Sertaç Ayçiçek

Background: Sexual function is an important patient-reported outcome after hysterectomy but remains underreported in direct comparisons of scar-minimizing surgical approaches. This study compared short-term sexual function, perioperative outcomes, and postoperative pain between transumbilical single-port laparoscopic hysterectomy and vaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynecologic indications. Methods: This retrospective cohort study included 90 consecutive eligible patients treated between January 2023 and January 2025: 49 underwent transumbilical single-port laparoscopic hysterectomy and 41 underwent vNOTES hysterectomy. Surgical route was selected according to patient preference after preoperative counseling. The primary outcome was the change in total Female Sexual Function Index (FSFI) score from baseline to 3 months postoperatively ( Δ FSFI). Secondary outcomes included postoperative pain, additional analgesic requirement, operative time, length of hospital stay, hematocrit change, and intraoperative complications. An adjusted analysis of postoperative FSFI accounted for baseline FSFI, age, BMI, and menopausal status. Results: Baseline age, BMI, parity, menopausal status, previous cesarean delivery, and uterine weight were comparable between groups. Median operative time was shorter with vNOTES than with single-port laparoscopy [58 (IQR, 55–65) vs. 79 (IQR, 75–87) min; p < 0.001], as was hospital stay [2 (IQR, 1–2) vs. 3 (IQR, 3–3) days; p < 0.001]. VAS scores were lower after vNOTES at 24 and 48 h (both p < 0.001), and additional analgesia was required less frequently (19.5% vs. 36.7%; p = 0.048). Preoperative and 3-month FSFI total scores were comparable between groups. FSFI decreased modestly within both groups at 3 months, but Δ FSFI did not differ between single-port and vNOTES groups (−2.17 ± 0.63 vs. −2.03 ± 0.54; p = 0.297). Surgical approach was not independently associated with postoperative FSFI after adjustment ( β =0.156; 95% CI, −0.090 to 0.402; p = 0.214). Intraoperative complication rates did not differ significantly (6.1% vs. 0%; p = 0.248). Conclusions: vNOTES hysterectomy was associated with shorter operative time, shorter hospital stay, lower postoperative pain, and less frequent additional analgesic requirement than transumbilical single-port laparoscopy, while short-term sexual-function outcomes were comparable between techniques. These findings support vNOTES as a feasible scar-minimizing alternative for appropriately selected patients undergoing hysterectomy for benign gynecologic disease.

Background: The aim of this study was to investigate the impact of intraovarian platelet-rich plasma (PRP) treatment on ovarian reserve markers, hormonal profiles, oocyte yield, fertilization potential, and pregnancy outcomes in infertile women with diminished ovarian reserve. Methods: This retrospective single-center study was conducted at a tertiary referral center between January 2021 and December 2024 in the Department of Obstetrics and Gynecology, IVF Clinic, Private Diyarlife Hospital, Diyarbakır, Turkey. A total of 78 infertile women with diminished ovarian reserve (DOR) were included. DOR was defined in the present study as an AMH level < 1.1 ng/mL and/or an antral follicle count (AFC) < 5 follicles. Pre-PRP and post-PRP measurements were compared in the same patients. Hormonal and clinical parameters, including prolactin, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), estradiol, endometrial thickness, gonadotropin dosage, antral follicle count (AFC), mature metaphase II (MII) oocyte count, and two-pronuclear (2PN) zygote count, were evaluated before and after PRP treatment. Results: Significant increases were observed in AMH and prolactin levels, whereas FSH levels significantly decreased following PRP treatment (all p < 0.001). Post-PRP AFC, MII oocyte count, and 2PN zygote count were significantly higher than pre-PRP values (all p < 0.001). A total of 21 pregnancies (26.9%) were achieved, including 17 clinical pregnancies (81.0% of pregnancies; 21.8% of all patients), 4 biochemical pregnancies (19.0% of pregnancies; 5.1% of all patients), 11 miscarriages (52.4% of pregnancies; 14.1% of all patients), and 6 live births (28.6% of pregnancies; 7.7% of all patients). Significant positive correlations were identified between post-PRP AFC and MII oocyte count (r = 0.803, p < 0.001), post-PRP AFC and 2PN zygote count (r = 0.624, p < 0.001), and MII oocyte count and 2PN zygote count (r = 0.728, p < 0.001). Conclusions: Intraovarian PRP administration was associated with improvements in ovarian reserve markers, oocyte maturation, and fertilization-related outcomes in women with DOR. Significant increases in AFC, MII oocyte count, and 2PN zygote count were observed after PRP treatment. However, these improvements in ovarian reserve markers were not associated with significant differences between women who achieved pregnancy and those who did not. Because of the retrospective design and the absence of a control group, these findings should be interpreted as associations rather than evidence of a causal treatment effect. Although clinical pregnancies and live births were observed during follow-up, larger, multicenter randomized controlled trials are required to confirm these findings and to further evaluate the effect of PRP on reproductive outcomes.

Background: Psychological distress is common among women with unexplained infertility and may interact with neuroendocrine stress pathways. However, the relevance of single-time endocrine stress markers such as cortisol and dehydroepiandrosterone sulfate (DHEAS) in reflecting chronic emotional burden remains uncertain. Objective: To investigate the association between psychological distress and single-time endocrine stress markers in women with unexplained infertility and to compare psychometric assessment with synchronized hormonal measurements. Methods: In this prospective case–control study, consecutive women with primary unexplained infertility (n = 50) and age-matched fertile controls (n = 52) were enrolled from the same tertiary gynecology outpatient clinic. Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS). Clinically relevant psychological distress was defined as HADS-Anxiety ≥8 and/or HADS-Depression ≥8. Serum cortisol and DHEAS concentrations were measured under standardized morning fasting conditions during the early follicular phase. Multivariable logistic regression analysis was performed using a parsimonious adjusted model including age, body mass index, smoking status, residential environment, cortisol level, and HADS-defined psychological distress. Results: Women with unexplained infertility demonstrated significantly higher HADS-Anxiety and HADS-Depression scores compared with fertile controls (p < 0.05 for both comparisons). Based on predefined HADS subscale cut-off values (HADS-A ≥8 and/or HADS-D ≥8), HADS-defined psychological distress was significantly more prevalent in the unexplained infertility group (76.0% vs. 42.3%, p = 0.001). Although follicle-stimulating hormone and estradiol levels differed significantly between groups, all measured values remained within physiological reference ranges. No statistically significant between-group differences were observed for cortisol, dehydroepiandrosterone sulfate (DHEAS), or anti-Müllerian hormone levels. In the final parsimonious multivariable logistic regression model adjusted for age, body mass index, smoking status, residential environment, cortisol level, and HADS-defined psychological distress, psychological distress remained independently associated with unexplained infertility (adjusted OR 3.907, 95% CI 1.610–9.478, p = 0.003). Exploratory ROC analyses demonstrated limited discriminatory performance of isolated single-time cortisol and DHEAS measurements for identifying HADS-defined psychological distress. Conclusion: Psychological distress was more prevalent among women with unexplained infertility, whereas single-time serum endocrine stress markers were not significantly different between groups. These findings support the relevance of psychological assessment in women with unexplained infertility; however, the cross-sectional case–control design does not allow causal inference regarding the direction of this association.

To compare perioperative, anatomical, and functional outcomes of conventional multiport laparoscopic sacrohysteropexy and single-port laparoscopic lateral suspension in women undergoing uterine-preserving surgery for apical pelvic organ prolapse. A retrospective comparative cohort study was conducted in a tertiary referral center with 68 women with symptomatic apical pelvic organ prolapse who underwent uterine-preserving laparoscopic surgery between January 2023 and January 2025. Interventions used included conventional multiport laparoscopic sacrohysteropexy (n = 32) or single-port laparoscopic lateral suspension (n = 36). Both techniques resulted in significant improvement in apical support, with comparable changes in POP-Q point C at 12 months. The single-port lateral suspension group demonstrated significantly shorter apical operative time and reduced hospital stay. Functional outcomes improved significantly in both groups, as reflected by reductions in PFDI-20 scores and increases in FSFI scores. Recurrence rates were low and comparable between groups. However, baseline differences between groups and the non-randomized study design should be considered when interpreting these findings. Single-port laparoscopic lateral suspension may represent a feasible minimally invasive alternative to conventional multiport sacrohysteropexy, demonstrating comparable short-term anatomical and functional outcomes with potential perioperative advantages. Further prospective studies are required to confirm these findings.