[Effect of salpingectomy on the results of IVF in women with tubal sterility--prospective study]. / Vliv salpingektomie na výsledky IVF u zen s tubární sterilitou--prospektivní studie.

OBJECTIVE: To compare the IVF results after salpingectomy of hydrosalpinges visible on ultrasound with IVF results in women with tubal infertility but without hydrosalpinx. DESIGN: Prospective study. SETTING: Sanatorium Pronatal, Na Dlouhé mezi 4/12, 147 00, Praha 4. METHODS: 101 women with tubal factor infertility were evaluated. In a prospective study we compared the results of first IVF cycle after salpingectomy of hydrosalpinges visible on ultrasound performed in 51 women (study group) with IVF results of 50 women with tubal infertility (confirmed by HSG and laparoscopy) but without hydrosalpinges and without salpingectomy. RESULTS: The maternal age in both groups (32.4 +/- 3.9 in salpingectomy group and 33.0 +/- 4.1 in control group), maximum estradiol levels (1392.6 +/- 675.8 pg/ml in salpingectomy group vers. 1624.7 +/- 909.7 pg/ml in control group), number of oocytes (11.3 +/- 5.8 after salpingectomy vers. 11.0 +/- 6.1 in controls), number of embryos generated (7.1 +/- 4.6 vers. 7.9 +/- 4.7) and number of embryos transferred were not statistically different. In their first IVF cycle after salpingectomy has been performed 30 women out of 51 became clinically pregnant (58.8%), while in control group a clinical pregnancy could be verified in 16 women (32.0%). Implantation rate in women after salpingectomy was 28.2% vers. 12.3% in control group. Both implantation rate and pregnancy rate were statistically different at 5% level of significance. CONCLUSION: After salpingectomy of hydrosalpinges visible on ultrasound the implantation rate and clinical pregnancy rate are significantly better when compared to IVF patients with tubal infertility without the presence of hydrosalpinges and without salpingectomy. Salpingectomy should be offered to all patients with hydrosalpinges visible on ultrasound. Moreover, this radical approach should be considered even in women with highly damaged tubes but without the presence of hydrosalpinges.

[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.

The influence of different types of antibodies on in vitro fertilization results.

PROBLEM: The influence of anti-sperm (ASA), anti-phospholipid (APA), and antizonal (AZA) antibodies on in vitro fertilization (IVF) results and the need for intracytoplasmic sperm injection (ICSI) were assessed. METHOD OF STUDY: Forty-four couples with infertility of immunologic origin were investigated. ASA in serum and ovulatory mucus were studied by a tray agglutination test (TAT) and indirect mixed anti-globulin reaction test (MAR) test, AZA were studied by passive hemagglutination and commercial enzyme-linked immunosorbent assay (ELISA; BioGen, Germany), and APA were tested by ELISAs in immunoglobulin isotypes IgG and IgM. RESULTS: Because of failed or very low fertilization after standard IVF in the previous cycle, ICSI had to be used in five out of 15 cases with ASA (33.3%), in 16 out of 18 couples with AZA (89.4%), and in only one case if APA were present (9%). Clinical pregnancy rate was 60% in cases with ASA, 38.5% with AZA, and 27.3% per embryo transfer (ET) if APA were detected. CONCLUSIONS: Immunologic infertility can be treated by IVF with very good results. The most important group are women with AZA, in whom IVF ICSI without any delay is recommended.

[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.

[Heterotopic pregnancy and its occurrence in assisted reproduction]. / Heterotopická gravidita a její výskyt v souvislosti s asistovanou reprodukcí.

OBJECTIVE: To assess the incidence of heterotopic pregnancy after infertility treatment using the technology of assisted reproduction. DESIGN: A prospective study of 618 women who became clinically pregnant following assisted reproduction technology (ART) procedures. SETTING: Sanatorium Pronatal, Na dlouhé mezi 4/12, 147 00 Praha 4-Hodkovicky. METHODS: Study group consists of clinical pregnancies conceived after ART procedures within the period from January 1, 1997 until June 30, 1998. A condition to be included in survey group was that there was a gestation sac detected by ultrasound or histological confirmation of ectopic pregnancy. RESULTS: Six-hundred-eighteen clinical pregnancies resulted and 23 of the pregnancies were ectopic gestations (3.7%). Seven out of the 23 (30.5%) ectopic pregnancies were heterotopic. Thus heterotopic pregnancy rate after ART was, 1.14% (1 in 88). CONCLUSION: The incidence of heterotopic pregnancy following assisted reproduction technique is relatively frequent. This condition represents a live-threatening complications of pregnancy. The prognosis for intrauterine gestation in case of heterotopic pregnancy is usually good. About 78% delivered living child at term.

[Hormone replacement for pregnancy in functionally agonadal women after transfer of thawed embryos in the in vitro fertilization program--problems of placental incompetence]. / Hormonální substituce tehotenství funkcne agonadálních zen po prenosu rozmrazených embryí v programu IVF--problematika placentární kompetence.

Experience with hormonal substitution of sterile women treated within the IVF programme by means of donated oocytes changed completely views on endocrinological prerequisites of successful implantations and the further development of early pregnancy. While the effect of oestrogens and progesterone on endometrial proliferation and receptivity has been elaborated in great detail in the literature, data on the substitution of early pregnancy and the onset of placental competence are much scarcer. 1. The placenta is during the 15th week of pregnancy already fully competent and hormonal substitution can be probably terminated already sooner. 2. From the shape of the curves (as compared with steroid levels in spontaneous pregnancies) the authors conclude that the used doses (in particular of progesterone were higher than physiological. 3. Pregnancy of women with primary or secondary ovarian failure is an ideal in vivo model for investigation of the receptivity of the endometrium, the problem of implantation and function of the foetoplacental unit. Available data are not uniform and therefore in this very interesting field further investigations are needed.

[Intracytoplasmic injections (ICSI) with epididymal and testicular spermatozoa]. / Intracytoplazmatická injekce (ICSI) s epididymálními a testikulárními spermiemi.

Azoospermia is no longer a clear indication for using donor sperm. Aspiration of epididymal sperm or extraction of testicular sperm offers the same hope of pregnancy as ICSI using ejaculated sperm. Not even the high effectiveness of ICSI should be the reason for less intensive efforts to assess the exact cause of azoospermia, in particular with regard to genetic aspects.

[Intracytoplasmic sperm injection in the treatment of the most severe cases of andrologic sterility]. / Intracytoplazmatická injekce spermie (ICSI) v lécbe nejzávaznejsích prípadu andrologické sterility.

Intracytoplasmic sperm injection (ICSI) is a procedure which dramatically eliminates the necessity to use donor sperm in androgenically conditioned sterility and enables almost all affected couples to achieve pregnancy. The results in this group, till recently untreatable, are at least comparable with results achieved in the standard IVF programme. The standard success of the transport IVF programme was confirmed also in the transport IVF-ICSI programme. The transport of gametes does not influence the achieved results. It seems that for the results of the transport programme the indication and possibly other (gynaecological) factors of sterility are decisive. Intracytoplasmic sperm injection has become due to its effectivity an integral part of our IVF programme.

[Andrologic and non-andrologic indications for intracytoplasmic sperm injection (ICSI)]. / Andrologické a neandrologické indikace intracytoplazmatické injekce spermie (ICSI).

Intracytoplasmic sperm injection (ICSI) is a very valuable method which implies a qualitative contribution to assisted reproduction and andrologically conditioned sterility, in particular. However, as one of the methods of cellular surgery it has its defined indications which must be respected.

[Experimental implantation of hydrogel into bone]. / Experimentální implantace hydrogelu do kosti.

In spite of the rapid development of various natural and artifical implants of bone tissue, bones or whole joints, no material was found as yet which would maximally resemble the structure of the bone tissue and would also be maximally compatible. The present study deals with the application possibilities of unsoluble hydrophilic gels (hydrogels) as substitutes of bone tissue in experiment. The study concerns above all their biocompatibility with regard to the porous qualities of the implant and to its chemical structure, and evaluates their behaviour in the spongious and compact bone. It was used polyhydroxyethylmethacrylate (polyHEMA) which is crossling with small amount of glycoldimethacrylate when by changing of ratio monomer: water is possible obtain from homogeneous to macroporous structure of polymers. The macroporous structure was increased and the surface of the macroporous structure of polymers. The macroporous structure was increased and the surface of the macroporous, sinterted HEMA modified and implanted. The so-called double porosity was thus obtained. The implants were prepared in the form of cylinders (3.5 mm in diameter) in 8 different modifications and surgically implanted into the subtrochanteric and supracondylic part of the rabbit femurs. 42 animals were operated on. The obtained preparations were then evaluated macroscopically, and histologically processed in half-thin cuts (3-4 micrones). 124 samples were thus obtained. Some samples were radiographically contrasting. The rabbits were killed at intervals from 1-6 months, i.e. 32-193 days. It was found that the hydrogels modifications used in the experiment are biocompatible, their compatibility increasing in dependence on the increasing porosity. The non-porous and microporous hydrogels are not compatible and are damarked. The sintered macroporous gel is surrounded by a thin fibrine membrane signifying a high degree of compatibility with the bone tissue. By adding metacrylate acid to the hydrogel, the adhesivity of the macrophages increases markedly. There also appears the destruction of the polymer, marked, above all, in the spongious bone. The gel is actively degraded in the marrow, although the direct phagocytosis can be proved. At degradation of the implant in the compact bone the activity of the macrophages is belated; at application of the gel without methacrylate acid it does not occur even after 193 days and the implant is pervaded only by the bone beams. When adding methacrylate acid to the polymer degradation occurs, in which process there play also an active role the blood vessels pervading the site of the gel implantation.(ABSTRACT TRUNCATED AT 400 WORDS)