Selma Oransay, MD

Dr. ORANSAY is 35 years experienced clinician in OB/ GYN. She worked in the main national maternity educational hospital of Turkey for 20 years than she moved to İstanbul and worked in private hospitals. Her published articles are mostly on topics of menopause and infertility. She is also experienced as a voluntary OB/GYN doctor in African healthcare program.

The need for fertility preservation in women with endometriosis

A variety of pathologies such as adhesions, inflammation, modified pelvic anatomy, and altered ovarian reserve are among the causes of infertility in women with endometriosis. Additionally, these patients experience suboptimal outcomes characterized by reduced pregnancy rates when they undergo assisted reproductive techniques. The molecular level involving dysregulation of steroids, oxidative stress, and angiogenesis within the follicular environment should be responsible for the cause of infertility in this disease. Moreover, removing ovarian endometriomas worsens the ovarian reserve and AMH levels. If the…

Key Points Lay Summary

Any link between endometriosis and neonatal uterine bleeding?

A Medline search using the keywords " neonatal uterine bleeding," " pathophysiology," and "premenarche" was made by Dr. Habiba et al. from the Department of Health Sciences, University of Leicester, Leicester, UK. A total of 2264 articles were collected, and the final twenty-one, after the exclusion criteria were used to compose the text recently published in Biomolecules. The authors aimed to focus on the evidence favoring and against the neonatal origin of perimenarchial endometriosis, they discussed the research in the…

Key Points Lay Summary

A concerning link between endometriosis and cardiovascular disease.

Endometriosis is a disease characterized by endometrial-like tissues outside the uterus, which causes inflammation, scarring, and adhesion formation. The pathologic process of forming those adhesions releases proinflammatory molecules, cytokines, and growth factors that may have systemic effects. Recent research, for example, mentioned an increased risk of atherosclerotic diseases in women with endometriosis. Unfortunately, early diagnosis and effective treatment of endometriosis remain limited in current practice. Under the leadership of Dr. Olivier Morel from the Division of Cardiovascular Medicine, Strasbourg University…

Key Points Lay Summary

Uterine innervation and its impact on endometriosis related pelvic pain.

Advancements in immunochemistry, fluorochromes, computer-associated anatomical dissection, and 3D reconstruction of uterine micro-innervation brought substantial progress in pelvic neuroanatomy. The complex uterine innervation and its interactions with uterine parts and layers are yet fully revealed. Austruc et al.,  from the Faculty of Medicine of Rennes University, France, reviewed the literature on the complexity of uterine innervation to deepen our understanding of female pelvic pain. The authors' final aim was to uncover valuable insights for enhancing pelvic nerve-sparing techniques in endometriosis…

Key Points Lay Summary

Key Aspects of Ureterolysis in deep endometriosis surgery

Deep endometriosis surgery needs talented surgeons to preserve and protect vital structures during the excision of endometriotic lesions. The technique for ureterolysis is essential to mitigate the risk of ureteral injuries and improve patient outcomes. Dr. Chatroux and Dr. Einarsson from the Department of Obstetrics and Gynecology of Harvard Medical School, Boston, USA, summarized the ureteral anatomy, identification, and optimal surgical practice of ureterolysis; and clarified the knowledge gaps about endometriosis surgery involving the ureter. After anatomical description and describing…

Key Points Lay Summary

The location of adenomyosis, and recurrent abortion

ESHRE defines repeated pregnancy loss (RPL) as the loss of pregnancies with two or more weeks of gestation. Adenomyosis is the presence of ectopic endometrium, in the myometrium. High-resolution transvaginal ultrasound and sonographic criteria can help to diagnose the disease clinically. However, no consensus has been reached on the classification of adenomyosis. The most likely reason why adenomyosis causes pregnancy complications is its location in the sub-endometrial layer of the myometrium. This affects the uterine functions, especially uterine peristalsis, which…

Key Points Lay Summary

Ultrasonographic findings and the clinical symptoms of pelvic endometriosis

Imaging techniques achieve the clinical diagnosis of endometriosis, which affects 10-15% of all women of reproductive age. Suspected patients with clinical history and symptoms need a systemic examination of the uterus, ovaries, adnexa, and peritoneal covering the rectouterine, retrocervical, and sigmoid regions. The efficacy of ultrasonographic examination has been shown in many studies. Transrectal and transvaginal ultrasonography are helpful and reliable tools for diagnosing endometriosis and mapping the nodules before laparoscopic surgery. Mostafavi et al., from the Department of Radiology…

Key Points Lay Summary

Visual representation of endometriosis pain

Endometriosis is accompanied by severe chronic pelvic pain that impacts quality of life, relationships, and work conditions. Studies aiming to improve pain are frequently encountered in the literature. Nonetheless, pain research is complex due to its subjective nature, and cannot be visualized. Various studies have focused on language tools such as metaphorical language to externalize the painful experience of women with endometriosis.  Visual representation of pain means externalizing painful experiences not only captured by verbal accounts but also by color,…

Key Points Lay Summary

Women's willingness to donate menstrual blood for endometriosis research

The menstrual blood is 50-100 ml/per cycle, with 80% lost during the first three days. On the heaviest bleeding day, 2 to 8 ml may be collected from a cup worn for four hours. This fluid could be investigated by collecting viable immune and endometrial cells. The menstrual immune cells are similar to the circular immune cells in peripheral blood, with fewer T lymphocytes and more natural killer cells. The delay in diagnosing endometriosis is estimated to be 8 years.…

Key Points Lay Summary

Postoperative pain-related quality of life for patiens with different types of endometriosis surgery.

Endometriosis surgery usually improves chronic pelvic pain and the quality of life in women suffering from that disease. Response to surgery depends on several factors, however, in younger ages, recurrence of both pain and endometriosis lesions are reported. Most research on the outcomes of surgeries was conducted in retrospective studies. There is a lack of prospective study design to evaluate the surgical outcomes in the literature. Lee et al. from the Department of Obstetrics and Gynecology of British Columbia Women's…

Key Points Lay Summary

Current practice in robotic surgery for deep-infiltrating endometriosis

Today, surgical excision of endometriotic lesions is the only cytoreductive procedure for managing endometriosis. Hormonal treatment may partly relieve the symptoms, but it suppresses rather than cytoreduction of the disease. Minimally invasive surgery is usually the most preferred method due to reduced blood loss, postoperative pain, and hospitalization. Laparoscopic surgery is recommended in advanced and complex cases but sometimes may result in tissue alterations provoked by adhesions. Compared to 3D robotic surgery, laparoscopic surgery may have some technical limitations such…

Key Points Lay Summary

Early use of hormonal contraceptives and the probability of endometriosis diagnosis later in life

Hormonal contraceptives are the first-line medical treatment of endometriosis. If an adolescent has chronic pelvic pain and is an "unresponder" to hormonal therapy, the likelihood of having an "endometriosis diagnosis" is higher. This sign should warn clinicians about endometriosis diagnosis to refer the adolescent to a tertiary endometriosis clinic.  Obern et al., from the Department of Children's Health, Uppsala University, Sweden, aimed to evaluate whether the early need for hormonal contraceptives could be a warning sign for endometriosis in adolescents.…

Key Points Lay Summary

Early diagnosis of deep infiltrating endometriosis in adolescence

Dysmenorrhea is widely observed in adolescence, and endometriosis is one of its causes. However, endometriosis diagnosis is usually made after 25 years of age. It is clear that early diagnosis and management of this progressive disease is essential and will have a good impact both on the quality of life and fertility. Moreover, patients who undergo surgery in advanced stages of the disease have more intra and postoperative complications. Martire et al. from the Gynecology Unit of the Department of…

Key Points Lay Summary

Cervical angle, retroflex uterus and abnormal placental position in women with endometriosis

Pregnancy complications such as miscarriage, preterm delivery, placenta previa, small for gestational age, and early abruption of the amniotic sac are more common in the pregnancies of endometriotic women. These complications could arise due to the inflammatory and adhesive characteristics of endometriosis disease resulting in retroflection. Dr. Higeta et al. from the Department of Obstetrics and Gynecology of Gunma University Graduate School of Medicine, Japan, aimed to evaluate the effect of endometriosis on perinatal complications by comparing pregnancies with and…

Key Points Lay Summary

Fertility outcomes after discoid excision for colorectal endometriosis.

Colorectal endometriosis is one of the most severe forms of deep endometriosis, composing 85% of all bowel lesions. Radical treatment is segmental resection of the bowels, which can cause postoperative severe complications such as rectovaginal fistula and voiding dysfunctions that negatively affect the quality of life. Surgeons are used to perform rectal shaving and discoid resection approaches besides this radical technique. Rectal shaving is usually indicated in serosal or superficial muscular involvement of endometriosis, with a higher risk of recurrence as…

Key Points Lay Summary

Management of uterine adenomyomas with percutaneous cryoablation.

Adenomyosis can negatively affect the quality of life by causing abnormal bleeding, pelvic pain, dysmenorrhea, and dyspareunia. It is often associated with endometriomas and/or leiomyomas. Treatment of the disease differs as conservative or radical, as well as pharmacological or surgical. For women with adenomyosis who want to preserve their uterus and fertility, adenomyomectomy is a challenging procedure due to excessive bleeding and a remaining uterine scar afterward. Ablation of adenomyomas using high-intensity focused US waves, microwaves, and radiofrequency has been performed…

Key Points Lay Summary

Spontaneous Conception After Deep Endometriosis Surgery

Deep endometriosis is a severe form of endometriosis where lesions invade deeper than 5 mm into subperitoneal space. Surgical management of the disease is a challenging task requiring a multi-disciplinary approach and significant expertise in the field. Anastomotic leaks, fistula, and pelvic abscesses are reported in around 5% of colorectal surgeries, even in expert clinics. Management of infertile women, particularly asymptomatic ones who are diagnosed with deep endometriosis, is open to debate between ART application or surgical approach. When the…

Key Points Lay Summary

Neonatal uterine bleeding at birth and endometriosis later in life

In the first few days after birth, some female newborns bleed from the vaginal route, and this is called newborn uterine bleeding. The overt and occult neonatal uterine bleeding prevalence rates are 3-5% and 25-60% retrospectively. The causative risk factors for this condition have been studied previously. The physiopathologic mechanism is similar to the adult endometrium, which is affected by circulating progesterone levels. Maternal progesterone levels caused decidual changes in developing fetal endometrium, and due to a rapid fall in progesterone…

Key Points Lay Summary

Bladder Function Alterations Following Endometriosis Surgery

Although endometriosis is a common gynecologic disorder, urinary tract involvement is present in only 1-5% of these patients. When endometriosis invades the urinary tract, clinical symptoms may vary from asymptomatic to frequency, urgency, bladder pain, hematuria, and recurrent urinary infections. These complaints lower the quality of life. Surgical management of endometriosis may cause short or long-term urinary dysfunctions as well. These urinary symptoms are not life-threatening but may affect the quality of life. To conduct a study for statistically comparing…

Key Points Lay Summary

Pregnancy outcomes of women with endometriosis/adenomyosis.

Endometriosis and adenomyosis are diseases presented by ectopic growth of endometrial-gland-like tissues, which we can find in ovaries, pelvic organs, and myometrium. These diseases are causes of hypermenorrhea, dysmenorrhea, chronic pelvic pain, and infertility. Although the number of reports about adenomyosis is less than endometriosis, increased perinatal mortality, small for gestational age, and stillbirths have been reported in those cases. Assisted reproductive technic applications and age are other factors that develop unwanted pregnancy outcomes. This study aimed to be the…

Key Points Lay Summary