[Pregnancy and delivery in a patient with pure 46,XY karyotype. Summary of actual knowledge about XY women]. / Tehotenství a porod u pacientky s cistým karyotypem 46,XY Souhrn dosavadních poznatku o XY zenách.

TYPE OF STUDY: Summary review and a case report. SETTINGS: GEST IVF, Centre of Reproductive Medicine, Prague. INTRODUCTION: In scientific literature there two syndrome have been described in the presence of pure 46,XY karyotype when an individual is phenotypically and psychosexually identified as a woman. Androgen insensitivity syndrome (AIS) and pure gonadal dysgenesis XY (GD XY, Swyer syndrome). Thanks to the presence of a uterus in Swyer syndrome we can treat this type of sterility with donated oocytes. METHOD: The paper describes both syndromes from prenatal, genetical, endocrinological, oncological, reproductive and perinatological points of view. A case study concerning a patient with pure gonadal dysgenesis XY, who successfully became pregnant through a donated oocytes programme, is also described. The pregnancy progressed physiologically, and a healthy boy, 3820g/52cm, was delivered in term by ceasarean section. DISCUSSION: In world scientific literature at least fifteen successful pregnancies with pure gonadal dysgenesis XY have been described. In spite of the expectation of diminished uterine capacity, children are born to term with a normal delivery weight. CONCLUSION: This article should be considered as a summary of all actual knowledge about these patients. This article should be available and usefull for clinicians who come across XY females. The case study provides evidence that even an individual with male genetic gender can be pregnant and deliver a healthy child.

[Monochorionic biamniotic twins with a common yolk sac in the first trimester ultrasound scan - is there a higher risk of a congenital defect?]. / Monochoriální biamniální gemini se spolecným zloutkovým váckem pri UZ vysetrení v I. trimestru -je zde zvýsené riziko vrozené vývojové vady?

TYPE OF STUDY: Case report. SETTING: GEST IVF, Centre of Reproductive Medicine, Prague. METHODS: The case report describes pregnancy after IVF + ET. The first trimester ultrasound scan showed monochorionic biamniotic twins with one common yolk sac (YS) only, which is possible in biamniotic twins, but very rare. Identical congenital defects such as anal, coccygeal atresia, and others, were diagnosed prenatally and postnatally in both twins. CONCLUSION: Yolk sac number in monochorionic twins can play an important role in embryogenesi. Any possible relation with certain congenital defects has not yet been described. It is necessary to describe more cases.

[Intracytoplasmic injections (ICSI) with epididymal and testicular spermatozoa]. / Intracytoplazmatická injekce (ICSI) s epididymálními a testikulárními spermiemi.

Azoospermia is no longer a clear indication for using donor sperm. Aspiration of epididymal sperm or extraction of testicular sperm offers the same hope of pregnancy as ICSI using ejaculated sperm. Not even the high effectiveness of ICSI should be the reason for less intensive efforts to assess the exact cause of azoospermia, in particular with regard to genetic aspects.

[Intracytoplasmic sperm injection in the treatment of the most severe cases of andrologic sterility]. / Intracytoplazmatická injekce spermie (ICSI) v lécbe nejzávaznejsích prípadu andrologické sterility.

Intracytoplasmic sperm injection (ICSI) is a procedure which dramatically eliminates the necessity to use donor sperm in androgenically conditioned sterility and enables almost all affected couples to achieve pregnancy. The results in this group, till recently untreatable, are at least comparable with results achieved in the standard IVF programme. The standard success of the transport IVF programme was confirmed also in the transport IVF-ICSI programme. The transport of gametes does not influence the achieved results. It seems that for the results of the transport programme the indication and possibly other (gynaecological) factors of sterility are decisive. Intracytoplasmic sperm injection has become due to its effectivity an integral part of our IVF programme.

[Importance of embryo cryopreservation in a program of in vitro fertilization: experience and results of 550 transfers of thawed embryos]. / Význam kryokonzervace embryí v programu in vitro fertilizace (IVF): zkusenosti a výsledky z 550 prenosu rozmrazených embryí.

Results of 550 transfers of cryopreserved and thawed embryos were analyzed. A total number of 47 pregnancies was achieved (8.5% per embryo transfer). Significantly better results were obtained when no selection of embryos before cryopreservation was made (i.e. pronucleate stage embryos and patients with all embryos frozen) compared to the "spare embryos" group-14 pregnancies per 99 transfers (14%) vs. 33 pregnancies per 451 transfers (7%) respectively. Cultivation of thawed embryos before embryo transfer has a beneficial effect on implantation-19 pregnancies per 121 transfers (16%) in the group of cultured embryos vs. 28 pregnancies per 429 transfers (7%) in the group without cultivation. Cryopreservation significantly contributes to the effectivity of IVF and provides further possibilities for conception in addition to those achieved from the fresh cycle.

[Andrologic and non-andrologic indications for intracytoplasmic sperm injection (ICSI)]. / Andrologické a neandrologické indikace intracytoplazmatické injekce spermie (ICSI).

Intracytoplasmic sperm injection (ICSI) is a very valuable method which implies a qualitative contribution to assisted reproduction and andrologically conditioned sterility, in particular. However, as one of the methods of cellular surgery it has its defined indications which must be respected.

[Chromosome aberrations in the etiology of abortions after infertility treatment using IVF and ET]. / Chromosomální aberace v etiologii potratu po lécbe sterility metodou IVF a ET.

Chromosomal aberrations are a frequent cause of miscarriages during the first trimester of gestation. The most frequent finding in the authors group was trisomy 16 (in five patients). After extracorporeal fertilization (IVF) the percentage of abnormal karyotypes does not increase, the main risk factor being the women's age.

[The transport system in the in vitro fertilization program]. / Transportní systém v programu in vitro fertilizace.

The programme of in vitro fertilization helps at present successfully to resolve the problem of sterility in an ever increasing number of married couples. It is, however, a method which is very pretentious from the technical aspect, from the aspect of time and financial demands. Therefore in February 1994 with the Institute for the Care of Mother and Child in Prague-Podolí collaboration in the Transport IVF programme was started. In our clinic the first two stages of the IVF programme are implemented, i.e. stimulation of the ovaries and aspiration of the follicles. The patients of our centre for sterility are included in the programme, if the following indications are present: tubal factor 82%, idiopathic sterility 4%, the remainder being endometriosis, andrological factor and others. The majority of women were in the age group from 30-35 years. Stimulation is most frequently implemented by GnRh analogues and menopausal gonadotropins, aspiration of follicles by the transvaginal route with short analgosedation under so-called semi-ambulatory conditions. The aspirated follicular fluid is immediately stored in a special transport incubator G-812 of K-system Co., Denmark. Within 20 minutes it is taken by the patient's husband to the embryological laboratory of the Institute for the Care of Mother and Child in Prague-Podolí. Between February and December 1994 a total of 69 aspirations in 56 patients were made and 15 pregnancies were achieved. It is 23% pregnancies by transfer.(ABSTRACT TRUNCATED AT 250 WORDS)

[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.

[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.

[Factors affecting the results of in vitro fertilization. II. The effect of andrologic factors]. / Faktory ovlivnující výsledky in vitro fertilizace--II. Vliv andrologického faktoru.

We studied 297 couples in our IVF and ET programme and male factor was present in 113 cases (38%). The parameters of standard spermiograms cannot predict the fertilization potential of the specimen in vitro. However, we could demonstrate that the number of the sperm cells after the swim-up procedure correlates very well with the fertilization rate in vitro and pregnancy rate (fertilization rate 63.6% vs. 27.7% in couples with less than 1 million spermcells/ml after swim-up, pregnancy rate 20.2% vs. 5.0%). In these cases the use of the more sophisticated laboratory methods is indicated.

[Factors affecting the results of in vitro fertilization--I. The effect of age]. / Faktory ovlivnující výsledky in vitro fertilizace--I. Vliv veku.

Age is a major factor affecting the results of IVF and ET. We studied the results of 697 couples treated in our programme of in vitro fertilisation and embryotransfer. We demonstrated increasing numbers of cancelled cycles in older women--the cancellation rate was 17.7% in patients under thirty and 50% in women 38-40 years old. The cut-off line of effectivity is the age of 36-37 years. In women aged 38 and older we demonstrated a decrease of pregnancy rate per transfer from 25.5% to 14-16%. However, there was no higher pregnancy loss in older women in our series.

[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.