R Levi

Ege University, İzmir, Izmir, Turkey

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Publications (25)27.98 Total impact

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    ABSTRACT: We report here a case of severe ovarian hyperstimulation syndrome with massive ascites in a 25-year-old woman with a history of primary infertility after an IVF-ET cycle. At the 9th gestational week she presented with neck pain and dyspnea and duplex Doppler sonographic examination of the neck veins revealed bilateral jugular venous thrombosis. Despite prompt administration of low-molecular weight heparin, pulmonary emboli developed a few days later.
    Journal of Obstetrics and Gynaecology Research 05/2010; 27(4):217 - 220. · 0.84 Impact Factor
  • Fertility and Sterility - FERT STERIL. 01/2008; 90.
  • Fertility and Sterility - FERT STERIL. 01/2008; 90.
  • Fertility and Sterility 09/2007; 88. · 4.17 Impact Factor
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    ABSTRACT: To evaluate the effect of the management modality of ovarian endometriomas on ovarian response to COH (controlled ovarian hyperstimulation) and ART (assisted reproductive technology) treatment outcome. Retrospective case control study. Ege University Infertility-Family Planning Research and Treatment Center. 115 cycles of 84 patients who underwent ICSI-ET (intracytoplasmic sperm injection-embryo transfer) with ejaculated sperm were enrolled in the study. The endometrioma resection group (Group I) was comprised of 36 cycles in 29 patients who were treated with laparoscopic endometrioma cyst resection prior to treatment; endometrioma aspiration (Group II) was comprised of 26 cycles in 15 patients whose endometriomas were aspirated prior to treatment; and the control group (Group III) was comprised of 53 cycles in 40 patients for whom the only infertility cause was the tubal factor. ICSI-ET treatment, laparascopic ovarian endometrioma cyst resection, transvaginal ultrasonography-guided endometrioma cyst aspiration. Main COH results and ICSI-ET treatment outcomes. The groups were similar in all characteristics except for the mean age of the patients in group II being older than those in group I. Gonadotropin consumption was higher, peak estradiol level lower, and the number of oocytes less in the laparascopic resection group (Group I) with respect to the control group. The number of follicles was lower in the cyst aspiration group (Group II) with respect to the control group. The number of follicles larger than 15 mm, number of metaphase II oocytes, the fertilization, pregnancy and implantation rates were similar in all three groups. Interventions (laparascopic endometrioma resection, transvaginal ultrasound-guided endometrioma cyst aspiration) performed on endometriomas prior to ART treatment do not worsen the treatment outcome.
    Clinical and experimental obstetrics & gynecology 02/2007; 34(4):215-8. · 0.38 Impact Factor
  • Fertility and Sterility - FERT STERIL. 01/2007; 88.
  • Article: P-433
    Fertility and Sterility - FERT STERIL. 01/2006; 86(3).
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    ABSTRACT: To examine the effect of premature luteinization on the outcomes in long gonadotropin-releasing hormone agonist cycles. Two-hundred and forty-eight patients who had undergone assisted reproductive technology for infertility treatment between 2001 and 2002 were enrolled into the study. The patients were separated into two groups according to P/E2 ratios on human chorionic gonadotropin administration day. Group A consisted of the patients whose P/E2 ratio was 1 (n = 116) and Group B consisted of the patients with premature luteinization of which P/E2 ratio was > 1 (n = 132). The P/E2 ratio calculation was performed as follows: P (in ng/mL) x dagger 1,000/E2 (in pg/mL). The primary outcome measures included oocyte quality, fertilization rates and clinical pregnancy rates. The mean number of mature oocytes retrieved in the groups were 9.5 +/- 4.8 and 6.4 +/- 3.6, respectively, and the difference was statistically significant (P < 0.05). Although the difference between the fertilization rates in Group A and Group B was not statistically significant (P > 0.05), the clinical pregnancy rates seemed to be affected adversely in the Group B patients with premature luteinization (41.4%versus 28%, respectively; P < 0.05). Premature luteinization, defined as P/E2 > 1 on human chorionic gonadotropin administration day, in long gonadotropin-releasing hormone agonist cycles seems to adversely affect clinical outcome.
    Journal of Obstetrics and Gynaecology Research 05/2004; 30(2):100-4. · 0.84 Impact Factor
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    ABSTRACT: To examine whether blood estradiol level tendencies during the late follicular and early luteal phases and the 11 days after embryo transfer have any association with the outcome of intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles. This prospective study involved 38 assisted reproductive technology cycles in 35 infertile patients treated with assisted reproductive technologies in which blood samples taken on the 4th, 7th, 9th and 11th days following ET were tested for progesterone, estradiol and hCG levels using an enzyme-linked immunoassay. The estradiol blood levels were compared with the maximal follicular phase blood estradiol. The data were analyzed using Microsoft Excel (Redmond, Washington) and SPSS 10.0 (Chicago, Illinois). The chi2, Mann-Whitney U, Wilcoxon and Pearson tests were usedfor statistical analysis. Average maximum estradiol blood level, number of oocytes produced,fertilization rates and cleavage rates did not show any significant difference between pregnant and nonpregnant cycles. The lower the ratios of estradiol levels measured on posttransfer days 4, 7 and 9 to the maximumfollicular phase level, the lower the probability of pregnancy (P < .01, P < .01 and P < .01, respectively). The steeper the decline in blood estradiol levels (affecting the periimplantation period) following ovum pickup relative to the maximum follicular phase estradiol levels, the lower the chance of pregnancy in ICSI-ET cycles.
    The Journal of reproductive medicine 02/2004; 49(2):108-14. · 0.75 Impact Factor
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    ABSTRACT: To determine the implications and predictive value of estradiol concentrations following pituitary down-regulation with gonadotrophin releasing hormone agonists in women undergoing controlled ovarian hyperstimulation for assisted reproductive technology. A total of 277 patients undergoing ovarian hyperstimulation for intracytoplasmic sperm injection (ICSI) were enrolled into the study and the patients were divided into four groups according to estradiol levels on the initial day of stimulation of which group-A consisted of the patients who had < or =25 pg/ml (n=90), group-B with levels between 26 and 50 pg/ml (n=104), group-C with levels between 51 and 75 pg/ml (n=67) and group-D with levels > or =76-90 pg/ml (n=16) and the results were compared. The primary outcome measures included ovarian response and the clinical pregnancy rates. The clinical pregnancy rates in groups-A, B, C and D were 33.3% (30/90), 26.0% (27/104), 35.8% (24/67), and 25.0% (4/16), respectively, and there was no statistically significant difference (P=0.482). The mean number of oocytes retrieved in groups were (9.7+/-5.8, 10.3+/-6.5, 11.0+/-6.8, and 12.1+/-6.6), respectively (P=0.453) and the fertilization rates in groups-A, B, C and D were found to be similar (75, 80, 73 and 79%, respectively; P=0.658). Complete and deep desensitization obviously seems not to be mandatory for successful stimulation in assisted reproductive technology cycles.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 11/2003; 111(1):55-8. · 1.84 Impact Factor
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    ABSTRACT: To provide a comparison between the follicular response to ovulation induction, and the pregnancy rate of women with a single or two ovaries, undergoing assisted reproductive technology. To evaluate the outcome of assisted reproductive technology, 46 treatment cycles in women with one ovary were compared to 123 cycles in women with two ovaries. The mean age of the patients in the two groups were not similar (34.4 +/- 3.8 and 33.1 +/- 4.0, respectively). The one ovary-group had significantly higher mean baseline Follicle Stimulating Hormone levels and required more ampoules for induction. Although the induction period was longer in the one-ovary group, the outcome of the assisted reproductive technology in both groups was similar. The maximum E2 levels on the day of Human Chorionic Gonadotropin administration were significantly lower in the one-ovary group, although endometrial thickness appeared to be the same in both groups. The patients with two ovaries had a significantly higher mean number of mature or immature oocytes aspirated, as well as embryos transferred. Although there was no statistical difference between the two groups following assisted reproductive technology, the pregnancy rate in the two-ovary group was more than double that of the one-ovary group. The potential for success after in vitro fertilization is not impaired in women with one ovary.
    Journal of Obstetrics and Gynaecology Research 11/2003; 29(5):321-5. · 0.84 Impact Factor
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    ABSTRACT: Aim: To provide a comparison between the follicular response to ovulation induction, and the pregnancy rate of women with a single or two ovaries, undergoing assisted reproductive technology.Methods: To evaluate the outcome of assisted reproductive technology, 46 treatment cycles in women with one ovary were compared to 123 cycles in women with two ovaries.Results: The mean age of the patients in the two groups were not similar (34.4 ± 3.8 and 33.1 ± 4.0, respectively). The one ovary-group had significantly higher mean baseline Follicle Stimulating Hormone levels and required more ampoules for induction. Although the induction period was longer in the one-ovary group, the outcome of the assisted reproductive technology in both groups was similar. The maximum E2 levels on the day of Human Chorionic Gonadotropin administration were significantly lower in the one-ovary group, although endometrial thickness appeared to be the same in both groups. The patients with two ovaries had a significantly higher mean number of mature or immature oöcytes aspirated, as well as embryos transfered. Although there was no statistical difference between the two groups following assisted reproductive technology, the pregnancy rate in the two-ovary group was more than double that of the one-ovary group.Conclusion: The potential for success after in vitro fertilization is not impaired in women with one ovary.
    Journal of Obstetrics and Gynaecology Research 09/2003; 29(5):321 - 325. · 0.84 Impact Factor
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    ABSTRACT: In the present study, we examined the outcome of assisted reproductive technology cycles in patients with or without baseline ovarian cysts following gonadotrophin-releasing hormone analogs administration. Three-hundred and fifty-six patients who had undergone assisted reproductive technology treatment were enrolled in the study. The patients, all of who had undergone cyst aspiration prior to ovarian stimulation, were grouped into two groups according to the absence or presence of ovarian cysts. These two groups were compared on the basis of the clinical pregnancy rates, the baseline E2 levels, the total follicle stimulating hormone ampules used, the total number of days of induction, the maximum E2 levels, the number of oocytes retrieved, the fertilization rates and the number of embryos available for transfer per controlled ovarian hyperstimulation cycle. The number of ampules used for induction was significantly higher in the cyst group 37.2 +/- 13.0, 32.1 +/- 11.7, respectively, (P = 0.001). The number of total induction days was also longer in the cyst group 9.7 +/- 2.2, 8.9 +/- 1.6, respectively, (P = 0.001). There was no difference between the mean E2 levels measured on the human chorionic gonadotropin administration days (P = 0.339). There was also no difference in terms of the number of oocyte retrieved (P = 0.846). The number of embryos transferred did not differ statistically between the groups (P = 0.233). Finally, there was no significant difference between the groups according to the clinical pregnancy rates 25.3%, 30.7%, respectively, (P = 0.218). Baseline ovarian cysts have a negative impact on the quality of ovarian hyperstimulation procedure; however, they have no negative effect on the pregnancy rates in IVF cycles.
    Journal of Obstetrics and Gynaecology Research 09/2003; 29(4):257-61. · 0.84 Impact Factor
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    ABSTRACT: To determine the value of ovarian stromal artery Doppler indices in the prediction of ovarian response in in vitro fertilization-embryo transfer (IVF-ET) cycles. Forty-five cases were involved in the study. Following controlled ovarian hyperstimulation and detection of at least three follicles > 17 mm in diameter by transvaginal sonography in both ovaries, human chorionic gonadotropin was administered and follicle aspiration performed at the 34th-36th hour. The patients were separated into two groups according to the number of oocytes collected. Group I consisted of 8 (18%) patients who had three or fewer oocytes (low-responder cases); group II consisted of 37 (82%) patients who had 4 or more oocytes (good-response cases). A significant negative correlation was found between both the stromal ovarian artery pulsatility index and the number of aspirated follicles (r = -.31, P = .04) and number of oocytes collected (r = -.32, P = .03). Although there was no significant correlation between the resistance index and number of aspirated follicles (r = .24, P = .12), a significant negative correlation was determined between the resistance index and number of oocytes collected (r = -.30, P = .04). Pulsatility and resistance indices were significantly different between the two groups (1.6 +/- 0.5 and 1.2 +/- 0.5, P = .02, versus 0.7 +/- 0.08 and 0.6 +/- 0.08, P = .03, respectively). Blood flow in the vessels that supply blood to the follicles in the ovaries in the early follicular phase correlates significantly with ovarian response.
    The Journal of reproductive medicine 11/2002; 47(11):886-90. · 0.75 Impact Factor
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    ABSTRACT: To compare fertilization rates, quality of embryos, pregnancy rates (PRs) and outcome of pregnancies in intracytoplasmic sperm injection (ICSI) using sperm from ejaculates of normal and abnormal semen and testicular sperm of non-obstructive azoospermia. Four hundred fifty-four patients who underwent 454 ICSI cycles were evaluated retrospectively. Patients were divided into three groups according to the quality and source of sperm. Patients in group 1 underwent 133 cycles of ICSI using ejaculated normal semen, group 2 underwent 235 cycles using ejaculated abnormal semen, and group 3 underwent 86 cycles using testicular sperm. The parameters were compared among the groups with respect to cycles induced by long (n = 160) and short (n = 294) protocol. In group 3, the fertilization and PRs were significantly lower than in all other groups (51.3 and 10.6% in the long protocol cycles, 53.3 and 5.1% in the short protocol cycles, respectively). There was no significant difference in the outcome of pregnancies in respect to abortion rates between different groups. The fertilizing ability of sperm in ICSI is highest with ejaculated sperm and lowest with sperm extracted by testicular biopsy. Also, the clinical PRs are significantly lower in ICSI with sperm from testicular biopsy. However, the outcomes of pregnancies are not affected by using surgically retrieved sperm from ejaculated semen.
    European Journal of Obstetrics & Gynecology and Reproductive Biology 10/2002; 104(2):129-36. · 1.84 Impact Factor
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    ABSTRACT: To determine the characteristics associated with clinical pregnancy rate after gonadotropin-induced intrauterine insemination cycles in patients without male or tubal factor infertility. One hundred and eighty patients undergoing controlled ovarian hyperstimulation followed by intrauterine insemination were included in the study retrospectively. The patients' files were retrospectively evaluated with respect to age, number of follicles, endometrial thickness and serum hormone levels at baseline and at the day of human chorionic gonadotropin (hCG) administration. The patients with male or unilateral tubal factor infertility were excluded from the study. The serum estradiol level at the day of hCG administration was not correlated with the clinical pregnancy rate (r=-0.05, p=0.481). The number of follicles was not correlated with the clinical pregnancy rate (r=-0.09, p=0.209). There was no significant difference between the clinically pregnants (n=32) and not pregnants (n=148) regarding the mean age, baseline serum levels of luteinizing hormone (LH) and estradiol, serum estradiol and LH levels at the day of hCG administration and endometrial thickness (p>0.05). Although not statistically significant, a pregnancy rate of 14.2% with less than 3 follicles > or = 18 mm is present compared to a pregnancy rate of 27.5% with at least 3 follicles > or = 18 mm and 24% with > or = 4 follicles > or = 18 mm. The clinical pregnancy rate does not seem to be affected with the number of follicles present at the time of intrauterine insemination or the serum estradiol level at the day of hCG administration in a controlled ovarian hyperstimulation cycle in non-andrologic and non-peritubal factor infertility; however, there is a clear trend towards higher pregnancy rates with higher number of follicles.
    Archives of Gynecology and Obstetrics 02/2002; 266(1):18-20. · 1.33 Impact Factor
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    ABSTRACT: This retrospective study was designed to determine whether there is any difference between short and long protocol ovulation induction with Gonadotropin Releasing Hormone agonist (GnRHa) and gonadotropins used in Assisted Reproductive Technology (ART) applications according to the number of retrieved oocytes, oocyte maturity, fertilization rates, embryo quality and the outcome of pregnancies. 240 cycles consisting of in vitro fertilization (IVF) cycles without andrologic factor and intracytoplasmic sperm injection (ICSI) cycles were evaluated. 112 cycles which were induced by short protocol GnRHa and Follicle Stimulating Hormone (FSH) + Human Menopausal Gonadotropin (HMG) combinations and 128 cycles which were induced by long protocol GnRHa and FSH + HMG combinations were compared according to the number of retrieved oocytes, cancellation rate of cycles, oocyte maturity, fertilization rates, embryo quality and pregnancy rates. The cancellation rate for short protocol cycles were found to be significantly higher than those with long protocol. The number of retrieved oocytes, mature oocytes and fertilized oocytes were also found significantly lower. The quality of embryos did not show any significant difference between these groups. The clinical pregnancy rates were evidently found to be high in the long protocol cycles. As a conclusion we have found that while the number of retrieved oocytes, mature oocytes, fertilized oocytes and clinical pregnancy rates were increasing, the cancellation rate of cycles were decreasing significantly in ART cycles induced by long protocol.
    Archives of Gynecology and Obstetrics 02/2002; 266(1):5-11. · 1.33 Impact Factor
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    ABSTRACT: To evaluate the efficacy of controlled ovarian hyperstimulation and intrauterine insemination for infertility associated with endometriosis. A retrospective analysis of 260 patients with the only diagnosis of endometriosis, or male factor, or tubal factor, or unexplained infertility were performed: a total of 56 patients with different stages of endometriosis, a control group consisting of 38 patients with male factor infertility, a group of 26 patients with tubal factor infertility and a group of 140 patients with others (unexplained infertility, ovulation disorders, cervical factor). Pregnancy rate, hormone levels, endometrial thickness and number of follicles were analyzed. Clinical pregnancy rates per patient were similar between endometriosis, male factor, tubal factor, and others including unexplained infertility, ovulation disorders and cervical factor groups (10.7%, 5.4%, 11.5%, 17.9%, respectively; p>0.05). Clinical pregnancy rates per patient were not effected between the 2 subgroups of endometriosis as minimal to mild and moderate to severe [5.1% (2/39) versus 23.5% (4/17), p=0.19]. Endometriosis did not affect the clinical pregnancy rate per patient compared to the other infertility factors. Endometriosis of various stages have no effect on the success of controlled ovarian hyperstimulation combined with intrauterine insemination.
    Archives of Gynecology and Obstetrics 02/2002; 266(1):21-4. · 1.33 Impact Factor
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    ABSTRACT: Successful pregnancy in a woman with complex endometrial hyperplasia with atypia was treated conservatively with gestagens. The patient was initially diagnosed with complex hyperplasia of the endometrium with atypia by endometrial curettage and treated with several cycles of different gestagens. After repeated endometrial curettage, in vitro fertilization and embryo transfer were introduced for immediate treatment of the patient's infertility in order to avoid the risk of recurrent hyperplasia of the endometrium from estrogens. A single pregnancy was achieved after transfer of embryos obtained from intracytoplasmic sperm injection. This was performed due to poor semen characteristics. The patient delivered a normal, healthy male infant at term. Conservative treatment of complex endometrial hyperplasia with atypia in young women wishing to preserve fertility should be considered in carefully selected cases.
    The Journal of reproductive medicine 10/2001; 46(9):859-62. · 0.75 Impact Factor
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    ABSTRACT: We report here a 37-year-old woman who underwent ovulation induction and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment because of infertility who developed vaginal bleeding at the 6th week of gestation. Abdominal ultrasonography was insufficient to distinguish the intrauterine gestational sac. Subsequently, vaginal doppler ultrasonography detected two separate unilateral twin ectopic pregnancies with cardiac activity in both fetuses, which were operated on pelviscopically.
    Journal of Obstetrics and Gynaecology Research 09/2001; 27(4):213-5. · 0.84 Impact Factor

Publication Stats

85 Citations
27.98 Total Impact Points

Institutions

  • 2002–2010
    • Ege University
      • • Family Planning Infertility Research and Treatment Center
      • • Faculty of Medicine
      • • Department of Obstetrics and Gynecology
      İzmir, Izmir, Turkey