Ceska Gynekologie-Czech Gynaecology最新文献

Objective: The aim of the study was to evaluate the occurrence of stress urinary incontinence after pelvic organ prolapse surgery using the laparoscopic sacrocolpopexy method. This is a retrospective multicenter study.

Methods: The study included 131 patients who underwent laparoscopic sacrocolpopexy and underwent at least a one-year follow-up in the form of a clinical examination.

Results: The group included patients with an average age of 63.4 years (38-80 years), BMI 26.6 kg/m2 (19.4-36 kg/m2), and parity 2 (0-4). Before surgery, 30 (22.9%) patients showed stress incontinence, and after surgery there were 50 (38.2%); the difference was statistically significant (P = 0.0007). Thirty (22.9%) patients underwent subsequent anti-incontinence surgery, while 10 (7.6%) patients experienced significant improvement of stress incontinence.

Conclusion: Pelvic organ prolapse reconstruction surgery by laparoscopic sacrocolpopexy is associated with the risk of postoperative stress incontinence in 38.2%, of which de novo in 22.9% of cases.

Aim: The sperm activation method is a modern methodological approach that is used more and more often in practice. The number of studies focused on methods of artificial activation of human sperm motility are constantly increasing. Standard sperm selection methods can fail in some cases, among other things, because very young sperm are isolated that have not yet completed their development. In these cases, artificial stimulation of their movement can have a positive effect and greatly facilitate and faster the process of selecting suitable sperm. Methylxanthines are most often used as activating agents. However, opinions on the safety of using these substances on sperm are not uniform. The aim of the thesis is to present current knowledge about artificial activation of sperm motility for in vitro fertilization and subsequent embryonic development.

Methodology: Research of relevant literature in Web of Science, Scopus, PubMed/Medline databases.

Results and conclusion: The literature analysis shows that this method is safe and effective in the selection of immotile spermatozoa. Scientific studies have been conducted to verify the safety and reliability of this method. The conclusion of these studies is the positive impact of this method of selection, especially in cases of sperm obtained from testicular tissue after method testicular sperm extraction. In these cases, the method of artificial sperm activation facilitated and accelerated the selection of sperm before intracytoplasmic sperm injection. Undamaged spermatozoa, which are immobile due to incomplete maturation, were activated.

Reactive oxygen species play a significant role in male fertility and infertility. They are essential for physiological processes, but when their concentration becomes excessive, they can be a cause of various sperm pathologies. Seminal leukocytes and pathologically abnormal sperm are the primary sources of oxygen radicals in ejaculate. They negatively affect sperm quality, including DNA fragmentation and sperm motility impairment. Addressing increased concentrations of reactive oxygen species involves various appropriate lifestyle modifications and measures, including the use of antioxidants, treatment of urogenital infections, management of varicocele, weight reduction, and others. In many cases, these interventions can lead to adjustments in the condition and improvement in sperm quality. Such improvements can subsequently lead to enhanced outcomes in assisted reproduction or even an increased likelihood of natural conception. In some instances, the need for donor sperm may be eliminated. However, a key factor is adhering to a sufficiently prolonged treatment, which requires patience on the part of both, the physician and the patient.

Aim: Within the in vitro fertilization (IVF) process, to evaluate the possibility of using the state of the meiotic spindle of oocytes as an indicator of maturity in order to optimize the timing of vitrification.

Patients and methods: In the presented report, the cause of couple infertility was a combination of a 38-year-old female and 43-year-old male with azoospermia, which was an indication for oocyte vitrification. Oocyte polar bodies and optically birefringent meiotic spindles were visualized by polarized light microscopy and their states and relative positions were used as indicators of oocyte maturation, i.e. readiness for vitrification. Oocytes which had an angle between the polar body and meiotic spindle a ≤ 30° or had a poorly visible meiotic spindle were vitrified 4 hours post-meiotic spindle evaluation (8 hours after ovum pick-up).

Results: After thawing, oocytes were fully maturated and prepared for intracytoplasmic sperm injection (ICSI). Following treatment with tamoxifen, vital sperm were retrieved from the patient's partner, the oocytes were thawed and fertilized with the obtained sperm, with subsequent embryo transfer and delivery of a healthy baby at term.

Conclusion: The meiotic spindle can be used as an oocyte maturation pointer in older women. After thawing, the oocytes were fully matured and ready for fertilization by ICSI.

The number of cycles of assisted reproduction using donor body parts is increasing significantly. In Europe alone, around one hundred thousand children are born each year who have some relationship to three or more parents. The European expert guarantor European Society of Human Reproduction and Embryology therefore issued a recommendation in 2022 to inform donors, recipients and children born in this way. Our article analyses developments in this area and proposes a solution for the Czech Republic. It is necessary for providers to immediately respond to the fact that the anonymity of donation can no longer be guaranteed, and to adapt the content of consultations and informed consents of potential donors and applicants accordingly. Legislation then has two possible solutions: first to adopt a system of "polyparenthoods" or second to fundamentally limit donation cycles.

Endometriosis is a common gynecological disease caused by the implantation of active endometrial cells outside the uterine cavity. In most cases, endometriosis occurs in the pelvic area, such as the ovary, Douglas' pouch, or uterine sacral ligament. Some rare cases of extrapelvic endometriosis can also occur in the perineum, urinary system, gastrointestinal tract, nervous system, chest, subcutaneous tissue, and skin. Endometriosis of the perineum is usually secondary to obstetric trauma, such as perineal laceration or episiotomy. To date, few cases of spontaneous perineal endometriosis have been reported. Herein, we report a rare case of spontaneous deep perineal endometriosis. Notably, the patient had typical symptoms of regular pain during menstruation with no history of delivery or perineal trauma. The patient recovered well after postoperative gonadotropin releasing hormone agonist injection.

Objectives: The presented research aimed to identify prenatal factors involved in abnormal neurodevelopment and postnatal manifestation of an autistic phenotype in 107 boys (average age 4.31 ± 2.24 years).

Materials and methods: Their biological mothers were asked to fill out a comprehensive questionnaire about their reproductive health, infections during pregnancy, oral contraceptive intake before conception, and potential substance abuse before and during pregnancy as well as delivery and newborn information. The boys were subsequently diagnosed with autism spectrum disorder (ASD) using the combination of Autism Diagnostic Observation Schedule (ADOS-2) and Autism Diagnostic Interview - Revised (ADI-R). Based on the ADOS-2 module chosen during diagnosis, boys diagnosed with Module 1 can be classified as nonverbal or minimally verbal (N = 68), while those diagnosed using Module 3 are fully verbal (N = 39).

Results: According to our results, reproductive health related to the length of the menstrual cycle before pregnancy with the autistic child seems to play a role with regards to the severity of the disorder (P = 0.017) as well as the number of previous pregnancies (P = 0.026). Mothers of nonverbal children reported to have had a much shorter menstrual cycle (27.35 ± 6.60 days) than those with verbal children (30.14 ± 4.44 days) and reported more previous pregnancies (0.93 ± 1.07 vs. 0.51 ± 0.91), while not reporting the number of live births before they had the autistic child. Children who were later diagnosed as non-verbal had a longer delivery time (from 2 to 48 hours; on average 11.13 hours, SD = 9.49) than verbal ones (between 1 and 27 hours, which was on average 7.09 hours, SD = 8.91), P = 0.0182. Delivery method didn't play a role in this context, and neither did the type of conception (natural, insemination, etc.).

Conclusion: Studying the involvement of prenatal factors in the etiology of autism based on the speech of the child seems to be a promising approach.

Aim: To investigate the quality of life of women with endometriosis before treatment and 3 months after the start of surgical and/or conservative treatment.

Sample and methodology: The sample comprised of 38 patients, of whom 26 underwent surgical treatment, 6 had pharmacological treatment, and 6 had both surgical and pharmacological treatment. The Endometriosis Health Profile (EHP-30) questionnaire in the Czech version and the Numeric Rating Scale (NRS) were used to assess quality of life. The questionnaires were completed before treatment and 3 months into the treatment.

Results and discussion: When comparing quality of life with the EHP-30 questionnaire, 3 months after the start of treatment, significantly better quality of life scores were found in all domains except the domain "Infertility." Statistically significant improvement was observed in the domains of "Control and powerlessness," "Emotional well-being," and "Pain" (P < 0.0001). Pain assessment using NRS showed subjective improvement in pain during menstruation, outside menstruation, during intercourse, micturition, and defecation. Statistically significant improvement was reported in pain during menstruation and outside menstruation (P < 0.0001).

Conclusion: Treatment of endometriosis improves the quality of life and also leads to a subjective reduction of pain intensity as one of the main symptoms of the disease.

Aim and methodology: To provide a comprehensive review on new findings and current recommendations regarding antiphospholipid antibodies with particular emphasis on clinical impact on gestation.

Conclusion: Antiphospholipid antibodies are an important risk factor for the development of a series of pregnancy-related complications. Early diagnosis and appropriate therapy can reduce the incidence of pregnancy loss and pregnancy-related complications.

Objective: We aimed to compare highly purified human menopausal gonadotropin (hp-hMG) and recombinant follicle stimulating hormone (rFSH) in short antagonist in vitro fertilization (IVF) cycles of patients with poor ovarian reserve (POR). Limited research exists on this comparison in short antagonist cycles for this patient group.

Materials and methods: This retrospective cohort study involved 165 POR patients aged 18-45 years who underwent IVF between 2018 and 2022. Patients were divided into two groups based on their GnRH antagonist protocol: hp-hMG (group 1 = 72) and rFSH (group 2 = 93). We compared pregnancy outcomes, number of oocytes collected, mature oocytes retrieved, mean fertilized oocytes, top quality embryos transferred, and serum estradiol (E2) and progesterone (P) levels on human chorionic gonadotropin (hCG) administration day.

Results: : No significant differences were found in E2 and P levels on hCG trigger day, endometrial thickness on transfer day, stimulation duration, total oocyte number, and mature oocyte number (P > 0.05). The total gonadotropin dose was significantly higher in the rFSH group (P < 0.001). The number of top-quality embryos transferred and clinical pregnancy and live birth rates did not diff er significantly between groups (P = 0.320; P = 0.310; P = 0.652; and P = 0.662, resp.).

Conclusion: Neither hp-hMG nor rFSH showed superiority in patients with POR, indicating similar effectiveness in this population.