Cíl: V rámci procesu in vitro fertilizace (IVF) zhodnotit možnost použití stavu meiotického vřeténka jako indikátoru zralosti oocytů za účelem optimalizace načasování vitrifikace. Pacienti a metody: V rámci léčby neplodnosti 38leté ženy a 43letého muže metodou IVF-ICSI (intracytoplazmatická injekce spermie) byla zobrazena dělicí vřeténka jako markery zralosti oocytů před jejich vitrifikací z důvodu azoospermie u partnera. Oocyty, u nichž byl úhel mezi polárním tělískem a meiotickým vřeténkem ≤ 30°, případně měly špatně viditelné meiotické vřeténko, byly vitrifikovány 4 hod po vyhodnocení meiotického vřeténka (8 hod po odběru oocytů). Standardně jsou oocyty vitrifikovány 6 hod po odběru oocytů. Výsledky: Delší doba inkubace oocytů pacientky umožnila, aby oocyty před vitrifikací plně dozrály (do fáze MII) a po rozmrazení byly připraveny pro oplodnění. U partnera pacientky byly následně získány vitální spermie po léčbě tamoxifenem, oocyty byly rozmrazeny a oplodněny získanými spermiemi, s následným embryotransferem a porodem zdravého dítěte v termínu. Závěr: Meiotické vřeténko je možné použít jako marker plné zralosti u oocytů před jejich vitrifikací u starších žen. Po rozmrazení byly oocyty zralé a připravené pro oplodnění metodou ICSI.
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.
- MeSH
- Spindle Apparatus * ultrastructure MeSH
- Biomarkers * analysis MeSH
- Adult MeSH
- Fertilization in Vitro * methods MeSH
- Infertility therapy MeSH
- Humans MeSH
- Oocytes pathology growth & development ultrastructure MeSH
- Polar Bodies MeSH
- Tamoxifen therapeutic use MeSH
- Vitrification MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
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
- Reproductive Techniques, Assisted * economics legislation & jurisprudence MeSH
- Infertility therapy MeSH
- Humans MeSH
- Preimplantation Diagnosis MeSH
- Registries MeSH
- Age Factors MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
- Geographicals
- Czech Republic MeSH
The aim of this study was to evaluate the efficiency of using meiotic spindle (MS) visibility and relative position to the polar body (PB) as indicators of oocyte maturation in order to optimize intracytoplasmic sperm injection (ICSI) timing. This was a cohort study of patients younger than 40 years with planned ICSI, the timing of which was determined by MS status, compared with those without MS evaluation. The angle between PB and MS and MS visibility were evaluated by optical microscope with polarizing filter. Oocytes with MS evaluation were fertilized according to MS status either 5-6 h after ovum pick-up (OPU) or 7-8 h after OPU. Oocytes without MS evaluation were all fertilized 5-6 h after OPU. For patients over 35 years visualization of MS influenced pregnancy rate (PR): 182 patients with MS visualization had 32% PR (58/182); while 195 patients without MS visualization had 24% PR (47/195). For patients under 35 years, visualization of MS did not influence PR: 140 patients with MS visualization had 41% PR (58/140), while 162 patients without MS visualization had 41% PR (66/162). Visualization of MS therefore appears to be a useful parameter for assessment of oocyte maturity and ICSI timing for patients older than 35.
For group of 281 oocytes obtained from 43 stimulated donors and cryopreserved by vitrification protocol using Cryotop and Kitazato medium we determined important parameters of oocytes collection and vitrification processes which strongly affect the probability that warmed oocytes will produce high-quality embryos for transfer. The probability to obtain high-quality embryos for transfer from vitrified and warmed oocytes was highest when two conditions were fulfilled: 1. oocytes were incubated before vitrification for 7-10 h and 2. stimulated ovaries of donors in one cycle produced a smaller number of oocytes (<7 oocytes from one donor per stimulated cycle). The probable reasons for these observations were: 1. early vitrification (less than 7 h) before final oocyte metaphase II maturation negatively affected the crucial process of post-warm remodelling of spindles and chromosomes, which reduced the fertilization and utilization rates, 2. the evaluated vitrification protocol amplifies negative impact of membrane defects of oocytes of those cohorts containing more than 6 oocytes - freezing places great demands on the integrity and elasticity of the cell membranes. The fact that cryopreservation influences a complex state of oocytes was confirmed by confocal microscopy.
Cíl studie: Popis postupu odebírání folikulární tekutiny u pacientky po transpozici ovarií. Typ studie: Kazuistika. Název a sídlo pracoviště: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha. Vlastní pozorování: Popisujeme případ IVF léčby u pacientky, která podstoupila léčbu po transpozici ovarií, a obtížnost odběru v souvislosti s transabdominálním přístupem. Závěr: Punkce folikulární tekutiny transabdominálně je možná, ale je technicky náročná s nižším ziskem oocytů. Doporučujeme získání oocytů IVF metodou před chirurgickým řešením.
Objective: Description of punction of follicular fluid in a patient after ovarian transposition. Design: Case report. Setting: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and the General Faculty Hospital, Prague. Case report: We present a case of IVF treatment in a patient with ovarian transposition undergoing punction of follicular fluid and difficulties during this procedure acording to transabdominal route. Conclusion: Transabdominal punction od follicular fluid is possible, but with technical difficulities and smaller amount of obtained oocytes. We recomend to aplicate IVF procedures prior to surgical solution.
- Keywords
- transpozice ovarií, punkce oocytů, onkofertilita,
- MeSH
- Adult MeSH
- Cryopreservation methods MeSH
- Humans MeSH
- Uterine Cervical Neoplasms MeSH
- Oocyte Retrieval methods MeSH
- Treatment Outcome MeSH
- Fertility Preservation * methods MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Cíl studie: Představit případ pacientky, léčené pro sterilitu ve věku 46 let, s následnou potvrzenou klinickou graviditou. Uvádíme postup léčby v tomto případě a shrnujeme další možnosti léčby u pacientek nad 40 let věku. Typ studie: Kazuistika. Název a sídlo pracoviště: Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze. Vlastní pozorování: Léčba neplodnosti u pacientek ve věku vyšším než 40 let je často bez kýženého výsledku a pro pacientku i ošetřujícího lékaře je mnohdy náročná. Popisujeme případ, kdy pacientka otěhotněla při použití vlastních oocytů, získaných při punkci z nativního cyklu IVF. Závěr: Management léčby u pacientek nad čtyřicet let věku nabízí několik možností, především je nutná volba páru, zda chtějí podstoupit léčbu s vlastními, či darovanými oocyty. Těhotenství u pacientek ve vyšším věku než 40 let při léčbě s použitím vlastních oocytů má výrazně menší úspěšnost. Také klesá, oproti mladším pacientkám, šance na dále fyziologicky probíhající graviditu, ukončenou porodem a narozením zdravého potomka. Doporučujeme rozšíření těchto informací do povědomí žen.
Objective: To present a case of a patient who was treated for a sterility at the age of 46. The treatment was successful, after that we confirmed a clinical pregnancy. We present the treatment procedure in this case and summarize other treatment options in patiens over 40 years of age. Design: Case report. Setting: The Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and the General Faculty Hospital Prague 2. Case report: Infertility treatment in patiens over 40 years is often without the desired result, it is often difficult for both the patient and the attending physician. We describe the case in which a patient became pregnant using her own oocytes obtained from a puncture from the native IVF cycle. Conclusion: Treatment management in patients over forty years of age offers several options, above all it is necessary to choose a couple whether they want to undergo treatment with their own or donated oocytes. Pregnancy in patiens over 40 years of age using treatment with thein own oocytes is significantly less successful. There is also a decrease in the chances of a continuing physiologically progressing pregnancy and the birth of a healthy offspring, compared to younger patients. We recommend spreading this information to women's awareness.
- MeSH
- Reproductive Techniques, Assisted MeSH
- Fertilization in Vitro methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Oocytes MeSH
- Treatment Outcome MeSH
- Infertility, Female * therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Cíl studie: Shrnutí současných poznatků o vlivu PCB (polychlorovaných bifenylů) a OCP (organochlorovaných pesticidů) na lidskou fertilitu. Typ studie: Přehledový článek. Název a sídlo pracoviště: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha. Metodika: Zpracování údajů z literatury a dostupných studií. Výsledky: Vypracovali jsme přehled o známých účincích PCB a OCP, které mohou ovlivňovat reprodukci a svou kumulací ve folikulární tekutině ovlivňovat výsledky léčby metodou IVF (in vitro fertilizace). Závěr: U těchto látek není jejich negativní vliv na lidskou reprodukci dostatečně prokázán. Je nutno doplnit naše poznatky o vlivu PCB a OCP na fertilitu a bránit lidskou populaci před negativním vlivem kumulace těchto xenobiotik.
Objective: To summarize the current knowledges about the influence of PCB (polychlorinated biphenyls) and OCP (organochlorinated pesticides) on human infertility. Type of study: Review article. Setting: The Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University and the General Faculty Hospital, Prague. Methods: Analysis of literature and current studies. Results: We prepared a review about the known effects of PCB and OCP on human reproduction, which can influence the results of IVF (in vitro fertilisation) program by their cumulation in follicular fluid. Conclusion: In these compounds there is not direct evidence of their negative influence of reproduction. We have to complete our knowledges about PCB a OCP on fertility and protect the population against their cumulation.
- Keywords
- organochlorované pesticidy,
- MeSH
- Reproductive Techniques, Assisted MeSH
- Hydrocarbons, Chlorinated adverse effects toxicity MeSH
- Endometriosis MeSH
- Body Mass Index MeSH
- Clinical Studies as Topic MeSH
- Reproductive Control Agents MeSH
- Humans MeSH
- Pesticides * adverse effects toxicity MeSH
- Polychlorinated Biphenyls * adverse effects toxicity MeSH
- Xenobiotics adverse effects toxicity MeSH
- Infertility, Female * etiology MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
OBJECTIVE: To establish the effect of chlorinated organic compounds on fertility. DESIGN: We analyzed the influence of polychlorinated biphenyls (PCBs) and pesticides in follicular fluid on the number of fertilized oocytes, the quality of oocytes and embryos, pregnancy rate, and number of embryos cryoconserved in IVF-ET program. SETTING: Department of Gynecology and Obstetrics, Charles University, First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic. PATIENT(S): Patients from the Center of Assisted Reproduction. INTERVENTION(S): We collected the follicular fluid of 99 infertile women. MAIN OUTCOME MEASURE(S): The levels of xenobiotics in follicular fluid were examined by high-resolution mass spectrometry and gas chromatography. Correlations between the levels of xenobiotics and IVF-ET program results were statistically analyzed. RESULT(S): The PCB levels varied from 0.1 to 254.6 ng/g of fat. Levels of DDT and its metabolites varied from 0.3 to 35 228.8 ng/g of fat. A correlation was found between the number of diploid oocytes and the level of DDT, the fertilization of oocytes and level of PCB 158, and the pregnancy rate and the number of embryos cryoconserved and levels of PCB 47. CONCLUSION(S): Xenobiotics can be detected in the fat compartment of the follicular fluid. Some correlation to the IVF-ET program results was established, to a degree that might be considered of concern, although it was not statistically significant at the 5% level.
- MeSH
- DDT pharmacology MeSH
- Adult MeSH
- Fertilization in Vitro methods MeSH
- Follicular Fluid drug effects physiology MeSH
- Environmental Pollutants pharmacology MeSH
- Humans MeSH
- Pesticides pharmacology MeSH
- Polychlorinated Biphenyls pharmacology MeSH
- Embryo Transfer methods MeSH
- Prognosis MeSH
- Pregnancy MeSH
- Pregnancy Rate MeSH
- Treatment Outcome MeSH
- Xenobiotics pharmacology MeSH
- Infertility, Female chemically induced diagnosis therapy MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Research Support, Non-U.S. Gov't MeSH
The aim of this study was to detect DDT and its metabolites, 1,1-dichloro-2,2-bis(4-chlorophenyl)ethene (DDE) and 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (DDD), in blood and follicular fluid of infertile women undergoing in vitro fertilization and the embryo transfer program. The accumulation of DDT, DDE and DDD in follicular fluid of 30 infertile women was confirmed. The concentrations of the compounds in blood were 1.7 ? 5985 in follicular fluid and 3.5 ? 35 229 ng g?1 fat, respectively.
Cíl práce: Cílem práce bylo prokázat přítomnost organochlorovaných pesticidů (OCP)- DDT a jeho metabolitů a lindanu a jeho optických konformerů (alfa, beta, gama a delta konformerů hexachlorocyklohexanu – HCH), hexacyklobenzenu (HCB) v krvi a ve folikulární tekutině neplodných žen zařazených do programu in vitro fertilizace a embryotransferu (IVF + ET). Při průkazu jejich přítomnosti potvrdit nebo vyloučit jejich možnou kumulaci ve folikulární tekutině. Typ studie: Pilotní studie. Název a sídlo pracoviště: Gynekologicko-porodnická klinika 1. LF a VFN, Praha, AXYS Varilab s.r.o., Vrané nad Vltavou, Ústav hygieny a epidemiologie 1. LF UK, Praha, Euromise Centrum, Karlova univerzita a Akademie věd, Praha. Metodika: Hladiny organochlorovaných pesticidů byly stanoveny v krvi a ve folikulární tekutině 30 žen zařazených do programu IVF+ET. Pod ultrazvukovou kontrolou byl proveden transvaginální odběr folikulární tekutiny. Před zahájením anestezie byl odebrán vzorek žilní krve. Po zpracování embryologem byla zbylá folikulární tekutina a odebraná krev zamražena a odeslána do laboratoře. Vzorky byly zpracovány metodou vysokorozlišující plynové chromatografie a hmotnostní spektrometrie (HR GC-MS). Výsledky: U většiny vyšetřených žen jsme prokázali přítomnost organochlorovaných pesticidů v krvi i ve folikulární tekutině. Statistické vyhodnocení rozdílů v koncentraci prokázalo jejich kumulaci ve folikulární tekutině. Hladiny DDT a jeho metabolitů v krvi se pohybovaly od 2,8 do 6399,3 ng/g tuku, ve folikulární tekutině od 1,4 do 4 099,8 ng/g tuku. Hladiny HCB se pohybovaly v krvi od 213,5 do 5290,4 ng/g tuku, ve folikulární tekutině od 85,9 do 3255,3 ng/g tuku. Hladiny konformerů HCH byly v krvi v rozmezí od 1,0 do 259,9 ng/g tuku, ve folikulární tekutině v rozmezí 0,1 až 197,9 ng/g tuku. Medián rozdílů hladin ve folikulární tekutině a krvi je 1,47–670,13 ng/g tuku. Průměr rozdílů hladin ve folikulární tekutině a v krvi je 4,08–936,71 ng/g tuku. Závěr: Organochlorované pesticidy je možné prokázat v krvi i ve folikulární tekutině. Byla prokázána jejich kumulace ve folikulární tekutině.
Objective: The aim of this study was to detect DDT and its metabolites, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyklohexane – HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women undergoing IVF+ET program. In the case if their detection, to confirm their cumulation in follicular fluid. Design: Pilot study. Setting: Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Faculty Hospital, Prague, AXYS Varilab s.r.o., Vrané nad Vltavou, Institute of Hygiene and Epidemiology, 1st Faculty of Medicine Charles University and General Faculty Hospital, Prague, Euromise Centrum, Charles University and Academy of Arts, Prague, Czech republic. Methods: We detected the level of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyklohexane – HCH) and hexacyclobenzene (HCB) in blood and folicular fluid of 30 infertile women undergoing IVF + ET program. We recieved the follicular fluid by transvaginal punction of follicular fluid under ultrasonography control. The venous blood was taken before begining of anestesia. The follicular fluid and blood were frozen and transported to the laboratory. There the samples were examinated by the methods of gass chromatography and mass spectrometry. Results: We confirmed the possibility of detection of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane – HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women. The differences in concentrations in blood and follicular fluid were statistically analysed. We confirmed the cumulation of DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane – HCH) and hexacyclobenzene (HCB) in follicular fluid of infertile women. The levels of these compounds in blood differed from 2.8 to 6399.3 ng/g of fat, in follicular fluid from 1.4 to 4 099.8 ng/g of fat. Conclusion: It is possible to detect DDT, DDE, DDD, lindane and its conformers (alfa, beta, gama and delta conformers of hexachlorocyclohexane – HCH) and hexacyclobenzene (HCB) in blood and follicular fluid of infertile women. The cumulation of these xenobiotics in follicular fluid was found.
- MeSH
- Chromatography, Gas methods statistics & numerical data MeSH
- DDT chemistry blood metabolism MeSH
- Fertilization in Vitro MeSH
- Research Support as Topic MeSH
- Follicular Fluid chemistry MeSH
- Pesticides chemistry blood metabolism MeSH
- Embryo Transfer MeSH
- Spectrometry, Mass, Secondary Ion statistics & numerical data MeSH
- Xenobiotics chemistry blood MeSH
- Infertility, Female diagnosis therapy MeSH
