Introduction: Microdissection testicular sperm extraction (microTESE) is considered the gold standard method for surgical sperm retrieval among patients with non-obstructive azoospermia (NOA). Aim: This study aimed to evaluate the correlation between histopathological findings after failed microTESE procedure and outcomes of the „second-look“ procedure and to provide insight into the most common histopathological patterns after testicular biopsy within our population. Methods: The retrospective study included 33 selected patients with NOA, who had undergone unsuccessful sperm retrieval. The diagnosis of NOA was made after the assessment of the patient’s history data, a physical examination, semen analysis, the hormonal profile, and genetic studies. After negative sperm retrieval, histopathological report has been analyzed for „second-look“ microTESE attempt. Results: Five testicular histopathological patterns were found: hypospermatogenesis (9,1%), Sertoli cell-only syndrome (43%), germ cell maturation arrest (15%), seminiferous tubule hyalinization (15%), mixed pattern (21%). Y-microdeletions were detected in 5 patients, of which 3 patients showed AZFc region deletions. Only 3 patients (9,1%) underwent a „second-look“ procedure after the evaluation of histopathological reports. After the stimulation therapy and „second-look“ procedure, we had a positive outcome in a single patient (33,3%). Mean FSH value in patients with confirmed spermatogenesis was 17.26±3.11IU/l, while mean FSH value in patients without presence or germ cell statistically significantly exceeded and was 24.28±4.71IU/L (p=0.038). Conclusion: Histopathological reports following the microTESE procedure are obligatory for the proper selection of patients who are candidates for the „second-look“ microTESE attempt. Patients with Sertoli cell-only syndrome and hypospermatogenesis particularly can benefit from the “second-look” procedure.

Background/aim To evaluate the effects of hysterectomy on rat ovaries and the possible protective role of peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist-rosiglitazone against ovarian reserve decrement. Materials and methods Forty-five adult Wistar albino rats were randomly divided into three groups. Hysterectomy was performed (n = 15) in group 1 [H]; 1 mg/kg/day PPAR-γ agonist/rosiglitazone was used for 50 days after hysterectomy (n = 15) in group 2 [H + R]; a sham operation was performed (n = 15) in group 3 [control, C]. Blood samples were collected for anti-Müllerian hormone (AMH) evaluation in all groups and simultaneous ovarian Doppler examination was performed in [H] and [H + R] groups before and after (50 days) hysterectomy. All animals were sacrificed to obtain ovaries for histological examination. Results AMH levels were found to be significantly decreased at postoperative day 50 in all groups (P < 0.05). Histopathologic analysis showed that primary, preantral, and antral follicle counts were significantly higher in the [H] group as compared to the [C] and [H + R] groups (P < 0.05). There was no significant difference between the [C] and [H + R] groups in terms of follicle numbers (P > 0.05). In the ovarian Doppler blood flow analysis, all parameters were significantly decreased in group [H] (P < 0.05), but not in the [H + R] group (P > 0.05) on postoperative day 50. Conclusion Hysterectomy affects the histopathological structure of rat ovaries and PPAR-γ agonist-rosiglitazone improves the ovarian Doppler blood flow parameters.

Introduction: Main categorisation of azospermic is in two grups: nonobstructive azoospermia (NOA) and obstructive azoospermia (OA). We had evaluation of prognostic factors and determinants in sperm retrieval procedures in azoospermic patients. Methods: Retrospective evaluation observed 21 selected patients with NOA and OA azoospermia, after that complete history, physical examination with ultarsound volume of testis and hormonal profile. Hormonal profile included: follicle stimulating hormone (FSH), luteinizing hormone (LH), testosteron (T) and prolactin (P) serum levels. Also karyotype and Y-deletion analysis were done and analyzed. Results: 9 OA patients (42,9%) were undergone for TESE operation and 12 NOA patients (57,1%) for Micro-TESE operation. All TESE procedures were positive (100%). Micro-TESE in 12 selected NOA patients, 5 patients (41,6%) were positive and 7 patients (58,4%) negative. Patients testicular size, serum FSH and testosterone level showed correlation in success of sperm retrieval procedures. Conclusion: TESE is elected procedure for obstructive azospermia (OA). Micro-TESE is appropriate sperm retrieval procedurec for patients with non-obstructive azoospermia (NOA) and correlate with high FSH and small volume of testis.

Objective: Assisted reproduction techniques have become widespread worldwide. Considering their costs, physicians endeavor to improve pregnancy rates. Infections are one of the disrupting problems in this arena. We aimed to investigate the effects of screening for vaginal infection on pregnancy rates in intracytoplasmic sperm injection cycles. Materials and Methods: One hundred twenty patients randomized into two groups for this study. Patients were screened for vaginal infections in group 1, and no screening was performed in group 2. The assisted reproduction outcomes were investigated and compared between the two groups. Results: There was no significant difference between ages, or durations and causes of infertility of patients who conceived and of those who did conceive. Forty-five patients in group 1, and 40 patients in group 2 reached the embryo transfer stage. The rates of conception were 23.5% (n=4) in culture-positive patients (n=17), and 42.9% (n=12) in culture-negative patients (n=28) in group 1. There was no significant difference among patients who were not screened, screen-positive, and screen-negative, in terms of pregnancy rates. None of the patients had Neisseria gonorrhoeae or Trichomonas vaginalis. Bacterial vaginosis was detected in 13 patients, and both bacterial vaginosis and Chlamydia trachomatis were detected in 4 patients. Three of 4 patients who conceived screen-positive and 8 of 12 patients who conceived screen-negative delivered healthily at term. Conclusion: No significant difference was found between patients who were sampled for culture and patients who were not sampled in terms of pregnancy rates. Also, no difference was found between the patients who were culture-negative and patients who were treated with antimicrobials after a culture positive result. Further larger studies are warranted to clarify this issue.

Introduction: To present results of MicroTese procedure in treatment of male infertility in patients with azoospermia at Bahçeci BIH IVF Center during two-year period of 2013-2014. Methods: In the stated time-period, 55 MicroTese surgeries were performed. In 52.7% of the cases, sperm cells were isolated after MicroTese surgery, and in 47.3% of the cases, there was a negative outcome of the procedure. Obtained sperm cells were subjected to cryopreservation. Furthermore, ICSI procedure was performed by use of the obtained sperm cells. Results: Of 29 positive MicroTese surgeries, 21 (72.4%) resulted in clinical pregnancies. Biggest percentage of negative MicroTese procedures happened in patients with cryptorchidism and orchidopexy. Conclusion: MicroTese is the most precise and successful method of retrieving sperm cells surgically in men with azoospermia. Our results are within scope of results in referent world centers.

The purpose of this study is to reveal the impact of endometrial thickness and endometrial pattern on pregnancy rates, in cases, at least, one grade 1 quality embryo transfer done from IVF and ICSI applied patients. We included the 440 cases into our studies in which at least one grade 1 quality embryo transfer done from IVF or ICSI applied patients in our in vitro fertilization clinic at our hospital between the years 2007 and 2010. The studies’s parameters consisted of the cases’ age, body mass index (BMI), indication, basal FSH levels, endometrial thickness measured on the hCG day and endometrial pattern, applied drug protocol, E2 values on the day of hCG. Pregnancy detection was confirmed 12 days after the transfer by βhCG measuring and ultrasonography of the embryonary sac. Our patients’ avarage age was 30.1± 5.5 (18-45) and pregnancy rate was %46.5. When the cases were classified as pregnant and non pregnant and evaluated, maximum E2 level in pregnants were observed as significantly higher on the day of hCG application (p=0.03<0.05). When we classified the cases according to their endometrial thickness, %10.3 case range between 1-7mm, %87.3 case range between 7.1-14mm and %2.4 is 14+. When we classified the cases according to their ages, 248 of them (%56.4) were 30 and below, 101 (%22.9) were between 31 and 35 and 91 of them (%20.7) were 36 and above. Statistically no significant distinction was observed when age and endometrial thickness comparison was done in subgroups’ pregnancy detection. When multiple logistic regression analysis (model R2=0.0263, p<0.001) was done, age’s effect on pregnancy detection was irrelevant (p=0.158). But, endometrial thickness’s effect was significant (p=0.01). Age and endometrial thickness, both had significant impact on pregnancy together (p=0.031). Endometrial pattern’s effect on pregnancy detection was insignificant. We observed that endometrial thickness as an important parameter affecting the success of IVF cycles. However, the same situation doesn’t apply to the endometrial pattern. Age is one of the most important factors that affecting to conceive. But when the quality of embryos given, age is not the primary factor to become pregnant.

The aim of this study was to evaluate the level of asymmetrical dimethylarginine (ADMA) levels before gonadotrophine treatment and on the day of oocytes retrieval in order to determine whether ADMA can be used as a predictive marker for implantation success in in vitro fertilization (IVF) cycles. Forty-four unexplained infertile patients were included in the study. Controlled ovarian hyperstimulation was performed using the recombinant follicle-stimulating hormone (FSH) with the standard long protocol for all patients. ADMA and E2 were measured at the beginning of the ovulation induction and on oocyte retrieval day. The primary outcome was the difference in ADMA levels in implantation positive and implantation negative women. At the beginning of the ovulation induction, the mean ADMA levels were 1553 μmol/L and 1.464 μmol/L in the implantation positive and negative groups, respectively. There was no statistically significant difference between groups (p: 0.90). On the day of oocyte retrieval, the mean ADMA levels were 1173 μmol/L and 1170 μmol/L in the implantation positive and negative groups, respectively. There was no statistically significant difference between groups (p: 0.97). In conclusion, ADMA levels before gonadotrophine treatment and the day of oocytes retrieval cannot be used as a predictive marker for implantation success in IVF cycles.

Objective: To present spontaneous resolution of isolated fetal ascites diagnosed at antenatal period. Case: A 30-year-old, G3, P2 patient admitted to our perinatology clinic in 26th week of pregnancy with a diagnosis of severe, isolated fetal ascites without any other anomalies revealed by ultrasound examination. The workup for Parvovirus B19, cytomegalovirus, toxoplasmosis, herpes simplex, rubella, hepatitis A, B, C and infectious markers were negative. Fetal karyotyping was reported as normal. As the persistence of fetal ascites was seen at 32 and 34 weeks gestation, a complete resolution of the ascites was detected at 36 weeks’ gestation. A normal 4,200 grams male infant was vaginally delivered at 39 weeks gestation. Conclusion: Isolated fetal ascites is a rare ultrasound finding and diagnosis is to be confirmed with exclusion of related fetal anomalies, immunologic and nonimmunologic causes. Parents should be counseled about other rare concomitant and undetectable anomalies despite detailed evaluation. Ultrasonografik izlemde spontan remisyona