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 added value of transvaginal hydro-laparoscopy for infertile women

The added value of invasive diagnostic laparoscopy has been questioned, postponed by the increased usage of ultrasonography for the evaluation of infertile patients. Gordts et al. from Life Expert Center, Leuven, Belgium have been working on an alternative way called "transvaginal hydro-laparoscopy" to evaluate the pelvic organs and adhesions of infertile women since the late '90s. The procedure should be performed by expert gynecologists in an outpatient clinic while the patient is in lithotomy position under conscious sedation. Access is gained by a reusable,…

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The incidence and prevalence of endometriosis in a United States population-based study .

To define the accurate incidence and prevalence estimates of endometriosis among nonselected cohorts in the USA, Christ et al. from the Departments of Obstetrics and Gynecology of the University of Washington, Seattle, planned a retrospective cohort study using the electronic KPWA database between 2006-2015. All enrollees who were 16 to 60 years of age women comprised the study population, who were continuously enrolled at least 2 years before cohort entry, and had at least 1 encounter with the health utilization.  During the…

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Transvaginal Ultrasound Accuracy for Uterosacral Ligament, Torus Uterinus and Posterior Fornix Endometriosis

The accuracy of transvaginal ultrasonography for the diagnosis of deep endometriosis depends on the location. The sensitivity is up to 80% when the lesion is in the rectosigmoid, but it decreases up to 66% for the detection of posterior vaginal fornix endometriosi. The difference becomes more relevant for uterosacral ligament, which is the most common site of deep endometriosis. Ros et al. from University of Barcelona, Spain, aimed to evaluate the diagnostic accuracy of transvaginal ultrasonography in predicting the presence…

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Non-pharmacological self-care: dietary modifications in women with endometriosis.

The academic interest on the role of diet in endometriosis has grown due to its possible relation with inflammation, estrogenic activity, and menstrual cycles. Multiple dietary strategies and prescriptions are being used to deal with the pelvic pain and gastrointestinal symptoms of patients with endometriosis. Current evidence suggests the regular intake of fish oils, green vegetables, and fruits reduces the risk of endometriosis. On the other hand, women who consumed regularly red meat have a higher risk of endometriosis. The…

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Preoperative endometrioma diagnosis

The current clinical experience of gynecologists and radiologists indicates that distinguishing a hemorrhagic cyst from endometriomas or ruptured corpus luteal cysts is compelling. For this reason, chosen criteria that can lead to decisive distinctions are valuable for preoperative identification of endometriomas. Classical magnetic resonance imaging characteristics of the high signal intensity for endometriomas on both TW1 and TW2 imaging are changeable and unreliable. The novel technique named "susceptibility-weighted imaging" is sensitive to blood breakdown compounds that appear with small signal voids.…

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Impact of adenomyosis on sexual life

Considering the similar etiopathogenesis and pain symptoms between adenomyosis and deep infiltrating endometriosis, Alcalde et al. from the Department of Gynecology, University of Barcelona, Spain, aimed to call attention to the presence of potential sexual dysfunction not only in patients with deep infiltrating endometriosis but also in patients with adenomyosis. To raise their concerns about this matter, the authors investigated and compared the charactheristics of women who were diagnosed with "adenomyosis only", with "deep infiltrating endometriosis", and the control group. This prospective,…

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Analyses of the main classification systems of endometriosis in terms of utrasound, MRI and surgery

Several classifications made by gynecologists, image readers, and radiologists lead to confusion while describing the situation and estimating the progress of endometriosis. Daniela Fischerova team from the Charles University of Prague, Czech Republic, analyzed the main classifications of endometriosis in three areas, namely ultrasound imaging, MRI, and surgery. While the papers in the current literature compare the classifications only in surgical aspect, the authors intend to call attention to all image readers and gynecologists to come together for a standardized universal…

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Outcomes of chronic pelvic pain of endometriosis after laparoscopic surgery

The prevalence of endometriosis is up to 35-50% among patients with pelvic pain. Among several medical and surgical options to relieve chronic pelvic pain, surgical options are the preferred method but this depends on patients' age, fertility desire, and disease severity as well. In the current literature, the management of pelvic pain focuses on comparing the surgical and medical therapies of pain relief, whereas the reoccurrence rate and reoperation after operative laparoscopy remain unclear. Laguerre et al from the University…

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Managing Persistent Pelvic Pain in a distinct "pain" clinic

Persistent pelvic pain is an important problem producing physiological stress and productivity loss during the reproductive period of women. A specific pelvic pain clinic named "Mater Health Persistent Pelvic Pain Clinic" was established in 2017 in a part of the emergency department in Mater Hospital, Queensland, Australia. The clinic aimed to reduce the burden of a busy emergency department and to eliminate the need to submit to an emergency department by a multidisciplinary follow-up of patients with persistent pelvic pain. Wilkinson et al.…

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Factors affecting complications and the recurrence of operated deep infiltrating endometriosis

Deep infiltrating endometriosis is classified as penetrating the endometrial tissues more than 5 mm deep on the peritoneal surface, mainly uterosacral ligament, rectovaginal septum, ovarian fossa, pelvic peritoneum, bowels, ureters, and bladder. Treatment of the disease depends on the need for pain relief, fertility, and to prevent the spread of endometrial foci. The surgical approach is the removal of endometriosis foci, and operation of the advanced stages requires highly skilled surgeons to prevent complications and lower the recurrence rate of…

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Endometriosis scar disruption may lead to "spontaneous hemorrhage in pregnancy" and can be life-threatening.

Kollikonda et al from Cleveland Clinic Women's Health Institute, Cleveland, Ohio, US penned a case report about their hemoperitoneum experience during labor, which was recently published in the "Journal of Obstetrics and Gyneaecology Canada". The aim is to warn obstetricians about the occurrence of spontaneous hemorrhage in pregnant patients with a history of advanced-stage endometriosis. Apart from the vascular nature of endometriotic adhesions and their low elasticity, repeated surgical resections may also be the predisposing factors of adhesions to become…

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Evaluation of preoperative risk factors of ureteral endometriosis

Endometriosis affects the urinary tract in 1% to 5.5% of the patients, and among them, bladder involvement is 70-85%, while ureteral involvement alone is 9% to 23%.  Ureteral endometriosis is most commonly unilateral, especially on the left side, usually affecting the distal part. Some patients with ureteral endometriosis don't complain of any related symptoms even though it can cause dysuria, dyspareunia, and chronic pelvic pain. Moreover, there are no standard imaging methods for preoperatively evaluating the presence of ureteral endometriosis.…

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Postoperative infertility management using Endometriosis Fertility Index in endometriotic women

"Endometriosis Fertility Index '' score, described by the World Endometriosis Society in 2017, is a robust score and assists to predict the spontaneous pregnancy rate of women with endometriosis, within 3 years after their operation. Its calculation is possible by patient characteristics such as age, pregnancy history, the duration of infertility, endometriosis stage, and the functional postoperative score assessed by the surgeon.  The patients with an unfavorable "Endometriosis Fertility Index '' necessitate more assisted reproductive techniques compared to the patients with a favorable "Endometriosis…

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The association of chronic endometritis, endometriosis and tubal infertility

Holzer et al. from the Department of Gynecologic Endocrinology and Reproductive Medicine of  Medical University of Vienna, Austria, set up apilot prospective cohort study to evaluate the relationship between chronic endometritis, infertility and endometriosis. The results of the study were recently published in the "Journal of Minimally Invasive Gynecology". This project includes 100 women diagnosed with infertility. The authors performed hysteroscopy, laparoscopy and histopathological evaluation for chronic endometritis on every patient to clarify the pathology of the endometrium, myometrium, and fallopian…

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Improvement of the quality of life after surgery for deep infiltrating endometriosis.

Deeply infiltrating endometriosis is the most severe form among the endometriosis types. The required laparoscopic approach is the appropriate excision of endometriotic foci from pelvis, by consideration of failure and side effects of the medical treatments. The specialist endometriosis centers showed good evidence of the safety and effectiveness of laparoscopic surgery for deep infiltrating endometriosis patients. Improved the quality of life at 6 months after surgery could be achieved and be maintained at 2 years in these specialized endometriosis  centers.…

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Postoperative long-term estro-progestin therapy for endometrioma

After the removal of ovarian endometriomas, the major concern is the high recurrence rate of symptoms and endometriotic cysts. The estimated recurrence rate of endometriomas is up to 50% at 5 years after surgery. To prevent the recurrence, postoperatively long-term combined or single hormone as progestins are generally advised. Del Forno and colleagues from Bologna University, Italy planned this retrospective cohort study to evaluate the efficacy of hormone therapy on their collection of 18 years of data. The paper is recently…

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Fertilization rate and pregnancy outcome in IVF cycles of endometriosis.

Endometriosis affects the pelvic cavity, uterus, ovaries and causes impaired fertility as a result. The chronic inflammatory nature of this disease negatively impacts the oocyte quality, maturation, and fertilization. Obviously, fewer oocytes can be harvested in the IVF cycles of endometriotic women when compared to controls. Data in the literature for the fertilization rates of endometriotic women are confusing. Prof. Jansen group from the Department of Gynecology, Leiden University, the Netherlands, studied IVF cycles of infertile endometriotic women to compare…

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Endometriosis, ART, fertility preservation

This review entitled "The impact of endometriosis on the outcome of assisted reproductive techniques: role of fertility preservation" was written by Necula et al. from Gynecology and Obstetrics Unit, Biel, Switzerland, and recently published in the journal "Hormone, Molecular Biology and Clinical Investigation". Endometriosis is a major cause of infertility. Although different types of endometriosis may require different types of therapy, recent understanding shows that individual treatment for every patient is important. The development of ART techniques facilitates to get conceived, however, the application…

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Endometriosis and possible cardiovascular outcomes

A retrospective population-based cohort study from the Institute of Applied Health Research, University of Birmingham, Birmingham, the UK, investigated the long-term cardiovascular outcomes of women with endometriosis. The study included 279,759 women in total, 20,1% (>56.000) were patients with surgically confirmed endometriotic patients, and the remaining 79,9% was the control group, matched with the endometriosis group in terms of age, body mass index, and health situation. Although the annual overall incidence of endometriosis remained stable throughout the 20 years of follow-up,…

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Environmental to occupational exposure, and possible risk factors for endometriosis.

Many objects in daily use are made of plasticizing agents. Studies suggest that chronic exposure to these agents are toxic to reproductive organs and cause metabolic disorders. For example, diethyl phthalate is still in use in cosmetic products.  Caporossi et al. from the Department of Epidemiology and Hygiene, Monte Porzio Catone, Italy, planned to examine the agents that cause the onset of endometriosis, and carried out a literature search for this purpose. Papers published from 1995 to 2020 in PubMed and…

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