[Role of leptin in human reproduction (anorexia, bulimia)]. / Úloha leptinu v lidské reprodukci (anorexie, bulimie).

Leptin may act as the critical link between adipose tissue and the reproductive system, indicating whether adequate energy reserves are presenting for normal reproductive functions. Future interventional studies involving leptin administration are excepted to further clarify this role of leptin and may provide new therapeutic options for the reproductive dysfunctions associated with states of relative leptin deficiency or resistance.

[Surrogate maternity--literature review and practice]. / Surogátní materství--literární názory a praxe.

OBJECTIVE: This review summarizes opinions on surrogacy including internatinal and governmental organizations attitudes, as well as some religious concerns. DESIGN: Literature review. SETTING: Reprofit International, Brno, Reproductive medicine and gynecology centre, Zlin, Department of obstetrics and gynecology, Palacky University, Olomouc. BACKGROUND: The developments in the field of assissted reproduction during the last twenty years have attracted unexpected public interest in some of its ethical and moral aspects. It is very difficult to find a uniform attitude to ethical concerns of assisted conception in plural society. Surrogate mother is defined as a woman who bears and relinquishes a child for another person. CONCLUSION: The european congress on human reproduction in Barcelona 2008 adopted following résumé on surrogacy: Public opinion has shifted to a position where surrogacy is recognized as an appropriate response to infertility in some circumstances and it is to be expected that this approach will be further strenghtened with stress on positive aspects of familiar life.

[Does oocyte retrieval influence the following morphological quality of embryos?]. / Ovliviiuje pocet získaných oocytu pri ovariální punkci následnou morfologickou kvalitu embryí?

OBJECTIVE: To verify that the number of retrieved oocytes influence the following morphological quality of transferred embryos and the success of IVF treatment. DESIGN: A retrospective study. SETTING: Clinic of assisted medicine and gynecology, Zlin. METHODS: By observing the collection is composed of 837 IVF cycles with embryotransfer, which were practised between June 2002 and December 2004. To observe the number of retrieved oocytes, following morfological quality of transferred embryos, (number of clinical pregnancies). RESULTS: We found that in cycles with more retrieved oocytes (7 oocytes and more), there were embryos of first morphological quality transferred significantly more frequently (59.2% cycles, p < 0.001) than in cycles with 1-6 retrieved oocytes. Morphologicaly abnormal embryos were found in cycles with more retrieved oocytes (7 oocytes and more) and transferred significantly less frequently (13.1% cycles, p < 0.001) than in cycles with 1-6 retrieved oocytes (34.8% cycles). We have found that on the retrieval of 16-18 oocytes, there were embryos of first morphological quality transferred in 67.4% cycles of treatment (p = 0.002). The number of cycles with transferred morphological abnormal embryos is decreasing in relation with increase of oocyte retrieval (p = 0.002). Most of clinical pregnancies were achieved in IVF cycles with retrieval of 16-18 oocytes (clinical pregnancies was achieved in 50.0% cycles, p < 0.001). CONCLUSION: The results show that the number of retrieved oocytes was influenced following morphological quality of transferred embryos. In IVF cycles with more retrieved oocytes there are transferred embryos of first morphological quality more frequently. These embryos have higher implantation potential. The number and quality retrieved oocytes are possibly more effective with type and dosing of hormonal stimulation, which should be suitable for every patient.

[Pregnancy and delivery after traumatic panhypopituitarism]. / Tehotenství a porod po traumatickém panhypopituitarismu.

OBJECTIVE: We describe a case of 23 years old woman who, with a history of car accident at the age of 11 and severe head injury, attended our Center of Reproductive Medicine complaining of primary infertility. The accident preceded menarche and the development of inner genitalia (uterus 46 mm, cervix:corpus ratio 1:1) as well as secondary sexual development was not fully accomplished. Ovarian failure was accompanied by amenorrhea, if not substituted. Under replacement therapy regular menstruation was established. Basal hormonal levels was extremely low (FSH and LH 0.2-0.3 IU/l, PRL 0.5 ng/ml, estrogens 0.08 nmol/l, PRGE was not detected). With oral administration of micronized estradiol (Check et al., 2001) endometrial thickness of 9 mm was achieved. All of five retrieved oocytes were fertilized with partner sperm (normospermy) and three embryos were transferred. Already the first attempt was successful. Patient suffered with transitional anorexia and vomiting which could be handled conservatively. Hormonals level were normal. Patient substituted with Hydrocortison and Euthyrox. On January 2, 2003 the pregnancy was finished by caesarian section, one week before the delivery term (girl, 2970, Apgar score 10-10-10). DESIGN: Case report. SETTING: Center of Reproductive Medicine, Zlin. CONCLUSION: This care report demonstrates that recent progress in assisted reproduction field enables to manage successfully even exceptional pathological conditions.

[Oocyte donation: ethical and practical questions]. / Dárcovství oocytu: etické a praktické otázky.

AIM OF THE STUDY: This review will summarize the current view on ethical and practical aspects involved in ovum donation. STUDY DESIGN: Literature review. INSTITUTION: Center of Reproductive Medicine, Zlín; Department of Gynecology and Obstetrics, Palacký University, Olomouc. CONCLUSION: Today there are three possible ways of recruiting ovum donors: 1) volunteer ovum donors, 2) related donors (searched by couples in need), 3) in vitro fertilization patients (egg-sharing).

[Legal and ethical problems in assisted reproduction--case report]. / Právní a etické problémy asistované reprodukce--kazuistika.

OBJECTIVE: The objective of the study is to evaluate legal and ethical aspects of the assisted reproduction in the Czech Republic. These aspects are described in the context of the concrete case. DESIGN: Case report. SETTING: Department of Social Medicine, Medical and Health Care Administration Faculty of the Masaryk University, Brno and Centre of the Reproductive Medicine Zlín. SUBJECT AND METHOD: The description of the concrete case that happened in the Czech Republic. A widow asked for the artificial insemination using the sperm of her deceased husband. CONCLUSION: It was concluded that there is absolutely insufficient legal regulation of the assisted reproduction techniques, it does not respond to the development of the medical knowledge and it responds insufficiently to the ethical dilemmas concerning the assisted reproduction.

A comparison of three preinduction cervical priming methods: prostaglandin E2 gel, Dilapan S rods and Estradiol gel.

The aim of the study was to evaluate the efficacy of three cervical priming methods. From January 1, 1994 to December 31, 1996 247 patients presenting an indication for induction of labor with an unripe cervix were randomly assigned to one of the following preinduction protocols: 0.5 mg of Prostaglandin E2 gel administered intracervically (n = 83), four hygroscopic Dilapan S rods applied intracervically (n = 82), and 150 mg of Estradiol gel administered intravaginally (n = 82). The inclusion criteria were the patient's informed consent, singleton pregnancy of more than 36 weeks, cephalic presentation, Bishop score < 5 points and reactive non-stress test. If the cervical maturation (Bishop score > or = 5, and/or Bishop score augmentation by 2 points) did not occur after 14 hours of priming, the case was considered a failure. In the opposite case the patient was induced by means of extraamniotic PGE2 administration. The mean gain in the Bishop score was 3.7 points in the PGE2 group 3.9 points in the Dilapan S group, and 2.8 points in the Estradiol group. 71 patients (85.5%) were successfully preinduced in the PGE2 group, 73 (89.0%) in the Dilapan S group, and 63 (76.8%) in the Estradiol group. Labor was induced by preinduction only in 23 patients (31.3%) of the PGE2 group in 17 (20.7%) of the Dilapan S group, and in 14 (17.1%) of the Estradiol group. The mean induction to delivery interval was 7 h 27 min in PGE2 group, 7 h 49 min in the Dilapan S group and 9 h 15 min in the Estradiol group. The Caesarean section rate was 24.4% in the PGE2 group, 10.5% in the Dilapan S group, and 24.4% in the Estradiol group. PGE2 gel and Dilapan S rods proved higher efficacy than Estradiol gel. The highest frequency of labor induced by preinduction only was in the PGE2 group. There were shorter induction to delivery intervals in the PGE2, and Dilapan S groups. The lowest Caesarean section rate was in the Dilapan S group. Neither serious side effects nor negative neonatal outcome were noted in either group.

[The National Register for Assisted Reproduction: results and analysis of complications]. / Národní registr asistované reprodukce: výsledky a analýza komplikací.

1. Analysis of achieved results of assisted reproduction provides evidence of a steadily increasing success of ART methods in the Czech Republic. 2. Analysis of results and complications makes it possible a) to prove optimal therapeutic procedures in different groups of patients b) to recommend preventive measures to avoid complications c) assess possible side-effects on women and the foetus.

[Direct and indirect detection of Chlamydia in infertile married couples in the assisted reproduction program]. / Prímý a neprímý prukaz chlamydií u neplodných manzelských páru zarazených do programu asistované reprodukce.

The authors pay attention to the relationship of pregnancy in women enlisted in the IVF programme and the detection of Chlamydia infection. A group of 74 infertile couples were investigated. A significant relationship was found between confirmed Chlamydia infection in women and men. Moreover a significant relationship was found between Chlamydia infection confirmed by immunofluorescence in men and impregnation in women in the IVF programme. This means that in female partners of men with acute Chlamydia infection the results of IVF are less successful. The authors recommend that all couples enlisted in the IVF programme should be examined for this infection and if it is positive given adequate treatment.

[Hemostasis using vasopressin analogs during conization of the uterine cervix and minor vaginal operations]. / Hemostáza analogy vazopresinu pri konizacích cípku a pri malých vaginálních operacích.

Peroperative haemorrhage is a frequent complication of conization of the portio uteri by surgery-by a "cold knife" scalpel or another method (LEEP, laser, etc.). In a clinical study comprising 41 patients with the diagnosis CIN I-III or laceration of the portio uteri classical conization by means of a scalpel was made with concurrent haemostasis with terlipressin (TLP) by paracervical administration (400 micrograms-REMESTYP 2 amp.). Concurrently the blood loss in ml was followed, the Hb level and other effects of the preparation. From the results ensues that side-effects after local administration of TLP were observed only in 12.2%. Peroperative blood losses were on average under 15 ml. Local paracervical TLP administration appears effective from the clinical aspect with regard to the low frequency of side-effects and the favourable haemostatic effect.

[Preinduction priming of the cervix. Comparison of the intracervical administration of PGE2 gel and vaginal administration of estradiol]. / Preindukcní zrání cípku. Srovnání intracervikální aplikace PGE2 gelu s vaginální aplikací estradiolu.

During the period between Jan.1, 1994 and May 31, 1996 at the Second Department of Gynaecology and Obstetrics in Brno preinduction was performed in 40 patients by means of PGE2 gel (Prepidil Upjohn) and in 38 patients by means of an estradiol gel (Biotika). The inclusion criteria in the group were: singleton pregnancy, 38 or more weeks of gestation, cephalic presentation, unripe cervix (Bishop score less than 5) and reactive NST. The gel was introduced into the cervical canal and left in situ for 12 hours. If maturation of the cervix occurred, induction was implemented by extraamnial administration of PGE2. In the group of patients preinduced with Prepidil there was a significantly greater increase of Bishop score and the first stage of labour was shorter during subsequent induction of delivery. As to other investigated parameters, the two methods did not differ significantly.