Nejvýznamnějším vědeckým a terapeutickým objevem léčby neplodnosti v posledních desetiletích je asistovaná reprodukce, která využívá metod hormonální ovariální hyperstimulace a plánovanou indukci ovulace. Tato léčba s sebou nese riziko rozvoje tzv. ovariálního hyperstimulačního syndromu, který se může vyskytovat v různých stupních. Cílem práce je upozornit na některé neurologické komplikace, které se mohou v souvislosti s ovariální stimulací vyvinout. Mezi nejzávažnější řadíme cévní mozkové příhody. V první kazuistice prezentujeme 27letou pacientku, která prodělala po ovariální stimulaci ischemickou cévní mozkovou příhodu. Další neurologickou komplikací je pravděpodobně zvýšená frekvence a intenzita bolestí hlavy, zejména u nemocných s migrénami v anamnéze. V druhé kazuistice popisujeme 35letou ženu, u které došlo po terapii k rozvoji komplikované migrény. Léčbou navozená hormonální fluktuace může také nepříznivě ovlivnit aktivitu a vnímavost k rozvoji některých autoimunitních chorob, včetně roztroušené sklerózy. Ve třetí kazuistice se věnujeme 37leté pacientce, u které vznikla po ovariální stimulaci první ataka roztroušené sklerózy.
Assisted reproductive techniques using hormonal ovarian hyperstimulation and intended induction of ovulation are the most important scientific and therapeutic discoveries in the treatment of sterility made over the last decades. This treatment is associated with a risk of a varied degree ovarian hyperstimulation syndrome. The aim of this review is to emphasize some neurological complications possibly resulting from ovarian stimulation. Cerebral strokes are the most important complications of ovarian stimulation. We present a case of ischemic stroke after a controlled ovarian hyperstimulation regimen in a previously healthy 27-year-old woman. An increased rate and intensity of headaches, mostly in patients with chronic migraine, is another neurological complication. In the second case report, we present a 35-year-old woman suffering from complicated migraine developed after ovarian stimulation. Treatment-induced hormonal fluctuation may have negative effect on the activity and susceptibility to autoimmune diseases, such as multiple sclerosis. In the third case report, we present a 37-year-old patient with the first attack of multiple sclerosis after ovarian stimulation.
- Keywords
- neurologické komplikace,
- MeSH
- Reproductive Techniques, Assisted * adverse effects MeSH
- Autoimmune Diseases MeSH
- Blood Chemical Analysis MeSH
- Time MeSH
- Stroke * etiology MeSH
- Diagnostic Techniques and Procedures MeSH
- Adult MeSH
- Gonadotropins agonists antagonists & inhibitors MeSH
- Contraceptives, Oral MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Migraine Disorders * etiology MeSH
- Neurology MeSH
- Ovarian Hyperstimulation Syndrome classification complications physiopathology MeSH
- Paresis MeSH
- Embryo Transfer adverse effects MeSH
- Multiple Sclerosis * etiology MeSH
- Pregnancy MeSH
- Thrombolytic Therapy MeSH
- Thrombosis MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
30 s. : il.
Iran has witnessed three major reversals of population policies since their inception in the 1960s. In response to a rapid decline in fertility to very low levels, the latest policy shift has led to the development of legislation that aims to encourage marriage and fertility, particularly the "Youthful Population and Protection of the Family" law approved in 2021. This study reviews the changes in population policy and their interrelations with fertility trends, focusing mainly on the shift towards pronatalist policies since 2005, and accompanying restriction of reproductive health and family planning services. Combining international and national sources, we position the new pronatalist drive in the country within the broader trend of government attempts to reverse fertility decline and promote conservative family values. Our study has three main aims. (1) We provide an overview of fertility trends, policy discourses and policy shifts in the context of the changes in the societal and political structures of Iran during the last half a century. (2) We highlight and discuss the most problematic features of the new Family Law, especially the legislation pertaining to maternal and reproductive health, access to abortion and contraception, and incentives supporting earlier marriage and higher fertility. (3) We discuss the likely consequences of the new legislation for maternal and child health and sexual and reproductive rights, for women in general, and the country's socio-economic disparities. As well as violating reproductive rights, the new policy is unlikely to achieve its aim of initiating a sustained rise in fertility in Iran.
Základní podmínkou pro optimální léčbu zhoubných nádorů, nejen v onkogynekologii, je přesná diagnostika onemocnění a exaktní stanovení jeho rozsahu (klinický staging). Klinický staging založený pouze na fyzikálním vyšetření je nedostatečný. Mnozí autoři proto zdůrazňují nutnost využití jedné z moderních zobrazovacích metod jako metody obligatorní v klinickém stagingu. Mezi moderní zobrazovací metody patří ultrazvuk (US), počítačová tomografie (CT), magnetická rezonance (MR) a pozitronová emisní tomografie (PET). Ultrazvukové vyšetření je základní zobrazovací metodou v onkogynekologii. V případě suboptimálního ultrazvukového vyšetření se využívají komplementárně další zobrazovací metody. Pro jejich správnou volbu je nezbytné znát možnosti, limity a případné kontraindikace daného vyšetření. Endoskopické metody (cystoskopie, rekto- nebo koloskopie) jsou indikovány až při klinickém podezření na infiltraci těchto orgánů. Využití klasických metod (intravenózní vylučovací urografie (IVU), nativní snímek břicha, irrigografie a jiné) ve stagingu je ojedinělé. V mnoha případech zapojení více diagnostických metod již neovlivní léčebný postup a vede ke zbytečné zátěži pacienta, časovému prodlení v léčbě i nadbytečným finančním výdajům. Práce se bude věnovat racionálnímu využití moderních zobrazovacích metod v diagnostice a stagingu zhoubných nádorů v gynekologii.
Precise diagnostics and clinical staging of the illness is the fundamental requirement for optimal treatment of malignant tumours, in all of oncology. Clinical staging only based on physical examination is insufficient. Many authors are therefore emphasizing the need for utilizing one of the imaging methods as obligatory during clinical staging. Those are ultrasound (US], computed tomography (CT), magnetic resonance (MR) a positron emission tomography (PET). Ultrasound is the principal method in oncogynecology. During suboptimal ultrasound examination other complimentary digital methods are used. It is important to know the capabilities, limits and even the contraindications of each examination method. Endoscopic methods (cystoscopy, coloscopy) are indicated only after clinical suspicion of infiltration of these organs. Classical methods (intravenous urography (IVU), plain abdominal X-ray, irigography and others) is quite rare during staging. In many cases engaging several diagnostic methods does not affect the therapeutic method and results in unnecessary burden for the patient, time delay for therapy and additional expenses. This project will deal with rational use of modern imaging methods in diagnostics and staging in gynaecology.
- MeSH
- Diagnostic Imaging economics methods MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Genital Neoplasms, Female diagnosis therapy MeSH
- Tomography, X-Ray Computed MeSH
- Positron-Emission Tomography MeSH
- Unnecessary Procedures MeSH
- Ultrasonography MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
The purpose of this study was to compare the midterm results of a radiological and surgical approach to uterine fibroids. One hundred twenty-one women with reproductive plans who presented with an intramural fibroid(s) larger than 4 cm were randomly selected for either uterine artery embolization (UAE) or myomectomy. We compared the efficacy and safety of the two procedures and their impact on patient fertility. Fifty-eight embolizations and 63 myomectomies (42 laparoscopic, 21 open) were performed. One hundred eighteen patients have finished at least a 12-month follow-up; the mean follow-up in the entire study population was 24.9 months. Embolized patients underwent a significantly shorter procedure and required a shorter hospital stay and recovery period. They also presented with a lower CRP concentration on the second day after the procedure (p < 0.0001 for all parameters). There were no significant differences between the two groups in the rate of technical success, symptomatic effectiveness, postprocedural follicle stimulating hormone levels, number of reinterventions for fibroid recurrence or regrowth, or complication rates. Forty women after myomectomy and 26 after UAE have tried to conceive, and of these we registered 50 gestations in 45 women. There were more pregnancies (33) and labors (19) and fewer abortions (6) after surgery than after embolization (17 pregnancies, 5 labors, 9 abortions) (p < 0.05). Obstetrical and perinatal results were similar in both groups, possibly due to the low number of labors after UAE to date. We conclude that UAE is less invasive and as symptomatically effective and safe as myomectomy, but myomectomy appears to have superior reproductive outcomes in the first 2 years after treatment.
- MeSH
- Adult MeSH
- Fertility MeSH
- Financing, Organized MeSH
- Gynecologic Surgical Procedures MeSH
- Ultrasonography, Interventional methods MeSH
- Leiomyoma surgery therapy MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Uterine Neoplasms surgery therapy MeSH
- Follow-Up Studies MeSH
- Postoperative Complications MeSH
- Prospective Studies MeSH
- Surveys and Questionnaires MeSH
- Reoperation MeSH
- Risk MeSH
- Pregnancy MeSH
- Embolization, Therapeutic adverse effects MeSH
- Pregnancy Outcome MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
How evolutionary novelties evolve is a major question in evolutionary biology. It is widely accepted that changes in environmental conditions shift the position of selective optima, and advancements in phylogenetic comparative approaches allow the rigorous testing of such correlated transitions. A longstanding question in vertebrate biology has been the evolution of terrestrial life histories in amphibians and here, by investigating African bufonids, we test whether terrestrial modes of reproduction have evolved as adaptations to particular abiotic habitat parameters. We reconstruct and date the most complete species-level molecular phylogeny and estimate ancestral states for reproductive modes. By correlating continuous habitat measurements from remote sensing data and locality records with life-history transitions, we discover that terrestrial modes of reproduction, including viviparity evolved multiple times in this group, most often directly from fully aquatic modes. Terrestrial modes of reproduction are strongly correlated with steep terrain and low availability of accumulated water sources. Evolutionary transitions to terrestrial modes of reproduction occurred synchronously with or after transitions in habitat, and we, therefore, interpret terrestrial breeding as an adaptation to these abiotic conditions, rather than an exaptation that facilitated the colonization of montane habitats.
- MeSH
- Biological Evolution MeSH
- Phylogeny MeSH
- Bufonidae physiology MeSH
- Reproduction * MeSH
- Environment * MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
Environmental stressors can be key drivers of phenotypes, including reproductive strategies and morphological traits. The response to stress may be altered by the presence of microbial associates. For example, in aphids, facultative (secondary) bacterial symbionts can provide protection against natural enemies and stress induced by elevated temperatures. Furthermore, aphids exhibit phenotypic plasticity, producing winged (rather than wingless) progeny that may be better able to escape danger, and the combination of these factors improves the response to stress. How symbionts and phenotypic plasticity, both of which shape aphids' stress response, influence one another, and together influence host fitness, remains unclear. In this study, we investigate how environmental stressors drive shifts in fecundity and winged/wingless offspring production, and how secondary symbionts influence the process. We induced production of winged offspring through distinct environmental stressors, including exposure to aphid alarm pheromone and crowding, and, in one experiment, we assessed whether the aphid response is influenced by host plant. In the winged morph, energy needed for wing maintenance may lead to trade-offs with other traits, such as reproduction or symbiont maintenance. Potential trade-offs between symbiont maintenance and fitness have been proposed but have not been tested. Thus, beyond studying the production of offspring of alternative morphs, we also explore the influence of symbionts across wing/wingless polyphenism as well as symbiont interaction with cross-generational impacts of environmental stress on reproductive output. All environmental stressors resulted in increased production of winged offspring and shifts in fecundity rates. Additionally, in some cases, aphid host-by-symbiont interactions influenced fecundity. Stress on first-generation aphids had cross-generational impacts on second-generation adults, and the impact on fecundity was further influenced by the presence of secondary symbionts and presence/absence of wings. Our study suggests a complex interaction between beneficial symbionts and environmental stressors. Winged aphids have the advantage of being able to migrate out of danger with more ease, but energy needed for wing production and maintenance may come with reproductive costs for their mothers and for themselves, where in certain cases, these costs are altered by secondary symbionts.
- MeSH
- Bacteria MeSH
- Pisum sativum MeSH
- Wings, Animal MeSH
- Aphids * MeSH
- Symbiosis MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, N.I.H., Extramural MeSH
- Research Support, U.S. Gov't, Non-P.H.S. MeSH
The quandary known as the Intracytoplasmic Sperm Injection (ICSI) paradox is found at the juncture of Assisted Reproductive Technology (ART) and 'andrological ignorance' - a term coined to denote the undervalued treatment and comprehension of male infertility. The prevalent use of ICSI as a solution for severe male infertility, despite its potential to propagate genetically defective sperm, consequently posing a threat to progeny health, illuminates this paradox. We posit that the meteoric rise in Industrial Revolution 4.0 (IR 4.0) and Artificial Intelligence (AI) technologies holds the potential for a transformative shift in addressing male infertility, specifically by mitigating the limitations engendered by 'andrological ignorance.' We advocate for the urgent need to transcend andrological ignorance, envisaging AI as a cornerstone in the precise diagnosis and treatment of the root causes of male infertility. This approach also incorporates the identification of potential genetic defects in descendants, the establishment of knowledge platforms dedicated to male reproductive health, and the optimization of therapeutic outcomes. Our hypothesis suggests that the assimilation of AI could streamline ICSI implementation, leading to an overall enhancement in the realm of male fertility treatments. However, it is essential to conduct further investigations to substantiate the efficacy of AI applications in a clinical setting. This article emphasizes the significance of harnessing AI technologies to optimize patient outcomes in the fast-paced domain of reproductive medicine, thereby fostering the well-being of upcoming generations.
Cíl studie: Práce chce podat přehled současných názorů na surogátní mateřství včetně postojů některých mezinárodních a vládních organizací a naznačit postoje významných církví. Typ studie: Literární přehled. Název a sídlo pracoviště: Reprofit International, Brno, Klinika reprodukční medicíny a gynekologie, Zlín, Klinika gynekologie a porodnictví, LF a FN Olomouc. Předmět studie: Poznatky v reprodukční medicíně za více než 20 posledních let otevřely neočekávaný, bezprecedentní zájem veřejnosti o určité aspekty lidské reprodukce spolu s požadavky, které dříve neexistovaly a které doprovázejí morální dilemata. Je však velmi nesnadné najít řešení pro etické problémy u reprodukčních technologií, které by byly přijatelné v pluralistické společnosti a ještě mnohem problematičtější je dosáhnout v těchto otázkách konsenzu. Surogátní matka je definována jako žena, která odnosí plod a porodí dítě pro další osoby, a která souhlasila s tím, že toto dítě dá pro tyto osoby k adopci. Závěr: Na evropském kongresu o lidské reprodukci v Barceloně v roce 2008 byl k surogátnímu mateřství přijat text: Společnost začíná akceptovat, že existují alternativní cesty, jak mít rodinu, a lze očekávat, že s postupem času a budou-li se zdůrazňovat pozitivní aspekty rodinného života, bude stigma náhradního mateřství mizet.
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.
In diurnal bird species, individuals breeding at high latitudes have larger broods than at lower latitudes, which has been linked to differences in the daily time available for foraging. However, it remains unclear how latitude is linked with parental investment in nocturnal species. Here, we investigate nestling provisioning rates of male Tengmalm's owls in two populations at different latitudes (Czech Republic 50 °N; Finland 63 °N) with the help of cameras integrated into nest boxes. Clutch sizes were smaller in the Czech population (CZ: 5.1 ± 0.1; FIN: 6.6 ± 0.1), but given the higher nestling mortality in the Finnish population, the number of fledglings did not differ between the two populations (CZ: 3.5 ± 0.3; FIN: 3.9 ± 0.2). Nestling provisioning patterns varied within days, over the reproductive season and between the two sites. Males delivered most food at dusk and dawn, having peak delivery rates at sun angles of -11° to -15° at both sites, and males increased the prey delivery rates with higher nestling requirements. Given the longer nights during summer in the Czech Republic compared to Finland, Czech males only showed a small shift in their delivery peak during the night from -17° in April to -14° in July. In contrast, Finnish males shifted their peak of prey delivery from -11° in April to -1° in July. Consequently, Czech males had a longer hunting time per night around midsummer when feeding young (360 min) than Finnish males (270 min). This suggests that nocturnal owl species in northern populations are constrained by the short nights during the breeding season, which can limit the number of young they can raise. Moreover, owls in northern populations are additionally constrained through the unpredictable changes in food availability between years, and both these factors are likely to influence the reproductive investment between populations.
- MeSH
- Nesting Behavior physiology MeSH
- Food MeSH
- Seasons MeSH
- Reproduction physiology MeSH
- Feeding Behavior physiology MeSH
- Strigiformes physiology MeSH
- Darkness MeSH
- Animals MeSH
- Check Tag
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
- Finland MeSH
