[EmbryoGlue the transfer medium with hyaluronan in the IVF+ET program]. / Transferové médium s hyaluronanem embryoGlue v programu IVF+ET.

OBJECTIVE: To assess, if the replacement of serum albumin by recombinant human albumin and hyaluronan in EmbryoGlue transfer medium effects embryo implantation within IVF+ET programme. DESIGN: A prospective study. SETTING: Department of Obstetric and Gynecology, University Hospital, Olomouc. METHODS: 297 IVF cycles with the embryotransfer (ET) were evaluated. The patients were divided into 2 groups according to the type of transfer medium (culture medium; G2.2, n = 112 and the transfer medium EmbyoGlue (EG) n = 185) and to three subgroups according to the age of the patients (< 30, 30-38, > 38). In both groups the following entry parameters were compared: average age, number of oocytes obtained, fertilization rate (FR), number of frozen embryos, number of transferred embryos. The outcome parameters compared were: pregnancy rate (PR), implantation rate (IR), abortions (AB) and the number of multiple pregnancies. RESULTS: In the group of patients up to 30 (EG = 72 vs. G2.2 = 51) and over 38 years of age EG = 18 vs. G2.2 = 18) no differences in input and output parameters have been discovered, while in the group of patients between 30 and 38 years of age (EG = 94 vs. G2.2 = 44) the results of EG group embryo implantation have been improved significantly (IR 27.7% vs. 153%, p < 0.01). No differences in any other output parameters have been encountered (PR 43.6% vs. 39.5%, AB 7.3% vs. 11.7%). CONCLUSION: Human serum albumin can be replaced by hyaluronan as a sole macromolecule in a human embryo transfer medium and by recombinant human albumin, without reduction of pregnancy rate (PR) and implantation rate (IR). Not only similar results were achieved in EG medium compared to currently used G2.2 medium, but in the group of 30-38 year old patients a statistically significant positive influence of EG on the implantation of embryos has been observed.

[Embryo quality evaluation according to the speed of the first cleavage after IntraCytoplasmic Sperm Injection (ICSI)]. / Kvalita embryí po ICSI v závislosti na rychlosti nástupu prvního bunecného delení.

OBJECTIVE: To evaluate morphological parameters of embryos obtained in the process of ICSI. DESIGN: A prospective study. SETTING: Centre of Assisted Reproduction, Dept. of Obstetrics and Gynecology, Palacký University Medical School, Olomouc. METHODS: In the present study 1116 embryos developing after ICSI (IntraCytoplasmic Sperm Injection) procedure in the period of 2001-2004 were evaluated. The beginning of the mitotic cleavage was assessed within the interval of 22-27 hours after insemination. The embryos were divided into three groups according to the speed of their division as Early Cleavage (EC) embryos, where two blastomeres were present at the time of assessment, Break Down ProNuclei stage (BDPN) where the pronuclei had already disappeared, and ProNuclei (PN) embryos, where both pronuclei were still present. In these groups the degree of fragmentation was evaluated on day two of cultivation and embryos were divided into four categories as: A--regular blastomeres, without fragmentation, B--irregular blastomeres or fragmentation below 30%, C--fragmentation 30-50%, D--fragmentation above 50%. The speed of further cleavage and average number of blastomeres were evaluated on day two and three of cultivation. Statistical analysis was preformed at the Palacky University Computer Centre. The chi2 test and t-test for independent samples were used. RESULTS: EC embryos were found in 37.4%, BDPN in 33.1% and PN in 29.5%. The degree of fragmentation between evaluated groups of embryos were statistically significant (p = 0.000). EC embryos were less fragmented (p = 0.000), had more blastomeres at the time of evaluation (p = 0.000) and their speed of cleavage was faster (p = 0.000). The cleavage of EC embryos was faster in comparison with the PN group (p = 0.000), but there were no significant differences between the EC and BDPN groups on day two of cultivation. On day three significant differences were found also between the EC and BDPN groups (p = 0.000). The embryonic developmental arrest was found only in PN embryos. CONCLUSION: The speed of the first cell cleavage is a useful additional criterion for the embryo selection for embryotransfer. EC embryos usually have better morphology and more blastomeres than the BPDN and PN ones.

[Embryo quality evaluation according to the speed of the first cleavage after conventional IVF]. / Kvalita embryí po klasickém IVF v závislosti na rychlosti nástupu prvního bunecného delení.

OBJECTIVE: To evaluate morphological parametres of embryos obtained in the process of conventional IVF. DESIGN: A prospective study. SETTING: Centre of Assisted Reproduction, Dept. of Obstetrics and Gynecology, Palacký University Medical School, Olomouc. METHODS: In the present study 549 embryos developing after conventional IVF in the period of 2001-2004 were evaluated. The beginning of the mitotic cleavage was assessed within the interval of 24 - 27 hours after insemination. The embryos were divided into three groups according to the speed of their division as early cleavage (EC) embryos, where two blastomeres were present at the time of assessment, break down pronuclei stage (BDPN) where the pronuclei had already disappeared, and pronuclei (PN) embryos, where both pronuclei were still present. In these groups the degree of fragmentation was evaluated on day two of cultivation and embryos were divided into four categories as: A - with regular blastomeres, without fragmentation, B - with irregular blastomeres or with fragmentation below 30%, C - with fragmentation 30-50%, D - with fragmentation above 50%. The speed of further cleavage and average number of blastomeres were evaluated on days two and three of cultivation. Statistical analysis was preformed in the Palacký University Computer Centre. The chi-square test and t test for independent samples were used. RESULTS: EC embryos were found in 45.5%, BDPN in 33.5% and PN in 21.0%. EC embryos were less fragmented (p = 0.000), had more blastomeres at the time of evaluation (p = 0.000) and their speed of cleavage was faster (p = 0.000). The cleavage of EC embryos was faster in comparisson with the PN group (p = 0.000), but there were no significant differences between the EC and BDPN groups on day two of cultivation. On day three significant difference was found also between the EC and BDPN groups (p = 0.000). CONCLUSION: The speed of the first cell cleavage is a useful additional criterion for the embryo selection for ET. EC embryos usually have better morphology and more blastomeres that the BPDN and PN ones.

[Comparison of apoptosis expression in the secretory endometrium during a normal menstrual cycle]. / Porovnání exprese apoptózy v sekrecním endometriu prirozeného menstruacního cyklu.

OBJECTIVE: Comparison of level of apoptosis in the mid-secretory human endometrium. DESIGN: Clinical-laboratory trial. SETTING: Department of Gynecology and Obstetrics, Medical Faculty, Palacký University, Faculty Hospital, Olomouc, Department of Gynecology and Obstetrics, Bata Hospital, Zlín. METHODS: Samples of secretory endometrium were obtained from 14 women. The women included in the study had the next criteria: a history of infertility of more than 12 months, regular menstrual cycles, age below 40 and FSH basal level range 5-9 IU/L. Sampling of tissue was performed after confirmed ovulation by LH surge and repeated ultrasound examinations. Patterns were processed by routine methods and apoptosis was detected using TUNEL assay. RESULTS: The level of apoptosis in the endometrial epithelial surface was significantly higher on day +7 compared to day after ovulation (P < 0.02). Apoptotic cells were seen only sporadically in endometrial stromal cells. The level of apoptosis in endometrial stroma was also higher (but not statistically significant) on day +7 compared to day The level of apoptosis was markedly higher in spongy layer on day +7 (P < 0.01) compared to day There were no significant differences between day and +7 in compact layers of the glands.

[Effect of early cleavage of embryos after intracytoplasmic sperm injection (ICSI) into oocytes on results of fertilization in vitro (IVF) and embryo transfer (ET)]. / Vliv casného nástupu prvního bunecného delení u embryí po vpichu spermie do cytoplazmy oocytu (ICSI) na výsledky IVF + ET.

OBJECTIVE: To evaluate the influence of early cleavage in embryos obtained using ICSI on the success rate of IVF-ET. DESIGN: A prospective study. SETTING: Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Medical Faculty, Palacký University, Olomouc. METHODS: The rate of the first cleavage of embryos was checked between 23 to 26 hours after ICSI in 115 cycles IVF-ET. "Early Cleavage" (EC) embryos which were already cleaved were cultivated separately from the "slow" (No Early Cleavage, NEC) embryos. After 3 days cultivation, no more than three 6- to 8-cell embryos were transferred. Only EC embryos were transferred in 43 cycles and only NEC embryos were transferred also in 43 cycles. The remaining 29 cycles, where both EC and NEC embryos had to be transferred, were not evaluated. In both groups the following entry parameters were compared: age of the patient, number of fertilized oocytes, fertilization rate (FR), number of frozen and evaluated embryos, number of EC embryos recorded and number of transferred embryos. The outcome parameters compared were: pregnancy rate (PR), number of gestational sacs with heart beats per number of transferred embryos (implantation rate, IR), abortions (AB) and the frequency of multiple pregnancy. Statistical evaluation was performed by t-test, chi 2 test and by Sheffe analysis. RESULTS: EC embryos were found in 57% of cycles (n = 66) after ICSI. Early cleavage was observed in 198 of 563 embryos (35%). Among entry parameters the only statistically significant differences (P < 0.05) were found in the number of retrieved oocytes as well as in the ratio of frozen embryos which were higher in the cycles with the transfer of only EC embryos. FR was the same (74%) in both types of transfer. Outcome parameters in the transfer of only EC versus NEC embryos were higher in PR (40% vs. 33%), about equal in IR (27% vs. 25%) and lower in AB (2% vs. 5%). Moreover, multiple pregnancies were less frequent in the transfer of only EC embryos: 65% of singleton pregnancy, 35% of twins and no triplet versus 36%, 57% and 7%, resp., in the transfer of only NEC embryos. The differences in outcome parameters are not statistically significant (P > 0.05) because of small numbers. CONCLUSION: The speed of the first cell cleavage is a useful additional criterion for better evaluation of quality and viability of embryos.

Detection of early atherosclerosis using the ultrasound parameter of the intima-media thickness of the common carotid artery in families with familial combined hyperlipidemia.

AIM: The aim of the present study was to quantify intima-media thickness (IMT) of the common carotid artery (CCA) in clinically asymptomatic members of familial combined hyperlipidemia (FCHL) families and to evaluate its association with lipids, apoproteins, blood pressure, surrogate markers of insulin resistance, fibrinogen and hs-CRP. METHODS: The group under study consisted of 82 individuals from 29 FCHL families (47 hyperlipidemic [HL] and 35 normolipidemic [NL]). They were compared with the age and sex adjusted control groups of healthy subjects (HL-c, n=20 and NL-c, n=20). IMT was measured by ultrasound at a far wall of both common carotid arteries. RESULTS: Hyperlipidemic subjects had increased IMT compared with healthy controls (0.695+/-0.118 vs 0.599+/-0.074 mm), with an age and sex corrected difference of 86 mm (p<0.001). No difference in IMT was recorded in NL FCHL members in comparison with their healthy controls. In HL subjects, significantly positive univariate correlations were observed between IMT and age, total cholesterol, LDL-cholesterol, non-HDL-cholesterol, apolipoprotein B, SBP, DBP, BMI, waist, fasting glycemia, C-peptide and proinsulin, whereas in NL subjects IMT correlated only with age. Multivariate regression analysis in FCHL subjects (HL+NL) revealed that age (p<0.001), sex (p<0.001), non-HDL-cholesterol (p<0.01) and BMI (p<0.05) were significant and independent predictors of IMT. CONCLUSIONS: The increase of IMT CCA in hyperlipidemic still clinically asymptomatic FCHL subjects corresponds to acceleration of the clinically ''silent'' atherosclerosis by about 8-14 years and is in agreement with their increased risk of atherosclerosis.

[Multiple pregnancy--a significant complication of in vitro fertilization protocols]. / Vícecetné tehotenství--významná komplikace programu IVF.

OBJECTIVE: To evaluate the history of pregnancies after IVF-ET, to define multiple pregnancy risk factors. DESIGN: A retrospective analysis of the period of 1992-2000. SETTING: Department of Gynecology and Obstetrics, University Hospital, Palacký University, Olomouc. METHODS: 343 pregnancies were evaluated, divided into 4 groups according to the patients' ages: < or = 29 yrs. (n = 150), 30-34 yrs. (n = 122), 35-39 yrs. (n = 66), > or = 40 yrs. (n = 5). The number of transferred embryos and frequency of pregnancies in relation to the patient' ages were compared as well as the multiple pregnancy and spontaneous abortion rates. The dependence of preterm labour rate, foetus weight and the incidence of operative delivery on the frequency of pregnancies were evaluated (n = 276). The data were analysed using the chi 2 and Sheffe tests. RESULTS: Three or four transferred embryos markedly increase the number of multiple pregnancies (P < 0.01). No relation to the patient's ages was found. An increased incidence of operative deliveries (P < 0.01) as well as preterm deliveries (P < 0.05) in multiple pregnancies was found. CONCLUSIONS: The number of transferred embryos is the most important risk factor for multiple pregnancy development. It is recommended to decrease the number of transferred embryos to two or one per ET.

[Early cleavage embryos and their effect on the results of standard in vitro fertilization]. / Embrya s casným delením (early cleavage) a jejich vliv na výsledky klasického IVF.

OBJECTIVE: To assess if early cleavage embryo is an additional indicator of embryo quality that could be used to increase the efficiency of IVF and ET. DESIGN: A prospective study. SETTING: Centre for Assisted Reproduction, Department of Gynecology and Obstetrics, Medical Faculty, Palacký University, University Hospital, Olomouc. METHODS: The study evaluates 62 cycles of conventional IVF in our Centre during 2001 to 2002. All embryos were observed for the presence or absence of "early cleavage" (EC), i.e. with completed first mitotic division 25 to 26 hours after insemination. The EC embryos were cultivated separately from the so called "late cleavage" or no early cleavage (NEC) embryos. After the three-day cultivation a maximum of three embryos were transferred in 6-8 cells stage. EC embryos were transferred in 28 cycles, NEC embryos in 18 cycles. The remaining 16 patients with "combined" transfer of EC + NEC embryos were excluded from the evaluation. The following parameters have been compared: age, number of fertilized oocytes, fertilization rate (FR), number of cryopreserved embryos, number of embryos assessed for EC, number of EC embryos found, number of transferred embryos, pregnancy rate (PR), implantation rate (IR), spontaneous abortions (AB). Statistical analysis was performed by Student's t-test, chi 2 test and Sheffe analysis. RESULTS: EC embryos were found in 71% of conventional IVF (n = 44). There were no significant differences in the entry parameters (age, number of fertilized and fertilizing oocytes, number of cryopreserved, assessed and transferred embryos) between the group with EC embryos versus the group with NEC embryos. When EC embryos were transferred, the following parameters were higher: PR (61% vs. 56%), IR (38% vs. 33%), compared to NEC group, while pregnancy loss was lower after EC (4% vs. 11%) compared to NEC. Due to small numbers in the subgroups the results, though suggestive, are not statistically significant (p > 0.05). CONCLUSIONS: The assessment of early cleavage embryo is one of the criteria for evaluation and selection of suitable embryos prior to transfer which could help in the process of selection to choose the best embryos between embryos of the same morphology on the day of transfer.

[Embryo transfer after 5 days of culture]. / Embryotransfer po 5denní kultivaci.

OBJECTIVE: To find out whether: 1) the blastocysts transfer rises the successfulness of IVF and ET (G/ET) and 2) the 2-blastocyst transfer lowers the incidence of multiple pregnancies (IR). DESIGN: Prospective study of 46 patients involved in a prolonged 5-day cultivation of IVF and ET programme. SETTING: Centre for Assisted Reproduction, Clinic of Gynecology and Obstetrics, Teaching Hospital and Palacky University in Olomouc. METHODS: Patients with at least 5 acquired embryos were included in the group. The cultivation in media commercially produced by Scandinavian IVF Science took 5 days. RESULTS: In 91% of patients in the observed group (n = 46) morulas or blastocysts were acquired. The IVF and ET success rate after 5-day cultivation and subsequent transfer of two embryos was 37% pregnancies per a started cycle (G/cycle), 40% pregnancies per an embryotransfer (G/ET) and the implantation rate (IR) was 31%. Relatively high percentage of double pregnancies (53%) is alarming. Following parameters were assessed: age, sterility cause, number of previous IVF cycles, stimulation scheme, E2 level on the day of hCG application, number of acquired oocytes and pronuclear stages, percentage of grown blastocysts, the quality of transferred embryos and endometrium thickness on the day of transfer. The only statistically significant difference was found in E2 level on the day of hCG application. Pregnant patients had lower levels of estradiol (average value 11.8 +/- 4.8 nmol/l) compared to patients who did not become pregnant (18.6 +/- 11.9 nmol/l). CONCLUSION: In selected groups of patients who refuse multiple pregnancies only one blastocyst should be transferred.

[Results of a study of serum hormones and biochemical findings in seminal plasma in subfertile men examined at the Clinic for Gynecology and Obstetrics in Olomouc 1995-1996]. / Výsledky hormonálních vysetrení v séru a biochemické nálezy v seminální plazme u subfertilních muzu sledovaných na Gynek.-porod. klinice v Olomouci v letech 1995-96.

Based on a comparative study in a group of healthy men and men suffering from oligospermia and azoospermia, the authors consider it useful to examine FSH, LH, PRL and testosterone serum levels for possible evidence of testicular hypofunction and for detection of stress situations associated with raised PRL levels. As to seminal plasma, the authors consider it useful and relevant to assess citric acid levels, total acid phosphatases and in particular fructose with alpha-glucosidase.

[Dental examination of old people in the Institute for the Chronically Sick, Faculty Hospital with Policlinic, Olomouc]. / Stomatologické vysetrení gerontu v lécebne dlouhodobe nemocných, fakultní nemocnice s polklinikou v Olomouci.

The authors made dental examinations in old age pensioners selected at random who were hospitalized in the Institute for the chronically sick in the Faculty Hospital with Policlinic in Olomouc. The group of hospitalized patients was compared with a random sample of pensioners treated at the prosthetic department of the Second Stomatological Clinic in Olomouc. The investigation revealed the necessity of dental treatment and treatment of the oral cavity in hospitalized patients. This applies in particular to partial removable dentures, total dentures and improvement of hygiene of the oral cavity. In the group of patients treated at the dental out-patient department it is important to improve in the first place the hygiene of the oral cavity.