Publications by authors named "Firat Tulek"

Article Synopsis
  • The study aimed to assess how adjuvant letrozole affects the rate of euploid embryos in patients undergoing GnRH antagonist cycles for fertility treatments.
  • It analyzed data from 713 patients, comparing 84 who received letrozole with 629 who did not, noting that those on letrozole used fewer gonadotropins but had a slightly longer stimulation time.
  • The results showed no significant difference in euploidy rates or live birth rates between the letrozole and control groups, concluding that letrozole does not impact embryo quality in this context.
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Introduction: Concerning contemporary fertilisation (IVF) practice, the use of frozen embryo transfer (FET) cycles has become more common than fresh transfers. Natural cycle (NC), programmed artificial cycle and mild stimulation cycle are primary endometrium preparation cycles. Monitoring serum progesterone levels in FET cycles are in the scope of current research focus.

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Article Synopsis
  • Liver transplantation is a crucial treatment for end-stage liver failure, with increasing numbers of reproductive-age women expected to undergo the procedure.
  • Studies indicate higher risks of perinatal and maternal complications in these patients, but data remains limited, prompting a retrospective evaluation of maternal and fetal outcomes post-transplantation.
  • The findings show that while there are increased risks of complications like preeclampsia and preterm delivery, pregnancy after liver transplantation generally leads to favorable outcomes with proper monitoring.
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Research Question: What should be the optimal route of luteal support in programmed frozen embryo transfer (FET) cycles?

Design: This was a randomized, parallel, phase IV pilot trial with three groups of women undergoing FET along with hormone replacement therapy for endometrial preparation at a tertiary private IVF centre (NCT03948022). Women with at least one autologous cryopreserved blastocyst were included. After preparing the endometrium with oestradiol, 151 women were randomly assigned to one of the following three progesterone arms before embryo transfer: oral (10 mg) dydrogesterone (DYD), total daily dose 40 mg (n = 52); 8% (90 mg) progesterone vaginal gel (VAG), total daily dose 180 mg (n = 55); or intramuscular progesterone (IMP) 50 mg/ml in oil, total daily dose 100 mg (n = 44).

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Objective: Aim of this study was to evaluate the effects of dual triggering with gonadotropin releasing hormone agonist and human chorionic gonadotropin (hCG) on outcomes of fresh embryo transfers following gonadotropin antagonist cycles in POSEIDON group 3 and group 4 low prognosis women and to compare the outcomes with hCG-only triggering.

Methods: This study was conducted by retrospective analysis of patients with expected poor ovarian response (POSEIDON group 3 and 4) that underwent fresh embryo transfers following in-vitro fertilization/intracytoplasmic sperm injection cycles with either dual triggering or hCG-only triggering between January 2010 and April 2020. A total of 1068 women that underwent dual triggering and 1931 that underwent hCG-only triggering were included in the study.

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Purpose: To evaluate the effects of adjuvant letrozole administration on outcomes of gonadotropin-releasing hormone (GnRH) antagonist cycles with intra-cytoplasmic sperm injection in POSEIDON groups 3 and 4 expected poor responder women.

Methods: This study was conducted by retrospective analysis of patients with expected poor ovarian response (POSEIDON groups 3 and 4) that underwent GnRH antagonist cycles with intra-cytoplasmic sperm injection between 2010 and 2020. A total of 488 patients with letrozole co-administration and 2564 patients without any adjuvant treatment that underwent GnRH antagonist cycles within the selected period of time were included in the study.

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Purpose: The aim of this study is to evaluate and compare the outcomes of fresh day 5 morula transfers and fresh day 6 blastocyst transfers after extended culture, in women with a whole cohort of slow growing embryos.

Methods: Fresh embryo transfer cycles of patients that underwent intracytoplasmic sperm injection between 2013 and 2020 with a whole cohort of slow developing embryos on 5th day of fertilization were evaluated for this retrospective cohort study. Outcomes of day 5 morula transfers and day 6 blastocyst transfers after extended culture were compared.

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Article Synopsis
  • The study investigates the impact of dual trigger versus hCG trigger on the ploidy rate of blastocysts in preimplantation genetic screening (PGT-A) cycles with 385 cases analyzed.
  • The results showed no significant difference in euploidy rates between the dual trigger group (26.1%) and the hCG group (23.4%), even after analyzing different age groups.
  • Although dual triggering reduced the stimulation duration, it did not improve pregnancy outcomes, indicating the need for further research on different infertility causes.
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  • The study examines how noncavity distorting intramural uterine fibroids affect maternal serum biomarkers used for first trimester aneuploidy screening.
  • Pregnant women with these fibroids showed significantly lower levels of the biomarker pregnancy-associated plasma protein-A (PAPP-A) compared to controls, particularly when the fibroids were larger than 5.5 cm.
  • The results suggest that larger fibroids are inversely correlated with PAPP-A levels, which is important for accurate risk assessment in prenatal screening.
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Objective: This study aimed to evaluate the effects of adjuvant growth hormone (GH) therapy on in vitro fertilization outcomes in women with infertility with expected normal ovarian response who underwent gonadotropin-releasing hormone (GnRH) antagonist protocol with dual triggering.

Materials And Methods: Records of women who underwent GnRH antagonist cycles with dual triggering in a single tertiary center between 2017 and 2020 were retrospectively analyzed. A total of 1054 women with expected normal ovarian response were evaluated, of which 131 were found to receive GH co-treatment (study group).

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Article Synopsis
  • The study aimed to assess the impact of intra-ovarian platelet rich plasma (PRP) injections on IVF outcomes for women classified as poor responders and those with premature ovarian insufficiency (POI).
  • A retrospective review of 71 women receiving PRP injections revealed improved retrieval of oocytes and embryo development in poor responders, but no significant increase in clinical pregnancy or live birth rates.
  • In women with POI, while some embryos were retrieved post-PRP injections, none resulted in clinical pregnancies, suggesting limited effectiveness of PRP for these patients.
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Although there is no known difference between the clinical manifestations of SARS-CoV-2 in pregnant and non-pregnant women based on the studies published until now, in vitro fertilization (IVF) treatments were suspended during the pandemic due to uncertainties with the suggestions of associated societies. However, we do not have enough data on the exact effects of SARS-CoV-2 on fertility and pregnancy and whether there are damaging effects on IVF outcome. There is no available evidence about the transmission of SARS-CoV-2 by either sexual way or through intrauterine insemination (IUI) or IVF.

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Objective(s): Cervical incompetence is an important cause of recurrent pregnancy loss, typically presenting in the second trimester with silent cervical dilation and premature delivery of the fetus. We aimed to evaluate the conception rate and time to conception or failure to conceive after preconceptional laparoscopic abdominal cerclage (LAC).

Study Design: We conducted this retrospective observational cohort study at a tertiary referral center.

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Objective: Embryo quality assessment with morphological evaluation remains the first-line method of assessment to select the best embryo for transfer. We aimed to determine if an effect of poor quality embryos on good quality ones exists, whether by a paracrine effect or an adverse endometrial influence, when they are transferred together.

Materials And Methods: We included 412 couples, who underwent intracytoplasmic sperm injection (ICSI) cycles in a tertiary IVF center.

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In vitro fertilization (IVF) involves controlled ovarian hyperstimulation using hormones to produce large numbers of oocytes. The success of IVF is tightly linked to the availability of mature oocytes. In most cases, about 70% to 80% of the oocytes are mature at the time of retrieval, however, in rare instances, all of them may be immature, implying that they were not able to reach the metaphase II (MII) stage.

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Objective: To observe and compare the effect of postpartum tubal ligation (TL) procedures on ovarian reserve at women desiring TL as a contraceptive method at the end of pregnancy.

Material And Methods: Eighty-one women were included in the prospective study. TL was performed at the time of cesarean delivery (CD) (n=49) and as an interval procedure by laparoscopy (LS) in the postpartum period (n=32).

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Objective: To compare the effectiveness and safety of oxytocin and a cervical ripening balloon in women with unfavorable cervices for inducing labor.

Material And Methods: A total of eighty pregnant women between 37-41 gestational weeks having singleton pregnancies and intact membranes with unfavorable cervices were randomized into two groups, cervical ripening balloon (n=40) and oxytocin infusion (n=40). The primary outcomes were the labor time and the route of delivery.

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Introduction: The role of lymphadenectomy in the management of uterine leiomyosarcoma (LMS) is controversial. We aimed to identify whether lymph node dissection (LND) has any survival benefit in uterine LMS.

Methods: Data of 95 patients with histologically proven uterine LMS from 2 tertiary centers (1993 through 2009) were retrospectively analyzed.

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Article Synopsis
  • The study evaluated risk factors, pregnancy outcomes, and follow-up challenges associated with isolated single umbilical artery cases in a Turkish population, highlighting potential ethnic influences.
  • Findings revealed a significantly higher incidence of small for gestational age (SGA) fetuses and hypertensive disorders in pregnancies with a single umbilical artery, with maternal smoking identified as an independent risk factor.
  • Preterm birth rates and cesarean delivery rates due to non-reassuring fetal heart patterns were not significantly different between the study and control groups, suggesting early diagnosis and monitoring are crucial.
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Objective: To assess the possible changes in first trimester screening test parameters in pregnancies complicated with placenta previa and to determine whether there is an association between hyperemesis gravidarum and placenta previa.

Material And Methods: A total of 131 singleton spontaneously conceived pregnancies that were complicated by placenta previa and delivered between May 2006 and May 2013 were evaluated from birth charts. Ninety patients without placenta previa were selected amongst patients who delivered within the same period of time as the control group.

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Krukenberg tumor in pregnancy is very rare and management of this condition is a dilemma for physicians. Moreover, the existence of a primary Krukenberg tumor is still in debate. Herein, we present a 29-year-old woman at 29 weeks of pregnancy, admitted with premature labor and revealed to have a signet ring cell ovarian tumor with an undetermined primary origin.

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Objective: Reliability of first and second trimester screening tests largely depends on accurate estimation of maternal serum marker values. Reduced reliability could lead redundant invasive tests or misdiagnosis. Adjustments of serum marker values for confounding factors like insulin-dependent diabetes, maternal weight or maternal rhesus status are essential.

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