Transabdominal punction of follicular fluid in IVF cyclus in a patient after ovarian transposition.

OBJECTIVE: Description of punction of follicular fluid in a patient after ovarian transposition. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and the General Faculty Hospital, Prague. CASE REPORT: We present a case of IVF treatment in a patient with ovarian transposition undergoing punction of follicular fluid and difficulties during this procedure acording to transabdominal route. CONCLUSION: Transabdominal punction od follicular fluid is possible, but with technical difficulities and smaller amount of obtained oocytes. We recomend to aplicate IVF procedures prior to surgical solution.

Native IVF cycle at woman in 46-age with clinical pregnancy.

OBJECTIVE: To present a case of a patient who was treated for a sterility at the age of 46. The treatment was successful, after that we confirmed a clinical pregnancy. We present the treatment procedure in this case and summarize other treatment options in patiens over 40 years of age. DESIGN: Case report. SETTING: The Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and the General Faculty Hospital Prague 2. CASE REPORT: Infertility treatment in patiens over 40 years is often without the desired result, it is often difficult for both the patient and the attending physician. We describe the case in which a patient became pregnant using her own oocytes obtained from a puncture from the native IVF cycle. CONCLUSION: Treatment management in patients over forty years of age offers several options, above all it is necessary to choose a couple whether they want to undergo treatment with their own or donated oocytes. Pregnancy in patiens over 40 years of age using treatment with thein own oocytes is significantly less successful. There is also a decrease in the chances of a continuing physiologically progressing pregnancy and the birth of a healthy offspring, compared to younger patients. We recommend spreading this information to women's awareness.

The effect of polychlorinated biphenyls and organochlorinated pesticides on human reproduction.

OBJECTIVE: To summarize the current knowledges about the influence of PCB (polychlorinated biphenyls) and OCP (organochlorinated pesticides) on human infertility. TYPE OF STUDY: Review article. SETTING: The Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and the General Faculty Hospital, Prague. METHODS: Analysis of literature and current studies. RESULTS: We prepared a review about the known effects of PCB and OCP on human reproduction, which can influence the results of IVF (in vitro fertilisation) program by their cumulation in follicular fluid. CONCLUSION: In these compounds there is not direct evidence of their negative influence of reproduction. We have to complete our knowledges about PCB a OCP on fertility and protect the population against their cumulation.

[Relationship between the levels of toxic polychlorinated biphenyls in blood and follicular fluid of sterile women]. / Vztah mezi hladinami toxických polychlorovaných bifenylu v krvi a ve folikulární tekutine sterilních zen.

OBJECTIVE: The aim of this study was to confirm the possibility of detection of toxic polychlorinated biphenyls in blood and follicular fluid of infertile women undergoing IVF+ET program and determine the levels of some congeners. To confirm their cumulation in follicular fluid. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, AXYS Varilab s.r.o., Vrané nad Vltavou, Institute of Hygieny and Epidemiology, 1st Faculty of Medicine Charles University and General Faculty Hospital, Prague, Euromise Centrum, Charles University, Prague. METHODS: We detected the level of polychlorinated biphenyls in blood and follicular fluid of infertile women undergoing IVF+ET program. We recieved the follicular fluid by transvaginal punction of follicles under ultrasonography control. The blood was taken before begining of anestezia. The follicular fluid and blood were frozen and transported to the laboratory. The samples were examined there by methods of gas chromatography and mass spectrometry. We were able to find all PCBs with 3-7 atoms of chlorine. RESULTS: We confirmed the possibility of detection of polychlorinated biphenyls (PCBs) in blood and follicular fluid of infertile women. We examineted the levels of PCB 77, 81, 105, 114, 118+123, 126, 156, 157, 167, 169, 189. The levels of PCBs were in ng/gram of fat. The levels of polychlorinated biphenyls differed from 0 to 400 ng/g of fat. Statistical analysis was made by t test a Wilcox test. All PCBs are cumulated in follicular fluid, except of PCB 126. CONCLUSION: The possibility of detection of PCBs in blood and follicular fluid of infertile women undergoing IVF+ET program was confirmed. The cumulation of these xenobiotics in follicular fluid was found. In the future we will analyse the relationship between the presence of these xenobiotics and achieving succesful pregnancy.

[Differences in the polychlorinated biphenyl levels in follicular fluid in individual types of sterility]. / Jak se lisí hladiny polychlorovan ch bifenylu ve folikulární tekutine u jednotlivých typu sterilit?

OBJECTIVE: To find the differences of polychlorinated biphenyls (PCBs) levels in follicular fluid in different indications to treatment with IVF + ET program. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, AXYS Varilab, s.r.o., Vrané nad Vltavou, Prague, Euromise Centrum, Charles University and Academy of Art, Prague. METHODS: We examinated 100 infertile women undergoing IVF + ET program in our pilot study. After ovarian pick-up, frozen follicular fluid were transported to the laboratory. We detected the levels of polychlorinated biphenyls in follicular fluid of infertile women. The levels were compared according to the different indications of treatment. The control group consist of patients with male factor of sterility. RESULTS: We confirmed the higher levels of PCB 114, 153, 156, 157, 180 and 189 in indication endometriosis compared with the others and with control group. The levels of PCBs were in ng/gram of fat. CONCLUSION: It has become apparent that higher levels of PCB 114, 153, 156, 157, 180 and 189 in endometriosis patients may be one of many factors participating in the origin of the disease.

[Threatening uterine rupture in pregnancy after previous laparoscopic myoma enucleation. Case report]. / Hrozící delozní ruptura v gravidite po predchozí laparoskopické enukleaci myomu. Kazuistika.

OBJECTIVE: To evaluate the negative effect of uterine myoma enucleation forcompact structure of the uterus. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Pronatal Sanatoruim, Prague METHODS: In this study, the authors analyze their experience of the course of pregnancy in a patient who had uterine myoma enucleation with penetration to the uterine cavity and large coagulation. The pregnancy was terminated by caesarean section for the indication of prior uterine surgery and the risk of uterine rupture in 38 week of pregnancy. CONCLUSION: This case report demonstrates the risk of uterine rupture in pregnancy after laparoscopy myoma enucleation.

[Delivery of a healthy child from pregnancy after IVF complicated hyperstimulation syndrome, phlebothrombosis and resection of uterine horn. Case report]. / Porod zdravého plodu v gravidite po IVF komplikované hyperstimulacním syndromem, flebotrombózou a resekcí rohu delozního. Kazuistika.

OBJECTIVE: To evaluate the negative effect of uterine horn resection for heterotopic pregnancy in the uterine horn in the first trimester on the course of pregnancy and labor. To point out the increased incidence of other complications in pregnancy after IVF+ET (ovarian hyperstimulation syndrome, phlebothrombosis of the pelvic veins). DESIGN: Case study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague. METHODS: In this study, the authors analyze their experience with the course of pregnancy of a patient who had uterine horn resection for a heterotopic uterine horn pregnancy after IVF+ET. The course of pregnancy was associated with further complications such as ovarian hyperstimulation syndrome and the resulting occurence of thrombosis in the 2nd trimester of pregnancy. The pregnancy was terminated by caesarean section for the indication of prior uterine surgery-resection of the uterine horn in the first trimester. A healthy infant was delivered. CONCLUSION: This case study demonstrates the multiple occurrence of serious complications in pregnancy after IVF+ET, which are associated with ovarian hyperstimulation and the transfer of multiple embryos. The pregnancy was terminated with the delivery of a healthy term infant.

[Comparison of organochlorine pesticide levels in blood and follicular fluid of infertile women]. / Porovnání hladin organochlorovaných pesticidu v krvi a ve folikulární tekutine neplodných zen.

OBJECTIVE: The aim of this study was to detect DDT and its metabolites, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyklohexane - HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women undergoing IVF+ET program. In the case if their detection, to confirm their cumulation in follicular fluid. DESIGN: Pilot study. SETTING: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, AXYS Varilab s.r.o., Vrané nad Vltavou, Institute of Hygiene and Epidemiology, 1st Faculty of Medicine Charles University and General Faculty Hospital, Prague, Euromise Centrum, Charles University and Academy of Arts, Prague, Czech republic. METHODS: We detected the level of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyklohexane - HCH) and hexacyclobenzene (HCB) in blood and folicular fluid of 30 infertile women undergoing IVF + ET program. We recieved the follicular fluid by transvaginal punction of follicular fluid under ultrasonography control. The venous blood was taken before begining of anestesia. The follicular fluid and blood were frozen and transported to the laboratory. There the samples were examinated by the methods of gass chromatography and mass spectrometry. RESULTS: We confirmed the possibility of detection of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane - HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women. The differences in concentrations in blood and follicular fluid were statistically analysed. We confirmed the cumulation of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane - HCH) and hexacyclobenzene (HCB) in follicular fluid of infertile women. The levels of these compounds in blood differed from 2.8 to 6399.3 ng/g of fat, in follicular fluid from 1.4 to 4 099.8 ng/g of fat. CONCLUSION: It is possible to detect DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane - HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women. The cumulation of these xenobiotics in follicular fluid was found.

[Thromboembolic complications in patients undergoing in vitro fertilization: retrospective clinical study]. / Tromboembolické komplikace u pacientek z programu IVF-ET: retrospektivní klinická studie.

OBJECTIVE: To determine the incidence and the type thromboembolic complications in patients undergoing in vitro fertilization (IVF). To evaluate their clinical course, the influence on reproductive outcomes, and the prevalence of thrombophilia in these women. DESIGN: Retrospective clinical study. SETTING: Assisted Reproduction Center, Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague. METHODS: The data, reflecting the diagnosis of thromboembolism (TE), were collected from all patients, who have undergone the IVF cycle in our clinic for the last 7 years. The following data were analyzed in these patients: medical history, type and course of TE, type and effect of ovarian stimulation, clinical pregnancy achievement, occurrence of ovarian hyperstimulation syndrome (OHSS), results of testing for thrombophilia, pregnancy course and outcome. RESULTS: From 2748 IVF cycles 3 cases of TE were found (0.11%). In all cases the unilateral thrombosis of internal jugular vein associated with OHSS, manifesting in 1st trimester of pregnancy and not complicated with pulmonary embolism occurred. At least two thrombophilic markers have been detected in all these women. The clinical course of TE, as well as of the whole gestation was favorable. Prevalence of TE in patients with severe OHSS was 4.1% (2 women from 49). CONCLUSION: The incidence of thromboembolism in women undergoing IVF is low. It appears almost exclusively in association with OHSS and the typical finding is deep venous thrombosis in the neck area. In our opinion, while screening of thrombophilia in all patients from IVF program is not indicated, the routine testing of most common thrombophilic markers in pregnant women with OHSS could decrease the risk of these serious complications.

[Effect of toxic substances in the environment on reproduction]. / Vliv toxických látek ze zivotního prostredí na reprodukci.

OBJECTIVE: To summarize the findings about the influence of some xenobiotics on human reproduction, especially infertility. TYPE OF STUDY: Review article. SETTING: The Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and the General Faculty Hospital, Prague METHODS: Analysis of literature. RESULTS: A review about the influence of some xenobiotics on human reproduction was given. In some there is a possible negative influence on the results of in vitro fertilisation program. It is a question of hormone disruptors, some heavy metals, some organic solvents, pesticides and smoking of cigarettes. CONCLUSION: In most of these xenobiotics there is direct evidence of their negative influence on reproduction and the results of in vitro fertilisation program. Therefore it is worth to continue in this evaluation.

[Antiemetics in gynecologic oncology]. / Antiemetika v onkogynekologii.

OBJECTIVE: The authors present a survey of available pharmacological possibilities of treatment of nausea and vomiting aimed at their application in oncological therapy of gynecological neoplastic diseases. TYPE OF THE STUDY: A review article. NAME AND ADDRESS OF THE INSTITUTION: Gynecological-Obstetrical Clinic, First Medical Faculty, Charles University and General Faculty Hospital, Praha. SUBJECT AND METHOD OF THE STUDY: A survey of published data from the Czech and foreign professional literature. CONCLUSION: 5-HT3 receptor antagonists take up the most important position in the antiemetic treatment of oncological patients. They efficiently prevent and treat vomiting induced by anticancer drugs with high and very high emetogenic effect. They have been used as monotherapy or in combination with corticoids. In the treatment of nausea and vomiting or vomiting induced by anticancer drugs with medium or light emetogenic effect, antiemetic preparations from the corticoid series and dopamine receptor antagonists may be recommended. In the treatment of anticipation vomiting, benzodiazepines are indicated for their anxiolytic and psychosedative influence.

[Pregnancy in myelodysplastic syndrome]. / Gravidita pri myelodysplastickém syndromeu.

OBJECTIVE: Evaluation of the influence of myelodysplastic syndromee (MDS) on the course of pregnancy and delivery. DESIGN: Case report. SETTING: Gynecological and Obstetric Department 1st Medical Faculty Charles University and General Faculty Hospital, Prague. SUBJECTS AND METHODS: The authors analyze their experience with the course of pregnancy and delivery in a patient with MDS and refractory anaemia who was treated on account of the disease for several years before pregnancy in the Institute of Haematology and Blood Transfusion. Pregnancy was not associated with progression of the basic disease and complications which developed during pregnancy were not associated with MDS. Pregnancy was terminated in this patient on account of preeclampsia gravis per sectionem caesarean by delivery of a healthy foetus. CONCLUSION: The example draws attention to a serious haematological disease while during pregnancy and delivery deterioration of the basic disease was not observed.

Multi-fetal pregnancy reduction does not influence perinatal results in twin pregnancies.

The objective of this study was to compare perinatal results in multifetal pregnancies where the reduction to twins was performed with non-reduced twin pregnancies. Perinatal results in 99 sets of twins after transabdominal multifetal pregnancy reduction of triple and higher-order multiple pregnancies performed in a single center were compared with a control group consisting of 151 twin pregnancies conceived in the same time period after infertility treatment, which were not a result of reduction. The main outcome measures were length of pregnancies, weight of the newborns, percentage of miscarriages and the mode of the delivery were analyzed. No significant difference could be found at a 5% level of significance regarding the average duration of pregnancy or average weight of the twins. Fisher test on 5% significance level did not ascertain any significant difference in the probability of miscarriage between the group with reduction (5.26%) and the group without reduction (12.84%). At a 5% level of statistical significance, no significant difference in probability of perinatal death of the fetus or delivery of a stillborn fetus was found. The percentage of cesarean sections did not differ significantly in both groups. The analysis of both groups demonstrated that reduction of multifetal pregnancies to twins may not influence perinatal results in comparison to twin pregnancies where reduction was not performed.

[Does reduction in multifetal pregnancy increase the risk of poor outcome in twin pregnancy?]. / Zhorsuje redukce vícecetné gravidity perinatální výsledky u dvoucetných gravidit?

OBJECTIVE: To compare perinatal results for multi-foetal pregnancies where the reduction was performed with pregnancies where the reduction was not performed. SETTING: Sanatorium Pronatal, Na Dlouhé mezi 4/12, 147 00, Praha 4--Hodkovicky. METHODS: We have analyzed results of pregnancies, after delivery, for women with twin pregnancy which originated in our sanatorium, as a result of treatment with assisted reproduction methods, in the period of time from January 1st 1996 to December 31st 1998. In the group being monitored there were 122 twin pregnancies originated as a result of reduction of triple and more-foetal pregnancies. We evaluated the percentage of miscarriages, length of pregnancies, weight of the newborns and the manner of termination of the delivery. These results were compared with our control group consisting of 180 cases of twin pregnancies which were not a result of reduction. RESULTS: Analysis was performed for those mothers only where complete data were available. At a 5% level of statistical significance, it was not proved that both groups differed in average term of pregnancy or average weight of the twins. Average age of the mothers differed at 5% level of significance (average age values were 30.16 for the group with reduction and 31.73 for the group without reduction). Fisher test on 5% significance level did not ascertain any significant difference in the probability of miscarriage between the group with reduction (5.26%) and the group without reduction (12.84%). At 5% level of statistical significance, no significant difference in probability of perinatal death of the foetus or delivery of a stillborn foetus was ascertained. However, it is necessary to point out a low frequency of these phenomena in our group. The percentage of cesarean sections did not differ significantly in both groups (86.24% in the group monitored vs 87.24% in the group of twins without reduction). CONCLUSION: The analysis of both groups proves that reduction of multi-foetal pregnancies does not worsen perinatal results in comparison to pregnancies where reduction was not performed.

[Monochorionic twins after treatment of sterility using assisted reproduction methods]. / Monochoriální dvojcata po lécbe sterility metodami asistované reprodukce.

OBJECTIVE: The goal of this study has been to determine frequency of occurrence of monochorial twins within the study group consisting of 521 pregnancies conceived through the In Vitro Fertilization (IVF) programme. DESIGN: An observational study. SETTING: Sanatorium Pronatal, Na Dlouhé mezi 4/12, 147 00 Praha 4-Hodkovicky. METHODS: A condition to be included in the study group was that there was a gestation sac detected by ultrasound. The first ultrasound examination was performed transvaginally and was done between the fifth and the sixth week of each pregnancy. A multiple pregnancy has been classified as monochorial in case when gestation sac contains two yolk sacs and two fetuses. RESULTS: Within the whole study group there were 13 monochorial twins which presents 2.5% of all pregnancies. The incidence of monochorionicity among all multiple pregnancies is 6.4%, in IVF cycles without micromanipulation techniques the occurrence of monochorial twins has been 0.9%, following cryoembryotransfer 3.9%, with micromanipulation (ICSI, AH) it reaches 5.7% of all pregnancies. CONCLUSION: Monochorial twins were detected seven time more frequent in comparison within occurrence in ordinary population. The occurrence rises in connection with the number of fetuses in uterus. In comparison with simple IVF cycles we have proved higher occurrence of monochorionicity in connection with micromanipulation techniques and cryoembryotransfer.

[Actocardiography in obstetrics]. / Aktokardiografie v porodnictví.

Introduction of ultrasonic techniques made more detailed follow-up of the motor activity of the foetus in its natural environment possible. The objective of the submitted paper is to present actocardiography as a method which makes it possible to visualize differences of motor activity of the foetus, in particular during the third trimester and to map different types of movements. The authors obtained thus objective records in a group of pregnancies which will be suitable for comparison with the motor activity of foetuses with signs of hypoxia, with foetuses with retarded growth or foetuses threatened by other risks. This method can be thus included and used as a method of routine in the spectrum of examinations of imminent foetal stress.