[The analysis of preliminary spermatological parameters in potential donors of semen]. / Analýza spermiologických parametru vstupního vysetiení potenciálních dáircu spermí.

OBJECTIVE: To contribute to the contemporary discussion on the male factor infertility through the evaluation of the basic spermatological parameters in men recruiting for semen donation. DESIGN: A retrospective demographic study. SETTING: Dept. of Obstetrics and Gynaecology, Dept. of Biology, Faculty of Medicine, Palacký University, Olomouc. METHODS: A total of 108 men aged 18 to 35 years came to the preliminary examination for the potential semen donors between January 2000 and April 2004. Spermatological analysis of the fresh ejaculates obtained by masturbation was performed according to WHO guidelines. The following parameters were evaluated: the volume of ejaculate, sperm concentration and total percent motility. RESULTS: Normospermia was found in only 46 men (42.6%). Three males (2.8%) were azoospermic. The most frequent problem was asthenospermia, which was documented in 49 (46.6%) men. CONCLUSION: The analysis of the obtained data may suggest a marked semen quality decline in the Czech male population. In our opinion, further multicentric epidemiological studies concerning fertility potential in Czech male population seem highly needed.

[A shortened exposure of oocytes to sperm in standard in vitro fertilization]. / Zkrácená expozice spermií s oocyty pri klasickém IVF.

OBJECTIVE: To find out if the shortened exposure of oocytes to sperm can influence the embryo quality and the implantation and pregnancy rate of the classical IVF also in Centre for Assisted Reproduction. DESIGN: A prospective study including 104 patients undergoing the classical IVF procedure. SETTING: Centre for Assisted Reproduction, Clinic of Gynaecology and Obstetrics, Palacký University Medical School and the University Hospital in Olomouc. METHODS: In the study group with the shortened exposure (54 patients) the oocytes were washed one hour after the insemination and transferred into the fresh medium. In the control group (50 patients) the classical procedure (e.g. transfer into the fresh medium 17 to 20 hours after insemination) has been used. The following parameters have been evaluated in both groups: the stimulation protocol, sterility cause, number of previous IVF cycles, age, serum estradiol level on the day of hCG application, number of retrieved oocytes, fertility rate (FR), embryo quality, pregnancy rate (PR) and the implantation rate (IR) expressed as the number of gestational sacs with heart action related to the number of transferred embryos. T-Test, Mann-Whitney Test and chi 2 were used for statistical evaluation. RESULTS: There were no statistically significant differences between the study and the control group in any of the parameters compared. CONCLUSION: In our study group the shortened exposure of oocytes to sperm did not influence the results of the classical IVF.

[Ascitic fluid puncture in the treatment of severe forms of ovarian hyperstimulation syndrome]. / Punkce ascitické tekutiny v lécbe tezké formy ovariálního hyperstimulacního syndromu.

OBJECTIVE: Evaluate the contribution and complications of ascitic fluid puncture in the treatment of severe ovarian hyperstimulation syndrome. DESIGN: Retrospective analysis of 18 patients. SETTING: Department of Gynaecology and Obstetrics, University Hospital, Palacky University, Olomouc. METHODS: 18 patients with the diagnosis of severe ovarian hyperstimulation syndrome admitted to intensive care unit from January 1996 to June 2000 were analysed. As a part of the therapy of severe OHSS 11 punctures of ascitic fluid was performed. In 3 patients the reinfusion of the ascites into the blood circulation was performed. RESULTS: The transabdominal paracentesis under the ultrasound control in 11 patients was performed. In 6 patients the puncture had to be repeated. The amount of removed ascitic fluid in single procedure was between 600-3750 ml. Total amount of fluid in different patients was between 1500-17,300 ml. Sterility of ascites and high contents of proteins was proved. In 3 patients with the refractory ascites the reinfusion of the ascitic fluid to the circulation was performed. No serious complications of the punctures were observed, 4 patients had a slight rise of body temperature, which fell down without antibiotics therapy. CONCLUSION: Puncture of the ascitic fluid is a save and effective part of the therapy of severe OHSS. In the treatment of the refractory ascites the reinfusion of the ascitic fluid should be used.

[Embryo transfer after 5 days of culture]. / Embryotransfer po 5denní kultivaci.

OBJECTIVE: To find out whether: 1) the blastocysts transfer rises the successfulness of IVF and ET (G/ET) and 2) the 2-blastocyst transfer lowers the incidence of multiple pregnancies (IR). DESIGN: Prospective study of 46 patients involved in a prolonged 5-day cultivation of IVF and ET programme. SETTING: Centre for Assisted Reproduction, Clinic of Gynecology and Obstetrics, Teaching Hospital and Palacky University in Olomouc. METHODS: Patients with at least 5 acquired embryos were included in the group. The cultivation in media commercially produced by Scandinavian IVF Science took 5 days. RESULTS: In 91% of patients in the observed group (n = 46) morulas or blastocysts were acquired. The IVF and ET success rate after 5-day cultivation and subsequent transfer of two embryos was 37% pregnancies per a started cycle (G/cycle), 40% pregnancies per an embryotransfer (G/ET) and the implantation rate (IR) was 31%. Relatively high percentage of double pregnancies (53%) is alarming. Following parameters were assessed: age, sterility cause, number of previous IVF cycles, stimulation scheme, E2 level on the day of hCG application, number of acquired oocytes and pronuclear stages, percentage of grown blastocysts, the quality of transferred embryos and endometrium thickness on the day of transfer. The only statistically significant difference was found in E2 level on the day of hCG application. Pregnant patients had lower levels of estradiol (average value 11.8 +/- 4.8 nmol/l) compared to patients who did not become pregnant (18.6 +/- 11.9 nmol/l). CONCLUSION: In selected groups of patients who refuse multiple pregnancies only one blastocyst should be transferred.