Feasible Influence of G-CSF on Clinical Pregnancy Outcome in Oocyte Donation Cycles for Patients with Recurrent Implantation Failure.

Background and Objectives: The aim of our single-center cohort study was the determination of the influence of the intrauterine lavage of granulocyte colony-stimulating growth factor (G-CSF) on clinical pregnancy rate in patients with a history of implantation failure older than 40 years. Materials and Methods: The study was conducted in Ferticare Prague SE between May 2018 and June 2020. Overall, 115 patients were distributed into two arms, with 48 subjects in the experimental and 67 in the control arm. All women have had a previous history of unsuccessful history of infertility treatment with their own genetic material and at least one ineffective cycle with the donated oocytes. The experimental arm underwent the intrauterine lavage of 0.5 mL of pure G-CSF from 120 to 48 h prior to embryo transfer. Results: The clinical pregnancy rate was 63.3% in the experimental arm and 47.8% in the control arm (p = 0.097 for Pearsonߣs χ2, and p = 0.133 for Fisher's exact test). However, the mean endometrial thickness on the day of embryo transfer did not appear to be statistically different (p = 0.139). Only the difference in endometrium thickness growth was statistically significant (p = 0.023). The increase in pregnancy rate is still encouraging for the future, even if it is not significant. Conclusion: Our study suggests the trend of increased pregnancy rate after the intrauterine G-CSF lavage in the interval of 120-48 h prior to embryo transfer.

Reactive oxygen species and their role in the andrological factor of couple fertility.

Reactive oxygen species play a significant role in male fertility and infertility. They are essential for physiological processes, but when their concentration becomes excessive, they can be a cause of various sperm pathologies. Seminal leukocytes and pathologically abnormal sperm are the primary sources of oxygen radicals in ejaculate. They negatively affect sperm quality, including DNA fragmentation and sperm motility impairment. Addressing increased concentrations of reactive oxygen species involves various appropriate lifestyle modifications and measures, including the use of antioxidants, treatment of urogenital infections, management of varicocele, weight reduction, and others. In many cases, these interventions can lead to adjustments in the condition and improvement in sperm quality. Such improvements can subsequently lead to enhanced outcomes in assisted reproduction or even an increased likelihood of natural conception. In some instances, the need for donor sperm may be eliminated. However, a key factor is adhering to a sufficiently prolonged treatment, which requires patience on the part of both, the physician and the patient.

The low birth weights of newborns conceived using assisted reproduction technology.

Couples are increasingly using assisted reproduction technology (ART) to facilitate having children. This raises the question of whether using ART leads to the same health outcomes as spontaneous conception.One of the major health outcome factors concerns the weight of the newborn. Many foreign studies have proved that newborns conceived via ART evince lower birth weights than newborns that were conceived spontaneously. The purpose of this study is to determine whether the risk of low birth weight differs according to the ART method selected (in-vitro fertilisation with fresh embryo transfer, frozen embryo transfer, oocyte receipt), and which of these methods is associated with the lowest risk of a low birth weight. Anonymised individual data on all deliveries that took place in Czechia between 2013 and 2018 was used for the analysis. The dataset was obtained from the National Registry of Reproduction Health (administered by IHIS CR).The binary logistic regression revealed that concerning many of the covariates controlled, women who underwent IVF had a higher risk (30 %) of giving birth to a child with a low birth weight than women who received frozen embryo transfer treatment (CI 1.15-1.48). Women who underwent oocyte receipt treatment were found to have an even higher (52 %, CI 1.17-1.97) risk than women who received frozen embryo transfer. This study supports existing international knowledge of the specifics of the health outcomes of women who use ART (Tab. 1, Fig. 3, Ref. 32). Keywords: Low birth weight, assisted reproduction technology, in-vitro fertilisation, frozen embryo transfer, oocyte receipt.

The association between preterm births and assisted reproductive technologies.

AIMS: The aim of this study is to determine whether the risk of preterm births differs according to the conception method: with or without ART and according to the ART method used (in-vitro fertilisation (IVF) with fresh embryo transfer, frozen embryo transfer (FET) and oocyte receipt (OoR)). METHODS: The research is based on individualised anonymised data on deliveries in Czechia in 2013-2018 (n=651,049) obtained from the National Health Information System. We employ the survival analysis approach applying survival functions (Life tables method) and Cox regression to model the risk of preterm births according to the conception method when controlling for a set of covariates. RESULTS: The results revealed that the risk of preterm births in singleton pregnancies is higher for ART-treated women (1.56 to 2.06 depending on the ART method) than for non-ART-treated women. The proportion of preterm births differs according to the ART method; the highest proportion was observed for OoR mothers. CONCLUSIONS: Overall, the differences between ART-treated mothers according to the conception method are due mainly to the structural differences between mothers. When controlling for the covariates (Cox regression model), no significant differences were observed concerning the risk of preterm births for women who underwent fresh IVF, FET and OoR.

Treatment of Vulvovaginal Laxity by Electroporation: The Jett Plasma Medical for Her II Study.

INTRODUCTION: Vaginal laxity is a widespread and undertreated medical condition associated especially with vaginal parity. AIM: To evaluate the efficacy and safety of electroporation therapy treatment of vulvovaginal laxity by the Jett Plasma for Her II device. METHODS: The Jett Plasma for Her II Study is a multicentric, prospective, randomized, single-blinded, and controlled study. Women presenting with vaginal laxity were randomized to receive electroporation therapy delivered to the vaginal tissue (active-82 patients) vs. therapy with zero intensity (placebo-9 patients). RESULTS: A total of 91 subjects whose average age was 48.69 ± 10.89 were included. Due to the results of a one-way analysis of variance, it may be concluded that in the case of the vaginal laxity questionnaire (VLQ), there is a statistically significant difference between actively treated patients and the placebo group (F1,574 = 46.91; p < 0.001). In the case of the female sexual function index (FSFI), a one-way ANOVA test also showed a statistically significant difference between the actively treated patients and the placebo group (F1,278 = 7.97; p = 0.005). In the case of the incontinence impact questionnaire-7 (IIQ-7), a one-way ANOVA test showed a statistically significant difference between the actively treated patients and the placebo group (F1,384 = 15.51; p < 0.001). It confirms that improvement of vaginal laxity is conjoined with benefits in symptoms of urinary incontinence. Biopsy performed after the end of the treatment shows an increase in the vaginal mucosa thickness by an average of 100.04% in the active group. The treatment was well tolerated with no adverse events. No topical anesthetics were required. CONCLUSIONS: Treatments of vulvovaginal laxity by electroporation therapy achieved significant and sustainable 12-month effectiveness. Responses to the questionnaires also suggest subjective improvement in self-reported sexual function, incontinence, sexual satisfaction, and urogenital distress.

Does advanced maternal age explain the longer hospitalisation of mothers after childbirth?

BACKGROUND: Fertility postponement, which has comprised the most significant reproductive trend in developed countries over the last few decades, involves a number of social, personal and health consequences. The length of stay (LOS) in hospital following childbirth varies considerably between countries. Czechia, where the fertility postponement process has been particularly dynamic, has one of the longest mean LOS of the OECD member countries. OBJECTIVE: We analyse the influence of the age of mothers on the LOS in hospital associated with childbirth. DATA AND METHODS: We employed anonymised individual data provided by the General Health Insurance Company of the Czech Republic on women who gave birth in 2014. Kaplan-Meier survival plots and binary logistic regression were employed to identify factors associated with long stays (> = 7 days for vaginal births, > = 9 days for CS births). RESULTS: The impact of the maternal age on the LOS is U-shaped. A higher risk of a longer hospitalisation period for young mothers was identified for both types of birth (OR = 1.58, 95% CI 1.33-1.87, p˂0.001 for age less than 20, OR = 1.31, 95% CI 1.20-1.44, p˂0.001 for age 20-24 compared to 30-34). The risk of a longer stay in hospital increases with the increasing age of the mother (OR = 1.23, 95% CI 1.13-1.35, p˂0.001 for age 35-39, OR = 2.05, 95% CI 1.73-2.44, p˂0.001 for age 40+ compared to 30-34), especially with concern to vaginal births. CONCLUSION: The probability of a long LOS increases significantly after the age of 35, especially in the case of vaginal births. Thus, the fertility postponement process with the significant change in the age structure of mothers contributes to the increase in health care costs associated with post-birth hospitalisation.

Prescription rules of hormone replacement therapy and its alternative.

Hormone replacement therapy is still the most effective treatment for acute climacteric syndrome and prevention of osteoporosis. When starting treatment within 10 years of menopause, i.e., before the onset of irreversible changes in the vessel wall and nervous tissues, it is a window of opportunity to prevent atherosclerosis and dementia. At a later start, on the contrary, it worsens these processes. To increase the safety of the treatment, especially in affecting the breast tissue, we choose the lowest effective dose of estrogen and give preference to gestagens structurally close to progesterone. For women who, for objective or subjective reasons, prefer non-hormonal treatment, they can choose from an extensive range of complementary and alternative medicines. Unfortunately, it does not always reliable documentation of efficacy and safety from well-performed studies. However, the data for fermented soybean extract DT56a, pollen extract PI82/GC Fem, and some traditional Chinese medicine procedures offer an interesting opportunity. Physical activity cannot be forgotten in a comprehensive approach.

Delayed umbilical cord clamping - benefits and risks.

Delayed umbilical cord clamping is a standard procedure for active management of the 3rd stage of labour. There are benefits associated with more than a 30 second delay, but 1 minute is usually recommended. For newborns, increased iron reserves are important having a positive impact on further development. A reduction in the risk of necrotizing enterocolitis and intraventricular hemorrhage is often reported in preterm births. In delayed umbilical cord clamping, no increased maternal blood loss was recorded, even in multiple pregnancies and caesarean sections.

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

BACKGROUND: Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia.  METHODS: Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model. RESULTS: Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95-35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14-34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76-2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16-1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86-2.21, p<0.001). CONCLUSIONS: The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.

Does Advanced Maternal Age Comprise an Independent Risk Factor for Caesarean Section? A Population-Wide Study.

OBJECTIVE: To investigate the association between a mother's age and the risk of caesarean section (CS) when controlling for health factors and selected sociodemographic characteristics. METHODS: Binary logistic regression models for all women who gave birth in Czechia in 2018 (N = 111,749 mothers who gave birth to 113,234 children). RESULTS: An increase in the age of a mother significantly increases the odds of a CS birth according to all of the models; depending on the model, OR: 1.62 (95% CI 1.54-1.71) to 1.84 (95% CI 1.70-1.99) for age group 35-39 and OR: 2.83 (95% CI 2.60-3.08) to 3.71 (95% CI 3.23-4.27) for age group 40+ compared to age group 25-29. This strong association between the age of a mother and the risk of CS is further reinforced for primiparas (probability of a CS: 11% for age category ≤ 19, 23% for age category 35-39, and 38% for age category 40+). However, the increasing educational attainment of young women appears to have weakened the influence of increasing maternal age on the overall share of CS births; depending on the model, OR: 0.86 (95% CI 0.80-0.91) to 0.87 (95% CI 0.83-0.91) for tertiary-educated compared to secondary-educated women. CONCLUSIONS: The age of a mother comprises an independent risk factor for a CS birth when the influence of health, socioeconomic, and demographic characteristics is considered.

Evaluation of the effect of Lepidium meyenii Walpers in infertile patients: A randomized, double-blind, placebo-controlled trial.

Male infertility refers to the inability to conceive a natural pregnancy in a fertile female, and approximately 15% of reproductive-aged couples worldwide face this problem. Several plants were used to treat fertility disorders and, among them, Lepidium meyenii, a folk medicament of Andean regions, is still used to enhance vitality and treat sterility in humans and domestic animals. The aim of the study was to evaluate the effects of L. meyenii Walpers on infertile patients by a randomized, double-blind, placebo-controlled trial. Fifty patients suffering from various reproductive-related problems were enrolled for 16 weeks to evaluate the effect of yellow maca on semen quality and serum hormone levels. Treatment with maca improved the percentage of sperm concentration by 40%, whereas the placebo improved by 76% after 8 and 16 weeks of treatment, but the results were statistically non-significant. No statistically significant change in hormone levels was reported by using maca, except a decrease in the level of free testosterone. Results are not sufficient to assess the efficacy of maca on male fertility. Further investigation and trials are required to obtain conclusive results.

Risky sexual behaviour and contraceptive use among young women in the Czech Republic.

OBJECTIVE: This study aimed to obtain sexual and reproductive behaviour data of late adolescent women in the Czech Republic and to analyse the relationships between sexual behaviour and social, demographic, and behavioural factors. METHODS: Data were obtained using the Computer-Assisted Web Interviewing method from 25 April to 2 May 2018 from a representative group of sexually active women aged 18-24 years. Results were statistically evaluated using sign schema on adjusted residuals. RESULTS: A total of 525 women participated (median age of coitarche - 16 years, condom use with/without hormonal contraception - 65%, unprotected sex - 9.3% in the sexual debut). Anamnestic artificial abortion and sexually transmitted disease (STD) rates were 5.3% and 3.8%, respectively. Early coitarche, number of sexual partners, history of abortion, and STDs were positively correlated with current hormonal contraceptive use; the number of sexual partners and use of hormonal contraception were negatively correlated. Hormonal contraceptive users were more likely vaccinated against human papilloma virus (HPV) in comparison with women without any contraception. There was no correlation between risky sexual behaviour, contraceptive use, and socio-demographic factors. CONCLUSION: Women with early coitarche and a high cumulative number of sexual partners have more unwanted pregnancies and STDs; moreover, those with regular coital activity without contraception are less frequently vaccinated against HPV.

Purified and specific cytoplasmic pollen extract: a non-hormonal alternative for the treatment of menopausal symptoms.

Research into non-hormonal, alternative therapies is necessary for women for whom menopausal hormone therapy is contraindicated or for women who do not wish to take hormones. This review focuses on one such non-hormonal option, namely, purified and specific cytoplasmic pollen extract, or PureCyTonin®. This extract has been evaluated in several preclinical and clinical studies, where it demonstrated its value as a safe and non-estrogenic alternative for menopause. This review presents the beneficial effects of PureCyTonin® in the treatment of menopausal symptoms (e.g. hot flushes) in healthy women, as well as in premenstrual syndrome. We discuss the mechanism of action of PureCyTonin®, an SSRI-'like' therapy. The lack of estrogenic effect demonstrated in preclinical studies suggests that PureCyTonin® may also be a suitable option for the management of menopausal symptoms in women with breast cancer.

Genitourinary syndrome of menopause: hard to communicate, easy to treat.

About 40 % of woman suffer from vulvovaginal atrophy after menopausal transition. It is very important to put question on this problem, because about 70 % of them are not able to start discussion on it. Regarding treatment, vaginal low doses estriol and estradiol are drugs of first choice with high efficacy and safety.

Tibolon - the only one member of STEARs group.

Tibolon is the only therapeutic approach to climacteric symptoms, prevention of osteoporosis and urogenital atrophy with the same efficacy as hormone replacement therapy. Tibolon has more positive effects on sexuality and mood changes in menopausal women. It decreases the mammographic density. Its safety for breast cancer is the same as for only estrogen therapy and better than for estrogen-gestagen therapy. Tibolon is the first choice for postmenopausal women with mood and sexuality disorders, women with mastodynia and high mammographic density.

Impact of the mothers age at childbirth on the birth weight of new-born children.

The various health risks associated with the increasing age of mothers at childbirth include the low birth weight of new-born children. The aim of the article is to verify the relationship between the birth weight of new-born children and the age of mothers at childbirth employing data on new-born children from the General Health Insurance Company of the Czech Republic. The data also allow take into consideration other characteristics such as the gender of the child, the frequency of childbirth, complications during hospitalisation and the type of conception (spontaneous or following IVF treatment). It was found that the proportion of new-born children with birthweights of 2500+ g exceeded 93% for women aged 25-39 and that the proportion is only slightly lower for women aged 40 and over. The lowest proportion (less than 88 %) was determined for women below the age of 20, while the proportion for women aged 20-24 years stood at 92 %. No relationship was proved between a higher proportion of children born with low weights and the higher age of women with respect either to single or multiple births. However, the research did reveal the significantly higher proportion of children from single births with lower birth weights most likely born following IVF treatment. Moreover, the proportion of new-born children hospitalised due to health complications increases with the increasing age of mothers at childbirth with respect to both normal and lower birth weights.

Sexual Dysfunctions in Obese Women Before and After Bariatric Surgery.

BACKGROUND Obesity and associated comorbidities increase the probability of sexual disorders. The present study evaluated sexual satisfaction levels in obese women prior to and following bariatric surgery, utilizing the validated Female Sexual Function Index (FSFI) to also evaluate the sexual satisfaction in obese and non-obese women. MATERIAL AND METHODS 60 obese women (mean initial BMI of 43.7±5.9 kg/m²; mean age of 41.7±10.8 years) were administered the questionnaire on sexual function (FSFI) preceding bariatric surgery (laparoscopic adjustable gastric banding, 22 women; gastric plication, 33 women; and biliopancreatic diversion, 5 women), 6 months and 12 months after the procedure, i.e., following substantial weight reduction (final mean BMI of 35.5±5.5 kg/m²). The control group comprised 60 non-obese women (mean BMI of 22.2±1.9kg/m²; mean age of 36.4±10.7 years). RESULTS Our findings indicate that baseline sexual function in the preoperative obese females was significantly lower than in non-obese women, with p<0.01 in each domain. Data gathered at the 6- and 12-month points following the procedure indicated no significant difference. Before the procedure, 31 obese subjects (51.6%) exceeded the cutoff for FSD, at the 6-month evaluation point, 17 women (39.5%) exceeded the cutoff, and at 12 months postoperatively, 18 subjects (41.9%) exceeded the cutoff, indicative of FSD. Among the non-obese controls, only 9 subjects (15%) exceeded the cutoff threshold. CONCLUSIONS These findings show that substantive weight reduction resulting from bariatric surgery results in reduced sexual dysfunction in female subjects.

Prospective observational study to evaluate the efficacy and safety of the pollen extract Sérélys® in the management of women with menopausal symptoms.

Safety concerns or contraindications to the use of hormones have resulted in a rise of the use of herbal medicinal products for the management of menopausal symptoms. The pollen extract Sérélys® represents, due to its ingredients and mode of action, a new and innovative alternative for the management of these symptoms. The aim of the present study was to demonstrate the efficacy and safety of Sérélys®. A prospective, open, observational, and multicentre study was performed on 104 menopausal women. The patients received over 3 months the pollen extract Sérélys® containing the extracts PI82 and GC Fem in a dosage of twice 160 mg extract and 5 mg vitamin E. Using a validated menopausal rating score, the improvement of menopausal symptoms was recorded. A significant decrease of different menopausal symptoms was observed between the starting point of the study and after 12 weeks (p < .0001). Hot flashes were reduced by 48.5%, sleep disturbance by 50.1%, depressive mood by 51.2%, irritability by 47.9%, fatigue by 47.8%, vaginal dryness by 39.63% and muscles and joint pain by 27.4%. The pollen extract Sérélys® reduced significant menopausal symptoms showing a very low side effect profile.

Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes.

BACKGROUND: Surgery is the optimal treatment for a severe form of clitoral phimosis (CP) that is initiated by lichen sclerosus (LS) and causes female sexual dysfunction. AIM: We aimed to determine the etiology of clitoral phimosis, its influence on sexual function, and outcomes after surgical treatment. METHODS: In this prospective cohort study, we observed the occurrence of clitoral phimosis and related changes in a group of 3,650 sexually active heterosexual women with a mean age of 34.8 ± 14.9 years (20-45 years) from September 2014 to September 2016. Ultimately, we compared the changes in sexual function and distress and satisfaction with postoperative genital appearance in 9 patients with severe clitoral phimosis at 12 months after surgical treatment. MAIN OUTCOME MEASURES: Sexual function was evaluated using the Female Sexual Distress Scale-Revised and the Female Sexual Function Index, and the patient's genital self-image was evaluated using the Female Genital Self-Image Scale; gynecologic examinations were performed on all patients. RESULTS: Various forms of CP were found in 46 of 3,650 patients (1.3%). Severe forms of CP were found in 9 cases, but it was complicated by stenosis of vaginal introitus in only 2 cases. These 9 patients underwent circumcision, and 2 of them underwent perineoplasty. Female sexual dysfunction occurred mainly in those with LS and severe forms of phimosis. Sexual function, as indicated by the total Female Sexual Function Index score, was significantly improved at 12 months after surgery (17.9 ± 0.9 vs 26.6 ± 0.5; P < .001). The Female Genital Self-Image Scale score assessing genital perception was significantly higher after surgery than before in women who underwent clitoral circumcision (20 ± 3.0 vs 12.3 ± 3.3; P < .001). The Female Sexual Distress Scale-Revised score was significantly lower after surgery than before (21.3 ± 6.2 vs 33.8 ± 6.9; P < .001). Sexual function in 2 women with CP and stenosis of vaginal introitus improved after surgery, but the sexual distress level did not decrease significantly. CLINICAL IMPLICATIONS: The results of this study will help clinicians to centralize treatment methods and advise patients on the management of clitoral phimosis. STRENGTHS & LIMITATIONS: This is a study evaluating postoperative results of sexual function, distress, and satisfaction with genitalia in women with severe CP, using validated questionnaires. However, the small number of patients and the absence of an appropriate control group are limitations. CONCLUSION: Surgical treatment of clitoral phimosis can improve sexual function, but because LS-a common underlying cause-is chronic in nature, patients may experience recurrence. Chmel R, M Novácková, Fait T, et al. Clitoral Phimosis: Effects on Female Sexual Function and Surgical Treatment Outcomes. J Sex Med 2019;16:257-266.

Menopause hormone therapy: latest developments and clinical practice.

Menopause hormone therapy (MHT) is the most efficient treatment for symptoms of acute climacteric syndrome and for efficient prevention of long-term estrogen deficiency. Vaginal administration of low doses of estrogen is a therapy of choice for treatment and prevention of urogenital atrophy and its consequences. Systemic treatment may include estrogen, but an equally efficient alternative is tibolone. Nonhormonal therapy relies on phytoestrogens, black cohosh extract, and serotonin reuptake inhibitors.