Repeated implantation failure (RIF) due to suboptimal endometrial lining is a major challenge in reproductive medicine. The study aims to evaluate effect of intrauterine platelet-rich plasma (PRP) treatment on frozen-thawed embryo transfer (FET) cycles in patients whose endometrium was unable to achieve optimal lining in unexplained infertility patients with history of RIF. We retrospectively analyzed the charts of a total of 302 cycles performed in 273 patients attending Diyar Life ART Centre between January 2014 and January 2017. After excluding 232 cycles, we compared pregnancy outcomes of 34 patients who had suboptimal endometrial lining and underwent PRP + FET and 36 patients who had optimal endometrial lining and underwent only FET. We observed that, endometrial thickness was higher after 48 hours from PRP when compared to endometrial thickness before PRP (10 mm vs. 6.25 mm, p < .001). Clinical pregnancy rate, and importantly live birth rate were also significantly higher in PRP group than the control group. Based on this information, we showed that intrauterine autologous PRP infusion is a safe, inexpensive adjuvant treatment for optimizing endometrium especially in patients with RIF history and intrauterine PRP infusion improved not only endometrial lining but also in vitro fertilization success and pregnancy outcome.

Objective: The aim of the study was to better understand the relationship between pain during intrauterine device (IUD) insertion and anxiety, negative perceptions of IUDs and previous mode of delivery, in parous women. Methods: We conducted a prospective cohort study between June and September 2018 in 210 women who opted for IUD placement for contraception. Sixty-six women who had previously had only vaginal delivery under epidural analgesia were allocated to the epidural delivery group; 60 women who had previously had at least one vaginal delivery without epidural analgesia were allocated to the vaginal delivery group; and 84 women who had previously had only caesarean delivery were allocated to the caesarean delivery group. Participants’ levels of anxiety before insertion were measured using the Beck Anxiety Inventory; participants’ levels of pain (anticipated pain and pain at the various stages of IUD insertion and 15 min after the procedure) were assessed using a visual analogue scale. Results: While the experience of caesarean delivery and pre-procedure anxiety were found to be associated with higher pain scores, the presence of negative perceptions of IUDs was the most significant predictor of pain during IUD insertion (p < .001). Experience of vaginal delivery under epidural analgesia was associated with lower pain scores at IUD insertion (p < .001). Conclusion: Fear of IUD insertion pain, pre-procedure anxiety and negative perceptions of IUDs may lead women to anticipate or feel a higher level of pain. Patient education to correct negative perceptions of IUDs and counselling to inform women of the true benefits and risks of IUDs and lower pre-procedure anxiety are a suggested strategy to manage IUD insertion pain in parous women.

Ionising radiation exposure of 5–10 gray (Gy) to the pelvic area induces premature ovarian failure (POF). Twenty-four young adult Wistar albino female rats were were treated with subcutaneous capsaicin 0.5 mg/kg per day or placebo for 10 days then exposed to whole body irradiation. Rats were randomly divided into four groups: (1) control; (2) capsaicin; (3) radiation only (IR): rats were injected with placebo before exposure to a single dose of 8.3-Gy whole body irradiation; (4) radiation–capsaicin (IR + CAP): rats were injected with capsaicin prior to whole body irradiation. Radiation triggered oxidative stress, increased ovarian inflammation, increased follicular apoptosis and diminished ovarian follicle pool. Capsaicin significantly ameliorated oxidative stress by decreasing serum total oxidant status, oxidative stress index, disulphide, and malondialdehyde levels (P ≤ 0.001); ovarian inflammatory status by decreasing expressions of TNF-α, IL-1β, PARP-1 (P = 0.002); apoptosis by decreasing expressions of active caspase-3 and p53 (P = 0.015, P = 0.002); and follicle counts by increasing primordial follicles and decreasing apoptotic follicles (P ≤ 0.001) in rats when administered before radiation exposure. The beneficial effects of capsaicin are demonstrated for the first time on ionising radiation exposed rat ovaries. Capsaicin pre-treatment before radiotherapy restores the primordial follicle pool, inhibits atresia of ovarian follicles and may be an acceptable therapeutic modality to prevent radiation-induced POF.

Objective: Although the experience of pain is multidimentional, and general psychological factors such as anxiety are found to be associated with acute pain, it is necessary to investigate individual emotional variables such as emotional reactivity (ER). The aim of this study was to determine if increased ER is associated with pain during intrauterine device (IUD) insertion even without existing pre-procedure anxiety. Study Design: Prospective cohort study. Methods: We measured the anxiety level in 237 women using the Beck Anxiety Inventory and the ER level using the Emotional Reactivity Scale (ERS) at Zonguldak Maternity Hospital between November 2018 and March 2019. The women rated their pain during IUD insertion. To evaluate the role of ER in the prediction of pain during IUD insertion, we divided the women into subgroups based on the presence of anxiety and level of pain during IUD insertion. Results: ER was higher in women who had anxiety and moderate-severe pain (p = 0.001). In women who were not anxious, ER was higher in those who had moderate-severe anticipated pain or IUD insertion pain than in those who had mild anticipated pain or IUD insertion pain (p = 0.001). In anxious women, the ERS cut-off value was ˃ 34 for predicting the level of pain whereas in non-anxious women, it was ˃ 25. Conclusion: ER is a psychological factor strongly associated with pain at IUD insertion and the ERS appears to be a beneficial tool for detecting ER for this purpose. Health professionals should be aware that psychological factors could contribute to perceived pain more than physiological factors do. Implications: ER is a psychological factor associated with pain at IUD insertion and increased ER is a predictive factor for pain during IUD insertion even without existing pre-procedure anxiety. ERS seems to be a beneficial tool for detecting ER.

Objective: To investigate whether multiple thrombophilic mutations had a significant effect on uterine artery blood flow of nonpregnant recurrent pregnancy loss (RPL) patients. Materials and methods: Among 71 RPL patients, FV Leiden (FV), prothrombin G20210A (PTGM) and MTHFR mutations, deficiency of protein S, protein C and antithrombin III (AT3), association of Val34Leu polymorphism of the FXIII (FXIII), 4G/5G polymorphism of plasminogen activator inhibitor (PAI), −455-G/A polymorphism of β-fibrinogen (fibrinogen), and HPA-1 a/b L33P polymorphism of GPIIIa (GPIIIa) genes were investigated. Doppler flow measurements of RPL patients and healthy controls were performed at mid-luteal phase. Results: Twenty-two patients who had no thrombophilic gene mutations were grouped as unexplained RPL. Also, while 25 patients had multiple mutations, 24 patients had single mutation. In the multiple mutation RPL group, the most frequent mutations were PAI (22%), MTHFR C677T (20%), MTHFR A1298C (19%), and fibrinogen (11%). Only in the multiple mutation RPL group, mean PI and dominant PI values were significantly higher than the control group. Conclusions: Our data showed negative effects of multiple thrombophilic gene mutations on uterine artery blood flow and clarified the different effects of single and multiple thrombophilic factors on uterine artery vasculature. It is concluded that investigating more thrombophilic mutations could ameliorate prognostic factors of RPL and interactions to improve uterine artery blood flow could bring benefit to obstetric outcome.