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Ulker A, Hansen KR. High antimüllerian hormone level in oocyte donors: Is it a problem? Fertil Steril 2024; 121:246-247. [PMID: 38042395 DOI: 10.1016/j.fertnstert.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Ashley Ulker
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Karl R Hansen
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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Ulker A, Evans MB, Craig LB. The impact of the Dobbs decision on in-vitro fertilization and fertility care. Curr Opin Obstet Gynecol 2023; 35:306-310. [PMID: 37266567 DOI: 10.1097/gco.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE OF REVIEW The 2022 Supreme Court ruling in Dobbs vs Jackson marks a frightening new reality in America. Physicians and patients have been left confused and concerned regarding the broader implications of this ruling. Now that the constitutional right to an abortion has been overturned and the power has been relinquished to individual states, there is justifiable concern regarding the impact on in-vitro fertilization (IVF). This review explores the ways IVF and fertility care are at risk in the context of our new reality. RECENT FINDINGS The decision to overturn the right to an abortion without specifying a viability standard opens the door to interpretation of when 'life' begins. Laws that do not specifically exempt IVF, or that include language suggesting that 'life begins at fertilization' pose a real threat to IVF. The potential for personhood laws poses a threat to embryo freezing and disposition, preimplantation genetic testing and culpability among other concerns. SUMMARY Limitations to IVF may become an unintended consequence to the Dobbs decision, making IVF less efficient, more costly and unsafe, and inevitably limiting access to care. It is therefore crucial that public health legislation be rooted in science and not dictated by religion or politics. Physicians must act alongside legislators to protect reproductive freedom and access to care.
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Affiliation(s)
- Ashley Ulker
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Ulker A, Evans MB. Follicle size vs. Estradiol levels: are we too quick to pull the trigger? Fertil Steril 2023; 119:792-793. [PMID: 36914149 DOI: 10.1016/j.fertnstert.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Ashley Ulker
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - M Blake Evans
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Brolinson MG, Jahandideh S, Ulker A, Barrison LE, Roura-Monllor JA, Devine K, Hill MJ, DeCherney AH, O'Brien JE. DO ULTRASOUND CHARACTERISTICS PREDICT MISCARRIAGE IN PGT-A TESTED EUPLOID EMBRYOS? Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gay S, Ulker A, Jahandideh S, Hill MJ, Devine K, Widra EA, DeCherney AH. IMMEDIATE START IVF STIMULATION FOLLOWING POLYPECTOMY DOES NOT IMPACT PREGNANCY OUTCOMES IN LARGE MULTICENTER COHORT OF OVER SIXTEEN HUNDRED EMBRYO TRANSFERS. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Garcia AN, Ulker A, Aserlind A, Timmons D, Medina CA. Enlargement of the genital hiatus is associated with prolapse recurrence in patients undergoing sacrospinous ligament fixation. Int J Gynaecol Obstet 2021; 157:96-101. [PMID: 34270804 DOI: 10.1002/ijgo.13828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To correlate genital hiatus (GH) size with surgical failures in patients undergoing sacrospinous ligament fixation (SSLF) and compare anatomic outcomes after classification based on GH size. METHODS A retrospective review of 81 patients who underwent SSLF for apical prolapse from 2010 to 2016 at a teaching hospital. Anatomical outcome is reported using the Pelvic Organ Prolapse Quantifications System. A comparison of parametric continuous variables was performed using unpaired Student t test. Categorical variables were evaluated using Pearson's χ2 test and Fisher's exact test. A P value <0.05 was considered significant. RESULTS Among the 81 patients, no difference in age, parity, body mass index, preoperative prolapse stage or follow-up time was noted between those whose surgery succeeded and those with failed surgery. Postoperatively, a widened GH was significantly associated with recurrent prolapse (P < 0.001). When the preoperative size of the GH was dichotomized into widened (≥4 cm) or normal (<4 cm), there was a non-significant (P = 0.444) trend of more failures in the widened GH group. A posterior colporrhaphy did not improve success. CONCLUSION Both preoperative and postoperative widened GH correlated with having more surgical failures following SSLF. Importantly, postoperatively a normal size GH was significantly associated with more surgical success.
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Affiliation(s)
- Alexandra N Garcia
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Jackson Memorial Hospital, University of Miami Health Systems, Miami, Florida, USA
| | - Ashley Ulker
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Jackson Memorial Hospital, University of Miami Health Systems, Miami, Florida, USA
| | - Alexandra Aserlind
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Jackson Memorial Hospital, University of Miami Health Systems, Miami, Florida, USA
| | - Douglas Timmons
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Jackson Memorial Hospital, University of Miami Health Systems, Miami, Florida, USA
| | - Carlos A Medina
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, Jackson Memorial Hospital, University of Miami Health Systems, Miami, Florida, USA
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Gonzalez AM, Artazcoz S, Quiñonez A, Jurio G, Ulker A, Carugno JA. 1766 Changing Patients' Lives with Neuropelveology. Laparoscopic Neuromuscular Pelvic Decompression of Deep Infiltrating Endometriosis (DIE) Causing Motor Dysfunction of the Lower Extremity. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Echeverri N, Fiorentino DG, Ulker A, Timmons DB, Ring S, Carugno JA. Vaginoscopy “No Touch” Technique: A Feasible Alternative to Paracervical Block for in Office Hysteroscopy [34E]. Obstet Gynecol 2019. [DOI: 10.1097/01.aog.0000559026.36059.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alonso L, Ulker A, Timmons D, Carugno J. Endometrial Fat Cell Metaplasia: An Incidental Shiny Gold Spot Inside the Uterus. J Minim Invasive Gynecol 2019; 27:7-8. [PMID: 30986564 DOI: 10.1016/j.jmig.2019.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Luis Alonso
- Endoscopy Unit, Centro Gutenberg, Malaga, Spain (Dr. Alonso)
| | - Ashley Ulker
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida (Drs. Ulker, Timmons, and Carugno)
| | - Douglas Timmons
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida (Drs. Ulker, Timmons, and Carugno)
| | - Jose Carugno
- Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida (Drs. Ulker, Timmons, and Carugno)..
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Tunc B, Filik L, Bilgic F, Arda K, Ulker A. Pulmonary function tests, high-resolution computed tomography findings and inflammatory bowel disease. Acta Gastroenterol Belg 2006; 69:255-60. [PMID: 17168120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
AIM The association between inflammatory bowel disease and pulmonary involvement has not been clearly established. The aim of this prospective study was to define the features of pulmonary function tests and high resolution computed tomography in inflammatory bowel disease patients and the relation between these and disease activity. METHOD Fifty-two patients with inflammatory bowel disease (20 with Crohn's disease and 32 with ulcerative colitis) were enrolled. The standard pulmonary function tests and thorax high resolution computed tomography findings were investigated with respect to inflammatory bowel disease activity. Crohn's disease activity index and the Rachmilewitz endoscopic activity index for ulcerative colitis were used to assess disease activity. Medications used and smoking status were also documented. RESULTS Among the patients with ulcerative colitis, 6.25% had an obstructive and/or restrictive ventilatory defect compared with 25% of the patients with Crohn's disease. Fifty percent of the patients with ulcerative colitis and 60% of the patients with Crohn's disease showed abnormal findings in high resolution computed tomography. Pulmonary function tests and high resolution computed tomography abnormalities did not differ significantly between Crohn's disease and ulcerative colitis. No significant difference related to inflammatory bowel disease activity was found (P > 0.05). CONCLUSION Findings of high resolution computed tomography and the pulmonary function tests did not differ between ulcerative colitis and Crohn's disease. Bowel disease activity did not seem to affect these measurements.
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Affiliation(s)
- B Tunc
- Gastroenterology Department, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey
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Ertuğrul I, Tunç B, Yüksel I, Yolcu OF, Ulker A. PSOAS abscess: an atypical initial presentation of Crohn's disease. Dig Liver Dis 2006; 38:357-8. [PMID: 16574516 DOI: 10.1016/j.dld.2005.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Accepted: 12/21/2005] [Indexed: 12/11/2022]
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Filik L, Ulker A, Tunc B, Disibeyaz S, Dagli U. Liver abscess: a rare but an important complication that must be considered in Crohn's disease. Acta Gastroenterol Belg 2004; 67:303-5. [PMID: 15587341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Liver abscess is a quite rare complication in Crohn's disease. Early diagnosis and differentiation of pyogenic abscess from amoebic abscess are as important as the choosing of proper treatment in the management of liver abscess. Herein, 28-year-old man with Crohn's disease developing liver abscess is presented. He was treated with surgical drainage.
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Affiliation(s)
- L Filik
- Turkiye Yuksek Ihtisas Hospital, Gastroenterology Clinic, Ankara, Turkey.
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Filik L, Ulker A, Dagli U, Parlak E, Tunc B, Disibeyaz S. Leukopenia and remission during azathioprine treatment. Aliment Pharmacol Ther 2003; 17:173. [PMID: 12492747 DOI: 10.1046/j.1365-2036.2003.01397.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Abstract
BACKGROUND Primary sclerosing cholangitis (PSC), which is a progressive cholestatic liver disease of unknown etiology, is strongly correlated with inflammatory bowel disease (IBD). GOALS To determine the prevalence and describe the characteristics of PSC in patients with IBD in Turkey. STUDY We determined the prevalence of PSC in patients with IBD admitted to our department during a 6-year period. Also, patients with PSC were investigated from an IBD aspect. Regardless of whether the patient had symptoms such as itching, jaundice, and abdominal pain, endoscopic retrograde cholangiopancreatography was performed on those with elevated alkaline phosphatase, and liver biopsy was done if endoscopic retrograde cholangiopancreatography failed to bring about the diagnosis. RESULTS Overall prevalence of PSC was 9 of 386 (2.3%) patients with ulcerative colitis (UC) and 4 of 110 (3.6%) patients with Crohn's disease (CD). Inflammatory bowel disease was established in 13 of 18 (72.2%; UC, 50.0%; CD, 22.2%) patients who were being observed for PSC. The male-to-female ratio was 5:4 in UC and 3:1 in CD patients with PSC. The mean age at diagnosis of PSC was 43.6 years (range, 30-54 years) in patients with UC and 30.5 years (range, 26-41 years) in patients with CD. In patients with UC, the extension of colitis was total in seven patients (7/110, 6.3%) and left-sided in two patients (2/142, 1.4%). In patients with CD, the disease was located in the ileum and colon in one patient (1/47, 2.1%) and in colon alone in three patients (3/21, 14.2%). CONCLUSIONS Prevalence of PSC-associated IBD in the Turkish community appear to be similar to the results of western origin studies.
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Affiliation(s)
- E Parlak
- Turkiye Yuksek Ihtisas Hospital, Department of Gastroenterology, Ankara, Turkey
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Parlak E, Ulker A, Dişibeyaz S, Alkim C, Dağli U. There is no significant increase in the incidence of Helicobacter pylori infection in patients with inflammatory bowel disease in Turkey. J Clin Gastroenterol 2001; 33:87-8. [PMID: 11418804 DOI: 10.1097/00004836-200107000-00025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Parlak E, Dağli U, Ulker A, Alkim C, Sahin B. Comparison of 5-amino salicylic acid plus glucocorticosteroid with metronidazole and ciprofloxacin in patients with active ulcerative colitis. J Clin Gastroenterol 2001; 33:85-6. [PMID: 11418802 DOI: 10.1097/00004836-200107000-00023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Akdoğan M, Parlak E, Ulker A, Dağli S. Accidental arytenoid banding: an unusual complication of single-shot ligation therapy. Endoscopy 2001; 33:193. [PMID: 11272225 DOI: 10.1055/s-2001-11921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- M Akdoğan
- Dept. of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey.
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Abstract
PURPOSE The aim of this study was to describe the sonographic features of achalasia. METHODS Thirty-five patients with achalasia (17 men and 18 women; mean age, 43 years) were examined with transabdominal sonography, and the findings were compared with those in 41 volunteers without esophageal disease (21 men and 20 women; mean age, 41 years), 10 patients with gastroesophageal junction carcinoma (7 men and 3 women; mean age, 55 years), and 4 patients with peptic stricture (3 men and 1 woman; mean age, 39 years). The distal end of the esophagus was evaluated, and the thickness of the esophageal wall was measured. RESULTS In 28 fasting patients (80%) with achalasia, sonography showed dilatation, retention of fluid, and smooth narrowing of the distal esophagus (like a bird's beak). These findings were not identified in the other patients or volunteers. In addition, in 6 of 7 achalasia patients who had no sign of esophageal dilatation in the fasting state, water retention was demonstrated after ingestion of water, bringing the total number of patients with achalasia with positive sonographic findings to 34 (97%). In patients with achalasia, the mean thickness (+/- standard deviation) of the esophageal wall at the gastroesophageal junction was 4.8 +/- 0.9 mm (range, 3.6-7.2 mm). The thickening was regular, symmetric, and localized to the gastroesophageal junction. In the volunteers, the mean thickness of the esophageal wall was 2.3 +/- 0.5 mm (range, 1.4-3.5 mm). The difference between the 2 groups was statistically significant (p < 0.001). In the patients with carcinoma, the mean wall thickness was 17.0 /+ 1.1 mm, and the thickening was irregular. In the patients with peptic stricture, the mean wall thickness was 5.1 +/- 1.1 mm (range, 3.8-8.3 mm), and the thickening was irregular and occupied a longer segment of the distal esophagus. CONCLUSIONS In patients with achalasia, transabdominal sonography clearly shows the regular thickening of the esophageal wall, water retention, dilatation of the distal esophagus, and the bird's beak appearance. Sonography may help in differentiating achalasia from carcinoma and peptic stricture of the gastroesophageal junction, which is difficult to do with other modalities.
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Affiliation(s)
- O Sezgin
- Department of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Sihhiye, Ankara, Turkey
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Abstract
We present the sonographic findings in 5 cases of retroperitoneal duodenal perforation during endoscopic sphincterotomy. In each case, sonography showed hyperechoic areas associated with shadowing and ring-down artifacts between the liver and the right kidney correlating with the retroperitoneal air seen on plain x-ray films. This brightly echogenic area with shadowing surrounded and obscured the kidney. In 4 patients, resolution was documented on follow-up sonographic examinations in agreement with other radiologic findings; the other patient died.
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Affiliation(s)
- O Sezgin
- Gastroenterology Clinic of Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey
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Abstract
BACKGROUND AND STUDY AIMS To aim of the present study was to determine the value of transrectal ultrasonography (TRUS) in the assessment of disease activity in ulcerative colitis patients, and in differentiating between mucosal inflammation and transmural inflammation. PATIENTS AND METHODS TRUS examinations were used to study 30 control individuals and 76 patients with inflammatory bowel disease, including 50 cases of ulcerative colitis and 26 of Crohn's disease. A rigid linear endorectal probe was used to examine the rectal wall. RESULTS In the 30 control individuals, the rectal wall showed five layers, with a mean total diameter of 2.6 mm. There were significant differences between patients with quiescent ulcerative colitis, active ulcerative colitis, and control individuals with regard to the total rectal wall thickness (P<0.001), submucosal thickness (P<0.001) and mucosal thickness (P<0.001). Using cut-off values, differentiation between active ulcerative colitis and remission ulcerative colitis was found to be 100% specific and 73 % sensitive for submucosal thicknesses. TRUS revealed a 100% specificity in differentiating between remission ulcerative colitis and control cases based on the total rectal wall thickness, submucosal, and mucosal thicknesses. In the differential diagnosis of active and remission ulcerative colitis, an increase in submucosal wall thickness and the existence of arterial and venous capillary flow in the submucosa were found to be specific and more sensitive than the other parameters. TRUS examination revealed transmural inflammation in 21 of the 26 Crohn's disease patients, and mucosal inflammation in all 50 of the ulcerative colitis patients. CONCLUSION TRUS is a reliable and easy method of assessing ulcerative colitis activity and differentiating between rectal diseases.
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Affiliation(s)
- U Dağli
- Gastroenterology Clinic, Yüksek Ihtisas Hospital, Ankara, Turkey
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Affiliation(s)
- H Over
- Dept. of Gastroenterology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey
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Abstract
A low molecular weight endoglucanase (1,4-beta-glucan glucanohydrolase E.C.3.2.1.4) was purified to homogeneity by a two-step procedure from 7 day old culture filtrates of Trichoderma reesei. The endoglucanase was obtained by BioGel A 0.5 m gel chromatography followed by preparative PAGIF. The purified endoglucanase was homogeneous upon titration curve separation. Enzyme characteristics were: Mr 25 kDa, pI 7.5. The amino acid composition is predominantly neutral (mainly glycine). The N-terminus is arginine. The pH-optimum for this endoglucanase was 5.8 and its optimal temperature was at 52 degrees C. The activity of this endoglucanase gave a strong increase in CMC-fluidity with only a small release of reducing sugars. The endoglucanase was 0.2% of total culture medium protein content. The reducing sugars upon CMC digestion were G1-G4. The enzyme had no specificity towards crystalline cellulose (Avicel) or xylan. The endoglucanase is not a glycoprotein.
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Affiliation(s)
- A Ulker
- Institut für Biotechnologie der Kernforschungsanlage Jülich, F.R.G
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