In the course of several past years, the question of healthcare quality was discussed from all angles, supported officially, and requested in some institutions; however, the level of the quality has often been defined chaotically, and it is not altogether clear what is to be expected from the various proposed systems. With the help of high-quality counselling, the team of the author's institution has introduced a system which from the start allowed setting up written and graphic working protocols based on the detailed analysis of all processes, definition of weak points and their reconstruction, and their following synthesis. These protocols are elaborated into detail horizontally and vertically in the form of processes, according to the needs of individual procedures, but in all of them the risk parts are clearly determined. For each risk point there is a definition of potential hazards, their solution, and the competent person responsible for their solution. The risk management system introduced in this way represents the most powerful instrument for providing healthcare in highest quality with minimizing the risk of damage to the patient. Regardless of other undeniable benefits (economic), the sole possibility to decrease the risk of patients‘ damage represents an unequivocal stimulus to introduce qualitative systems into the healthcare institutions.
During the period of January 2003 – May 2007, 223 microTESE interventions were performed in non-obstructive azoospermia cases. Data pooled from only 25 couples reflect the fact that sperm were found only in 48% of interventions. The intervention in NOA cases is performed in advance and most cycles had not been completed then; also, for various reasons embryos were not examined in some couples. Sperm were collected under the optical control of operation microscope Zeiss with magnification 10x to 25x; parallel histological examination confirmed moderate to severe impairment of spermatogenesis. Both parents underwent previous genetic tests; laboratory testing of the karyotype and cystic fibrosis gene tests, in men additional examination excluding Y chromosome microdeletions were performed. Results: In embryos fertilized with sperm obtained during microTESE, biopsy and testing of 8 chromosomes were completed. Only 48% out of all 184 examined cells did not display any numerical as well as morphological damage to the tested chromosomes. In embryo transfer without chromosome impairment, pregnancy was obtained in 58% cases. Conclusion: Combination of the sperm collection technique using optical control with transfer of only embryos genetically intact for the tested chromosomes represents an exceptionally effective method for treatment of the most severe forms of andrology cause of the couple sterility.
- MeSH
- aneuploidie MeSH
- aparát dělícího vřeténka fyziologie MeSH
- blastomery cytologie MeSH
- mikrofotografie využití MeSH
- mitóza fyziologie genetika MeSH
- Publikační typ
- abstrakty MeSH
- MeSH
- aneuploidie MeSH
- aparát dělícího vřeténka fyziologie MeSH
- blastomery cytologie MeSH
- mikrofotografie využití MeSH
- mitóza fyziologie genetika MeSH
- Publikační typ
- abstrakty MeSH