[Immunologically conditioned fertility disorders in men--experience of the immunobiological department of the Institute for Maternal and Child Care]. / Imunologicky podmínené poruchy plodnosti u muzu - zkusenosti imunobiologického pracoviste Ustavu pro péci o matku a díte.

OBJECTIVE: To provide an overview of the results obtained from the more than ten-year systematic monitoring of the contribution of immunopathological mechanisms to the ethiopathogenesis of fertility disorders in men. DESIGN: A summarising retrospective study. SETTING: Mother and Child Care Institute, Prague. METHODS: The data source is a selected group of a total of 3,800 couples, who were examined in the Immunobiological Department (ID) of the Mother and Child Care Institute (MCCI) in Prague- -Podolí for fertility disorders in the past. From among the laboratory quantities, the following ones were systematically monitored: a) sperm parameters; b) cell-mediated immunity against spermatozoa; c) the presence of anti-spermatozoa auto-antibodies attached to spermatozoa; d) in a part of the clinical group, the serum concentrations of FSH, testosterone, SHBG and the free androgen index (FAI) were monitored. RESULTS: After selection was made according to defined criteria, the group comprised of a total of 1,680 men, of whom 49.4% were normozoospermic and 50.6% suffered from some form of seminal pathology. Increased cell-mediated immunity against spermatozoa was identified in 10.2% of fertile men, in 18.5% of normozoospermic men and in 66.3% of azoospermic men. In asthenozoospermic and teratozoospermic men, the increased cell-mediated immunity against spermatozoa was identified in 48.3% and 53.1% of them, respectively. The auto-antibodies attached to spermatozoa were identified in 3 out of every 42 fertile men (7%), while in asthenozoospermic men, it was a total of 21% (IgA antibodies) and 22% (IgG antibodies). As concerns the concentration of free androgens (FAI) in the serum, there was no difference among the individual subgroups of men. In oligoasthenozoospermic men, FSH was significantly higher on the average in comparison with normospermic men. CONCLUSION: The significantly higher incidence of increased cell-mediated immunity against spermatozoa in men with a pathological spermiogram in comparison with the control group (fertile men and normozoospermic men) indicates that cell-mediated immunity participates in the pathogenesis of seminal pathologies.

[Prediction of pregnancy-induced hypertension in women with risk factors]. / Moznosti predikce tehotenstvím indukované hypertenze u zen s rizikovými faktory.

UNLABELLED: The objective of the presented work was to find possible predictive factors of pregnancy-induced hypertension (PIH) in women with the risk of gestational diabetes (GDM) during pregnancy. A group of women with the risk of development of gestational diabetes was selected because it is known that in women with GDM a hypertension is encountered 2-4 times more frequently than in women without disorders of glucose tolerance during pregnancy. The patients were divided into four groups with regard to the risk of development of hypertension. The examinations were made once during the 20th week of gestation. PIH is manifested in the great majority of patients only after the 20th week of pregnancy. All patients were normotensive at the time of examination. During the subsequent course of pregnancy in all patients the diagnosis of gestational diabetes and pregnancy-induced hypertension was investigated. The investigated parameters were fasting insulin levels during the 20th week of gestation, coagulation factors--antithrombin III (AT III), D-dimer, number of thrombocytes. The authors investigated also anamnestic data on the presence of type II diabetes and hypertension in close relatives of the patients. RESULTS: No differences were found in the insulin, antithrombin III and D-dimer levels nor in the number of thrombocytes. A significant relationship was revealed between the incidence of hypertension during pregnancy and the family history of the patient. In women where there was diabetes type 2 and hypertension in the family, there was a markedly more frequent incidence of pregnancy-induced hypertension after the 20th week of pregnancy (p > 0.0002) than in the other investigated groups.

[The effect of diazepam and flumazenil on pulsatile secretion of prolactin and LH in women]. / Vliv diazepamu a flumazenilu na pulsní sekreci prolaktinu a LH u zen.

The authors examined the effect of diazepam and flumazenil on prolactin and LH secretion in women. The experiment lasted 12 hours during which specimens of venous blood were collected for assessment of LH and prolactin after 10-minute intervals. After 5 hours to a group of 8 women (4 in the luteal and 4 in the follicular stage of the cycle) flumazenil was administered--3 x 10 mg i.v. after 30 minute intervals, and to a group of 7 women (3 in the follicular and 4 in the luteal stage of the cycle) diazepam was administered--10 mg i.v. after 30-minute intervals. Flumazenil administration did not affect the LH or prolactin secretion. Diazepam caused in 3 of 4 women in the luteal phase of the cycle a significant rise of the prolactin secretion (p < 0.001), in the remaining women in the luteal phase and 3 women in the follicular stage a rise of prolactin was recorded but it did not reach statistical significance. The LH level was significantly influenced (i.e. decreased) in one of 7 women.

[Factors affecting the results of in vitro fertilization. V. Co-culture of embryos]. / Faktory ovlivnující výsledky in vitro fertilizace-V. Kokultivace embryí.

Pronuclear stage embryos were divided into two groups and cultivated in i) M-199 or in ii) M-199 on a monolayer of Vero cells for 48, 60 or 72 hours respectively. Under the standard conditions (i) no significant differences in pregnancy rate (PR) were found (48 and 60 h; PR 20.14% and 20.39%). The prolonged culture influenced negatively embryo development (data not shown). On the other hand, clear differences were found after the culture on the Vero cell monolayer. Embryos cultured for 48 h gave considerably higher PR compared for 60 h (24.34% and 13.04% resp.). The embryos developing successfully after 72 h produced the highest PR (33.33%). The implantation rate is also significantly higher (19.1% P < 0.001). Although it is quite clear that our culture conditions are not yet ideal, it is evident that embryos which are able to develop normally for three days in vitro are much better equipped for further development.

[Cryopreservation of embryos in the IVF/ET program at the Maternal and Child Care Institute in Prague]. / Kryokonzervace embryí v programu IVF/ET v Ustavu pro péci o matku a díte v Praze.

Two methods for embryo cryopreservation using 1,2-propanediol were compared--ultra-rapid vitrification and controlled freezing. No significant differences were found in the pregnancy and implantation rates although better results were achieved by the controlled freezing method. Significantly better results both in pregnancy and implantation rates were obtained when the embryos were frozen in the pronuclear stage compared to cleaved stage embryos. In the group of pronuclear stage embryos 3 pregnancies were achieved as a result of 11 embryo transfers (27%, implantation rate 9%) vs 14 pregnancies from 193 embryo transfers (7%, implantation rate 2.5%) for the cleaved embryos.

[Factors affecting the results of in vitro fertilization--IV. Importance of the stimulation protocols combining GnRH analogs and HMG in women with unsuccessful stimulation with combinations of clomiphene citrate-HMG]. / Faktory ovlivnující výsledky in vitro fertilizace--IV. Význam stimulacních protokolu kombinujících analoga GnRH a hMG u zen neúspesne stimulovaných kombinací klomifencitrát-hMG.

Poor responders, whose cycles were cancelled after CC-hMG stimulation because of inadequate response, were stimulated with GnRH analogues (Suprefact nasal spray) and hMG in short protocol. In this highly negative selected group the cancellation rate was significantly lower (16.2%) than in the "normal" IVF population stimulated with clomiphene citrate and hMG (24.8%). All other parameters (number of oocytes and embryos, pregnancy rate) did not differ in the two groups. Embryos were frozen in 23.4% of cycles after GnRH-hMG stimulation and in 26.1% of cycles after CC-hMG stimulation. In GnRH-a cycles more ampoules (17.7) were injected per patient than after CC-hMG protocols (11.1 ampoules). Severe ovarian hyperstimulation syndrome developed in 4.0% CC-hMG cycles and in 2.8% cycles where GnRH analogues were used.

[Risk of diabetes mellitus, variations in glucose tolerance, insulin secretion and lipid parameters in offspring of diabetic mothers]. / Riziko diabetes mellitus, odchylek glukózové tolerance, sekrece inzulinu a lipidových parametru u potomku diabetických matek.

BACKGROUND: Children of diabetic mothers are a relatively new population group which started its existence due to revolutionary changes in the treatment of insulin-dependent diabetes during pregnancy. In the Institute for the Care of Mother and Child since the fifties comprehensive care of diabetic mothers was concentrated and thus it became possible to follow-up a relatively large group of their children to adult age. METHODS AND RESULTS: The authors investigated 176 children of diabetic mothers (CDM) aged 20.75 +/- 0.31 years. All mothers suffered from insulin-dependent diabetes mellitus (IDDM). In 7.95% CDM diabetes developed at the age of 11-23 years (IDDM in 4.54% and NIDDM in 3.41% of CDM). An impaired glucose tolerance was revealed in 6.25%. The mean blood sugar level during the oral glucose tolerance test was significantly higher than in a control group of 31 subjects of the same average age without a family-history of diabetes (p < 0.01). The ratio of insulinaemia to the blood sugar level was markedly higher not only when the glucose tolerance was impaired (p < 0.005) but also in CDM with a normal glucose tolerance (p < 0.025). The total cholesterol and triacylglycerol levels did not differ from the control group. In the group of DDM with an impaired glucose tolerance the non-esterified fatty acid levels were higher, as compared with controls (p < 0.05). CONCLUSIONS: The results of the described group of CDM which is one of the groups followed-up for the longest period reported in the literature indicate the risk of children of diabetic mothers and the necessity to follow-up and screen subclinical signs of the disease.

[Factors affecting the results of in vitro fertilization--III. The effect of the height and properties of the endometrium in the ultrasound image on the probability of implantation]. / Faktory ovlivnující výsledky in vitro fertilizace--III. Vliv výsky a charakteru endometria v UZ obrazu na pravdepodobnost implantace.

Ultrasound examination of endometrium thickness and texture (triple-line, homogenous, hyperechogenic) did not help us to predict the implantation after embryo transfer. However, in patients stimulated with GnRH analogues and hMG the endometrium was significantly higher than in patients stimulated with clomiphene citrate and hMG. Triple-line endometrium was more common in women stimulated with GnRH analogues and hMG than in those stimulated with clomiphene citrate and hMG.

[The early androgen syndrome--effect on the hormonal and immune system]. / Casný androgenní syndrom--ovlivnení hormonálního a imunitního systému.

Administration of 1 mg testosterone propionate to neonate mice of both sexes on the 4th day after birth causes marked and prolonged changes in some parameters of the immune and hormonal system. At the age of one month the oestradiol level in males and females is markedly elevated, but not the testosterone level. There is a marked increase in the metabolic activity of peritoneal macrophages stimulated by zymosan and at the same time also in the percentage of cells phagocytizing inert HEMA particles. There was a marked increase in the amount of haemoglobin in females and of the bone marrow cellularity (in particular in males). Obviously also changes in cell differentiation occur, the ratio of different cell types in the peripheral blood stream changes. There is a decline of neutrophil granulocytes with a divided nucleus (in particular in males, where also the number of lymphocytes rises). The cell-mediated immune response is also altered as the graft response to the host is more intense. The humoral immunity against T-dependent antigen is also affected. The titre of IgG antibodies is reduced and the titre of IgM antibodies elevated. The results are discussed, but so far it is difficult to decide whether the observed changes of the immune system are primary, i.e. directly induced by testosterone, or whether they are secondary, i.e. induced by an elevated testosterone level.

[Complications in insulin-dependent diabetic mothers during pregnancy and the long-term prognosis for their children]. / Komplikace inzulin-dependentních diabetických matek v tehotenství a dlouhodobá prognóza jejich detí.

The authors investigated whether vascular complications of insulin-dependent diabetic pregnant women can influence on a long-term basis their children in adult life. In a group of 169 children of diabetic mothers (CDM) 12 developed diabetes during childhood and adolescence; in the remaining 157, age 20.75 +/- 0.31 (SE) the following tests were made: oral glucose tolerance test (OGTT), insulin level, parameters of the lipid metabolism, and blood pressure was assessed. CDM were divided into three groups: 1. CDM whose mothers had diabetic complications; according to White's classification of diabetes during pregnancy they belonged into class D and F (n = 10). 2. CDM whose mothers were classified with regard to diabetes during pregnancy as class B and C with subsequent toxaemia of pregnancy (n = 27), 3. CDM of mothers class B and C without toxaemia of pregnancy (n = 117). All investigated groups of CDM had significantly higher sums of blood sugar and insulin levels during the OGTT (P < 0.01), as compared with the control group (n = 31). In the first group of CDM the values were significantly higher than in the third group of CDM. As to cholesterol and triacylglycerol levels, the differences were not significant, the non-esterified fatty acid levels were higher in the second group than in controls (P < 0.05). In the first two groups also a higher systolic pressure was recorded than in controls (P < 0.01). Two children of the first group, two children of the second group and eight children of the third group of CDM developed diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in hypophyseal-ovarian axis hormone levels in the first days after central nervous system surgery]. / Zmeny hladin hormonu hypofýzo-ovariální osy v prvních dnech po operacích centrálního nervového systému.

The authors examined the FSH, LH, prolactin, oestradiol and progesterone levels during the perioperative period in 14 women, mean age 35.7 years, who were subjected to intracranial operations. They found that during the first postoperative days the FSH level (p < or = 0.01), LH level (p < or = 0.01) and oestradiol level (p < or = 0.05) declined, while the progesterone and prolactin level do not change significantly. This is consistent with data in the literature on transient hypogonadotropic hypogonadism after head injuries or after operations and injuries of other organs. The disorder is only of a short-term character and does not lead to serious impairment of the menstrual cycle.

[Cryopreservation of embryos in the in vitro fertilization/embryo transfer program]. / Kryokonzervace embryí v programu IVF/ET.

An ultra-rapid method for cryopreservation of human embryos, using 1,2-propane-diol, was developed. 280 spare embryos obtained in the IVF program were frozen by this method. 91 embryos were thawed and 68 of them (74.7%) survived the procedure with more than half the blastomeres intact. 65 embryos were transferred in 28 cycles. Two pregnancies developed (7.1%), one of which ended by the birth of a healthy girl (the first birth after transfer of a frozen/thawed embryo in the Czech Republic). The other pregnancy is ongoing.

[Selective reduction of multiple pregnancy in the 1st trimester: results and experience in 10 cases]. / Selektivní redukce mnohocetných tehotenství v prvním trimestru: výsledky a zkusenosti u 10 prípadu.

Ten patients with multiple gestations, all resulting from in vitro fertilization, underwent multifoetal pregnancy reduction. In four cases transvaginal puncture was performed, six patients underwent transabdominal pregnancy reduction. Seven women delivered, all three pregnancy losses occurred in the transvaginal punction group--there was one early loss after the procedure and two abortions in the late second trimester. There were 5 sets of twins and two singletons were delivered. Multifoetal pregnancy reduction represents an important addition to the management of unplanned multifoetal pregnancy resulting from infertility treatment. The procedure is not without risks and these must be weighted against expected benefits.

[Use of modern methods in prenatal diagnosis of congenital adrenal hyperplasia--examination protocol]. / Vyuziti modernich metod v prenatálni diagnostice kongenitálni adrenálni hyperplázie (CAH)--protokol vysetreni.

The prenatal diagnosis of congenital adrenal hyperplasia (CAH) in the second trimester of gestation (as done so far in this country) is late and unsuitable with regard to possible interruption of pregnancy. Modern methods of early prenatal diagnosis are based on examination of material from chorionic villi (6th-10th week of gestation) or early amniocentesis (10th-12th week of gestation). The authors present their decision taking scheme, examination protocol and their own experience with the use of molecular genetic analysis and assessment of 17-hydroxyprogesterone from early amniocentesis in the prenatal diagnosis of CAH. This procedure is a priority in this country.

[Multiple pregnancies in the IVF and ET programs at the Institute for Maternal and Child Care]. / Vícecetná tehotenství v programu IVF a ET v Ustavu pro péci o matku a díte.

Of the 71 clinical pregnancies achieved in the IVF and ET programme at the Institute for the Care of Mother and Child between January 1989 and June 1991 22 were multiple (30.9%). In seven cases (31.3%) spontaneous reduction occurred. A total of six patients underwent a multifoetal pregnancy reduction.

The correlation of serum prolactin level and psychic stress in women undergoing a chronic hemodialysis programme.

Altogether eight women undergoing a chronic hemodialysis treatment were studied for five months. Four of them were in the premenopause and four in the postmenopause. Once a month levels of prolactin, FSH, LH, estradiol and progesterone were measured, Lüscher colour test was performed, from which the screamer index as an indicator of psychic stress was calculated and the levels of urea, creatinine and hematocrite were assessed to inform us of the adequacy of dialysis. We tested the hypothesis, whether there exists a correlation between psychic stress and the prolactin level in these women. For statistic evaluation we used linear regression under the use of dummy variables to intercept the interindividual differences in the Lüscher test. We found that the fluctuation of the prolactin level and of the value of the screamer index of the Lüscher test are parallel (p less than 0.05). These results bear witness of a participation of psychic stress in the onset and level of hyperprolactinemia in women being in a chronic hemodialysis treatment.

[FSH, LH, prolactin, estradiol and progesterone after burn injuries in premenopausal and postmenopausal women]. / FSH, LH, prolaktin, estradiol a progesteron po popáleninovém traumatu u premenopauzálních a postmenopauzálních zen.

The authors examined 49 women who suffered severe burns and had to be hospitalized. Thirteen of these women were postmenopausal, 35 premenopausal and in one women, incipient pregnancy was revealed. In 14 women repeatedly FSH, LH oestradiol, progesterone and prolactin were assessed in serum by RIA. The group of premenopausal and postmenopausal women did not differ as to the levels of oestradiol, progesterone and prolactin. The gonadotropin levels in postmenopausal women were somewhat higher but the difference was significant only in FSH. The mean levels of the investigated hormones in premenopausal and postmenopausal women were: FSH 7.98 and 21.56 mIU/ml resp. oestradiol 151.88 and 183 micrograms/ml) resp. These differences cannot be explained by possible differences in the extent of burns or the time when the serum sample was taken. The authors interpret the results to the effect that the adrenals and steroid hormones produced by them resp. have a central position in the dysfunction of the pituitary-ovarian axis. These hormones influence by a backfeed mechanism the secretion of pituitary gonadotropins. This is consistent with data in the literature dealing with burns in men.