Objective: Endometriosis may negatively affect the ovarian reserve, and also endometriosis surgery may cause further damage to the ovarian reserve. There is lack of definite data for the effect of endometriomas and treatments on the ovarian reserve over time. This study aims to determine the effects of endometrioma and its treatment modalities on ovarian reserve. Design: Prospective cohort study Setting: Turkey tertiary hospital Population: Eighty women with endometrioma diagnosed by ultrasonography and 20 healthy age-matched women as the control group were enrolled in this prospective study. Patients in the study group were divided into four subgroups (20 patients for each group). Methods: Treatment modalities for each study group were expectant management, oral contraceptive (OCP), dienogest, and surgery. All patients were evaluated with ultrasonography, and blood samples were taken during recruitment for anti-mullerian hormone (AMH) values. Additional assessments were done six months after the first assessment. Main Outcome Measures: Prospectively compare the rates of change over time in AMH levels, a reliable ovarian reserve marker, between patients with endometriomas left intact and healthy controls, as well as between patients treated with OCP or dienogest and those who underwent surgical excision due to pain symptoms Results: The median rate of decline in serum AMH levels were 19% in the expectant management group, 26% in the OCP, 21% in the dienogest, 38% in the surgery, and 8% in the healthies. Thus, the rate showed a significant difference between the OCP therapy and healthy control groups (p=0.034) and the surgery and healthy control groups (p=0.001). Multivariate logistic regression analysis suggested that only age was correlated with the rate of decline. Conclusion: Our study is the first in the literature to report on the impact of different endometrioma treatment modalities on ovarian reserve. Our results indicate that surgical intervention is the most harmful treatment while others result in a slight decrease in ovarian reserve. Trial Registration Number: Clinical Trials, NCT03620838

Objective: To determine the frequency of uterine abnormalities in PCOS patients compared to normo-ovulatory patients and their relationship to androgen levels. Design: Retrospective cohort study. Setting: Tertiary University Hospital Population: Total of 103 women, 51 PCOS, and 52 male factor infertility Interventions: HSG images of all patients were numbered and evaluated by ten senior reproductive endocrinologists blinded to the research and chose the most appropriate figure for each patient’s HSG image and marked the shape of cavity according to the ASRM and ESGE/ESHRE classification. Main outcome measures: Abnormal HSG Rates, serum AMH and androgen levels Results: The percentage of the normal uterine cavity was significantly lower in the PCOS group than control group as 51 % and 66.7 %, 77 % and 94.2 % according to the ASRM and ESHRE/ESGE classifications, respectively. The frequency of Partial Septate Uterus (ESHRE-ESGE U2a / ASRM Va, 21.6% vs 5.8 % p<0.05), Complete Septate Uterus (ESHRE-ESGE U2b / ASRM Vb, 7.8% vs 0% p<0.01) and Dysmorphic Uterus (ESHRE-ESGE U1c) / ASRM VII) 3.9 % vs 0 p<0.05) were significantly higher in PCOS patients than controls. The frequency of arcuate uterus classified as VI in ASRM and considered normal in ESHRE/ESGE was 16 % and 17.3 % in PCOS and control groups, respectively, without statistically significant difference. The increased frequency of intrauterine cavity abnormalities was correlated with serum-free testosterone levels. Conclusion: This study provides that the frequency of uterine cavity abnormality is clearly higher in PCOS patients compared to the healthy population.

Objective: To determine the sexual outcomes and motherhood plans of the Mayer Rokitansky Küster Hauser (MRKH) Syndrome patients operated with Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty operation Design: Cohort Study Setting: Tertiary University Hospital Patients: Women with MRKH syndrome Methods: This study involves the patients with MRKH syndrome who underwent Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Operation between the years 2008-2020. The first step of the study is about our surgical technique outcomes. The second step consists of long-term results for sexual functioning which was assessed by female sexual function index (FSFI) survey and motherhood plans by another survey. Main Outcome Measure: FSFI and Motherhood Survey Results Results Total 42 patients with MRKH syndrome underwent vaginoplasty operation. At least one year after surgery all patients was physically examined. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (min:24-max:36) Thirty-six of the patients answered a survey about motherhood. Thirty-one of the patients (86%) had a desire for motherhood. Most of the patients (21/31 – 68%) choose uterine transplantation as a first option. Three of the patients (9.6%) choose mater option and seven patients (22.5%) wants to be a mother by adoption. Conclusion: Uncu Modified Remnant-Supported Laparoscopic Double-Layer Peritoneal Pull-Down Vaginoplasty Operation is a satisfactory option for patients with MRKH syndrome with high FSFI scores and low complication rates. But creating only a neovagina is not enough for these patients, because of nearly 70% motherhood desire by uterine transplantation.

Objective: To determine the incidence of uterine abnormalities in patients with PCOS Design: Retrospective Cohort Study Setting: Tertiary University Hospital Population: Infertile patients with PCOS vs. male factor infertility were selected from the IVF center electronic database from between the years 2011-2019. Methods: A total of 103 patients, 51 PCOS, and 52 male factor infertility were enrolled in the study. Hysterosalpingography (HSG) images of all patients were numbered. For the study, six different shapes of the intrauterine cavity were figured. All HSG images were evaluated by ten senior reproductive endocrinologists and surgeons. Seniors were blinded to the research and chose the most appropriate figure for each patient’s HSG image. Results and Demographic parameters were compared between PCOS and Male Factor Groups. Anti-Mullerian hormone correlation with Uterine abnormality was further analyzed. Main Outcome Measure: Percentage of the abnormal uterine cavity Results: The percentage of the normal uterine cavity was significantly lower in the PCOS group. (45.9 % and 73.1 %, p<0.01) The abnormal cavities were compared; Arcuate Uterus (22.18% vs 6.6% p<0.05), Partial Septate Uterus (5.1% vs 0% p<0.05), Complete Septate Uterus (5.47% vs 1.2% p<0.01) and Y-Shaped Uterus (7.47% vs 0 p<0.05) were significantly higher in PCOS patients. T-Shaped Uterus (13.8% vs. 18.9%) was statically similar. There was no correlation between serum AMH levels and the presence of uterine abnormality. Conclusion: This study provides that, compared to the healthy population, the uterine abnormality frequency is clearly higher Key Words: Polycystic Ovary Syndrome, Uterine Abnormality, Anti-Mullerian Hormone

Objective: To elucidate the prognostic factor for IVF&ICSI cycle cancellation in patients with endometriosis related infertility Design & Setting The study was a retrospective cohort study and conducted at Uludag University School of Medicine, ART center, between the years 2011-2017. Population Electronic database were screened and infertile patients with endometriosis, patients without male factor, systemic disease, undefined adnexal mass and aged <40 yrs were selected. Cycles were divided in two groups. (Cancelled vs. Embryo transferred) Results 44 cycles were cancelled and in 178 cycles embryo was able to transferred. When the groups were compared Age, day3 FSH were statically higher and AMH, AFC were statically lower in cycle cancelled (CC) group. Presence of adenomyosis was higher in CC group. (64% vs. 40% p<0.01) Surgery rate with laparotomy was higher in CC group. (54.5% vs. 13.5% p<0.01) AFC (OR:0.81, CI:0.70:0.93) remained as only independent factor associated with prognoses of IVF cycle with binary logistic regression analysis. Cancellation rates were similar between the phenotypes of endometriosis. Conclusions: Poor ovarian reserve, advanced age, presence of adenomyosis and the history of laparotomy are negative prognostic factors associated with IVF&ICSI cycle cancellation in endometriosis related infertility. AFC is the only independent factor to predict cycle cancellation. Phenotype of endometriosis does not affect the results. There is no funding in this study. Key Words: Endometriosis, Infertility, Adenomyosis, Intracytoplasmic Sperm Injections,