The Prediction of IVF Outcomes with Autologous Oocytes and the Optimal MII Oocyte/Embryo Number for Live Birth at Advanced Maternal Age.

Background and Objectives: Delayed childbearing in advanced age might be associated with a low prognosis for achieving pregnancy. Therefore, it is important to establish a predictive tool that will optimize the likelihood of a live birth at advanced age. Material and Methods: The retrospective study was conducted at the Ferona Fertility Clinic in Novi Sad (Republic of Serbia), between January 2020 and May 2021. The survey included 491 women aged ≥35 who met the inclusion criteria and who were subjected to an IVF (in vitro fertilization) treatment cycle. Results: The average number of retrieved oocytes, MII (metaphase II) oocytes, and developed embryos significantly decreased in advanced age. Age was also found to have a significant adverse effect on pregnancy and live birth rates. In women aged ≥35, 10/12 MII oocytes or 10/11 embryos are required for reaching an optimal live birth rate/cumulative live birth rate. Optimal CLBR (cumulative live birth rate) per one oocyte was achieved when 9 MII oocyte were retrieved. Conclusions: The study indicates that the cut-off for increased risk is ≥42 year. However, despite low live birth rates, autologous IVF for these women is not futile. An increase in the number of retrieved mature oocytes and a generation of surplus cryopreserved embryos could reinforce LBR (live birth rate) and CLBR. Clinicians should be very cautious in counseling, as autologous IVF may only be applicable to women with good ovarian reserve.

T-2 toxin downregulates LHCGR expression, steroidogenesis, and cAMP level in human cumulus granulosa cells.

Our goals were to investigate whether environmentally relevant doses of T-2 toxin can affect human ovarian granulosa cells' function and to reveal the potential mechanism of T-2 toxin's action. Results showed that T-2 toxin strongly attenuated luteinizing hormone/choriogonadotropin receptor (LHCGR) mRNA expression in follicle-stimulating hormone (FSH)-stimulated human cumulus granulosa cells. Addition of human chorionic gonadotropin was not able to elicit maximal response of ovulatory genes amphiregulin, epiregulin, and progesterone receptor. T-2 toxin reduced mRNA levels of CYP19A1 and steroidogenic acute regulatory protein (STAR) and lowered FSH-stimulated estradiol and progesterone production. Mechanistic experiments demonstrated that T-2 toxin decreased FSH-stimulated cyclic adenosine monophosphate (cAMP) production. Addition of total PDE inhibitor 3-isobutyl-1-methylxanthine prevented T-2 toxin's action on LHCGR, STAR, and CYP19A1 mRNA expression in FSH-stimulated human cumulus granulosa cells. Furthermore, T-2 toxin partially decreased 8-bromoadenosine 3'5'-cyclic monophosphate (8-Br-cAMP)-stimulated LHCGR and STAR, but did not affect 8-Br-cAMP-stimulated CYP19A1 mRNA expression in human cumulus granulosa cells. Overall, our data indicate that environmentally relevant dose of T-2 toxin decreases steroidogenesis and ovulatory potency in human cumulus granulosa cells probably through activation of PDE, thus posing a significant risk for female fertility.

Atrazine suppresses FSH-induced steroidogenesis and LH-dependent expression of ovulatory genes through PDE-cAMP signaling pathway in human cumulus granulosa cells.

Atrazine (ATR) alters female reproductive functions in different animal species. Here, we analyzed whether ATR disturbs steroidogenic and ovulatory processes in hormone-stimulated human cumulus granulosa cells and mechanism of its action. Results showed that treatment of human cumulus granulosa cells with 20 µM ATR for 48 h resulted in lower FSH-stimulated estradiol and progesterone production. ATR reduced mRNA levels of aromatase (CYP19A1), steroidogenic acute regulatory protein (STAR) and luteinizing hormone/choriogonadotropin receptor (LHCGR). Addition of hCG 48 h after FSH and ATR treatment did not trigger maximal expression of the ovulatory genes amphiregulin (AREG) and epiregulin (EREG). Mechanistic experiments showed that ATR activated cPDE and decreased cAMP level. Addition of total PDE and specific PDE4 inhibitors, IBMX and rolipram, prevented ATR's action on CYP19A1 and STAR mRNA expression in FSH-stimulated human cumulus granulosa cells. This study suggests that ATR alters steroidogenesis and ovulatory process in human cumulus granulosa cells jeopardizing female reproduction.

Flexible GnRH antagonist protocol vs. long GnRH agonist protocol in patients with polycystic ovary syndrome treated for IVF: comparison of clinical outcome and embryo quality.

OBJECTIVES: Polycystic ovary syndrome (PCOS) is a common endocrine disorder, primarily affecting women of the reproductive age. The aim of the study was to assess the clinical efficacy and embryo quality in flexible gonadotropin-releasing hormone (GnRH) antagonist protocol in comparison to the long GnRH agonist protocol in PCOS women undergoing in vitro fertilization (IVF). MATERIAL AND METHODS: This prospective, randomized study was conducted at the Department of Gynecology and Obstetrics, Clinical Center Nis, Serbia, between 2013 and 2014. The treatment included either a flexible GnRH antagonist protocol (n = 45, antagonist group) or a long GnRH agonist protocol (n = 45, agonist group). RESULTS: The length of the stimulation, total amount of gonadotropins used, as well as the average number of the aspirated and mature oocytes were higher in the agonists group. The endometrial thickness was also greater in the agonists group. A higher number of Class I and Class IV embryos were obtained after the agonist treatment and higher number of Class II and Class III embryos were obtained after the antagonist treatment. Pregnancy, implantation, and miscarriage rates were comparable between the groups. CONCLUSIONS: The GnRH antagonist protocol in PCOS patients has a pregnancy rate comparable to that of the GnRH agonist protocol. Since this protocol has a lower rate of complications and is more convenient for patients, we believe that the GnRH antagonist protocol should be used as the first-line treatment for PCOS patients in an IVF program.

INFLUENCE OF BODY MASS INDEX ON IN VITRO FERTILIZATION OUTCOME IN WOMEN WITH POLYCYSTIC OVARY SYNDROME.

INTRODUCTION: The purpose of this study was to investigate the influence of the body mass index on the outcome of in vitro fertilization in patients with polycystic ovary syndrome. MATERIAL AND METHODS: The study sample consisted of 123 patients with polycystic ovary syndrome who completed their in vitro fertilization treatment at the Department of Gynecology and Obstetrics, Clinical Center Nis. Republic of Serbia, and they were retrospectively analyzed. The patients were divided by body mass index into two groups for the comparison of the findings. One group (normal weight) consi- sted ofwomenwithbodymass index ≤25 kg/in² (mean22.O8±1.90), and the other group (overweight) included women with body mass index>25 kg/in² (mean 27.65±1.47). The patients underwent either the standard long gonadotrophin-releasing hormone agonist protocol or flexible multidose gonadotrophin-releasing hormone antagonist protocol. RESULTS: The normal-weight patients had a higher number of mature oncytes, significantly higher fertilization rate (p

In vitro fertilization outcome in women with endometriosis & previous ovarian surgery.

BACKGROUND & OBJECTIVES: Women with endometriosis often need in vitro fertilization (IVF) to concieve. There are conflicting data on the results of IVF in patients with endometriosis. This study was undertaken to elucidate the influence of endometriosis on IVF outcome to give the best counselling for infertile patient with this problem. METHODS: The outcome measures in 78 patients with surgically confirmed endometriosis were compared with 157 patients with tubal factor infertility, all of whom have undergone IVF. The groups were matched for age and follicle stimulating hormone (FSH) levels. Outcome measures included number of follicles, number of oocytes, peak oestradiol (E2) concentrations and mean number of ampoules of gonadotropins. Cumulative pregnancy, miscarriage and live birth rates were calculated in both the groups. RESULTS: Higher cancelation rates, higher total gonadotropin requirements, lower peak E2 levels and lower oocyte yield were found in women with endometriosis and previous surgery compared with those with tubal factor infertility. However, no differences were found in fertilization, implantation, pregnancy, miscarriage, multiple births and delivery rates between the endometriosis and tubal factor infertility groups. INTERPRETATION & CONCLUSIONS: The present findings showed that women with endometriosis and previous surgery responded less well to gonadotropins during ovarian stimulation and hence the cost of treatment to achieve pregnancy was higher in this group compared with those with tubal factor infertility. However, the outcome of IVF treatment in patients with endometriosis was as good as in women with tubal factor infertility.

The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding.

BACKGROUND/AIM: Abnormal uterine bleeding is the most common problem which brings woman to the gynecologist during the postmenopausal period. The aim of this study was to define the significance of hysteroscopy as a diagnostic procedure for the evaluation of patients with postmenopausal bleeding, as well as to define it as a surgical procedure by which the cause of bleeding can be treated in most cases in the same sitting. METHODS: The study involved 148 female patients referred to the Clinic for Gynecology and Obstetrics in Nis for postmenopausal bleeding in the period of 12 months. Hysteroscopy with endometrial biopsy were performed in all the patients. Biopsy materials were directed to histological examination, and the hysteroscopic and histological findings were compared afterwards. Polyps and submucous miomas were hysteroscopically removed in the same sitting and also directed to histological examination. RESULTS: The success rate of the method was 95.1%, while complications occurred in 1.37% of the cases. The hysteroscopic findings were normal in almost 30% of the cases, and the most common pathological finding was endometrial polyp. The sensitivity of hysteroscopy in the detection of intrauterine pathology was 100%, the specificity 81%, the positive predictive value 92% and the negative predictive value 100%. In 69.7% of the patients the cause of bleeding was hysteroscopically removed. Hysteroscopy was performed in 58.1% of the patients in the same sitting, and in 11.6% of the patients after obtaining histological findings. CONCLUSION: Hysteroscopy is a safe, highly sensitive diagnostic procedure, thus being an ideal method for evaluation of patients with postmenopausal bleeding. The application of hysteroscopy with endometrial biopsy leads to accurate diagnosis. An adequate diagnosis is crucial for the selection of relevant treatment of postmenopausal bleeding and avoidance of unnecessary major surgical procedures. Except for being a diagnostic method hysteroscopy, is also an outpatient minimally invasive surgical procedure for treating the cause of bleeding in the majority of cases in the same sitting.

[The role and contribution of transvaginal endoscopy to diagnostics and treatment of infertility].

Transvaginal endoscopy (TVE) presents minimal invasive endoscopic method that involves hysteroscopy, transvaginal laparoscopy and salpingoscopy. It gives a new approach to both basic evaluation of marital infertility and its treatment. The role of TVE is a subject of controversies regarding its justification as standard infertility treatment. Another aspect is a role of TVE prior to methods of assisted reproductive technologies (ART). The aim of this paper was to try, through the analysis of the available literature, to clarify the role of TVE in reproductive medicine, as well as to show our experience. The concept of one-day diagnostics, which is so-called one stop fertility clinic, is performed in the Clinical Center of Vojvodina, Department of Gynecology and Obstetrics on a daily basis. It consists of history, gynecology and ultrasound exam, spermiogram, hormone tests, and TVE. Patients are informed about results on the very same day and advised on the proper infertility treatment. By forming the infertility diagnostics protocols, which use the methods of TVE, we consider it possible to evaluate adequately and accurately the fertility within the shortest possible time. It replaced standard laparoscopy in certain indication fields; it eventually confirmed the necessity of its use in recurrent IVF implantation failure, raising the question of its routine use prior to the first IVF cycle that is a topic requiring further randomized trials.

Postpartum HELLP syndrome--the case of lost battle.

Unexpected rapid maternal death after delivery due to HELLP syndrome is rarely encountered and may become the subject of forensic expertise. Unexpectedness, suddenness, and fulminant course of this syndrome as well as absence of classical signs of pre-eclampsia can confuse physicians and lead to diagnostic delay. A definitive post-mortem diagnosis of HELLP syndrome in questionable cases of maternal death should be based on accepted laboratory criteria and characteristic histopathological alterations. We present a case of acute postpartum HELLP syndrome complicated by disseminated intravascular coagulation and acute renal failure which caused rapid maternal death only 20 hours after a caesarean section following an uncomplicated pregnancy.

[Results of in vitro fertilization cycles at the Clinic for Gynecology and Obstetrics, Clinical Center of Nis].

INTRODUCTION: Infertility affects 15-17% of reproductive age couples in our country. In vitro fertilization brought revolution in treatment of this problem, bringing hope to many couples around the world for more than 3 decades. The aim of this paper was to present results and experiences of implementation of this method of treatment at the Clinic of Gynecology and Obstetrics in Nis. MATERIAL AND METHODS: The study included the first 402 women who had undergone in vitro fertilization program at the Clinical Center of Nis. The data were statistically analyzed by basic descriptive methods. The main outcome measures were demographic features, cause of infertility, duration of stimulation, average gonadothropine consumption, number of oocytes per aspiration and embryos transferred, mode of conception as well as clinical pregnancy and aspiration rate. RESULTS: The two main factors were the male infertility and tubal factor inferitily, being 51.61% and 48.39%, respectively The classical method of in vitro fertilization constituted 72.40% of all cycles, while intra cytoplasmic sperm injection method was used in 27.60% of all cycles. The average number of embryos transferred was 2.75. The cycle cancellation rate was 15.05%. The clinical pregnancy rate per ermbryo transfer was 35.44%; while the live birth rate per embryo transfer was 26.53%. DISCUSSION AND CONCLUSION: Our success rates are comparable with those in other European countries, where for in vitro fertilization the clinical pregnancy rates per aspiration and per transfer were 29.0 and 32.4%, respectively in the observed period. For intra cytoplasmic sperm injection, the corresponding rates were 29.9 and 33.0%. The main difference from the European average was the average number of transferred embryos and lower percentage rate of intra cytoplasmic sperm injection as a method of conception. Results

Fetal ultrasound scan--prerogatives for the basic level.

Adequate level of prenatal ultrasound scan is a prerequisite for a successful definition of high risk population that needs further investigations. "Basic", standardized fetal mid-trimester scan, with an informative report enables not only diagnosis of anomaly but also evaluation of state of pregnancy in general. This paper was aimed at reviewing the benefits of and requirements for a complete basic mid-trimester fetal ultrasound scan and the necessary documentation. Potential directions for development of organization of basic mid-trimester fetal ultrasound scans are standardization of the scan, with establishing the number and the level of examination, and continual education of both the doctors and the patients. In order to standardize the exam, a uniform check list is needed, so that the examination should always be done in the same manner and at the same level, no matter where it is done and by whom. International and national guidelines should be agreed upon and they should state clear standards on who should do the scan, how, what kind of ultrasound machine should be used and what documentation should be kept. This paper presents a possible standardization of basic level mid trimester fetal ultrasound scan. A routine complete second trimester ultrasound between 18 and 22 weeks and a complete ultrasound report will provide the best opportunity to diagnose fetal anomalies and to help in the management of prenatal care. It will also reduce the unnecessary number of ultrasound examinations done during the second trimester for completion of fetal anatomy survey, which would decrease the costs.

Variations of serum copper values in pregnancy.

INTRODUCTION: Copper is essential micronutrient and has an important role in the human body. The serum copper increases during pregnancy and is doubled at full term. Lower levels of serum copper in pregnancy are connected with some pathological conditions. OBJECTIVE: The aim of this study was to estimate the levels of serum copper in normal and pathological pregnancies, comparing them with values of serum copper in non-pregnant women, to determine if serum copper is lower in some pathological pregnancies and if this is of some importance. METHODS: A total of 2170 plasma samples for copper analyses were made in the following groups: healthy non-pregnant women; healthy pregnant women from the 5th-40th gestational week, during the first delivery stage and during the first three postpartum weeks, in pregnant women with habitual abortion, imminent abortion, abortion in progress, missed abortion (9th-24th weeks), missed labour and premature rupture of membranes (29th-40th weeks). Levels of serum copper were determined by colorimetric technique of bathocuproin with disulphate as a chromogen. RESULTS: Serum copper values in non-pregnant women range from 11.6-25.8 micromol/L. In healthy pregnant women, there is a constant trend of the increase of serum copper. The mean serum copper values revealed three significant peaks at the 22nd, 27th and 35th gestational week. Serum copper values in the patients with some pathological pregnancies in relation to the serum copper values of the healthy pregnant women were significantly lower. CONCLUSION: Serum copper values can be used as an indicator of some pathological pregnancies.

Results and experiences after 2000 performed hysteroscopies.

INTRODUCTION: Hysteroscopy is one of the oldest endoscopic procedures which uses the cervix for introducing a telescope to place a camera into the uterine cavity. OBJECTIVE: The aim of the study was to present our experiences with this procedure during the long-term work starting from the time when hysteroscopic method of treatment was first introduced at this Clinic until today. METHODS: This prospective study involved 2000 female patients referred to the Clinic for Gynecology and Obstetrics in Novi Sad from January 2005 till January 2011 for diagnostic and operative hysteroscopy. The following parameters were analyzed: the presence of minor and major pathology of the endometrium, type of anesthesia, technique of operative work, instruments and energy used during hysteroscopy and complications. RESULTS: Seventy-eight percent of all procedures were done under intravenous anesthesia. The most common operative procedure was polypectomy and the most complicated one was myomectomy. By histopathological examination of hysteroscopic biopsy specimens four endometrial carcinomas were revealed. The combination of mechanical instrument and bipolar energy were used in most of the cases, while the percentage of complications was extremely low. CONCLUSION: Hysteroscopy is a safe, highly sensitive, precise diagnostic and operative endoscopic procedure. Our experiences and dilemmas open a field for discussion and offer salutations to everyday problems. The introduction of this procedure into out-patients conditions has contributed to the efficiency of the treatment of vaginal pathological processes, thus enabling that the method has become available to all gynecologists. This fact requires further study and new results.

Thromboprophylaxis implementation during pregnancy in women with recurrent foetal losses and thrombophilia.

Recurrent foetal loss is a significant clinical problem, occurring in 1-5% of reproductive females. Inherited or acquired thrombophilia has been diagnosed in 50-65% of women with history of unexplained foetal loss. The low molecular weight heparin was applied in 24 women with inherited thrombophilia and previous recurrent foetal loss and in 6 women with primary antiphospholipid syndrome throughout their following pregnancies. The dose of low molecular weight heparin for the majority of women was 35-75 u/kg. Women with primary antiphospholipid syndrome received both low molecular weight heparin and aspirin 50-100 mg daily. Implementation of thromboprophylaxis resulted in successful pregnancy outcome in 29 out of38 pregnancies, which represents a significant improvement of pregnancy outcome in comparison to previous 81 pregnancy losses. The number of treated pregnancies in our study is small, but the rate of successful pregnancy outcomes is high (76%), indicating that low molecular weight heparin may be a promising approach to women with thrombophilia and recurrent foetal loss.

[Effect of hysteroscopic examination on the outcome of in vitro fertilization].

BACKGROUND/AIM: Implantation failure after embryo transfer is one of the main problems of in vitro fertilization (IVF) and intrauterine pathologies can lead to unsuccessful outcome. The aim of this study was to determine if hysteroscopic examination of uterine cavity and consequent treatment of intrauterine lesions prior to IVF could improve the pregnancy rate in women under 38. METHODS: This study included 480 patients under 38, who had undergone IVF or IVF\ICSI--embryo transfer cycles, in which one or more good quality embryos were transferred. By transvaginal sonography performed within the past 2 months, the uterus was found normal in all the patients enrolled in our IVF unit. The patients were divided into three groups: group A--with no hysteroscopic evaluation and no pathology, group B --with hysteroscopy but no pathology, and group C--with abnormal hysteroscopy finding and corresponding treatment. RESULTS: The obtained results revaled no difference in the mean age, duration of infertility, number of mature oocytes in either group (p > 0.05). Clinical pregnancy rates in the groups A, B and C were 36.9%, 58.75% and 32.7%, respectively, and delivery rates were 27.5%, 48.7% and 25.7%, respectively. There was a statistically significant difference among the groups concerning pregnancy and delivery rates. CONCLUSION: Considering the results of this study we could conclude that hysteroscopy, as a routine examination, should be performed before the first IVF-ET cycle in all patients thereby reducing the failures and then the costs of IVF-ET.

[Results and experiences after 1000 IVF cycles at the Clinic for Gynecology and Obstetrics in Novi Sad].

INTRODUCTION: Infertility affects 15-17% of reproductive age couples in our country, and 10-15% of couples worldwide. The aim of this paper was to present results and experience gained after the first 1000 cycles of the national In Vitro Fertilization (IVF) program, to offer professional standard of work in our country and to compare it with results obtained in Europe and worldwide. MATERIAL AND METHODS: The study prospectively included 1000 women who had undergone national In Vitro Fertilization program from October 2006 until November 2009 at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina, Novi Sad. RESULTS: The analysis included 1000 in vitro fertilization cycles. Male factor infertility was the leading cause (56.9%) followed by tubal factor (45.9%). The classic method of in vitro fertilization constituted 72.3% of all cycles, while intracytoplasmic sperm injection (ICSI) method was used in 27.7% of all cycles. The average number of embryos transferred was 2.67. The cycle cancellation rate was 14.10% and the aspiration rate was 94.40%. The clinical pregnancy and live birth rate were 33.41% and 26.78% per embryo transfer respectively. DISCUSSION AND CONCLUSION: The results in our study showed that in our setting there are far less intracytoplasmic sperm injection cycles compared with the European average of 66.5% of all fresh cycles, and that we transferred more embryos on average. Our success rates are comparable with those in other European countries where the clinical pregnancy rates per aspiration and per transfer for in vitro fertilization were 29 and 32.4%, respectively in the period of observation. For intracytoplasmic sperm injection, the corresponding rates were 29.9 and 33%.

[Fetal multicystic kidney disease--outcome and follow up].

INTRODUCTION: Congenital fetal anomalies are the great problem and one of the main causes of increased perinatal mortality and morbidity. The aim of this study is to determine the outcome of prenataly detected multicystic dysplastic kidney and to point to the necessity of postnatal diagnostic procedures. MATERIAL AND METHODS: The retrospective-prospective study encompasses 38 cases of the prenatally diagnosed unilateral fetal multicystic dysplastic kidney. The associated anomalies were revealed either by autopsy findings when the pregnancy was terminated, or when the pregnancy continued, by clinical and operative findings the newborns. RESULTS: The autopsy finding revealed bilateral multicystic displastic kidney or unilateral mylticystic displastic kidney and the agenesis of the contralateral kidney. The postnatal evaluation of the newborns with unilateral multicistic disease revealed that 84.3% of them had some concomitant anomaly of the urinary tract, most of them had an anomaly of the contralateral kidney (31.4%). The surgery was performed in 73.6% of children, in 17% of children the kidney function deteriorated after the surgery. CONCLUSION: The findings of bilateral multicystic kidney disease and unilateral multicystic kidney disease and amnion are the indication to terminate the pregnancy. The finding of an isolated unilateral multicystic dysplastic kidney require thorough examination, both prenatally and postnatally. We propose obligatory serial prenatal ultrasound examinations, followed by postnatal ultrasound, isotope scan, and urinary cystourethography.

[Medical abortion--modern method for termination of pregnancy].

INTRODUCTION: Modern methods of medically induced abortions are being used in many countries all over the world. These methods are safe and effective when used in an appropriate way. DRUGS USED FOR MEDICAL ABORTION: The most widely used regimens for drug induced abortions include antiprogestogen mifepriston followed by administration of a synthetic prostaglandin analogue--gemeprost vaginally or misoprostol orally or vaginally. When used for abortions up to 9 and 7 weeks of pregnancy, this method has efficacy up to 98%. The regimen between 9 and 12 completed weeks is still under investigation. Methods for medical abortion after 12 completed weeks since last menstrual period include several regimens and medications--combination of mifepriston and repeated doses of misoprostol, misoprostol or gemeprost alone, methotrexate, synthetic prostaglandin analogues, oxytocin and some others. MEDICAL ABORTIONS AT OUR DEPARTMENT OF OBSTETRICS AND GYNECOLOGY, NOVI SAD, CLINICAL CENTER VOJVODINE, SERBIA: Medical abortions in the second trimester were introduced at our Department of Obstetrics and Gynecology Novi Sad, Serbia, in early 1980s using prostaglandin analogues. This method was improved in year 2000 introducing two dinoprostone gels intracervically/extraaminally instead of just one, for cervical preparation before intramuscular application of carboprost thrometamine, which led to significantly shorter abortion interval. During the years 2003/2004 we took part successfully in one of the multicentric WHO projects for investigating new regimens on early medical abortions with mifepriston and misoprostol. CONCLUSIONS: Modern methods of medical abortions are safe and effective for termination of unwanted pregnancies in the first and second trimester.

[Single dose of antibiotic prophylaxis in elective cesarean sections].

INTRODUCTION: The aim of our study was to determine whether a single-dose preoperative administration of antibiotics was sufficient to prevent intra and postoperative infections in the parturients without a high risk of developing an infection, in whom the delivery was completed by cesarean section, as well as to answer whether the administered dose of antibiotics satisfied the requirements of therapeutic concentrations necessary to protect against infection in the period during the surgical procedure and during the first 6 postoperative hours. MATERIAL AND METHODS: All investigated pregnant women were planned to have elective cesarean section as a mode of delivery. They were distributed in groups depending on the type (cephalexin, gentamycin and cephazolin) of antibiotic prophylaxis administered as a single dose. In all patients the clinical postoperative course was followed for possible infection. The concentrations of antibiotics were estimated immediately and 6 h following the operation. The estimation of antibiotic concentrations was done by the method of liquid chromatography (for antibiotics belonging to the group of cephalosporins), i.e. RIA method for antibiotics from the group of aminoglycosides. RESULTS AND CONCLUSION: The total number of infections in investigated groups was 5.18%. The measured mean concentrations of administered antibiotics following the operation and 6 h later were above MIC. This is a proof that the obtained antibiotic prophylaxis by a single dose administration of anbtibiotic is sufficient to prevent the invasion of pathogenic microorganisms from the skin.

[Labour after intracytoplasmic sperm injection].

INTRODUCTION: The aim of our study was to describe labour characteristics after intracytoplasmic sperm injection programme. This is the first study of those deliveries at the Department of Gynecology and Obstetrics in Novi Sad. PATIENTS AND METHODS: Subjects were 73 parturients and their babies from the intracytoplasmic sperm injection programme (48 singletons, 22 twins and 3 triplets), delivered from January 1st, 2001 to December 31st, 2006. RESULTS: At the Department of Gynecology and Obstetrics in Novi Sad, 0.65% of all deliveries are those from assisted reproductive programmes. 30.67% of all labours after assisted reproductive programmes are after intracytoplasmic sperm injection. One half of all labours after intracytoplasmic sperm injection are twins. The mean age of women is 33-34. More than 95% of all babies were delivered by Cesarean section. DISCUSSION: The most frequent pathologies in labours after intracytoplasmic sperm injection are hypertensive disorders and premature rupture of membranes. There is still a matter of debate what is a real cause for those pathologies, especially for hypertension (age of woman, laboratory factors and or induction of ovulation). CONCLUSION: At the Department of Gynecology and Obstetrics in Novi Sad, one third of all deliveries after assisted reproductive programme are after intracytoplasmic sperm injection. The most frequent pathologies after intracytoplasmic sperm injection are hypertensive disorders, which is similar to findings of other authors. The mean age of women is also similar to the mean European age of women after intracytoplasmic sperm injection.