Relationship between follicular volume and oocyte competence, blastocyst development and live-birth rate: optimal follicle size for oocyte retrieval.

OBJECTIVE: To analyze oocyte competence in gonadotropin-releasing hormone agonist (GnRHa) stimulation cycles with regard to maturity, fertilization and blastocyst rate, as well as clinical outcome (pregnancy and live-birth rate), in relation to follicular volume, measured by three-dimensional transvaginal sonography (3D-TVS), and follicular fluid composition. METHODS: This was a prospective single-center study conducted between June 2012 and June 2014, including 118 ovum pick-ups with subsequent embryo transfer. Ovarian stimulation was performed using the GnRHa long protocol. Of 1493 follicles aspirated individually, follicular volume was evaluated successfully in 1236 using automated 3D-TVS during oocyte retrieval. Oocyte maturity and blastocyst development were tracked according to follicular volume. Intrafollicular concentrations of estradiol, testosterone, progesterone, luteinizing hormone, follicle-stimulating hormone and granulocyte-colony stimulating factor were quantified by immunoassay. Clinical outcome, in terms of implantation rate, (clinical) pregnancy rate, miscarriage and live-birth rate (LBR), was evaluated. RESULTS: Follicles were categorized, according to their volume, into three arbitrary groups, which included 196 small (8-12 mm/0.3-0.9 mL), 772 medium (13-23 mm/1-6 mL) and 268 large (≥ 24 mm/> 6 mL) follicles. Although oocyte recovery rate was significantly lower in small follicles compared with medium and large ones (63.8% vs 76.6% and 81.3%, respectively; P < 0.001), similar fertilization rates (85.1% vs 75.3% and 81.4%, respectively) and blastocyst rates (40.5% vs 40.6% and 37.2%, respectively) per mature metaphase II oocyte were observed. A trend towards higher LBR after transfer of blastocysts derived from small (< 1 mL) follicles compared with medium (1-6 mL) or large (> 6 mL) follicles (54.5% vs 42.0%, and 41.7%, respectively) was observed. No predictive value of follicular fluid biomarkers was identified. CONCLUSIONS: Our data indicate that the optimal follicular volume for a high yield of good quality blastocysts with good potential to lead to a live birth is 13-23 mm/1-6 mL. However, oocytes derived from small follicles (8-12 mm/0.3-0.9 mL) still have the capacity for normal development and subsequent delivery of healthy children, suggesting that aspiration of these follicles should be encouraged as this would increase the total number of blastocysts retrieved per stimulation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Ovarian stimulation in ART - Unwinding pressing issues.

Conventional controlled ovarian stimulation (cCOS) can cause significant discomfort, including ovarian hyperstimulation syndrome (OHSS). Clearly, management of OHSS and poor responder patients requires new strategies to overcome these problems and facilitate the birth of a healthy child with the fewest stimulation cycles. Several alternative methods have been developed. Non-conventional controlled ovarian stimulation (non-cCOS) is based on low-dose stimulation regimens and is often termed "light", "soft", "mini", "minimal", "mild", "low cost", or "low dose IVF". Non-controlled ovarian stimulation therapies (non-COS) include natural cycle IVF or a mixture between non-controlled and non-cCOS, termed "modified natural IVF" or "antiestrogen/aromatase inhibitor/low dose FSH-cycles", in which cycles are monitored but not controlled. These approaches promise to reduce the physical, emotional, and financial burden of IVF therapy while maintaining acceptable pregnancy rates. Such approaches might reduce the risk of OHSS. However, the overall cost per baby increases due to the higher number of stimulation cycles required, and the inconvenience of ovum pick-up still remains. The primary focus should be to obtain several good quality blastocysts after a single cCOS cycle. Thus, adequate numbers of mature oocytes are mandatory. What is more difficult and expensive for patients: several non-COS/non-cCOS cycles to obtain a baby or a single cCOS cycle with a high probability to obtain more than one child? Classic cCOS using the GnRH agonist long protocol followed by single embryo transfer (SET) at the blastocyst stage and aseptic vitrification of surplus embryos optimizes the IVF outcome. This strategy, combined with outpatient management in the case of OHSS, minimizes inconvenience and risks of OHSS. Accumulation cycles (AC) by repeated COS with subsequent freezing of blastocysts, combined with preimplantation genetic screening (PGS), is a promising new approach for low responders, especially in cases of advanced maternal age (AMA).

History of incidence of autoimmune and oncological diseases in identical female twins.

PROBLEM: The aim of study was to investigate identical female twins born in 1977 suffered from autoimmune diseases (twin A - Sjogren's syndrome, and twin B - systemic lupus erythematosus). METHOD OF STUDY: It was refer retrospective analysis of both sisters suffered beside autoimmune alterations (Sjogren's syndrome and systemic lupus erythematosus) also from gynecological diseases (twin A - praecancerosis of cervix uteri, twin B - carcinoma vaginae). RESULTS: Relationships between disease activities and severities in the female twins were similar and the treatments were directed according to clinical symptoms and laboratory results. Dramatic change, unfortunately, occurred with twin B. The reason may be the association between SLE activity (lupus nephritis), hematological complication (leukopenia) and oncological vaginal recidivation. CONCLUSION: Association between autoimmune disease and gynecological cancer (or praecancerosis) is major risk than without immunology deviation. Twin A is periodically gynecologically observed.

[Monitoring of haemocoagulative changes during long-term doses of low molecular weight heparin during pregnancy]. / Sledování hemokoagulacních zmen v prubehu tehotenství zen s opakovaným potrácením v závislosti na podávání nízkomolekulárního heparinu.

OBJECTIVE: The aim of study was to compare plasma levels of selected coagulation parameters in pregnant women with long-term administration of low molecular weight heparin (LMWH) versus cohort of healthy women LMWHs untreated. DESIGN: Prospective study. SETTING: Department of Haematology, Institute of Clinical Biochemistry and Haematology, Charles University and University Hospital, Plzen. METHODS: We examined 67 pregnant women with recurrent fetal loss in previous pregnant history treated by long-term prophylactic administration of LMWH. Blood samples were collected before gestation and at 10th, 20th, 30th gestational weeks. RESULTS: Pregnant women with own history of recurrent fetal loss treated by the long-term prophylactic dose of LMWHs during pregnancy have the same values of the coagulation parameters as the control cohort in spite of fact that the clinical efficacy of administered LMWHs is high. CONCLUSION: Our results suggest that heparin may act by many unknown different mechanisms, such as inhibition of complement binding or secretion of prostaglandins.

[Endometrial ablation and resection techniques]. / Techniky ablace a resekce endometria.

OBJECTIVE: To summarize all currently used and experimental, hysteroscopic and non-hysteroscopic methods of endometrial ablation and resection, their indications, operation techniques, and treatment results. DESIGN: Literary review. SETTING: Department of Obstetrics and Gynecology, Medical Faculty and Faculty Hospital, Charles university, Capkovo námestí 1, Plzen, Czech Republic. METHODS: Analysis of the literature (textbooks, medical journals, database Medline, Current Contents, Embase, PubMed). RESULTS AND CONCLUSION: Endometrial ablation and resection play an important role in the treatment of dysfunctional uterine bleeding. Hysteroscopic methods visualize the uterine cavity and enable to treat lesions in it at the same time. Non-hysteroscopic methods are less invasive for the patient and comfortable for the surgeon. Both groups of methods have similar treatment results.

[Hysteroscopic polypectomy versus fractionated curettage in the treatment of corporal polyps--recurrence of corporal polyps]. / Hysteroskopická polypektomie versus frakcionovaná kyretáz v lécbe korporálního polypu--recidivy korporálních polypu.

OBJECTIVE: The evaluation of hysteroscopy contribution in the treatment of endometrial polyp. The evaluation of the risk of endometrial polyp recurrence. DESIGN: Prospective clinical study. SETTING: Department of Obstetrics and Gynecology of Medical faculty and Faculty Hospital, Pilsen. METHODS: Two groups of patients were followed. Group I had 81 patients (30 premenopausal and 51 postmenopausal) that underwent hysteroscopical polypectomy followed by diagnostic hysteroscopy in 6-12 months. Group II consisted of 100 patients (36 premenopausal and 64 postmenopausal) that underwent fractional curretage with histological diagnosis of endometrial polyp. These patients were checked by diagnostic hysteroscopy in up to 12 months. Presence of endometrial polyp during diagnostic hysteroscopy and a relation of its recurrence or persistence to a type of preceding procedure, risk factors and histological findings during the first procedure were evaluated. RESULTS: 11 (13.5%) cases of an endometrial polyp were recorded in hysteroscopical controls in group I. 46 (46%) cases of an endometrial polyp were recorded in group II. Recurrence of the endometrial polyp was revealed only in one case of atrophic endometrium and in no case of atrophic endometrial polyp. CONCLUSION: Hysteroscopical polypectomy showed considerably better results in the treatment of endometrial polyp comparing to fractional curretage. The recurrence risk of endometrial polyp is expected in a case of presence of an abnormal proliferative activity or hyperplasia both in the endometrial polyp and the surrounding endometrium.

[Monitoring immunity factors in serum and peritoneal fluid after laparoscopy in women. II. Sperm and zona pellucida antibodies]. / Sledování nekterých faktoru imunity v séru a v peritoneální tekutine u laparoskopovaných zen--II. Protilátky proti spermiím a proti zona pellucida.

A team of authors investigated antibody levels against spermatozoa and against the zona pellucida in sera and peritoneal fluids in infertile women where diagnostic laparoscopy was indicated. The immunological cause of infertility was diagnosed in some women with a normal laparoscopic finding on the inner genital, as well as in patients with endometriosis and in women with adhesions. A minimal antibody response to antigens of gametes was recorded in women with the diagnosis of uterus myomatosus, uterus hypoplasticus and polycystic ovary. The authors present detailed findings on antibodies in different groups of patients.

[Immunologic factors in the serum and peritoneal fluid in women after laparoscopy. I. Nonspecific factors]. / Sledování nekterých faktoru imunity v séru a v peritoneální tekutine u laparoskopovaných zen. I. Nespecifické faktory.

The authors examined by diagnostic laparoscopy and immunologically 180 patients in 1993-1995. They assessed in serum and peritoneal fluid IgG, IgA, IgM, haptoglobulin, A2-macroglobulin, A1-antitrypsin, transferrin, C4- and C3-complement, orosomucoid, A2AP-glycoprotein, albumin, prealbumin and hemopexin. The authors found that some individual pathological results as regards non-specific immunity supplement the clinical diagnosis, in particular in endomeriosis, multiple adhesions, polycystic ovaries and chronic anovulation.