Asistovaná reprodukce je nedílnou součástí léčby neplodnosti. Základní metodou je mimotělní oplození (IVF – fertilizace in vitro), běžně se používá i intracytoplazmatická injekce spermie do oocytu, kryokonzervace spermií, oocytů a embryí. Podíl embryí preimplantačně geneticky testovaných (PGT) na chromozomální aneuploidie nebo vady konkrétních genů stoupá. Významné je i použití darovaných oocytů, zejména z důvodu vyčerpání ovariální rezervy u žen starších 40 let. Efektivita léčby je vždy velmi zásadně závislá na věku ženy. Léčba asistovanou reprodukci je v Česku velmi dobře dostupná, stejně tak i záchrana plodnosti zmražením spermií/oocytů.
Assisted reproduction is an integral part of infertility treatment. The basic method is in vitro fertilisation (IVF), and intracytoplasmic sperm injection into the oocyte, cryopreservation of sperm, oocytes and embryos is also commonly used. The proportion of embryos tested with preimplantation genetic testing (PGT) for chromosomal aneuploidy or defects in specific genes is increasing. The use of donated oocytes is also significant, particularly because of the depletion of ovarian reserve in women over 40 years of age. The effectiveness of treatment is always very fundamentally dependent on the age of the woman. Assisted reproductive treatment is very well available in the Czech Republic, as is fertility preservation by sperm/oocyte freezing.
- MeSH
- asistovaná reprodukce * ekonomika zákonodárství a právo MeSH
- infertilita terapie MeSH
- lidé MeSH
- preimplantační diagnóza MeSH
- registrace MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
STUDY QUESTION: What are the data and trends on ART and IUI cycle numbers and their outcomes, and on fertility preservation (FP) interventions, reported in 2019 as compared to previous years? SUMMARY ANSWER: The 23rd ESHRE report highlights the rising ART treatment cycles and children born, alongside a decline in twin deliveries owing to decreasing multiple embryo transfers; fresh IVF or ICSI cycles exhibited higher delivery rates, whereas frozen embryo transfers (FET) showed higher pregnancy rates (PRs), and reported IUI cycles decreased while maintaining stable outcomes. WHAT IS KNOWN ALREADY: ART aggregated data generated by national registries, clinics, or professional societies have been gathered and analyzed by the European IVF-Monitoring (EIM) Consortium since 1997 and reported in a total of 22 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN, SIZE, DURATION: Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE each year. The data on treatment cycles performed between 1 January and 31 December 2019 were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons in one of the 44 countries that are members of the EIM Consortium. PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall, 1487 clinics offering ART services in 40 countries reported, for the second time, a total of more than 1 million (1 077 813) treatment cycles, including 160 782 with IVF, 427 980 with ICSI, 335 744 with FET, 64 089 with preimplantation genetic testing (PGT), 82 373 with egg donation (ED), 546 with IVM of oocytes, and 6299 cycles with frozen oocyte replacement (FOR). A total of 1169 institutions reported data on IUI cycles using either husband/partner's semen (IUI-H; n = 147 711) or donor semen (IUI-D; n = 51 651) in 33 and 24 countries, respectively. Eighteen countries reported 24 139 interventions in pre- and post-pubertal patients for FP, including oocyte, ovarian tissue, semen, and testicular tissue banking. MAIN RESULTS AND THE ROLE OF CHANCE: In 21 countries (21 in 2018) in which all ART clinics reported to the registry 476 760 treatment cycles were registered for a total population of approximately 300 million inhabitants, allowing the best estimate of a mean of 1581 cycles performed per million inhabitants (range: 437-3621). Among the reporting countries, for IVF the clinical PRs per aspiration slightly decreased while they remained similar per transfer compared to 2018 (21.8% and 34.6% versus 25.5% and 34.1%, respectively). In ICSI, the corresponding PRs showed similar trends compared to 2018 (20.2% and 33.5%, versus 22.5% and 32.1%) When freeze-all cycles were not considered for the calculations, the clinical PRs per aspiration were 28.5% (28.8% in 2018) and 26.2% (27.3% in 2018) for IVF and ICSI, respectively. After FET with embryos originating from own eggs, the PR per thawing was at 35.1% (versus 33.4% in 2018), and with embryos originating from donated eggs at 43.0% (41.8% in 2018). After ED, the PR per fresh embryo transfer was 50.5% (49.6% in 2018) and per FOR 44.8% (44.9% in 2018). In IVF and ICSI together, the trend toward the transfer of fewer embryos continues with the transfer of 1, 2, 3, and ≥4 embryos in 55.4%, 39.9%, 2.6%, and 0.2% of all treatments, respectively (corresponding to 50.7%, 45.1%, 3.9%, and 0.3% in 2018). This resulted in a reduced proportion of twin delivery rates (DRs) of 11.9% (12.4% in 2018) and a similar triplet DR of 0.3%. Treatments with FET in 2019 resulted in twin and triplet DR of 8.9% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 8.7% after IUI-H (8.8% in 2018) and at 12.1% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.7% and 0.4% (in 2018: 8.4% and 0.3%) and 6.2% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%), respectively. Eighteen countries (16 in 2018) provided data on FP in a total number of 24 139 interventions (20 994 in 2018). Cryopreservation of ejaculated sperm (n = 11 592 versus n = 10 503 in 2018) and cryopreservation of oocytes (n = 10 784 versus n = 9123 in 2018) were most frequently reported. LIMITATIONS, REASONS FOR CAUTION: Caution with the interpretation of results should remain as data collection systems and completeness of reporting vary among European countries. Some countries were unable to deliver data about the number of initiated cycles and/or deliveries. WIDER IMPLICATIONS OF THE FINDINGS: The 23rd ESHRE data collection on ART, IUI, and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Although it is the largest data collection on MAR in Europe, further efforts toward optimization of both the collection and the reporting, from the perspective of improving surveillance and vigilance in the field of reproductive medicine, are awaited. STUDY FUNDING/COMPETING INTEREST(S): The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.
- MeSH
- asistovaná reprodukce * MeSH
- dítě MeSH
- fertilizace in vitro * MeSH
- lidé MeSH
- registrace MeSH
- retrospektivní studie MeSH
- sperma MeSH
- těhotenství s dvojčaty MeSH
- těhotenství MeSH
- úhrn těhotenství na počet žen v reprodukčním věku MeSH
- výsledek těhotenství epidemiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- asistovaná reprodukce * ekonomika klasifikace statistika a číselné údaje trendy MeSH
- donorské početí statistika a číselné údaje MeSH
- fertilizace in vitro statistika a číselné údaje MeSH
- kliniky reprodukční medicíny statistika a číselné údaje MeSH
- lidé MeSH
- preimplantační diagnóza statistika a číselné údaje MeSH
- přenos embrya statistika a číselné údaje MeSH
- sběr dat statistika a číselné údaje MeSH
- věk matky MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
Úvod: V průběhu 30. sympozia asistované reprodukce konaného 11. listopadu 2020 v Brně byla prezentována problematika řešená v reprodukční medicíně v ČR v roce 2020. Vybraná témata se týkala aktuálních otázek z oblasti klinické embryologie a genetiky, gynekologie, ale i legislativy či etiky. Řešená témata: 1. Kolik času má lékař v ambulanci centra asistované reprodukce na pacientku a jak s klienty komunikuje embryolog? 2. Reprodukce a preimplantační genetické testování monogenních chorob (PGT-M) u onkologických pacientů a pacientů v riziku s hereditárními onkogenními mutacemi. 3. Neinvazivní genetické testování embryí z kultivačního média. 4. Editace genomu. 5. Jaká je potřeba monitorování hormonálních hladin ve stimulačních protokolech? 6. Monitoring a výběr embrya pro transfer/ kryokonzervaci. 7. Nastal čas změnit zákon o odměňování dárců/ dárkyň? Metodika: Témata předem připravili pověření členové naší společnosti s úkolem vypracovat teze, které prezentovali v samostatném konferenčním bloku. Prezentace i s diskuzí byla vysílána přímo z vysílacího studia v Hotelu International online připojením. Po skončení konference byly všechny diskuzní náměty a připomínky zapracovány. Závěr: Práce předkládá stav řešených problémů reprodukční medicíny v ČR.
Introduction: During the 30th symposium of assisted reproduction held on November 11, 2020 in Brno, the solved problems in reproductive medicine in the Czech Republic in 2020 were presented. The selected topics have concerned not only current issues in the field of clinical embryology and genetics as well as gynecology, but also legislation and ethics. Discussed topics: 1. How much time does the doctor have in the CAR (centrum of assisted reproduction) outpatient clinic per patient and how does the embryologist communicate with clients? 2. Reproduction and PGT-M in oncology patients and patients at risk with hereditary oncogenic mutations. 3. Non-invasive genetic testing of embryos from culture medium. 4. Genome editing. 5. What is the need to monitor hormonal levels in stimulation protocols? 6. Monitoring and embryo selection for transfer/kryo. 7. Is it time to change the law on donor remuneration? Methods: The topics were prepared in advance by authorized members of our company with the task of elaborating theses, which they presented in a separate conference block. The presentation and the discussion were broadcast directly from the broadcast studio at Hotel International via an online connection. After the conference, all discussion topics and comments were incorporated. Conclusion: The work presents the state of the solved problems of reproductive medicine in the Czech Republic.
- Klíčová slova
- monitoring embryí,
- MeSH
- asistovaná reprodukce MeSH
- editace genu MeSH
- fertilizace in vitro MeSH
- genetické testování MeSH
- lidé MeSH
- reprodukční lékařství * MeSH
- reprodukční techniky * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: About a third of people in the world are infected with Toxoplasma gondii. This parasite has been found in the reproductive organs and semen of males of many animal species as well as humans. The effects of toxoplasmosis on sperm count, motility and morphology were confirmed in rats. A higher prevalence of toxoplasmosis has been observed in infertile men. On the other hand, no significant effect of infection on semen parameters in men was found in one already published study. OBJECTIVES: To compare the prevalence of toxoplasmosis in men with and without semen pathology and to examine in detail the possible impact of infection on semen volume, sperm count, motility and morphology. MATERIALS AND METHODS: The pre-registered cross-sectional study included 669 men who visited the Centre for Assisted Reproduction in Prague from June 2016 until June 2018. RESULTS: The incidence of fertility problems was significantly higher in the 163 Toxoplasma-infected men (48.47%) than in the 506 Toxoplasma-free men (42.29%), τ = 0.049, P = 0.029. After correction for multiple tests, we found significantly lower sperm concentration, concentration of progressively motile sperm, and concentration of non-progressively motile sperm in Toxoplasma-positive men than in Toxoplasma-negative men using partial Kendall correlation with age controlled. In addition, toxoplasmosis correlated with sperm quality in smokers but not in non-smokers. DISCUSSION AND CONCLUSION: Our results suggest that latent toxoplasmosis affects certain semen parameters (sperm count and motility), but does not seem to affect sperm morphology and semen volume. Impairment of semen parameters may be either a side effect of the presence of Toxoplasma gondii in male reproductive organs or a product of manipulation activity of the parasite aimed to increase the efficiency of the sexual route of its transmission. Tobacco smoking also appears to exacerbate the negative impact of toxoplasmosis on semen parameters.
- Publikační typ
- abstrakt z konference MeSH
Cíl práce: Zjistit trendy v asistované reprodukci (AR) v České republice v letech 2007–2017.Typ studie: Retrospektivní epidemiologická celostátní studie. Název a sídlo pracoviště: Gynekologicko-porodnická klinika 1. LF Univerzity Karlovy a Všeobecné fakultní nemocnice v Praze. Metodika: Analýza dat Národního registru asistované reprodukce České republiky (NRAR) za roky 2007–2017. Výsledky: Z analýz dat v NRAR se ukazuje mírný, ale trvalý nárůst počtu cyklů AR v ČR (42 773 v roce 2017), stejně tak i pracovišť AR (43 v roce 2017). Významný je segment darování oocytů – ED (5003 cyklů roku 2017) a cyklů s jejich přijetím – OoR (6057 roku 2017). Narůstá zastoupení cyklů s ICSI oplozením (96 %). Daří se snižo-vat počet embryí transferovaných do dělohy (průměr 1,18 embrya roku 2017 u žen do 35 let) s cílem předejít mnohočetné graviditě. Efektivita AR je vyjádřena řadou ukazatelů, jejichž zásadním parametrem je věk – od 32 let již plodnost žen klesá. Závěr: Národní registr asistované reprodukce České republiky poskytuje podrobné informace o léčbě AR, a poskytuje tak oporu pro rozhodování zdravotních pojišťoven, ministerstva zdravotnictví i samotných lékařů a pacientek.
Objective: Find trends in assisted reproduction (AR) in Czech Republic (CR) in years 2007–2017.Design: Retrospective national epidemiologic study. Settings: Department of Obstetric and Gynaecology, 1st Faculty of Medicine, Charles University and Genereal University Hospital, Prague.Methods: Data analysis of Czech Republic National Assisted Reproduction Register (NRAR) in years 2007–2017. Results: Analyses of NRAR show mild, but permanent growth of AR cycles in CR (42 773 in 2017), as well as the nubmer of AR centers (43 in 2017). Important part of AR in CR are Egg Donation cycles (5003 in 2017) and Oocyte Receipt cycles (6057 in 2017). Fertilisation by ICSI is permanently growing (96% cycles in 2017). CR succeeded in decreasing in the number of transferred embryos (average1, 18 embryo in 2017 for women up to 35 years) with the aim to prevent multiple pregnancies. AR efficacy can be evaluated by several indicators, and the age is the main parameter – since 32 years the fertility of women is diminishing.Conclusion: Czech national assisted reproduction register provides detailed information about AR treatment and enables qualified decisions for Ministry of Health, health insurances, treatment doctors and patients.
- Klíčová slova
- Národní registr asistované reprodukce,
- MeSH
- asistovaná reprodukce * statistika a číselné údaje MeSH
- lidé MeSH
- registrace MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- asistovaná reprodukce * MeSH
- časové faktory MeSH
- choriogonadotropin aplikace a dávkování MeSH
- diagnostické techniky porodnicko-gynekologické MeSH
- endosonografie metody MeSH
- hormon uvolňující gonadotropiny agonisté aplikace a dávkování MeSH
- indukce ovulace metody MeSH
- lidé MeSH
- luteinizační hormon účinky léků MeSH
- oocyty růst a vývoj účinky léků MeSH
- ovulace účinky léků MeSH
- vagina MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- MeSH
- asistovaná reprodukce etika trendy MeSH
- fertilizace in vitro etika metody trendy MeSH
- lidé MeSH
- zachování plodnosti trendy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
