Browsing by Author "Tohma, Yusuf Aytac"

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Citation - WoS: 4
Citation - Scopus: 4
Individualized Luteal Phase Support in Frozen-Thawed Embryo Transfer After Intramuscular Progesterone Administration Might Rectify Live Birth Rate
(Frontiers Media Sa, 2024) Boynukalin, Fazilet Kubra; Tohma, Yusuf Aytac; Yarkiner, Zalihe; Gultomruk, Meral; Bozdag, Gurkan; Ozkavukcu, Sinan; Demir, Berfu; 01. Atılım University
Background: The serum P concentrations are suggested to have an impact on pregnancy outcome. However there is no consensus about the optimal progesterone cut-off during the luteal phase. Few studies evaluated the effectiveness of a "rescue protocol" for low serum P concentrations and most of these studies used vaginal progesterone administration. There is paucity of data on the effectiveness of rescue protocol using intramuscular progesterone (IM-P) in frozen-thawed embryo transfer (FET). Methods: This study is a retrospective cohort study included 637 single or double blastocyst FETs with artificially prepared endometrium receiving 100 mg IM progesterone (P) after incremental estrogen treatment. Serum P concentrations were evaluated using blood samples obtained 117-119 hours after the first IM-P administration and 21 +/- 2 hours after the last IM-P administration. Patients with serum P concentrations <20.6 ng/ml on the ET day were administrated 400 mg vaginal progesterone for rescue. Results: Demographic and cycle characteristics were similar between patients receiving rescue vaginal P (embryo transfer (ET)-day P concentration < 20.6 ng/ml) and patients who did not need rescue vaginal P (ET-day P concentration >= 20.6 ng/ml). Clinical pregnancy, miscarriage, and live birth rates were similar between two groups: 52.9%(45/85) vs 59.6%(326/552), p=0.287; 11.1%(5/45) vs 14.1%(46/326), p=0.583; and 47.1%(40/85) vs 50.7%(280/552), p=0.526, respectively. Logistic regression analysis revealed that the female age (p = 0.008, OR=0.942, 95% CI = 0.902-0.984) and embryo quality (ref: good quality for moderate: p=0.02, OR=0.469, 95% CI =0.269-0.760; for poor: p=0.013, OR= 0.269, 95% CI = 0.092-0.757) were independent variables for live birth. Following rescue protocol implementation, ET-day P concentration was not a significant predictor of live birth. Conclusions: Rescue vaginal P administration for low ET day serum P concentrations following IM-P yields comparable live birth rates.
Citation - WoS: 4
Citation - Scopus: 4
A Novel Technique- Subendometrial Autologous Platelet Rich Plasma Injection in Patients With Unresponsive Thin Endometrium Undergoing Frozen-Thawed Embryo Transfer: a Prospective Cohort Study
(BMC, 2025) Cakiroglu, Yigit; Tohma, Yusuf Aytac; Yuceturk, Aysen; Karaosmanoglu, Ozge; Aslan, Ilke Ozer; Kopuk, Sule Yildirim; Tiras, Bulent; 01. Atılım University
Background The purpose of this study was to investigate the effects of subendometrial PRP injection on endometrial thickness and pregnancy outcomes in patients with a history of unresponsive thin endometrium undergoing frozen-thawed embryo transfer (FET). Methods This prospective cohort study was conducted at Acibadem Mehmet Ali Aydinlar University-Istanbul, Turkey. Women with a history of suboptimal endometrial proliferation (< 7 mm) were offered to participate in the study. Group 1 consisted of 100 individuals who consented to subendometrial PRP injection, while Group 2 consisted of 100 individuals who did not accept PRP injection. Within ten days of the menstrual cycle ending, autologous PRP was produced by centrifuging peripheral blood and administered transvaginally into the subendometrial region under ultrasound monitoring. After the PRP procedure, 14 days of oral estradiol supplementation were started as part of the hormonal treatment on the 2-4th day of the second menstrual cycle. Women determined to have adequate endometrial thickness following the initiation were scheduled for embryo transfers. Embryo transfer was scheduled for women who were found to have adequate endometrial thickness after the initiation of progesterone. Pregnancy (positive serum hCG) and livebirth rates were followed. Results A total of 200 women (age 36.4 +/- 5.8) were included in the study. Endometrial thickness increased after PRP therapy as compared to the control group (7.7 +/- 1.9 mm vs. 6.1 +/- 1.2 mm; p < 0.01). Three women (3.0%) in the PRP group conceived spontaneously, whereas 97 women (97.0%) attempted FET; no spontaneous pregnancies occurred in the control group. Compared to 75/100 (75% of the total) in the control group, 33/97 women (34.0%) in the PRP group were unable to undertake ET because of persistently unresponsive thin endometrium or fluid in the endometrial cavity (p < 0.001). The PRP group had a considerably higher percentage of positive serum hCG tests than the control group (25.8% vs. 9.0%; p = 0.002). Additionally, the PRP group had a higher clinical pregnancy rate (22.7% vs. 7.0%; p = 0.002). The live birth rate was significantly higher in the PRP group than the controls (17.5% vs. 2.0%; p < 0.001). Conclusions In women with a history of suboptimal endometrial development, subendometrial PRP injection was associated with improved endometrial thickness and livebirth rate.
Serum Progesterone Variability on Embryo Transfer Day in Hormone Replacement Therapy Cycles Using Intramuscular Injections During Frozen Embryo Transfers
(Springer/plenum Publishers, 2025) Boynukalin, Fazilet Kubra; Tohma, Yusuf Aytac; Demir, Berfu; Gultomruk, Meral; Polyzos, Nikolaos P.; Bahceci, Mustafa; Bozda, Gurkan; 01. Atılım University
Purpose To assess the intra-individual variability of serum progesterone (P) levels on embryo transfer (ET) day, when the same dose of intramuscular progesterone (IM-P) was used in two consecutive hormone replacement therapy (HRT) frozen embryo transfer (FET) cycles. Methods A total of 75 patients undergoing two consecutive HRT-FET cycles in one year performed at Bahceci Ankara IVF Center between November 2019 and February 2022 were retrospectively analyzed. Serum P levels were measured at the 117th-119th hours of support by a single laboratory. The two measurements of P levels performed on the day of the first and the second FET were compared to evaluate the intra-individual variability of serum P levels. Results Comparisons between the 1st and 2nd FET cycles revealed statistically significant intra-individual variation, with an average difference of -2.47 ng/mL (95% CI: -4.65 to -0.29, p = 0.027) between the two consecutive measurements. To assess their consistency, the limit of agreement was also tested with the Bland-Altman method, in which the mean difference (+ 1.96 x SD and -1.96 x SD) was -2.47 (16.1 and -21.1). Based on a previous study, the frequency of low P levels, as expressed by being > 20.6 ng/mL on ET day, was similar between the 1st and 2nd FET cycles (14.7% vs. 9.3%, p = 0.31). Notably, most patients had improved P levels in the second cycle if initially low, while decreases were rare among those with initially higher levels. Conclusion Serum P levels may vary within the same individual across FET cycles despite the use of the same dosage of IM-P. Increasing maternal age, high body mass index, and fluctuating estradiol levels on the day of ET were identified as risk factors contributing to this variability.