Modern terminology and classification of female pelvic organ prolapse.

OBJECTIVE: The aim of this study is to clarify the news and to summarize recommended methods in the quantification of female pelvic organ prolapse (POP). DESIGN: Summarizing study. SETTING: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. METHODS: The terminology of POP was significantly reworked in last decades. It is important to use common classification system for mutual communication of specialists and for exact interpretationof research. RESULTS: The older classifications of POP are not exact enough for interpretation of research. International classification system Pelvic organ prolapse quantification (POP-Q) brought necessary consensus in the terminology, encompassing many parameters that exactly define individual anatomy of each female patient. This detailed terminology could be replaced with simplified but also satisfactorily detailed version called Simplified POP-Q for the regular clinical practice. Modern classification of POP is still developing and new concepts of vaginal and perineal measurements for description of operation techniques effectiveness are waiting for further validation. CONCLUSION: Modern terminology and classification of POP meets the requirements of current science and research and also is usable for regular clinical practice.

Comparison of incisional and epidural analgesia in the treatment of postoperative pain after cesarean section.

OBJECTIVE: Comparison of incisional and epidural analgesia in the treatment of postoperative pain after cesarean sectio. DESIGN: Prospective cohort study in the period from 2015 to 2016. SETTING: Department of Obstetric and Gynecology, Masaryk University, University Hospital Brno. MATERIAL AND METHODS: The group included 72 patients in the 38th-41st. week of pregnancy. They were divided at the time of indication to the cesarean section (SC) into two groups according to the selected type of analgesia (epidural/incisional). Women with epidural analgesia (EA) received bupivacaine and sufentanil after surgery in the epidural catheter. A second group was patients during general anesthesia SC introduced into the surgical wound IA Painfusor which was continuously administered bupivacaine. The intensity of the patients pain was evaluated on the visual analogue scale (VAS). If the VAS exceeded 4, the dose of the opioid analgesic piritramide (additional dose of DDA analgesic) was administered intravenously. The intensity of pain and the number of DDAs required were evaluated 24 hours after SC. Satisfaction with pain relief, sleep quality, and patient side effects were assessed using a questionnaire. RESULTS: Patients in the EA group (n = 36) evaluated postoperative pain (PB) value of 4.4 ± 1.8 according to VAS, women in group IA (n = 36) reported a PB according to VAS of 4.4 ± 1.3 (p = 0.972). The difference in the number of applied DDA was not statistically significant compared groups (2.3 ± 0.9 EA vs. 2.4 ± 0.9 IA, p = 0.301). By comparing the other parameters evaluated by the questionnaire statistically significant more vertigo cases were found in women with IA (22.2% EA vs. 72.2% IA, p < 0.001). In the other evaluated parameters the differences between the two methods were not statistically significant. CONCLUSION: Epidural and incisional analgesia are comparable methods in the effectiveness of pain management during the first day of the cesarean section. Except for vertigo, both methods were also comparable in terms of the occurrence of undesirable effects.

Radiofrequency endometrial ablation - new possibility of heavy menstrual bleeding conservative treatment.

OBJECTIVE: Evaluation of radiofrequency endometrial ablation (RFEA) clinical efficacy in patients with heavy menstrual bleeding (HMB). DESIGN: Original article. SETTING: Department of Gynecology and Obstetrics, University Hospital and Masaryk University Medical School, Brno. METHODS: Study included 20 patients with HMB who had failed hormonal therapy and met the study inclusion criteria. All RFEA procedures were performed in the operating theater in general anesthesia by two experienced surgeons according to a standardized protocol. All RFEA were performed using specific disposable electrodes and radio frequency generator M-3004 (RF Medical Co., South Korea). Study outcomes were evaluated three months post-surgery included percentage of women with amenorrhoea or menstrual bleeding persistence measured by the modified Pictorial Blood Assessment Chart (PBAC) score. Furthermore, chronic pelvic pain intensity assessed by visual analogue scale (VAS), patient satisfaction (Patient Global Impression of Improvement, PGI-I score), and the incidence of complications were evaluated. RESULTS: All RFEAs were performed without operational or technical complications, the average age being operated was 43.0 ± 2.9 years and the operating time did not exceed ten minutes. In the early postoperative follow-up, patients did not require any analgesics and were all released to outpatient care the following day. Percentage of amenorrhea at three months post-treatment was 35.0%, mean PBAC score for women with menstrual bleeding was 1.8 ± 0.6. Patients satisfaction with the treatment was evaluated by 1.6 ± 0.6 on the PGI-I scale and long-term pelvic pain was on average 2.1 ± 0.8 by VAS, which counts an improvement of 31.0%. CONCLUSION: The HMB treatment with RFEA achieves good clinical results in three-month evaluation with objective and also subjective parameters. The technique is suitable for outpatient treatment and is an alternative to hysteroscopy endometrial ablation. Its wider clinical usage is limited by the high cost of the radiofrequency generator and disposable probes. Keywords heavy menstrual bleeding, hysteroscopy, radiofrequency endometrial ablation, amenorrhoea, complication.

[Fertility preserving methods in women with breast cancer before gonadotoxic therapy]. / Zachování fertility u zen s karcinomem prsu pred gonadotoxickou lécbou.

OBJECTIVE: To present current options and own experiences with ovarian stimulation in young women with breast cancer before gonadotoxic therapy. DESIGN: Review article with own experiencies. METHODS: Literary search, analysis of own experiences with complex therapy in women with breast cancer planning pregnancy, definitions of stimulating protocols, using methods of assisted reproduction. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno. RESULTS: Embryo and oocyte cryopreservation are important methods of fertility preservation requiring controlled ovarian stimulation before the start of chemotherapy. Current studies demonstrante effectivenes of this special stimulating protocol and did not find negative side effects such a progression of the breast cancer. Since January 2016 to June 2016 we performed controlled ovarian stimulation and oocyte retrieval in three patients with breast cancer before chemotherapy. We used short stimulation protocol with recombinant FSH, GnRH agonists and letrozole and retrieved 13, 12 and 9 oocytes. We cryopreserved 8 and 6 embryos, one woman prefered freezing of 12 oocytes. During the stimulation estradiol level did not exceed 1,6 nmol/l. CONCLUSION: Neither the normal nor the cancerous cells in the breast react to the gonadotropins FSH, LH, nor to hCG. Conversely, there is a cellular proliferation and an increase in cancer cell lines with oestrogen receptors with exposure to oestrogen, and it is dose - dependent. The special stimulation protocol with FSH, GnRH agonists and letrozole is effective in gain of efficient amount of gamets with minimal increase of estradiole level. Current study reviews did not find higher risk of progression of breast cancer in association with ovarian stimulation. It is important to respect the recomendation of oncology committee and to effectively suppress the estradiol level.

[Surgical treatment of the female stress urinary incontinence - from needles to mini-slings]. / Chirurgická lécba stresové inkontinence moci u zen - od jehel az k (mini)pásce.

OBJECTIVE: Stress urinary incontinence (SUI) is a clinical problem affecting a large part of female population, its incidence increases with age. Aim of this article is to show the spectrum of surgical procedures which are used to treat SUI, their advantages and limits, and define suitable patients. DESIGN: Review article. SETTING: Department of Gynecology and Obstetrics LF OU and University Hospital Ostrava; Department of Gynecology and Obstetrics LF MU and University Hospital Brno. METHODS: Systematic literature review using keywords and Medline database with detailed survey results analysis - full-text papers or abstracts published in years 1966-2016. RESULTS: Historical and recent methods of SUI testament are summarized including its effectiveness and complications focused mainly on techniques developed in the last two decades. CONCLUSION: There is a wide spectrum of surgical techniques available for SUI treatment for women and in last twenty years the procedures improved significantly regarding its effectiveness and complication rate. This paper review and summarize these methods, its efficacy, recent indications, advantages and limits. Although none of those techniques is perfect, patients treated by experienced surgeons have significant chance in quality of live improvement.

[External cephalic version of breech fetus after 36 weeks of gestation - evaluation of efectiveness and complications]. / Obrat plodu zevními hmaty z polohy podélné koncem pánevním po 36. týdnu gravidity - hodnocení úspesnosti a komplikací.

OBJECTIVE: Evaluation of success rate and the safety of external cephalic version after 36 weeks of gestation. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. METHODS: A retrospective analysis of external cephalic version attempts performed on a group of 638 singleton breech pregnancies after 36 weeks gestation in the years 2003-2016 at the Department of Gynecology and Obstetrics, Masaryk University, Brno. The effectiveness, number and type of complications, mode of delivery and perinatal result were observed. RESULTS: The effectiveness of external cephalic version from breech to head presentation was 47.8% (305 cases). After a successful external cephalic version 238 patients (78.0%) gave birth vaginally. After unsuccessful cephalic version 130 patients (39.0%) gave birth vaginally. The number of serious complications did not exceed 0,9% and did not affect perinatal outcomes. External cephalic version-related emergency cesarean deliveries occurred in 6 cases (2 placental abruption, 4 abnormal cardiotocography). The fetal outcome was good in all these cases. The death of the fetus in connection with the external version has not occurred in our file. Spontaneous discharge of amniotic fluid within 24 hours after procedure occurred in 5 cases (0.8%). The spontaneous onset of labor within 24 hours of procedure occurred in 5 cases (0.8%). The pH value of a. umbilicalis < 7.00 occurred in 2 cases in the group with a successful external version and in the group with unsuccessful external version in 9 cases. The Apgar score in the 5th minute < 5 was both in the successful and unsuccessful group in 1 case. CONCLUSION: The external cephalic version of the fetus in the case of breech presentation after the 36th week of pregnancy is an effective and safe alternative for women who have a fear of the vaginal breech delivery. Performing the external cephalic version can reduce the rate of elective caesarean sections due to breech presentation at term.

The intracellular concentration of homocysteine and related thiols is negatively correlated to sperm quality after highly effective method of sperm lysis.

The aims of this study were to determine concentrations of total homocysteine, cysteine, cysteinylglycine and glutathione in spermatozoa, seminal fluid and blood plasma and to analyse their relationships with sperm parameters. For this reason, a new highly effective method of spermatozoa lysis was developed, using methanol, freezing and subsequent thawing in ultrasonic bath. An HPLC-FD assay was conducted on thiols concentrations in lysed spermatozoa, seminal fluid and blood plasma. Concentrations of thiols in spermatozoa were significantly lower in men with normozoospermia than in samples with pathological semen parameters. Statistical analysis found significant correlations between thiol concentrations in spermatozoa and semen parameters, while the same analysis with thiol concentrations in seminal fluid was substantially less powerful. Only cysteinylglycine concentrations in seminal fluid significantly correlated with pathological semen parameters. No significant differences or correlations were found with blood plasma concentrations.

[Efficacy of surgical treatment of stress urinary incontinence with mini-invasive single incision sling]. / Výsledky operacní lécby stresové inkontinence moci mini-invazivní transobturatorní páskou z jedné inc.

OBJECTIVE: The purpose of this study is to evaluate the surgical treatment of stress urinary incontinence by the single incision sling Ophira (Promedon). DESIGN: Prospective observational study. SETTING: Department of Obstetrics and Gynaecology, Masaryk University and University Hospital Brno, Brno. METHODS: Patients with confirmed urodynamic stress urinary incontinence (SUI) were included in the study. Patients with urgent urinary incontinence or mixed incontinence with predominance of urgent folder, patients with insufficiency of internal sphincter of the urethra and pelvic organ prolapse, as well as after previous surgical treatment, patients with pelvic organ prolapse or with other serious pathology of organs of small pelvis were excluded. All patients included in the study received single incision sling (SIS) Ophira (Promedon). The length of the surgery and blood loss and complication was observed. Postoperative observation one year after the treatment was set and evaluated objective and subjective parameters of SUI. RESULTS: In the study were 138 patients examined, total of 45 (34.8%) were included. Postoperative observation completed 44 (97.7%) patients. Mean age was 62.3 years. The mean follow-up was 12.9 months, when 40 patients (90.9%) had a negative cough standardized test (CST). Total of 41 patients (93.1%) evaluated the operation as a major improvement by using a questionnaire Patient Global Impression of Improvement (PGI-I). Quality of life scores were evaluated by International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Before the surgery ranged from 14.8 ± 2.5 points, after the surgery 3.3 ± 2.0 which is an improvement of 11.5 ± 3.1 points. There weren't serious perioperative and postoperative complications. CONCLUSION: Our results are comparable with literary data and are correlated with other studies evaluating the effectiveness of other types of SIS. The method seems to be safe and efficient enough. Observing the group of patients will be continued in order to assess the short- and long-term results.

Fertility status of Hodgkin lymphoma patients treated with chemotherapy and adjuvant gonadotropin-releasing hormone analogues.

PURPOSE: Aim of this prospective observational study was to analyze fertility status of Hodgkin lymphoma (HL) patients treated with different types of chemotherapy while receiving GnRH analogues to preserve ovarian function. METHODS: Fertility status was assessed among 108 females in reproductive age treated by curative chemotherapy for freshly diagnosed HL between 2005 and 2010 in university-based tertiary fertility and oncology center. All patients received GnRH analogues during chemotherapy to preserve their ovarian function. Their reproductive functions were assessed by follicle-stimulating hormone (FSH) measurement and pregnancy achievement. Ovarian function was determined separately in three groups with increasing gonadotoxicity of chemotherapy. RESULTS: One year following the treatment, normal ovarian function was found in 89 (82.4%) of patients. Two years after chemotherapy, 98 (90.7%) of patients retained their ovarian function, and 23 (21.3%) achieved clinical pregnancy during the follow-up period. Average FSH after chemotherapy was 11.6 ± 17.9 IU/l 1 year after the treatment resp. 9.0 ± 13.8 at the 2 years interval. There were significantly more patients with chemotherapy induced diminished ovarian reserve (chDOR) among the group receiving escalated BEACOPP chemotherapy in comparison with the other types of treatment (58.1% vs. 87.9% resp. 95.5%). CONCLUSION: The rate of chDOR is significantly higher after EB poly-chemotherapy and there is no tendency for improvement in time. The 2 + 2 chemotherapy with GnRH-a required for more advanced HL retained ovarian function significantly better after 2 years. Another important advantage of GnRH-a co-treatment is the excellent control of patient's menstrual cycle.

[Medical termination of pregnancy by mifepristone and misoprostol - evaluation of succes rate, complications and satisfaction of patients]. / Farmakologické ukoncení gravidity mifepristonem a misoprostolem - zhodnocení úspesnosti, komplikací a spokojenosti pacientek.

OBJECTIVE: The purpose of this study was to evaluate the success rate and complications of medical termination of pregnancy up to 49 days of amenorrhea and present the outcome of our phone questionaire of satisfaction of patients. DESIGN: Retrospective analysis. SETTING: Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno. METHODS: The analysis of 111 patients, who underwent medical termination of pregnancy at the Department of Obstetrics and Gynecology Masaryk University and University Hospital Brno from 1. 6. 2014 to 30. 6. 2015 using 600 mg of mifepristone (Mifegyne) and 400 µg of misoprostol (Mispregnol). In our set of patients we monitored subjective perception of medical termination of pregnancy (pain, nausea, vomiting, satisfaction with this method) and objective process (hospitalisation, surgical intervention). The view of patients was found out by the phone questionnaire RESULTS: Complete abortion without a surgical intervention underwent 103 patients. Nausea, pelvic pain, and intensity of bleeding were evaluated as suitable. Only 1 patient (0.9%) was hospitalised for nausea and 1 patient (0.9%) was hospitalised in case of need for an emergency curretage and transfusions. Some kind of contraception after the medical termination of pregnancy started using 98.0% of women. The satisfaction rate of this method was high - 101 patients declared themselves satisfied - 66.7% very satisfied, 24.3% rather satisfied. CONCLUSION: Medical termination of pregnancy has good efficiency, we consider it safe with minimum side-effects and is well evaluated by patients.

Establishment and evaluation of a post caesarean acute pain service in a perinatological center:retrospective observational study.

OBJECTIVE: The aim of this study was to determine the efficacy of establishing a Post Caesarean Acute Pain Service. DESIGN: Retrospective observational study. SETTING: University Hospital Brno. METHODS: We evaluated all patients undergoing delivery via Caesarean Section under anaesthesia in the periods 10/2009 - 9/2010 and 11/2010 - 10/2011. During the postoperative period at predefined times, we measured the Visual Analogue Scale, Additional Analgesic Requests, blood pressure, pulse rate and recorded any complications. We compared the Visual Analogue Scale Score and number of Additional Analgesic Requests in two groups of women, 212 patients before and 195 patients after the establishment of an Acute Pain Service in the first 72 hours after Caesarean Section. RESULTS: There was a statistically significant difference in Visual Analogue Scale Score between the groups (p<0.05). The number of Additional Analgesic Requests 24-72 hours after Caesarean Section decreased below one requirement per 24 hours. The most effective analgesic method after Caesarean Section during the first 24 hours postoperatively was epidural analgesia. There was no statistically significant difference 24-72 hours after Caesarean Section between the methods of analgesia used. CONCLUSION: In conclusion, implementation of a Post Caesarean Acute Pain Service led to decrease in Visual Analogue Scale Score postoperatively. KEYWORDS: Acute Pain Service, postoperative analgesia, Caesarean Section, non-opioid analgesia, opioid analgesia, epidural analgesia.

[The use of synthetic mesh implants in surgical treatment of pelvic organ prolapse]. / Vyuzití syntetických sítových implantátu v operacní lécbe sestupu pánevních orgánu

INTRODUCTION: Pelvic organ prolapse (POP) surgical treatment went through major changes thanks to availability and wider expansion of mesh implants (MI). This work is focused on critical analysis of outcomes of these surgical procedures and recommendation prescription for their uses in application pelvic surgery. METHODS: There was made analysis of published outcomes and experience with MI use in POP surgical treatment. OUTCOMES were analysed separately for each pelvic bottom section. Main criteria were surgical complications and treatment effectivity based on objective measurable parameters and subjective patients evaluation. OUTCOMES: There are formalized suitable indications and conditions for individual pelvic bottom sections for safe MI use in reconstructive POP surgery. On the basis of objective data authors also define specific situations when MI use doesn't bring any benefit and it is not recommended. CONCLUSION: Mesh implants have their definite place in POP surgical treatment. Implants with right indication and right surgical technique in comparison with classic surgical procedures have significantly lower recurrence risk with comparable or higher surgical complication rate.

[Outcomes of anterior vaginal wall repair using polypropylene mesh]. / Výsledky operacní lécby sestupu prední posevní steny s pouzitím polypropylenové sítky.

INTRODUCTION: Pelvic organ prolapse (POP) is a major health concern especially in the elderly women. Anterior vaginal wall prolapse (AWP) represents the most common form of POP with reoperation rate 30-40% when primary treated by anterior colporrhaphy. Modern surgical techniques of POP repair uses polypropylene (PP) mesh implants to better support pelvic structures and lower the risk of recurrence. Aim of our study was to assess the safety and efficacy of anterior vaginal wall prolapse repair using PP mesh system NAZCA TC (Promedon). The kit consists of preformed PP mesh anchored to pelvic structures by two needle inserters via pre-pubic and trans-obturator route. METHODS: From January 2010 to February 2011, 21 patients with stage III/IV AWP underwent transvaginal repair with implantation of PP mesh. The stage of POP measured according to POP-Q system, surgery length, blood loss and complications has been evaluated six month after the surgery. Surgery has been assessed as successful when POP stage 0/I o has been reached. In 42.9% of patients AWP repair was combined with other procedures: vaginal hysterectomy or posterior vaginal repair. (Statistical evaluation was done by Wilcoxon test.). RESULTS: The average age of operated women was 62.4±9.4 years, average body mass index was 27.5±4.1 kg/m2, with overall parity of 2.2±1.4 children. The surgery time was 64.0±26.0 minutes with average blood loss of 185.0±17,0 ml. No serious per-operating complication has been recorded. The objective cure rate at 6 months was 90.5%. Statistically significant difference in the position of points Aa, Ba and C (p<0,05) has been observed. Difference in the position of other POP-Q points has not been statistically significant. Post operatively one case of small mesh erosion managed by observation only has been documented. CONCLUSION: Transvaginal repair of AWP with polypropylene mesh is an effective and safe technique in the hands of surgeon experienced in classical POP reconstruction techniques. For the assessment of long term efficacy the further follow-up of patients is necessary.

[Ovarian tissue cryopreservation in cancer patients--six years of clinical experience]. / Kryokonzervace ovariální tkáne u onkologických pacientek--6 let klinických zkuseností.

OBJECTIVE: Presentation of clinical results and experience with this technique during past six years. DESIGN: Original paper. SETTINGS: Gynekologicko-porodnická klinika LF MU a FN Brno, Interní hemato-onkologická klinika LF MU a FN Brno, Department of Obstetrics and Gynecology. Hadassah University Hospital Ein-Karem, Jerusalem, Izrael. INTRODUCTION: Ovarian tissue cryopreservation (OTC) and its future auto-transplantation becomes an alternative for patients to prevent serious damage of ovarian function by oncology treatment. METHODS: Patient is indicated to OTC in case of high risk of ovarian failure due to planned chemotherapy and impossibility to use other oncofertility techniques. Ovarian tissue harvesting is done by laparoscopy in short-term general anesthesia. After tissue processing the samples are cryopreserved in programmable automatic freezer or by vitrification. The auto-transplantation of ovarian tissue is planned after the complete cure of patient's malignancy. Our workplace doesn't have own experience with tissue transplantation - until now cryopreserved tissue has not yet been utilized by the patients. Clinical experience with this technique gained by our team during academic stay in abroad Israeli clinic is presented. RESULTS: During the years of 2005-2011 the OTC was performed in 19 cancer patients before chemotherapy. In majority of cases, patients suffered from blood or lymph node systemic malignancy (84%). Average age of women was 26 years. The patient set consisted of mostly nulliparous women (88%). Patient's average body mass index was 23,9 kg/m2. The length of systemic chemotherapy averaged 7.1 months. Time from fertility preservation counseling to chemotherapy was not exceeding one week (7.2 days on average). Ovarian tissue harvesting was conducted by laparoscopic surgery in all cases. The length of surgery did not exceed 60 minutes and no surgical complications were observed. The case of ovarian tissue transplantation performed on abroad university settings is discussed. CONCLUSION: In the consensus of with international guidelines OTC is offered to patients with high risk of ovarian failure doe to cytotoxic oncology treatment. Research in the field of oncofertility is focused on the techniques of in-vitro folliculogenesis in retrieved ovarian tissue.

[Vaginal birth after previous caesarian section--outcomes analysis 2007-2010]. / Vedení porodu po predchozím císarském rezu, analýza výsledku z let 2007-2010.

OBJECTIVE: Analysis of births after previous caesarean section (SC) at Department of Obstetrics and Gynaecology, Masaryk University, Brno. Determination of successful vaginal deliveries after previous SC (complete vaginal birth) and the factors that influence success. Risk identification and determination of the frequency of complications. Comparison of vaginal births after previous SC (VBAC) with elective repeat caesarean section (ERCS). MATERIALS AND METHODS: Retrospective analysis of 24,342 births, which were conducted in 2007-2010 at Department of Obstetrics and Gynaecology, Masaryk University, Brno. For the reporting period a total of 1391 pregnant women with a history of caesarean section gave birth (100.0%). The distribution of births after previous caesarean section into 2 groups according to a method of delivery. Trying to line vaginal birth (VBAC) with 986 mothers (70.9%). Elective repeat caesarean section (ERCS) was performed in 405 mothers (29.1%). Analysis and comparison of results in both groups. RESULTS: The overall success of VBAC (complete vaginal births after previous SC) in our group reached 80.8%. When evaluating the success of the subgroups was the strongest positive predictive factor the onset of spontaneous contractile activity (89.5% success rate) and vaginal delivery in history (88.2% success rate). The most significant negative predictive factor was a history of previous caesarean birth because of failure mechanism of birth (success rate 72.0%). The most common complication in both groups VBAC and ERCS group was blood loss (5.1% versus 2.0%, p = 0.045). Detection of dehiscence at the previous uterotomy (0.4% versus 0.5%, NS). In our group has been reported no case of uterine rupture. The frequency of postpartum hysterectomy was comparable in both groups (0.3% versus 0.5%, NS). In both groups, VBAC and ERCS was reported one case of bladder lesion, as surgical complications during the acute or planned caesarean section. No maternal or fetal death in relation to birth in our cohort occurred. CONCLUSION: Vaginal birth after previous caesarean section is a safe way of delivery in selected groups of mothers. An essential requirement is careful monitoring during labor to the exclusion of excessive uterine activity and protracted labor.

[New methods increasing assisted reproduction results]. / Nové metody zvysující úspesnost asistované reprodukce.

OBJECTIVE: The brief review of historical development and application of the assisted reproduction methods at our centre and the recent methods increasing the assisted reproduction results. The new mentioned methods are sperm selection before the intracytoplazmatic sperm injection (PICSI = preselected sperm intracytoplasmic injection) and continuous embryo development monitoring. DESIGN: Review article.

Combination of fertility preservation strategies in young women with recently diagnosed cancer.

BACKGROUND/AIMS: The study describes clinical management and outcomes of currently available fertility preservation techniques in a set of 154 young female cancer patients. METHODS: Patients in reproductive age with newly diagnosed cancer were offered embryo or oocyte cryopreservation, ovarian tissue cryopreservation and the administration of GnRH analogues during chemotherapy. Particular attention was given to the technical aspects and clinical application of these fertility preservation techniques. RESULTS: During the study period (2004-2009), 154 young female cancer patients were offered fertility preservation counseling. Patient's average age was 29.4 years and average parity was 0.7 children. Administration of GnRH analogues (n = 123, 79.9%) and ovarian tissue cryopreservation (n = 15, 9.7%) were the most commonly used fertility preservation strategies. In 20 cases (16.1%), the combination of several fertility preservation techniques was offered to individually selected patients. CONCLUSIONS: Combination of fertility preservation techniques gives young cancer patients the best chance for future fertility and should be concentrated in specialized centers.

[Oncofertility--a new trend in reproductive medicine]. / Onkofertilita--nový smer reprodukcní medicíny.

Effective treatment of cancer often causes patients irreversible damage of reproductive abilities. New trend in reproductive medicine commonly described as oncofertility offers cancer patients not only infertility treatment, but also potent prevention of irreversible damage of reproductive organs and functions. Efficacious methods of women reproductive function damage prevention has been developed at Brno University Hospital Department of Obstetrics and Gynecology since year 2004. The paper describes current oncofertility techniques implemented to clinical practice--embryo and oocyte banking, ovarian tissue cryopreservation including further possibility of its orthotopic autotransplantation and administration of gonadoliberin analogues for ovarian protection. During past 6 years expert consultation before start of gonadotoxic treatment has been provided to 195 young women with newly diagnosed cancer or autoimmune disease. Attention is applied to pro and contras of previously described methods of ovarian protection in the discussion. Limitations regarding implementation of oncofertility techniques in practice are mentioned. Furthermore short recommendations regarding pre-treatment oncofertility consultation with patients are given.