Browsing by Author "Perovic, Milan (36543025300)"

Background/aims: Obese and overweight women experience a lower probability for pregnancy after IVF. However, despite the increasing prevalence of obesity, the large majority of infertile women are non-obese. One of the most common indications for IVF is endometriosis. Thought-provoking inverse correlation has been established between BMI and endometriosis. Lower BMI is a risk factor for development of endometriosis and a predictive factor for severe endometriosis. Since severe endometriosis carries lower reproductive chances, even after IVF, we preliminary tested a hypothesis that higher BMI among non-obese endometriosis patients improves IVF outcomes. Methods: Preliminary retrospective observational cross-sectional study was performed in women with endometriosis as a sole infertility cause who underwent IVF. During analyzed period we performed 2782 IVF procedures. In order to achieve highly homogenous study sample and to eliminate almost all confound factors that could lead to bias, we implemented strict study criteria. The number of eligible subjects was 156 and they were divided into underweight, normal weight and overweight groups. Primary outcomes were number of retrieved oocytes, good quality oocytes, embryos, and the rates of biochemical, clinical and ongoing pregnancies. For group comparisons, we used parametric test, analysis of variance, and non-parametric tests (Kruskal-Wallis test, Chi-square test). Logistic regression and General linear model was used to assess correlation between BMI and dependent variables (outcome and stimulation duration) when adjusted for age. Results: Endometriosis as a single infertility factor among IVF couples had prevalence of 5.61%. Underweight women accounted for 10.26%, normal weight 71.15% and overweight 18.59% of study population. Significant differences were not found in number of retrieved oocytes (p = 0.880), good quality oocytes (p = 0.476), obtained embryos (p = 0.706), and biochemical (p = 0.298), clinical (p = 0.770) and ongoing (p = 0.822) pregnancy rates between study groups. Conclusion: Although preliminary results do not support our hypothesis, increase in BMI did not adversely affect the outcome of IVF in non-obese endometriosis patients, which is in contrast to literature data as regards general population of infertile women undergoing IVF. Prospective studies with large number of patients with endometriosis or prospective case-control studies should address these issues and provide more comprehensive counseling of infertile endometriosis patients regarding achievement of optimal BMI prior to IVF with the intention of achievement higher pregnancy rates. © 2017 The Author(s).

Relationship between physical activity and mental disorders in late pregnancy is unclear. In this work, we demonstrate that there is a significant association between the time spent on walking and symptoms of depression and anxiety in antenatal period. The cross-sectional study was done on a sample of 200 healthy women in 9th month of physiological pregnancy at Health center Kraljevo, Serbia during 2015. Each participant was given a questionnaire consisting of general questions regarding physical activity, pregnancy, and other parameters. Also, each participant completed a Beck depression inventory (BDI) and Zung anxiety scale (ZAS). There was a statistically significant negative correlation (p<0.05) between the BDI score and the daily time spent on walking. There was also a strong positive connection between the daily time spent on walking and level of anxiety (p<0.01). To our knowledge this is the first study to jointly test the relationship between scores of Beck depression inventory and Zung anxiety scale, and time spent on walking as physical activity in antenatal period. The results represent the basis for further research in the field of gynecological psychology, psychiatry and behavioral physiology. © 2016 Elsevier Ireland Ltd

Relationship between physical activity and mental disorders in late pregnancy is unclear. In this work, we demonstrate that there is a significant association between the time spent on walking and symptoms of depression and anxiety in antenatal period. The cross-sectional study was done on a sample of 200 healthy women in 9th month of physiological pregnancy at Health center Kraljevo, Serbia during 2015. Each participant was given a questionnaire consisting of general questions regarding physical activity, pregnancy, and other parameters. Also, each participant completed a Beck depression inventory (BDI) and Zung anxiety scale (ZAS). There was a statistically significant negative correlation (p<0.05) between the BDI score and the daily time spent on walking. There was also a strong positive connection between the daily time spent on walking and level of anxiety (p<0.01). To our knowledge this is the first study to jointly test the relationship between scores of Beck depression inventory and Zung anxiety scale, and time spent on walking as physical activity in antenatal period. The results represent the basis for further research in the field of gynecological psychology, psychiatry and behavioral physiology. © 2016 Elsevier Ireland Ltd

Infertility is a major global health issue, affecting approximately 9% of couples worldwide. Its prevalence increased steadily over the preceding decades, paralleling environmental and lifestyle changes. One assisted reproductive technique to overcome infertility is in vitro fertilization (IVF). The IVF procedure consists of several stages, one of which is controlled ovarian stimulation (COS) via various protocols allowing follicular recruitment and maturation in preparation for oocyte retrieval. Follicular fluid (FF) is the microenvironment in which oocytes develop during folliculogenesis, and FF information could be used to assess follicle and oocyte development and maturation stages. Nitric oxide (NO) is a component of FF that is being studied as a predictive factor of follicle maturation and egg quality and as a potential indicator of the success of COS during the IVF process. The hypothesis was that COS affects NO levels in the serum; more specifically, that NO levels in serum after COS correlate with NO levels in FF, based on literature data on the influence of female reproductive hormones on NO metabolism and data on the change in the hormonal milieu affected by COS use. Furthermore, it was hypothesized that NO levels in serum and FF after COS were related to the number of high-quality female reproductive cells obtained during IVF. Assuming that NO levels in serum after COS correlate with NO levels in FF, the central hypothesis of this study is that serum NO levels after COS could be a valuable predictor of oocyte quality and the number of high-quality female reproductive cells achieved by COS. As a result of the hypothesis, measuring NO could be a novel way to improve the efficiency of IVF treatment. © 2023

OBJECTIVE: To compare the effects of 2 commercially available media on birth weight and length in a group of singleton live births ≥37 weeks. STUDY DESIGN: University hospital-based cohort study, conducted between January 2007 and April 2013, on patients undergoing IVF-ICSI. We analyzed 1,831 fresh cycles retrospectively. Cook Medical Embryo Culture Sequential System Fertilization medium and Cleavage medium was used in 1,134 cycles, while embryos from 697 cycles were cultured in Universal IVF Medium and ISM1 (Medicult). A total of 244 nullipara, who delivered live newborns from singleton pregnancies ≥37 weeks, were included in the study. Additionally, we analyzed only patients <41 years of age with a body mass index <30 kg/m2. We excluded patients with pregnancy-related complications including vanishing twin syndrome, diabetes, hypertension, preeclampsia, and intrauterine growth restriction. Birth weight and length of newborns were compared between the 2 culture media groups: Cook (n=157) vs. Medicult (n=87). RESULTS: When comparing 157 live-born singletons in the Cook group and 87 live-born singletons in the Medicult group, no significant association could be found between the type of culture medium and mean birth weight (3,290.4±406.0 vs. 3,280.0±416.5, p=0.849) or mean birth length (52.04±2.17 vs. 51.36±2.17, p=0.322). CONCLUSION: We found that culture of human embryos in either Cook or Medicult media did not show a significant effect on birth weight or length of full-term singletons. © Journal of Reproductive Medicine®, Inc.

Introduction: Follicular and serum vitamin D are considered potential markers of the oocyte and embryos' quality and predictors of in vitro fertilization (IVF) outcomes. Methods: This retrospective cross-sectional study correlated vitamin D in sera and follicular fluid of women with unexplained infertility mutually and with IVF outcomes. ELISA was used for measuring vitamin D. Results: The results show positive correlation only between follicular and serum levels of vitamin D (Rho = 0.615, p = 0.025), and between follicular levels of vitamin D and the percentage of embryo fragmentation (Rho = 0.544; p = 0.036). Conclusions: The results suggest that serum and follicular fluid vitamin D measurements could be complementary tools to the routine assessment of embryos. © 2021 Termedia & Banach.

Objective: This study was aimed at analyzing alterations in K-ras gene and SMAD4 gene promoter in endometrial carcinoma tissue in Serbian patients. Methods/Materials: The study has encompassed 36 patients whose endometrial cancer tissue samples and peripheral blood samples were analyzed for the presence of alterations in the K-ras gene and the SMAD4 gene promoter. The detection of K-ras codon 12 mutation was performed by polymerase chain reaction restriction fragment length polymorphism technique. Analysis of mononucleotide repeat variants at -462T(15) and -4T(12) of the SMAD4 gene promoter was performed by capillary electrophoresis analysis of DNA fragments fluorescently labeled by polymerase chain reaction. Results: Mutation in codon 12 of the K-ras gene was detected with relatively high frequency of 75.0% (27 of 36 cases). Analysis of 2 mononucleotide repeats in the SMAD4 gene promoter showed that in most cases, haplotypes -462T(15)/-4T(12) and -462T(16)/-4T(12) were present; whereas in one case, a novel haplotype -462T(15)/-4T(10) was detected. Conclusions: Findings on the role and potential significance of the K-ras codon 12 mutation and SMAD4 gene promoter variants in patients with endometrial carcinoma remain controversial, and their occurrence in this type of cancer should be further investigated. Copyright © 2012 by IGCS and ESGO.

Purpose: We aimed to evaluate if ovarian stimulation with individualized dosing of recombinant follicle-stimulating hormone (rec-FSH) with follitropin delta compared with standard gonadotropin dosing reduce occurrence of follicular asynchrony in women with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF). Methods: Matched case–control study analyzed occurrence of follicular growth asynchrony during ovarian stimulation and IVF outcomes in women with PCOS. Follicular growth was considered to be asynchronous when one or two leading follicles were at least 4 mm larger in diameter than the rest of the cohort on day 5 and 9 of stimulation. Analysis encompassed 44 women stimulated with individualized rec-FSH dosing, and 88 women treated with standard dosing. The patients were matched in terms of age, Anti-Müllerian hormone levels and body weight. Results: Early and late follicular asynchrony were present less frequently in individualized dosing compared to standard dosing group (4.5% vs 17%, p = 0.04 and 2.3% vs 37.5%, p < 0.001, on stimulation day 5 and 9, respectively). Multivariate logistic regression on follicular asynchrony revealed that individualized dosing significantly decreases the occurrence and chances for late follicular asynchrony (Odds Ratio 0.28, p < 0.001). Shorter duration of stimulation (9.6 vs 10.4 days, p = 0.001), lower total gonadotropin dose (1118 vs 1940 IU, p < 0.001), higher number of metaphase II oocytes (7.1 + 4.3 vs 5.4 ± 3.0, p = 0.001), good quality embryos (3.8 vs 2.0, p < 0.001), and implantation rates (31.0 vs 23.4, p = 0.04) were observed in the individualized dosing group. Conclusion: Individualized rec-FSH dosing reduces asynchronous follicular growth and improves ovarian stimulation efficiency in women with PCOS undergoing IVF. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.

Concurrent global increase of prevalence of obesity and male fertility implies link between overweight and obesity with male subfertility. This hypothesis is supported by numerous population-based epidemiological studies. Increase in body mass index (BMI) is associated with poor sperm quality in fertile, and more noticeable in infertile men. Nevertheless, some studies disprove damaging effect of BMI on semen quality. To examine the influence of men’s BMI in infertile couples undergoing in vitro fertilization (IVF) on semen analysis parameters and IVF outcomes. Study encompassed all couples who underwent IVF at Gynecology and Obstetrics Clinic Narodni Front in Belgrade during 2018 and 2019. Exclusion criteria were azoospermia, conditions and diseases that could affect the semen analysis parameters (diabetes, malignant diseases treated with radiation and/or chemotherapy, trauma or surgery of the genital organs, mumps or undescended testicles in childhood). Evaluated semen analysis parameters included semen ejaculate volume, sperm pH, sperm count, sperm motility, and sperm morphology. IVF outcomes comprised total number of embryos, number and percentage of obtained good-quality embryos and clinical pregnancy rates. Based on BMI value, participants were divided into a group of underweight (Group 1), normally weight (Group 2), overweight (Group 3), and obese men (Group 4). After applying inclusion and exclusion criteria, 411 men (couples) were included in the analysis. The largest number of men were overweight, while the smallest belonged to the group of underweight participants. There are no significant differences in the semen analysis parameters between study groups. Correlation analysis shown weak and insignificant correlation between BMI and semen analysis parameters. The number and proportion of good quality embryos is significantly lower in overweight and obese study groups compared to normal weight and underweight groups (2.89, 2.91, 2.42, and 2.36, respectively, P = .041). The differences in other IVF outcomes: total number of embryos (3.61, 3.74, 3.21, and 3.37, respectively) and clinical pregnancy rates (41.26%, 43.09%, 42.78%, and 39.95%, respectively) between study groups were not significant (P > .05). BMI does not significantly affect semen analysis parameters, but a higher BMI is associated with a lower number and proportion of good quality embryos in IVF outcomes. Copyright © 2024 the Author(s)

The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64–0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36–0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55–2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18–1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15–0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64–0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36–0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55–2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18–1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15–0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

The term thrombophilia describes disorders associated with an increased predisposition of developing venous thromboembolism (VTE). It may be acquired, like in those with antiphospholipid syndrome or inherited. The aim of this review was to compare the complications and outcomes of pregnancies in women with inherited thrombophilia between different populations, including the population of our country where the results of the research are scarce. The review of literature included all papers indexed on PubMed and Medline in the last 20 years, with different study design, including other reviews of literature, systematic reviews with meta-analysis and several case-control studies and population-based cohort studies. We aimed to cover as many geographic regions as possible with the aim to show the differences in the different parts of the world and including our country. Our analysis showed that types of thrombophilia differ in different geographic regions. Also, the differences exist between one particular type of thrombophilia in different regions. Nevertheless, no matter what the differences are between prevalence, all authors investigated the association between inherited thrombophilia and poor pregnancy outcome and managed to find some kind of association. The case with our own country is similar. Although we lack in studies with this issue and the design of published studies is not powerful enough, we may conclude that in our samples, women with thrombophilia are in potential risk of several poor pregnancy outcomes. Further and better analyses are necessary to prove this hypothesis not only on the level of study sample but also on general population. Given the fact that thrombophilia certainly affects the pregnancy and its outcome, the urge to perform screening tests in every woman suspected to have this kind of disorder and with respect to differences that exist in different world regions is inevitable. © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Objective: Evaluation of adjuvant insulin therapy effects on glycemic control, perinatal outcome and postpuerperal glucose tolerance in impaired glucose tolerance (IGT) pregnant women who failed to achieve desired glycemic control by dietary regime. Methods: A total of 280 participants were classified in two groups: Group A patients continued with dietary regime and Group B patients were treated with adjuvant insulin therapy. Glycemic control was assessed by laboratory and ultrasonograph means. Pregnancy outcomes were evaluated by prevalence of pregnancy induced hypertension (PIH), high birth weight, neonatal hypoglycemia and caesarean section rates. Postpuerperal glucose tolerance was assessed by oral glucose tolerance test (oGTT). Results: All laboratory and ultrasound indicators of glycemic control had significantly lower values in Group B. Group A women were more likely to develop the EPH (Edema, Proteinuria, Hypertension) syndrome, 20% versus 7.86% (p0.003). High birth weight occurred more frequently in Group A, but the difference was not significant (p0.197). Higher rate of caesarean delivery was in Group A than in Group B, 16.43% versus 26.43% (p0.041). The difference in neonatal hypoglycemia was not significant (p0.478). Pathological oGTT results were observed in 73 Group A patients and in 15 Group B patients. Conclusion: Lower caesarean section rates and the EPH syndrome incidence are the benefits of adjuvant insulin therapy in IGT patients. © 2012 Informa UK, Ltd.