Rafael Levi

Publications (9)9.37 Total impact

• Article: Bilateral Jugular Venous Thromboembolism and Pulmonary Emboli in a Patient with Severe Ovarian Hyperstimulation Syndrome

  Erol Tavmergen, Hasan Tayfun Özçakir, Rafael Levi, Şaban Adakan, Murat Ulukuş, Mustafa Coşan Terek
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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. · 0.94 Impact Factor
• Article: Premature luteinization defined as progesterone estradiol ratio >1 on hCG administration day seems to adversely affect clinical outcome in long gonadotropin-releasing hormone agonist cycles.

  Hasan Tayfun Ozçakir, Rafael Levi, Erol Tavmergen, Ege Nazan Tavmergen Göker
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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. · 0.94 Impact Factor
• Article: Premature luteinization defined as progesterone estradiol ratio >1 on hCG administration day seems to adversely affect clinical outcome in long gonadotropin‐releasing hormone agonist cycles

  Hasan Tayfun Özçakir, Rafael Levi, Erol Tavmergen, Ege Nazan Tavmergen Göker
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  ABSTRACT: Aim: To examine the effect of premature luteinization on the outcomes in long gonadotropin-releasing hormone agonist cycles.Methods: 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) ׆1,000/E2 (in pg/mL). The primary outcome measures included oocyte quality, fertilization rates and clinical pregnancy rates.Results: 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).Conclusion: 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 03/2004; 30(2):100 - 104. · 0.94 Impact Factor
• Article: Early and midluteal phase blood estradiol levels after ovum pickup and pregnancy rates after ICSI cycles.

  Rafael Levi, S Eser Ozyurek, Ege N Tavmergen Goker, Erol H Tavmergen
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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. · 0.87 Impact Factor
• Article: The outcomes of assisted reproductive technology cycles in patients with one or two ovaries.

  Rafael Levi, Hasan Tayfun Ozçakir, Erkan Alatas, Ege Nazan Tavmergen Göker, Erol Tavmergen
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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. · 0.94 Impact Factor
• Article: The outcomes of assisted reproductive technology cycles in patients with one or two ovaries

  Rafael Levi, Hasan Tayfun Özçakir, Erkan Alatas, Ege Nazan Tavmergen Göker, Erol Tavmergen
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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. · 0.94 Impact Factor
• Article: Effect of ovarian cysts detected on the beginning day of ovulation induction to the success rates in ART cycles.

  Rafael Levi, Hasan Tayfun Ozçakir, Saban Adakan, Ege Nazan Tavmergen Göker, Erol Tavmergen
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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. · 0.94 Impact Factor
• Article: Intraovarian stromal artery Doppler indices in predicting ovarian response.

  Mustafa Altundag, Rafael Levi, Saban Adakan, Ege Nazan Tavmergen Goker, Refik Killi, Hasan Tayfun Ozcakir, Erol Tavmergen
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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. · 0.87 Impact Factor
• Article: Comparison of the ICSI outcome of ejaculated sperm with normal, abnormal parameters and testicular sperm.

  Ege N Tavmergen Göker, Fatih Sendag, Rafael Levi, Handan Sendag, Erol Tavmergen
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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. · 1.97 Impact Factor