[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.

[Effect of the number of transferred embryos on multiple pregnancy]. / Vliv poctu transferovaných embryí na cetnost gravidity.

OBJECTIVE: The aim of this retrospective study was to assess the influence of the number of transferred embryos on multiple pregnancy. DESIGN: Retrospective clinical study. SETTING: Department of Obstetric and Gynecology FN UP, Olomouc. METHODS: Over the last seven years 572 embryotransfers (ET) have been performed in our centre. RESULTS: Of the 173 pregnancies (P) achieved there were 56% singletons, 35% twins and 9% triplets. One embryo was transferred in 10% of cases and all 8 pregnancies (15% P/ET) ended with a live birth. Two embryos were transferred in 17% of cases. The pregnancy rate was 20% P/ET, 55% of pregnancies were twins and 10% pregnancies were lost in abortion or ectopic pregnancy. Three embryos were transferred in most cases (62%). The pregnancy rate was the highest in this group (36% P/ET) with 13% twins and 3% triplets. The overall pregnancy loss was 16%, the highest loss, 27%, recorded in triplets. Four embryos were transferred in 11% of cases. The pregnancy rate decreased to 28% P/ET, as well as the number of twins (6%), while the number of triplets increased slightly (5%). Pregnancy loss occurred only in singleton pregnancies. CONCLUSION: We can conclude that in our setting the pregnancy rate increases with a higher number of embryos up to three embryos transferred. Unfortunately, the higher pregnancy rate with three embryos transferred is on the expense of a higher risk and losses due to multiple pregnancy. Therefore we recommend to transfer two embryos unless there are some specific reasons.

[The ovarian hyperstimulation syndrome with pericardial and pleural effusions complicated by supraventricular arrhythmia]. / Ovariální hyperstimulacní syndrom s perikardiálním a pleurálním výpotkem komplikovaný supraventrikulární arytmií.

Problems which arise in conjunction with the use of assisted reproduction methods are no longer resolved only by the gynaecologist. The authors demonstrate on the case of a female patient the necessity of interdisciplinary collaboration in the diagnosis and therapy of developed ovarian hyperstimulation syndrome (OHSS)--the most serious complication of assisted reproduction.

[Ovarian hyperstimulation syndrome as a rare cause of pericardial effusion. 2 case reports]. / Ovariální hyperstimulacní syndrom jako vzácná prícina perikardiálního výpotku. Dve kazuistiky.

Assisted reproduction techniques (ART) are modern medical methods which should help infertile couples to resolve their problems. With the introduction of ART new ethical and technical problems arise. The authors wish to demonstrate on the submitted two case-histories the need of interdisciplinary collaboration of the specialist in internal medicine and gynaecologist when dealing with a serious complication of ART--ovarian hyperstimulation syndrome (OHSS).

[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.

[Results of IVF and ET 1992-95 at the Gynecological-Obstetrical Clinic in Olomouc--comparison of stimulation protocols]. / Výsledky IVF a ET v letech 1992-95 na Gynek.-porod. klinice v Olomouci--srovnání stimulacních protokolu.

The authors compared three types of stimulation protocols used in their department in 1992-1995. In the standard protocol they evaluated the use of hMG and FSH with regard to the number of abolished cycles and the number of achieved pregnancies. They compared protocol No. 1 "standard: CC + G (FSH), protocol No. 2 "short": GnRH-a + hMG (FSH) and protocol No. 3 "long" GnRH-a + hMG (FSH). They evaluated the number of abolished cycles, the effectiveness of the protocols as regards the number of obtained oocytes, the number of performed embryo transfers, the number of clinical pregnancies/embryo transfers and the number of cryopreservations. The abortion rate in relation to the used protocol was also evaluated.

[Infectious agents and treatment of infertility with IVF and ET]. / Infekcní agens a lécba infertility metodou IVF + ET.

An infectious agent is a confirmed etiological factor of female tubal sterility. In conjunction with the recorded decline of fertility of the male population the participation of infection in this trend can be taken into consideration. In the submitted paper the authors are concerned with the detection of an infectious agent in spermatozoa in the sterile population and its role when using assisted reproduction techniques (ART). From the results ensues that cultivation examinations of spermatozoa before a programme of in vitro fertilization and embryo transfer (IVF + ET) has its place in the screening of the treated couple. Detection of virulent types of microorganisms has a negative effect on results of IVF + ET. Groups of men with this finding should be treated with antibiotics with regard to sensitivity and at the same time cultivation examinations of their partners should be made an necessary treatment and provided.

Initial rise of progesterone in spontaneous, stimulated and pathologic cycles.

We followed 124 cycles and compared the preovulatory rise of progesterone in the groups of spontaneous ovulation and stimulated ovulation with those of ovulation of small follicles and cycles with LUF syndrome. No significant differences were found between normal and abnormal cycles.

Metoclopramide test in women with PCO syndrome after ovarian wedge resection.

Afternoon serum PRL levels and PRL responsiveness to metoclopramide (MCP) were determined in 36 women, aged 30.5 +/- 4.5, with normoprolactinemic anovulation. All women underwent a bilateral ovarian wedge resection with diagnosis polycystic ovarian disease (PCO) 2.9 +/- 2.0 years ago. After operation only four women had been pregnant. A bolus i.v. dose of 10 mg metoclopramide was given and serum PRL was estimated before, 30 and 60 min. after MCP administration. Diurnal serum PRL levels were approximately 9 ng in all patients. The PCO patients were classified into 2 groups in terms of the responsiveness to metoclopramide test. MCP induces rapid and marked elevation in serum PRL levels in all subjects. The maximum post MCP PRL value in the group I patients (n = 16) was 143.0 +/- 37.7 ng/ml, which was significantly higher than the maximum value in the II group patients (104.3 +/- 32.5 ng/ml) (P less than 0.005). Nine (56.2%) of the I group patients had maximum PRL values higher than 150 ng/ml; the proportion was statistically higher than 10 percent maximum PRL values in the group II (P less than 0.01). This finding suggests that the patients who had enhanced PRL responsiveness to MCP test have latent hyperprolactinemia, which can not be detected by analyzing PRL levels in blood samples taken randomly. This latent hyperprolactinemia presumably might be normalized by dopamine agonist therapy, resulting in resumption of ovulatory cycles in these women.

Terguride in the treatment of hyperprolactinemia.

Thirty-two women with ovarian dysfunction due to hyperprolactinemia were treated with a new derivative of lisuride-terguride. Twenty-three patients were treated for infertility. A microadenoma was confirmed in five, and three other patients had had a macroprolactinoma surgically removed. The finding in one of the patients was diagnosed as the syndrome of empty sella. Galactorrhea was present in 18 women. The duration of treatment ranged from 2 to 33 months. The determination of therapeutic dosages was based on individual responses on the prolactin levels within a range from 0.1 to 4.5 mg per day. Increased prolactin levels were successfully normalized in twenty-one treated patients. Regular periods were reappeared in 59% of the women. Thirteen (56%) became pregnant, seven gave birth to healthy babies, two of the patients aborted in the first trimester. Four women are still in later stages of pregnancy. Galactorrhea disappeared in 56% of the patients, being markedly inhibited in the remaining ones. In two cases, microadenoma disappeared after treatment, and in those after surgery the postoperative findings were decreased, in one patients there is no alteration in the pathology. Side effects were seen in 34% of the patients, being mostly mild in nature, and including in most cases nausea, headache and stomach pain. The complaints were transient, receding after prolonged treatment.

Ultrastructure of human granulosa cells obtained from follicular fluid aspirates.

Samples of the granulosa cells obtained from a punctured human preovulatory follicles stimulated for in vitro fertilization purposes were studied by means of light and electron microscopic methods. Early and late preluteinized granulosa cells were characterized by the presence of high amount of pale and homogeneous lipid droplets, moderate accumulation of glycogene and progressive development of smooth endoplasmic reticulum. A new type of granulosa cell containing dense-cored granules with fine granular contents of a secretory nature was identified in this material and discussed in comparison with some earlier published indications of its possible existence.