Gynegology and Obstetrics
Aritmi Osmangazi Hospital is at the forefront of remarkable advances in gynecological oncology, high-risk pregnancy and IVF / PGD treatments, and expert in all areas of women's health for women of all ages, from adolescence on.
Aritmi Osmangazi Hospital offers a highly expert hand of advice and intervention to women of all ages and covering the entire range of women's health issues and diseases, pre- and post-natal, menopausal changes, and gynecological cancer cases.
High-risk pregnancies and childbirth
The joyful part of coming to hospital is pregnancy… The Aritmi Osmangazi Hospital Gynecology department is based on an awareness of how special this period is, offering expectant mothers expert care and observation in a homely and relaxing environment.
Expectant mothers are briefed and made aware of all issues relating to their health and the health of their babies, and monitored using the most advanced equipment and techniques. The high-risk pregnancy unit uses the latest techniques and equipment to treat cases of gynecological bleeding, diseases of the reproductive tract, sexual dysfunction and ovarian cysts.
Another area in which the Aritmi Osmangazi Hospital Gynecology department focusses is adolescent gynecology. Yeditepe University Hospital has a dedicated unit for the diagnosis and treatment of adolescent conditions and diseases that require a particular expertise and sensitivity. The unit offers monitoring and follow-up of adolescent development, menstruation, pubescence, irregular menstrual cycles, as well as preventive packages such as the HPV cervical cancer vaccination
"The Aritmi Osmangazi Hospital Gynecology department aims to reach high success rates in pregnancy and live childbirth in the light of new developments in IVF treatment."
· Gynecological Oncology
· Menopause Clınıc
· Reproductive Health Clınıc / IVF
· Adolescent Health Center
Aritmi Osmangazi Hospital is at the forefront of remarkable advances in gynecological oncology, high-risk pregnancy and IVF / PGD treatments, and expert in all areas of women’s health for women of all ages, from adolescence on.
Aritmi Osmangazi Hospital offers expert advice and intervention to women of all ages and covering the entire range of gynecological cancer cases.
The Gynecological Oncology Center at Aritmi Osmangazi Hospital provides the latest diagnostic tests and state-of-the-art treatment for malignancies involving the female reproductive organs. These malignancies include:
· Cervical Cancer
· Endometrial Cancer
· Fallopian Tube Cancer
· Gestational Trophoblastic Disease
· Ovarian Cancer
· Uterine Sarcoma
· Vaginal Cancer
· Vulvar Cancer
Our team, including gynecologic oncologists and radiation oncologists, meets regularly to review all cases, examining treatment options and developing coordinated management plans.
Our Center provides care for women with cancer of the reproductive tract and conducts research in order to improve methods of diagnosis and treatment of gynecologic cancer.
Uterine cancer is a cancer of the inner membrane of the uterus. Known factors in uterine cancer include conditions that increase the amount of estrogen such as early menstruation, delayed menopause, infertility and obesity. Its first symptom is generally post-menopause vaginal bleeding. It is important to consult your doctor in the event of abnormal menstrual bleeding. Early diagnosis can be achieved by means of annual preventive check-ups. In rare cases of early detection, women who want to become pregnant may be treated successfully with medication.
In the event that irregular menstruation or bleeding during menopause occurs, early diagnosis is normally possible and the success rate of treatment is high. 85% of uterine cancer patients experience no disease-related problems. Surgery is generally sufficient. In a small group of patients, radiotherapy or chemotherapy is required.
Cervical cancer is a serious but preventable disease. It is possible to detect changes in the cervical cells before the cancer develops. Since more than 95% of these early detected cases are cured, early diagnosis and treatment is essential. This is possible by means of regular gynecologic examinations and screening tests. Every woman between the ages of 21 and 65 should undergo a gynecologic examination and Pap smear test at least once a year. In addition, the HPV vaccine prevents 80% - 100% of HPV-type cervical cancers.
The risk factors in ovarian cancer, the seventh most common form of cancer in the world, include being over 40 years of age, not having had children, having a high fat diet, using talcum powder in the genital region, and a family history of the disease. The risk is decreased by the use of contraceptive pills, childbirth and breastfeeding, removal of the uterus and the Fallopian tubes. Unfortunately three in four cases are diagnosed at a late stage. Nowadays the best way for an early diagnosis is regular gynecologic examinations and a detailed assessment of the patient’s family history.
The gold standard in ovarian cancer treatment is a first operation conducted by a gynecologic oncologist that leaves none of the cancer behind.
Perinatology is a subspecialty of obstetrics concerned with the care of the fetus and complicated, high-risk pregnancies. Perinatology is also known as maternal-fetal medicine; the maternal-fetal medicine specialist typically works in consultation with the obstetrician.
Some of the conditions evaluated by Aritmi Osmangazi Hospital maternal-fetal specialists include:
Maternal conditions or diseases, including:
· Hypertension (high blood pressure)
· Preeclampsia (toxemia)
· Maternal metabolic diseases, including diabetes (both pregestational and gestational types)
· Infectious diseases (to include parvovirus, toxoplasmosis, hepatitis, HIV, and AIDS)
· Platelet alloimmunization (NAIT or FMAIT) (e.g. Rh negative mother sensitized to an Rh positive fetus)
· Maternal lupus (collagen vascular disorder)
· Poor past obstetrical history (e.g. past preterm deliveries, preterm labor, preterm cervical dilatation, premature rupture of membranes, repetitive pregnancy loss)
Multiple gestation (twins and higher order multiples)
A known/suspected fetal anomaly
· Suspected abnormal fetal growth
· Macrosomia (a baby that is too large)
· Fetal growth restriction (a baby that is too small)
Maternal family history of:
· Cardiac disease
· Renal disease
· Gastrointestinal disease
· Cystic fibrosis
Prenatal genetic testing and consultation: Aritmi Osmangazi Hospital specialists in various fields work side by side to diagnose and provide comprehensive care for the following:
· AFP (alpha fetoprotein) blood test (including the suspicion of a neural tube defect)
· Antenatal serum screening (triple screen/quad screen) with an increased risk/suspicion of a chromosomal abnormality such as Trisomy 21 [Down syndrome], Trisomy 13 or Trisomy 18
· The need for invasive fetal testing procedure(s) or other in utero therapeutic techniques (i.e., blood sampling/transfusion, platelet infusion, fetal bladder stent placement, chorionic villus sampling (CVS) or amniocentesis (amnio) for maternal age or other factors
The menopause represents the natural end to a stage in every woman’s life when her ovarian functions are winding down and menstruation ceases. This stage of life can see such symptoms as hot flushes, sweating, palpitations, inattentiveness, insomnia, irritability, fluctuating moods and nervousness become a part of a women’s life. As well as medical treatment, psychological support is essential in terms of getting through menopause. Women should consult their doctor concerning advice and treatment to prevent the development of osteoporosis.
Menopause is a natural biological process. Although it ends fertility, you can stay healthy, vital and sexual. Some women feel relieved because they no longer need to worry about pregnancy.
Even so, the physical and emotional symptoms of menopause may disrupt your sleep, cause hot flashes, lower your energy or — for some women — trigger anxiety or feelings of sadness and loss.
Don't hesitate to seek treatment for symptoms that bother you. Yeditepe University Hospital’s Menopause Clinic is available to offer advice on many effective treatments, from lifestyle adjustments to hormone therapy.
In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:
· Irregular periods
· Vaginal dryness
· Hot flashes
· Night sweats
· Sleep problems
· Mood changes
· Weight gain and slowed metabolism
· Thinning hair and dry skin
· Loss of breast fullness
It's possible, but very unusual, to menstruate every month right up to your last period. More likely, you'll experience some irregularity in your periods.
If you've skipped a period but aren't sure you've started the menopausal transition, you may want to determine whether you're pregnant. Skipping periods during perimenopause is common and expected. Often, menstrual periods will occur every two to four months during perimenopause, especially one to two years before menopause. Despite irregular periods, pregnancy is possible.
When to contact the Aritmi Osmangazi Hospital Menopause Clinic:
Starting at perimenopause, schedule regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause. Preventive health care can include recommended screenings at menopause, such as a colonoscopy, mammography, lipid screening, thyroid testing if suggested by your history, and breast and pelvic exams.
Always seek medical advice if you have bleeding from your vagina after menopause.
Menopause can result from:
Natural decline of reproductive hormones: As you approach your late 30s, your ovaries start making less estrogen and progesterone — the hormones that regulate menstruation — and your fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually — on average, by age 51 — your ovaries stop producing eggs, and you have no more periods.
Hysterectomy: A hysterectomy that removes your uterus but not your ovaries (partial hysterectomy) usually doesn't cause menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But surgery that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause, without any transitional phase. Your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms, which can be severe, as these hormonal changes occur abruptly rather than over several years.
Chemotherapy and radiation therapy: These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures.
Tests and Diagnosis at Aritmi Osmangazi Hospital Menopause Clinic:
Tests typically aren't needed to diagnose menopause. But under certain circumstances, your doctor may recommend blood tests to check your level of:
· Follicle-stimulating hormone (FSH) and estrogen (estradiol), because your FSH levels increase and estradiol levels decrease as menopause occurs
· Thyroid-stimulating hormone (TSH), because hypothyroidism can cause symptoms similar to those of menopause
Aritmi Osmangazi Hospital treats the area of adolescent health as a separate specialty, with full access to all Aritmi Osmangazi Hospital other areas of expertise through our multidisciplinary approach and philosophy.
At the Aritmi Osmangazi Hospital Adolescent Health Center, young people can find a wide range of services specially designed for their needs, including:
· Primary health care
· Counseling, support, mental health and family therapy
· Sexual and reproductive health
· Dental care
· Nutrition, fitness and wellness programs
Pediatric and Adolescent Psychology
We offer psychotherapy services to children, adolescents and their families in line with recognition / evaluation studies of the individual emotional, behavioral and learning difficulties. Amongst the psychotherapy provided are play therapy, individual therapies (psychodynamic and cognitive-behavioral-oriented), group therapy, and child / youth focused family therapy. In addition, we work hand in hand with the department of child – adolescent psychiatry when this is required and beneficial. Our adult psychology also provides individual and couples therapy to parents.
The most common psychological problems dealt with at our department are as follows:
· Fear, Phobias and Concerns
· Potty Training
· Family conflict / communication problems within the family
· Disciplinary problems
· School problems
· Attention deficit hyperactivity disorder, specific learning disorders
· Behavioral Problems
· The process of divorce
Another area in which the Aritmi Osmangazi Hospital Gynecology department focusses is adolescent gynecology. Aritmi Osmangazi Hospital has a dedicated unit for the diagnosis and treatment of adolescent conditions and diseases that require a particular expertise and sensitivity. The unit offers monitoring and follow-up of adolescent development, menstruation, pubescence, irregular menstrual cycles, as well as preventive packages such as the HPV cervical cancer vaccination.
The Aritmi Osmangazi Hospital Gynecology department aims to reach high success rates in pregnancy and live childbirth in the light of new developments in IVF treatment.
· Gynecological Oncology
· Menopause Clinic
· Reproductive Health Clinic / IVF
· Adolescent Health Center
REPRODUCTIVE HEALTH CLINIC / INFERTILITY CENTER
Reproductive Health, IVF and PGD Center
“Bringing Hope to Patients from Around the World”
“Our IVF and PGD Center aims to increase the possibility and rates of fertility and successful childbirth. Transferred embryos are maintained under the constant observation and control of our trained specialist physicians. Our Center has the most advanced laboratory systems, embryoscopy equipment, high-tech incubators and other technology - significantly increasing fertility success rates, even in cases that have previously not responded to treatment.
The underlying cause for much infertility is genetic; our state-of-the-art genetic laboratory aims to identify and resolve such issues by determining gamete and embryo anomalies, leading to the development of effective and successful treatment strategies for our international patients.”
Infertility: a common issue
10-15% of all couples are affected by infertility, defined as failure to conceive after at least a year of trying. Following examination and treatment, however, around two-thirds of these couples go on to have children.
Causes of infertility in men:
· Low sperm quality, e.g. due to a hereditary disorder, infection or malformation
· Blocked sperm ducts, due to rupture or prostate surgery
· Impotence, e.g. due to diabetes
· Antibodies to own sperm
· Hormone deficiency, e.g. due to brain tumor
Causes of infertility in women:
· Hormone disorders such as polycystic ovary syndrome (PCOS)
· Turner syndrome (genetic disorder where one X-chromosome is wholly or partially missing)
· Being extremely overweight or underweight
· Damaged Fallopian tubes
· Early menopause
· Uterine fibroids
Causes of infertility in both men and women:
· Cancer in the reproductive organs
· Damage to ovarian or testicular tissue due to chemotherapy
· Chromosome abnormalities and inherited genetic disorders
Polycystic ovary syndrome (PCOS)
The most common cause of ovulation problems is polycystic ovary syndrome (PCOS), which affects 5-10% of all women of childbearing age. PCOS has hereditary origins and can lead to increased production of the male sex hormone testosterone and problems with insulin and blood sugar balance.
The disease results in numerous small cysts - immature follicles - in the ovaries, failure to ovulate and irregular periods. PCOS is treated through diet, exercise, weight loss and contraceptive pills. If a woman with PCOS wishes to conceive, medication and follicle-stimulating hormone can be used to stimulate the maturation of follicles in the ovaries and induce ovulation.
Endometriosis - a cause of pain and fertility problems
Another common cause of infertility is the chronic disorder endometriosis, where the lining of the womb grows outside the womb itself, generally in the abdominal cavity. It often leads to blockages in the Fallopian tubes and can affect egg quality. It can also cause severe pain during menstruation and intercourse. 10% of all women suffer from endometriosis to some degree.
In vitro fertilization (IVF)
Hormones are given to the woman to make more eggs mature from one of the ovaries.
Mature eggs from the woman's ovaries used to be extracted using keyhole surgery. Today, ovarian follicles are located using ultrasound and the eggs are extracted with a thin needle.
Sperm are added to the egg so that fertilization can take place. The fertilized egg begins to divide and develops into an embryo.
The young embryo is returned to the womb where it attaches to the lining.
Aritmi Osmangazi Hospital: the right choice for IVF and PGD treatment for international patients
· We provide a comprehensive solution - all treatment steps and logistics are managed by our dedicated International Office, from start to finish
· High success rates
· Aritmi Osmangazi Hospital’s International Office delivers VIP services to our international patient with a professional management team and your own dedicated professional from our International Services Department
· Immediate Availability
· We understand that reproductive issues are emotional as well as physical
Aritmi Osmangazi Hospital’s dedicated team of reproductive health specialists, physicians and nursing staff understand that our international patients are placing their hopes and dreams in our hands. We have a specially trained team designated to the care of our international patients. Your personal Recovery Specialist works to make you feel comfortable from the moment you walk through our doors. Aritmi Osmangazi Hospital’s spacious clinic provides confidential genetic testing and counseling that respects your dignity and privacy at all times. All of these services under one roof means that your care is never “outsourced.”
Aritmi Osmangazi Hospital Advanced Fertility Services help your family grow The Aritmi Osmangazi Hospital center offers the full range of diagnostic and treatment options for couples who are unable to conceive naturally. It is our goal to provide our patients with the most advanced reproductive technology available, in such a way as to minimize the stress that is normally associated with these procedures.
VIP attention and services Aritmi Osmangazi Hospital regards you not just as an international patient, but as a guest from abroad who is entitled to special treatment and service while you are with us. We provide you and your family with a specialized confidential service - in your language of choice, and sensitive to your cultural norms and traditions. Our International Office provides 24-hour care from a case management team including your personal International Patient Recovery Specialist who will manage, coordinate and explain your program, logistics, financial aspects and coordination.
PGD (Pre-implantation Genetic Diagnosis)
Our state-of-the-art genetic laboratory equipment, experienced specialists and highly trained technicians ensure that an embryo will be free of genetic or chromosomal abnormalities prior to the embryo transfer. The Center’s diagnostic, PGD and IVF treatment unit offers detailed and comprehensive examination and analysis of male infertility, as well as the capacity for high-quality sperm selection. The underlying cause for much infertility is genetic; our state-of-the-art genetic laboratory aims to identify and resolve such issues by determining gamete and embryo anomalies, leading to the development of effective and successful treatment strategies.
Freezing / Vitrification
Our Center’s specialists are experienced in the freezing of eggs, semen or embryos for fertility preservation, using the world’s leading freezing technology and protocols - with a 97% survival rate for oocytes or embryos
Aritmi Osmangazi Hospital has adopted technologies that are now international industry standards.
Embryo Cryopreservation OocyteCryopreservation (Egg Freezing) Assisted Hatching Blastocyst Culture
Pre-implantation Genetic Diagnosis (PGD)
Endocrine Dysfunction Ovulatory Dysfunction Polycystic Ovarian Syndrome Recurrent Miscarriages
Full Service Andrology Laboratory
Intrauterine Insemination (IUI) Sperm Wash Semen Analysis Comprehensive Diagnosis ICSI (Intracytoplasmic Sperm Injection) Non-Surgical Sperm Aspiration (NSA) Sperm Freezing
What is Infertility?
Infertility is the failure of a couple to conceive a pregnancy after trying to do so for at least one full year without using any method of birth control. This health issue may originate with problems originating in either or both members of the couple. About 30% of the time, the root of the couple's infertility is due to a problem with the male partner; about 30% of the time, it is due to the female partner; and about 40% of the time, there are fertility problems with both the man and the woman, or else the root cause is undetermined.
What factors cause infertility?
The main factors are infection by sexually transmitted diseases, a history of infection of the female reproductive organs, a history of testicular or sperm duct infection, a history of mumps in men, irregular or no menstruation, endometriosis (a condition in which bits of the tissue from the lining of the uterus flourish outside the uterus), congenital anomalies of the uterus, chronic diseases, advanced age, smoking, alcohol and drug addiction.
IUI (Intrauterine Insemination)
Sperm obtained through masturbation is processed in the laboratory, with the best examples being extracted and concentrated. The prospective mother whose eggs have been matured with hormone medication undergoes a painless 15-minute procedure in which motile sperms are inserted into her uterus for spontaneous fertilization. Vaccination treatment can be performed up to 4 times as long as there is nosevere disorder in the sperm, the woman’s tubes are open and there is no concern in terms of problems with the eggs or age. On average, each procedure carries a 20% chance of success.
Test Tube Babies
Technically called in-vitro fertilization (IVF),the “test tube baby” method is a procedure in which eggs collected from the prospective mother’s ovaries are combined with the prospective father’s sperm in the laboratory, and the embryos that are obtained are re-implanted in the mother’s uterus. In the first stage of the treatment the eggs are formed and are then collected at the appropriate time. Fertilization occurs when they are combined with the sperm in the laboratory, and the embryos that develop are re-implanted in the mother’s womb. Traditional IVF methods were first carried out in 1978 and soon began to spread worldwide. Our Center has been carrying out successful IVF procedures since 1998, using the microinjection “ICSI” (Intracytoplasmic Sperm Injection) technique invented in 1992.
Traditional IVF (In Vitro Fertilization – Test Tube Baby)
About 500,000 sperms are combinedwith every 7 or 8 eggs, and spontaneous fertilization is then awaited. IVF is generally the preferred method for women who are unable to conceive because of blocked or restricted fallopian tubes,for male-factor infertility, and forwomen who do not have egg-related problems.
A single sperm is selected under the microscope and injected into each egg with a thin needle. Subsequent stages in the procedure follow the same path as the traditional test tube baby method. This method reduces the risk of non-fertilization. First introduced in 1992, ICSI represents a revolutionary development for couples who are unable to have a child, especially for male-factor reasons. Microinjection is the method of choice for minimizing failure to fertilize not only for male-factor infertility cases, but also when thickening or hardening of the outer egg membrane prevents entry of the sperm, for couples who have previously tried IVF without success, and in particular for older couples and women who produce few eggs. ICSI (Intracytoplasmic Sperm Injection – Microinjection Method)
Who are suitable candidates for IVF?
Both fallopian tubes are severely blocked. In this case, the sperm cannot reach the egg for fertilization; even in less severe casesin which fertilization may occur rarely, there is an increased rate of ectopic pregnancy.
There is severe disorder in sperm count, motility or appearance. These sperm-related problems may occur in conjunction or on their own, and the success rate for couples only facing sperm-related problems is generally higher.
IVF is not recommended for couples who have still failed to conceive after 4 attempts.
Endometriosis. This is a condition in which cells from the lining of the uterus (the endometrium) that assure a regular monthly menstrual cycle flourish outside the uterus, in the tubes, ovaries and abdomen. Bleeding occurs in these regions during menstruation; adhesions develop in the abdomen and cysts in the ovaries and IVF treatment may be necessary.
Age. We know that egg reserves diminish markedly in women over the age of 35. In these cases, IVF is recommended without undue delay.
IVF Treatment Step-by-Step
Various medications are used in order to stimulate egg development in the ovaries. Under normal conditions, one egg grows every month but in IVF treatment we know that the probability of success is increased when between 10 and 20 eggs are developed. For that reason the ovaries are stimulated with the controlled administration of medication. The eggs develop within small aggregations of cells called follicles. The eggs inside the follicles are not visible and follicle growth can only be followed using ultrasonography. Under ultrasonography, the eggs are collected in the 36th hour after the injection of hCG (a hormone used to induce ovulation). Eggs are collected in operating theater conditions via the vagina, under general anesthetic and with the aid of ultrasonography. Sperm is obtained from the male in a specially prepared room by means of masturbation and the highest quality sperms are selected in the laboratory. Subsequent procedures differ according to whether the couple is undergoing test tube baby or microinjection treatment.
The outer membrane of the egg (zona pellucida) is opened under the microscope by laser or mechanically, facilitating the emergence of the embryo before it is implanted in the uterine wall.
Defragmentation (removal of cell debris)
From time to time the embryos expel debris as they divide; these structures diminish embryo quality and can hinder the progress of division. This debris is removed by means of the insertion of a thin pipette.
If pre-implantation genetic diagnosis is to be carried out, one or two of the cells that comprise the embryo are removed for genetic examination. This aims to achieve selection of the healthiest embryos.
PGD (Pre-implantation Genetic Diagnosis)
In IVF procedures, embryos are selected between the 2nd and 6th days and transferred to the prospective mother. In spite of the selection of the embryos with the best appearance, the success rate for implantation into the uterine wall and clinical pregnancy is not 100%. In the first 3 months after pregnancy has occurred, miscarriages due to genetic disorders may take place. PGD techniques developed in recent years allow detection of this group of embryonic genetic disorders. The introduction of PGD in IVF applications has revealed some of the causes of low pregnancy rates. This method has shown that depending on age, an average of 30% of even the embryos with the best appearance (and 90% of those considered poor quality) are genetically impaired. For that reason, the probability of pregnancy resulting from embryos that appear healthy but have genetic abnormalities is very low, and even if pregnancy occurs there is a high probability of miscarriage.
Who has a higher incidence of embryonic genetic disorder?
· Women over the age of 37
· Men with severe sperm disorder or whose sperm has been obtained by means of testicular biopsy and micro-injected.
· Women whose male partners have a close family history of chromosomal disorder, having or carrying genetic disease.
· Couples who have undergone IVF treatment a number of times without success.
· Women who have miscarried 3 or more times.
· Couples with a history of births with genetic disease.
If at least 2 healthy embryos are formed apart from the embryos that are transferred after treatment, they can be frozen and stored for up to 5 years. These embryos are stored in liquid nitrogen in very specific conditions at - 196° C and can be implanted in the patient’s uterus when desired. This process is designed to achieve pregnancy using the frozen embryos without having to repeat the egg development, collection and laboratory work that has already been carried out.
Implanting embryos in the uterus (Embryo Transfer)
2 to 6 days after the collection of eggs and fertilization, one or two of the embryos that have formed are implanted in the mother’s uterus by means of a special catheter in a highly sterile and sensitive manner. The procedure is painless and considerably easier than a normal gynecological examination. This takes about 15 minutes. The patient is then given detailed information about the number and quality of the implanted embryos, the risks of multiple pregnancy and the precautions that can be taken. The patient can return home after resting for half an hour or so. She may return to work the next day as long as it does not involve intense stress and physical activity. Sexual intercourse is not advisable during this period.
“REMEMBER: As a patient from abroad, you will have the support and guidance of experts from our International Services Department at all times before, during and after your treatment at Aritmi Osmangazi Hospital.”