Jinemed Hospital | IVF Clinic

• Prof. Dr Coskun Tunca from Chicago Gynecology-Oncology Center
• Prof. Dr Kutluk Oktay, New York Cornell Hospital.

Treatments
Jinemed Medical Center specializes in infertility treatments that include:

• Intrauterine insemination (IUI)
• In Vitro fertilization (IVF)
• Intracytoplasmic sperm injection treatments (ICSI)
• Gynecological laparoscopic surgeries, including ovarian and vaginal procedures, myomectomy
• and hysteroscopy procedures
• Urogynecology
• Gynecological oncology
• High risk obstetrical care

Currently, Jinemed Hospital also offers a variety of IVF technologies, including:

• Laser assisted hatching
• Embryo freezing
• Ovarian cortex freezing
• Blastocyst transfer
• ICSI ( microinjection)
• TESE (testicular biopsy)

IVF success rates
The hospital carried out 1200 IVF cycles in 2005 with the following success rates (FSH hormone below 10, with normal uterus and with ejaculated sperm):

Below age 38 = 50-60%
Age 38-40 = 40%
Age 40+ = 25%

These figures indicate clinical pregnancy.

Please Click here to request more information from Jinemed Hospital Medical Center.

Mission: Based on evidence-based medicine and state of the art technology, our mission is to provide top quality medical service on a wide range of branches while specializing in Gynecology, and Infertility treatments.

Vision: Our vision is to provide absolute customer satisfaction, and be trustworthy medical centers while contributing to both Turkish and World healthcare.

Hotel Accommodation
IVF Turkey offers both economic hotels, and luxury hotels in Istanbul.

Some of the hotels we work with are the following :

• Ta?l?k Hotel

Please Click here to request more information from Jinemed Hospital.

COST OF IVF

• (one) IVF ICSI cycle price is 1500 GBP (2250 USD) + extra medication 800 GBP ( 1200 USD )
• Package price inc 17 nights double room Hotel stay ( 3 star ) is 2800 GBP ( 4200 USD).
       WIFI Internet in the room is available. Breakfast for 2 is included.
• Package price inc 17 nights double room Hotel stay ( 4 star) is 3200 GBP ( 4800 USD)
       WIFI internet is available. Breakfast for 2 is included.
• Package price with 17 nights double room Hotel stay ( 4+star) is 3500 GBP ( 5250 USD)
        Indoor , outdoor  swimming pool, turkish bath, sauna, fitness center, WIFI.
        Breakfast for 2 is included.
  Airport transfers within Istanbul are also included in the above prices. Airfares, lunch, dinner and clinic-hotel transportations are not included. 

GYNECOLOGY & INFERTILITY ( IVF/ICSI )Jinemed comes from the combination of the words "jinekoloji"  (gynecology) and "medical".

Jinemed has first started as an obstetrics & gynecology group practice in 1989. It has been founded by Professor Dr Teksen Camlibel , FACOG (Fellow American College of Obstetrics & Gynecology) who is a well-known physician with practice experience of 12 years in the USA and 22 years in Turkey. Over the years, with its American and European educated physicians, and best trained Turkish doctors, Jinemed became the top known OB/GYN clinic in Turkey. Consultants come from USA periodically to consult  patients, such as Prof. Dr Coskun Tunca  from Chicago Gynecology-Oncology Center; Prof. Dr Kutluk Oktay, New York Cornell Hospital.

We can divide Jinemed`s specialty into five sections:

• Infertility is the main specialty of Jinemed Hospital. Procedures such as IUI,  IVF/ICSI are performed everyday. Jinemed is also the first private IVF center of Turkey. Mainly, infertility patients who are in need of IVF/ICSI treatment are candidates for medical travel. Jinemed Hospital does over a thousand IVF cycles each year with great success rates.The clinic has also its own andrology lab for male infertility and perform procedures such as TESE (testicular biopsy). Jinemed can also perform ovarian cortex and egg freezing procedures which are the newest, experimental techniques in the world of infertility to stop the premature menopouse
• In Gynecology, all laparoscopic surgeries such as hysteroscopy,myomectomy, ovarian surgery and vaginal procedures are done routinely. Jinemed has ACGE certificated doctors. The ACGE certificate is given by the American College of Gynecologic Endoscopists to physicians who complete long and pain-staking training.
• In Urogynecology, top subspecialists are in Jinemed, who perform TVT, TOT and so on.
• When it comes to gynecologic oncology, Jinemed is one of the pioneers in the field. Dr Teksen Camlibel, the president and medical director of Jinemed, is a gynecologist who trained in the USA, subspecialised in gynecologic oncology. Therefore, gyecologic oncology is one of Jinemed`s most successful branches.
• Jinemed is a high risk obstetrical center with perinatologist and NICU on board. We promote natural birth in home like environment

Female Factor
Causes of Female Infertility

Age Factor
In normal conditions, the chance of pregnancy during a regular unprotected sexual intercourse is % 80 in the first year. In the second year, the chance is %10, in the third year the chance is % 1,2 and in the fourth year %0, 6. After 40 years of age, the chance of pregnancy decreases greatly. Even though ovulation happens, the chance of fertilization is very low.

Problems in the Egg Reserves
A newborn girl has almost 1-2 millions of eggs. This number reduces to 400.000 as the girl approaches the first menstrual cycle. From this moment until the menopausal age, only couple of eggs gets mature in each menstrual cycle. The egg reserve tells us how many eggs the women carry in her body. The number varies from person to person. The determination of the egg reserve is vital for women who will undergo IVF or IVF/ICSI treatment. In these treatments, the goal is to obtain as much quality eggs as possible. If the number is low, the success of the treatment will be lower.Via ultrasound guidance, and certain hormonal tests such as FSH, LH, Estradiol, Prolactin, TSH are being evaluated to determine the egg reserve. It is not possible to treat the egg reserve, to increase its number, but what’s being done is to find out the most applicable treatment method for the patient.

Factors that diminish the egg reserve

• Ovarian surgeries
• Removal of one ovary
• Cysts in the ovary
• Inflammation and infections
• Endometriosis
• Radiation
• Chemotherapy or Radiotherapy
• Smoking
• Age
• Family History

Problems in the Fallopian Tubes :
% 35 of the female infertility consists of problems in the fallobian tubes. Blocked tubes, interior liquids, damage from tuberculosis, cyctic and curvy structure of the tubes reduce the chance of pregnancy tubes.

We ask for HSG ( Hystersosalpingography) ( X-RAY of the uterus and the tubes ) . When HSG is performed, a special radiopaque substance is given with pressure and a possible blockage in the tube can be opened. Therefore, pregnancy may happen and the patient should be informed about this possibility. In order to make a healthier and better decision, hysteroscopy should be performed after the HSG.

Uterine Problems
The lining of the womb ( endometrium) is where the embryo attaches and starts to grow. If this lining is not thick enough, if there are polyps , and myomas , then the embryo cannot attach well to the lining and cannot grow. Therefore, hysteroscopy is the perfect method to find these problems out .

Problems in the Cervix
There are certain liquids in the cervix such as antibodies which kill the sperm We analyze the cervical liquid from the female, the sperm from the man, and also blood samples from both the female and the male.
The best method for this is the IUI ( Intra Uterine Insemination ) which is injecting the fast-motile sperm into the uterus directly. If there is no pregnancy after 3 IUI procdures, then IVF or IVF/ICSI will be used.

Problems in the abdominal lining ( peritoneum)
Abdominal lining can reduce the ability of the fallopian tube to receive the egg inside. For the diagnosis, we use laparoscopy. Laparoscopy is a surgical procedure and allows the physician to see the interior of the abdomen and proceed with the treatment. For example, endometriosis can be diagnosed via laparoscopy and today % 20 of infertile women suffer from this condition

Polycystic Ovarian Syndrome ( PCOS )
This is a fertilization problem during the fertile period of the woman. Almost % 5-10 of women suffer from this condition. There is a hormonal imbalance which prevents the ovaries to function normally. Usually, ovaries get bigger because of certain cycts full of liquids.
Here are some diagnostic findings of this condition,

• None or irregular cycles
• None or irregular ovulation
• Being overweight
• No reaction to insulin
• Hypertension
• High cholesterol level and trigliserid level
• Oily skin
• Increase in hairiness of the face or body
• Hair loss like in men
• The best treatment method in PCOS patients is to loose weight and balance of the insulin level. Afterwards, different kind of medication will be used to treat the ovulation problem. If all these fail, then IVF or IVF/ICSI will be the answer.

Endometriosis
Endometriosis is one of the most important reasons for infertility in women. Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body. Endometriosis lesions can be found anywhere in the pelvic cavity: on the ovaries, the fallopian tubes, and on the pelvic sidewall.Other common sites include the uterosacral ligaments, the cul-de-sac, the Pouch of Douglas, and in the rectal-vaginal septum. In addition, it can be found in caecarian-section scars, laparoscopy or laparotomy scars, and on the bladder, bowel, intestines, colon, appendix, and rectum. In rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, even in the lung, spine, and brain. The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways. Endometriosis can also cause scar tissue and adhesions to develop that can distort a woman’s internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a "frozen pelvis." .

For the diagnosis of endometriosis, laparoscopy is being used. We look if the tissue is present in different places of the lining. The treatment method will be chosen according to the level of the endometriosis

Women's Cancer
 
Our patients are scanned by our doctors specialized on gynecological cancers by means of gynecologic cancers, Pap smear, vaginal ultrasound, blood tests and breast inspections. Jinemed is a women scanning center. It is one of the most appropriate centers to consult on Gynecological Oncology.

• Pap Smear
• HPV Virus
• Wart Infection
• Thin Prep
• Cone Biopsy
• LEEP
• Uterus Cancers
• Irregular Bleedings
• Endometrial Hyperplasia
• Endometrial Polyp
• Myomas, Sarcomas
• Ovarian Cancer, Chocolate Cyst
• Ca 125
• Ca 19-9
• Vulvar Cancers
• Vaginal Cancers
• Breast Cancers

Male Factor
Sperm Extraction and Testicular Biopsy

If there is no sperm in the ejaculate, either PESA, MESA, TESA or TESE will be performed. An Urologist will decide which of these procedures will be the most effective one for the patient. According to this decision, The Urologist and the Embryolog will perform the selected procedure together. Each of these procedures will be performed under local anesthesia.

PESA: Percutaneous testicular aspiration, or non-surgical sperm aspiration, involves entering the testicle with a needle and making multiple passes with a 2-3" 21 g. needle under high negative pressures. This procedure can be performed in the office using only local anesthesia. Typically, fragments of seminiferous tubules become trapped in the tip of the needle and drawn out to the skin. The sperm are found within the seminiferous tubules. This technique is performed for men with obstructive azoospermia. The advantage of this method is that it is non-surgical and easily repetitive. The disadvantage is that the collected sperm may not be enough.

MESA: Microsurgical Epididymal Sperm Aspiration (MESA) With a MESA procedure, under local anesthesia and general sedation, an incision is made in the scrotum, exposing the epididymus, the tubules immediately adjacent to the testicles that collect the sperm. Using an operating microscope, an incision is made into these tubules and sperm is aspirated. Although millions of motile sperm can often be collected, this sperm has not acquired the ability to penetrate an egg and must be injected into eggs via the IVF-ICSI technique. The advantage of MESA over TESE for men with obstructive azoospermia is that sperm collected in this manner can usually be frozen, and even if his partner has to undergo more than one IVF procedure, the MESA should provide adequate sperm for all subsequent IVF procedures.

TESA: The TESA harvests only a few sperm, not enough to perform simple artificial insemination, but enough to inject the sperm directly into the egg in a process called Intra-Cytoplasmic Sperm Injection or ICSI. In order to acquire the eggs, the female partner of the couple will need to undergo In Vitro Fertilization (IVF); this is done in concert with a female fertility specialist, also known as a Reproductive Endocrinologist. The husband is brought to the operation suite and the area is washed with an antibiotic cleanser. Local anesthesia is administered. A needle, which is attached to a silicone rubber tube, is passed across the scrotum and into the testicle. A vacuum is applied by a syringe and a small amount of fluid is removed. After four passes, the recovered material is evaluated in the adjacent lab. When there is enough sperm the procedure is terminated. The sperm is processed and frozen for future use. Typically, there is enough sperm-obtained for at least two cycles of IVF. Sometimes there is not enough sperm retrieved from the aspiration, and a simple biopsy is required. In that case a small incision is made in the scrotum, then in the testicle, and a small amount of tissue is removed. The scrotum is stitched together with suture that dissolves on its own. Usually, enough sperm are harvested from one side, but on rare occasions the other side is aspirated as well. Whether the sperm is obtained via TESA or biopsy, an ice pack is applied and should stay on for as much of the next 24 hours as possible.

TESE: Testicular sperm extraction : This method is being performed if the sperm production in the testis is minimal. An incision is made under local or general anesthesia, so we can reach the interior of the testis. Then, several layers are taken out from the testis and sperm is being searched under special microscopes in the lab. If there are sperm, we separate them from the layer and use them for the ICSI procedure. Microsurgical TESE is very effective and it increased the chance of finding sperm in azospermic patient.

IVF AND JINEMED  When the first "test tube baby" was born in London in 1978, even the doctors couldn't have known how this development would open a new era in treating infertility. Louise Brown was born after years of hard work and several failed attempts. Since that first success, in vitro fertilization (IVF) has provided the key to treating infertility not only in England, but worldwide.

Through IVF, gynecologists learned more about hormonal treatments, and patients gained new hope. Great successes led to the opening of many centers around the world. Jinemed opened the first private IVF center in Turkey, and today has three units serving both domestic and foreign patients. Our patients come from both Europe and the United States.

Currently, we offer the following techniques directly at Jinemed Hospital:

• Laser-Assisted Hatching
• Embryo Freezing
• Ovarian Cortex Freezing
• Blastocyst Transfer
• PGD ( Embryo Biopsy) ICSI ( microinjection)
• TESE ( testicular biopsy)

In order to assist some of our patients while observing Turkish legal restrictions, other treatments such as ovum, sperm, or embryo donation and gender selection with preimplantation genetic diagnosis (PGD) are performed in associated clinics which are located near ?stanbul, just beyond Turk?sh border.

What Every Fertility Patient Should Know
IVF is a wonderful solution to infertility; however, it is not the only solution. We begin with each patient by asking about prior treatments, such as ovulation induction and artificial insemination. We explore with them whether or not IVF treatment will be the best for their needs. At this stage, if male-factor infertility is a possibility, the urologist checks the patient. Necessary hormonal and ultrasound tests are done. We try to resolve male infertility via medication and/or surgery. In women, ovulation problems will be solved first. If blocked tubes are present, laparoscopic surgery will be needed. If taking these first steps does not result in pregnancy, intrauterine insemination (IUI) or IVF should be tried.

I caution patients against believing blanket statements such as the solution for all infertility has been found, or that all couples will have children. Despite great developments, there will be couples who won't have any children. For example, azoospermic males and males from whom no sperm can be found with testicular biopsy procedure (Micro-TESE) have currently no chance of having their own biological child. The same situation exists for women. Women who entered menopause at an early age or who cannot produce eggs have currently no chance of having a biological child. In the future, we expect both males and females may have the option of freezing their sperm and eggs at an early age and use them in the future to solve their infertility. Also, stem cell research looks promising, it may be everyday therapy 5-10 years from now. At present, all women should know about their mother`s menopausal age and if that age is early, they should start considering their "conception plans."

Women should also know that smoking and being overweight decreases the pregnancy chance. Women with PCOS condition should use medications to decrease their blood sugar level; otherwise, the eggs are not of good quality. Endometriosis, on the other hand, affects the implantation of embryos, and decreases the pregnancy chance. If HSG (hysterosalpingography) shows that tubes are blocked (as in the case of a hydrosalpinx) or if inherited anomalies exist in the uterus, laparoscopic sugery will be needed. Also, the importance of myomas or fibroid tumors, the most frequently-found type of tumors in the uterus, has increased greatly. Currently, myomas that expand towards the interior of the uterus are being removed via Hysteroscopy. Myomas on the wall of the uterus or that expand to the exterior of the uterus should be taken out if they are larger than 4 to 5 cm in size.

Why Our Patients Choose Jinemed
Several factors attract a great variety of patients from all parts of the world.

Jinemed's success rates are above the world standards. For women under age 38 and using healthy sperm, the success rates are at 60 percent. Over age 40, this number decreases.

Since becoming the first Turkish clinic to utilize intracytoplasmic sperm injection (ICSI) beginning in 1995, Jinemed now uses the procedure for all IVF cycles. The reason is that ICSI increases the chance of fertilization greatly and has a positive affect on the chances for pregnancy.

We at Jinemed Hospital are proud to have Dr. Kutluk Oktay of Cornell Medical Center in New York as a consultant. By performing the first ovarian cortex freezing procedure in the world, Dr. Oktay is at the forefront of efforts to “stop premature menopause,” so to speak. Our team under his supervision applies his new developments at our center.

Jinemed has also expanded our consultant team with the additions of Dr Mehmet Genc in Perinatology (from Harvard Medical School) and Dr. Josh C. Tunca (of Chicago Gynecologic Oncology Center).

All standard and developing techniques regarding gynecology and obstetrics are being performed by consultants and doctors at Jinemed. Continous research is ongoing for women over age 38 regarding age as a serious factor affecting IVF treatment. The decreased chances are trying to be increased with re-examining of medical protocols. In working against the maternal age factor, Jinemed uses antagonist, letrozol, microflare-up and modified natural and natural cycles, and in vitro maturation (IVM) procedures.

Unlike the case in many European countries, Turkish Law does not limit IVF transfers to two embryos per cycle. Under Turkish Law, a maximum of three embryos can be transferred, increasing chances of pregnancy. Additionally, depending on the patient's age and embryo quality, there is enough flexibility that this number may be increased to four.

Furthermore, ICSI, blastocyst transfers, and assisted hatching are being done routinely for no extra charge. The reason is that the staff of Jinemed wants to increase the pregnancy chances of couples.

Problems
Problems encountered during treatment:
Some problems may occur during the in vitro fertilization or microinjection procedure which would cause the treatment to be discontinued.
These are as follows :

• Formation of cysts: Cysts may develop on the ovaries at the beginning of the treatment due to the medication. Because hormone production continues from the cysts, they may have a negative effect on the development of eggs. For this reason, they must be emptied or the treatment stopped so that the cysts can be shrunk with medication and removed, after which treatment can be resumed.
• Insufficient egg development: In spite of the medicinal stimulation, it is possible that the ovaries will not respond to the treatment and a sufficient number of follicles will not form. This problem is more frequent in patients who already have reduced egg reserves but can happen in any patient. In this situation, it may be necessary to stop treatment and cancel the procedure. However, what the patient wants to do in this situation is also very important.
• Failure to obtain eggs: It is possible to aspirate the follicles that develop on the ovaries and still not obtain any eggs. This condition, known as Empty Follicle Syndrome, may be caused by the patient not having the HCG injection done at the specified time or in the specified amount or it could be the result of the medication itself. In this situation the treatment is terminated because it is impossible to continue to the next stage.
• The man's inability to provide sperm or obtain sperm from the testicles : Knowing whether or not the male has a problem providing sperm makes it possible to take precautionary measures. For this reason, do not hesitate to inform your doctor beforehand if there is such a problem. If the man has no such problem but for psychological reasons is still unable to provide sperm on the day the eggs are collected, then the assistance of a urologist may be requested. However, if this is also unsuccessful, the testicles may be opened to obtain sperm.
• If sperm cannot be obtained from men with azospermia on the day of the procedure, it will be necessary to cancel it. For this reason, even in situations where sperm is known to be present from prior pathology reports, performing a procedure known as testicular sperm extraction before beginning treatment will inform us of the situation before beginning treatment and help us find appropriate solutions.
• Failure to realize fertilization: Failure of the eggs to fertilize even though the sperm and egg are combined in the laboratory occurs with both IVF and micro-injection procedures. This situation is rarely encountered when micro-injection is used for the procedure but may be the result of anomalies in some eggs or sperm. For this reason, it is critical to determine which treatment is most appropriate for which patients. However, if fertilization does not occur, the treatment must be stopped and research conducted to determine the reasons for the failure.
• Failure of the embryo to develop: Sometimes cell division and the development of an embryo does not occur even though fertilization was successful. Again, this may be due to a developmental problem in either the sperm or the egg. For this reason, treatment will be terminated and research will have to be conducted.

Infertility Treatments-INSEMINATION ( IUI )Insemination – placing sperm in a woman`s vagina by means other than sex-is an option to treat infertility in the couple. In most cases, the sperm are treated in a lab to increase the chances for fertilization. Around the time of ovulation, the sperms are placed into the vagina, cervix, or uterus by the doctor. The woman`s partner or a donor may provide the sperm for insemination. It depends on the nature of the problem. Semen from a donor is frozen while the donor is checked to be sure he is free of gecetic disorders and some sexually transmitted diseases ( STDs), including human immunodeficiency virus ( HIV).

Donor procedures are illegal in Turkey, therefore IVF Turkey will assist you in Greece or Cyprus for these procedures. Usually, preparation is made in Turkey, then the couple flies to these countries for the egg collection, ICSI, and Embryo Transfer procedures.

Infertility Treatments-IVM
IVM ( In vitro maturation) = This procedure can be thought of IVF without the use of heavy of medication. Eggs are being collected when they reach 14 mm in size (unlike IVF where the size is usually 17-19 mm), or when egg becomes to get bigger than the others. IVM is preferred usually for patients who suffer from Polycystic Ovarian Syndrome. In PCOS patients, if one egg gets too big, it starts to kill the other ones. IVM is used to prevent this situation. Cycle day 3 Antral Follicle count is needed, which has to be done by a gynaecologist.

PCOS
Polystic ovary syndrome (PCOS) is a disorder in which the ovaries are enlarged and contain many small cysts (fluld-filled sacs). Women with PCOS may have irregular or no menstrual periods.PCOS ia a condition that can last many years and can have a major impact on a women's health.This pamphlet discuses PCOS and explains how it can be treated.

The Menstrual Cycle
An average menstrual cycle is about 28 days, including 5-7 days of bleeding -counting the first day of bleeding as day 1. Normal cycles can vary from 23 to 35 days.During the menstrual cycle,the ovaries produce hormones that prepare the lining of the uterus- the endometrium- for a possible pregnency.

Hormones trigger the menstrual cycle.From about day 5 to 14, the hormone estrogen signals the endometrium to thicken.On about 14,an egg is released from one of the ovaries. This process is called ovulation After ovulation, the hormone progesterone causes blood vessels in the endometrium to swell and other changes to occur in preparation for a possible pregnanncy.

After egg is realeased from the ovary,it moves into one of the fallopian tubes connected to the uterus. If an egg joins with a sperm in the fallopian tube,it is fertilized. After the egg is fertilized, it travels through the follpian tubes to the uterus. It then attaches to the endometrium and begins to grow.

If the egg is not fertilized, the hormone levels decrease,and the endometrium is shed with some bleeding (menstrual period) on about day 28. The first day of the menstrual period marks the strart of the new cycle(day 1).

Pcos occurs as a result of increase in the production of androgens (male hormones by the ovaries and adrinal glands

What is PCOS?
Everyone has both male and female hormones.PCOS occurs as a result of an increase in the production of androgens (male hormones) by the ovaries and the adrenal glands.In PCOS, the ovaries often become enlarged and contain many small cysts. The increase in androgen causes irregular menstrual periods and may stop ovulation. Because of this, women continue to make esterogen, but they do not produce progesterone.

In some women, the presence of estrogen without progesterone increases the risk that the endometrium will grow too much. This is a condition known as endometrial hyperplasia may turn into cancer. PCOS is linked to other diseases that occur later in life, such as diabetes,atherosclerosis,and high blood pressure.
The symptoms of PCOS usually include:

• Irregular menstrual periods or no periods
• Excess hair on the face and body(known as Hirsutism)
• Acne
• Obesity
• Inferrtility

Diagnosis and Treatement
To diagnose PCOS,your doctor will ask you questions about your health and your menstrual cycle.He or she will also perform a complete exam that may include blood tests.The type of treatement you receive depends on your symptoms and whether you want to become pregnent.

To treat irregular menstrual periods ,your doctor may prescribe either the hormone progestrone or birth control pills.Women who wish to become pregnant may be given fertility drugs instead of birth contol pills.

Your doctor may also prescribe birth control pills and other medications to slow the growth of new excess body hair. It may take several months, however, for you to notice any results. To remove unwanted hair sooner.you may want to try electolysis or other hair removal methods.

If you are overweight,losing weight can help relieve the symtoms of PCOS. Weight loss can also help lower the risk of other long-term conditions.

Finally
If you have any symptoms of PCOS, see your doctor. If PCOS is confirmed, follow your doctor's directions carefully. with proper treatment, the condition can be managed and your symptoms can be relieved.

Endometriosis
The Endometrium
The lining of the uterus responds to change that take place during a woman's monthly menstrual cycle.The cycle often is about 28 days. First, the endometrium grows and thickens to prepare for a possible pregnancy. If pregnancy does not occur, the endometrium then thins and is shed by bleeding. These changes are triggered by hormones (estrogen and progesterone) made by the ovaries.

What Is Endometriosis?
With endometriosis, tissue like the endometrium is found in other areas in the body it looks and acts like tissue in the uterus. It most often appears in places within the pelvis:

• Ovaries
• Fallopian tubes
• Surface of the uterus
• Cul-de-sac (the space behind the uterus)
• Bowel
• Bladder and ureters
• Rectum

Endometrial tissue may attach to organs in the pelvis or to the peritoneum. It also may be found in other parts of the body. This is very rare, though. Endometial tissue that grows in the ovaries may cause a cyst (also known as an endometrioma) to form.

Endometrial tissue outside the uterus responds to change in hormones. It also breaks down and bleeds like the lining of the uterus during the menstrual cycle.This bleeding can cause pain, especially before and during your period.

The breakdown and bleeding of this tissue each month also can cause scar tissue,called adhesions. Sometimes adhesions bind organs together. Adhesions also can cause pain.

The symptoms of the endometriosis often worsen over time. In many cases, treatment may help keep the condition from getting worse.

Who Is at Risk?
Endometriosis is most common in women in their 30s and 40s, but can occur any time in women who menstruate. Endometriosis occurs more often in women who have never had chidren. Women with a mother, sister, or daughter who have had endometriosis is found in about three quarters of the women who have chronic pelvic pain.

Symptoms
The main symptom of endometriosis is pelvic pain. Such pain may occur with sex, during bowel movements or urination, or just before or during your menstrual cycle.Menstrual bleeding may occur more than once a month. Severe endometriosis also may cause infertility.

Although these symptoms may be a sign of endometriosis, they could also be signs of other problems. if you have any of these symptoms, see your doctor.

No one is certain of the cause of endometriosis. For most women , a small amount of blood and cells flow through the fallopian tubes into the abdomen during their period. For women with endometriosis, the cells in the blood that flows through the tubes attach to other places and grow. Endometrial cells also may be carried through blood and lymph vessels.

The amount of pain does not always tell you how severe your condition is. Some women with slight pain may have a severere case others who have a lot of pain may have a mild case.

Many women with endomeriosis have no symptoms. In fact, they may first find out that they have endometriosis if they are not able to get pregnant. Endometriosis is found in about one third of infertile women.

Women often find that symptoms are relieved while they are pregnant. In fact , many of the drugs used to relieve symptoms of endometriosis are based on the effects of hormones produced during pregnancy.
 
Diagnosis
If yoy have symptoms of endometriosis, your doctor may do physical exam, including a pelvic exam. If other causes of pelvic pain can be ruled out, your doctor may treat endometriosis without doing any further exams or surgery.

Endometriosis can be mild, moderate, or severe. The extent of the disease can be confirmed by looking directly inside the body. This can be done by laparoscopy (see figure) .

Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy. The tissue then will be studied in a lab. You will be given pain relief for these procedures.

Endometriosis also can be treated during a laproscopy. If endometrial tissue is found during the laproscopy, your doctor may decide to remove it right away.
 
Treatment
Treatment for endometriosis depends on the extent of disease, your symptoms, and whether you want to have children. It may be treated with medication, surgery, or both. Although treatments may relieve pain and infertility for a time ,symptoms may come back after treatment.

Medications
In some cases of endometriosis, medications or NSAIDS(nonsteroidal antiinflammatory drugs) may be used to relieve pain, These drugs will not treat any other symptoms of endometriosis.

Hormones also may used to relieve pain .The hormones also may help slow the growth of the endometrial tissue and may prevent the growth of new adhesions. It will not make them go away, though. Hormone treatment is designed to stop the ovaries from releasing hormones. The hormones most often prescribed include:

• Oral contraceptives
• Gonadotropin-releasing hormone (GnRH) medicines
• Progestin
• Danazol

These medications are not for all women. As with most medications, there are some side effects linked to hormone treatment. Some women may find the relief of pain is worth the side effects.These medications do not relieve pain in all women.
 
Oral contraceptives. Birth control pills often are prescribed to treat symptoms of endometriosis. The hormone in them helps keep the menstrual period regular, lighter, and shorter and can relieve pain. Your doctor may prescribe the pill in a way that prevents you from having periods.

Ganadotropin-releasing hormone. GnHR is a hormone that helps control the menstrual cycle. GnHR agonists are drugs that are much like human GnHR but many times stronger than the natual substance. They lower estrogen levels by turning off the ovaries. This causes a short-term condition that is much like menopause

GnHR can be given as a shot, an implant, ornasal spray. In most cases endometriosis shrinks and pain is relieved with GnHR use. Side effects in women taking this medication may include:

• Hot flushes
• Headaches
• Vaginal dryness
• Thin bones

Treatement with GnHR most often lasts at least 3 months. To help reduce the amount of bone loss from long-term use, your doctor may prescribe certain hormones or medications to take along with Gn HR agonists. In many cases , this therapy also may reduce other side effects. After stopping GnHR treatment, you will have periods again in about 6-10 weeks.

pregestin. The hormone progestin also can be used to shrink endometriosis. Progestin works against the effects of estrogen on the tissue. Although you will no longer have a monthly menstrual period when taking progestin, you may have irregular vaginal bleeding. Progestin is taken as a pill or injection. Side effects in women taking this medication may include:

• Mood changes
• Weight cahnges
• Bloating
• Sexual problems

Danazol . Danazol is another type of hormone that shrinks endometrial tissue. It lowers levels of estrogen and progestrone. It is taken as a pill for at least 6 months You will no longer have a menstrual period while taking danazol. The side effects of danazol may include:

• Weight gain
• Acne
• Deepening of the voice
• Hisutism

Surgery
Surgery may be done to remove endometriosis and the scarred tissue around it. in most severe cases of endometriosis, surgery often is the best choice for treatment. Healthy ovaries and normal follopian tubes are left alone as often as possible.

Surgery most often is done by laproscopy. During laproscopy endometriosis can be removed or burned away. Not all cases can be handled by laproscopy. Sometimes a procedure called laprotomy may be needed .Discuss with your doctor which method may be best for you.

After surgery you may have relief from the pain . Symptoms may return though. Many patients are treated with both surgery and medications to help extend the symptom -free period.

Symptoms return within 1 year in about half of women who have had surgery. The more severe the disease, the more likely it is to return.

If pain is severe and doesn't go away after treatment, a hysterectomy (surgery to remove your uterus) may be an option . Endometriosis is less likely to come back if your ovaries also are removed. After this procedure, a women will no longer have periods or be able to get pregnant.There is a small chance that your symptoms will come back even if your uterus and ovaries are removed.
 
Coping
Endometriosis is a long-term condition. many women have symptoms that occur off and on until menopause. Keep in mind that there are treatment options. A women can work with her doctor in making the right decision for her.

It also may help to talk with other women who are coping with endometriosis. Ask your doctor or nurse to suggest a support group in your area.
 
Finally
Endometriosis can cause pain and infertility. It often can be treated with success. You may need more than one kind of treatment. If you have any symptoms of endometriosis, see your doctor.

Success Rates
Treatment's Success Rate:

The success rate of in vitro fertilization and microinjection is obtained by dividing the number of couples who have children with these methods by the number of couples who begin the treatment process. The global success rate of such procedures is approximately 30%. This percentage reflects the average of every age group. However, if patients are divided into groups by age, there is a success rate of 60-70% among young patients between 20-30 years of age, decline by 50% after age 35 and finally dropping to 25% after age 40. The most important cause of this decline is advanced age and egg reserves of reduced quality and quantity. These percentages are representative of the Turkish population as well. In other words, 30 of every 100 couples that begin treatment end up with a child. However, it would be misleading for every patient to use this percentage when evaluating their own condition because the causes of infertility and age are not the same for all patients who receive treatment.
 

Ovarian cortex Freezing
 For young women with certain types of cancer (breast, lymphomas, etc.), chemotherapy is required which is detrimental for ovarian functions. If these women desire future pregnancy part of the ovaries should be removed and frozen. This is done laparoscopically. Outer layer of the ovary contains numerous eggs which can be frozen and used for ICSI procedures in the future. This new technique seems very promising.

Hysteroscopy
Uses of Hysteroscopy
Hysteroscopy is a minor surgery that may be done in a doctor's office or operating room with local, regional, or general anesthesia. In some cases, little or no anesthesia is needed. the procedure poses little risk for most women. Hysteroscopy may be used for diagnosis, treatment, or both.

Diagnostic Hysteroscopy
Hysteroscopy can be used to diagnose some problems in the uterus. it also can be used to confirm the results of other tests, such as hysterosalpingonraplry(HSG)

The Hysteroscope is sometimes used with other instruments or techniques. For instance, it may be done before dilation and curettage(D&C) or at the same time as laproscopy. In a D&C, the cervix is widened (dilation) and part of the lining of the uterus is removed (curettage).In laproscopy, a slender, telescope like device is inserted into the abdomen through a tiny incision (cut) made through or just below the navel. Hysteroscopy also may be used for other conditions.

• Abnormal Uterina Bleeding. A women has this condition if she has heavier or longer periods than usual, bleeds between periods, or has any bleeding after her periods have stopped at menopause Hysteroscopy may help the doctor and find the cause of abnormal bleeding that other methods have not found. It may be used to take a biopsy
• Infertility. A couple may not be able to achieve pregnancy for a number of reasons. Sometimes the cause of female infertility is related to the defect in the shape or size of the uterus. One example of this is a seperate uterus( a thin sheet of tissue divides the inside of the uterus into two sections). Hysteroscopy may find these problems if other tests do not.
• Repeated Miscarriages. Some women , although able to get pregnant,lose the fetus to miscarriage the loss of a pregnancy before 20 weeks. Hysteroscopy can be used with other tests to help find the causes of repeated miscarriage.
• Adhesions. Bands of scar tissiue, or adhesions, may form inside the uterus. This is called Asherman syndrome. These adhesions may cause infertility and changes in menstrual flow. Hysteroscopy can help locate adhesions.
• Abnormal Growths. Sometimes bening growths, such as polyps and fibroids, can be diagnosed with the hysteroscope, Hysteroscopy mighthelp a doctor to biopsy a growth in the uterus to find out whether it may be cancer or may become cancer.
• Displaced IUDs. An intrauterine device (IUD) is a small plastic device inserted in the uterus to prevent pregnancy. In some cases, it moves out of its proper position inside the uterus. It then embeds it self in the uterine wall or the tissue around it.Sometimes hysteroscopy can be used to locate an IUD.

The uterus is a muscular organ located in the pelvis. It is broad at the top and narrow at the bottom. At each side of the upper part, a follopian tube leads outword toword an ovary. The ovaries contain many eggs,or ova, and normally release one during each menstrual cycle. The tubes carry a fertilized egg from the ovaries to the uterus. The lower end of the uterus, Called the cervix, is a norrow channel with a small opening. It opens into the vagina

Laproscopy sometimes is done along with hiseroscopy
 
Operative Hysteroscopy
When hysteroscopy is used to diagnose certain conditions, it may be used to correct them as well. For instance, uterine adhesions or fibroids often can be removed through the hysteroscope. Sometimes Hysteroscopy can be used insted of open abdominal surgery. Often it will be done in an operating room with general aneshesia.

The hysteroscope is used to perform endometrial ablation -- a procedure in which the lining of the uterus is destroyed to treat some causes of heavy bleeding. after this is done, a women can no longer have children. For this procedure, the hysteroscope is sometimes used with other instruments, such as a laser or a resectoscope. The resectoscope is a specially designed telescope with a wire loop or a rollerball at the end . Using electric current, any of these tips can be used to destroy the uterine lining. Endometrial ablation is done in an outpatientsetting in most cases.

What to Expert
Hysteroscopy is a safe procedure. problems such as injury to the cervix or the uterus, infection, heavy bleeding, or side effects of the anesthesia occur in less than 1% of cases

Before surgery
Hysteroscopy is best done during the first week or so after a menstrual period. This allows a better view of the inside of the uterus.

If you having a hysteroscopy in a hospital, you may be asked not to eat or drink for a certain time before the procedure. Some routine lab tests may be done. You will be asked to empty your bladder. Then your vaginal area will be cleansed with an antiseptic.

Aneshesia
Hysteroscopy may be performed with local,regional, or general aneshesia. The type used depends on a number of factors. This includes whether other procedures are being done at the same time. Where you have your surgery-- in your doctor's office or in the hospital-- also may affect the kind of pain relief used. You will want to discuss your options with your doctor.

Before procedure, your doctor may prescribe a medication to help you relax (a sedative) before the anesthetic is injectd. When a local anesthetic is used , it is injected around the cervix to numb it. You may feel some cramping

With regional anesthesia, a drug will be injected to block the nerves that recieve feeling from the pelvic region. You be awake but will not feel any pain. The anesthetic will be given through a needle or tube in your lower back. This is called a spinal or epidural.

With general anesthesia,you breathe a mixture of gases through a mask. you will not be conscious during the surgery. After the aneshetic tasks effect, a tube may be put down your throat to help you breathe.

The procedure
Before a hysteroscopy, the opening of your cervix may need to be dilated (made wider) with a special device. The hysteroscope then is inserted through the vagina and cervix and into the uterus.

A liquid or gas may be released through the hysteroscope to expand the uterus so that the inside can be seen better. A light shone through the device allows the doctor to view the inside of the uterus and the openings of the fallopian tubes into the uterine cavity. If surgery is to be done , small instruments will be inserted through the hysteroscope.
 
For more complicated procedures, laproscope may be used at the same time to view the outside of the uterus. In this cas, a gas is followed into the abdomen. The gas expands the abdomen. This creates a space inside by rising the wall of the abdomen moving it away from the internal organs. This makes the organs easier to see. Most of this gas is removed at the end of the procedure. This procedure is not done in the office.

Recovery
If local anesthesia was used, you will be able to go home in a short time.If regional or general aneshesia was used , you may need to be watched for some time before you go home.
You may feel a pain in your sholders if laproscopy was done with hystroscopy or if gas was used during hysteroscopy to inflate the uterus. In most cases, the pain passes quickly as the gas is absorbed. You may feel faint or sick or you may have slight vaginal bleeding and cramps for a day or two. get in touch with your doctor if you have:

• A fever
• Severe abdominal pain
• Heavy vaginal bleeding or discharge

Finally
Because hystroscopy allows your doctor to see the inside of the uterus, it may permit a diagnosis of some medical problems. It also may be used to treat them. The procedure and recovery time are brief in most cases.

Laparoscopy
To diagnose certain problems, a doctor needs to look directly into the abdomen and at the reproductive organs. this can be done with laproscopy.

Use of laproscopy
There are several reasons why laproscopy may be recommended. If your doctor suspects that you have a certain problem, he or she may use laproscopy to confirm the diagnosis. Laproscopy may be used if you have problems with infertility or if you want to be sterilized. It is also used to check for ectopic pregnanacy, causes of pelvic pain, and masses.

Besides using the laproscope to look into the abdomen to diagnose a problem , your doctor can use it for treatment as well, for some procedures,laproscopy has replaced the need for Laparotomy.Laproctomy involves opening the abdomen to operate on reproductive organs.

Diagnosis and Surgery
Laproscopy is often used to diagnose causes of abdominal pain.If the doctor finds that he or she can treat the condition during the procedure,diagnostic laproscopy can turn into operative laproscopy. This procedure is used to treat many helth problems.Before undergoing laproscopy, you and your doctor will discuss the procedure and any other treatment.

• Endometriosis. Tissiue like endometrium (the lining of the uterus) some times grows in places outside of the uterus. The tissue bleeds every month, as with a menstrual cycle.This condition is called endometriosis. It can cause pain, scar tissue, and infertility.One way to be certain that endometriosis is present is by laproscopy.Sometimes,endometriosis can also be treated through the laproscope.
• Adhesions. Sometimes tissues in the abdomen stick together and form scar tissue called adhesions.This can happen because of infection, endometriosis, or surgery. Adhesions can cause pain. They often can be seperated during the laproscopy.
• Fibroids. Fibroids are growths that form on the inside,outside,or within the wall of the uterus. Laproscopy can diagnose some fibroids.
• Ovarian Cysts Overies sometimes develop cysts(fluid-filled scas). These cysts may be harmless, causing only mild pain. Some cause infertility or menstrual disorders. Some ovarian cysts may disappear after a short time. If they don't , your doctor may choose to remove them during laproscopy.
• Hyserectomy. The laproscope can used to assist in a vaginal hysterectomy(removal of the uterus through the vagina). The laproscope is used to help the doctor see inside the abdomen during part of the surgery. laproscopy can also assist with the removal of the ovaries. It can be done to remove ovaries alone. whether or not the uterus has already been removed.

Infertility and sterlization
Women who have trouble getting pregnant may have laproscopy to find problems like endometriosis or cysts. With laproscopy, your doctor can also tell whether the fallopian tubes are blocked.
 
Laproscopy is also used for Sterilization. In this operation , the doctor uses the laproscope as a guide to block the fallopian tubes by cutting, clipping, or burning them. It is meant to be a permanent method of birth control.
 
Ectopic Pregnancy
When a women has pain in her lower abdomen during early pregnanacy, the doctor may suspect an ectopic pregnancy, An ectopic pregnancy is one that may be located in the tube instead of the uterus. It may rupture the tube and cause abdominal bleeding that may require emergency surgery. The doctor can perform a laproscopy to diagnose and often treat an ectopic pregnancy.
 
Benefits of Laproscopy
In the past, most surgery involving reproductive organs was done by laparotomy. Now , many of these same procedures are done through the laproscope. There are many benfits to laproscopy- a shorter hospital stay , smaller incisions, and a shorter recovery.
 
The Procedure
You will be given medication to block the pain before the doctor begains the laproscopy. The anesthesia used depends on the type of procedure, your doctor's advice, and your personal choice. General anesthesia is usually used so that you will not be awake. If local or regional anesthesia is used , you will be awake.

After the anesthesia is given, small cut is made below or inside the navel. A gas, such as carbon dioxide or nitrous oxide, is usually put into the abdomen. The gas swells the abdomen so the pelvic reproductive organs can be seen more clearly.

Your body will be tilted slightly with your feet raised higher than your head. This shifts some of the abdominal organs toward the chest and out of the way.

The laproscope is placed through the cut. Another cut is often made above the public region. Through this cut , an instrument is used to move the organs into view. One to four small cuts may be made, 1/4- 1/2- inch wide. A device called a uterine manipulator may be placed in the uterus through the vagina to move the uterus during the procedure.

Usually, the laproscope projects images of the surgery onto a television screen. This makes the image larger and easier for the doctor to see. These images can be photographed for later viewing.

Other surgical instruments can be inserted through the scope or through another small cut.

Various types of instruments can be used:

• edical surgical instruments, such as scissors, forceps, and clamps.
• Electosurgical instruments that use electric current through the laproscope to perform surgery.
• Laser that use a high-energy light beam to perform the same procedure as electosurgery.

After the rocedure, the instruments are removed and the gas released. The cuts are then closed, usually with stitches that dissolve. In a few hours you can go home.You should plan to have some one take you home and stay with you, at least for awhile.
 
Possible Problems
Although problems seldom occur with laproscopy, there some coplications. You may have some bleeding, reactions to the anesthesia, or injury to the other organs. The most common organs injured during the procedure are the blood vessels that surround the lower abdomen, the bowel, and the urinary tract. A follow-up laparotomy may be needed, which will require thatyou be admitted to the hospital. There is also a risk of infection after the procedure.
More common problems include:

• Nausea
• Pain around the cuts made in your abdomen
• Scatchy throat if a breathing tube was used during general anesthesia
• Abdominal cramps
• Discharge(like your period) that lasts a few days
• Swollen abdomen
• Tender navel
• Shoulder pain

Call your doctor if you are bleeding from incision, if you have fever, or if you are unable to urinate.

Recovery
The recovery time from laproscopy is much shorter than that from regular surgery. It is safe to resume normal activities as soon as you feel up to it, usually within a few days. If you are sexually active, talk with your doctor about when you can have sex again.
 
There are many benfits to laproscopy-- a shorter hospital stay, smaller incisions, and a shorter recovery.
 
Hysterectomy
Hysterectomy- the removal of the uterus-- is a way of treating problems that affect the uterus. Because it is major surgery, your doctor may suggest trying other treatments before hysterectomy. For severe conditions- and those that have not resonded to other treatment-- a hysterectomy may be the best choice. The choice depends to some extent on the effect of the condition, and the surgery, on your life. You shold be fully informed of all options before you decide.
This pamphlet explains:

Types of hysterectomy
Why it might be needed
Effects and risks of treatment

About the Uterus
The uterus is a muscular organ in the pelvis. The opening of the uterus is the cervix.In pregnancy the uterus holds and nourishes the fetus.In labor,it contracts to deliver the baby. When a women is not pregnant, the lining of the uterus(the endometrium) is shed each month in her menstrual period.

Sometimes, there are problems with uterus. A women may have pain or heavy bleeding . Growth or cancer also can occur. These problems require treatment.

Conditions Affecting the Uterus
Hysterectomy may be done to treat conditions that affect the uterus. Some are bening(not cancer).Others are cancer. Some have symptoms that cause discomfort. Others can be treaten your life.

Your condition may be treated with medicine or various types of surgery, including hysterectomy. The choice of treatment depends on the nature and extent of your condition. It also depends on personal factors. These factors include your plan to have children in the future, the amount of discomfort you are having, and other options avaliable.

Other forms of treatment often are tried first. If they don't work, your doctor may suggest hysterectomy. Following are some of the conditions for which hysterectomy may be performed.

The pelvic organs before(left) and after (right) the uterus is removed

Uterine Fibroids
Uterine fibroids (myomas) are the most common type of growth found in a woman's pelvis. They are bening and can don't cause symptoms or need to be treated.

If fibroids growth, they may cause pain. They may press against the bladder and other pelvic organs. Fibroids that press against the lining of the uterus may cause irregular or heavy bleeding.

Fibroids tend to shrink after a women goes through menopause. If a woman with fibroids is near menopause, she may want to see how it affects her fibroids before trying any treatments.

Some medications can shrink fibroids. However, they work only as long as they are taken. Once they are stopped, the fibroids may grow again. These medications can help women near menopause who have symptoms. The medicine used to shrink fibroids can cause bone loss if it is used for too long. Therefore, it is used for just a few months in most cases.

Medicine also may be used briefly to shrink fibroids before surgery, such as myomectomy. In myomectomy, only the fibroids are removed. The uterus is left in place. Sometimes, a myomectomy canot be done . Then the whole uterus must be removed to relieve symptoms.

Abnormal Uterine bleeding
Abnormal uterine bleeding is irregular, heavy, or severe bleeding from the uterus. It may be caused by fibroids or by hormonal changes. It also may be caused by infection of the uterus or cancer.

Treatment is aimed at the cause of the bleeding. Hormone therapy may help control the bleeding.
If you have lost a lot of blood, you may not have enough iron. Iron may be given to build your stores, but it will not stop the bleeding . hysterctomy may be an option if other treatments don't work and the bleeding is a problem for you.
 
Fibroids may appear on stemlike structure or be attached directly to the inside or outside of the uterus.

Cancer
Over time, diseases of the cervix can develop into cancer. They can progress quickly or develop slowly over years. It depends on the person and the extent of the disease. Changes of the cervix that may lead to cancer can be detected by a Pap test. If they are diagnosed early,they can be treated with success without a hysterectomy.

Disease of the cervix becomes serious-- invasive cancer--when it moves into deeper tissue layers or spreads to other organs. Cancer also can affect the lining of the uterus and the ovaries. In some women with these cancers, radiation and other treatment may control the disease. In other women ,hysterectomy may be the only way to stop the cancer from spreading to other organs.

Pelvic support problems
The pelvic organs (bladder, uterus, rectum, and intestines) are supported by muscles, ligaments, and fiscia (tough sheet of tissue). The ligaments and fascia may be weak and not able to support these organs. This may occur because of obesity, chronic cough, or streching in childbirth. This can allow the pelvic organs to sag or even stick out through the opening of the vagina. There may be a "bearing-down" feeling of pressure in the pelvic region and problems in controlling urine.

There are things you can do to ease these problems. Avoid doing things that strain the pelvic muscles:

• Stop smoking
• Lose weight
• Avoid constipation by getting plenty of fluids and fiber in your diet.

You can strengthen your pelvic muscles by doing kegel exercises. Your doctor or nurse can show you how. you also can be fitted with a pessary( a device placed in the vagina that holds the organs in place). If you are past menopause, taking hormones may help keep the tissiues more flexible and less apt to stretch.
Sometimes surgery can be done to put the organs back in place. If other treatment falls, a hysterectomy may be needed to corerrect pelvic support problems.

Endometriosis:
Cells like those lining the uterus also may grow on the ovaries, fallopian tubes, and other pelvic structures. This is called endometriosis. Pathes of endometriosis may bleed at the menstrual period or at other times. The blood may build up in cysts. Endometriosis may cause scarring, adhesions, pain, or infertility.

The condition mostly affects women who are of childbearing age. In most cases, it is not a problem after menopause because a woman no longer has menstrual periods.
 
About Hysterectomy
There are three types of hysterectomy:

• partial(or subtotal), in which the upper part of the uterus is removed but the cervix is left in place
• Complete(or total), in which he entire uterus, including the cervix, is removed
• Radical, in which the entire uterus, lymph nodes, and support structures around the uterus are removed. This is done if cancer is present and extensive.

The ovaries and follopian tubes be removed at the same time. This is called a salpingooophorectomy
the uterus may be removed through a cut in the abdomen or through the vagina. The method used depends on the reason for the surgery and the findings of a pelvic exam.

During a vaginal hysterectomy, some doctors use a laproscope to help them see inside the abdomen and do part of the surgery. This procedure is called laparoscopically assisted vaginal hysterectomy (LAVH).

Before the procedure:

• Your blood and urine will be tested.
• You may be given one or more enemas
• Your abdominal and pelvic areas may be shaved.
• Antibiotics may be given to prevent infection.
• A needle may be placed in your arm or wrist. (It is attached to a tube that will supply your body with fluids,medication, or blood. This is called an IV line)
• Monitors will be attached to your body before anesthesia (pain relief) is given. (you may be given a general anestesia, which puts you to sleep, or a regional one, which blocks out feeling in the lower part of your body.)

Risks
As with any surgery, problems may occur. These could include:

• Thrombophlebitis (blood clots in the veins or lungs)
• Severe infection
• Bleeding after surgery
• Bowel blockage
• Injury to the urinary tract
• Problems related to aneshesia
• Death

Although the risks of hysterectomy are among the lowest of any major surgery, you and your doctor must weigh the benfits and risks.
 
After surgery
The length of stay in the hospital after hysterectomy varies by the type done. You can expect to have some pain for the first few days. Normal activities, including sex, can be resumed in about 6 weeks in most cases, Meanwhile, don't put anything in the vagina.

As you recover, activities such as driving , sports, and light physical work may be increased slowly.You and your doctor can plan your return to normal activities. If you can do an activity without pain and fatigue, it should be akay. If activity causes pain, discussit with your doctor.

The surgery can have other effects that are both physical and emotional. Some last briefly. Others are long term. You should be aware of these effects before having a hysterectomy.
 
Physical
After hysterectomy, a woman's periods will stop. She can no longer get pregnant. The ovaries still produceeggs. But, becausethe eggs are not fertilized, they dissolve in the abdomen. If the ovariesare left in place, Though, They still produce hormones, A women who still has her ovaries will not have the symptoms that often occur with menopause, such as hot flashes.

If the ovaries also are removed with the uterus before menopause, there are removed with the uterus before menopause, there are hormone-related effects. It is as though the body goes through menopause all at once, rather than over a few years as is normal. Symptoms often can be treated with the hormone estrogen.
 
Emotional
Many women have a brief emotional reaction to the loss of the uterus. This response depends on a number of factors:

• How well they were prepared for the procedure
• Timing of the procedure
• Reason for having it.
• Whether the problem is cured

Some women may feel depressed because they can no longer have children.If problems persist, discuss them with your doctor.
 
Hysterectomy and sex
Some women may notice change in their sexual response after a hysterectomy. Beacause the uterus has been removed, uterine contractions that may have been felt during orgasm will no longer occur.
 
However, some women have a heightened response. This may occur because they no longer have to worry about getting pregnant and may be relieved of discomfort.
 
If the ovaries have not been removed, the outer genitals and the vagina are affected .In this case, a woman's sexual activity often is not impaired. If the ovaries are removed with the uterus, vaginal dryness may be a problem during sex. Use of estrogen can help relieve dryness.
 
If the procedure required making the vagina shorter, deep procedure thrusting during sex may be painful. Bein on top during sex or bringing your legs closer together may help.
 
Ovarian Drilling
Laparoscopic Ovarian Drilling ( LOD) . The outer layer of the ovary will be drilled from 8 or 10 different positions. This changes the hormonal activities and FSH starts to get greater. More eggs get produced, which is an essential part of infertility treatments. In our associated centers 50 percent of women get pregnant through this procedure. This procedure is also preffered for PCOS patients whose LH hormone levels are greater than FSH levels which affects ovulation negatively.

Myomas
Myomas are none-cancer tumors which stem from the uterine murcle. Uterus is a mass of muscles and myomas are tumors that come from this muscle tissue. This mass of muscle is needed to push the baby out of the uterus. Myomas are one of the most frequently seen women diseases. According to the statistics , 20 % all women have myomas and the number increases to 40 % for women above the age 35. Women do not complain about myomas and their presence is sometimes recognized understood through pelvic examination.

Myomas expand towards the exterior of the uterus , some of them stay inside the muscle and some of them expand towards the interior where the menstrual bleeding happens. Myomas expanding to the interior may cause irregular menstrual bleeding. The ones in the lining though may cause pain during the menstrual bleeding, as well.

There is not an cause of why myomas occur. But, inheritance is a common factor.

Myomas increase their size with the estrogen hormone. The hormone is more active while using fertility medications or during IVF cycles. Therefore medications increasing the estrogen are not given to patients with myomas. Myomas may also cause miscarriage during the pregnancy. Today, the medical opinion on myomas is that they need to be taken out if they expand to the interior of the uterus which will increase the chance of pregnancy and decrease the chance of a miscarriage.

If myomas, expanding toward the exterior and the ones that stay in the muscle, are over 5cm, they are also removed. This is usually done for patients suffering from infertility.

Myomas can reoccur and increase in number through out the time.

It is known that some patients even had 40 myomas which mean that many surgeries need to be done. If a patient has completed his family and close to the menopausal age, sometimes the uterus is being taken out in order to save the patient from future surgeries.

If there is no change in the myomas after the menopause then their removal is not necessary.
 
Tubal Reversal
Fallopian tubes may be blocked by some reasons such as infection, previous surgery, some immunological problems etc. After excision of damaged area reanastomosis of both healthy ends can be performed to obtain tubal patency. However pregnancy rate after such an operation is approximately 30% in advanced centers. This rate may be different according to place and type of obstruction. If there was a prior surgery, then doctors need to know how the tubes were tide.

Some questions will be the following :
1.Has the surgery done laparoscopically ceuterised ?
2.Is it ligated post-portum after cesarean and normal birth ?

A HSG report ( hysterosalpingography) will be needed to determine the depth of the canal. The tube canals are almost 10- 12 cm in size. 5-6 cm will be required to perform the tubal reversal.

The stay for the tubal reversal is 2 days + maximum 5 days after surgery, totaling 7 days alltogether.

Please Click here to request more information from Jinemed Hospital.

IVF TEAM

Professor Teksen CAMLIBEL,MD, FACOG
(Fellow, American College of Obstetrics & Gynecology)

EDUCATION

• High School: Science High School, Ankara, Turkey
• Medical School: Cerrahpa?a Medical School, Istanbul, Turkey

OBSTETRICS & GYNECOLOGY INTERNSHIP

• 1974 - 75 Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.

OBSTETRICS & GYNECOLOGY RESIDENCY

    1975-79 Medical College of Ohio, Toledo, Ohio, U.S.A.

FELLOWSHIP

    1979-1981 Albany Medical Coll>ege, Albany, New York, U.S.A.

ACADEMIC APPOINTMENS

• 1981-1984 Clinical ?nstructor of Obstetrics & Gynecology, Albany Medical College, New York
• 1981-1984 Assistant Professor of Obstetrics & Gynecology, Albany Medical College, New York, U.S.A.
• 1985-1987 Chairman & Associate Professor of Obstetrics & Gynecology, Marmara Medical School, Istanbul, Turkey
• 1989-1997 Chairman of Obstetrics & Gynecology, International Hospital, Istanbul, Turkey
• 1997-2002 Chairman of Obstetrics & Gynecology Kadir Has University Medical School, Metropolitan Hospital, ?STANBUL
• 1999-now Professor of Obstetrics & Gynecology, Kadir Has University Medical School, Istanbul, Turkey

LICENCES

• Michigan State Licence
• Ohio State Licence
• New York State Licence
• Turkish Medical Licence

CERTIFICATIONS AND MEMBERSHIPS

• American Board of Obstetrics & Gynecology
• Fellow, American College of Obstetrics & Gynecology
• Member, American Association of Gynecologic Laparoscopist
• Member, American Society of Reproductive Medicine
• Advanced Operative Hysteroscopy and Gynecologic Laparoscopy Certificate American Council For Gynecologic Endoscopy
• Member, European Society of Human Reproductive Endocrinology
• IVF Specialist Certificate, TURKEY

AWARDS

• 1974 - NO.1 Graduate of Medical School
• 1977 - Best Baper of Obstetrics & Gynecology Residents, CINCINATI, OHIO

PUBLICATIONS:

• Çamlibel FT. Spontaneous rupture of uterus by placenta percreta. New York State Journal of Medicine. 3:1373-1376, 1981.
• Çamlibel FT. Caputo TA. Chemotherapy of granulosa cell tumors of ovary. Am J. Obstet Gynecol. 145:763-765, 1983
• Çamlibel FT. Promiscuity and Cervical Cancer. Cerrahpasa Med. Rev. 3:5-10, 1984.
• Çamlibel FT. Propnostic Influence of Peritoneal Cytology In Endometrial Cancer. Cerrahpasa Med. Rev. 3:24-30, 1984.
• Çamlibel FT. Caputo TA, Ryan N. Perforation of Uterus By Invasive Mole: A Case Report Cerrahpasa Med. Rev. 3:43-47, 1984.
• Çamlibel FT. Müllerian Adenosarcoma Case Report and Review of Literature Cerrahpasa Med. Rev.3:48-52, 1984.
• Çamlibel FT. Caputo TA. Estrogen receptor in ovarian cancer and patient survival. Acta Reprod Turc 8:21-26, 1986.
• Çamlibel FT. Correlation of amniotic fluid Lecithin-Sphyngomyelin Ratio (L/S) and optical density at 650nm (OD 650) with the development of fetal respiratory distress syndrome (RDS). Acta Reprod Turc 7:66-73, 1986.
• Çamlibel FT. Joshi S. Study on response to progestins in endometrial cancer. Acta Reprod Turc 8:48-58, 1987.
• Pekin S, Ceylan N, Çamlibel T, Gerçel G. Intraperitoneal cisplatin with systemic thiosulfate protection. (Abst) Marmara Medical Journal. 1:109, 1988.
• Çamlibel T, Akbasak BS. Direct intraperitoneal insemination (DIPI) of husband?s washed sperm. (Abst) Marmara Medical Journal. 1:112, 1988.
• Akbasak BS, Çamlibel T. Total functional sperm fraction measurements; benefits of sperm washing and swim-up methods. (Abst) Marmara Medical Journal. 1:111, 1988.
• Çamlibel FT. Prognostic influence of peritoneal cytology in endometrial cancer. Marmara Medical Journal. 2:6-9, 1989.
• Demircan A, Çamlibel T, Atasü T, Kervancioglu E, Sarikamis B, Turner P, Gent JM, Djahanbakch O. In vitro fertilization performance of non-responders in repeat cycles, Abstract Book (10th Annual Meeting of ESHRE, Brussels 1994) Abst no 537, p 196, 1994.
• Demircan A, Atasü T, Çamlibel T, Kervancioglu E, Sarikamis B, Turner P, Gent JM, Djahanbakch O. Ovarian cyst formation following gonadotrophin-releasing hormone agonist use and the outcome of stimulation cycle. Abstract Book (10th Annual Meeting of ESHRE, Brussels 1994) Abst no 572, p 207, 1994.
• Erkan S, Çamlibel T, Ünlüer Z, Sarikamis B, Çepel E, Insel H. Routine scrotal doppler sonography of infertile men. Abstract Book. II Int. Congress on Andrology, Turkey, p 78, 1995.
• Engür A, Basaran S, Karaman B, Çamlibel T, Yüksel Asak M. Cytogenetic Findings in 123 Spontaneous Abortuses. (2nd Congress of Balkan Human Genetics, Istanbul, 1996) Abs no b 46.
• Kervancioglu ME, Saridogan E, Atasü T, Çamlibel T, Demircan A, Sarikamis B, Djahanbakch O. Human fallopian tube epithelial cell co-culture increases fertilization rates in male factor infertility but not in tubal or unexplained infertility. Human Reproduction. 1253-1258, 1997.
• Karacan M, Çamlibel FT, Kolankaya A, Sarikamis B, Atasü T, Djahanbakch O. Serum CA-125 levels do not predict outcome of intracytoplasmic sperm injection embryo transfer cycles. In Vitro Fertilization and Assisted Reproduction. Gomel V, Leung PCK (Eds). 919-922, 1997.
• Demircan A, Kervancioglu E, Çamlibel FT, Sarikamis B, Karacan M, Atasü T, Kolankaya A, Djahanbakch O. Late intracytoplasmic sperm injection (ICSI) should it be considered as an alternative method? In Vitro Fertilization and Assisted Reproduction. Gomel V, Leung PCK (Eds). 941-944, 1997.
• Çamlibel T, Cankat D. Congenital Urogenital Malformations in infants concieved by Intracytoplasmic Sperm Injection. Pediatr Nephrol 13 (7): C 31, 1999.
• Mocan H, Aksoy A, Çamlibel T. Serum carnitine in children with nephrotic syndrome. Pediatr Nephrol 13 (7): C 63, 1999.
• Çamlibel FT, Mocan H, Kutlu N, Kutlu N. Roberts SC Phocomelia with isolated cleft palate, thrombocytopenia, and eosinophilia. Genetic Counseling Vol. 10, No 2, 1999, pp. 157-161
• Çamlibel T, Mocan H, Kutlu N. Roberts SC: Phocomelia with isolatedcleft palate, thrombocytopenia and eosinophilia. Genetic Counseling 10: 157-161, 1999.
• Mocan H, Yildiran A, Çamlibel T, Kuzey M.: Microscopic Nephrocalcinosis and Hypercalciuria in Nephrotic Syndrome. Human Pathology 31 (11): 1363-1367, 2000.
• Karacan M, Erkan H, Karabulut O, Sarikamis B, Çamlibel T, Benhabib M.:Clinical pregnancy rates in an IVF program. Journal of Reproductive Medicine 46:5, 485-9: 2001.

Doctors
Upon request, female patients can be treated by female doctor

EMRE YAZICIOGLU, MD

EDUCATION
Ankara Deneme High School 1974
Istanbul University 1980

INTERNSHIP
Belfast Royal Maternity Hospital, Ireland

RESIDENCY
Hacettepe University School of Medicine. 1987

COMPULSORY SERVICE
Boyabat State Hospital

EXPERIENCE
International Hospital from 1989 to 1997
Jinemed since its inception

MERIC KARACAN, MD

EDUCATION
The Istanbul School of Medicine in 1987

RESIDENCY
Cerrahpa?a School of Medicine

POST GRADUATE
Reproductive Endocrinology department at the State University of New York
Robert Wood Johnson University in the USA from 1992-1995.

EXPERIENCE
Director of IVF Center at the International Hospital Istanbul. from 1998-2003
Director of IVF center at Jinemed Hospital since 2003

MUNIP BERBEROGLUGIL, MD
EDUCATION
Uccle Royal High School in Brussels, Belgium 1986
Brussels Free University School of Medicine in 1993.

RESIDENCY
Gynecology Service of Saint Pierre Hospital in the Universite Libre de Bruxelles (ULB), 93-98

EXPERIENCE
Saint Pierre Hospital in the Universite Libre de Bruxelles
Member of Laparoscopic Gynecological Surgery & IVF Team at the same hospital
Laparoscopic Gynecological Surgery Unit at New York Columbia University Presbyterian Hospital, supervised by Prof. Harry Reich.
Director of IVF center at Jinemed-Kalam?? Medical Center since 2000

MUSTAFA KIR , MD
EDUCATION
Kabata? Boys High School 1983
Hacettepe University English Language Medical School in 1990

RESIDENCY
Marmara University School of Medicine specializing in gynecology.

EXPERIENCE
Department head at Marmara University Medical School's Vakf? Academic Hospital.
Perinatology Department at SUNY Stony Brook,NY in 2000
Michigan University Hospital from 2002-2003.
Certification from the 11-14th Week Nuchal Scan Program.

MEMBERSHIPS
Turkish Perinatology Association
FMF (Fetal Medicine Foundation)

MELIKE BATUKAN, MD

EDUCATION
Istanbul School of Medicine in 1997

EXPERIENCE
Researcher in the Gynecology Department of the Istanbul School of Medicine from 1997-2000.
She conducted research on fetal dopplers from 2000-2002, submitting the results in her specialty thesis.
In 2002, she served as a consultant on efforts to set up the necessary health infrastructure in Afghanistan on a special assignment with the Ministry of Foreign Affairs.
In 2002, she also worked with a perinatolgy research group in Athens

ZIYA CEBI, MD

• University: University of  Trakya, 1991
• Asistanship: Suleymaniye Hospital, Obstetrics and Gynecology Department
• Specialist: Suleymaniye Hospital, Obstetrics and Gynecology Department
• He graduated from University of Trakya in 1992 and completed residency in Suleymaniye Hospital, Department of  Obstetrics and Gynecology in 1998.
• He started working in Suleymaniye Hospital, Obstetrics and Gynecology Department as a  specialist.
• He worked for 4 years in Department of  Gynecology – Obstetrics.
• He studied in University of Ege, Department of In Vitro Fertilization for 6 months in 2001.
• He was the founder of IVF Department in Suleymaniye Hospital and worked as a director until 2007.
• He joined to Jinemed Clinics – Istanbul in 2007 and has been a specialist in IVF team.

NIHAL CAMLIBEL, MD

EDUCATION
Valedictorian of Izmir ?ehit Fethi Bey High School in 1981
Ege University 87
Master's degree in Health Institution Administration Marmara University

RESIDENCY
Cerrahpa?a School of Medicine from 1990-1995, where she specialized in anesthesiology and recovery.

EXPERIENCE
Anesthesiologist in the Metropolitan Florence Nightingale Hospital and World Eye Hospital.
Jinemed - Kalam?? Medical Center.

MUGE ADIL, MD

EDUCATION
Tarsus American College 87
Istanbul University Cerrahpa?a English Language Medical School in 1994.

RESIDENCY
Marmara University School of Medicine from 1998-2003, specializing in Anesthesiology and Recovery.

EXPERIENCE
Jinemed team since January of 2005.

MURAT ULUG, Embryologist
EDUCATIONAnkara University Biology Department 1993
Masters at Ankara University Institute of Sciences 1994
Masters degree on Medical Biology and Genetics at Kadir Has University Health Sciences Institute 2004

EXPERIENCE
IVF Department at Ankara University Sciences Institute 96-01
Director of Embryology Laboratory at Jinemed since 01

AYSE ARVAS, MD

EDUCATION
Istanbul University School of Medicine 1995 PHD degree on Hystology - Embryology at KTU Medical Faculty

EXPERIENCE
Research Assistant at KTU Medical Faculty Founded IVF center of Turkiye Hospital in 2001-2004 Joined the Jinemed Team on 2004

ROMINA PAKERTIK, IVF COORDINATORRomina is in touch with our foreign patients when they are in Istanbul. Patients come directly to her desk in the hospital before doctor and nurse appoinments. Romina is also in charge of the patients when they are outside of the hospital and have questions for her simply about everything.

Education :

• She was graduated from Anadolu University Department of Public Relations.
• She attended Public Relations and Advertising training for 2 years.
• She has a certificate from Bogazici University Department of English in advanced level.
• Experience :
• She was a part of Educational Volunteers and taught English to primary school students in 2004.
• She has been with Jinemed Hospital  since May 2006.

Prof. Dr. Coskun TUNCA

EDUCATION:

• 1962-1968 M.D. - Istanbul University, Cerrahpasa Medical School - graduated with honors Istanbul, Turkiye

POSTDOCTORAL TRAINING:

• June 1968-June 1969 Rotating Internship New Hanover Memorial Hospital
  Wilmington, North Carolina, USA
• July 1969-July 1973 Residency in Obstetrics & Gynecology
  Bowman Gray School of Medicine
  Wake Forest University
  Winston Salem, North Carolina USA
• July 1973-September 1975 Fellowship in Gynecologic Oncology
  Emory University School of Medicine
  Atlanta, Georgia, USA
• 1978 - 1980 Fellowship - American Cancer Society
• LICENSURE: Flex - Illinois - 1972
  Reciprocity: North Carolina - 1973
  Georgia - 1973
  West Virginia - 1975
  Wisconsin - 1977

CERTIFICATIONS:

• 1975 Diplomat - American Board of Obstetrics
  & Gynecology
• 1977 Advanced Certification
  American Board of Obstetrics & Gynecology
  Division of Gynecologic Oncology

ACADEMIC APPOINTMENTS:

• 1975 - 1977 Assistant Professor & Director
  Division of Gynecologic Oncology
  Department of Obstetrics & Gynecology
  West Virginia School of Medicine
• 1977 - 1982 Assistant Professor
  Division of Gynecologic Oncology
  Department of Obstetrics & Gynecology
  Wisconsin School of Medicine
• 1982 - 1984 Chief & Associate Professor
  Division of Gynecologic Oncology
  Department of Obstetrics & Gynecology
  University of Illinois at Chicago
• 1984 - present Clinical Associate Professor
  Division of Gynecologic Oncology
  Department of Obstetrics & Gynecology
  University of Illinois at Chicago

PRIVATE PRACTICE:

• Chicago Gynecologic Oncology, S.C.
• November 1984-June 1988 Des Plaines, Illinois
• October 1986-May 1993 Arlington Heights, Illinois
• June 1988 - present Schaumburg, Illinois
• June 1994 - present Elk Grove Village, Illinois
• August 1996 - present Vernon Hills, Illinois
• February 2000 - present Geneva, Illinois

SOCIETIES:

• American College of Obstetricians &
• Gynecologists, Fellow
• American Medical Association
• American Society for Colposcopy & Colpomicroscopy
• American Society of Clinical Oncology
• Association of American Physicians and Surgeons
• Chicago Medical Society
• Chicago Medical Society, Irving Park Branch, President
• Gynecologic Oncology Group
• Illinois State Medical Society
• Society of Gynecologic Oncologists

COMMITTEES:

• Member of Department of Obstetrics & Gynecology
  - Seventeen affiliated hospitals
• Member of Tumor Board
  - Alexian Brothers Medical Center
  - Northwest Community Hospital
  - Sherman Hospital
• Member of Cancer Committee
  - Alexian Brothers Medical Center
  - Good Shepherd Hospital
• Member of Medical Care Evaluation Subcommittee
  - Sherman Hospital
• President of the Medical Staff
  - Northwest Community Hospital

RESEARCH:

• 1973 -Herpes Virus Type II associated antigen detection by
  fluorescence antibody technique in the dyplastic and
  carcinoma in situ cells; with Dr. Andre Nahmias, Emory
  University School of Medicine, Atlanta, Georgia.
• 1974-1977 -Cervical cancer induction with herpus virus Type II in
  cebus monkeys; with Dr. Andre Nahmias, Atlanta, Georgia.
• 1975 -Isolation of human tumor associated antigens (cervical
  and ovarian cancers); with Robert Veltri, Ph.D., West
  Virginia University School of Medicine, Morgantown,
  West Virginia.
• 1976 -Investigation of human cervix uteri squamous epithelium
  metaplasia through induction of tissue cultures of human
  cervical columnar epithelial tissue; with David Yelton,
  Ph.D., Wets Virginia School of Medicine.
• 1977 -Human ovarian tumor cell culture and cell line and
  ovarian tumor markers investigation; McArdle Institute,
  collaboration with Dr. Gerald Mueller and Dr. Kazuto
  Kajiwara, University of Wisconsin Medical School.
• -Chemical induction of ovarian cancer in the rat model.
• -Development of ovarian cancer cell lines in culture
  after D.V.M., with Edward Grunden, Ph.D., University
  of Wisconsin Clinical Cancer Center and Animal Care
  Center, supported by patient gift grant and in part
  by NCI grant 14520.
• -An epidemiologic study of populations previously exposed
  to hexachlorobenzene; with Dr. H. Peters, Erdogan
  Erturk, Ph.D., Dr. G. Bryan; under NCI/EPA contract
  68-01-5002.
• -Carcinogens and endometrial cancer; with John Tsibris,
  Ph.D., University of Illinois Medical Center at Chicago.
• -Estrogen and progestron receptors of invasive cervical
  carcinoma; with Harold Verhage, Ph.D., University of
  Illinois Medical Center at Chicago.
• -Chemical carcinogens and ovarian carcinoma; with
  Ertugrul Erturk, Ph.D., University of Wisconsin,
  Madison, Wisconsin.
• -Chemical carcinogens and ovarian-uterine cancer; with
  John Tsibris, Ph.D., University of Illinois Medical
  Center at Chicago.

SCIENTIFIC PAPERS PRESENTED TO SOCIETIES:

• 1974 -Management of Abnormal Cytology by Colposcopy. At
  April Teaching Hospital Post Graduate Colposcopy Course.
  Atlanta, Georgia.
• 1974 -Management of Abnormal Cervical Cytology During
  November Pregnancy by Colposcopy; Obstetrical & Gynecological
  Society of the Southern Medical Associations,
  Atlanta, Georgia.
• 1974 -Colposcopic Manifestations of Cervical Intradermal
  December Neoplasia; Gynecologic Society, Emory University,
  Atlanta Georgia.
• 1976 -Pregnancy - Abnormal Cervical Cytology and Colposcopy;
  April presented to the Conference of Continuing Education
  Program of the Department of Obstetrics and Gynecology,
  West Virginia University Medical School.
• 1976 -Recent Advances in the Management of Intradermal
  May Neoplasia of Cervix Uteri; presented to the Medical
  Society of Monogalia County, Morgantown, West Virginia.
• 1976 -Physiology and Pathology of Human Cervix Uteri;
  June presented as main speaker at the Annual Meeting of
  Tygart County Medical Society, Elkins, West Virginia.
• 1976 -Squamous Cell Carcinoma or Sarcoma of Cervix Uteri. In
  November the Sixth George Papanicolaou Memorial Seminars,
  New Orleans.
• 1977 -Colposcopic Examination of the Cervix of the Cebus
  January Monkey Previously Infected with Herpes Simplex Virus,
  Type II; presented to the Society of Gynecologic
  Oncology, Miami, Florida.
• 1977 -Transformation Zone of the Cervix Uteri. As one of the
  four main speakers, presented to the Cervical Cancer
  Teaching Day at the Annual West Virginia Cancer Teaching
  Day.
• 1980 -Cancer of the Female Urethra; presented to the Society of
  Gynecologic Urology, New Orleans.
• 1980 -Management of Ovarian Cancer-Caused Bowel Obstruction;
  October presented to the Society of Memorial Gynecologic
  Oncologists, Bethesda, Maryland.
• 1981 -Ovarian Cancer-Caused Colonic Obstruction & Colostomies;
  November presented at the Society of Memorial Gynecologic
  Oncologists, Port-au-Prince, Haiti.
• 1983 -Chemical Induction of Ovarian Tumors in Rats. Accepted
  May for presentation by the American Society of Cancer
  Research, San Diego.
• -Nutritional Evaluation of Gynecologic Cancer Patients.
  Submitted to the Society of Memorial Gynecologic
  Oncologists.
• 1984 -Insertion of Implantable Catheters for Gynecologic
  November Oncology Patients. Submitted to the Society of
  Memorial Gynecologic Oncologists.
• 1986 -Development of Ovarian Carcinoma in the Rats through
  November Chemical Carcinogens. Submitted to the Society of
  Memorial Gynecologic Oncologists.
• 1990 -Ureteral Surgeries for Gynecologic Cancer Patients.
  Submitted to the Society of Memorial Gynecologic
  Oncologists, Miami.
• 1991 -Intraperitoneal Chemotherapy. Submitted to the Society
  of Memorial Gynecologic Oncologists, Philadelphia.
• 1992 -ARDS Development and Ovarian Cancer Debulking Surgery,
  Submitted to the Society of Memorial Gynecologic
  Oncologists, Dearborn.
• 1985-1991 CHAIRMAN OF INTENSIVE OB/GYN COURSE AT NORTHWEST
  COMMUNITY HOSPITAL
• 2000-2001 Secretaary/Treasurer Northwest Community Hospital
• 2001-2002 Vice President Northwest Community Hospital
• 2002 President of the Medical Staff Office
  Jan-Present Northwest Community Hospital

VISITING ASSOCIATE PROFESSOR
GYNECOLOGIC ONCOLOGY

• 1979 -Emory University, Department of OB/GYN.
  November 22 - 29, 1979
• -University of Illinois College of Medicine of Chicago.
• 1983 to -In this capacity, multiple presentations to numerous
  present hospitals have been given.
• 1990 -Post Graduate Gynecologic Oncology Meetings, Istanbul,
  1991 Turkiye.
  April 28-May 5, 1990
  September 26-28, 1991
• 1993 -Analysis of Endometrial Cancer. Department of
  October 6 Obstetrics & Gynecology, Hacattepe University,
  Ankara, Turkiye.
• 1993 -Recent Advances of Ovarian Cancer, Department of
  October 7 Obstetrics & Gynecology, Hacettepe University,
  Ankara, Turkiye.
• 1995 -Gynecologic Oncology Course. Department of
  November Obstetrics & Gynecology, Hacettepe University,
  Ankara, Turkiye.
• 1996 -Borderline Ovarian Cancers: An Overview. Gynecologic
  April 13 Oncology Symposium 1996/Program Coordinator. Alexian
  Brothers Medical Center, Elk Grove Village, IL.
• -Ovarian Cancer 1997. IV. Gynecology and Obstetrics
  Sept. 9-12 Congress, Hacettepe University, Ankara, Turkiye
• -Ovarian Cancer General Review 1998. Northwest Community
  February 5 Hospital, Arlington Heights, IL
• 1998 -Vulvar Cancers. European Society of Oncology Course,
  March 25-28 Hacettepe University, Ankara, Turkiye.
• -Lymph Node Metastasis in Endometrial Carcinoma
  June 8 Sherman Hospital, Elgin, IL
• 1998 -The 6th National Congress on Gynecologic Oncology
  October -Uterine Sarcomas
  11-15 -Training in Gynecologic Oncology
  Hacettepe University Ankara-TURKIYE
• 1999 -Endometrial Ca. & Lymphanedectomies. Delnor Community
  April 14 Hospital, Geneva, IL
• -The 5th International Congress on Obstetrics&Gynecology
  May 6-9 Izmir, Turkey
  -Posterior Exenteration During Ovarian Cancer Debulking
  -Uterine Sarcoma
• 1999 -Recent Advances in the Treatment of Ovarian Cancer
  November10 -General Review of Endocervical Adenocarcinoma
  Good Shepherd Hospital, Barrington, IL
• European School of Oncology - Izmir, Turkey
  April 22-26 Gynecologic Oncology Symposium
  -Wertheim Hysterectomy
  -Posterior Exenteration During Ovarian Cancer Debulking
  Surgery
• 2001- Nov 24-27 -Hacettepe University School of Medicine, TURKEY
  Key Note Speaker, Gynecologic Oncology Symposium
• - Radical Abdominal Hysterectomy versus Laparoscopic
  Hysterectomy for stage I-B Cervical Cancer
  Second Look Laparotomy after Modified Posterior
  Exenteration with stage III-IV Ovarian Cancer

CONTINUING EDUCATION CREDITS:

• -Laser Training with Dr. Duane Townsend and Dr. V. Cecil
  Wright.
• -Advanced course in Cerviocography and Colposcopy under
  Dr. Adolph Stafl.
• -Use of CO2 Laser in Gynecologic Oncology.
  Alexian Brothers Medical Center.
• -Laser in General Surgery and Gynecologic Oncology.
  Northwest Community Hospital.
• -Modern Management of Abnormal Cervical Cytology.
  Northwest Community Hospital.
• 1984- -OB/GYN Clerkship Program, Northwestern Facility Member
• 1989 -I.V. International Symposium on Gynecologic Oncology
  Surgery and Urology.
  Mayo Clinic, April 16 - 19, 1989.
• 1989 -Gynecologic Cancer and Liver Surgery.
  Wayne State University, October 27, 1989.
• -Course Director - OB/GYN Review Course Symposium.
  Northwest Community Hospital.
• 1990 -Advanced Colposcopy and HPV Update. Course Directors:
  April V.C. Wright, M.D., A.D. DePetrillo, M.D.
• 1991 -Recent Advances in Cancer Therapy. University of
  August 2-4 Colorado School of Medicine.
• -Clinical Course in Pelviscopic Surgery and
  August22-24 Vaginosonography. Baltimore, Maryland.
• 1991 -Urogynecology and Pelvic Surgery Course. Orlando,
  February5-9 Florida.
• -Urogynecology & Pelvic Surgery: An Update
  February6-8 Orlando, Florida
• 1992 -Carcinoma in Situ of the Cervix. Tumor
  March 5 Conference, St. Joseph Hospital, Elgin, IL.
• 1992 -Society of Gynecologic Oncology, Annual Meeting,
  March 15-18 San Antonio, Texas.
• 1992 -Early Cervical Cancer; Surgery vs. Radiotherapy.
  April 1 Postgraduate Course in Gynecologic Oncology.
  Chicago, Illinois.
  1992 -Myocutaneous Flabs & Early Cervical Cancer, Radical
  May 28-29 Surgery vs. Radiation Therapy. Antalya, Turkiye.
• 1992 -Advanced Operative Laparoscopy for the Gynecologic
  July 10-11 Oncologist. Tucson, Arizona.
• 1993 -Society of Gynecologic Oncology-24th Annual Meeting
  Feb 8-10 Palm Desert, California -
• -Urogynecology: A Clinical Preceptorship/Participant
  August 2-6 Women's Hospital, LBMMC, Long Beach, California and
  UCIMC, Orange, California.
• 1993 -16th Annual Meeting of The Society of Memorial
  Oct 28-30 Gynecologic Oncologists
• 1996 -Society of Gynecologic Oncology-27th Annual Meeting
  Feb 10-14 New Orleans, LA
• 1998 -Society of Gynecologic Oncology-29th Annual Meeting
  Feb 7-11 Orlando, FL
• -Update Pelvic & Vaginal Surgery
  Dec 4-5 Scott & White Memorial Hospital, San Antonio, TX
• 1999 -Gynecologic Oncology Group
  Jan 22-24 Nashville, TN
• 1999 -Update-Pelvic/Vaginal Surgery
  Dec 10-11 Scott & White Memorial Hospital
• 2000 -Society of Gynecologic Oncology-31st Annual Meeting
  Feb 7-9 San Diego, CA
  -Lymphatic Mapping - February 5, 2000
  -Clinical Practice Seminar - February 5, 2000
• 2002 - NWCH Leadership Conference for Trustees
  Feb 10-13 Palm Beach , Florida
• 2003 - SGO 34th Annual Meeting
  Jan31-Feb4 New Orleans, Louisiana
• 2003
  Dec 12-13 - Controversies in Gyne.Maligan.
  Chicago, Illinois
• 2004
  Dec22-Jan2 – Seminar on Legal-Medical Issues
  Grand Caribean Cruise
• 2004
  Jan 16-18 - GOG Semi Annual Meeting
  Atlanta,Georgia
• 2004 - CME Dinner Event
  Nov 3 Chicago, Illinois
• 2004 -Controversies in Gyne.Maligan.
  Dec 3 New York, NY
• 2005 - SGO Annual Meeting
  March 19-23 Miami Beach, Florida
• 2005
  July 8 - GOG Semi Annual Meeting
  Baltimore, Maryland

Prof. Dr. Ozgur HARMANLI
August 2006
OZ HARMANLI, M.D., F.A.C.O.G.Chief, Division of Urogynecology and Pelvic Surgery
Baystate Medical Center, Department of Obstetrics and Gynecology
Springfield, Massachusetts
Professor of Obstetrics and Gynecology, Tufts University School of Medicine
 
EDUCATION
UNDERGRADUATE /MEDICAL SCHOOL:
Hacettepe University School of Medicine, Ankara, Turkey  (Undergraduate education is included within a 6-year medical education)
MD, graduated in July 1986
1980-1986
GRADUATE EDUCATION:
Temple University, The Fox Business and Management School, Philadelphia, Pennsylvania
Masters in Business Administration (MBA)
(not completed)
1997-1999

POSTDOCTORAL TRAINING
POSTGRADUATE MEDICAL EDUCATION IN TURKEY:
Residency, Obstetrics and Gynecology and Board certification Dr. Z. T. Burak Women’s Hospital, Ankara, Turkey  1987-1990 and 1991-1992
POSTGRADUATE MEDICAL EDUCATION IN THE USA:
Internship, General Surgery (PGY 1) Christiana Care, Newark, Delaware 1990-1991 Residency, Obstetrics and Gynecology (PGY 2)
Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania  1992-1993Residency, Obstetrics and Gynecology (PGY3-4)
Temple University School of Medicine, Philadelphia, Pennsylvania 1993-1995 Fellowship, Female Pelvic Medicine and Reconstructive Surgery
Temple University School of Medicine, Philadelphia, Pennsylvania
1997-1999
 
LICENSURE AND CERTIFICATION
LICENSURE:
Pennsylvania
License NO. MD-042855-L
1995-present
Massachusetts
License NO. 221035
2004-present
BOARD CERTIFICATION:
American Board of Obstetrics and Gynecology
Diplomat No. 951714
November 1997
 
ACADEMIC APPOINTMENTS
Instructor of Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, Pennsylvania 1995-1998
Assistant Professor of Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, Pennsylvania 1998-2004
Associate Program Director of the Obstetrics and Gynecology Residency Program, Temple University School of Medicine, Philadelphia, Pennsylvania 2001-2004
Director, Temple University Center for Urogynecology and Pelvic Reconstructive Surgery, Philadelphia, Pennsylvania 2001-2004
Director, , Urogynecology and Pelvic Surgery Division, Det. Of OB/GYN, Baystate Medical Center, Springfield, Massachusetts 2005-present
Associate Professor of Obstetrics and Gynecology, Tufts University School of Medicine, Springfield, Massachusetts 2005-present
 
HOSPITAL APPOINTMENTS
Attending physician, Lower Bucks Hospital, Bristol, Pennsylvania 1995-1995
Attending physician, Temple University Hospital, Philadelphia, Pennsylvania 1995-2004
Attending physician, Roxborough Memorial Hospital, Philadelphia, Pennsylvania 1995-2004
Attending physician, Baystate Medical Center, Western Campus of Tufts University School of Medicine, Springfield, Massachusetts 2004-present
 
ACADEMIC HONORS AND AWARDS
Ranked 29th among approximately 500,000 high school graduates "University Entrance Examinations" in Turkey, an aptitude examination similar to SAT in the USA 1980
"?s Bank Science Award", Hacettepe University School of Medicine, Ankara, Turkey 1980
University Research Scholarship TUBITAK, The Scientific and Technical Research Council of Turkey 1980-1986
First Prize in Mathematics The Central Region of Turkey 1980
Second Place in the Scientific Paper Contest among the residents from all disciplines Medical Center of Delaware, Newark, Delaware 1991
"Hero of the Month" for performing an emergency cesarean section on a dying car accident victim in a timely fashion and saving the premature baby. "Philadelphia" Magazine, Philadelphia, Pennsylvania 1994
"Phillips F. Williams Prize Paper Award" American College of Obstetricians and Gynecology District III Meeting in Cancun, Mexico. 1994
Second place in the "Residents’ Bowl"  Scientific contest in “Jeopardy” format among all the OB/GYN residency programs of Greater Philadelphia Area, Philadelphia, Pennsylvania 1995
"Excellence in Endoscopy" Honorary Award American Association of Gynecologic Laparoscopists 1995
 
ACADEMIC HONORS AND AWARDS (continued)
Best Resident Research Award Temple University School of Medicine, Philadelphia Pennsylvania 1995
Faculty Research Award Temple University School of Medicine, Philadelphia, Pennsylvania 2004
Residents’ Teaching Award  Temple University School of Medicine, Philadelphia, Pennsylvania 2004
ACOG-CREOG National Faculty Teaching Award Tufts University, School of Medicine, Baystate Medical Center, Springfield, Massachusetts 2006
Marquis Who’s Who in Medicine and HealthCare   2006
 
PROFESSIONAL ACTIVITIES
EDUCATIONAL
Teaching -attending physician in Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, Pennsylvania 1995-2004
Teaching-attending physician, Baystate Medical Center, Western Campus of Tufts University School of Medicine, Springfield, Massachusetts 2004-present
Reviewer, Obstetrics and Gynecology October 1999
Reviewer, American Journal of Obstetrics and Gynecology May 2004
 
COMMITTEES
Member, Medical Records Review Committee, Roxborough Memorial Hospital, Philadelphia, Pennsylvania 1996-1999
Member, Emergency Room Committee, Roxborough Memorial Hospital, Philadelphia, Pennsylvania 1996-1999
Graduate Medical Education Committee, Temple University School of Medicine, Philadelphia, Pennsylvania 2002-2004
 
 PROFESSIONAL SOCIETIES
LOCAL, REGIONAL, NATIONAL
Member, American Medical Association  1992-present
Fellow, American College of Obstetricians and Gynecologists  1997-present
Member, American Association of Gynecologic Laparoscopists  1995-present
Member, American Urogynecologic Society 2004-present
Council-at-large, The Obstetrical Society of Philadelphia  2002-2003
Member, Society of Gynecological Surgeons ( invitation only) 2003-present
 
MAJOR RESEARCH INTERESTS
The role of collagen in pelvic floor disorders
Transvaginal uterine artery ligation for treatment of uterine leiomyomas
Definition of "normal endometrial flora"
Hysterectomy routes and previous pelvic surgery

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From our first phone call from England there has always been a great willingness to help and advice. Upon arrival we have enjoyed the care and helpfulness from all of the staff here at this lovely hospital. Romina has been very helpful with answers to all our questions. The doctors and staff have been very proffesional and the hospital is very modern and very clean. We have both enjoyed our stay with you and would recommend you to anyone hoping for a new baby.
Thank you for everything
T. Page - England

We have found the experience at the Jinemed to be excellent and highly proffesional. The staff were through and caring throughout the process well at eeach stage.We would have no hesitation in recommending the Jinemed to other potential patients.
Many thanks,
Helen & Brian

I would like to thank all the staff at Jinemed for their warm welcome and excellent care that they provided. The staff have been exceptionally professional and provided the best possible treatment. We would recommend this hospital to all our friends.
Thanks,
Mushta & Shahla

Dear Romina
Myself and Imran would like to thank everyone at Jinemed Hospital for the wonderful treatment we both received during our time at Jinemed.

We were both nervous not knowing what was going to happen as going to a foreign country and receiving treatment is quite daunting. But you were absolutely wonderful at every step of our treatment answering all our questions and making it all seem so simple and straight forward.

Thankfully the treatment went well and I now hope and pray that we have a positive result and that our dreams come true of becoming proud parents Inshallah..
We hope to come back to Jinemed again as the care we received was excellent..
Happy New Year to all and hope the coming year brings you and everyone at Jinemed more sucess..
Take care and will keep you posted with our result. Please pray for us!
All the best and once again, thank you for all your help..
Kind regards
Shery & Imy

Myself + husband have been extremely happy with treatment at Jinemed. It was good to have continuity if care + seeing the same doctors (Munip+Prof. Teksen) + Romina throughout treatment helped to make us feel more comfortable + that everyone involved knew that what was going on all the time in our treatment. Everyone has been extremely proffesional + kind. I felt that we are in the best possible hands. We would come back for more treatment if we are unsuccessful. It has been a s stress free an experience as I think IVF could be!
Many thank to all the lovely team.
Samantha + Colin

We are so pleased we came to Jinemed for our first cycle (and hopefully our last. Fingers crossed!). All the staff have been brilliant particularly Romina who is a god send and helped me so much!
Could not have asked for more and am happy to say I highly recommend Jinemed:)
Amy& Jon

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Sightseeing
?STANBUL TOURS

Masterpieces of Byzantine Art and Architecture
(half day tour)

First we visit the church of Saint Saviour, now the Kariye Museum. World famous because of her well preserved mosaics and extraordinary frescoes. Later on we visit the Hippodrome, with the square abelisk and the snake shaped pillar, the Byzantine cistern and the impressive Agia Sophia, masterpiece of Byzantine architecture.
Back to hotel.

Masterpieces of Ottoman Art and Architecture
(half day tour)

We start with a visit to Topkap? Palace, the fairytale like residence of the Ottoman sultans. Here you can enjoy the splendour of the interior, the mysterious harem, most valuable crown jewellery, holy relics, rich collections of armoury and rare Chinese and Japanese porcelain. Following a visit to the famous Grand Bazaar, where the best Turkish rugs, kelims, antiquities and copperware are sold.
Back to hotel.

Masterpieces of Byzantine and Ottoman Architecture
(full day tour)

This tour is a combination of TITCO 1 and 2. Visit to all the masterpieces of Byzantine and Ottoman art and architecture. Lunch in a good and typical Turkish restaurant.
Back to hotel.

Bosphorus and Dolmabahçe Palace
(Two Continents. Full day tour. Including lunch).

By bus over the intercontinental Bosphorus Bridge to Çaml?ca-hill on the Asian side, to enjoy the beautiful panorama of ?stanbul. Later to Beylerbey, a lovely holiday resort at sea, to visit the impressive Beylerbey Palace.

From here depart for a trip by boat along the Asian and European shoes of the Bosphorus to Sar?yer, a typical fishing community on the Black Sea. Lunch in a fish restaurant at the sea. Afterwards a visit to the Military Museum. Here the traditional Ottoman Military Mehter Chapel will perform in their original Janniasary uniforms and playing on authentic instruments. After this spectacle we shall visit the magnificent 19th century Dolmabahçe Palace.
Back to hotel.

Princess Islands
(Full Day tour, includes lunch)

Trip by boat on the Sea of Marmara to Buyukada (biggest of Princess Island). Swimming and sunbathing. Lunch in one of the best restaurants on the island. Afterwards a romantic tour by carriage on the island. Back by boat to port and from there by bus to hotel.

Istanbul by night
By bus to the historical Galata Tower. Dinner at the top floor restaurant. From here you have a wonderful panorama over the ancient city. Later in the evening visit to one of Istanbul`s most famous night-clubs to enjoy a whirling show with oriental music, Turkish folklore and belly dancers.

ISTANBUL CLASSICS

• Half Day Morning Tour
• St. Sophia * Blue Mosque of Sultan Ahmet
• Hippodrome * Serpentine Column
• Obelisk of Theodosius * German Fountain
• Grand Covered Bazaar

DOLMABAHÇE PALACE & TWO CONTINENTS (EUROPE TO ASIA)

• Half Day Afternoon Tour
• Dolmabahce Palace * Bosphorus Bridge
  Çamlica Hill

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