المؤلفون: Tomassetti, Carla, Adamson, David, Arici, Aydin, Canis, Michel, Hompes, Peter, Hummelshoj, Lone, Mol, Ben-Willem, Nardo, Luciano, Rombauts, Luk, D’Hooghe, Thomas

المصدر: Journal of Endometriosis and Pelvic Pain Disorders; September 2018, Vol. 10 Issue: 3 p158-173, 16p

مستخلص: Background: Clinical management of endometriomas, prior to starting treatment with assisted reproductive technologies (ART), has since long been a matter of debate. Whereas cystectomy has been advocated in the past, recently more evidence has emerged on the potential negative effect of surgery on ovarian reserve. Parallel to this, prolonged downregulation with GnRH-a (gonadotropin-releasing hormone agonists) has been described to improve ART pregnancy rates in women with endometriosis. However, none of these strategies have been assessed in a large randomized controlled trial. The aim of the EndoART study is to assess whether ovarian surgery or prolonged GnRH-a downregulation result in higher pregnancy rates after ART compared to no intervention in women with endometrioma(s).Methods/design: A parallel randomized multi-center trial has been designed to compare ART pregnancy rates in three different treatment groups: no intervention, ovarian surgery, and prolonged hormonal suppression by GnRH-a prior to ART. The primary outcome measure studied is the clinical pregnancy rate with fetal heart-beat within 6 months after initiation of a fresh ART cycle. Secondary outcome measures studied include live birth rate after one initiated fresh ART cycle, cumulative clinical pregnancy rate with fetal heart-beat and live birth rates (after one fully completed ART cycle: initiated fresh + eventual associated frozen embryo transfer cycles), ART–specific data (e.g. number of oocytes, number of good quality embryos), complications, pelvic pain, and quality of life.Conclusion: This trial may answer the most frequently asked questions by both women with endometriosis and physicians: how do you treat endometrioma in women prior to treatment with ART?

المؤلفون: Guzel, Elif, Basar, Murat, Ocak, Nehir, Arici, Aydin, Kayisli, Umit A.

المصدر: Biology of Reproduction; July 2011, Vol. 85 Issue: 1 p121-127, 7p

مستخلص: The human endometrium is a dynamic tissue that undergoes cyclic changes under the influence of steroid hormones as well as numerous local paracrine and autocrine factors. Heat shock 70 kDa protein (HSPA5; also known as GRP78/BiP), a molecular chaperone within the endoplasmic reticulum, plays crucial roles in normal cellular processes as well as in stress conditions, in which it is a central regulator for the unfolded protein response (UPR). We hypothesized that HSPA5 expression level is variable throughout the menstrual cycle in human endometrium and that estrogen signaling cross-talks with UPR signaling by interacting with HSPA5. HSPA5 expression throughout the menstrual cycle was evaluated in vivo in normal human endometrium. Using in vitro techniques, we then assessed the bidirectional regulation of HSPA5 and estrogen signaling in human endometrial glandular (Ishikawa) and stromal cells (ESC). HSPA5 immunoreactivity in endometrial glandular and stromal cells was cycle-dependent, and was significantly higher in phases of the menstrual cycle when estradiol (E2) levels are known to be the lowest compared with the rest of the cycle (P< 0.001). E2did not affect HSPA5 expression after 8–24 h incubation in Ishikawa cells and ESC in vitro. However, tunicamycin-induced HSPA5 expression was significantly lowered in these cells when pretreated with E2(P< 0.01 and P <0.05, respectively). On the other hand, tunicamycin decreased E2up-regulated alkaline phosphatase activity (P< 0.001). In conclusion, there is cycle-dependent HSPA5 expression with a possible inverse correlation between HSPA5 expression and E2levels in human endometrium. We suggest that estrogen signaling cross-talks with the UPR cascade by interacting with HSPA5, as supported by our in vitro findings.

المؤلفون: Matalliotakis, Ioannis M., Sakkas, Denny, Illuzzi, Jessica, Matalliotaki, Charikleia, Arici, Aydin

المصدر: Journal of Endometriosis and Pelvic Pain Disorders; April 2011, Vol. 3 Issue: 2 p86-92, 7p

مستخلص: Purpose To reconsider the implantation and delivery rates which occurred six years later in women with endometriosis from the Yale IVF Programme.Methods Five hundred and ninety-seven consecutive IVF and ICSI treatment cycles were analyzed retrospectively. Patients with endometriosis (n=130; 258 cycles) were compared with an age-matched control group with tubal infertility (n=104; 206 cycles) and also with a group with male infertility (n=59; 133 cycles). Data from the endometriosis group were analyzed further in minimal-mild (144 cycles) and moderate-severe (114 cycles) subgroups. All the patients underwent laparoscopy prior to IVF treatment.Results Fewer oocytes were retrieved and similar fertilization (59% vs. 61%), implantation (12.3% vs. 16%), and delivery (23.7% vs. 26.3%) rates were found in patients with endometriosis compared to tubal infertility. A trend towards reduced pregnancy rate per transfer (17.5%) in the male infertility vs. endometriosis or tubal infertility groups (34% and 37.8% respectively) was observed. The number of embryos transferred in each group was comparable. Analysis of first cycles only across all groups revealed that the implantation rate did not have any statistically significant differences in the endometriosis versus the tubal or male infertility groups. Within the endometriosis group, the implantation, pregnancy, and delivery rates were similar in subgroups.Conclusions We conclude that in patients with endometriosis, implantation, pregnancy, and delivery rates are similar with tubal factor infertility, and higher compared to male infertility. Our results suggest that embryo quality and uterine receptivity remain unaffected in women with endometriosis.

المؤلفون: Matalliotakis, Ioannis M., Goumenou, Anastasia G., Matalliotakis, Michail, Arici, Aydin

المصدر: Journal of Endometriosis and Pelvic Pain Disorders; October 2010, Vol. 2 Issue: 4 p213-217, 5p

مستخلص: Objective Uterine anomalies are associated with higher rate of infertility, spontaneous abortion, premature birth and endometriosis. We report our experience in 13 cases with uterine malformations and endometriosis.Methods The medical files of 425 cases with endometriosis and 200 without endometriosis, all of them studied by laparoscopy, were studied retrospectively in Yale University Hospital. Thirteen cases were observed and analyzed.Outcome measures Presenting symptoms, stage of endometriosis, menstrual characteristics, obstetrics outcome, family history, the type of uterine anomaly and presence of other anomalies were studied.Results In our series, we found 13/425 (3%) of women with endometriosis and congenital malformation. The mean age was 29.6 years (range 25–30). In this population, septate uterus (54%) was the most common malformation, followed by didelphic uterus (23%), unicornuate uterus (15.3%) and bicornuate uterus (7.7%). In 3 (23%) of these patients, we observed anomalies of the urinary tract. In the control group, we found only one case (0.5%) with septate uterus. Seven out of 13 (54%) of patients had severe endometriosis. The main symptom of all patients was infertility. Five out of thirteen conceived after assisted reproductive technology (ART) procedures. Five cases (38%) were found with first-degree family history with endometriosis.Conclusions Our results seem to support a link between uterine anomalies and subsequent development of endometriosis with infertility. The role of ART needs to be better evaluated. The co-existence of uterine anomalies with endometriosis and familiar aggregation of endometriosis should be examined in future studies, in order to improve our understanding of the genetic aspect of these diseases.

المؤلفون: Luk, Janelle, Arici, Aydin

المصدر: Current Opinion in Obstetrics and Gynecology; June 2010, Vol. 22 Issue: 3 p177-182, 6p

مستخلص: The majority of infertility patients require more than one in-vitro fertilization cycles to achieve pregnancy, which results in repeated stimulation in the ovaries. There have been raising concerns for patients about the effect of repetitive assisted reproductive technology (ART) cycles on ovarian response in subsequent cycles. Whether or not there is deterioration in ovarian response with repetitive treatment will allow clinicians to provide better counseling to patients before treatment.

المؤلفون: Matalliotakis, Ioannis, Cakmak, Hakan, Sakkas, Denny, Matalliotaki, Charikleia, Arici, Aydin

المصدر: Journal of Endometriosis and Pelvic Pain Disorders; April 2010, Vol. 2 Issue: 2 p87-94, 8p

مستخلص: Objective The aim was to determine the number and the grade of oocyte-corona-cumulus complex (OCCC) and the most viable embryos for transfer in women with endometriosis compared to those with tubal factor infertility.Study methods Patients underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at the Yale IVF program. The endometriosis group of 135 patients was monitored in 262 consecutive cycles. The controls consisted of 103 patients with tubal factor infertility undergoing 203 consecutive assisted reproductive technology (ART) cycles. All the patients underwent laparoscopy before IVF treatment. Response to gonadotropins, the oocyte and embryo grade, fertilization, cleavage, implantation, pregnancy, delivery and abortion rates were noted.Results Oocyte-corona-cumulus complex (OCCC), two-pronuclear (2PN) oocytes, and the grade 1 and 2 embryos on days 2 and 3 were lower in women with endometriosis compared to those with tubal factor infertility. Higher total gonadotropin requirements, fewer mature follicles, lower peak E2, a lower number of oocytes collected, and higher cancellation rates were found with the endometriosis group compared to controls. However, no differences were found in fertilization, cleavage, implantation, pregnancy, miscarriage, and delivery rates between the endometriosis and tubal factor groups.Conclusions Despite the lesser quality of oocytes and embryo grading and diminished ovarian reserve, the presence of endometriosis does not affect implantation and delivery rates in patients undergoing ART procedures.

المؤلفون: Martin, J Ryan, Arici, Aydin

المصدر: Current Opinion in Obstetrics and Gynecology; June 2008, Vol. 20 Issue: 3 p216-220, 5p

مستخلص: To review the recent literature on fragile X and the genotypic and phenotypic implications on human reproduction.

المؤلفون: Rackow, Beth W., Arici, Aydin

المصدر: Postgraduate Obstetrics & Gynecology; January 2008, Vol. 28 Issue: 1 p1-7, 7p

المؤلفون: Ulukus, Murat, Arici, Aydin

المصدر: Current Women's Health Reviews; November 2007, Vol. 3 Issue: 4 p217-227, 11p

مستخلص: Recurrent pregnancy loss is classically described as three or more consecutive miscarriages occuring before the 20th weeks of gestation. The overall incidence of spontaneous miscarriage varies between 15 and 25, whereas recurrent miscarriage affects around 1 of fertile couples. First trimester losses consist of 75 of recurrent miscarriages and second trimester losses the remaining 25. Genetic, anatomical, endocrine, immune, infective and environmental factors are believed to play important roles in the pathophysiology of recurrent pregnancy losses. However, the majority of recurrent miscarriage cases are idiopathic and no identifiable cause is found. In this review we aim to summarize the identifiable causes of recurrent pregnancy losses and discuss the current treatment modalities.

المؤلفون: Kodaman, Pinar H., Arici, Aydin

المصدر: Postgraduate Obstetrics & Gynecology; November 2007, Vol. 27 Issue: 21 p1-8, 8p