Browsing by Author "Polat, Mehtap"

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    Article
    Citation Count: 1
    Comparison of the efficacy of subcutaneous versus vaginal progesterone using a rescue protocol in vitrified blastocyst transfer cycles
    (Elsevier Sci Ltd, 2023) Yarali, Hakan; Mumusoglu, Sezcan; Polat, Mehtap; Erden, Murat; Ozbek, Irem Yarali; Esteves, Sandro C.; Humaidan, Peter; First and Emergency Aid Program
    Research question: Does administration of subcutaneous (s.c.) progesterone support ongoing pregnancy rates (OPR) similar to vaginal progesterone using a rescue protocol in hormone replacement therapy frozen embryo transfer cycles?Design: Retrospective cohort study. Two sequential cohorts -vaginal progesterone gel (December 2019-October 2021; n=474) and s.c. progesterone (November 2021-November 2022; n=249)-were compared. Following oestrogen priming, s.c. progesterone 25 mg twice daily (b.d.) or vaginal progesterone gel 90 mg b.d. was administered. Serum progesterone was measured 1 day prior to warmed blastocyst transfer (i.e. day 5 of progesterone administration). In patients with serum progesterone concentrations <8.75 ng/ml, additional s.c. progesterone (rescue protocol; 25 mg) was provided.Results: In the vaginal progesterone gel group, 15.8% of patients had serum progesterone <8.75 ng/ml and received the rescue protocol, whereas no patients in the s.c. progesterone group received the rescue protocol. OPR, along with positive pregnancy and clinical pregnancy rates, were comparable between the s.c. progesterone group without the rescue protocol and the vaginal progesterone gel group with the rescue protocol. After the rescue protocol, the route of progesterone administration was not a significant predictor of ongoing pregnancy. The impact of different serum progesterone concentrations on reproductive outcomes was evaluated by percentile (<10(th), 10-49(th), 50-90(th) and >90(th) percentiles), taking the >90(th) percentile as the reference subgroup. In both the vaginal progesterone gel group and the s.c. progesterone group, all serum progesterone percentile subgroups had similar OPR.Conclusions: Subcutaneous progesterone 25 mg b.d. secures serum progesterone >8.75 ng/ml, whereas additional exogenous progesterone (rescue protocol) was needed in 15.8% of patients who received vaginal progesterone. The s.c. and vaginal progesterone routes, with the rescue protocol if needed, yield comparable OPR.
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    Review
    Citation Count: 6
    The effect of £6 cm sized noncavity-distorting intramural fibroids on in vitro fertilization outcomes: a systematic review and meta-analysis
    (Elsevier Science inc, 2023) Erden, Murat; Uyanik, Esra; Polat, Mehtap; Ozbek, Irem Yarali; Yarali, Hakan; Mumusoglu, Sezcan; First and Emergency Aid Program
    Importance: The potential detrimental effects of fibroids on natural fecundity and in vitro fertilization (IVF) outcomes may be influ-enced by their size, location, and number. The impact of small noncavity-distorting intramural fibroids on reproductive outcomes in IVF is still controversial, with conflicting results.Objective(s): To determine whether women with noncavity-distorting intramural fibroids of & LE;6 cm size have lower live birth rates (LBRs) in IVF than female age-matched controls with no fibroids.Data Sources: MEDLINE, Embase, Global Health, and Cochrane Library databases were searched from inception until July 1, 2022. Study Selection and Synthesis: Women undergoing IVF with noncavity-distorting intramural fibroids & LE;6 cm constituted the study group (n = 520), whereas women with no fibroid formed the controls (n = 1392). Female age-matched subgroup analyses were performed to evaluate the impact of different cut-offs for size (& LE;6, & LE;4, and & LE;2 cm), location (the International Federation of Gynecology and Obstetrics [FIGO] type-3), and the number of fibroids on reproductive outcomes. Mantel-Haenszel odds ratios (ORs) with 95% confidence intervals (CIs) were used for outcome measures. All statistical analyses were performed using RevMan 5.4.1Main Outcome Measure(s): The primary outcome measure was LBR. Secondary outcome measures were clinical pregnancy, implan-tation, and miscarriage rates.Result(s): After adopting the eligibility criteria, 5 studies were included in the final analysis. Women with & LE;6 cm noncavity-distorting intramural fibroids had significantly lower LBRs (OR: 0.48, 95% CI: 0.36-0.65, 3 studies, I2=0; low-certainty evidence) compared with women with no fibroids. A significant reduction in LBRs was noted in & LE;4 cm but not in the & LE;2 cm subgroups. The FIGO type-3 fibroids of 2-6 cm size were associated with significantly lower LBRs. Owing to a lack of studies, the impact of the number of noncavity-distorting intramural fibroids (single vs. multiple) on IVF outcomes could not be assessed.Conclusion(s): We conclude that 2-6 cm sized noncavity-distorting intramural fibroids have a deleterious effect on LBRs in IVF. The presence of FIGO type-3 fibroids of 2-6 cm size is associated with significantly lower LBRs. Conclusive evidence from high-quality randomized controlled trials, the reference standard study design for studies of health care interventions, is needed before myomectomy might be offered in daily clinical practice to women with such small fibroids before undergoing IVF treatment. (Fertil Sterile 2023;119:996-1007. & COPY;2023 by American Society for Reproductive Medicine.)El resumen esta disponible en Espanol al final del articulo.
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    Article
    Citation Count: 5
    Vitrified-warmed blastocyst transfer timing related to LH surge in true natural cycle and its impact on ongoing pregnancy rates
    (Elsevier Sci Ltd, 2022) Erden, Murat; Polat, Mehtap; Mumusoglu, Sezcan; Ozbek, Irem Yarali; Dere, Gonca Ozten; Sokmensuer, Lale Karakoc; Yarali, Hakan; First and Emergency Aid Program
    Research question: Does the timing of warmed blastocyst transfer in true natural cycle (tNC) differ according to six different commonly used definitions of LH surge, and do differences in timing have any impact on ongoing pregnancy rate (OPR)?Design: Prospective monitoring, including repeated blood sampling and ultrasound analyses of 115 warmed blastocyst transfer cycles performed using tNC between January 2017 and October 2021.Results: The reference timing of follicular collapse +5 days would be equivalent to LH surge +6 days in only 5.2- 41.2% of the cycles employing the six different definitions of the LH surge. In contrast, the reference timing was equivalent to LH surge +7 days in the majority of cycles (46.1-69.5%) and less commonly to LH surge +8 days (1.8- 38.3%) and +9 days (0-10.4%). For each definition of the LH surge, the OPR were comparable among the different warmed blastocyst transfer timings related to the LH surge (LH surge +6/+7/+8/+9 days). When logistic regression analysis was performed to evaluate the independent effect of variation of warmed blastocyst transfer timing (LH surge +6/+7/+8/+9 days) on OPR and taking LH surge +6 days as the reference, change in timing was not an independent predictor of OPR for any of the definitions of the LH surge.Conclusions: Employing a policy of performing warmed blastocyst transfer on follicular collapse +5 days and using six different definitions of the LH surge, vitrified-warmed embryo transfer timing is indeed equivalent to LH surge +7/+8 and even +9 days in a significant proportion of tNC with comparable reproductive outcomes.