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Publication Metadata only Surgical Removal of Hydrosalpinx Improves Endometrium Receptivity by Decreasing Nuclear Factor-Kappa B Expression(Springer, 2020) Adevıye Erşahın, Aynur Adeviye; Ersahin, Suat Süphan; Dokuzeylül Güngör, Nur; Adevıye Erşahın, Aynur Adeviye, Department of Obstetrics and Gynecology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Ersahin, Suat Süphan, Department of Obstetrics and Gynecology, Altinbas Universitesi, Istanbul, Turkey; Dokuzeylül Güngör, Nur, Department of Obstetrics and Gynecology, Medicalpark Goztepe Hospital, Istanbul, TurkeyAlthough physiologic amount of inflammation is necessary for successful implantation, pathological inflammation inhibits the expression of receptivity molecules and genes. Because hydrosalpinges is an inflammatory disease, adverse effects of hydrosalpinges on implantation may be in part mediated by disturbed endometrial expression of nuclear factor-kappa B (NF-κB), a dimer implicated in inflammation. We examined the expression of NF-κB p65 (Rel A) during the window of implantation in the endometrium of infertile women (n = 14) with uni or bilateral hydrosalpinges prior to and following salpingectomy and of fertile controls (n = 14) by immunohistochemistry. We assessed the influence of salpingectomy on NF-κB p65 expression by comparing pre- and post-operative endometrial samples. To evaluate the intensity of endometrial NF-κB p65 (Rel A) immunoreactivity, H-score method was used. We showed a decrease in NF-κB p65 expression in 13 out of the 14 post-salpingectomy endometrial samples. The mean NF-κB p65 level was significantly higher in the endometrium of women with hydrosalpinges before salpingectomy compared with control cases without hydrosalpinges (3.94 ± 6.2 vs 2.18 ± 0.7, p <.02). Salpingectomy decreased the mean endometrial NF-κB p65 levels in both unilateral and bilateral hydrosalpinges (2.87 ± 1.1). When we compared the endometrial NF-κB p65 levels of the post-salpingectomy samples with their age-matched fertile controls, we did not observe any significant difference. After salpingectomy, the mean H-score of endometrial NF-κB p65 expression significantly decreased to a level similar to that of the fertile group (2.87 ± 1.1 vs 2.18 ± 0.7, p >.64). NF-κB p65 expression was detected in cytoplasmic and membranous parts of luminal and glandular epithelial cells of endometrium obtained before salpingectomy. Both epithelial and stromal components of the endometrium showed decreased staining for NF-κB p65 compared with the pre- and post-salpingectomy samples. The decreased NF-κB p65 (Rel A) immunoreactivity was predominantly localized to luminal and glandular epithelial cells. Uni or bilateral hydrosalpinges causes pathological endometrial inflammation. Improvement in pathological inflammation following salpingectomy in women with hydrosalpinges may be in part mediated by the downregulation of endometrial NF-κB p65 (Rel A) expression. © 2020 Elsevier B.V., All rights reserved.Publication Metadata only Antithyroid antibodies may predict serum beta HCG levels and biochemical pregnancy losses in euthyroid women with IVF single embryo transfer(Taylor and Francis Ltd., 2021) Güngör, Kaǧan; Dokuzeylül Güngör, Nur; Güngör, Kaǧan, Department of Endocrinology & Metabolism, T.C. Saglik Bakanligi Istanbul Goztepe Egitim ve Arastirma Hastanesi, Goztepe, Turkey; Dokuzeylül Güngör, Nur, Department of Reproductive Endocrinology and IVF, Bahçeşehir Üniversitesi, Istanbul, TurkeyObjective: To investigate the relationship between thyroid autoimmunity and early pregnancy serum β-HCG levels in intracytoplasmic sperm injection patients. Methods: The study subjects were 85 female euthyroid patients undergoing intracytoplasmic sperm injection embryo transfer cycles with GnRH antagonist treatment. Patients who received transfer of more than one embryo, those with serum TSH levels of greater than 2.5 IU/ml and subjects using levothyroxine were excluded. Normal responder patients under the age of 40 years were randomly selected from the patient files retrospectively. Subjects were divided into two groups: those with autoimmune thyroid disease (thyroid autoimmunity group, n = 39) and those without the disease (control group, n = 46). Results: The age, body mass index, trial number, total rFSH treatment dose, the number of cumulus oophorus complexes, number of metaphase II oocytes, and number of 2-pronuclei embryos were similar in the thyroid autoimmunity and control groups. Serum β-HCG levels measured on the 14th day after oocyte pickup were significantly lower in the thyroid autoimmunity group than in the control group (93.8 ± 35.8 versus 128.5 ± 55.8 mlU/ml, respectively, p <.001). The miscarriage rate was higher in the thyroid autoimmunity group than in the control group (34.4% versus 21.7%, respectively, p =.034). Conclusion: We found that early-stage pregnancy serum β-HCG hormone levels among euthyroid patients undergoing intracytoplasmic sperm injection were lower in subjects with thyroid autoimmunity than in those without thyroid autoimmunity. This result, reported for the first time in the literature on euthyroid pregnant women with thyroid autoimmunity, may be predictor of early pregnancy losses in pregnant women with thyroid autoimmunity.Key message In intracytoplasmic sperm injection (ICSI)/IVF patients, due to lack of evidence-based data about the relationship between thyroid autoimmunity and pregnancy loss the current research was conducted. Early-stage pregnancy serum β-HCG hormone levels in euthyroid ICSI patients with thyroid autoimmunity are lower than those without autoimmunity which may be associated with early pregnancy losses. © 2021 Elsevier B.V., All rights reserved.Publication Metadata only Spectroscopy analysis of endometrial metabolites is a powerful predictor of success of embryo transfer in women with implantation failure: a preliminary study(Taylor and Francis Ltd., 2021) Yurci, Arzu; Dokuzeylül Güngör, Nur; Gürbüz, Tuǧba; Yurci, Arzu, Gynecology Obstetrics & Reproductive Medicine, Memorial Kayseri Hospital, Kayseri, Turkey; Dokuzeylül Güngör, Nur, Gynecology Obstetrics & Reproductive Medicine, Medical Park Hospital, Bursa, Turkey; Gürbüz, Tuǧba, Medistate Hospital Gynecology and Obstetric Clinic, Istanbul, TurkeyObjective: To investigate whether prior endometrium spectroscopy predicts the success of embryo transfer in patients with recurrent implantation failure (RIF). Materials and methods: Twenty women with RIF who were scheduled for IVF-ET and six fertile women were included the study. All women with RIF and fertile controls underwent endometrium spectroscopy before embryo transfer. A multi-voxel spectroscopy sequence was used for the detection of choline (Cho), creatine (Cr), lactate, and lipids. Women with RIF were divided into two subgroups as successful (n = 8) and unsuccessful RIF (n = 12) according to both Cho and Cr metabolite characteristics and whether pregnancy was achieved. Associations between the metabolite intensities of the RIF subjects and the implantation rate (IR) and clinical pregnancy rate (CPR) were assessed. Results: While 8 of 20 RIF cases became pregnant, pregnancy could not be achieved in 12 cases. The common spectroscopy finding in all 8 cases who conceived was high Cho and low lactate. The main metabolite change detected in 12 patients who could not conceive was the increase in lactate and lipid signals. The cutoff value of Cho, Cr, lactate and lipid were 1.01 ppm, 1.44 ppm, 0.86 ppm and 1.22 ppm respectively in patients who achieved pregnancy following ET. A positive and significant correlation was found between Cho and Cr intensities and IR or CPR. Conclusions: Receptive endometrium represents some specific metabolites in spectroscopy that can be used for prediction of the success or failure of embryo transfer in women suffering implantation failure. © 2021 Elsevier B.V., All rights reserved.Publication Open Access Evaluation of metabolic and hormonal parameters in women with PCOS living in Black Sea Region(Ondokuz Mayis Universitesi, 2021) Dokuzeylül Güngör, Nur; Çelik, Samettin; Güçlü, Mehmet; Çelik, Sebahattin; Cengiz, Ferhat; Dokuzeylül Güngör, Nur, Department of Reproductive Endocrinology and IVF, Bahçeşehir Üniversitesi, Istanbul, Turkey; Çelik, Samettin, Department of Obstetrics and Gynecology, Samsun Education and Research Hospital, Samsun, Turkey; Güçlü, Mehmet, Department of Obstetrics and Gynecology, Marmara Üniversitesi, Istanbul, Turkey; Çelik, Sebahattin, Department of Obstetrics and Gynecology, Balikesir State Hospital, Balikesir, Turkey; Cengiz, Ferhat, Department of Histology and Embryology, Bahçeşehir Üniversitesi, Istanbul, TurkeyPolycystic ovary syndrome (PCOS) is the most common endocrinopathy which is frequently associated with metabolic syndrome. The aim of this study is to compare the clinical, biochemical and hormonal characteristics of healthy women and women with PCOS in Black Sea Region. 91 healthy women (Group 1) and 109 PCOS (Group 2) patients were included in this retrospective study. This study was conducted in Samsun Women and Children's Health Research and Training Hospital between October 2019-May 2020.The anthropometric, clinical and laboratory characteristics of the women were recorded. The Institutional Review Board of the hospital approved the study. IBM SPSS Statistics 22 program was used for statistical analysis. Variables were expressed as mean ± standard deviation or as a number (percentage), and statistical significance was defined as a p value of less than 0.05. In this study, no statistically significant difference was found between patients with PCOS and control subjects in age, height, BMI, waist circumference and waist-to-hip ratio. Weight, BP systolic, BP diastolic and FG scores, were significantly higher in patients with PCOS compared to control subjects. In this study, no statistically significant difference was found between patients with PCOS and control subjects in FSH, estradiol prolactin, TSH, fT3, fT4 and DHEASO4 levels. But, LH, cortisol, total and free testosterone and 17-OH progesteron levels were significantly higher in patients with PCOS compared to control subjects. Also in this study, vitamin B12 and the 25-OH-D levels were significantly lower in patients with PCOS compared to control subjects. HbA1C,fasting blood glucose levels, fasting insulin levels and HOMA-IR were significantly higher in patients with PCOS compared to control subjects. Total-C, LDL-C and TG levels were significantly higher in women with PCOS compared to control subjects. Also, HDL-C levels were significantly lower in women with PCOS compared to control subjects. As a result, the risk of metabolic syndrome is increased in PCOS patients because of high androgen levels, obesity and insulin resistance. © 2021 Elsevier B.V., All rights reserved.Publication Metadata only Pregnancy outcomes of intrauterine insemination in age-matched young women according to serum anti-müllerian hormone levels(Journal of Reproductive Medicine, Inc., 2021) Dokuzeylül Güngör, Nur; Gürbüz, Tuǧba; Dokuzeylül Güngör, Nur, Bahçeşehir Üniversitesi, Istanbul, Turkey; Gürbüz, Tuǧba, Bahçeşehir Üniversitesi, Istanbul, TurkeyOBJECTIVE: Serum anti-Müllerian hormone (AMH) measurements can be used to determine female fertility potential and response to treatment. The present study aimed to retrospective-ly examine the intrauterine insemination (IUI) cycles and to determine the effect of 3 levels of AMH when pregnancy was obtained in women aged ≤38 years. STUDY DESIGN: This single-center, retrospective, cohort analysis included infertile women aged <38 who underwent IUI cycles in the assisted reproductive technology center. The patients were separated into 3 groups according to AMH levels: Group I: AMH ≤1.0 ng/mL (n=207), Group II: AMH 1–5 ng/mL (n=266), and Group III: AMH ≥5.0 ng/mL (n=313). RESULTS: Baseline antral follicle count was highest in Group III (17.04±1.6, p<0.0001). The day 3 follicle-stimulating hormone (FSH) was highest in Group I (12.2±1.2, p<0.0001). An increase was determined in the pregnancy rate as the AMH level increased: Group I: 13.5%, Group II: 20.7%, and Group III: 22.4% (p= 0.031). The rates of biochemical miscarriage (p=0.866), clinical miscarriage (p=0.809), and ectopic pregnancy (p=0.932) did not differ in terms of the AMH level. There was no significant difference between the groups in respect to reproductive outcomes. CONCLUSION: The pregnancy rate and the baseline antral follicle count increased with increasing AMH levels irrespective of age. (J Reprod Med 2021,66:195–202). © 2021 Elsevier B.V., All rights reserved.Publication Open Access First trimester glycosylated hemoglobin for gestational diabetes mellitus screening(Elsevier Ltd, 2021) Çetin, Cihan; Dokuzeylül Güngör, Nur; Yavuz, Melike Erkoç; Çetin, Cihan, Department of Obstetrics and Gynecology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Dokuzeylül Güngör, Nur, Department of Obstetrics and Gynecology, Medical Park Göztepe Hospital, Istanbul, Turkey; Yavuz, Melike Erkoç, Department of Public Health, Bahçeşehir Üniversitesi, Istanbul, TurkeyObjective: Our aim in this study is to evaluate the efficacy of HbA1c in screening for GDM during the first trimester of pregnancy. Materials and methods: In this retrospective cohort study, we evaluated the first trimester HbA1c (ft-HbA1c) levels of 195 pregnant women who attended our university hospital's obstetrics clinic. Blood samples were drawn from patients during 11–14 weeks of gestation. After that, all patients were screened using standardized one-step 75gr OGTT between 24 and 28 weeks of pregnancy. Results: In this study, 195 pregnant women were included. Thirty-two (16.4%) of the women included in this study were diagnosed with GDM. The mean ft-HbA1c level was 5.52% in those who developed GDM and 5.21% in those who did not develop GDM (p = 0.000). Only seven (3.6%) of the women included in this study had an ft-HbA1c level above the prediabetes limit of 5.7%. All these women with prediabetes developed GDM. The cut-off value for ft-HbA1c to distinguish GDM was 5,33%. For this cut-off value, the sensitivity was 71.9%, and the specificity was 82.8%. Conclusion: The findings suggest that ft-HbA1c level is a promising biomarker for GDM screening. Especially, patients with ft-HbA1c level ≥5.33% are at increased risk for developing GDM. © 2021 Elsevier B.V., All rights reserved.Publication Open Access Defective expression of endometrial BMP-2 contributes to subfertility in women with unexplained infertility(IMR Press Limited, 2021) Yurci, Arzu; Dokuzeylül Güngör, Nur; Gürbüz, Tuǧba; Yurci, Arzu, Gynecology Obstetrics & Reproductive Medicine, Memorial Kayseri Hospital IVF Center, Kayseri, Turkey; Dokuzeylül Güngör, Nur, Gynecology Obstetrics & Reproductive Medicine, Medical Park Hospital, Bursa, Turkey; Gürbüz, Tuǧba, Medistate Hospital Gynecology and Obstetric Clinic, Istanbul, TurkeyBackground: This study was planned to measure bone morphogenetic protein 2 (BMP-2) levels in the endometrial samples of unexplained infertility (UEI) cases who had a history of unsuccessful in vitro fertilization - embryo transfer (IVF-ET) and therefore decided to have frozen-thawed embryo transfer (FET). Methods: Thirty patients diagnosed with UEI and decided to transfer frozen-thawed embryo transfer were included in the study. The UEI patients were selected among the patients whose previous IVF-ET trials were unsuccessful and were scheduled for FET this time. Thirty participants in the control group were selected among patients diagnosed with polycystic ovary syndrome (PCOS) and scheduled for FET. Serum total testosterone, fasting insulin, follicle-stimulating hormone and luteinizing hormone levels were measured. Homeostatic model assessment - insulin resistance (HOMA-IR) Formula was used for calculating insulin resistance. Endometrial samples were collected by pipelle during oocyte pick-up, washed three times with a sterile saline solution to remove blood and transferred into RNA stabilization buffer until analysis. Endometrial BMP-2 concentrations were measured by enzyme-linked immunosorbent assay. Results: Serum total testosterone, insulin levels and HOMA-IR of patients in the control group were significantly higher than the UEI group. BMP-2 levels in the endometrial supernatants of UEI patients were found to be about 2 times lower than the patients in the control group (984.5 (350) pg/mg wet tissue vs. 1720 (318) pg/mg wet tissue, p < 0.000, Z = –6.6). A strong and significant positive correlation was found between endometrial thickness, estradiol levels measured on HCG day and BMP-2 levels. A positive and significant correlation was found between endometrial BMP-2 levels and serum luteinizing hormone (LH), fasting insulin, glucose, testosterone, HOMA-IR and mature oocyte counts. Conclusion: BMP-2 is associated with UEI and mechanistically it may be useful to study this further to determine is this is causal or merely a biomarker. © 2023 Elsevier B.V., All rights reserved.Publication Metadata only Relationship between serum Vitamin D levels semen parameters and sperm DNA damage in men with unexplained infertility(Verduci Editore s.r.l, 2022) Güngör, Kaǧan; Dokuzeylül Güngör, Nur; Başar, Mehmet Murad; Cengiz, Ferhat; Ersahin, Suat Süphan; Çil, Kaan; Güngör, Kaǧan, Department of Endocrinology & Metabolism, Istanbul Medeniyet University, Istanbul, Turkey; Dokuzeylül Güngör, Nur, BAU Medical Park Göztepe Hospital Reproductive Endocrinology and IVF, Istanbul, Turkey; Başar, Mehmet Murad, Department of Urology and Andrology, Istanbul Memorial Hospital, Okmeydani, Turkey; Cengiz, Ferhat, Department of Embryology, Bahçeşehir Üniversitesi, Istanbul, Turkey; Ersahin, Suat Süphan, Department of Obstetrics and Gynecology, Altinbas Universitesi, Istanbul, Turkey; Çil, Kaan, Medizinische Fakultät und Uniklinikum Magdeburg, Magdeburg, GermanyOBJECTIVE: The aim of the study was to investigate the relationship between serum level of vitamin D, semen analysis parameters and sperm DNA damage in men with unexplained subfertility. PATIENTS AND METHODS: Fifty-eight men diagnosed with unexplained infertility and 50 age and BMI matched fertile men were included in the study. A participant whose semen parameter is normal but pregnancy is not achieved was accepted as unexplained male infertility. Blood samples were taken from all participants following three-day abstinence for measurement of vitamin D. Sperm DNA damage was assessed by Aniline Blue staining of the collected samples. RESULTS: Compared with the fertile men, male patients with unexplained infertility had significantly lower vit D levels (27.00 ng/mL (12.63-39.30) vs. 23.66 ng/mL (7.50-55.00), p<0.004). While the number of patients with vitamin D levels lower than 20 ng/mL was 26 (44.8%) in the infertile group, it was recorded as 5 (10.0%) in the fertile group (p<0.001). DNA damage was found in 31.50% (9.0-71.0) of the infertile men and 26.00% (11.0-54.0) of the fertile men. DNA damage was found to be significantly higher in the unexplained infertile group (p<0.002). In men with unexplained male infertility, serum vit D levels were positively correlated with total sperm count (r = 0.527, p<0.001), total motility (r = 0.527, p<0.001) and sperm morphology (r = 0.416, p = 0.001). There was a negative and significant correlation between vit D levels and sperm DNA damage (r = -0.605, p<0.001). In the logistic regression analysis, serum vit D > 20 ng/mL led to an improvement in fertility outcome. CONCLUSIONS: Men with unexplained infertility exhibit decreased serum vit D levels and increased sperm DNA damage. © 2022 Elsevier B.V., All rights reserved.Publication Open Access Preliminary results of blood growth differentiation factor-9 (GDF-9) measurement in cats: future aspects of GDF-9 on stage of the cycle and spaying history(Polska Akademia Nauk, 2022) Evkuran Dal, Gamze; Baykal, Aslihan; Toydemir Karabulut, Tuğba Seval Fatma; Dokuzeylül Güngör, Nur; Turna, Özge; Evkuran Dal, Gamze, Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Istanbul, Turkey; Baykal, Aslihan, Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Istanbul, Turkey; Toydemir Karabulut, Tuğba Seval Fatma, Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Istanbul, Turkey; Dokuzeylül Güngör, Nur, Department of Reproductive Endocrinology and IVF, Bahçeşehir Üniversitesi, Istanbul, Turkey; Turna, Özge, Department of Obstetrics and Gynecology, Istanbul University-Cerrahpasa, Istanbul, TurkeyGrowth differentiation factor-9 (GDF-9), an oocyte-derived member of the TGF-β superfamily, plays an essential role in regulation of follicular development. This study aimed to determine the cyclic changes in serum GDF-9 concentration, compare its levels before and after ovariohysterectomy (OHE), and investigate its potential as a tool in ovarian remnant syndrome (ORS) diagnosis in cats. GDF-9 measurements were performed on 50 cats referred for routine OHE. The stage of the estrous cycle was determined by vaginal cytology and measurement of serum estradiol and progesterone levels was carried out to detect the cyclic changes in circulating GDF-9. One week after OHE, serum samples were collected again from 30 cats to reveal differences in GDF-9 levels. GDF-9 levels in the follicular phase were significantly higher than those in the interestrus (p<0.05). The postoperative analysis could be performed. GDF-9 levels slightly decreased one week after OHE (p=0.053). In conclusion, blood GDF-9 levels change during the estrous cycle, and may decrease with age in cats. However, further studies are needed to reveal the efficiency of GDF-9 in ORS diagnosis. © 2022 Elsevier B.V., All rights reserved.Publication Open Access Correlation of serum leptin and ghrelin levels with endocrine and reproductive parameters in women with clomiphene citrate resistant polycystic ovary syndrome, Klomifen sitrat rezistant polikistik over sendromlu hastalarda ghrelin ve leptin düzeylerinin endokrin ve reprodüktif parametrelerle korelasyonu(Turkish Society of Obstetrics and Gynecology, 2022) Yurci, Arzu; Dokuzeylül Güngör, Nur; Güngör, Kaǧan; Hatirnaz, Safak; Yurci, Arzu, Istanbul Memorial Hospital, Okmeydani, Turkey; Dokuzeylül Güngör, Nur, Clinic of Reproductive Endocrinology and In Vitro Fertilization, Bahçeşehir Üniversitesi, Istanbul, Turkey; Güngör, Kaǧan, Department of Endocrinology & Metabolism, Istanbul Medeniyet University, Istanbul, Turkey; Hatirnaz, Safak, Mediliv Medical Center, Samsun, TurkeyObjective: To investigate the changes in serum ghrelin and leptin levels in patients with clomiphene-resistant polycystic ovary syndrome (PCOS). Materials and Methods: Thirty-five patients who could not achieve ovulation or pregnancy despite using 150 mg/day of clomiphene citrate (CC) participated in the study. Thirty-five patients who were compatible with the study group in terms of age and body mass index (BMI) but did not have clinical and laboratory findings of PCOS constituted the control group. On the third day of the cycle, in addition to the basal hormone profile, ghrelin and leptin levels were also measured. Patients in both groups went to IVF/ICSI. Basal hormone values, leptin, ghrelin, metabolic, demographic parameters, and clinical pregnancy rates were correlated. Results: Patients in both groups were recorded to be similar in terms of age (29.4±0.11 vs 28.5±7.30), BMI (24.3±3.07 vs 23.8±1.55), and infertility time (6.14±4.30 vs 6.03±1.28). Serum ghrelin levels of the PCOS group were significantly lower than the control group (0.48±2.21 vs 1.19±4.02) Serum leptin levels of the PCOS group were significantly higher than the control patients (45.6±304 vs 16.5±0.32). Serum leptin levels and BMI (r=0.65, p<0.01) A positive correlation was found between luteinizing hormone (LH) (r=0.53, p<0.02), and insulin resistance (r=0.74, p<0.03). There was a negative (r=-0.76, p<0.03) correlation between serum ghrelin and LH. A positive and significant correlation was found between serum ghrelin, testosterone, mature oocyte, and implantation rates. Conclusion: Serum ghrelin correlates with fertility outcomes in women with CC-resistant PCOS undergoing IVF/ICSI. © 2022 Elsevier B.V., All rights reserved.
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