[Corifollitropin alfa in women stimulated for the first time in in vitro fertilization programme]. / Corifollitropin alfa u zen poprvé stimulovaných v programu mimotelního oplodnení.

OBJECTIVES: To compare results after stimulation with corifollitropin alfa (Elonva) in unselected group of women entering for the first time in in vitro fertilization programme (IVF) with results from Phase III randomized trials with selected groups of women. DESIGN: Prospective study. SETTING: Sanatorium Pronatal, Praha. METHODS: 40 unselected women with adequat ovarian reserve entering for the first time in IVF programme were stimulated with corifollitropin alfa and GnRH antagonists. Avarage age in the study group was 32,8 years (29-42 years), women younger then 36 and less then 60 kg received Elonva 100 µg , all others (age > 36 let, weight > 60 kg) Elonva 150 µg. Five days after egg retrieval one blastocyst was transferred (single embryo transfer - eSET). Our results were compared with the resuls in higly selected groups of women from Phase III randomized trials. RESULTS: After stimulation with corifollitropin alfa and GnRH antagonists on average 10,6 (9,2 ± 4,2) eggs could be retrieved, among them 7,3 (6,6 ± 3,9) were M II oocytes (68,9%) and fertilisation rate was 84,6%. After first embryo transfer ("fresh" embryos and embryos from "freeze all" cycles) 14 pregnancies were achieved (37,8%), three pregnancies were achieved later from transfer of frozen-thawed embryos (cumulative pregnancy rate 45,9%). There were three abortions. No severe hyperstimulation syndrom occured. Our results in unselected group of women stimulated for the first in an IVF programme with corifollitropin alfa are fully comparable with results published in randomized trials with selected group of patiens. CONCLUSION: Corifollitropin alfa in combination with daily GnRH antagonist can be successfully used in normal-responder patients stimulated for the first time in an IVF programmeKeywords: corifollitropin alfa, GnRH antagonists, ovarian stimulation, pregnancy.

[Successful ovarian tissue transplantation in woman with premature ovarian failure after gonadotoxic treatment]. / Úspesná transplantace ovariální tkáne u pacientky s ovariálním selháním po onkologické lécbe.

OBJECTIVE: To demonstrate successful restoration of ovarian function after ovarian transplantation in young woman with premature ovarian failure after gonadotoxic treatment of breast carcinoma and to discuss its possibilities. DESIGN: Case report. SETTING: Sanatorium Pronatal, Prague. CASE REPORT: We demonstrate successful ovarian transplantation and restoration of ovarian function in 33 years old woman after cryopreservation of ovarian tissue performed before chemotherapy and radiotherapy of breast carcinoma and discuss possibilities of this approach in women diagnosed with cancer and subsequent risk of ovarian silure. CONCLUSION: Cryopreservation of ovarian tissue is one of efficient options to preserve fertility in young patients facing gonadotoxic treatment.

[Guidlines for the good laboratory practice in assisted reproduction - clean environment]. / Smernice ke správné laboratorní praxi pri asistované reprodukci - cistota prostredí

The guidlines are the recommendation for good laboratory practice in embryological laboratories. In this first part the requirements of the clean environment from the point of view of the oocytes, sperm, and embryos protection against infection and from point of view of the embryological laboratory staff health protection were described.

Socio-demographic and fertility-related characteristics and motivations of oocyte donors in eleven European countries.

STUDY QUESTION: Do the socio-demographic and fertility-related characteristics and motivations of oocyte donors differ in European countries? SUMMARY ANSWER: The socio-demographic and fertility-related characteristics and motivations of oocyte donors differ considerably across countries. WHAT IS KNOWN ALREADY: There have been no other international studies comparing the characteristics of oocyte donors. Regarding their motivations, most studies indicate mixed motives. STUDY DESIGN, SIZE, DURATION: The proposed study was a transversal epidemiological study. Data were collected from 63 voluntarily participating assisted reproduction technology centres practising oocyte donation in 11 European countries (Belgium, Czech Republic, Finland, France, Greece, Poland, Portugal, Russia, Spain, UK and Ukraine). The survey was conducted between September 2011 and June 2012 and ran for 1-6 calendar months depending on the number of cycles of oocyte donation performed at the centre. The sample size was computed in order to allow an estimate of the percentage of a relatively rare characteristic (∼2%) with a precision (95% confidence interval) of 1%. The calculation gave 1118 donors. PARTICIPANTS/MATERIALS, SETTING, METHODS: In total, 1423 forms were obtained from oocyte donors. All consecutive donors in these centres filled out an anonymous questionnaire when they started their hormonal stimulation, asking for their socio-demographic and fertility-related characteristics, their motivations and compensation. Population characteristics were described and compared by country of donation. Motives for donation and mean amount of money were compared between countries and according to the donors characteristics. MAIN RESULTS AND THE ROLE OF CHANCE: The socio-demographic and fertility-related characteristics and motivations of oocyte donors varied enormously across European countries. The number of received forms corresponded with a participation rate of 61.9% of the cycles performed by the participating centres. Mean age was 27.4 years. About 49% of donors were fully employed, 16% unemployed and 15% student. The motivation in the total group of donors was 47.8% pure altruism, 33.9% altruism and financial, 10.8% pure financial, 5.9% altruism and own treatment and finally 2% own treatment only. About 15% of the donors were egg sharers (patient donors), mainly from the UK and Poland. Women were donating for the first time in 55.4% of cases, for the second time in 20.3% and for the third time in 12.8%. The motivation to donate was significantly related to being of foreign origin (P < 0.01), age (P < 0.001), living in couple or not (P < 0.01), level of education (P < 0.001) and number of donations (P < 0.001). The amount of compensation differed considerably between centres and/or countries. The general donor profile in this study was a well-educated, 27-year-old woman living with her partner and child who mainly donated to help others. LIMITATIONS, REASONS FOR CAUTION: The selection of clinics in some countries and the limited participation rate may have led to a bias in donor characteristics. A possible effect of social desirability in the answers by the donors should be taken into account. WIDER IMPLICATIONS OF THE FINDINGS: The diversity of the donor population reflects the differences in European legislation (for example, on anonymity and payment) and economic circumstances. The differences in systems of reimbursement/payment demonstrate the need to have a thorough discussion on the specific meaning of these terms. STUDY FUNDING/COMPETING INTEREST(S): The study was funded by the European Society for Human Reproduction and Embryology. The authors declare no conflicting interests.

Steroids pretreatment in assisted reproduction cycles.

The objective is to present an overview of trials and appreciate the relevant data on the effect of steroids pretreatment (oral contraceptives, 17ß-estradiol and estradiol valerate) in assisted reproduction cycles. The subject of the study is to evaluate the clinical characteristics during steroids pretreatment cycles focused on the prevention of ovarian cysts, the positive contraceptive effect on the onset of regular period during long gonadotropin releasing hormone agonist protocol. In gonadotropin releasing hormone antagonist protocol the review is interested in supporting ovarian stimulation in low responders, the idea of cycle scheduling and improving treatment outcomes. The method is a review from MEDLINE/Pubmed database between 1994 and July 2012. We identified 15 randomised controlled trials (n=3069 patients). One trail (n=83 patients) assessed GnRH agonist protocol with or without steroids pretreatment, 8 trials (n=1884 patients) assessed GnRH antagonist protocols with or without steroids pretreatment and 6 trials (n=1102 patients) assessed GnRH antagonist protocols versus agonist ones with steroid pretreatment. Data demonstrates that oral contraceptives offer the effective prevention of functional ovarian cysts, the predictable onset of period during desensitisation. Existing data suggest that pretreatment with oral contraceptive pills or estradiol valerate give no advantage concerning number of oocytes or pregnancy rate. Pretreatment with oral contraceptive pills aiming to avoid weekend oocytes retrievals has to be more elucidated. In low responders oral contraceptive pill pretreatment may be beneficial in improving ovarian responses by reducing the amount of gonadotropins and the number of days required for ovarian stimulation. Current research indicates that also 17ß-estradiol may be encouraging pretreatment in low responders and in cycle scheduling. This article is part of a Special Issue entitled 'Pregnancy and Steroids'.

[Current issues of assisted reproduction in the Czech Republic]. / Aktuální otázky asistované reprodukce v Ceské republice.

INTRODUCTION: Participants of the lunch table discussion held during the 22nd symposium of assisted reproduction in Brno discussed some current topics of assisted reproduction. DISCUSSED TOPICS: More than 150 participants at round tables discussed 10 topics: 1. IVF in native AR cycle,2. observation of the embryo development dynamics, 3. evaluation and support of endometrial receptivity,4. increased number of elective single embryo transfers (eSET), 5. transport of gametes and embryos in the Czech Republic and between the Czech Republic and abroad, 6. National registry of assisted reproduction,7. new view on sperm pathology, 8. problems with the SAR membership records, 9. surogacy motherhood and 10. preimplantation genetic diagnosis and preimplantation genetic screening. CONCLUSIONS: All findings were presented in the afternoon session. Some of the topics brought concrete results. Some topics could not be clearly concluded and will be the subject of further discussions. A brief summary of those discussion conclusions presents this paper.

[Possibilities of IVF in native cycle]. / Moznosti IVF v nativním cyklu.

OBJECTIVE: To evaluate the benefits and possibilities of the native cycle and/or minimal stimulation with subsequent use of methods of in-vitro fertilization. TYPE OF STUDY: Overview. SETTING: Pronatal, sro, Prague. METHODS AND RESULTS: Native or modified cycles with minimal stimulation now experiencing a renaissance, mainly due to the onset of antagonists of gonadoliberines. Except for the standard controlled ovarian hyperstimulation protocols we use for acquiring of oocyte other different methods - free native cycles, ovulation induction with antiestrogens and/or adding the minimum doses of gonadotropins. Concomitant use of antagonists prevents premature peak of luteinizing hormone, that was previously characteristic for these procedures. Native cycles we can use virtually for all the factors of infertility. Pregnancy rate per cycle is about 17%, but the cumulative pregnancy rate after three consecutive cycles reaches over 30%. CONCLUSION: Native cycle and its current modifications and subsequent in vitro fertilization offers the benefit of minimal consumption of drugs and the practical absence of side effects. It is characterized by short duration, lower price and the possibility of repetition each month. Virtually eliminates the occurrence of multiple pregnancies. Its efficiency is however limited and is characterized by a high number of cancellations. The cumulative pregnancy rate per embryo transfer is comparable with pregnancy rate of conventional stimulation protocols.

[Single embryo transfer--possibilities and limits]. / Prenos jednoho embrya (single embryo transfer): moznosti a limity.

OBJECTIVE: To evaluate the results of single embryo transfers, on a set of patients, for a given period of time. DESIGN: Retrospective study. SETTING: Pronatal Sanatorium, Prague. METHODS: Between January 2008 and May 2010, we evaluated the results of all cycles with single embryo transfers in our workplace. There were four groups of patients: the first group with elective single embryo transfers (ESET, n=147), the second group with only a single embryo transfer without selection (SET n=269), the third group with transfer of one embryo derived from the native cycle (NC, n=70) and the last group with transfer of only one embryo examinated by preimplantation genetic diagnosis (PGD, n=104). All patients were monitored by age, length of cultivation of embryos, clinical pregnancy rate/transfer (CPR/ET), pregnancy loss (AB) and baby take home rate (BTR). Statistical evaluation was performed using the chi square test. RESULTS: The group with ESET achieved a significantly higher success rate (50% CPR/ET, p<0.001) compared to the other groups: 22% for SET, 7% of spontaneous cycles and 18% after PGD. A significant difference (p<0.001) was also apparent in the evaluation of BTR: ESET 41%, 16% SET, NC 4%, 12.5% of PGD. Patients that made ESET were significantly younger (p<0.001) compared to the other monitored groups (32.9 ESET, SET 35.2, NC 39.6, 39.1 PGD). CONCLUSION: We consider that assisted reproduction is only successful with the birth of one healthy child. For women 38 years old or younger the most successful treatment is to transfer a single high quality embryo and to therefore eliminate multiple pregnancy. The age of a woman and the quality of the embryo are major prognostic factors.

[Preimplantation genetic diagnosis (PGD) in carriers of chromosomal translocations: possibilities and results]. / Moznosti a výsledky preimplantacní genetické diagnostiky (PGD) u páru s chromozomální translokací.

AIM OF THE STUDY: To assess the PGD results in couples with robertsonian and reciprocal translocations. DESIGN: Retrospective study. SETTING: Sanatorium Pronatal, Prague, accredited IVF unit. METHODS: 94 infertile couples with translocation (44 couples with robertsonian and 50 couples with reciprocal translocations) were included in the study. The mean woman's age was not different: 33 +/- 4,4 in robertsonian vers. 33 +/- 3.9 in reciprocal translocations. The performance of FISH probes in specific cases was tested on patient's lymfocytes before the treatment was started. After ovarian stimulation (recombinant FSH or hMG + GnRH agonist, "long" protocol) and transvaginal oocyte pick-up, embryo biopsy of a single cell was performed 72 hours after fertilization. After blastomere fixation, translocated chromosomes + chromosomes 13, 18, 21, X and Y were tested using FISH. The maximum of two embryos euploid for detected chromosomes were transferred, supernumerary euploid embryos were frozen. RESULTS: From the total number of 629 embryos, 126 embryos (21.9%) were detected as normal or with balanced translocation--25.2% (68/270) in couples with robertsonian and 16.4% (59/359) with reciprocal translocation. Embryotransfer was performed in 30 cycles (68.2%) in robertsonian and 27 (54%) in reciprocal translocations. 24 pregnancies were achieved--15 (39% per cycle and 50% per ET) for robertsonian and 9 (19% per cycle and 33% per ET) for reciprocal translocation--this difference was statistically significant (p = 0.033). Only one pregnancy in each group ended as abortion. SUMMARY: IVF is a valuable option for couples with infertility problems and translocation. This technique allows in short-term a conception and delivery of a healthy baby with general better prognosis for couples with robertsonian translocation.

[Clinical effects of recombinant versus urinary gonadotropins in ovulation induction]. / Prokázané klinické ucinky rekombinantních gonadotropinu v porovnání s urinárními v indukci ovulace.

OBJECTIVE: To present an overview of trials and discussion focused on the clinical characteristics of recombinant gonadotropins compared with urinary ones in ovulation induction. SUBJECT: Review article. SETTING: Sanatorium Pronatal, Prague. SUBJECT AND METHOD: The subject of the study is to compare the clinical characteristics of recombinant gonadotropins versus urinary ones focused on the daily dose of FSH achieving FSH threshold and the risk of multifollicular development in ovulation induction before intrauterine insemination, number of follicles and oocytes, the risk of ovarian hyperstimulation syndrome (OHSS), total consumption of FSH, cost effectiveness and expected pregnancy rate during in vitro fertilization technique. The method is a MEDLINE research of articles from 1994 to 2010. CONCLUSIONS: Data demonstrates that recombinant FSH (rFSH) offers higher ovarian response, less consumption of gonadotropins, lower risk of complications (multiple pregnancy and OHSS) compared with urinary FSH (uFSH). Expected pregnancy rate is probably comparable.

[Comparison of human chorionic gonadotropin (Pregnyl 10 000 IU i.m.) versus GnRH agonist (triptorelin 0,2 mg s.c.) for final oocytes maturation in the same egg donors--clinical and embryological characteristics]. / Srovnání lidského choriového gonadotropinu (Pregnyl 10 000 IU i.m.) s GnRH agonistou (triptorelin 0.2 mg s.c.) pro maturaci oocytu u stejných dárkyn vajícek--klinické a embryologické charakteristiky.

OBJECTIVE: To compare clinical and embryological characteristics in donor cycles triggered for final oocytes maturation with Pregnyl 10 000 IU i.m. versus triptorelin 0.2 mg s.c. in the same patients in two sequential stimulation cycles. The aim of the study is to decrease the risk of the development of ovarian hyperstimulation syndrome (OHSS) at high response donors by the replacement of Pregnyl 10 000 IU i.m. vs. triptorelin 0.2 mg s.c. The administration of a single dose of gonadotropin-releasing hormone agonist (triptorelin 0.2 mg s.c.) induces release of LH from the pituitary gland similarly to a spontaneous LH surge. SUBJECT: Prospective cross-over trial. SETTING: Sanatorium Pronatal, Praha. SUBJECT AND METHOD: From August 2009 to July 2010 we analysed 24 stimulation cycles in 12 egg donors treated with GnRH antagonist protocol with recombinant FSH (follitropin beta). We identified patients with more than 15 follicles during examination by transvaginal ultrasound. When at least 3 leading follicles reached 17 mm in diameter we administrated Pregnyl 10 000 IU i.m. for final oocytes maturation and triptorelin 0.2 mg s.c in the subsequent treatment cycle. RESULTS: The primary outcome measure was number of oocytes, proportion mature oocytes and fertilized oocytes. The secondary outcome were duration of FSH stimulation, total dose of gonadotropins and mean daily dose of gonadotropins. Data was analysed by paired t-test. We retrieved 17.2 +/- 8.6 vs. 15.8 +/- 5.3 (ns) oocytes, 12.6 +/- 7.3 vs. 13.0 +/- 5.4 (ns) metaphase II oocytes, proportion of metaphase II oocytes (%) was 73 vs. 83 (ns), number of fertilized oocytes 11.5 +/- 6.7 vs. 11.7 +/- 4.5 (ns), fertilization rate (%) 91 vs. 90 (ns) in Pregnyl's vs. triptorelin's group, resp. Duration of FSH stimulation (days) 12.2 +/- 0.8 vs. 12.4 +/- 0.7 (ns), total dose of gonadotropins (IU) 1744 +/- 277 vs. 1740 +/- 276 (ns), mean daily dose of gonadotropins (IU) 238 +/- 43 vs. 221 +/- 36 (ns), were not statistically different in both groups. CONCLUSIONS: Number of mature oocytes and subsequent embryonic cleavage is comparable to standard hCG treatment. There are no differences in clinical and embryological characteristics in both groups. Only one patient with administration of Pregnyl 10 000 IU i.m. was treated for OHSS grade II by vaginal paracentesis. Administration of triptorelin 0.2 mg s.c. is a safe and effective approach to achieve mature oocytes in egg donation programme, where we do not take care of implantation, which has got some limitations based on several studies.

[The role of three-dimensional ultrasonography in assisted reproduction]. / Vyuzití a význam 3D ultrasonografického vysetrení v asistované reprodukci.

OBJECTIVE: Clarifying the role of three-dimensional transvaginal sonography in diagnosis sterility and assisted reproduction treatment. DESIGN: Review. SETTING: Institute for the Care of Mother and Child, Department of IVF, Charles University, Prague. METHODS: Study of current literature. SUMMARY: With arrised frequency of ovarian, uterus and another pelvic patologies remains the three-dimensional transvaginal sonography in diagnosis of sterility women very actual in the fields of reproductive medicine. Actually the assessment of ovarian reserve belong to the essentials investigations in the diagnosis of primary and secondary sterility at this time. The advance in the three-dimensional transvaginal sonography allows to assess the endometrial volume, echogenity, endometrial vascularity and endometrial receptivity. There is a significant importance of 3D power Doppler angiography by measurement of folicular and ovarian vascularity with three indices (VI, FI, VFI) and provides the calculation of ovarian vascularity from the volume. New Sono-Automatic Volume Calculation (Sono-AVC) software that identifies and quantifies hypoechoic regions within a three-dimensional dataset and provides automatic estimation of their absolute dimensions, mean diameter and volume. An unlimited number of volumes can theoretically be quantified, which makes it an ideal tool for assessment of the ovarian volume and the antral follicle count (AFC) in women undergoing controlled ovarian stimulation.

Antimüllerian hormone (AMH) not only a marker for prediction of ovarian reserve.

The main characteristics of the Antimüllerian hormone from the points of view of biochemistry, molecular genetics, physiological functions and importance for diagnostics in reproductive endocrinology and related biomedical fields are reviewed. The role of the hormone in male and female development, its participation in oocyte maturation including selection of a dominant follicle are summarized, as well as its changes under various pathological situations in both sexes. The physiological changes of serum AMH leves in the life span in both sexes and their alterations under various pathological conditions are provided, too.

[Long GnRH agonist vs. GnRH antagonist protocol in randomized controlled trial in unselected patients--hormonal and cycle characteristics--pilot study]. / Randomizované srovnání dlouhého GnRH agonistického cs 0ynek7 vs. GnRH antagonistického protokolu--hormonální parametry a charakteristiky cyklui--pilotní studie.

OBJECTIVE: To evaluate hormonal and cycle characteristics (estradiol and LH level on day 5 and on the day of hCG administration) comparing long GnRH agonist vs. GnRH antagonist protocol for unselected patients. SUBJECT: Randomized prospective pilot study. SETTING: Sanatorium Pronatal, Praha. SUBJECT AND METHOD: From January 2006 to June 2006 we randomized 40 unselected patients into GnRH agonist (triptorelin 0.1 mg) and GnRH antagonist (cetrorelix 0.25 mg) group. We recommended starting dose from 150 to 225 IU of rFSH or hMG based on the response to clomifencitrate treatment. We examined follicular growth on day 5 and on day 8 by transvaginal ultrasound and estradiol (E2) level on day 5 and on the day of hCG administration. RESULTS: We randomized 21 patients in GnRH agonist and 19 patients in GnRH antagonist group. We proved E2 on day 5 (pg/ml) 269 +/- 243 vs. 385 +/- 293, LH on day 5 (IU/l) 1.7 +/- 1.2 vs. 2.8 +/- 1.4, E2 on the day of hCG administration (pg/ml) 1548 +/- 1167 vs. 1397 +/- 1076 (p < 0.05) and LH on the day of hCG administration (IU/l) 2.2 +/- 1.9 vs. 1.4 +/- 1.1 (ns), endometrial thickness (mm) 10.6 +/- 1.8 vs. 9.2 +/- 0.9 (ns), total dose of FSH (IU) 1865 +/- 517 vs. 1513 +/- 357 (p < 0.001), duration of FSH stimulation (days) 9.3 +/- 1.6 vs. 7.8 +/- 1.2 (p < 0.001) in GnRH agonist vs. GnRH antagonist group, resp. CONCLUSIONS: There are significant differences in hormonal characteristics and cycle characteristics comparing both protocols (longer duration of treatment and higher consumption of gonadotropins, higher E2 levels on the day of hCG administration in GnRH agonist compared to GnRH antagonist group).

[The diagnostic value of hysterosalpingography in the diagnosis of tubal disease]. / Význam hysterosalpingografie v prukazu tubárního faktoru neplodnosti.

OBJECTIVE: To present an overview of trials and discussion focused on the diagnostic value of hysterosalpingography in the diagnosis of tubal disease. SUBJECT: Review article. SETTING: Sanatorium Pronatal, Prague. CONCLUSIONS: Hysterosalpingography may be a screening test for tubal patency. Data demonstrates high specificity of hysterosalpingography for diagnosis of proximal tubal occlusion or hydrosalpinx and low sensitivity in cases with peritubal adhesions. Routine use of diagnostic laparoscopy should be delayed for asymptomatic women. It is expected hysteroscopy and transvaginal hydrolaparoscopy for asymptomatic women may decrease indications for diagnostic laparoscopy with complete visualization of the pelvic cavity.

[Psychomotor and cognitive development of children born after intracytoplasmic sperm injection]. / Psychomotorický a kognitivní vývoj detí narozených po mimotelním oplodnení metodou intracytoplazmatické injekce spermie.

OBJECTIVE: To analyse data on psychomotor and cognitive development of children born after intracytoplasmic sperm injection (ICSI). DESIGN: Open cross-section clinical study. SETTING: Institute for the Care of Mother and Child, Prague and Department of Paediatrics, Charles University, 2nd Medical School and University Hospital Motol, Prague. METHODS: In 133 children (75 boys and 58 girls) psychological examination was made at the age range 11 months - 8.5 years in the years 2004-2006. All children were born after intracytoplasmic sperm injection (ICSI). Psychomotor development of children aged from 11 months to 3.5 years was assessed using the Bayley Scales (BSID-II). In older children, Global Intelligence McCarthy Test was used. RESULTS: In our sample of ICSI-children, no significantly higher incidence of children delayed in mental (cognitive) as well as in motor development has been found as compared with the population norms. However, the results indicate a significantly lower average value of the Psychomotor Developmental Index (PDI) in the group of younger children as compared with the given norm (92.3 +/- 13.9 versus 100 +/- 15; p<0.01). In the group of older children, lower average value of the General Cognitive Index (GCI), as compared with corrected population norm has been found (105.1 +/- 14.7 versus 110 +/- 16; p<0.05). In the group of twins, a significantly higher number of mild developmental disorders was ascertained on the contrary in the group of singletons (64.7% versus 333%; p<0.01) in our older children conceived by ICSI. CONCLUSION: The results indicate only mild lowering of some performances in our ICSI-children: in motor domain in younger children, and in cognitive domain in older children. Children from multiple pregnancies are at greater developmental risk than singletons.

[Parental attitudes and socio-emotional development in children born after ICSI]. / Rodicovské postoje a socioemocní vývoj detí pocatých po ICSI.

OBJECTIVE: To analyze parental attitudes and socio-emotional development of children conceived by ICSI. DESIGN: Open cross-sectional study. SETTING: Department of Clinical Psychology, Thomayer University Hospital, Prague and Department of Paediatrics, Charles University, 2nd Medical School, University Hospital-Motol, Prague. METHODS: 133 children (75 boys, 58 girls) conceived by ICSI, age ranged from 11 months to 8.5 years were psychologically assessed between the years 2004-2006. Children's behavior was evaluated by 4 rating scales during the assessment. Parents answered questionnaires concerning children's temperament, behavioral problems (TBC) and the parental attitudes questionnaire (PARQ). RESULTS: Children's behavior during the psychological assessment was rated mostly as very good or good, although the children were often less communicative. Most of the children have mixed or easy temperament, a difficult type of temperament didn't report any of the parents. Most of the parents didn't describe significant behavioral problems in their children, in particular there were very few externalizing difficulties (opposition, aggression), but in 29.5% of the sample, there were found some social or emotional difficulties. We found surprisingly high frequency of milder forms of autism spectrum disorders and another social problems (social and other anxiety disorders) in the sample, other psychopathology was rare. Parental attitudes had a tendency to grater involvement with the child and high affection in relation with him. CONCLUSION: Socio-emotional development of ICSI children is good, although some have specific social difficulties, externalising problems were present only exceptionally. Parental attitudes toward ICSI children are positive, there is slight tendency to higher emotional involvement with the child.

[Children born after intracytoplasmic sperm injection (ICSI): factors of infertility, pregnancy complications, neonatal period and neonatal characteristics]. / Deti narozené po intracytoplazmatické injekci spermie: faktory neplodnosti, prubeh tehotenství a porodu, perinatální období.

OBJECTIVE: To analyze the type of infertility, pregnancy and neonatal outcome in children conceived after intracytoplasmic sperm injection (ICSI children). DESIGN: Prospective open cross-sectional clinical study. SETTING: University hospital and private IVF unit. METHODS: Type of infertility, pregnancy complications, neonatal period and neonatal characteristics were evaluated in 135 newborns conceived after ICSI from singleton and twin pregnancies and compared to general population. RESULTS: The percentage of twins was significantly higher after ICSI compared to general population (31% versus 1.7%; p<0.001) as well as the percentage of caesarean section deliveries (31% versus 17.8%; p<0.001). Some complication in neonatal period was found in 21.5% ICSI newborns (18 out of 42 twins and 12 out of 93 singletons; p< 0.001). Some complication during the course of pregnancy was found in 50.9% ICSI children. CONCLUSIONS: no differences in gestational age, birth weight and birth length were found when ICSI and spontaneously conceined (sc) singletons and ICSI and SC twins were compared. However, complications during the course of pregnancy and in the neonatal period were more frequent in ICSI conceived children.

[Birth defects, medical outcome and somatic development in children conceived after intracytoplasmic sperm injection (ICSI)]. / Vrozené vývojové vady, zdravotní stav a somatický vývoj detí narozených po intracytoplazmatické injekci spermie.

OBJECTIVE: To analyze the incidence of birth defects, medical outcome and somatic development in children conceived after intracytoplasmic sperm injection (ICSI). DESIGN: Prospective open cross-sectional clinical study. SETTING: University hospital and private IVF unit. METHODS: 135 Czech children (59 girls, 76 boys) from singleton and twin pregnancies conceived after ICSI (age 03-9.5 years; median 5.9) were assessed during the period 2004-2006. The incidence of birth defects, medical outcome and somatic development were evaluated and compared with data of general population and/or with control group matched for sex and age. RESULTS: Birth defects were found in 133% of ICSI children (compared to 4.6% in children after spontaneous conception; p<0.001). The general health of ICSI children did not differ significantly compared to general population. ICSI children required more surgery or hospitalization compared to general population data. There is high rate (69.6%) among ICSI children in the care of various specialised clinics. Body height and weight in ICSI children is in normal range and corresponds to their growth potential. Head circumference in ICSI children is larger compared to reference data (0.43 SD; p<0.001). CONCLUSIONS: No clinically important differences in somatic development between ICSI and general population of Czech children were found. Birth defects were more frequent in ICSI children. The overall general health in ICSI children seems satisfactory but ICSI children were more likely to need health care compared to general population.

[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.