[Prevalence of Chlamydia trachomatis infection in patients treated for infertility]. / Výskyt Chlamydia trachomatis pri lécbe neplodnosti.

AIM OF THE STUDY: To determine the prevalence of Chlamydia trachomatis infection in patients treated for infertility. STUDY TYPE: A retrospective analysis. SETTING: Fertimed, infertility treatment center, Olomouc. METHOD: At Fertimed, we used DNA detection of Chlamydia trachomatis by the PCR method of the company GeneProof to examine, between 2009-2011, 785 women undergoing one of the infertility treatment methods and their 113 partners. In the second group, we examined 121 oocyte donors and 30 men before sperm donation. We appraised the frequency of Chlamydia trachomatis detection in the specific groups and the clinical impact of the infection on the female reproductive organs. RESULTS: In the group of women treated for infertility, we detected 20 (2.5%) women with an active infection. After treatment, 9 of them underwent an examination of Fallopian tube patency using the UTHL (ultrasonographically guided transvaginal hydrolaparoscopy) method. In 7 cases, we indicated a bilateral salpingectomy due to a sactosalpinx and in one case severe pelvic adhesions were found (88.9%), and in one patient, the result was normal. In the control group of 43 PCR-negative women who were examined for Fallopian tube patency, 9.3% rate of tubal pathology was found (p<0.001). In the oocyte donor group, we detected the presence of Chlamydia trachomatis in 12 (9.9%) women, and in the sperm donor group, in 7.6% men. Treatment with 500 mg of Sumamed (azithromycin), given in 3 doses, was successful in all of the positive patients. CONCLUSION: We found that Chlamydia trachomatis detection was lower in the women treated for infertility than in the female donor group. Women with a confirmed infection had a high prevalence of inflammatory changes in the Fallopian tubes compared with women devoid of a confirmed infection. The treatment with azithromycin is effective.

Is there a declining trend in ovarian function among infertility clinic patients?

BACKGROUND: There is a growing body of evidence that testicular function has decreased rapidly over the last 50 years. However, much less is known about corresponding trends in ovarian function. Herein, we examine the temporal changes in ovarian function in a large sample of infertile patients from the Czech Republic over a period of 14 years. METHODS: In a retrospective study, we analysed a large body of data from women, 20-40 years of age, undergoing IVF/ICSI treatment between 1995 and 2008. We defined ovarian function using five variables: basal FSH level, estradiol (E2) level on the day of HCG administration, dose of gonadotrophins used for ovarian stimulation, number of retrieved oocytes and dose of gonadotrophins per oocyte. Controlling simultaneously for temporal changes in patient age and stimulation protocol, we applied generalized additive models to describe the temporal trends. RESULTS: During the study period the mean age of the study population increased by 2.7 years. Whereas the basal FSH and gonadotrophin dose did not change over time, the E2 level and oocyte retrieval declined, and the dose of FSH per oocyte increased during the study period. CONCLUSIONS: The results are indicative of a small, but detectable decrease in ovarian function over a period of 14 years, which is not causally related to the ageing population.

[The age of women treated for infertility increases]. / Vek zen podstupujících lécbu neplodnosti roste.

OBJECTIVE: The age of women at first child in the Czech Republic increases. We investigated whether this trend translates into the group of patients treated for infertility by IVF. SETTING: Fertimed, infertility centre, Olomouc. METHODS: We summoned data from 4689 women treated for infertility in our centre. We investigated the age of the patient, FSH levels, E2 levels, number of FSH units needed for ovarian stimulation, number of oocytes and embryos. We analysed the results by the method of regression analysis. RESULTS: We found that the mean age increased from 28.7 to 32 years in a period of 10 years. We also demonstrated that the increasing age was accompanied by a decrease in ovarian function. CONCLUSION: Women older than 32 years should be informed about the decreased ability to conceive. The treatment of women for infertility can be complicated by the growing age of patients in coming decades.