The Influence Of Intrauterine Pressure On Embryo Retention In A Catheter After Embryo Transfer.

The retention of the embryo in the transfer catheter after embryo transfer (ET) during in vitro fertilization is a very common phenomenon, encountered by even the most experienced operators, and embryos retained in the transfer catheter or its sleeve require a repeat transfer. The exact mechanism of embryo retention has not been explained. Therefore, the present study aimed to investigate the mechanism of embryo retention in the catheter during embryo transfer by using a transparent uterus model equipped with pressure sensors and a video recorder. The results indicate that pressure changes in the uterine cavity during ET can influence the distribution of the transferred fluid containing the embryo. Under certain conditions, the transferred fluid can flow backward in the catheter, which may lead to retention of the embryo in the catheter.

[Influence of naloxone on uterine contractions in patients with primary dysmenorrhea]. / Wplyw naloksonu na czynnosc skurczowa macicy u pacjentek z pierwotnym zespolem bolesnego miesiaczkowania.

UNLABELLED: Dysmenorrhea is a common condition among women in childbearing age. An increased uterine contractions, resulting among others from increased vasopressin and oxitocin secretion, is considered as a main cause of the primary dysmenorrhea. The endogenous opioids play the important role in the control of oxytocin and vasopressin release from the pituitary gland. Naloxone is a selective opioid receptor antagonis. So far, there is not much data on naloxone effect on uterine contractions. The aim of study was to determine the influence of naloxone on uterine contractions in patients with primary dysmenorrhea. MATERIAL AND METHODS: There were 10 female patients with primary dysmenorrhea included into the study. The uterine contractions had been recorded for 30 minutes before and 2 hours after injection of naloxone at the first day of menstruation. RESULTS: The intrauterine pressure recordings revealed a severe spontaneous uterine contractions, with high frequency and amplitude, at the time of dysmenorrhea. An intravenous administration of naloxone decreased uterine contractile activity and pain intensity. CONCLUSIONS: Naloxone acting on central nervous system decreases the uterus contractions in the patients suffering from dysmenorrhea. Unexplained mechanisms and multiple factors involved in the pathogenesis of primary dysmenorrhea indicates a need for the further studies on this subject.

[Influence of functional status of ovaries on results of controlled ovarian hyperstimulation]. / Wplyw stanu czynnosciowego jajników na wyniki kontrolowanej hiperstymulacji hormonalnej.

UNLABELLED: The controlled ovarian hyperstimulation is an integral part of infertility treatment. Its main objective is to obtain oocytes with a highest developmental potential. The stimulation protocols involving the gonadotropin-releasing hormone analogues and gonadotropins are considered as the most efficient. Despite many years of use, some aspects of controlled ovarian stimulation has not yet been clarified, especially the role of the functional status of ovaries before hormonal stimulation. The aim of study was to assess the influence of the functional status of ovaries on the results of the controlled ovarian hyperstimulation. MATERIALS AND METHODS: The retrospective study included female patients suffering from infertility The patients were divided into two groups depending on ultrasonographic appearance of ovaries before controlled ovarian hyperstimulation. The patients with small antral follicles < 6 mm in diameter were selected into group I. The patients with five or more antral follicles > or = 8 mm in diameter in each ovary were included into group II. The patients from both groups underwent similar treatment process. The major area of interest was the number, type and quality of oocytes obtained from patients from both groups after ovarian puncture. RESULTS: A retrospective study was conducted on 635 infertile patients (group I 382, group II 253). Altogether, 4055 oocytes were obtained in the group I and 2555 oocytes in the group II. The mean number of MII oocytes in group I was 9,2 and 8,7 in group II; p < 0.05. There were significantly more MI oocytes in group I than II. The mean numbers of immature oocytes were comparable between groups. The athretic and dysmorphic oocytes were more prevalent in group II. CONCLUSIONS: The results of the present study indicates that the functional status of ovaries before controlled ovarian hyperstimulation plays pivotal role for the treatment outcome.

[Etiopathogenesis of dysmenorrhea]. / Etiopatogeneza zespolu bolesnegomiesiaczkowania.

Dysmenorrhea is a common and frequently disabling condition among women of childbearing age. Based on results of large epidemiological studies, it is estimated that over a half of the population of young women suffers from dysmenorrhea. In spite of such a high frequency of this condition, its literature. Pain and lower abdominal cramps are among the most common causes for gynecological referral. Dysmenorrhea is sometimes associated with nausea, vomiting, diarrhea, fatigue, fever, headache, back pain, and dizziness. The exact cause of the disorder is not completely understood. However, there are many known factors that play significant roles in the pathogenesis of dysmenorrhea. The most important are: excessive uterine contractility, disturbances in uterine blood supply, synthesis of prostaglandins and anatomical abnormalities of the female reproductive tract. Primary dysmenorrhea refers to painful menstrual bleedings in the absence of any detectable underlying pathology. Secondary dysmenorrhea represents the clinical situation where menstrual pain can be related to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Unexplained mechanisms and multiple factors involved in the pathogenesis of primary dysmenorrhea indicate a vivid need for further studies on this subject.

Influence of embryo transfer on embryo preimplantation development.

OBJECTIVE: To investigate the impact of injection speeds of the transferred load on embryo development. DESIGN: A laboratory model for in vitro simulation of ET was developed to investigate the impact of varying injection speeds of the transferred load on embryo development. SETTING: Academic research institutes of reproduction biotechnology and private centers of reproductive medicine. ANIMAL(S): Mouse hybrid F(1) females (C57bl/10 J × CBA-H; N = 15) aged 2-3 months. INTERVENTION(S): In vitro exposure of mouse embryos with either the fast ET (ejection speed, >1 m/s) or slow ET (ejection speed, <0.1 m/s) and consecutive culture for 36 hours. MAIN OUTCOME MEASURE(S): Development rate, morphology and apoptotic index of embryos. RESULT(S): The development rate was the slowest in embryos exposed to the fast ET. Morphological changes in response to ET were observed only among embryos exposed to the fast ET. The mean apoptotic index was 17.6% in the group exposed to the fast ET, 5.6% in the group exposed to the slow ET, and 2.58% in the control group. CONCLUSION(S): A reduction of the ejection speed of the transferred load allows avoidance of a developmental delay and diminishes injury of the embryos. Therefore, it is reasonable to suggest transferring the embryos at the lowest possible ejection speed.

[Influence of the anti-inflammatory, anti-bacterial and anti-oxidative treatment combined with the dietary supplementation on sperm parameters]. / Wplyw skojarzonego leczenia przeciwzapalnego, przeciwbakteryjnego i antyoksydacyjnego oraz suplementacji zywieniowej mwzczyzn na jakosc nasienia.

UNLABELLED: The severe oligospermia and lukocytospermia is diagnosed among 25-40% of the infertile patients despite the absence of any clinical manifestation of the inflammatory process. The white blood cells are the main source of the free oxidative radicals, which can injure the cell membranes and the sperm DNA integrity influencing the reproductive potential of the male gametes. The aim of study was to assess the influence of the anti-inflammatory anti-bacterial and anti-oxidative treatment combined with the dietary supplementation on sperm parameters in the patients with severe oligospermia and lukocytospermia. MATERIALS AND METHODS: 100 patients with a severe oligospermia and leukocytospermia were qualified into the study. The anti-inflammatory anti-bacterial and anti-oxidative treatment combined with dietary supplementation was applied for 90 days. The sperm analysis was performed before and after the treatment. RESULTS: The mean volume of sperm samples and spermatozoa concentration were comparable before and after treatment. The leukocyte concentration was significantly lower after the therapy. There were significantly more spermatozoa in the fast and slow forward movement, less spermatozoa without movements and comparable concentration in spermatozoa in slow undirected movement after applied treatment. CONCLUSIONS: The present study demonstrated that the anti-inflammatory, anti-bacterial and anti-oxidative treatment combined with dietary supplementation in the patients with severe oligospermia and lukocytospermia improves the sperm movement parameters and reduces the inflammatory response. Therefore, it might be beneficial to patient suffering from the infertility.

[Thrombosis in the course of ovarian hyperstimulation syndrome]. / Zespól Hiperstymulacyjny Powiklany Zakrzepica.

A 28-year-old woman sought medical advice in the gynecology department because of infertility. Based on the results of the infertility workup, it was decided to apply in vitro fertilization treatment in her case. On the 12th day after embryo transfer, the patient was admitted to hospital because of nausea, vomiting, abdominal distention, and difficulties in breathing. The diagnosis was early pregnancy and the ovarian hyperstimulation syndrome (OHSS). After conservative treatment, the OHSS symptoms disappeared, and she was discharged in a good condition. However, nine days later the patient was readmitted due to a dull pain in her left shoulder, radiating onto the neck and left arm. Ultrasound examination revealed a thrombotic clot at the junction of the left external jugular vein and subclavian vein. Treatment with low-molecular-weight heparin was initiated. After 21 days of medication, the patient's symptoms resolved and, further, her pregnancy continued without complications. Although thromboembolic events are not frequently encountered in the course of OHSS, prophylactic anticoagulant therapy should be considered in all such patients.

Fluid dynamics during embryo transfer.

OBJECTIVE: To study fluid dynamics during ET. DESIGN: Computational fluid dynamics were applied to calculate fluid velocity changes, dynamic pressure differences, and shear stress in the transferred load for the following injection speeds: 0.1, 1, 6, 12, and 20 m/sec. SETTING: Academic research institute of mechanical engineering and reproduction biotechnology and private centers of reproductive medicine. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Fluid velocity, dynamic pressure, and shear stress during injection of the transferred load. RESULT(S): An increase of injection speed for the transferred load increased the shear stress, dynamic pressure, and velocity differences acting on the embryo. The narrowing of the catheter lumen diameter by 20% amplified the transferred fluid velocity by 78%. An embryo positioned in proximity to the catheter's wall was exposed to considerably higher shear stress, dynamic pressure, and velocity difference than an embryo in the center of the catheter's lumen. CONCLUSION(S): The transfer of an embryo should be conducted gently and with minimal injection speed. Any narrowing of the catheter lumen should be eliminated. Preferably the embryo should be kept far from the catheter's wall during injection of the transferred load.

Pressure induced nucleus DNA fragmentation.

PURPOSE: The present study was designed to investigate the impact of pressure on nuclear DNA integrity in viable cells of mouse blastocysts. METHODS: The blastocysts of hybrid F1 females [(C57Bl/10 J × CBA-H);N = 15] aged 2-3 months were exposed into the pressure impulse lasting ~0.021 s and characterized by a positive pressure peak of ~76 mmHg. The nuclear DNA fragmentation index of mouse blastocysts was assessed by TUNEL assay within 60 s after exposure to pressure impulse. RESULTS: The mean nuclear DNA fragmentation index was significantly higher in the experimental group (83%) than in the control group (19.7%); p < 0.001. CONCLUSION(S): A low magnitude pressure impulse can induce nuclear DNA fragmentation in mouse blastocysts. The compression and decompression forces appearing during pressure fluctuations are responsible for the observed DNA shearing.

Influence of embryo transfer on blastocyst viability.

OBJECTIVE: To investigate the impact of injection speeds of the transferred load on embryo viability. DESIGN: Laboratory model for in vitro simulation of embryo transfer (ET). SETTING: Academic research institutes of reproduction biotechnology and private centers of reproductive medicine. ANIMAL(S): Mouse hybrid F1 females, C57bl/10J × CBA-H (N = 15), aged 2 to 3 months. INTERVENTION(S): In vitro exposure of mouse blastocysts to either fast ET with an ejection speed of the transferred load of >1 m/s or slow ET with an ejection speed of <0.1 m/s. MAIN OUTCOME MEASURE(S): Morphologic changes and apoptotic index of blastocysts. RESULT(S): Morphologic changes in response to ET were most prevalent in blastocysts exposed to fast ET. The mean apoptotic index was 52% in the group exposed to fast ET, 25% in the group exposed to slow ET, and 12.8% in control group. CONCLUSION(S): Fast ejection of the transferred load can trigger both morphologic changes and apoptosis in mouse blastocysts. A reduction of the ejection speed of the transferred load minimizes injury to the embryos. Therefore, embryos should be transferred at the lowest possible speed.

Pressure changes during embryo transfer.

OBJECTIVE: To investigate the pressure changes in the transferred load during mock ET. DESIGN: Experimental setup. SETTING: Academic Research Institute of Mechanical Engineering and private centers of reproductive medicine. PATIENTS(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Laboratory simulations of ET into a rigid transparent uterine model equipped with a pressure sensor. RESULT(S): Injection of a transferring load during mock ET could increase pressure locally up to 155 mm Hg in <0.1 seconds. The recorded pressure increase slope reached values as high as 72,000 mmHg/s, and the pressure decrease slope reached 144,000 mmHg/s. The pressure buildup in the transferred liquid was proportional to the ejection speed of the transferred load. CONCLUSION(S): ET can cause rapid pressure fluctuations in the transferred liquid. Therefore, it is advisable to transfer the embryo gently with minimum ejection speed, to avoid exposing the embryo to the steep pressure gradient.

Liver dysfunction in severe ovarian hyperstimulation syndrome.

We report the case of a 32-year-old woman suffering from severe liver dysfunction in the course of ovarian hyperstimulation syndrome (OHSS). Complications occurred after successful fertilization subsequent to ovarian stimulation with human menopausal gonadotropin followed by ovulation induction with human chorionic gonadotropin. Because of nausea, vomiting, abdominal distention and enlarged ovaries on an ultrasound examination, she was admitted on the diagnosis of OHSS. During the course of hospitalization severe hepatic injury developed. An increase of more than 100-fold in blood aminotransferase activity was observed. Applied treatment resulted in gradual reduction of ovarian size and resolution of ascites, as well as pleural and pericardial effusions. The patient was discharged from hospital after 46 days. Follow-up examinations at the 13th and 32nd weeks of gestation did not reveal any abnormalities. Pregnancy developed without complications and the woman went into spontaneous labor, giving birth to a viable child at 38 weeks' gestation. Taking into account the above case and previously published reports, the issue of liver dysfunction may have a great impact on the understanding both the pathology and the treatment of OHSS.

[Two treatment methods of infertility associated with polycystic ovarian syndrome]. / Porównanie skutecznosci dwóch metod leczenia nieplodnosci zwiazanej z zespolem policystycznych jajników.

OBJECTIVES: 30 patients treated for infertility associated with PCO were analyzed. Anovulatory cycles and US scans of ovaries were taken as criteria for PCO. MATERIALS AND METHODS: Patients were treated either by the laparoscopic electrocauterization (n = 16) of ovaries or by the ultrasonographic punction of follicles (n = 14). Number of ovulatory cycles, cumulative pregnancy rate and hormonal changes were analyzed. RESULTS: We observed the same efficacy of both methods in terms of ovulatory cycles and pregnancy rates. The cumulative pregnancy rate was 37.5% in laparoscopic and 35.7% in ultrasonographic groups during the 3 months' observation. CONCLUSIONS: Ultrasonographic punction has appeared to be easier to do and safer for the patient and have the same pregnancy rate. It also gives opportunity for in vitro culture and maturation of obtained oocytes.