[Sperm disorder in males with obesity and metabolic syndrome--pilot study].

UNLABELLED: The aim of the study was to compare the semen quality in men with metabolic syndrome /MS/ and controls. MATERIALS AND METHODS: Semen samples were collected from 42 males (mean age--27.69 +/- 7.98 years). 21 of them had the features of the metabolic syndrome according to the IDF definition and 21 were healthy volunteers. The semen samples were analyzed according to the World Health Organization 1999 guidelines. RESULTS: The patients with MS had similar age, ejaculate volume, percentage of spermatozoa with normal morphology, sperm concentration (in million per milliliter), and total sperm count (in million) compared to controls. However, they had lower percentage of motile spermatozoa (p = 0.002). Men with obesity (BMI > 30) had significantly lower sperm concentration and total sperm count in comparison to normal- or overweight males (BMI < 30). CONCLUSION: reduced semen quality could be established in patients with obesity and MS. Further investigations are necessary to clarify the changes in the exocrine testicular function in males with MS and their consequences for the reproduction.

[Course of pregnancy and delivery in cases with cervical deciduosis].

AIM: The aim of this study was to establish influence of cervical deciduosis on pregnancy and time and route of delivery. MATERIAL AND METHODS: The study included 28 pregnant women with diagnosis of cervical deciduosis. We followed progress of pregnancy, genital bleeding manifestation and time and route of delivery. RESULTS: We found that 90% of cervical deciduosis cases were diagnosed in the first half of pregnancy. 71.4% were diagnosed after they completed 12 gestational weeks. In case of disruption of deciduosis foci, because of trauma or infection, bleeding occurs. Four of pregnancies were terminated before 28 weeks gestation (14.3%)--two of them miscarriages, one cessation of pregnancy because of polymalformative fetus and one with Cesarean Section. Five of the pregnancies ended in preterm deliveries (17.9%)--three vaginal deliveries and two Cesarean Sections. Nineteen cases ended in term deliveries (67.8%)--seventeen vaginal deliveries and two Cesarean Sections. DISCUSSION: In cases with cervical deciduosis we found increase in preterm rupture of membranes. For this reason these patients have increased risk for miscarriage and preterm delivery.

[Changes of activation in T-lymphocyte subpopulations in peripheral blood during pregnancy].

From an immunological point of view during pregnancy the interactions between the steroid sex hormones and immunocompetent cells as a part of the dynamic local and peripheral immune response is of a particular interest. The aim of our study is to investigate the expression of the early activation marker CD69 in T-lymphocytes subpopulation: CD4+ and CD8+ in peripheral blood from pregnant and non-pregnant women. Our data clearly demonstrate an increase of the percentage of activated CD4+ lymphocytes in pregnant women in comparison to non-pregnant and this difference is statistically significant. A similar but not statistically significant dependency is observed in CD8+ and CD69+ lymphocytes. From the obtained results we conclude that during pregnancy the activation of CD4+ lymphocytes is increased, which probably leads to an increased production of cytokines that shifts the immune response to Th2 type which is protective for pregnancy. This could be partly due to the increased levels of progesterone.

[The anti-mullerian hormone--physiology and application into clinical practice].

The Anti-Mullerian hormone /AMH/ is a glycoprotein of the transforming growth factor-beta superfamily. It induces regression of the Mullerian ducts during the male sex differentiation. The hormone actions occur through serin/threonin kinase receptors-AMHRI and AMHRII. The AMH and AMHRII gene defects in men cause the syndrome of oviductus persistens. Recent findings accent not only on the hormone fetal role, but also on the postnatal AMH secretion, especially in women. The hormone is produced mostly by granulosa cells of the preantral and small antral follicles. Therefore, its levels in women after puberty are similar to those in males and it could be used as a marker for the ovarian reserve and preantral and small antral follicle count. In this review, we discuss the role of AMH in the follicular development, the polycystic ovary syndrome and the ovarian ageing. After gathering all data, it could be assumed that in the future AMH will be widely used in the clinical practice as a marker of the ovarian function.

[Contraception in women with diabetes mellitus].

Contraception in women suffering of diabetes mellitus is an important question mainly due to it has been proven that pregnancy outcome both for the fetus and for the mother depends on glycemic control before conception right to delivery. That's made planning of future pregnancy mandatory for patients with diabetes mellitus. Patients are advised for contraception until optimization of metabolic control has been achieved or until complete and contemporary treatment of the diabetes complications has been fulfilled. Incorrect contraceptive method could extend metabolic disorders and to reinforce vascular complications of the diabetes. Choice of contraception depends on the aim: short lasting contraception aiming on future pregnancy planning or long lasting contraception aiming on family planning. In women with diabetes mellitus it is extremely important to take into consideration such factors as type of the diabetes, its lasting, degree of metabolic compensation, presence of diabetic complications, body-mass index of the patient, presence of risk factors for cardiovascular diseases and future pregnancy planning. In cases when pregnancy is planning it has been preferred local contraception, such as condoms, diaphragms. In cases of nullipara or in women with plenty of partners, condoms are method of choice. In women who gave birth intrauterine device is such a method. In women with diabetes mellitus type I (insulin dependent diabetes mellitus) it is possible to use hormonal contraception depending on patient's request or on medical indications only in cases when diabetes has less than 15 years duration and microangiopathic complications and other vascular risk factors lack. Combined hormonal contraceptive preparations have to contain less than 30 microg ethinylestradiol and gestagen of "third" or "fourth" generation. This contraception has to be prescribed together with insulin dosage correction and demands on strict metabolic control of the diabetes and body weight. When the combined preparations are contraindicated it could be suggested progestagenic oral hormonal contraception if gynecologic contraindications lack and if this not leads to menstrual disturbances. In women with diabetes mellitus type II (non insulin dependent diabetes mellitus) combined hormonal contraceptives has not to be used, because they could provoke clinical manifestation and deteriorate progress of the diabetes mellitus.