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    Fertility following spinal cord injury
    (ASRM, 2006) Cıncık, Mehmet; Akar, M. Erman; Bedir, S.; Selam, Belgin; Coban, H.; Ergür, A.R.
    OBJECTIVE: To investigate the fertility of patients with spinal cord injuries (SCI) and their partners. DESIGN: Retrospective study. MATERIALS AND METHODS: Between April 2004 and April 2006, electroejaculation method was used to procure semen from 12 patients with anejaculation in 14 cycles. Sperm quality of the ejaculate was evaluated. All patients received concomitant pituitary down regulation with GnRH-agonist (Lupron, 0.1 mg sc) beginning in the midluteal phase of the preceding cycle. GnRH agonist was continued until the day of the HCG injection. Dose of recombinant FSH was individually adjusted every 1-3 days thereafter based on the results of serum E2 determinations. Routine IVF /ICSI procedures were performed. Oocytes were retrieved 34 hours after hCG injection. RESULTS: Semen was retrieved in all of the IVF/ICSI cycles. Embryo transfer was cancelled in three cycles because there was no fertilization. Mean age of the male patients was 28.4 6.1 (range 22-31). Mean number of grade 1 embryos on day 3 were 3.4 2 (range 1-10). Pregnancy rate per cycle was 21%. CONCLUSION: Semen for fertility purposes can be effectively obtained in patients with anejaculation using electroejaculation. Research may be focused on increasing sperm quality for these patients during assisted reproductive techniques.
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    P-681: Obesity and semen quality
    (Elsevier, 2006) Cıncık, Mehmet; Akar, M. Erman; Bedir, S.; Ergür, A. R.; Yazıcı, M.; Selam, B.
    Objective We aimed to compare semen quality and serum reproductive hormones in obese and non obese men. Design Prospective Materials and methods From April 2004 to April 2006, 21 obese men and 42 non obese men were included in the study. Men with body mass index(BMI=W(kg)/L2(m)) of more than 35 were included in the obese group. Men with BMI between 20 and 25 were included in the non obese group. Semen volume, sperm concentration(in milliliters), sperm concentration(in million per milliliter), percentage of motile spermatozoa , percentage of spermatozoa with normal morphology, total sperm count(in million) and serum reproductive hormones were evaluated. Results Serum FSH and testesterone levels were found to be significantly higher in the non obese control group. Serum steroid hormone binding globulin(SHBG) was significantly lower in the obese group which correlated with elevated bioavailability of both testesterone and estradiol in the obese group. Serum luteinizing hormone levels were no different suggesting that free testerone levels were unchanged. Percentages of normal spermatozoa were reduced significantly among men with high BMI(p<0.05). Semen volume and percentage of motile spermatozoa was not effected by obesity. Conclusion Our findings confirmed that obesity was associated with reduced semen quality. If this is further confirmed with larger study groups, some cases of male infertility might be preventable.
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    Short term follow up results of the first human uterus transplantation from cadaver
    (Elsevier, 2012) Akar, M. Erman; Özkan, O.; Erdoğan, O.; Cincik, Mehmet; Mutlu, D.; Gunseren, F.; Pestereli, E.; Kocak, H.; Dinckan, A.; Hadimioglu, N.; Suleymanlar, G.
    Study Objective: To present the short term follow up results of the first human uterus transplantation from cadaver. Design: Case report. Setting: University hospital. Patients: A 19 year old female patient with complete mullerian agenesis presented with primary amenorrhea and inability to achieve intercourse. Intervention: Vaginal reconstruction with jejunum graft, in vitro fertilization and embryo vitrification procedures were performed. Following immunocompatibility tests for the transplantation, the patient was elected as the most suitable recipient for the uterus. The cadaver uterus was screened for the presence of any structural abnormalities and infections preoperatively. Uterus transplantation procedure consisted of revascularisation, reanastomoses of the right and left uterine arteries and veins(ishemia time for five hours), fixation of the uterovesical flap to the preexisting urinary bladder, suspension of the uterosacral ligament to sacrum. Measurements and Main Results: Early postoperative course was uneventful. Intraoperative and postoperative induction immunosuppressive therapy with thymoglobulin, tacrolimus, mycophenolate mofetil and prednisone was well tolerated. Maintanance immunosuppressive therapy with tacrolimus, mycophenolate mofetil and prednisone and prophylactic antiviral, antibacterial therapy was initiated. Bilateral uterine artery doppler ultrasonography showed good perfusion. We observed no signs of rejection and infection confirmed with laboratory and cytological findings. She has had six menstrual cycles since the operation. Conclusion: We have described restoration of menstrual cycles following uterus transplantation which might be a promising option to restore fertility in this selected group of patients.