[Thromboembolic complications in patients undergoing in vitro fertilization: retrospective clinical study]. / Tromboembolické komplikace u pacientek z programu IVF-ET: retrospektivní klinická studie.

OBJECTIVE: To determine the incidence and the type thromboembolic complications in patients undergoing in vitro fertilization (IVF). To evaluate their clinical course, the influence on reproductive outcomes, and the prevalence of thrombophilia in these women. DESIGN: Retrospective clinical study. SETTING: Assisted Reproduction Center, Department of Obstetrics and Gynecology, 1st Faculty of Medicine and General Faculty Hospital, Charles University, Prague. METHODS: The data, reflecting the diagnosis of thromboembolism (TE), were collected from all patients, who have undergone the IVF cycle in our clinic for the last 7 years. The following data were analyzed in these patients: medical history, type and course of TE, type and effect of ovarian stimulation, clinical pregnancy achievement, occurrence of ovarian hyperstimulation syndrome (OHSS), results of testing for thrombophilia, pregnancy course and outcome. RESULTS: From 2748 IVF cycles 3 cases of TE were found (0.11%). In all cases the unilateral thrombosis of internal jugular vein associated with OHSS, manifesting in 1st trimester of pregnancy and not complicated with pulmonary embolism occurred. At least two thrombophilic markers have been detected in all these women. The clinical course of TE, as well as of the whole gestation was favorable. Prevalence of TE in patients with severe OHSS was 4.1% (2 women from 49). CONCLUSION: The incidence of thromboembolism in women undergoing IVF is low. It appears almost exclusively in association with OHSS and the typical finding is deep venous thrombosis in the neck area. In our opinion, while screening of thrombophilia in all patients from IVF program is not indicated, the routine testing of most common thrombophilic markers in pregnant women with OHSS could decrease the risk of these serious complications.

[Internal jugular vein thrombosis in a patient with ovarian hyperstimulation syndrome]. / Trombóza vnitrní jugulární zíly u pacientky s ovariálním hyperstimulacním syndromem.

OBJECTIVE: To describe a case of right internal jugular vein thrombosis complicating ovarian hyperstimulation syndrome (OHSS). DESIGN: Case report. SETTING: 1st Medical Faculty, Charles University and General Faculty Hospital, Prague. PATIENT: A 27-year-old primiparous woman undergoing in vitro fertilisation (IVF).

[Homocysteinemia and ovariectomy--initial experience with functional monitoring]. / Homocysteinémie a ovarektomie--první zkusenosti s funkcním monitorováním.

OBJECTIVE: Metabolic study on plasmatic levels of homocysteine (Hcy) in 30 women post ovarectomy suffering from benign diseases. Based on previous pilot study by 6 women patients after ovarectomy the Hcy level increase has been supposed. Further objective was to detect possible change of homocysteinemia after application of estrogen replacement therapy (ERT). Hyperhomocysteinemia (HHC)--increased level of free amino acid homocysteine in blood--is considered on lipids independent risk factor in early development of cardiovascular diseases. The deficiency of 5,10-methylatetetrahydrofolate reductase (mutation C677T) is suspected as the main reason for decreased remethylation of Hcy. The group of women heterozygous for MTHFR mutation was compared with group of women patients without this mutation during the 8 weeks--monitoring after application of foliculostimulating hormone (FSH), estradiol (E2) for folate, vitamin B12 and Hcy in plasma. DESIGN: Basic study to get our own data about HHC in population of operated women before and after ovarectomy and after ERT. SETTING: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University, Prague. METHODS: Total homocysteine in plasma was estimated by chromatographic method with use of fluorescence detection. The level of hormones in plasma was estimated by RIA test of DCL company. The mutation of gen for 5,10-MTHFR was estimated by genetic examination. Six blood taking were performed within 8 weeks. The 1st before ovarectomy, further 1., 3., 7., 28. and 56. day after operation. Since the 28th day 50 micrograms of 17-beta estradiol have been substituted by weekly transdermal system. RESULTS: No homozygote for 5,10-MTHFR has been found in the group of operated women, only 5 heterozygotes and 25 healthy homozygotes were found. Hcy values were similar in both groups. The patients were distributed into 2 groups according to their FSM level in the plasma (40 UI/I was stipulated as the limit). After ovarectomy the Hcy increased by both groups and after hormonal treatment the Hcy decreased. The folate level in both groups corresponded with Hcy level, in B12 vitamin concentration no dependence has been proved (P < 0.0001). CONCLUSION: Significant increase of Hcy levels after overactomy and subsequent decrease after substitutive treatment by estradiol. This correlation was followed by folate levels. No difference or correlation in monitored parameters was observed between heterozygotes for MTHFR and healthy homozygotes.