Objective: One of the most common treatments for infertility is intrauterine insemination. The objective of this study was to determine the effect of endometrial injury on pregnancy outcomes in unexplained infertile women undergoing intrauterine insemination.
Materials and Methods: In this randomized clinical trial, 122 women with unexplained infertility who referred to Shariati Hospital from 2018 to 2020 were enrolled. They underwent ovulation induction by letrozole and gonadotropins. On day 9 of stimulation, they randomly were assigned to two similar groups of same size. First group underwent endometrial local injury by pipelle endometrial sampling and second group (control group) received no intervention. Only 1 intrauterine insemination cycle was performed for each patient. Patients with negative pregnancy outcomes were followed up for 3 months. Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate, miscarriage rate and spontaneous pregnancy rate after intrauterine insemination cycle were compared between two groups.
Results: Endometrial thickness, dominant follicle count, chemical and clinical pregnancy rate and miscarriage rate in the same intrauterine insemination cycle were not different in two groups (P>0.05). However, spontaneous pregnancy rate after intrauterine insemination cycle was significantly higher in endometrial injury group (P=0.02).
Conclusion: According to the results and parameters of this study, endometrial injury increases pregnancy rates in later cycles but not the same intrauterine insemination cycle.

Objective: The most common indications for levonorgestrel intrauterine device (LNG-IUD) are contraception and management of abnormal uterine bleeding (AUB). This study was conducted with the aim of exploring the differences in the clinical profile and outcome of women using LNG-IUD for contraception and for AUB.
Methods: This is a retrospective comparative cross-sectional study of women had LNG-IUD (52 mg ) between 2012 to 2017 and their electronic health records were reviewed till the last follow up documented or to December 2021.
Results: Total of 235 women had LNG-IUD with age range of 21 to 62 years and a mean of (37.98 years ± 6.76). Of those women, 65.1% had it for AUB and 34.89% had it for contraception. The follow up was 1-94 months with (mean ± SEM) follow up for the AUB group of ( 21.48± 2.31) months and for contraception group was (20.74 ± 1.76 ) months (p-value of 0.80).There was a significant difference between the two groups in the age and BMI where women who had LNG-IUD for AUB were older (mean of 42.54 ± 6.49 years, P-value < 0.001) and had higher BMI ( 31.88±7.52 Kg/m2, p-value =0.011). All the LNG-IUD for contraception were inserted as out-patient. However; 68.3% of the the AUB were inserted in operating theatre in conjunction with hysteroscopy. After combining both expulsion and removal of LNG-IUD during the follow -up period; there was no significant difference between the 2 groups in the overall retention rate (p-value = 0.998).
Conclusion: this study shows that women using LNG-IUD for management of AUB are older and has higher BMI than those using it for contraception. AUB Women experienced more expulsion compared to the contraception group but there was no difference between the 2 groups in the overall survival/retention of LNG-IUD.

Amaç: Bu çalışma, abortus imminens (AI), abortus ve ilk trimesterde sağlıklı gebeliklerde maternal serum tiyol/disülfit homeostazındaki farklılıkları karşılaştırmayı amaçlamaktadır.
Materyal ve Metodlar: Araştırma prospektiftir. XXXX'daki kadın hastalıkları ve doğum kliniğine başvuran, 6 ile 14 haftalar arasında AI veya abortus tanısı almış, normal gebelik takibi yapılan, kronik hastalığı bulunmayan ve folik asit dışında çoklu vitamin veya antioksidan takviyesi almayan gebeler bu çalışmaya dahil edilmiştir. Çalışma, 33 AI, 36 abortus tanılı ve 40 normal gebelik olmak üzere toplam 109 gebe kadını kapsamaktadır. Üç grup arasındaki tüm katılımcılar yaş, gebelik yaşı ve vücut kitle indeksi açısından eşleştirilmiştir. Tiyol/disülfit seviyeleri, yeni geliştirilen otomatik spektrofotometrik bir yöntem kullanılarak değerlendirilmiştir.
Bulgular: AI grubundaki toplam tiyol seviyeleri ve nativ tiyol (SH) değerleri, abortus grubundakinden anlamlı derecede yüksekti. Ancak, sağlıklı grup ile diğer iki grup arasında anlamlı bir fark görülmedi. Serum disülfid (SS) seviyeleri, üç grup arasında istatistiksel olarak anlamlı bir fark göstermedi. Benzer şekilde, SS/SH, SS/toplam tiyol ve SH/toplam tiyol oranları arasında da gruplar arasında anlamlı bir fark bulunmadı (p>0.05).
Sonuç: Abortus grubundaki hastalarda AI grubuna kıyasla azalmış toplam tiyol ve SH seviyeleri gözlemlenmiştir, her iki bileşenin de antioksidan özellikleri bulunmaktadır. Vücuttaki antioksidan seviyelerindeki azalma, abortus etiyolojisine katkıda bulunabilir. Mevcut literatür ile birlikte bulgularımızı değerlendirdiğimizde, serum tiyol-disülfit oranının sağlıklı gebelik veya AI sonrası abortusu tahmin edip edemeyeceği konusunda kesin bir sonuca varılamamıştır. Bu nedenle, gebelik sağkalımını değerlendirmede umut verici bir tanı aracı olarak düşünülemez. Erken gebelik kaybı üzerinde dinamik tiyol/disülfit homeostazının etkisini göstermek için daha fazla araştırmaya ihtiyaç vardır.

Objective: This study aimed to compare the differences of maternal serum thiol/disulfide homeostasis in women with abortion imminens (AI), missed abortion (MA), and healthy pregnancies during the first trimester.
Material and Methods: The research design was prospective. Pregnant women who attended the obstetrics clinic at XXXX, diagnosed with AI or MA between 6 to 14 weeks, who had a normal pregnancy follow-up, and who had no chronic illnesses, and took no multivitamin or antioxidant supplements except from folic acid, were enrolled in this study. The study comprised 33 pregnant women with AI, 36 with a MA diagnosis, and 40 with normal pregnancies. All participants across the three groups were matched for age, gestational age, and body mass index. Thiol/disulfide levels were assessed using a newly developed automated spectrophotometric method.
Results: Total thiol levels and native thiol (SH) values in the AI group were significantly higher than in the MA group. However, there was no significant difference between the healthy group and the other two groups. Serum levels of disulfide (SS) did not show statistically significant differences across the three groups. Similarly, the ratios of SS/SH, SS/total thiol, and SH/total thiol did not differ significantly among the groups ( p>0.05).
Conclusion: We observed reduced total thiol and SH levels, both of which possess antioxidant properties, in patients with MA compared to the AI group. A decrease in the antioxidant levels in body may contribute to the etiology of MA. Evaluating our findings in conjunction with existing literature, it remains inconclusive whether the serum thiol-disulfide ratio can predict a healthy pregnancy or MA following AI. Therefore, it cannot be considered a promising diagnostic tool for assessing pregnancy viability. More research is needed to demonstrate the impact of dynamic thiol/disulfide homeostasis on early pregnancy loss.

Amaç: Tekrarlayan implantasyon başarısızlığı (RIF) ve tekrarlayan gebelik kaybı (RPL) olan hastalarda implantasyon başarısızlığının nedeni net olarak belirlenememiştir. Bu çalışmada, RIF ve RPL hastalarında, endometriumun reseptif döneminde, HOXA-11, β1 integrin, FAK, CD44 ve ECM1 moleküllerinin immünohistokimyasal değişikliklerini değerlendirmeyi amaçladık.
Gereç ve Yöntem: Bu çalışma bir üniversite hastanesinde retrospektif olarak yapıldı. Endometriumda, reseptör seviyesinde değişikliğe neden olabilecek patolojisi olan olgular dışlandıktan sonra, endometriumun reseptif döneminde yapılan biyopsiler seçildi. Hastalar RPL (n=15), RIF (n=16), ve kontrol (n=16) grupları olarak 3 gruba ayrıldı. Tüm preparatlar HOXA11, β1 integrin, FAK, CD44 ve ECM1 için immünohistokimyasal olarak boyandı. Boyanma özellikleri değerlendirildi.
Bulgular: HOXA-11 ve β1 integrin ekspresyon değişiklikleri, RIF ve kontrol grupları arasında benzerdi. Ancak RIF grubunda FAK ekspresyonu anlamlı düzeyde artmıştı (p<0,01). Ayrıca RIF grubunda ECM1 ve CD44 ekspresyonlarının kontrol grubuna göre anlamlı düzeyde azaldığı görüldü (p<0,01). RPL öyküsü olan hastalarda HOXA-11, FAK ve ECM1'in endometriyal boyanmasında anlamlı fark yoktu. Ancak RPL grubunda β1 integrin ve CD44 düzeylerinin kontrol grubuna göre anlamlı düzeyde düşük olduğu belirlendi (p<0,05).
Sonuç: İmplantasyon karmaşık bir süreçtir ve endometrial reseptivitede rol oynayan adezyon mekanizmalarındaki değişimler, RIF ve RPL'li hastalarda defektif implantasyonla ilişkili olabilir. Adezyon molekülleri arasında CD44, β1 integrin, FAK ve ECM1 moleküllerinin ekspresyonu, defektif implantasyon durumunda, normal popülasyona göre değişkenlik gösterir.

Objective: The cause of implantation defects in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL) has not been clearly established. We aimed to evaluate the immunohistochemical changes in HOXA-11, β1 integrin, FAK, CD44, and ECM1 molecules during the receptive endometrial period in patients with RIF and RPL.
Materials and Methods: This study was retrospectively conducted in a university hospital. After the exclusion of cases with pathology that may cause a change in the level of receptors in the endometrium, biopsies performed during the receptive period were selected, and the patients were categorized into RPL (n=15), RIF (n=16), control (n=16) groups. All preparations were immunohistochemically stained for HOXA11, β1 integrin, FAK, CD44, ECM1.
Results: HOXA-11 and β1 Integrin expression changes were similar between the RIF, and control groups. However, FAK expression was significantly increased in the RIF group (p<0.01). Additionally, ECM1 and CD44 expressions were significantly decreased in the RIF group compared to the control group (p<0.01). There was no significant difference in the endometrial staining of HOXA-11, FAK, and ECM1 in patients with a history of RPL. However, β1 Integrin and CD44 levels were found to be significantly decreased in the RPL group than in the control group (p<0.05).
Conclusion: Implantation is a complex process, and altered adhesion mechanisms involved in endometrial receptivity might be related to defective implantation in patients with RIF and RPL. Among the adhesion molecules, expression of CD44, β1 integrin, FAK and ECM1 molecules vary in inappropriate implantation compared to the normal population.

Objective: Endometriosis is associated with various symptoms, but their severity varies from case to case. In this research we investigated the reality of symptoms presented by patients with clinically early-stage endometriosis-associated ovarian cancer (EAOC), and explored the relationship between symptoms and laboratory/imaging findings, pathological findings and prognosis.
Materials and methods: This was a retrospective case-control study of patients who received initial surgical treatment and were diagnosed with clinically early-stage EAOC including ovarian endometrioid carcinoma (OEC), ovarian clear cell carcinoma (OCCC), and seromucinous borderline tumor (SMBT). Patients with OEC/OCCC diagnosed between 2006 and 2016, and patients with SMBT diagnosed between 2006 and 2020 were included. Chi-square and Kaplan-Meier estimates were used for statistical analyses.
Results: 107 patients (OEC, n=31; OCCC, n=39; SMBT, n=37) were included. Fifty-nine (55.1%) patients presented with symptoms, and patients with OEC who presented with symptoms was significantly higher than that of others (OEC, 77.4%; OCCC, 43.6%; SMBT, 48.6%). The details of symptoms differed significantly among pathological types (lower abdominal pain/abdominal discomfort/abnormal bleeding, OEC: 11/8/9; OCCC: 6/12/1; SMBT: 15/5/3). Only in the OEC group, symptomatic patients showed significantly higher white blood cell (WBC) count and neutrophil/lymphocyte (N/L) ratio (symptomatic vs. asymptomatic, median: WBC count: 7250 vs. 5000, p=0.008; N/L ratio: 4.6 vs. 1.7, p=0.013). None of the asymptomatic patients showed recurrence during follow-up.
Conclusion: Patients with EAOC show varying symptoms depending on the histological type of the tumor. Laboratory findings underlying symptoms also vary by histopathological type, which may reflect the difference in carcinogenesis process.

Amaç: Erken evre (Evre 1-2) Endometriyal Kanserde (EC) lenfovasküler alan invazyonu (LVSI) pozitifliğini, EC'nin prognostik faktörlerini içeren bir Prediktif Model kullanarak tahmin etmek.
Gereç ve Yöntem: Bu çalışmaya 2010-2020 yılları arasında kliniğimizde erken evre EK tanısıyla primer tedavi olarak pelvik-paraaortik lenfadenektomi ile birlikte total histerektomi ve iki taraflı salpingo-ooferektomi uygulanan veya pelvik-paraaortik lenfadenektomi yapılan 461 hasta dahil edildi. Ayrıca tüm cerrahi örnekler LVSI pozitifliği veya negatifliği açısından histopatolojik olarak incelendi ve hastalar bu patolojik sonuçlara göre iki gruba ayrıldı. Hastaların klinikopatolojik ve demografik özellikleri olarak yaş, menopozal durum, histolojik tip (Tip 1-2), histolojik derece (Grade 1-2-3), miyometrial invazyon derinliği ve peritoneal sitoloji sonuçları kaydedilerek analiz edildi. Gözlemlenen ve tahmin edilen sonuçlar arasındaki ilişkiyi belirlemek için Loess algoritması kullanıldı. Algoritmalar arasındaki ayrım C-endeksi (AUC) hesaplanarak değerlendirildi.
Bulgular: LVSI pozitifliği ileri yaş, menopoz, Tip 2 EC, ileri histolojik derece, malign peritoneal sitoloji, servikal tutulum ve miyometrial derinliğin %50'sini aşan tümör ile anlamlı düzeyde ilişkiliydi. Dikkat çekici bir şekilde LVSI, üç açıklayıcı değişkenle en güçlü şekilde ilişkiliydi: 1- %50'den fazla miyometrial invazyon (Odds Ratio [OR]: 3.78; %95 confidence interval [CI]: 1.80-7.60), 2- İleri histolojik derece (OR= 1.98 [1.20-3.20] %95 CI), 3- Malign peritoneal sitoloji (OR= 3.06 [1.40-6.30] %95 CI). Cezalandırılmış maksimum olasılık tahmini (PMLE) modeli, dahil edilen hastaların %87'sini doğru şekilde sınıflandırmıştır (C-endeksi: 0,876).
Sonuç: Tahmin modelimiz, farklı prognostik faktörlere dayanarak LVSI'nin tahmin edilmesine yardımcı olabilir. Nomogramda yer alan prognostik faktörler, özellikle %50'den fazla miyometrial invazyon derinliği, ileri histolojik derece ve malign peritoneal sitoloji olmak üzere LVSI ile anlamlı düzeyde ilişkiliydi.

Objective: To predict lymphovascular space invasion (LVSI) positivity in early-stage (Stage 1-2)Endometrial Cancer(EC) using a Predictive Model with prognostic factors of EC.
Materials and Methods: The 461 patients who underwent total hysterectomy and bilateral salpingo-oophorectomy with pelvic-paraaortic lymphadenectomy as the primary treatment for presumed early-stage EC at our clinic between 2010-2020 were included in the current study. Moreover, all surgical specimens were examined histopathologically for the positivity or negativity of LVSI, and the patients were divided into two groups based on these pathologic outcomes. Age, menopausal status, histological type (Type 1-2), histological grade (Grades 1-2-3), depth of myometrial invasion, and peritoneal cytology results were recorded and analyzed as clinicopathological and demographic characteristics of the patients. The Loess algorithm determined the relationship between the observed and predicted outcomes. The distinction between algorithms was evaluated by calculating the C-index (AUC).
Results: LVSI positivity was significantly associated with advanced age, menopause, Type 2 EC, advanced histological grade, malignant peritoneal cytology, cervical involvement, and a tumor exceeding 50% of the myometrial depth (p<0.001, respectively). Remarkably, LVSI was most strongly associated with three explanatory variables: 1- More than 50% myometrial invasion ( Odds ratio [OR]: 3.78; 95% confidence interval [CI]: 1.80-7.60), 2- Advanced histological grade (OR= 1.98 [1.20-3.20] 95% CI), 3- Malignant peritoneal cytology (OR= 3.06 [1.40-6.30] 95% CI). The Penalized maximum likelihood estimation (PMLE) model correctly classified 87% of the included patients (C-index: 0.876).
Conclusion: Our predictive model may help the prediction of LVSI based on different prognostic factors. The included prognostic factors in the nomogram were significantly associated with LVSI, especially myometrial invasion depth of more than 50%, advanced histological grade, and malignant peritoneal cytology.

Objectives: MCAM -1(CD146) is an endothelial cell adhesion molecule belonging to the immunoglobulin superfamily. Recent studies have found CD146 expression as a critical marker for tumor progression, migration, and metastasis in various malignancies. This study aims to evaluate CD146 immunohistochemical expression in various gynecological cancers.
Material and Methods: This study was conducted in a tertiary medical center in central India. A total of 49 gynecological cancer cases and 16 site-matched controls were taken. The cases comprised 27 cervical, 10 endometrial, 10 ovarian, and two miscellaneous cancers. CD146 immunohistochemistry was carried out and assessed for immunoreactivity score(IRS), microvascular density (MVD), and microvascular caliber (MVC). An IRS of 5 or more was considered CD146 positive.
Results: The p value for CD146 positivity for cases vs control was 0.0531, 0.0580 and 0.007 for cervical, endometrial and ovarian sites respectively. The mean MVD was found to be significantly higher in cases compared to benign tissues (p value<0.00001) and the mean MVC of cases was found to be smaller when compared to the controls (p-value< 0.0001).
Conclusion: MVD by CD146 was found to be higher in the gynecological malignancies highlighting its role in cancer neo-angiogenesis and its potential therapeutic role. CD146 epithelial expression was also significantly higher in ovarian cancers. Further studies with larger sample size need to be done to support that this protein may be a potential theranostic target in gynecological cancers.

Amaç
Amacımız, dünya çapında kadın hastalıkları ve doğum asistan hekimleri ve genç uzmanları arasında İnsan Papilloma Virüsü (HPV) ve aşılama bilgisi ve anlayışını araştırmaktır.
Gereç ve Yöntemler
Bu kesitsel çalışma, Dünya Kadın Hastalıkları ve Doğum Asistanları ve Genç Uzmanları Birliği (WATOG) tarafından Şubat 2023 ve Ağustos 2023 tarihleri arasında 28 sorudan oluşan bir anket aracılığıyla gerçekleştirildi. Anket ile çalışma katılımcılarının demografik verileri, HPV ve HPV aşılarına dair bilgileri ve anlayışları elde edildi.
Bulgular
Anketi 52 ülkeden 205 kadın hastalıkları ve doğum asistanı ve genç uzmanı tamamladı. Ankete katılanların çoğunluğunu asistan hekimler oluşturdu (158, %77,1). Asistan ve genç uzman hekimlerin büyük bir kısmı HPV'yi ilk kez tıp fakültesi sırasında öğrenmiş (149, %72,6). Katılımcıların neredeyse tamamı (204, %99,5) HPV'nin cinsel yolla bulaştığını yanıtladı. Ankete katılanların yarısından fazlası HPV aşısı yaptırmadığını belirtti (110, %53,7). Aşı, katılımcılara çoğunlukla kıdemli meslektaşları tarafından önerilmiş (110, %53,7). Ankete katılanların çoğu HPV pozitif hastaların nasıl yönetileceğini bildiğini belirtti (179, %87,3).
Sonuç
Bu çalışma, kadın hastalıkları ve doğum asistan hekimleri ve genç uzmanları arasında HPV ve HPV aşısı hakkındaki bilgilerinin tatmin edici olmasına rağmen, HPV’ye karşı aşılanma miktarının hala yetersiz olduğunu göstermektedir. Altında yatan potansiyel sorunu anlamaya ve çözmeye ihtiyaç vardır.

Objective
Our goal is to research the understanding of Human papillomavirus and its vaccination among obstetrics and gynecology trainees and young specialists worldwide.
Methods
This cross-sectional study was conducted through an online survey consisting of 28 questions, by the World Association of Trainees in Obstetrics and Gynecology (WATOG) between February and August 2023. Questionnaire collected demographic data of the study participants, assessed the respondents’ knowledge and perception of HPV, HPV vaccines and vaccine dosing schedule.
Results
205 Ob/Gyn trainees and young Ob/Gyns from 52 countries completed the survey. The majority of respondents were trainees (158, 77.1%). Most trainees and young Ob/Gyns learned about HPV for the first time during medical school (149, 72.6%). Almost all (204, 99.5%) the Ob/Gyns responded that HPV was sexually transmitted. More than one-half of the respondents had not received HPV vaccination (110, 53.7%). The vaccine was recommended for respondents mostly by their Ob/Gyn senior colleagues (110, 53.7%). Most of the respondents knew how to manage HPV positive patients (179, 87.3%).
Conclusion
This study suggests that even though the knowledge on HPV and its vaccination is satisfactory amongst trainees and young Ob Gyns, HPV vaccination remains deficient. There is a need to understand, educate and address the potential problem lying underneath.