[Main principles and IVF-ET results of the centre for assisted reproduction "Varna", Bulgaria].

The authors formulate the main principles of IVF-ET, based on personal experience i.e. hormonal ovarian stimulation, ovarian puncture, fertilization and ET, prophylaxis and therapy of early complications. Clinical pregnancy was achieved in 287 of 612 patients (43.9% per cycle and 46.9% per transfer). The cancellation rate is 9.6% (42 patients), the miscarriage rate is 14.2% (41 patients). In three cases the pregnancy was ectopic. The multiple pregnancy rate is 32.7% (94 cases): 84 bigemini, 9 trigemini and 1 quadrigemini. In 2006 the multiple pregnancy rate was reduced to 28%. The mean number of transferred embryos was 3.2 and in 2006--2.8; 80.5% of the pregnant women were under 35 years of age. Severe complications occurred in 16 cases--2.6%: OHSS in 15 cases and one with massive intraabdominal hemorrhage from ruptured ovaries. In conclusion the authors stressed the necessity of undelayed resort to ART treatment. Hydrosalpinxes have to be removed preliminarily and partial resection of the ovaries should be done only in rare cases. In Bulgaria at least 6000 fully reimbursed IVF-ICSI procedures yearly ought to be done because of the considerable rate of the inflammatory female and male infertility.

[Role of intercellular adhesion molecule-1 and E-selectin in the pathogenesis of ovarian hyperstimulation syndrome].

OBJECTIVE: To explore the ICAM-1 and E-selectin in patients with OHSS and clarifying its role in pathogenesis of the syndrome. MATERIALS AND METHODS: 20 patients were included in the research and 20 control patients with stimulating ovarian cycle for the purposes of ART, during the period from 01.01.2004 till 01.01.2005 years in the center of ART-MU-Varna and Department of Obstetrics and Gynecology-IVF-ward-MU-Ben-Gurion, Israel. The patients were divided into 3 subgroups according to the degree of OHSS by the classification of Golan- mild, moderate, severe. The method of ELISA was used to record the values of the factors under research. RESULTS: Six patients with severe OHSS, showed increase in the value of the ICAM-1 and somebody of them, showed low level of E-selectin testing in serum and ascitic fluid in comparison with the control group and the rest of the patient with OHSS. CONCLUSION: OHSS is a life-threatening complication in which the main pathophysiology factor is the increased of capillary permeability. ICAM-1 are expressed on human granulosa cells and by the vascular endothelium after the stimulation by inflammatory cytokines and acts as a mediator of the cohesion with the lymphoid cells. E-selectin is produced by the endothelium after cytokine activation. The soluble forms of these molecules are found in serum, follicular fluid during the COH, as well as in ascitic fluid in severe OHSS. In our research adhesion molecules- ICAM-1 are correlated to the OHSS, especially in the severe forms of the syndrome.

[Measurement of endometrial volume and endometrial thickness for assessment of endometrial receptivity in assisted reproductive techniques].

The authors investigated the role of 3D endometrial volume measurements as a predictor of clinical pregnancy in ART and comparison between endometrial volume and endometrial thickness in order to find the better predictor for endometrial receptivity in ART. Endometrial volume emerged recently as a new efficient predictor of endometrial response to hormonal stimulation and successful implantation. In this clinical study, participated 58 infertile patients undergoing IVF-treatment, during the period from 01.01.2004 till 01.01.2005. Endometrial volume of < 2 ml on the day of Embryotransfer (ET) was a better predictor for low endometrial receptivity, than Endometrial thickness on the same day and resulted in significant lower IVF clinical pregnancy and implantation rates. Endometrial volume > 2 ml on the day of ET was a positive predictor for ART outcome.

[Is there a correlation between the vaginal colonization with group B streptococci and premature deliveries?]. / Ima li zavisimost mezhdu vaginalnata kolonizatsiia sus streptokoki ot grupa B i prezhdevremennite razhdaniia?

The study covered 110 pregnant females during the period from January 1, 2002 till April 30, 2003. Nine females (8.18%) delivered premature newborns. Samples were taken from the posterior vaginal fornix and canalis cervicalis in the 18th and 24th gestational week. The preparations stained after Gram were examined under light microscope. Microbial cultures on blood agar were examined, too. It was established that 18 or 16.36% of all the cases presented with cultures positive for group B streptococci (Str. agalactiae) and Ureaplasma urealythicum. Some other microbial flora representatives such as Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis were additionally identified. The independent colonization with Str. agalactiae prior to the 18th gestational week does not relate to the spontaneous abortions and premature deliveries at all. On the other hand, the colonization with Group B streptococci or their symbiosis with other microorganisms after the 23rd-24th gestational week displays a certain correlation with the premature births.

[Diagnostic and clinical status of premature ovarian failure]. / Diagnostichno-klinichni pokazateli pri ranno nastupila iaichnikova nedostatuchnost.

Premature Ovarian Failure is a heterogeneous disorder with numerous causes. The exact prevalence of POF is unknown. In this study, we want to make Differentiate diagnosis of hypergonadotropic amenorrhea and to determine the difference between them. Retrospective, we follow up 475 women at which we perform ovarian stimulation and we observe that 6 (1.3%) have Gonadotropin resistant ovary syndrome in IVF-centre--MU--Varna.

[Some aspects of ovarian hyperstimulation syndrome]. / Niakoi aspekti na ovarialniia khiperstimulatsionen sindrom.

Ovarian hyperstimulationsyndrome (OHSS) is a serious and potentially life-threatening complication of ovarian stimulation. The clinical picture of severe OHSS, includes ovarian enlargement, ascites, pleural effusion, hypercoagulation and electrolyte disorders. In this study we describe some factors which are linked with pathogenesis of OHSS. We had a case of moderate OHSS with a twin pregnancy after IVF-ET. In this case, because of abdominal pain and discomfort from the ascites, we perform abdominal paracentesis without termination of pregnancy.

[The results of using ICSI at the Center for Assisted Reproduction, Varna]. / Rezultati ot prilozhenieto na IKSI v Tsentura za asistirana reproduktsiia--Varna.

The authors present the results of 31 consecutive cycles of ICSI. Fertilization occurred in 251 /88%/ of 279 oocytes which resulted in 8 clinical pregnancies /27% per transfer/--3 singleton, 2 multiple uterine pregnancies, 2 abortions and 1 ectopic pregnancy.

[Fetal shoulder girdle dystocia during labor]. / Distotsiia na ramenniia poias na ploda po vreme na razhdane.

Shoulder dystocia occurred in 98 women (0.9%) among 10,695 deliveries during the period of 1986-1988. The most frequent cause was overweight and strangulated umbilical cord. The following maneuvers were used: pressure on the uterine fundus, strong flexion of legs (maneuver of Knebel-Macroberts-Korokawa) and in 12 cases--extraction of the posterior hand. The head should be rotated to the opposite thigh of the parturient in cases with incorrect rotation of the head--the most frequent cause for low shoulder dystocia. Prophylactic measures are of special significance: cesarean section in women with large fetus, estimated by ultrasound, or with fetus with thoracic diameter larger than biparietal diameter with 1.5 sm. The delivery should be managed by the most experienced obstetricians and should not be protracted or precipitate without indications.