[Role of leptin in human reproduction (anorexia, bulimia)]. / Úloha leptinu v lidské reprodukci (anorexie, bulimie).

Leptin may act as the critical link between adipose tissue and the reproductive system, indicating whether adequate energy reserves are presenting for normal reproductive functions. Future interventional studies involving leptin administration are excepted to further clarify this role of leptin and may provide new therapeutic options for the reproductive dysfunctions associated with states of relative leptin deficiency or resistance.

[Surrogate maternity--literature review and practice]. / Surogátní materství--literární názory a praxe.

OBJECTIVE: This review summarizes opinions on surrogacy including internatinal and governmental organizations attitudes, as well as some religious concerns. DESIGN: Literature review. SETTING: Reprofit International, Brno, Reproductive medicine and gynecology centre, Zlin, Department of obstetrics and gynecology, Palacky University, Olomouc. BACKGROUND: The developments in the field of assissted reproduction during the last twenty years have attracted unexpected public interest in some of its ethical and moral aspects. It is very difficult to find a uniform attitude to ethical concerns of assisted conception in plural society. Surrogate mother is defined as a woman who bears and relinquishes a child for another person. CONCLUSION: The european congress on human reproduction in Barcelona 2008 adopted following résumé on surrogacy: Public opinion has shifted to a position where surrogacy is recognized as an appropriate response to infertility in some circumstances and it is to be expected that this approach will be further strenghtened with stress on positive aspects of familiar life.

[Does oocyte retrieval influence the following morphological quality of embryos?]. / Ovliviiuje pocet získaných oocytu pri ovariální punkci následnou morfologickou kvalitu embryí?

OBJECTIVE: To verify that the number of retrieved oocytes influence the following morphological quality of transferred embryos and the success of IVF treatment. DESIGN: A retrospective study. SETTING: Clinic of assisted medicine and gynecology, Zlin. METHODS: By observing the collection is composed of 837 IVF cycles with embryotransfer, which were practised between June 2002 and December 2004. To observe the number of retrieved oocytes, following morfological quality of transferred embryos, (number of clinical pregnancies). RESULTS: We found that in cycles with more retrieved oocytes (7 oocytes and more), there were embryos of first morphological quality transferred significantly more frequently (59.2% cycles, p < 0.001) than in cycles with 1-6 retrieved oocytes. Morphologicaly abnormal embryos were found in cycles with more retrieved oocytes (7 oocytes and more) and transferred significantly less frequently (13.1% cycles, p < 0.001) than in cycles with 1-6 retrieved oocytes (34.8% cycles). We have found that on the retrieval of 16-18 oocytes, there were embryos of first morphological quality transferred in 67.4% cycles of treatment (p = 0.002). The number of cycles with transferred morphological abnormal embryos is decreasing in relation with increase of oocyte retrieval (p = 0.002). Most of clinical pregnancies were achieved in IVF cycles with retrieval of 16-18 oocytes (clinical pregnancies was achieved in 50.0% cycles, p < 0.001). CONCLUSION: The results show that the number of retrieved oocytes was influenced following morphological quality of transferred embryos. In IVF cycles with more retrieved oocytes there are transferred embryos of first morphological quality more frequently. These embryos have higher implantation potential. The number and quality retrieved oocytes are possibly more effective with type and dosing of hormonal stimulation, which should be suitable for every patient.

Oocyte recovery, in vitro insemination, and transfer into the oviduct after its microsurgical repair at a single laparotomy.

A method combining recovery of a preovulatory oocyte, its in vitro insemination, and transfer into the oviduct with tubal microsurgery at a single laparotomy is described. Of four women in whom tubal microsurgery was clinically indicated and the accompanying tubal transfer of an oocyte inseminated in vitro was performed, two became pregnant. It is not clear whether fertilization occurred in vitro or in vivo. One of the pregnancies miscarried in the fifth week after surgery; the other pregnancy continued without any complications. A normal male infant was subsequently delivered at term. The proposed method is discussed as a possible alternative to in vitro fertilization and embryo transfer in some cases of infertility and as a suitable supplemental procedure in some cases in which tubal microsurgery is indicated.

Fine structure of human two-cell ova fertilized and cleaved in vitro.

The human two-cell ovum consists of two equally sized blastomeres, surrounded by the zona pellucida. Cumulus cells may be apposed to the exterior of the zona. The blastomere nuclei contain spherical nucleoli, made up of fibrillar matrix, and randomly dispersed chromatin. The cytoplasmic structures include mitochondria, smooth endoplasmic reticulum, annulate lamellas, the Golgi complex, free ribosomes, secondary lysosomes, cortical granules, and microtubules. The cell membrane bristles with microvilli and displays signs of pinocytosis except at the site of apposition of the two blastomeres. The fine structure of the two-cell ova fertilized and cleaved in vitro corresponds with the presumptive pattern with respect to the current knowledge of mammalian embryo preimplantation development. The ova seem to have been capable of further growth.

[Legal and ethical problems in assisted reproduction--case report]. / Právní a etické problémy asistované reprodukce--kazuistika.

OBJECTIVE: The objective of the study is to evaluate legal and ethical aspects of the assisted reproduction in the Czech Republic. These aspects are described in the context of the concrete case. DESIGN: Case report. SETTING: Department of Social Medicine, Medical and Health Care Administration Faculty of the Masaryk University, Brno and Centre of the Reproductive Medicine Zlín. SUBJECT AND METHOD: The description of the concrete case that happened in the Czech Republic. A widow asked for the artificial insemination using the sperm of her deceased husband. CONCLUSION: It was concluded that there is absolutely insufficient legal regulation of the assisted reproduction techniques, it does not respond to the development of the medical knowledge and it responds insufficiently to the ethical dilemmas concerning the assisted reproduction.

[Intracytoplasmic sperm injection--a possible therapy for male subfertility]. / Intracytoplazmatická injekce spermie (ICSI)--mozná lécba muzské subfertility.

The authors describe a new method of assisted fertilization, i.e. intercytoplasmic injection of spermatozoa. They submit an account of their technical equipment and the initial experience with this method on the degenerated human oocyte as well as on the blastocyst of cattle. Before this method can be introduced into clinical practice, it must be approved by the ethical commission.

[Treatment of post-partum atonic hemorrhage with prostaglandin F2 alpha analogs]. / Lécba poporodního atonického krvácení analogy prostaglandinu F2alpha.

In the authors' group of patients with haemorrhage during childbirth, in 1990-1994 a total of 28 atonic haemorrhages were recorded, 15 of them were controlled by uterotonic treatment, in the remaining 13 cases haemostasis using PG F2 alpha was applied after ruling out post-partum injury. Some patients were given moreover saline infusions. According to initial results and consistent with the literature analogues of PG F2 alpha are effective uterotonic preparations of a new generation. With regard to their simple and rapid administration they are becoming the drug of first aid in the treatment of acute atonic haemorrhage.

[Hysteroscopic sterilization using Ovabloc]. / Hysteroskopická sterilizace Ovablokem.

The authors give an account on 29 sterilizations made by the hysteroscopic route, using the preparation OVABLOC. It is a reversible block of the oviducts by occlusive material. Under hysteroscopic control into the inner orifice of the oviduct by means of a special injecting device under pressure a two-component mixture of silicone and a catalyst is instilled which causes within 5 min. hardening of the mass and the formation of an elastic relief filling of the entire oviduct. In 25 of the women (86.2%) the procedure was accomplished without complication, in the 3 (10.3%) the procedure failed on account of technical difficulties and in one case (3.5%) during hysteroscopy the uterine wall was perforated. On X-ray check-up after three months of 25 successfully operated women in 24 the position of the tubal occlusion was unaltered (the material is due to dispersed silver particles contrasting on X-ray); in one case it was loosened. The advantages of the method are that it is sparing, well tolerated and easily reversible, the disadvantage is that it is relatively laborious and expensive.

[Hysteroscopic resection of myomas]. / Hysteroskopická resekce myomu.

The authors give an account of their initial experience with hysteroscopic resection of myomas. During the investigation period (January 1991-August 1992) 34 of these operations were performed. In all instances at the same time laparoscopy was performed. The operation was free from complications in 26 patients (76.5%), in three instances (8.8%) peroperative haemorrhage developed, in 4 (11.8%) postoperative haemorrhage and in one instance (2.9%) perforation of the uterine wall. In 29 (85.3%) thus operated patients the menstrual cycle became normal within three months, after this period of time amenorrhoea persisted in three patients (8.8%). Two women (5.9%) reported irregular bleeding after the operation. To improve the success of the operation accurate indication is necessary, preferably based on previous diagnostic hysteroscopy, and improvement of the surgical technique.

[Oocyte donation: ethical and practical questions]. / Dárcovství oocytu: etické a praktické otázky.

AIM OF THE STUDY: This review will summarize the current view on ethical and practical aspects involved in ovum donation. STUDY DESIGN: Literature review. INSTITUTION: Center of Reproductive Medicine, Zlín; Department of Gynecology and Obstetrics, Palacký University, Olomouc. CONCLUSION: Today there are three possible ways of recruiting ovum donors: 1) volunteer ovum donors, 2) related donors (searched by couples in need), 3) in vitro fertilization patients (egg-sharing).

[Lateral pathologic flow in the uterine artery in the 3rd trimester of pregnancy and the fetal status]. / Lateralizovaný patologický prutok v a. uterina ve III. trimestru gravidity a stav plodu.

From a total of 2,312 Doppler examinations made in 1992 at the Gynaecological Department of the University Clinic in Zürich in 34 patients in the 3rd trimester of pregnancy a lateralized pathological blood flow in the uterine artery on the non-placental side was found. As a control group the authors selected a group of 34 patients comparable as to age, gestation period, time when the Doppler examination was made and the type of delivery. The results of the investigation are not statistically significant in view of the low percentage incidence of lateralized pathology, however, it may be stated that the finding may be the first symptom of incipient foetal hypoxia.

[Dilatation of the cervical canal with Dilapan before induced abortion in the first trimester of pregnancy in primigravidas]. / Dilatace cervikálního kanálu Dilapanem pred umelým ukoncením tehotenství v prvním trimestru u primigravid.

During the period between Oct. 1, 1993 and June 30, 1994 the authors inserted by the intracervical route in 32 primogravidae with unwanted pregnancies before abortion with pregnancies shorter than 8 weeks a hydrophil dilator Dilapan. After 12 hours the rod was removed under general anaesthesia and the pregnancy terminated by vacuum aspiration. In three instances after Dilapan insertion slight haemorrhage occurred which, however, did not call for removal of the rod. Apart from slight tenderness in the hypogastrium, similar as during menses, no side-effects were observed. In two instances during Dilapan extraction the rod was disrupted and the residue had to be removed by means of Kocher's forceps. In all patients the dilation of the cervical canal was sufficient for a 6 mm suction curette and further dilation of the cervix by means of metal dilators was not necessary. On examination after menstruation the patients did not report more massive bleeding nor febrile complications or residues. Based on the described results, the authors are of the opinion that gradual dilation of the cervix before abortion in the first trimester should be part of the procedure and all women who must face this situation should be given this opportunity.

[Hemostasis using vasopressin analogs during conization of the uterine cervix and minor vaginal operations]. / Hemostáza analogy vazopresinu pri konizacích cípku a pri malých vaginálních operacích.

Peroperative haemorrhage is a frequent complication of conization of the portio uteri by surgery-by a "cold knife" scalpel or another method (LEEP, laser, etc.). In a clinical study comprising 41 patients with the diagnosis CIN I-III or laceration of the portio uteri classical conization by means of a scalpel was made with concurrent haemostasis with terlipressin (TLP) by paracervical administration (400 micrograms-REMESTYP 2 amp.). Concurrently the blood loss in ml was followed, the Hb level and other effects of the preparation. From the results ensues that side-effects after local administration of TLP were observed only in 12.2%. Peroperative blood losses were on average under 15 ml. Local paracervical TLP administration appears effective from the clinical aspect with regard to the low frequency of side-effects and the favourable haemostatic effect.

[Pregnancy and delivery after traumatic panhypopituitarism]. / Tehotenství a porod po traumatickém panhypopituitarismu.

OBJECTIVE: We describe a case of 23 years old woman who, with a history of car accident at the age of 11 and severe head injury, attended our Center of Reproductive Medicine complaining of primary infertility. The accident preceded menarche and the development of inner genitalia (uterus 46 mm, cervix:corpus ratio 1:1) as well as secondary sexual development was not fully accomplished. Ovarian failure was accompanied by amenorrhea, if not substituted. Under replacement therapy regular menstruation was established. Basal hormonal levels was extremely low (FSH and LH 0.2-0.3 IU/l, PRL 0.5 ng/ml, estrogens 0.08 nmol/l, PRGE was not detected). With oral administration of micronized estradiol (Check et al., 2001) endometrial thickness of 9 mm was achieved. All of five retrieved oocytes were fertilized with partner sperm (normospermy) and three embryos were transferred. Already the first attempt was successful. Patient suffered with transitional anorexia and vomiting which could be handled conservatively. Hormonals level were normal. Patient substituted with Hydrocortison and Euthyrox. On January 2, 2003 the pregnancy was finished by caesarian section, one week before the delivery term (girl, 2970, Apgar score 10-10-10). DESIGN: Case report. SETTING: Center of Reproductive Medicine, Zlin. CONCLUSION: This care report demonstrates that recent progress in assisted reproduction field enables to manage successfully even exceptional pathological conditions.

[Induction of cervical maturation using vaginal administration of estrogens]. / Indukce zrání cípku pomocí vaginálne aplikovaného estrogenu.

During the period between September 1, 1993 and September 1, 1994 the authors preinduced 38 pregnant women in term by oestrogen administered by the vaginal route. The group comprised patients with a single pregnancy, PPH, CS 5n and reactive NST. For preinduction 150 mg oestradiol in a viscous gel were used which along with a pessary was inserted 24 hours before the planned induction of delivery by the vaginal route on the portio uteri. After removal of the pessary the CS was evaluated and then delivery was induced by intracervically administered prostaglandin. The preinduction was successful in 32 patients (84.3%), in 6 patients uterine contractions started during preinduction, delivery by forceps was used twice (5.3%) and Caesarean section six time (15.8%). In the course of preinduction there were no side-effects, no irregularities in the course of parturition were observed. The described method can be recommended as the method of choice for the treatment of an immature portio uteri before planned induction of delivery.

[Direct and indirect detection of Chlamydia in infertile married couples in the assisted reproduction program]. / Prímý a neprímý prukaz chlamydií u neplodných manzelských páru zarazených do programu asistované reprodukce.

The authors pay attention to the relationship of pregnancy in women enlisted in the IVF programme and the detection of Chlamydia infection. A group of 74 infertile couples were investigated. A significant relationship was found between confirmed Chlamydia infection in women and men. Moreover a significant relationship was found between Chlamydia infection confirmed by immunofluorescence in men and impregnation in women in the IVF programme. This means that in female partners of men with acute Chlamydia infection the results of IVF are less successful. The authors recommend that all couples enlisted in the IVF programme should be examined for this infection and if it is positive given adequate treatment.

[Programmed labor--beneficial for the mother and fetus or an obstetrical hazard?]. / Programovaný porod, prospech pro matku a plod nebo porodnický hazard?

During the period between Jan. 1, 1992 and Dec. 31, 1995 at the Second Department of Gynaecology and Obstetrics 482 full-term pregnancies were terminated by elective induction of labour. Labour was induced by extraamnial administration of PGE2 (Prostin UPJOHN 3.0 mg tablets vag). Depending on the maturity of the portio uteri a maximum of two doses after two hours were administered: 0.5 mg PGE2 when the cervical score was > 8 and 1.0 mg PGE2 when the score was 5-8 points. The results were compared with 278 non-risk pregnant women who were delivered of babies between Jan. 1 and June 30, 1995. The first stage of labour was longer in patients with spontaneous labour. The second stage of labour was longer in patients with induced labour. From the results ensues that an elective induction of labour does not increase the perinatal risk for mother and foetus, and conversely if all conditions are respected it is better for the mother, her family and the staff of the labour ward.

[Labor induction with extra-amnial administration of PGE2 vaginal tablets]. / Indukce porodu extraamniální aplikací vaginálních tablet PGE2.

UNLABELLED: During the period between Jan. 1 1992 and Dec. 31, 1995 at the Second Department of Gynaecology and Obstetrics in Brno labour was induced in 1159 patients by extraamnial fractionated administration of PGE2 vaginal tablets. After assessment of the indication and the baseline examination (NST, amnioscopy, US biometry and cervical score) according to the CS to the patient the first dose of PGE2 was administered into the extraamnial space beyond the inner os uteri (CS 5-8:1.0 mg PGE2, CS > 8 : 0.5 mg PGE2). After two hours the patient was examined again and if regular uterine contractions had started or the finding on the os uteri was larger than 2 cm, the amniotic sac was disrupted. If not, another dose was administered. After two hours the patient was re-examined and if the os was larger than 2 cm, and there were regular uterine contractions, the amniotic sac was disrupted. If the changes did not take place, the induction was considered a failure. RESULTS: there were 1007 successful inductions (95.5%), the mean period from the onset of induction to the onset of uterine contractions was < 120 mins-269 (24.6%), 120-180 mins.: 501 (45.9%) and > 180 mins.: 322 (29.5%). The mean period of the first stage of labour was 228 mins., stage II 10 mins., stage III 8 mins. Five times uterine hypertonus was recorded and a blood loss greater than 500 ml occurred in four patients. Forty-nine Caesarean sections were made (4.2%) and 51 (4.4%) forceps deliveries. The rate of epidural analgesia was 27 (2.3%). Revision of the uterine cavity was made in 39 patients (3.4%) and manual lysis of the placenta in 30 (2.6%). The Apgar score was inferior to 6 in 10 neonates (0.9%). The protocol of induction of labour described by the authors is effective and associated with a minimum of side-effects, safe for the mother and foetus, well tolerated by patients and cost-effective.

A comparison of three preinduction cervical priming methods: prostaglandin E2 gel, Dilapan S rods and Estradiol gel.

The aim of the study was to evaluate the efficacy of three cervical priming methods. From January 1, 1994 to December 31, 1996 247 patients presenting an indication for induction of labor with an unripe cervix were randomly assigned to one of the following preinduction protocols: 0.5 mg of Prostaglandin E2 gel administered intracervically (n = 83), four hygroscopic Dilapan S rods applied intracervically (n = 82), and 150 mg of Estradiol gel administered intravaginally (n = 82). The inclusion criteria were the patient's informed consent, singleton pregnancy of more than 36 weeks, cephalic presentation, Bishop score < 5 points and reactive non-stress test. If the cervical maturation (Bishop score > or = 5, and/or Bishop score augmentation by 2 points) did not occur after 14 hours of priming, the case was considered a failure. In the opposite case the patient was induced by means of extraamniotic PGE2 administration. The mean gain in the Bishop score was 3.7 points in the PGE2 group 3.9 points in the Dilapan S group, and 2.8 points in the Estradiol group. 71 patients (85.5%) were successfully preinduced in the PGE2 group, 73 (89.0%) in the Dilapan S group, and 63 (76.8%) in the Estradiol group. Labor was induced by preinduction only in 23 patients (31.3%) of the PGE2 group in 17 (20.7%) of the Dilapan S group, and in 14 (17.1%) of the Estradiol group. The mean induction to delivery interval was 7 h 27 min in PGE2 group, 7 h 49 min in the Dilapan S group and 9 h 15 min in the Estradiol group. The Caesarean section rate was 24.4% in the PGE2 group, 10.5% in the Dilapan S group, and 24.4% in the Estradiol group. PGE2 gel and Dilapan S rods proved higher efficacy than Estradiol gel. The highest frequency of labor induced by preinduction only was in the PGE2 group. There were shorter induction to delivery intervals in the PGE2, and Dilapan S groups. The lowest Caesarean section rate was in the Dilapan S group. Neither serious side effects nor negative neonatal outcome were noted in either group.