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Objective: Presentation of rare complication following the assisted reproduction at a patient after cesarean section and bilateral salpingectomy., Design: Case report., Settings: Department of Obstetrics and Gynaecology, Regional Hospital Liberec, a. s.; Department of Obstetrics and Gynaecology, Palacky University Hospital, Olomouc., Observation: Pregnant woman, 26-years old, primiparous, with history of cesarean section and bilateral salpingectomy, was referred from the assisted reproduction centre to solve suspicion of molar intrauterine pregnancy. This diagnosis was settled on the basis of ultrasound scan of uterine cavity and high level of human choriogonadotropine. Instrumental revision of uterine cavity was performed, however there was not consequently demonstrated any histological prove of the pregnancy tissue in uterine cavity and decrease of human choriogonadotropine values. The verifying ultrasound examination was made and then the suspicion of ectopic pregnancy on the right side of the uterus was expressed. Laparoscopy diagnosed ectopic pregnancy localized in the right broad ligament. It was treated by exstirpation of the pregnancy tissue., Conclusion: The diagnosis of ectopic pregnancy should be based on personal history, human choriogonadotropine level assessment and pelvic ultrasound examination. Although it´s important to evaluate all the components globally, ultrasound examination is in a majority of cases the most important part for setting the right diagnosis.

Background: Assisted reproduction, as well as pregnancy itself, in patients with breast cancer or other hereditary type of cancer, is a widely discussed topic. In the past, patients treated for breast cancer were rarely involved in the discussion about reproductive possibilities or infertility treatment. However, current knowledge suggests, that breast cancer is neither a contraindication to pregnancy, nor to assisted reproduction techniques. On the contrary, assisted reproduction and preimplantation genetic diagnosis methods might prevent the transmission of genetic risks to the fetus., Aim: In this review we summarize data concerning pregnancy risks in patients with increased risk of breast cancer. In addition, we introduce current possibilities and approaches to fertility preservation prior to assisted reproduction treatment as well as novel methods improving the safety of fertility treatment. In the second part of this review, we focus on karyomapping--an advanced molecular genetic tool for elimination of germinal mutations in patients with predisposition to cancer. Moreover, the rapid development of preimplantation genetic diagnosis methods contributes to detection of both chromosomal aneuploidy and causal mutations in a relatively short time-span.

Design: Case report., Setting: Departement of Obstetrics and Gyneacology, Silesian Hospital in Opava., Methods: Case interpretation., Conclusion: Heterotopic pregnancy after spontaneous conception is diagnosed with a rare, often difficult to ascertain, however, the increasing incidence has justified its place in the differential diagnosis of acute abdominal not only for women enrolled in the program of assisted reproduction.

Objective: Obesity and overweight negatively affect the ability of women to conceive naturally, contributes to the increased incidence of obstetric complications during pregnancy and affect the outcome of assisted reproduction techniques (ART). The aim of our study was to compare the results of treatment of infertilityin a group of infertile women undergoing ART, depending on the values of BMI and changes in levels of selected hormones and markers of oxidative stress in follicular fluid., Design: Retrospective comparative study., Setting: Faculty of Medicine in Pilsen, Charles University in Prague; Institute of Reproductive Medicine and Endocrinology, IVF Centers - Prof. Zech, Plzeň., Methods: The studied group consisted of 44 women (mean age of 31.9 years, SD = 4.35) treated for infertility at the Institute of Reproductive Medicine and Endocrinology - IVF Centers Prof. Zech. Women were divided into 2 groups according to BMI (37 women had normal BMI, 7 women were overweight). Prolactin, free T3 and T4 hormone, homocysteine, malondialdehyde, glutathione peroxidase, total antioxidant capacity and total protein were analyzed in the follicular fluid both groups. Only blood free samples were studied after pooling of all FF samples of each patient., Results: We observed significantly lower levels of glutathion peroxidase in the group of overweight women(p = 0.0044). The pregnancy success rate with women with normal BMI and overweight women did not differ significantly from each other (p = 0.4430)., Conclusion: Our study did not confirm the negative effect of obesity on the results of treatment of infertility, specifical-ly pregnancy rate in a group of infertile women undergoing treatment with assisted reproduction techniques.

This review article provides information on the impact of HIV-1 on male reproductive functions. HIV-positive patients of reproductive age with now a long-term prognosis may wish to have children. If only one partner is infected, natural conception brings the risk of virus transmission. The article reviews the reproduction possibilities for HIV-positive couples and explains the ways to reduce the risk of transmitting the virus to the healthy partner or a child. Assisted reproduction techniques, especially intrauterine insemination, in vitro fertilization and intracytoplasmic sperm injection in combination with sperm washing can successfully reduce the risk of HIV transmission. Current trends and dilemmas of infertility treatment in HIV-positive couples are discussed.

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.

Improvement in early diagnostics and treatment options led to an increase in the number of young oncological patients in reproductive age. These young oncological patietns have life-long consequences of treatment, such as infertility, early menopause and sexual dysfunctions. There is the possibility of maintening fertility by assisted reproduction methods. So far, ovarian stimulation followed by ICSI and cryopreservation of embryos seem to be the most successful method. Unfortunately, this method is suitable only for patients with a stable partner where there is no risk of delay because of necessary stimulation of ovulation. For patients without a partner, it is possible to freeze stimulated oocytes. Cryopreservation of immature oocytes followed by in vitro maturation seems to be a very promising method. Freezing ovarial tissues followed by transplantation is at this point only an experimental procedure. The authors present their experience with in vitro maturation of oocytes of 28 women with pregnancy rate 14.3%. Twenty-seven cases of infertility with a high risk of ovarial hyperstimulation syndrome and one case of breast cancer patient before chemotherapy were chosen for IVM.

The therapy of serious organ damages in systemic connective tissue diseases and systemic vasculitis often requires the use of cytostatics. The serious adverse events associated with such therapy include irreversible damage to the foetal gonadal tissue. Unlike in the case of other fast proliferating tissues of the human body, damage to the ovaries is mostly irreversible, due to the predetermined number of ovarian follicles at birth. Destruction of follicles causes primary ovarian insufficiency and the subsequent sterility with climacteric syndrome symptoms. The issue of preserving ovarian function has not yet been fully resolved. The paper provides an overview of current options for the preservation of reproductive functions in women undergoing cytostatic therapy which include modern techniques of assisted reproduction and new methods of pharmacological protection of the ovaries using gonadoliberin analogues.

Fertilization treatment is established therapy of infertility in the cases, where other approaches have failed or were impossible. In eating disorders, majority of fertility problems has been secondary and so fully reversible if appropriately treated. Fertilization treatment should not be used in patients refusing the psychological treatment of the illness. In patients in active phase of the illness fertility treatment at fertility are contra-indicated. Two cases of negative impact of fertility treatment in patients with anorexia nervosa are presented.

Objective: A retrospective study of data, with an analysis of bio-social factors and the incidence of birth defects in the children born out of pregnancy resulting from assisted reproduction in the Czech Republic in the period from 1995 to 2002. Also, the objective was to analyse these factors in comparison with a group of children born during the same period after spontaneous conception., Data Source and Methods: The data were obtained from the National Health Registers, the administration of which has been entrusted to the Institute of Health Information and Statistics of the Czech Republic (IHIS CR). Specifically, the National Register of Birth Defects and the National Register of Neonates were used. Groups of children born after spontaneous conception and after assisted reproduction were analysed. We analysed the frequency of pregnancy, the gestation week at birth and birth weight, the incidence of immaturity at birth, hypotrophy, hypertrophy, the incidence of birth defects in prenatally and postnatally diagnosed cases and the mortality rate during the 1st year of life., Results: In the period 1995-2002, a total of 731,617 children were born in the Czech Republic. During the same period, a total of 14,243 children were born after assisted reproduction. A statistically significant higher (p<0.0001) proportion of the children born out of multiple pregnancies (40% in the assisted reproduction group as compared with 1.7% in the spontaneous conception group) was identified. The overall mortality rates (early neonatal mortality and infant mortality) are significantly influenced by the number of children within a pregnancy, and as a consequence of the unfavourable distribution in the assisted reproduction group (statistically significant higher representation of children from multiple pregnancies), the rates are higher in the assisted reproduction group., Conclusion: The frequencies of children born with a birth defect in the assisted reproduction group and in the group of other born children were not statistically significant. The differences in mortality rates, birth weights and the gestation week are caused by the unfavourable demographic distribution in the assisted reproduction group.

Objective: To analyse psychological development of children born after assisted reproductive technology., Design: Psychological analysis of the child's development related to the technology of assisted reproduction, length of pregnancy and multiple birth was performed and compared with the control group., Setting: Institute for the Care of Mother and Child, Prague., Methods: Out of the total number of 123 children born after assisted reproductive technology during the 1st half of the year 1998 in the Center ISCARE IVF, psychological development was evaluated in 109 children (88.6%). Ninety four children from this sample were assessed using mental, motor and behavior scales of the Bayley Scales of Infant Development II., Results: Mental and motor development of infants born after intracytoplasmatic injection (ICSI) and after in-vitro-fertilisation (IVF) was not significantly different. Fullterm singletons born after assisted reproductive technology did not differ from control fullterm children. There was a developmental delay in both fullterm and preterm children from multiple pregnancies in comparison to control children. No child had serious impairment of psychic functions (developmental index <50). There were no significant differences in behavior records between children born after assisted reproductive technology and control children, but some parents had problems in educational care of their children born after assisted reproductive technology., Conclusion: From children born after assisted reproductive technology, those from multiple pregnancies may be at risk for later psychological development. The occurrence of educational problems in assisted reproductive families indicates a need of accessible professional care in this field.

Objective: We describe a case of 23 years old woman who, with a history of car accident at the age of 11 and severe head injury, attended our Center of Reproductive Medicine complaining of primary infertility. The accident preceded menarche and the development of inner genitalia (uterus 46 mm, cervix:corpus ratio 1:1) as well as secondary sexual development was not fully accomplished. Ovarian failure was accompanied by amenorrhea, if not substituted. Under replacement therapy regular menstruation was established. Basal hormonal levels was extremely low (FSH and LH 0.2-0.3 IU/l, PRL 0.5 ng/ml, estrogens 0.08 nmol/l, PRGE was not detected). With oral administration of micronized estradiol (Check et al., 2001) endometrial thickness of 9 mm was achieved. All of five retrieved oocytes were fertilized with partner sperm (normospermy) and three embryos were transferred. Already the first attempt was successful. Patient suffered with transitional anorexia and vomiting which could be handled conservatively. Hormonals level were normal. Patient substituted with Hydrocortison and Euthyrox. On January 2, 2003 the pregnancy was finished by caesarian section, one week before the delivery term (girl, 2970, Apgar score 10-10-10)., Design: Case report., Setting: Center of Reproductive Medicine, Zlin., Conclusion: This care report demonstrates that recent progress in assisted reproduction field enables to manage successfully even exceptional pathological conditions.