In Vitro Fertilization and Pregnancy Outcomes Among Patients After Kidney Transplantation: Case Series and Single-Center Experience.

INTRODUCTION: Kidney transplantation (KTx) is the treatment of choice in patients with end-stage renal failure. Among various medical issues in female graft recipients, the need for maternity can become an overriding one. Gonadal dysfunction usually resolves within 6 months after transplantation; however, the prevalence of infertility is similar to this in the general population. MATERIALS AND METHODS: This case series describes the experience in infertility treatment and following perinatal care among KTx women who underwent successful in vitro fertilization (IVF). We followed three patients who previously received KTx and underwent IVF between 2014 and 2015. The 34-year-old (patient A) and 39-year-old (patient B) women received single KTx, and the 31-year-old (patient C) woman had received three previous transplantations. Patients A and C were diagnosed with primary tubal factor infertility, while patient B suffered from secondary idiopathic infertility. The stimulation protocols had no influence on their general condition nor graft function. Viable singleton pregnancies were confirmed in all cases. All newborns were born preterm, via cesarean section, as a consequence of severe preeclampsia. Patients A and C gave birth at 34th week of gestation (WG) (A: 1810 g and C: 2295 g), while patient B gave birth at 36th WG (2655 g). Other pregnancy complications were intrauterine growth restriction (patient A) and gestational diabetes mellitus (patient B). Although mild graft dysfunction was observed prior to delivery, all clinical measures and hypertension resolved during the puerperium. CONCLUSIONS: In these cases, pregnancy after KTx did not implicate persistent graft dysfunction. Regardless of the method of conception, pregnancy following KTx is associated with an increased incidence of complications, therefore it requires a multidisciplinary approach. IVF itself seems to be a safe procedure in KTx recipients if the pregnancy is advisable.

The effect of pregnancy on humoral rejection in patients after vascularized organ transplantation.

The aim of the study was to evaluate the effect of pregnancy on the production of donor- and nondonor-specific anti-human leukocyte antigen antibodies (anti-HLA Abs) in organ allograft recipients. The study group included four pregnant kidney (RT) and four liver (LT) transplant recipients. The genotype of HLA class I (A, B) and class II (DR) antigens was assessed. Anti-HLA antibodies class I and II were evaluated between 36 and 40 weeks' gestation. Two different control groups consisted of the following: group I (n=8) with nonpregnant RT (n=6) and LT recipients (n=2), and group II with healthy pregnant women (n=10) with anti-HLA Abs detected between 38 and 41 weeks' gestation. The HLA genotype was determined in fathers of the fetuses from the study group and group II controls. Half of group II controls had donor-specific anti-HLA (A, B, and/or DR) Abs, while nondonor-specific anti-HLA Abs were detected in all subjects from that group. Anti-HLA Abs were found in all group II controls. In the study group, anti-HLA Abs were found in only two LT recipients and one RT recipient, but they were not confirmed as donor-specific. Anti-HLA antibodies were not detected in the study group, whereas six out of ten group II controls had anti-HLA Abs against the HLA of the child's father. Pregnancy in vascularized organ recipients does not trigger the mechanism of humoral rejection involving anti-HLA class I and II antibodies with a potentially adverse impact on graft function.

Intrauterine growth restriction in pregnant renal and liver transplant recipients: risk factors assessment.

BACKGROUND: Nowadays pregnancy after organ transplantation is possible due to advances in surgical and immunosuppressive therapies. One of the possible complications in pregnancy after organ transplantation is intrauterine growth restriction (IUGR). This may lead to various adverse perinatal outcomes. Prevalence of IUGR in the general population is estimated at 3%-10% with smoking being the most frequent maternal risk factor. The aim of this study was to determine the risk factors of IUGR in pregnant renal transplant recipients (RTR) or liver transplant recipients (LTR) in comparison with healthy pregnant women. METHODS: Retrospective analysis included 48 RTR and 52 LTR. IUGR was defined as estimated fetal weight less than the 10th percentile for gestational age. IUGR was diagnosed in 15 (31.3%) pregnant RTR and in 10 (19.2%) LTR. The control group consisted of 60 healthy pregnant women diagnosed with IUGR. Fisher exact test and Student t test were used to assess the differences in fractions and means, respectively, between distinguished groups of patients. Test for fractions based on asymptotic normal distribution was used to compare the proportion of patients with IUGR with the proportion of 10% in the general population. The logistic regression model was used to assess the statistical significance of correlations between the assumed risk factors and the prevalence of IUGR in multivariate settings. RESULTS: Hypertension, anemia, and proteinuria were the most frequent complications in the study group. They were more prominent in RTR than in LTR. Hypertension was diagnosed in all RTR, whereas severe anemia requiring erythropoietin treatment or blood transfusion was found in 4 RTR and in 1 LTR. CONCLUSION: IUGR is more common in organ recipients. Therefore, vigilant obstetric care is highly recommended in pregnant patients after renal or liver transplantation. Hypertension, severe anemia, and proteinuria proved not to be statistically significantly correlated with the prevalence of IUGR among patients after transplantation.

[The results of GnRH analog treatment of endometriosis]. / Wyniki leczenia endometriozy analogami GnRH.

Our study consisted of 146 patients with endometriosis diagnosed during laparoscopy. The age of those women varied from 19 to 43. Pathological changes were classified according to Revised American Fertility Society scale. Numeric scale was also used to evaluate clinical symptoms characteristic to this disease. During the initial laparoscopy biopsies were taken, endometrial implants were coagulated, pelvic adhesions deliberated and endometriomas were enucleated or their wall cut out and coagulated. When endometriosis was histopathologically confirmed the hormonal treatment was undertaken during a period of time from 3 to 6 months depending on the severity of the disease. The patients were treated with 3.6 mg gosereline and 3.75 mg triptorelin monthly or with 400 mcg of naphareline daily. The hormonal therapy was monitored by the concentration of estradiol in blood serum. After full cycle of GnRH analogues treatment laparoscopy was repeated. The mean of The Symptom Severity Scores decreased from 7.1 to 2.1 after the treatment which is a 70% decrease. In the group of women with pain complains 96% of patients noticed improvement, in the group suffering from infertility there were 26.3% of patients who got pregnant. GnRH analogues were good tolerated by patients during the treatment.

[Semen parameters in secondary infertile couples]. / Analiza parametrów nasienia we wtórnej nieplodnosci malzenskiej.

OBJECTIVE: The aim of this study was to evaluate sperm values in the group of secondary infertile couples. MATERIAL AND METHODS: The material of the study included 35 couples with abortion in anamnesis, 12 couples with delivery in past and 11 couples conceive and deliver during studies. Sperm analysis was performed according to the WHO guidelines. RESULTS: Men from couples with abortion in past had significantly higher sperm concentration compare to couples with delivery in past. In other parameters there was no significant differences observed. CONCLUSION: Sperm concentration can be important factor in secondary infertility.

[The atherogenic lipid profile parameters and fibrinogen serum concentration in climacteric women under various routes of hormone replacement therapy administration]. / Ocena stezenia aterogennych czynników lipidowych i fibrynogenu w surowicy kobiet stosujacych rózne formy hormonalnej terapii zastepczej w okresie klimakterium.

OBJECTIVES: Influence of various routes of HTR on atherogenic lipid profile parameters and serum fibrinogen concentration was investigated. DESIGN: In 85 women in four groups receiving HRT transvaginally, transdermally, orally and intramuscularly, the total cholesterol, HDL-cholesterol, triglycerides, apoB, apoA, LpA and fibrinogen serum concentration was assessed before treatment and after six month. RESULTS: Most of tested parameters: total cholesterol, LpAI, apoB, LDL cholesterol, non HDL cholesterol, changed favorably (lowered concentration) in group using HRT orally and intramuscularly. CONCLUSION: Orally and intramuscularly route of administration HRT have better cardioprotective effects.

[Results of clomiphene citrate ovarian stimulation vs laparoscopic electrocoagulation of the ovaries in infertile women with PCOS]. / Wyniki stymulacji owulacji cytrynianem klomifenu vs elektrokoagulacja jajników u pacjentek z zespolem PCO.

OBJECTIVE: To assess the results of clomiphene citrate ovarian stimulation vs laparoscopic electrocoagulation of the ovaries in infertile women with PCOS. DESIGN: 47 women with PCOS were included into the study. 25 of them had ovarian stimulation using clomiphene citrate (100 mg for 5 consecutive days, during 6 cycle) and 22 underwent laparoscopic electrocoagulation of the ovary (6 cycle follow-up) No significant differences were detected between age and body mass index. RESULTS: In the first group ovulatory cycles were confirmed in 68% of women, pregnancy rate was 28%. In the second group ovulations were observed in 90.9% of women and pregnancy rate was 63.6%. There were statistically significant differences. CONCLUSION: In summarising, the results showed lower, statistically significant differences in pregnancy rate in the treatment of infertility associated with PCOS. It seems that the much more successful result of the PCOS therapy may be achieved after laparoscopic ovarian diathermy in comparison with stimulation of the ovaries with CC.

[Analysis of female infertility structural factors]. / Analiza czynników bioracych udzial w strukturze nieplodnosci kobiecej.

The study was aimed to evaluate, within the population of infertile women, the interrelations between such characteristics as patient's age, duration and type (primary, secondary) of infertility, its etiologic factor as well as the treatment outcome (pregnancy rate). Retrospective analysis was performed in 176 women aged 20-43 years (mean age 29.5 years). Primary infertility was less common in older women (above 35 years). Duration of primary infertility was independent of age, on an average 1.5 years shorter compared to secondary infertility. Participation of all causal factors in the structure of infertility was steady--11.6-20.2%. The most frequent reasons of secondary infertility were unexplained infertility 55.3% and tubal pathology--19.1%. The pregnancy rate was 30% in all treated women. In the studied population of women, pregnancy rate was not significantly influenced by the patients's age, type of infertility and its cause.

[Clinical effectiveness of Marvelon]. / Analiza kliniczna stosowania Marvelonu.

Clinical results of a new contraceptive pills--Marvelon (Organon) were studied. 32 women, ages 30 +/- 5 years, participated in the study during at least 6 cycles. Marvelon was good tolerated and subjective side-effects were very low. The cycles were regular, duration of withdrawal bleeding was 3-5 days and the amount of the blood lost were unchanged or milder. Marvelon didn't affect body weight and blood pressure. Favourable lipid profile--increased a mean level of HDL-Cholesterol and decreased a mean level of LDL-Cholesterol were noticed. Pearl Index was 0,0.

PIP: Marvelon is an oral contraceptive of the third generation of contraceptives introduced in the 1980s. These preparations contain progestagens (desogestrel, gestodene, and norgestimate) and ethinyl estradiol. Marvelon contains .03 mg of ethinyl estradiol and .15 mg of desogestrel. The results of clinical use of Marvelon (made by Organon), were studied in 32 women aged 30 +or- 5 years in the course of at least six cycles. Marvelon was well tolerated and the subjective side effects were minor. The cycles were regular and withdrawal bleeding lasted 3-5 days. The duration of menstrual cycles with the use of Marvelon constituted 27-30 days. The amount of bleeding did not change in 26 women, while it became less in 6 women. Marvelon did not affect body weight and blood pressure. The weight of the patients varied within the limit of +or- 2 kg. It produced a favorable lipid profile by increasing the mean level of high density lipoprotein (HDL) cholesterol and lowering the mean level of low density lipoprotein (LDL) cholesterol. The level of HDL cholesterol was 1.56 mmol/l in cycle 0 compared with 1.85 in cycle 6. The average level of LDL cholesterol was statistically lower in the 6th cycle of Marvelon use (2.73 mmol/l) in comparison to cycle 0 (3.29 mmol/l). Marvelon did not significantly influence the values of glucose, total cholesterol, and triglycerides. The Pearl Index was 0.0.

[Clinical treatment results of treating androgenization symptoms in women with preparation Diane-35]. / Wyniki badan klinicznych leczenia objawów androgenizacji u kobiet preparatem Diane 35.

26 women with androgenization: hirsutism, acne, seborrhea, aged 18-30 were treated with Diane 35 during at least 12 cycles. In investigated group of patients acne was in remission in 82.4% after 3 cycles, seborrhea was reduced in 85.5% after 3 cycles and in 96.2% after 6 cycles. Hirsutism was reduced only in 19.2% women after 12 cycles. Diane 35 was well tolerated and effective in contraception all investigated women.

[Clinical observations using the new contraceptive preparation containing gestagen]. / Obserwacje kliniczne stosowania nowego preparatu antykoncepcyjnego za wierajacego gestoden.

31 women aged 26-35 were observed during hormonal contraception with Femovan (in Poland registered as Femoden). The aim of the study was an analysis of effectiveness, influence on menstrual cycles and adverse effects in Femovan users. The conclusions of the study indicated that Femovan is very effective in contraception (Pearl index = 0). It provides good cycle control. It reduced in 50% women nausea and breast tenderness which occurred before starting of contraception. There were not body gain and elevated blood pressure in any women. Acne was reduced in 40% women after 3 months of using.

[Analysis of congenital malformations in newborns]. / Analiza wad wrodzonych u noworodków.

We analyzed data from 194 newborns with congenital malformations of central nervous, cardiovascular, gastro-intestinal, skeletal, genito-urinary systems and Down's syndrome. We detected that the highest frequency of congenital malformations occurred from may 1986 to december 1986. Congenital malformations were detected more frequently in female newborns and newborns delivered by multipara. The percentage of CNS malformations was constant but at the same time the number of other malformations were significantly changed. We made an attempt of statistical analysis of frequency and type of malformations taking into consideration possible influence of radiation during analyzed period.