag G, Basaran A, Gultekin M Hacettepe University, School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey

OBJECTIVES: To present the second healthy ongoing pregnancy achieved with frozen thawed embryo transfer in a patient with non-mosaic Klinefelter Syndrome METHODS: A 34-year-old man with azospermia and nonmosaic Klinefelter Syndrome and his 26-year-old wife were presented. RESULTS: Intracytoplasmic sperm injection using surgically retrieved spermatozoa was planned. At total of 15 motile and 10 immotile spermatozoa were identified after testicular sperm extraction. Eighteen metaphase-II oocytes were retrieved. Since pre-implantation genetic diagnosis (PGD) is not available at our center and large percentage of sperm produced by patients with Klinefelter Syndrome are normal (23,X or 23,Y), PGD was not performed. The patient did not conceive with the fresh transfer. A frozen-thawed cycle was planned six months after the fresh cycle. Three embryos were transferred after four hour incubation. The serum beta- hCG test 14 days after oocyte retrieval was 194 mlU/mL. Amniocentesis was performed at the 17th week of the pregnancy showing 46, XY karyotype. CONCLUSIONS: Since Bourne et al, 38 healthy children after ICSI from nonmosaic Klinefelter patients have been reported. However, to our knowledge, this is the second reported pregnancy achieved by day 3 frozen thawed embryo transfer in a patient with Klinefelter Syndrome. KEY WORDS: frozen thawed embryo transfer, pregnancy, Klinefelter Syndrome

Poster -E&RM-028 Early stepping-up the FSH dose due to inadequate ovarian response at luteal-long agonist protocol may yield acceptable pregnancy rates

Saygili Yilmaz E 1, Bozdag G 2, Esinler 12, Bayer U 3, Gunalp S 2, Aksu m 2, Gultekin M 2, Basaran A 2, Yarali H 2 1Adana Maternity Hospital, Department of Obstetrics and Gynecology, Adana, Turkey 2 Hacettepe Universi~ School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey 3 Karaelmas University, School of Medicine, Zonguldak, Turkey

OBJECTIVES: To evaluate, as an alternative to cycle cancellation, whether early stepping-up the FSH dose due to inadequate ovarian response will yield acceptable pregnancy rates in the intracytoplasmic sperm injection (ICSI) and

embryo transfer (ET) cycles. METHODS: Retrospective case-control study. RESULTS: Unexpected inadequate ovarian response was defined as serum E <100 pg/ml despite 6 days of gonadotropin treatment. The gonadotrophin dose was needed to be increased by 150 IU/day in such 46 cycles to rescue the cycle. 148 female age and BMI matched patients with FSH dose stepped-down served as the controls. All data were expressed as mean_+SD. Stepwise logistic regression analysis, one-way ANOVA and Mann-Whitney U tests were used for statistical analyses. CONCLUSIONS: If the cycle is not cancelled, an early need for stepping up the FSH dose in such patients is not detri- mental to ICSI-ET outcome. KEY WORDS: stepping-up, ovarian response, pregnancy rates

ICSI and ET outcome of stepping-up the FSH dose due to unexpected ovarian response

Characteristic FSH Control P stepped-up group value group (n=148) (n=35)

Female age (y) 31,5_+4,0 31,0_+4,1 NS BMl(kg/m2) 25,0_+4,2 25,2_+6,8 NS Duration of stimulation 11,3_+1,5 9,9_+2,5 <0.05

(day) Total dose of gonado- 2 8 5 3 _ + 1 1 6 7 2610_+923 NS

trophins used (IU) E2 on the day of hCG 1620_+900 2208_+1398 <0.05

(pg/mL) No. of oocytes 11,8_+6,0 12,7+_6,7 NS Fertilization rate (%) 67,0 71,6 NS No. of embryos 2,6_+1,1 3,2+_1,4 NS

transferred Clinical pregnancy/ET 62,9 39,9 NS

Poster -E&RM-029 Relationship Between Leptin and Testosterone Levels and Malate Dehydrogenase Activity in Fertile and Infertile Semen Samples

Leventerler H 1, Taga S t, Cetin T t, Solmaz S 2, Dikmen N 3 1 Cukurova University, Faculty of Medicine, Gynecology and Obstetric Department, Adana, Turkey 2 Cukurova University, Faculty of Medicine, Histology and Embriyology Department, Adana, Turkey 3 Cukurova University, Faculty of Medicine, Biochemistry Department, Adana, Turkey

OBJECTIVES: Leptin affects reproductive functions by stimulating gonadotrophine releasing hormone. Malate Dehydrogen- ase (MDH) found in cytoplasmic and mitochondrial forms, has an effective role on energy metabolism of sperm. In this study, changes in MDH activity, leptin and testosterone levels and the relationship between these variables were investigated. METHODS: Semen samples were studied by microscope and evaluated according to their concentration, motility and morphology. MDH-NAD activity in seminal fluid was evaluated spectrophotometrically. Leptin and free testosterone levels were measured with RIA kit. Semen samples were classified into fertile (control), oligoteratospermic and asthenospermic groups.

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RESULTS: Leptin and free testosterone levels were significantly (p<0,05) lower in oligoteratospermic group than control group. Free testosterone level and MDH-NAD activity were significantly lower (p<0,05) in asthenospermic group than control group. A negative correlation (r=-0,416 p=0,03) was found between MDH-NAD activity and leptin level in the oligoteratospermic group. CONCLUSIONS: Our results suggest that, in additon to testosterone present in seminal fluid, leptin may be effective on male reproductive functions and sperm activity. We also believe that NAD-dependent MDH activity present in seminal fluid may have an important contribution in the evaluation of sperm functions. KEY WORDS: infertility, leptin, testosterone, semen

Leptin and Testosterone Levels and MDH-NAD Activities in Fertile and Infertile Semen Samples

Variable Control Oligoterato- Astheno- spermic spermic

(n=40) (n=25) (n=12) Sperm concert- 53,1 +_31,6 12,4-+3,9 27,1+_22,9

tration (xl06/ml) Motility 71,3+_6,6 64,0-+10,0 18,8+_14,3

(% motile) Morphology 17,8+_4,4 3,9+_2,1 2,5+_1,8

(% normal) Leptin (ng/ml) 2,4_+1,3 2,1 +-1,6" 3,6+-1,2 Testosterone 0,20+-1,9 0,11-+0,1" 0,14+_0,13*

(pg/ml) MDH-NAD 93,9+_52,1 111,8+_72,1 40,0+25,7"

(mU/ml)

* meaningfull at p<0,05 level

Poster -E&RM-030 Are uterine leiomyomas related with IGF-I levels and endocrine disorders ?

Karal6k H., liter E., Tufekci C., Yilmaz S., Karal6k A.E, Batur O. Department of Gynecology and Obstetrics, Bakirkoy Dr.Sadi Konuk Research and Training Hospital, Istanbul, Turkey

OBJECTIVES: To determine the relationship of uterine leiomyomas with serum levels of insulin-like growth factor-I (IGF-I), thyroid stimulating hormone (TSH), total T3 (TT3), total T4 (TT4), parathyroid hormone (PTH), glucose intolerance and body mass index (BMI). METHODS: 120 women with uterine leiomyomas (study group) were compared with normal women which had no gynecological disorder (control group, n=120). The serum levels of TSH, TT3, TT4, PTH, BMI, 75rag oral glucose tolerance test were measured in both groups. We selected 30 women from each group with similar characteristics (age, parity etc.) which had a normal thyroid function and oral glucose tolerance test result, for the measurement of serum levels of IGF-I. RESULTS: Serum TSH, T3, T4, PTH levels and BMI calcu- lations were similar in both groups(p>0.05). Women with leiomyomas had a significant glucose intolerance compared with the control group (p<0.05). Serum IGF-I levels were higher in women with leiomyomas then normal women but not statistically significant (p>0.05). CONCLUSIONS: These data support the hypothesis that serum IGF-I levels may not be directly related with the grow-

th of uterine leiomyoma. Also we found no relation between the BMI, thyroid, parathyroid function and leiomyomas. KEY WORDS: uterine leiomyoma, insulin-like growth factor-I, endocrine disorders

Poster-E&RM-031 Acute Effects Of Aerodiol~ On Coagulation Parameters; Is It Different From Climara~?

Asian E, Bagis T, Kilicdag E, Haydardedeoglu B, Tarim E, Zeyneloglu HB Baskent University, Medicine Faculty, Department of Obstetrics and Gynecology

OBJECTIVES: The aim of this study is to compare pharma- cokinetics of nasal and transdermal estrogen and to determine the effects of both routes of administration on coagulation parameters. METHODS: Forthythree patients were admitted to the study. First 28 patients received 300 lag 17 I~-estradiol, as Aerodi- ol | Climara | reservoir patch containing 3.8 mg estradiol was applied to the other 15 patients. Thirthy minutes, two hours and 12 hours after each treatment, blood samples were taken and fibrinogen, factor VII, antithrombin III, protein C, protein S, prothrombin time, activated partial thromboplastin time and estradiol levels were assessed in all samples. RESULTS: Area under curve(AUC) for estrogen levels for the first 12 hour was three times higher in Aerodiol group than Climara group. Protein C levels increased in Climara group and decreased in Aerodiol group but difference was not significant. After 12 hours of administration Protein S levels decreased with Aerodiol but not with Climara. APTT and PT levels did not change after Aerodiol treatment but PT levels decreased with Climara. CONCLUSIONS: Although AUC for estrogen levels was significantly higher in Aerodiol group, the effect on coagulation parameters was not prominent. KEY WORDS: coagulation, estradiol, hormone replacement theraphy

Poster -E&RM-032 Cabergoline versus lisuride: a randomized, controlled, open label study in patients requiring ablactation

Api M, G01tekin E, GSrgen H, Cetin A, Yayla M Ob&Gyn, Haseki Hospital, Istanbul, Turkey

OBJECTIVES: Our purpose was to compare cabergoline and lisuride in the ablactation in terms of their effectiveness and side effects. METHODS: A randomized, prospective, open label comparative study have been conducted to assess the lactation in- hibitory effects and adverse outcomes with the medication either Iisuride or cabergoline. RESULTS: Fourteen women who gave birth for a dead fetus have been treated orally either cabergoline 0,5 mg tablet (n=9) or lisuride hydrogen maleate 0,2 mg tablet (n=5). The- re were statistically no difference between the study medica- tions in terms of demographic parameters, efficacy, adverse effects, but duration of therapy was shorter in cabergoline (mean 1,44 days) group than lisuride group (mean 13,8

E n d o c r i n o l o g y A n d R e p r o d u c t i v e Med ic ine - Pos te r P resen ta t i ons

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days), (p--0,003). On the other hand, lisuride therapy was found to be cheaper. CONCLUSIONS: Our results suggest that either lisuride or cabergoline are effective treatment modalities for ablactation purposes. Their side effects are mild and similar. Neverthe- less, cabergoline can be chosen for its short treatment period, and lisuride for its cheapness. KEY WORDS: cabergoline, lisuride, ablactation

Poster-E&RM-033] The clinical and biochemical effects of me t fo rmm in the treatment of po lycys t i c ovary syndrome patients

Ozkilic T., Arikan I., Abali R., Arikan D., Bozkurt S. Department of Obstetrics and Gynecology, tstanbut Research and Training Hospital, Istanbul, Turkey

OBJECTIVES: In this study; we evaluated the menstrual regulation, clinical decrease in the hirsutismus level and the changes in the hormone profile of the polycystic ovary syndrome (PCOS) patients who received metformin treatment. METHODS: 26 PCOS patients are included in this study. Homburg Ultrasonographic Criterias and the presence of at least two of the clinical symptoms of PCOS are used as the choices of criteria. Metformin 850 mg p.o. twice a day with the meals without diet are given to patients for 6 months. The BMI, waist/hip ratio, fasting insulin level, free testoste- ron, DHEA-S,FSH and LH levels of the patients are compared before and after the treatment. RESULTS: We observed a statistically significant decrease in the BMI of patients after the treatment without diet (p<0,05).There was statistically significant difference between the BMI,insulin,DHEA-S,testesterone,FSH and LH levels before and after the treatment (p<0,05). 18(%69,2) of 24(%92,3) patients who had irregular mestruations at the beginning of the study began to have regular menstruations after 6 month of metformin treatment. CONCLUSIONS: Favourable changes are seen in the BMI,androgen levels and menstrual regulation of PCOS patients after the metformin treatment to decrease the hyperin- sulinemia and insulin resistance. Most of the PCOS patients are anovulatuar and infertile and the infertilty rates are affec- ted favourably. KEY WORDS: metformin, polycystic ovary syndrome, insulin resistance, infertilty

Poster-E&RM-034 Acrosome Malformation of Spermatozoa In a Family. (Globozoospermia) Case Report

Demir B 1, Gunalp S 2, Erden A.C. 1 i Department of Obstetrics and Gyncology, School of Medicine, Dicle university, Diyarbakir, Turkey 2 Department of Obstetrics and Gyncology, Division of Andrology, School of Medicine, Hacettepe university, Ankara, Turkey

A complete absence of acrosomal structures due to a genetic defect can be observed in about 0,1% of all androgical patients. The morphological and functional integriyt of the acrosome in human spermatozoa is a prerequisite for attac-

ment and binding of sperm cells to the ovum investments in order to allow gamete fusion. Therefore, disturbances of acrosomal devolopment and function will significantly impair the fertilizing capacity of sperematozoa. The occurrence of exclusively round-headed spermatozoa (Globozoospermia) was first discussed by MeyhSfer (1965) and completely ellu- cidated by Schirren et al (1971) and Holstein et al (1973). Nistal et al. (1978) observed 2 infertile brothers with round- headed spermatozoa. Two brothers have spermiograms with a similar pattern: absolute teratozoospermia with round- headed (Globozoospermia) spermatozoa. The familial trait only has been previously one time in the literature. The spermatozoa show several abnormalities in the head. They lack acrosome and postacrosomal sheath. The hormonal assays and the biochemical tests are normal and karyotype analysis of 46 XY in both patients. KEY WORDS: Globozoopermia, Acrosome Malformation, spermiogram

Poster-E&RM-035 Comparison Of Microdose Flare-Up Protocols And Microdose Flare-Up Stop Protocols In Poor Responder Or Advanced Age Patients In A IVF Program

S6nmez S, Ozcan J, Cebi Z, Koc S, Yasar L, Yazicioglu F, Demirbas R S(Jteymaniye Maternity and Women's Disease Research and Reaching Hospital

OBJECTIVES: To compare the results of two controlled ovarian hyperstimulation protocols, microdose flare-up protocol and microdose flare-up stop protocol in poor responder or advanced age patients in an ivf program. METHODS: 62 poor responder ICSI cycles,treated with microdose flare-up protocols or microdose flare-up stop protocols, were evaluated in our study. RESULTS: Though insignificant, the most encouraging result was the success in pregnancy rate which was found to be %51.7 with the microdose flare-up stop protocol.The pregnancy rate was found to be % 33.3 in the comparative group.Total rFSH dose administered in group I patients, was 3073+/-1307,19 mlU/L while the total dose of the r FSh administered in group II, was estimated to be 3995,70+/- 1423,98 mlU/L. This difference was found to be significant (p=0.010). CONCLUSIONS: : Microdose stop protocol that we used in this study is a new option for the poor responder infertile patients. This protocol might be an alternative for those cases in which response to gonadotropin stimulation takes a longer time and so might go for cancellation. KEY WORDS: IVF, gonadotropins, controlled ovarian hyperstimulation, poor responders

Endocrinology and reproductive medicine

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