P-067 Correlation between Zn/Cu ratio and Bisphenol A in seminal plasma in men with varicocele

Study question

Is there a relationship between concentration of Bisphenol A (BPA), Zn contents and Zn/Cu ratio in seminal fluid and spermiogram parameters in men with varicocele?

Summary answer

Our results document correlations between BPA, Zn/Cu and sperm motility. We found that the negative effect of BPA can be attenuated by higher Zn/Cu levels.

What is known already

A range of environmental factors including organic endocrine disruptors affects spermatogenesis. Bisphenols are endocrine disruptors often used in production of plastics. BPA is an endocrine disruptor with negative effects on reproduction. Presence of BPA also induces production of reactive oxygen species with negative impact on spermatogenesis. Zinc and copper are trace elements important for human spermatogenesis. Zn and especially the ratio of Zn/Cu are good parameters of the antioxidant potential of seminal plasma. The relationship between BPA levels, Zn concentration and Zn/Cu ratio with human sperm parameters is still unclear.

Study design, size, duration

In this study, we evaluated correlation between BPA concentration, Zn concentration and ratio of Zn/Cu in seminal plasma in relation to sperm concentration, number of spermatozoa, total motility, progressive motility, morphology and DNA fragmentation. A total of 123 nonsmoking patients aged 18 - 45 (average 28) years with varicocele were included in this prospective study from 2019 to 2021.

Participants/materials, setting, methods

All the men signed an informed consent and agreed with analyses. Ethical Committee of University Hospital Brno approved analyses. Seminal plasma was collected after centrifugation. BPA was determined by the LC-MS/MS method (liquid chromatography-tandem mass spectrometry). The concentrations of Zn and Cu were measured by inductively coupled plasma mass spectrometry (Agilent 8900 ICP-MS/MS). Statistical evaluation was performed using Spearmen test (p = 0.05). The relationship between parameters was expressed by Spearman's correlation coefficient (ρ).

Main results and the role of chance

Analytical examination of seminal fluids detected presence of BPA in 89 samples (72.3 % of all samples analysed with average value 0.1627 ng/ml). In 18 samples, the concentration was under the level of detection and in 16 samples under the level of quantification. Zn was detected in all 123 patients with average concentration 139.44 µg/ml. The Zn/Cu ratio was calculated with average value 1.73. Subsequently, individual parameters of spermiogram plus DNA integrity were assessed. In case of BPA, negative correlations were found between BPA concentration and total motility (p = 0.010) and progressive motility (p = 0.012). Similarly, positive significant correlations between Zn/Cu ratio and total motility (p = 0.032) and progressive motility (p = 0.028) were found. For Zn concentration, we found positive non-significant correlation with total motility (p = 0.144) or progressive motility (p = 0.147). There were non-significant correlations between the BPA, Zn/Cu ratio or Zn and other parameters. Similarly, for BPA and Zn/Cu ratio a non-significant positive correlation was found (p = 0.157) and neither significant correlation was found between BPA and Zn (p = 0.452). In several cases we observed normal progressive and total motility in patients with high BPA concentrations together with high Zn/Cu ratio which probably has a protecting effect from the high BPA levels.

Limitations, reasons for caution

A limitation for this study is the final number of patients analysed in this study, which slightly reduced the power of statistical analysis. Currently, more analyses focused on detection of BPA in seminal plasma are being carried out in order to obtain sufficiently larger data set.

Wider implications of the findings

In this study, BPA was detected in 72 % of analysed samples. Our first results indicate a higher sensitivity of spermatozoa to BPA presence in seminal fluid, affecting mainly their motility. Interestingly, a higher Zn/Cu ratio is potent to reduce partially the negative impact of BPA on human spermatozoa.

Trial registration number

Supported by Czech Health Research Council (NV18-01-00544 and NV18-08-00291) and MH CZ – DRO (FNBr, 65269705). Jana Navratilova was supported by the Czech Ministry of Education, Youth and Sports (CZ.02.2.69/0.0/0.0/19_074/0012727). Authors also thanks to Research Infrastructure RECETOX RI (No LM2018121) financed by the Ministry of Education, Youth and Sports, and Operational Programme Research, Development and Innovation - project CETOCOEN EXCELLENCE (No CZ.02.1.01/0.0/0.0/17_043/0009632) for supportive background.

Uterine microbiome and endometrial receptivity

OBJECTIVE

Structure and correct function of endometrium is necessary for embryo implantation, pregnancy development and childbirth. It is a result of many factors - anatomical and histological structure, hormonal effects and signalling pathways at the molecular genetic level. A little known phenomenon is the presence of microorganisms on the endometrium. Traditionally, the uterine cavity was considered sterile, but new findings have been changing this view fundamentally. The aim of this work is to present new findings on endometrial microbiome and its importance for embryo implantation and development.

DESIGN

Review article.

SETTING

Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno; Department of Obstetrics and Gynecology, University Hospital Faculty of Medicine, Palacky University Olomouc.

METHODS

PubMed was searched for articles in English indexed until 30th June 2018 with terms of „uterine microbiome analysis“ and „endometrial receptivity“.

RESULTS

The vital information on bacterial colonization of endometrium brought new diagnostic methods for their detection based on ribosomal RNA analysis in 16S subunit, which are capable of detection and exact identification of bacteria that cannot be detected by classical cultivation methods. The endometrial microbiome is assumed to modulate the function of endometrial cells and local immunity system, it prevents growth of pathogenic microorganisms by its presence and production of protective substances.

CONCLUSION

Endometrial microbiome seems to be important factor of endometrial receptivity.

[Medroxyprogesteron acetate use to block LH surge in oocyte donor stimulation]

OBJECTIVE

To compare the results of ovarian stimulation with LH surge blockade by medroxyprogesterone acetate or GnRH antagonist in oocytes donors. To present current options of exogenous and endogenous progestins instead of GnRH analogues to block LH surge during ovarian stimulation.

DESIGN

Retrospective study of oocyte donor cycles and literature review.

SETTING

Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk university and University Hospital Brno.

METHODS

Thirteen oocyte donors (26.8 ± 2.5 years old) were stimulated with recFSH and MPA to block the LH surge during January - October 2017. The results were compared to the previous cycle stimulated with recFSH and GnRH antagonist performed during January -December 2016. Wilcoxon´s pair test was used to test the statistics. A literature search of SCOPUS was carried out.

RESULTS

In cycles with MPA blockade the average number of oocytes was 14.5 ± 5.1, in cycles with GnRH anta-gonist blockade 12.0 ± 4.5 oocytes (statistical significance p = 0.025). FSH total dose (1611 ± 327 vs. 1565 ± 322 IU), days of stimulation (9.1 ± 0.8 vs. 8.5 ± 0.9) and maximum estradiol levels (5.9 ± 2.1 vs. 6.0 ± 3.0 nmol/l) were not statistically different. Progestins are effective in blocking the LH surge during ovarian stimulation and do not affect the number and quality of collected oocytes or obtained embryos. Their adverse effect on the endometrial receptivity obstructs the embryo implantation in the same cycle. Such protocol requires total freezing and delayed transfer. Progestins can be used in a variety of stimulation protocols - progestin primed follicular phase stimulation, luteal phase stimulation with endogenous progesteron, double stimulation in follicular and luteal phase of the same cycle "duostim" in low responders.

CONCLUSION

Eggs donor ovarian stimulation with MPA resulted in more oocytes than stimulation protocol with GnRH antagonist, the total dose of FSH and the length of stimulation were similar. According to current experiences progestins effectively block the LH surge and do not affect the number and quality of collected eggs and obtained embryos. Their use opens new possibilities of ovarian stimulation protocols and their flexibility. Its main constraint is that it requires total freezing and delayed transfer.

[Fertility preserving methods in women with breast cancer before gonadotoxic therapy]

OBJECTIVE

To present current options and own experiences with ovarian stimulation in young women with breast cancer before gonadotoxic therapy.

DESIGN

Review article with own experiencies.

METHODS

Literary search, analysis of own experiences with complex therapy in women with breast cancer planning pregnancy, definitions of stimulating protocols, using methods of assisted reproduction.

SETTING

Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno.

RESULTS

Embryo and oocyte cryopreservation are important methods of fertility preservation requiring controlled ovarian stimulation before the start of chemotherapy. Current studies demonstrante effectivenes of this special stimulating protocol and did not find negative side effects such a progression of the breast cancer. Since January 2016 to June 2016 we performed controlled ovarian stimulation and oocyte retrieval in three patients with breast cancer before chemotherapy. We used short stimulation protocol with recombinant FSH, GnRH agonists and letrozole and retrieved 13, 12 and 9 oocytes. We cryopreserved 8 and 6 embryos, one woman prefered freezing of 12 oocytes. During the stimulation estradiol level did not exceed 1,6 nmol/l.

CONCLUSION

Neither the normal nor the cancerous cells in the breast react to the gonadotropins FSH, LH, nor to hCG. Conversely, there is a cellular proliferation and an increase in cancer cell lines with oestrogen receptors with exposure to oestrogen, and it is dose - dependent. The special stimulation protocol with FSH, GnRH agonists and letrozole is effective in gain of efficient amount of gamets with minimal increase of estradiole level. Current study reviews did not find higher risk of progression of breast cancer in association with ovarian stimulation. It is important to respect the recomendation of oncology committee and to effectively suppress the estradiol level.

The intracellular concentration of homocysteine and related thiols is negatively correlated to sperm quality after highly effective method of sperm lysis

The aims of this study were to determine concentrations of total homocysteine, cysteine, cysteinylglycine and glutathione in spermatozoa, seminal fluid and blood plasma and to analyse their relationships with sperm parameters. For this reason, a new highly effective method of spermatozoa lysis was developed, using methanol, freezing and subsequent thawing in ultrasonic bath. An HPLC-FD assay was conducted on thiols concentrations in lysed spermatozoa, seminal fluid and blood plasma. Concentrations of thiols in spermatozoa were significantly lower in men with normozoospermia than in samples with pathological semen parameters. Statistical analysis found significant correlations between thiol concentrations in spermatozoa and semen parameters, while the same analysis with thiol concentrations in seminal fluid was substantially less powerful. Only cysteinylglycine concentrations in seminal fluid significantly correlated with pathological semen parameters. No significant differences or correlations were found with blood plasma concentrations.

[Surgical treatment of endometriomas and ovarian reserve]

OBJECTIVE

To present an overview of affect an ovarian reserve in women after laparoscopic surgery for ovarian endometriosis.

SUBJECT

Review.

SETTING

Department of Obstetric and Gynecology, Hospital Kyjov; Department of Obstetric and Gynecology, University Hospital, Brno.

METHODS

Summary of the results of recent studies.

RESULTS

The decrease in ovarian reserve has been detected in 8 of 9 evaluated studies, specifically in one retrospective study, six prospective studies and in one systematic review, the results of the meta-analysis don´t prove the reduction of ovarian reserve after the surgery for endometrioma, reduced ovarian reserve evaluated by the antral follicle count has been proven in the affect ovary before the surgery.

CONCLUSION

Endometriosis is among the most frequent benign gynecological diseases, affecting the women in reproductive age. Laparoscopic surgery techniques are currently the method of choice in the treatment of endometriotic ovarian cysts. Excision of endometriotic cyst is associated with significant reduction in ovarian reserve. The women with previous surgery of endometrioma have significantly fewer mature oocytes capable of fertilization, the ovarian response to stimulation is reduced and the number of live births is lower.

[Current issues of reproductive medicine in the Czech Republic]

INTRODUCTION

During the 25th symposium of assisted reproduction in Brno was lunch time organised as the lunch table discussion on the selected topics of assisted reproduction. More than 150 specialists reviewed themes related to gynecology and embryology.Discussed topics: Lunch table discussion covered the following topics: (1) Cross-border health care in assisted reproduction; (2) Indication for PGS (preimplantation genetic screening) in the context of actual information; (3) Does ovarian stimulation belong to the ambulance of registering gynecologists? (4) Therapy with clomifen - only for IVF specialists? (5) How and with whom should psychological support be directed during IVF? (6) Stimulation in women with low ovarian reserve; (7) Is basic semen analyses sufficient? (8) Time-lapse systems as relevant markers of embryonic development; (9) How to be oriented with choices of media and consumables in the IVF lab, and (10) "Freeze All" - is this new trend in cryopreservation suitable for all?

CONCLUSIONS

Panel conclusions were presented during the afternoon session, which had great attendance, featured lively commentary, and produced some definitive consensus. Certain issues remained inconclusive, and these matters will be the subject of further discussion in the future. Specific summation of all deductions is presented in this paper.

Fertility status of Hodgkin lymphoma patients treated with chemotherapy and adjuvant gonadotropin-releasing hormone analogues

PURPOSE

Aim of this prospective observational study was to analyze fertility status of Hodgkin lymphoma (HL) patients treated with different types of chemotherapy while receiving GnRH analogues to preserve ovarian function.

METHODS

Fertility status was assessed among 108 females in reproductive age treated by curative chemotherapy for freshly diagnosed HL between 2005 and 2010 in university-based tertiary fertility and oncology center. All patients received GnRH analogues during chemotherapy to preserve their ovarian function. Their reproductive functions were assessed by follicle-stimulating hormone (FSH) measurement and pregnancy achievement. Ovarian function was determined separately in three groups with increasing gonadotoxicity of chemotherapy.

RESULTS

One year following the treatment, normal ovarian function was found in 89 (82.4%) of patients. Two years after chemotherapy, 98 (90.7%) of patients retained their ovarian function, and 23 (21.3%) achieved clinical pregnancy during the follow-up period. Average FSH after chemotherapy was 11.6 ± 17.9 IU/l 1 year after the treatment resp. 9.0 ± 13.8 at the 2 years interval. There were significantly more patients with chemotherapy induced diminished ovarian reserve (chDOR) among the group receiving escalated BEACOPP chemotherapy in comparison with the other types of treatment (58.1% vs. 87.9% resp. 95.5%).

CONCLUSION

The rate of chDOR is significantly higher after EB poly-chemotherapy and there is no tendency for improvement in time. The 2 + 2 chemotherapy with GnRH-a required for more advanced HL retained ovarian function significantly better after 2 years. Another important advantage of GnRH-a co-treatment is the excellent control of patient's menstrual cycle.

[Current issues of assisted reproduction in the Czech Republic]

INTRODUCTION

Participants of the lunch table discussion held during the 22nd symposium of assisted reproduction in Brno discussed some current topics of assisted reproduction. DISCUSSED TOPICS: More than 150 participants at round tables discussed 10 topics: 1. IVF in native AR cycle,2. observation of the embryo development dynamics, 3. evaluation and support of endometrial receptivity,4. increased number of elective single embryo transfers (eSET), 5. transport of gametes and embryos in the Czech Republic and between the Czech Republic and abroad, 6. National registry of assisted reproduction,7. new view on sperm pathology, 8. problems with the SAR membership records, 9. surogacy motherhood and 10. preimplantation genetic diagnosis and preimplantation genetic screening.

CONCLUSIONS

All findings were presented in the afternoon session. Some of the topics brought concrete results. Some topics could not be clearly concluded and will be the subject of further discussions. A brief summary of those discussion conclusions presents this paper.

[The new technologies for the analytical examination of the embryonic metabolome and its prospects]

OBJECTIVE

To review current technologies for the analytical examination of the embryonic metabolome and its perspectives.

DESIGN

Review article.

SETTING

Department of Gynecology and Obstetrics, Faculty of Medicine, Masaryk University, and University Hospital, Brno, Department of Biochemistry, Faculty of Science and CEITEC, Masaryk University, Brno.

METHODS AND RESULTS

Nowadays, very sensitive analytical technologies are available. They enable exact measurement of various molecules - products of embryo metabolism during first days of cultivation. The capillary electrophoresis is one of promising method. Recent studies analysed metabolic differences between embryos that result in a pregnancy and those that do not. Amino acid levels, glucose or pyruvate in the embryo culture media were analysed most frequently. However, results of these studies are ambiguous.

CONCLUSIONS

The capillary electrophoresis with contactless conductivity detection may provide a useful data of the embryonic metabolome. A comprehensive analysis of the used culture medium may represent a valuable adjunct to morphological criteria for enhanced rates of implantation and delivery.

[Ovarian tissue cryopreservation in cancer patients--six years of clinical experience]

OBJECTIVE

Presentation of clinical results and experience with this technique during past six years.

DESIGN

Original paper.

SETTINGS

Gynekologicko-porodnická klinika LF MU a FN Brno, Interní hemato-onkologická klinika LF MU a FN Brno, Department of Obstetrics and Gynecology. Hadassah University Hospital Ein-Karem, Jerusalem, Izrael.

INTRODUCTION

Ovarian tissue cryopreservation (OTC) and its future auto-transplantation becomes an alternative for patients to prevent serious damage of ovarian function by oncology treatment.

METHODS

Patient is indicated to OTC in case of high risk of ovarian failure due to planned chemotherapy and impossibility to use other oncofertility techniques. Ovarian tissue harvesting is done by laparoscopy in short-term general anesthesia. After tissue processing the samples are cryopreserved in programmable automatic freezer or by vitrification. The auto-transplantation of ovarian tissue is planned after the complete cure of patient's malignancy. Our workplace doesn't have own experience with tissue transplantation - until now cryopreserved tissue has not yet been utilized by the patients. Clinical experience with this technique gained by our team during academic stay in abroad Israeli clinic is presented.

RESULTS

During the years of 2005-2011 the OTC was performed in 19 cancer patients before chemotherapy. In majority of cases, patients suffered from blood or lymph node systemic malignancy (84%). Average age of women was 26 years. The patient set consisted of mostly nulliparous women (88%). Patient's average body mass index was 23,9 kg/m2. The length of systemic chemotherapy averaged 7.1 months. Time from fertility preservation counseling to chemotherapy was not exceeding one week (7.2 days on average). Ovarian tissue harvesting was conducted by laparoscopic surgery in all cases. The length of surgery did not exceed 60 minutes and no surgical complications were observed. The case of ovarian tissue transplantation performed on abroad university settings is discussed.

CONCLUSION

In the consensus of with international guidelines OTC is offered to patients with high risk of ovarian failure doe to cytotoxic oncology treatment. Research in the field of oncofertility is focused on the techniques of in-vitro folliculogenesis in retrieved ovarian tissue.

[New methods increasing assisted reproduction results]

OBJECTIVE

The brief review of historical development and application of the assisted reproduction methods at our centre and the recent methods increasing the assisted reproduction results. The new mentioned methods are sperm selection before the intracytoplazmatic sperm injection (PICSI = preselected sperm intracytoplasmic injection) and continuous embryo development monitoring.

DESIGN

Review article.

Combination of fertility preservation strategies in young women with recently diagnosed cancer

BACKGROUND/AIMS

The study describes clinical management and outcomes of currently available fertility preservation techniques in a set of 154 young female cancer patients.

METHODS

Patients in reproductive age with newly diagnosed cancer were offered embryo or oocyte cryopreservation, ovarian tissue cryopreservation and the administration of GnRH analogues during chemotherapy. Particular attention was given to the technical aspects and clinical application of these fertility preservation techniques.

RESULTS

During the study period (2004-2009), 154 young female cancer patients were offered fertility preservation counseling. Patient's average age was 29.4 years and average parity was 0.7 children. Administration of GnRH analogues (n = 123, 79.9%) and ovarian tissue cryopreservation (n = 15, 9.7%) were the most commonly used fertility preservation strategies. In 20 cases (16.1%), the combination of several fertility preservation techniques was offered to individually selected patients.

CONCLUSIONS

Combination of fertility preservation techniques gives young cancer patients the best chance for future fertility and should be concentrated in specialized centers.

[Oncofertility--a new trend in reproductive medicine]

Effective treatment of cancer often causes patients irreversible damage of reproductive abilities. New trend in reproductive medicine commonly described as oncofertility offers cancer patients not only infertility treatment, but also potent prevention of irreversible damage of reproductive organs and functions. Efficacious methods of women reproductive function damage prevention has been developed at Brno University Hospital Department of Obstetrics and Gynecology since year 2004. The paper describes current oncofertility techniques implemented to clinical practice--embryo and oocyte banking, ovarian tissue cryopreservation including further possibility of its orthotopic autotransplantation and administration of gonadoliberin analogues for ovarian protection. During past 6 years expert consultation before start of gonadotoxic treatment has been provided to 195 young women with newly diagnosed cancer or autoimmune disease. Attention is applied to pro and contras of previously described methods of ovarian protection in the discussion. Limitations regarding implementation of oncofertility techniques in practice are mentioned. Furthermore short recommendations regarding pre-treatment oncofertility consultation with patients are given.

[Process of women's reproductive ageing--causes, evaluation and possible clinical usage]

Women's fertility steeply decreases with increasing age, but the intensity of the decrease is individually significantly variable. The main cause of fertility drop is rapid decrease of ovarian follicle count. Deletion of ovarian follicles happens mainly by the mechanism of cell apoptosis. Nevertheless in the whole process participates also others exogenous and endogenous factors. At present new major steps in the complex ovarian ageing process has been identified and some innovative therapeutic strategies have been suggested to influence this process. At the end this paper evaluates currently available markers of ovarian reserve and its abilities to be used in routine clinical practice.

[Evaluation of the ectopic pregnancies developed after in vitro fertilisation in the Center of Assisted Reproduction CAR 01 Brno between 1988-2006]

OBJECTIVE

To review prevalence and management of ectopic and heterotopic pregnancies developed after in vitro fertilisation and embryotranfer in the Center of Assisted Reproduction CAR 01 LF MU a FN Brno in a 20-year period. An analysis of their management and therapy.

DESIGN

A retrospective analysis.

SETTING

Obstetrics and Gyneacology Department, University Hospital Brno.

METHODS

The collection of 1487 pregnancies arisen after IVF/ET cycles accomplished in the period of 1988-2006 in the Center of Assisted Reproduction CAR 01 Brno, in which the prevalence and the therapy of extrauterine and heterotopic pregnancies was observed. Also the therapeutic procedures of ectopic pregnancies and developement of heterotopic pregnancies were analysed.

RESULTS

In the follow-up file the numbers of ectopic pregnancies was 84 from 1487 (5.65%) clinical pregnancies. Heterotopic pregnancy occured in seven cases (0.47%). Both ectopic and heterotopic pregnancy rate is higher than in a common population. From the seven heterotopic pregnancies two resulted in the delivery of the intrauterine pregnancy. From the total number of 84 ectopic pregnancies 68 (88.10%) resulted in laparoscpic salpingectomy as the therapy, only nine of them (11.90%) were treated conservatively with the tube preservation.

CONCLUSION

Evaluation of the ectopic and heterotopic rate prevalence after assisted conception treatment in the Centre of Assisted Reproduction CAR 01 Brno in the period of 1988 - 2006 shows higher appearance of these complications in pregnancies, which origin is in IVF and ET as an infertility treatment.

[Sperm banking before gonadotoxic treatment--11-years experience]

INTRODUCTION

The aim of this study was to analyze possible relation of sperm pathology and diagnosis of malignant disease and present our experience of sperm banking programme for cancer patients.

DESIGN

Retrospective clinical study.

SETTING

Department of Obstetrics and Gynecology, Masaryk University, Brno.

MATERIAL AND METHODS

521 patients (age 26.0 +/- 6.7 years) were referred to our unit by oncology specialists for semen cryopreservation before cancer treatment during 1995-2005. Sperm samples obtained by masturbation were analysed according to guidelines of WHO. Cryoprotective medium and Planer Kryo F 10 were used for standard cryopreservation. National cancer register was used to analyze patients survival. Basic statistics was used for data description and relations among sperm parameters and diagnosis were tested by Kruskal-Wallis ANOVA. Standard intracytoplasmic sperm injection (ICSI) using frozen spermatozoa was used for infertility treatment following malignant disease recovery.

RESULTS

Testicular cancer was diagnosed in 45.7% patients, malignant disease of lymphatic and haemopoetic tissue in 32.0% cases--out of them 16.5% Hodgkinps lymphoma. Sperm concentration > or =20 mil/ml had 45.9% men. Severe oligospermia < or =1 mil/ml was found in 23.2% men and azoospermia in 10.0% patients. Severe asthenospermia < or =10% was in 60.8% men. Sperms were retrieved in 76.7% of 30 boys 14 to 16 years old, in 46.7% was concentration lower than 1 mil/ml and in 26.1% sperm motility lower than 1%. Sperm concentration was significantly lower in men with testicular cancer (p = 0.002), differences in sperm motility were insignificant. Cryopreserved samples were used in 30 patients (5.8%), 22 of them in our centre. Intracytoplasmatic sperm injection was used in all cases, 7 clinical pregnancies (31.8%) and 5 deliveries were achieved. In the group of all patients died 62 men (11.9%).

CONCLUSION

Cancer patients have high frequency of severe sperm pathology. The lowest sperm concentration was in men with testicular cancer. Only minority of patients return for fertility treatment. Cryopreserved spermatozoa of cancer patients are able to achieve pregnancy by assisted reproduction techniques.

[Ovarian tissue cryopreservation--an opportunity to preserve fertility in women with cancer]

Chemoterapy is one of the basic modalities of oncological therapy and usually leads to permanent consequences. Infertility is one of the most common consequences resulting from irreversible gonadal damage. The potentially effective method of reproductive function protection in women undergoing chemotherapy is ovarian tissue cryopreservation. This paper summarizes the medical and scientific knowledge in this interesting multidisciplinary medical field an also presents authors own experience with this novel and interesting method of ovarian tissue protection.

Ovarian tissue cryopreservation--new opportunity to preserve fertility in female cancer patients

INTRODUCTION

Malignant disease and the therapy are major factors that may result in complete loss of fertility. There are several strategies for fertility preservation in fertile women faced with cancer. A modern and potentially effective method of reproductive function protection is ovarian tissue cryopreservation.

MATERIALS AND METHODS

This paper summarizes the medical and scientific knowledge in this interesting multidisciplinary medical field. Furthermore, the authors' own experience with this novel and interesting method of ovarian tissue protection is presented. Ovarian tissue was obtained during laparoscopic surgery in five nuliparous women (aged 19-33) with a diagnosis of lymphoma before chemotherapy from 2004 to 2006. After laboratory preparation, tissue was frozen by a slow cooling technique and stored in liquid nitrogen.

RESULTS

In total 75 women with malignant lymphoma before chemotherapy were referred to our center for consultation--68 chose ovarian inactivation by GnRH analogues during chemotherapy, two IVF cycles with embryo or oocyte cryopreservation and five ovarian tissue cryopreservation. In these five women one to two slices of ovarian cortex from both ovaries were recovered. Totally 20 cryotubes with three pieces of tissue in each were cryopreserved. In no case was metastasis of cancer cells found by histological evaluation.

CONCLUSIONS

Cryopreservation of ovarian tissue represents an effective alternative or addition to the cryopreservation of embryos or oocytes for women at risk of premature ovarian failure due to chemotherapy. Reproductive function protection requires close cooperation between oncology departments and assisted reproduction centers.

[Long-term experience with MESA, TESE techniques in the University Hospital (FN) in Brno]

Authors evaluated the experience of application MESA, TESE and ICSI techniques during 9 years long cooperation between Department of Urology University Hospital Brno and Institulions of reproductive Medicine University Hospital Brno. 104 surgical procedures were performed during this time period and as result 24 children were born.

[Antibodies against the chlamydial heat shock protein in women with periadnexal adhesions]

OBJECTIVE

To compare and analyze IgG antibodies against chlamydial heat shock protein (cHSP60) in the blood serum of women with or without periadnexal adhesions in small pelvis.

DESIGN

Retrospective study.

SETTING

Department of Gynaecology and Obstetrics, Masaryk University, Brno, Veterinary Research Institute, Brno, Department of Clinical Microbiology, Faculty Hospital Brno.

METHODS

IgG antibodies against cHSP60 in the blood serum were detected by means of recombinant enzyme immunoanalysis ("cHSP60 - IgG - rELISA medac"). The presence of antibodies was expressed as +, ++ or +++ pozitive. Laparoscopy according to a standard procedure was performed in 76 women (age 28 +/- 43 years) from couples with fertility disorders treated in the Centre of Reproductive Medicine, Department of Gynaecology and Obstetrics. Chí-square test (programme Statcalc - EpiInfo 6) and calculation of OR value were used for statistical analysis.

RESULTS

Twenty-four women (31.6%) had normal finding in small pelvis. Periadnexal adhesions were detected in 43 (56.6%) patients, hydrosalpinx in 13 cases (17.1%), endometriosis in 27 (35.5%) patients and uterine myomas in 11 (145%) women. In the group of 33 women without periadnexal adhesions cHSP-60 antibodies were pozitive in 3 women (9.1%), in 43 women with periadnexal adhesions were pozitive in 17 cases (39.5%). In 13 patients with hydrosalpinx cHSP-60 antibodies were pozitive in 61.5%. In patients with periadnexal adhesions semiquantitative pozitivity +++ was detected in 8 cases (18.6%), 4 of them with hydrosalpinx (30.8%). Statistical analysis found significantly higher presence of cHSP-60 antibodies in women with periadnexal adhesions (OR = 654, CI interval = 1.59 - 37.81, chi-square: p = 0.0028)

CONCLUSION

Women with periadnexal adhesions have more frequent and stronger pozitivity of IgG antibodies against chlamydial heat shock protein cHSP60.

[Posthumous sperm procurement and use--ethical and legal dilemmas]

OBJECTIVE

To present a review of bioethical discussion and recommendations concerning posthumous sperm procurement and postmortem parenthood.

DESIGN

Review article.

SETTING

Department of Obstetrics and Gynecology, Masaryk University, Brno, Department of Obstetrics and Gynecology, Palacky University, Olomouc.

SUBJECT AND METHOD

Literature search in Database of Abstracts of Reviews of the Evidence (DARE) and MEDLINEplus. Posthumous sperm procurement and cryopreservation must be performed within 36 hours after death. To established appropriate medical practice, it is important to consider all stakeholders in the decision-making process: the deceased, the requesting party, the child, the physician and the society. There are only few legislative measures concerning postmortem parenthood and posthumous sperm procurement. The essential elements for postmortem reproduction are: judicial order, ethics committee approval, bereavement period of at least 6 month before use.

CONCLUSION

Posthumous sperm procurement is fraught with ethical and legal implications. All stakeholder should be considered. Society for reproductive medicine should prepare acceptable standard protocol.

Ascorbic acid and infertility treatment

AIM OF THE STUDY

To assess the ascorbic acid (AA) in the follicular fluid in women treated by in vitro fertilization and embryonic transfer levels (IVF/ET) and to analyse the influence of vitamin C supplementation on the results of infertility treatment.

TYPE OF THE STUDY

Prospective study in women treated by IVF/ET.

METHODS

The influence of vitamin C supplementation on the outcome of infertility treatment in the assisted reproduction programme in 76 women (38 of them smokers, 38 non-smokers) was studied. Half the women (19 smokers and 19 non-smokers) were administered vitamin C in daily doses of 500 mg in so-called pellets allowing for gradual release over 8 to 12 hours. The control group consisted of the same number of smokers and non-smokers. In all the women, ascorbic acid levels were determined in two urine samples (prior to supplementation and at follicle retrieval) and in follicular fluid by means of a colorimetric method. Ovarian response to hormonal stimulation with gonadotropins (hMG, FSH) at a dosage of 150-225 IU per day combined with GnRH analogues in the short (buserelin) or long (triptorelin) protocols, and 5,000-10,000 IU of human chorionic gonadotropin was evaluated based on the number of follicles created and number of retrieved oocytes. Fertilisation was assessed, based on the number of successfully fertilised oocytes (fertilisation rate) and based on the number of cultivated embryos. The success of the infertility treatment was evaluated based on the number of pregnancies.

RESULTS

Ascorbic acid levels in follicles were significantly higher (p < 0.001) in women with vitamin C supplementation than in the control group (8.98 +/- 5.09 vs. 5.04 +/- 2.85 mg/l). The administration of vitamin C during the period of hormonal stimulation showed a statistically insignificant impact in terms of the higher number of pregnancies (34.2% vs. 23.7%). Vitamin supplementation had a greater impact on the number of pregnancies in the non-smokers' group (57.9% vs. 31.6%). The pregnancy rate was significantly higher (p < 0.01) in non-smoking women than in smokers--44.7% vs. 13.2%, which appears to be a reason for asking women to cease smoking prior to infertility treatment.

[Importance of sensitization of insulin receptors in the prevention of ovarian hyperstimulation syndrome]

OBJECTIVE

Aim of our study was to analyze the influence of insulin receptor sensitization on the course of controlled ovarian stimulation in the program of assisted reproduction and to identify the availability of ovarian response improvement due to the reduced production of intraovarian androgens. Further we tried to identify the preventive influence of metformin on development of ovarian hyperstimulation syndrome.

DESIGN

Prospective randomized controlled study of 172 patients involved in the assisted reproduction program from May 2000 to December 2001.

SETTING

Centre of Assisted Reproduction, Department of Gynecology and Obstetrics, Medical Faculty, Masaryk University and University Hospital, Brno.

MATERIAL AND METHODS

Patients undergoing the ovarian stimulation with increased risk of development of ovarian hyperstimulation syndrome due to the polycystic ovarian syndrome were included in the study and randomized to two groups. (1) Women in the first group used the insulin receptor sensitizing drug metformin together with gonadotropins, and (2) women in the second group underwent the classic stimulation protocol alone. The control group (3) consisted of patients with intact ovarian function and different infertility factor. Complex hormonal status was assessed before the treatment initiation and the level of androgens in the follicular fluid was investigated in all patients.

RESULTS

Metformin during gonadotropin stimulation has significantly reduced the risk of ovarian hyperstimulation syndrome in women with PCOS. Significantly lower intraovarian androgen levels were documented in comparison to women without metformin and also when compared to patients with intact ovarian function. Metformin had also significantly reduced estradiol blood levels at the day of hCG application without significant influence on the number of obtained oocytes.

CONCLUSIONS

The risk of ovarian hyperstimulation syndrome development was significantly decreased in patients with PCOS in consequence to insulin receptors sensitization.

[Cryopreservation of sperm before neoplasm therapy--7 years' experience]

OBJECTIVE

To compare sperm count of cancer patients with health men, to analyze possible relation of sperm pathology and diagnosis of malignant disease and present experience of our cryopreservation programme for cancer patients.

DESIGN

Retrospective clinical study.

SETTING

Department of Obstetrics and Gynecology, Masaryk University, Brno, Czech Republic.

METHODS

215 patients (age 25.4 +/- 5.6 years) were referred to our unit by oncology specialists for semen cryopreservation before cancer treatment during 1995-2001. Sperm samples were analysed according to guidelines of WHO. Richardson's medium and Planer Kryo 10 were used for standard cryopreservation. Sperm count results were compared to control group of 84 men (23.1 +/- 3.6 year) examined as possible sperm donors. Program SPSS version 9 was used for statistical analysis. Standard intracytoplasmic sperm injection (ICSI) using frozen spermatozoa was used for infertility treatment following malignant disease recovery.

RESULTS

Testicular cancer was diagnosed in 115 (53.5%) patients, malignant disease of lymphatic and haemopoetic tissue in 75 (34.9%) cases--out of them 35 (16.3%) Hodgkin's lymphoma. Twelve men (5.6%) were treated for osteosarcoma and 13 for other malignant disease. Only 2.8% patients had normospermia. Severe oligospermia < 5 mil/ml was found in 73 men (33.9%) including 22 cases of azoospermia (10.2%) and 12 cases (5.6%) of cryptozoospermia. 138 (64.2%) patients had asthenospermia < 10% of progressive motility, 49 (22.8%) had terratozoospermia < 10% spermatozoa with standard WHO morphology. Sperm concentration, progressive motility and morphology were in cancer patients significantly lower (P < 0.001) than in control group. Men with testicular cancer had significantly higher frequency of severe sperm pathology. Only 4 patients have returned for assisted reproduction treatment. In all cases ICSI was used, 1 pregnancy and delivery was achieved. During more than 4 years after cryopreservation died 16.6% of patients.

CONCLUSION

Cancer patients has significantly higher frequency of severe sperm pathologies than healthy men. The most severe sperm pathologies are among men with testicular cancer. Only minority of patients return for fertility treatment. Cryopreserved spermatozoa of cancer patients are able to initiate pregnancy by assisted reproduction techniques.

Is environmental cadmium a serious hazard to Czech population?

The main objective of the study was to asses whether the environmental cadmium exposure in the Czech Republic is high enough to be able to affect significantly the human reproduction. Cadmium levels were measured in the blood and follicular fluid of 220 women in in vitro fertilization (IVF) therapy, using atomic absorption spectrometry. The mean value of cadmium in venous blood was 0.85 ng x ml(-1) with significantly higher values among smokers (1.18 ng x ml(-1), SD = 1.6, 95%CI: 0.6-1.1) as compared to non-smokers (0.46 ng x ml(-1), SD = 0.4, 95%CI: 0.4-0.6) (p < 0.0001). In all, 1518 blood-free follicles were assessed to determine cadmium residues in follicular fluid. The mean cadmium value was 0.34 ng x ml(-1) (SD = 0.45, 95%CI: 0.28-0.41). No association was found between the cadmium levels in blood and follicular fluid, and similar cadmium levels were observed in the follicular fluid of women with different smoking habits. The calculated dietary cadmium intake was similar in all our patients and had no relation to either blood or follicular cadmium levels. The follicular cadmium levels were approximately 20 times lower as compared to those found in the group of Canadian women. Our study confirmed the previous findings on the low exposure of the Czech population to environmental cadmium.

[Polymorphism of angiotensin converting enzyme (ACE) and TNF-beta genes in men with disorders of spermatogenesis--pilot study]

INTRODUCTION

The presence of components of the renin angiotensin system and tumour necrosis factor in a male reproductive tract supports the hypothesis that these substances may influence reproductive functions. It was proved that angiotensin II as a product of ACE has influence on sperm capacitation and motility. TNF-beta is released from T-lymphocytes and has the regulatory effect on steroidogenesis and spermatogenesis. Aberrations of these agents can result in infertility.

OBJECTIVE

The aim of this study was to determine the allele frequency of ACE and TNF-beta genes in men with pathological sperm count and men with normal fertility. We examined the insertion/deletion (I/D) ACE and B1/B2 TNF-beta gene polymorphic alleles and analyzed their frequency in patients and fertile men.

DESIGN

A pilot study.

SETTING

1st Clinic of Gynaecology and Obstetrics and Institute of Pathologic Physiology, Masaryk University, Brno, CR.

MATERIAL AND METHODS

The genomic DNA was isolated from peripheral blood leukocytes by a standard method according to Sambrook in a group of 46 patients (33.4 +/- 7.2 years) with pathological sperm count (9 azoospermia, 21 severe oligoasthenospermia, 16 moderate oligoasthenospermia) and in a control group of 88 healthy men (31.2 +/- 9.3 years) with normal fertility. Polymerase chain reaction (PCR) was used for genom analysis. The method according to Rigat was used for the I/D ACE polymorphism. B1/B2 TNF-beta genotype of each patient was determined after Nco I digestion of the amplified product and subsequent agrose gel electrophoresis. Fisher's exact test and chi square test were used for statistical analysis.

RESULTS

In the study we found these differences of allel frequency and their combination: 1. Combinations of the genotype II (ACE) + B1B2 (TNF-beta) and genotype II (ACE) + B2B2 (TNF-beta) were less frequent in patients (8.7%) than in fertile men (28.4%), this difference was statistically significant (p = 0.021). 2. Allele B1 (TNF-beta) was more frequent among patients (40.2%) than in the control group (29.5%), this difference was near to the point of statistical significance (p = 0.05). 3. Allele D (ACE) frequency was higher in men with pathological sperm count (52.2%) than in fertile men (44.9%), this difference was not statistically significant (p = 0.15).

CONCLUSION

The study has found different allele frequency of I/D ACE and B1/B2 TNF-beta genes polymorphism in men with pathological sperm count compared to men with normal fertility. These results could contribute to elucidate the genetic background of a male infertility.

[Analysis of factors affecting the results of assisted reproduction using a system for information mining of the SHLUK database]

OBJECTIVE

To retrospective explorating computer analysis of data about therapeutic cycles in assisted reproduction technology (ART) to confirm applicability of system for data mining SHLUK in partial analysis of fertilisation phase of therapeutic cycle. Relations between parameters of sperm count analysis and outcome of in vitro fertilisation were analyzed.

DESIGN

Retrospective analysis.

SETTING

1st Depart of Obstet. and Gynaecol., Masaryk University, Brno; FEI, VSB, Ostrava.

METHODS AND MATERIAL

Conditions of successful therapy in single phases of ART therapeutic cycles, were analysed using system SHLUK, which included a lot of methods for data mining. Analysis of relation between reasons and results in ART therapeutic cycles was done through method IMPL and method of group implication GRIMPL. Analysed file included data about 8516 therapeutic cycles ART in 4470 patients and data about 666 clinical pregnancies stored in electronical form in clinical data register. The model analysis of fertilisation tested relations between parameters of sperm analysis and outcome of in vitro fertilisation. Fertilisation rate (FR)--ratio of fertilized oocytes/obtained oocytes was evaluated as fertilisation stage outcome.

RESULTS

Significantly higher FR--60.9% was in the group with sperm concentration before preparation 41-60 mil/ml. When sperm concentration before preparation was under 10 mil/ml--FR was significantly lower--42.2%. Motility of sperm before preparation under 10%--FR was significantly lower--45.3%. Motility of sperm before preparation 41-50%--FR was significantly higher--56.9%. Significantly higher FR--minimal 56.0% was in group of examinations with sperm after preparation was 41-90%, then FR was significantly higher--53.5%. In sperm survival test, where more than 30% of sperm survive 24 hours of cocultivation with oocytes FR was significantly higher--minimal 55.9%.

CONCLUSION

Applicability of system for data mining SHLUK in the analysis of factors with influence on assisted reproduction outcome was proved. System for data mining SHLUK makes possible to define statistically significant relations between attributes of fertilisation stage of ART cycles and it is able to postulate basic hypothesis about existing reasons and results in therapeutic cycles of ART.

The outcome of infertility treatment by in-vitro fertilisation in smoking and non-smoking women

The former and current smoking habits of 159 patients treated for infertility by means of IVF/ET technique were observed. The data were verified by a cotinine examination in urine. The basal levels of gonadotropines before treatment, the process and outcome of ovarian stimulation, oocyte fertilisation and incidence of pregnancy were observed. There were no differences between smokers and non-smokers in terms of their age and professional risks; smoking correlated with a lower level of education. The overall response of active smokers to hormonal stimulation was worse than that of non-smokers: a lower number of mature follicles (12.3 vs. 16.2) and a lower number of oocytes were gained (7.3 vs. 10.9). There was a correlation between the age of the smokers and the higher consumption of FSH needed for stimulation and lower levels of 17 beta-estradiole. The number of fertilised oocytes in smokers was significantly lower (p < 0.01; 68.2% vs. 47.8%). A negative correlation between the duration of exposure to cigarette smoke and fertilisation rate was shown (p < 0.05). There were fewer embryos in smokers as compared with non-smokers (3.3 vs. 4.7). A total of 35 women became pregnant (i.e. 22.1%), of which 28.8% were non-smokers, 12.5% were occasional smokers, and none were regular smokers. The OR value in non-smokers was 1.48, and in occasional smokers 0.57. In this study, the negative influence of smoking on the outcome of treatment by IVF/ET technique was proved. The phasing out of smoking should be an integral part of human infertility treatment.

[Present possibilities of prevention of adhesions and their immunologic aspects]

The study reviews recent developments with regard to postsurgical adhesion formation, the role of some cytokines and possible prevention. Interleukin-1 beta (IL-1 beta) levels in peritoneal fluid were assayed during 24 and 48 hours after laparoscopic or laparotomic surgery and the influence of diclofenac was evaluated. IL-1 beta levels in peritoneal fluid were substantially lower after laparoscopic adnexal surgery than after laparotomy. Application of diclofenac after abdominal hysterectomies reduced substantially intraperitoneal IL-1 beta levels.

[The National Register for Assisted Reproduction: results and analysis of complications]

1. Analysis of achieved results of assisted reproduction provides evidence of a steadily increasing success of ART methods in the Czech Republic. 2. Analysis of results and complications makes it possible a) to prove optimal therapeutic procedures in different groups of patients b) to recommend preventive measures to avoid complications c) assess possible side-effects on women and the foetus.

[Treatment of pelvic endometriosis with goserelin, an LHRH agonist]

OBJECTIVE

To determine the safety and effectiveness of ZOLADEX depot (goserelin) in the therapy of endometriosis (study No. 9393CZ/0001).

MATERIAL AND METHODS

A multicentric prospective open study of 60 women with endometriosis. R-AFS score of pelvic endomemtriosis was established in patients suffering from pelvalgia, dyspareunia and dysmenorrhoea during pre-treatment laparoscopy. The effect of Zoladex depot applied subcutaneously were evaluated by gynaecological and laboratory examinations, including assessment of subjective complaints every four weeks in the course of six months. Laparoscopic check-up was carried out immediately after terminating the therapy.

RESULTS

(1) The average total score of subjective complaints decreased by 90% after 24 weeks of treatment. (2) Treatment was successful in 67% patients, i.e. laparoscopic examination showed a decrease of the R-AFS score by at least 50%. In 28% treated women visible endometrial foci disappeared completely. (3) The most frequent side-effects of therapy are associated with hypoestrogenic effects of GnRH agonists. Vasomotor instability, flushes and night hyperidrosis occurred in 93% and 90% treated women, respectively.

CONCLUSION

Goserelin acetate is a synthetic GnRH agonist suitable for safe and effective therapy of pelvic endometriosis. The administration of 3.6 mg goserelin every day for 24 weeks reduced markedly the size of endomerial foci and painful symptoms.