Erhan Hüseyin Cömert

Objectives: To investigate how obstetricians’ and gynaecologists’ self-rated familiarity with pelvic venous disorders (PeVD), including pelvic congestion syndrome (PCS), and local interventional access relate to self-reported recognition, diagnostic choices, and management pathways in chronic pelvic pain (CPP) care. Methods: We conducted an anonymous web-based survey of obstetricians and gynaecologists involved in CPP care in Türkiye between January 2026 and February 2026. Outcomes were frequency of considering PCS/PeVD, self-reported annual PCS diagnoses, first-choice imaging, clinical approach, and treatment knowledge. Ordinal proportional-odds and multinomial logistic regression models adjusted for age, gender, years in practice, institution type, and monthly CPP volume; interventional radiology/embolisation availability was added where clinically relevant. The invitation denominator could not be reliably enumerated, so no response rate was calculated. Results: Among 528 respondents, 79.8% considered PCS/PeVD at least sometimes and 20.3% considered it very rarely. In the past year, 25.2% reported no PCS diagnoses, 58.9% reported 1–5, 12.5% reported 6–10, and 3.4% reported >10. Transvaginal Doppler ultrasound was the most common first-choice imaging modality (78.4%). Limited self-rated familiarity was associated with lower odds of more frequent consideration (aOR 0.25, 95% CI 0.17–0.37), whereas university-hospital setting was associated with higher consideration frequency (aOR 2.94, 95% CI 1.29–6.69). On-site embolisation availability was associated with a lower relative risk of choosing no PCS-specific treatment versus conservative management (RRR 0.23, 95% CI 0.06–0.84). Limited familiarity was also associated with lower treatment knowledge (aOR 0.42, 95% CI 0.29–0.61). Conclusions: Self-rated familiarity and local interventional access were associated with self-reported PCS/PeVD recognition and management choices. These exploratory associations should be interpreted cautiously because key exposure and outcome measures were subjective and partly overlapping. PeVD-oriented education, ultrasound training, and clearer multidisciplinary referral routes warrant prospective evaluation.

Objective: To examine whether clinicians’ awareness of a recent US Food and Drug Administration (FDA) regulatory communication on menopausal hormone therapy (MHT) was associated with reported changes in clinical practice, counseling priorities, and treatment choices in standardized clinical vignettes. Methods: This cross-sectional, web-based survey included 600 practicing obstetricians and gynecologists providing menopause or perimenopause care. A composite Regulatory Awareness Score was created from survey items addressing recognition of the regulatory action, perceived relevance, understanding of its rationale, and appraisal of its correctness and timeliness. The primary outcome was self-reported change in routine clinical approach after the regulatory communication. Multivariable logistic regression was used to examine the association between awareness and reported practice change. Ranked counseling factors were compared across awareness tertiles, and vignette choices were examined using multinomial logistic regression. Results: Regulatory awareness was not independently associated with reporting a change in clinical practice (adjusted odds ratio [aOR]: 0.89; 95% CI: 0.69-1.14; P =0.345). Higher odds of reported change were associated with use of a standard hormone therapy protocol (aOR: 1.50; 95% CI: 1.05-2.14; P =0.024), more favorable perceptions of compounded bioidentical hormone therapy (BHT) (aOR: 1.85; 95% CI: 1.35-2.54; P P =0.004), and higher menopause patient volume (aOR: 1.01; 95% CI: 1.00-1.01; P =0.042). Across awareness tertiles, counseling priorities were broadly similar, with only modest differences for symptom severity. In vignette analyses, higher awareness was associated with lower relative selection of compounded BHT in a context-dependent manner. Conclusion: Regulatory awareness alone did not explain self-reported change in menopausal hormone therapy practice after adjustment for clinician characteristics, protocol use, BHT perceptions, and counseling priorities. BHT perceptions, use of a standard protocol, and patient-preference prioritization showed stronger associations with reported change, whereas awareness was more clearly reflected in vignette-based treatment choices than in global self-reported practice change.

High altitude is associated with reduced barometric pressure and lower oxygen availability, which may impair fetoplacental oxygen transfer and adversely affect fetal growth and neonatal adaptation. This study compared birth weight, maternal oxygenation parameters, and early neonatal outcomes between two centers located at 1800 m and 2500 m above sea level in Eastern Türkiye.In this comparative cross-sectional study, 540 mother–infant pairs were evaluated, including 270 deliveries from Ardahan (1800 m) and 270 from Göle (2500 m). Data were obtained from retrospectively reviewed hospitals from 2018 year. Maternal partial pressure of oxygen (PaO₂), oxygen saturation (SaO₂), hemoglobin, lactate, gestational age, mode of delivery, birth weight, small-for-gestational-age (SGA) status, and neonatal intensive care unit (NICU) admission were compared between centers. Continuous variables were analyzed using independent-sample t tests and analysis of variance, whereas categorical variables were compared using chi-square tests. Additional analyses included analysis of covariance, multivariable linear regression, logistic regression for SGA and NICU admission, interaction analysis, receiver operating characteristic analysis, and effect size estimation. Compared with the 1800 m group, pregnancies at 2500 m were associated with lower mean birth weight (2315 g vs 3396 g), lower maternal PaO₂ and SaO₂, and higher hemoglobin and lactate levels (all p

Purpose: This study aimed to explore transfer-level factors associated with clinical pregnancy after intracytoplasmic sperm injection (ICSI) using a deliberately lower-claim analytical strategy. Methods: This retrospective single-centre study screened 332 ICSI-linked records from 2020 to 2025 and analysed 300 embryo transfers from 300 couples. Eligibility criteria, complete-case handling, one-transfer-per-couple preparation, variable coding, logistic regression specification, bootstrap optimism correction, calibration assessment, and software details were documented to support reproducibility. The primary outcome was clinical pregnancy per embryo transfer, defined as an intrauterine gestational sac on transvaginal ultrasonography. Since only 37 events were available, the primary multivariable analysis was restricted to four prespecified candidate variables: female age, anti-Müllerian hormone (AMH), sperm source, and embryo-transfer stage. This restriction was driven primarily by statistical proportionality and the limited event count, rather than an assumption that the omitted variables were not clinically significant. The analysis was intended to examine exploratory associations that could frame cautious transfer-day counselling discussions once all four variables were known; however, it was not designed as a clinical decision support mechanism. Exploratory baseline comparisons, a univariable logistic regression analysis, a four-variable multivariable association analysis, bootstrap-corrected discrimination, descriptive calibration assessment, and a fuller eight-variable sensitivity analysis were used. Results: Clinical pregnancy occurred in 37 of 300 transfers (12.3%). In the simplified multivariable analysis, older maternal age was associated with lower odds of clinical pregnancy (adjusted odds ratio [aOR] 0.91 per year, 95% confidence interval [CI] 0.83–0.99; p = 0.032), whereas higher AMH was associated with higher odds (aOR 2.02 per unit, 95% CI 1.39–2.94; p < 0.001). A more invasive sperm-source category was associated with lower odds (aOR 0.39, 95% CI 0.17–0.92; p = 0.032), and blastocyst transfer was associated with higher odds than cleavage-stage transfer (aOR 3.90, 95% CI 1.29–11.74; p = 0.016). The apparent area under the curve was 0.779, and the bootstrap-corrected area under the curve was 0.750. Conclusion: In this dataset, female age, AMH, sperm source, and transfer stage showed the clearest exploratory associations with clinical pregnancy per embryo transfer. Since the event count was limited and calibration, coefficient stability, and transportability remain uncertain, the findings should be interpreted as hypothesis-generating. They may support cautious transfer-day counselling discussions but are not sufficient for routine predictive implementation without larger external validation studies.

Impact of cervical preservation on vaginal length and female sexual function after hysterectomy for benign conditions: a retrospective cohort study - Journal of the Turkish-German Gynecological Association

To evaluate the short- and long-term clinical outcomes of fractional CO₂ laser therapy in postmenopausal women with genitourinary syndrome of menopause (GSM), including durability of symptom control and the need for booster sessions. This retrospective single-center study included 126 postmenopausal women with GSM who underwent a standardized three-session fractional CO₂ laser protocol. Booster sessions were applied in cases of symptom recurrence. Outcomes were assessed at baseline, 4-6 weeks, 1 year, and 2 years using validated instruments: Patient Satisfaction Score, Michigan Incontinence Severity Index (MISI), Female Sexual Function Index (FSFI) and its subdomains, Vulvovaginal Symptoms Questionnaire (VSQ), and Female Genital Self-Image Scale (FGSIS). Significant improvement was observed in all outcome measures at 4-6 weeks, including GSM-related symptoms, sexual function, and genital self-image (all p < 0.0001). These benefits were largely sustained at 1 year. Although a slight decline was noted at 2 years, scores remained significantly improved compared to baseline. For example, FSFI lubrication scores improved from 2.97 ± 0.55 at baseline to 4.54 ± 0.49 at 1 year, and both VSQ and FGSIS demonstrated persistent gains at 2 years. Satisfaction scores continued to increase over time. Post hoc analyses confirmed significant differences across all evaluation time points. Fractional CO₂ laser therapy provides clinically meaningful and durable improvement in GSM-related symptoms in postmenopausal women. While some decline may occur over time, benefits remain superior to baseline, and booster sessions may support long-term maintenance. Fractional CO₂ laser may represent a nonhormonal, symptom-oriented option for carefully selected patients with GSM; however, it should not be considered first-line therapy, and prospective controlled studies are needed to further define long-term efficacy and patient selection.

Objective: To assess women’s awareness, use, and preferences regarding family planning (FP) methods in a remote rural province of northeastern Turkey and to examine how education, parity, and contraceptive knowledge shape contraceptive behavior.Methods: In this descriptive cross-sectional study, 822 sexually active women aged 15–65 years attending Ardahan State Hospital between January 2019 and December 2020 completed a structured questionnaire on sociodemographic characteristics, reproductive history, awareness and use of contraceptive methods, reasons for non-use, and sources of information. Knowledge of ten modern methods was operationalized as recognition of each method and scored from 0 to 10. Descriptive statistics, chi-square tests, one-way ANOVA, and multivariable regression (binary logistic for current contraceptive use; linear for knowledge score) were applied.Results: The mean age was 30.9 ± 8.4 years. Awareness of modern methods was high (77.1% for intrauterine devices and 63.6% for both oral pills and condoms), yet only 41.1% reported current use of any contraceptive method, including withdrawal. Among users, the intrauterine device (52.7%) and withdrawal (21.3%) were the most common methods. In multivariable analysis, higher education (adjusted OR = 1.28, p = 0.003), greater parity (adjusted OR = 1.87, p < 0.001), and higher contraceptive-knowledge score (adjusted OR = 1.35, p = 0.001) were independently associated with current contraceptive use, whereas age and income were not significant predictors.Conclusion: In this rural setting, modern contraceptive methods were widely known; however, uptake of modern methods remained limited and withdrawal remained common. Although pregnancy intention accounted for a substantial share of non-use, strengthening female education and embedding midwife- and physician-led FP counselling into routine primary care may help close the gap between awareness and effective contraceptive practice in rural Turkey and comparable middle-income country contexts.

Background/Objectives: Round spermatid injection (ROSI) is considered an experimental “last resort” option for couples with severe male factor infertility when mature spermatozoa cannot be obtained. We aimed to identify which stage of the clinical chain most strongly constrains overall success in routine practice and to describe the observed safety signal. Methods: We conducted a retrospective single-center cohort study of 221 consecutive ROSI-evaluated cycles (2021–2024). Outcomes were analyzed using a chain-of-outcome framework with explicit denominators: cycle-level feasibility (≥1 injected oocyte), two pronuclei (2PN) formation per injected oocyte, blastocyst development per 2PN, transfer per blastocyst cycle, and clinical pregnancy per transfer and per initiated cycle. Exact (Clopper–Pearson) 95% confidence intervals (CIs) were reported. Results: ROSI feasibility was observed in 5 of 221 initiated cycles (2.3%; exact 95% CI 0.7–5.2). Among the five transfer procedures performed after successful progression through upstream stages, clinical pregnancy occurred in four (80.0%; exact 95% CI 28.4–99.5). At the initiated-cycle level, overall clinical pregnancy was 4 of 221 cycles (1.8%; exact 95% CI 0.5–4.6). Conclusions: The overall effectiveness of ROSI remained low at the initiated-cycle level because very few cycles reached procedural feasibility and early attrition remained substantial. Conditional downstream outcomes may appear favorable only among the rare cycles reaching fertilization and transfer, while safety inference remains highly imprecise due to small denominators. Because only five cycles reached feasibility, all downstream conditional estimates remained highly unstable and sensitive to single-case variation.

Objective:The aim of this study was to investigate the effectiveness of fetal right heart doppler findings in determining pulmonary maturity. Method:The study focused on women with late preterm and term pregnancies. The main measurements included the doppler findings of the main pulmonary arter and the right pulmonary artery, as well as the E/A wave ratio of the mitral valve, which represents the ratio of peak blood flow velocity during left ventricular relaxation in early diastole to peak velocity during late diastole caused by atrial contraction, and the lamellar body count. Result:We observed a significantly higher mean number of lamellar body count in the control group (84.70± 42.77) compared to the study group (41.21±34.81).Additionally, we noticed that the systolic-diastolic ratio (S/D) of the MPA and RPA was significantly higher in the preterm group (7.8±1.9, 7.4 ± 1.2) compared to the term group (6.7±1.3,6.1±1.6).However, we did not find any significant difference in the pulsatile index and resistance indices of RPA and MPA, as well as the acceleration/ejection time ratio. Conclusion:We observed that the systolic-diastolic ratio of the main pulmonary artery and right pulmonary artery was significantly higher in preterm cases (study group). Fetal lung maturity can be non-invasively assessed using Doppler ultrasonography.

Introduction and Hypothesis To evaluate the long-term effectiveness of fractional CO₂ laser in the treatment of stress urinary incontinence (SUI), the permanence of symptom control, and additional session requirements over a 2-year follow-up period. Methods This retrospective cohort study included 215 women with clinically diagnosed SUI who underwent a standardized course of fractional CO₂ laser therapy. Assessments were conducted at baseline, 4–6 weeks, 1 year, and 2 years. Primary outcome measures included patient-reported satisfaction and Michigan Incontinence Symptom Index (MISI) scores. Secondary outcomes were changes in sexual function determined using the Female Sexual Function Index (FSFI), vaginal symptom severity using the Vaginal Symptom Questionnaire (VSQ), and genital self-image using the Female Genital Self-Image Scale (FGSIS). Data distribution was evaluated using the Shapiro–Wilk test. Repeated measures were analyzed using Friedman or repeated-measures ANOVA, followed by the Dunn or Newman–Keuls post hoc tests. Statistical significance was set at p < 0.05. Results Significant improvement was observed throughout follow-up in all primary and secondary outcomes (p = 0.0001). Satisfaction scores increased significantly at 4–6 weeks compared to baseline and still exhibited a high level at 1 year. Although a partial decrease occurred in the second year, values still remained significantly above baseline (from median 2 to 4; p = 0.0001). MISI decreased from 19.51 ± 4.41 at baseline to 1.96 ± 1.38 at 4–6 weeks. Although values rose to 6.31 ± 4.01 in the second year, significant improvement compared to baseline was maintained (p = 0.0001). Significant improvement was observed in all FSFI subdomains (including desire, arousal, lubrication, orgasm, satisfaction, pain, and total score) in the early period (p = 0.0001), and despite a slight decrease in the second year, the gains were largely maintained. Similar marked improvements were also observed in VSQ and FGSIS scores, with no return to baseline values despite a partial decline in the second year (p = 0.0001). Supportive additional session requirements were determined in association with subjective worsening in symptoms in the second year in approximately 20% of the participants. Conclusions Fractional CO₂ laser therapy produces significant and clinically important improvement in SUI symptoms, sexual function, vaginal symptoms, sexual function, vaginal comfort, and genital self-image. All effects peak at 4–6 weeks, are largely preserved at 1 year, and despite a partial decline in the second year, remain markedly superior to baseline. These findings show that fractional CO₂ laser is an effective, minimally invasive, nonsurgical option in the management of SUI.