KUMULATIVNA STOPA TRUDNOĆA OSTVARENA NAKON PRIJENOSA ZAMETAKA U SVJEŽEM CIKLUSU I PRVOM NAREDNOM CIKLUSU S ODMRZNUTIM ZAMETCIMA: JE LI VRIJEME ZA PROMJENU PRAKSE?

The aim: was to clarify parameters that contribute to successful pregnancy outcomes from one oocyte retrieval cycle with the least procedure steps. Methods: This retrospective study included 42 stimulated IVF cycles with fresh embryo transfers (fresh ET) and the subsequent 42 frozen embryo transfer cycles (FET) performed between January 2012 and December 2015. Results: The observed clinical pregnancy rate of 21.4% in stimulated cycles with fresh embryo transfers was significantly lower compared with the pregnancy rate of 52.4% in cycles with thawed embryo transfers (p=0.015) indicating impaired endometrium quality in stimulated IVF cycles. Most of the patients (78.6%) failed to achieve pregnancy after fresh ET, but more than half of them (57.6%) succeeded to achieve pregnancy after FET. The cumulative pregnancy rate after fresh ET and the first subsequent FET was 73.8% per initiated cycle. Conclusion: The results suggest that not only the presence of supernumerary good-quality blastocysts but also a receptive endometrium is needed for a successful IVF outcome. Our findings suggest that ovarian stimulation protocol had an impact on the pregnancy rate in the fresh cycle and that a better chance of conceiving was after FET. Thus, IVF outcomes can be improved with a better embryo transfer strategy.Cilj rada je razjasniti parametre koji pridonose uspješnom ostvarivanju trudnoće iz jednog započetog postupka prikupljanja jajnih stanica uz najmanji broj postupaka koji slijede. Metode: U retrospektivnu studiju uključeno je 42 stimulirana IVF ciklusa s prijenosom svježih zametaka (“svježi ET”) i 42 ciklusa prijenosa kriopohranjenih zametaka (“FET”) učinjenih između siječnja 2012. i prosinca 2015. Rezultati: Zabilježena je značajno niža stopa kliničkih trudnoća (p=0,015) nakon prijenosa svježih zametaka u stimuliranim ciklusima (21,4 %) u usporedbi sa stopom trudnoća nakon prijenosa odmrznutih zametaka (52,4 %) što ukazuje na smanjenu kvalitetu/receptivnost endometrija u stimuliranim IVF ciklusima. Ukupna, kumulativna stopa trudnoća nakon “svježeg ET” i FET postupka iznosila je 73,8 % po započetom ciklusu. Zaključak: Rezultati ukazuju da je osim kvalitetnih blastocisti za uspješnost IVF postupka nužan i receptivni endometrij. Uočen je utjecaj protokola stimulacije jajnika u svježem ciklusu na stopu trudnoća i veća uspješnost začeća nakon FET postupka. Stoga bi se uspješnost IVF postupka mogla poboljšati boljom strategijom prijenosa zametak

Follicular fluid vascular endothelial growth factor is associated with type of infertility and interferon alpha correlates with endometrial thickness in natural cycle in vitro fertilization

The aim of this study was to analyse the presence of vascular endothelial growth factor (VEGF) and interferon alpha (IFN-α) in the follicular fluid (FF) and their possible influence, as pro-angiogenic or anti-angiogenic factors, on in vitro fertilization outcome. The concentrations of VEGF and IFN-α were correlated with oocyte and embryo quality, concentrations of hormones in the serum, perifollicular blood flow and endometrial thickness. VEGF was detected in all FF samples (median 706.6 pg/ml, range 182.9-6638 pg/ml). IFN-α was detected in 60% of the samples (median 6.5 pg/ml, range 0-79.4 pg/ml), while in 40% of the samples its levels were below the test detection limit. VEGF and IFN-α concentrations did not correlate with the cause of infertility, concentrations of FSH, LH, E2 and prolactin, oocyte or embryo quality. Significantly higher concentrations of VEGF have been found in women with primary compared with secondary infertility (p = 0.011, Mann Whitney test). The concentrations of VEGF and IFN-α did not correlate with the resistance index (RI) on days of hCG administration, follicular aspiration and embryo transfer. However, the concentrations of IFN-α correlated with endometrial thickness on the day of embryo transfer (Spearman correlation coefficient ρ = 0.4107; P < 0.05) but not on days of hCG administration and follicular aspiration. The mechanism of VEGF association with the previous ability of having a child needs to be clarified in future studies. The results of this study indicate a possible role of IFN-α in pathways of endometrial remodelling

CONSERVATIVE TREATMENT OF CERVICAL PREGNANCY Review and case report

Cervikalna trudnoća je najrjeđi, ali i najopasniji oblik ektopične trudnoće. U prošlosti se cervikalna trudnoća liječila kirurškim metodama koje su često završavale histerektomijom. Danas se u terapiji cervikalne trudnoće primjenjuju konzervativne medikamentozne metode. Najčešće korišten lijek je metotreksat. Prikazana je 33-godišnja nulipara koja je primljena u Kliniku zbog klinički i ultrazvučno dijagnosticirane cervikalne trudnoće u 6. tjednu amenoreje. Unutar cerviksa nađen je embrionalni odjek od 4 mm, s pozitivnom srčanom akcijom, a betahCG bio je 9970 IU/L. Započeta je terapija metotreksatom 75 mg iv u infuziji na koju se nadovezala terapija Leukovorinom. Ista terapija je ponavljana 8. i 17. dan. Nakon prve doze betahCG je porastao na 12650 IU/L i potom je kontinuirano padao do 33. dana kada je bio 52,6 IU/L. Pacijentica je 36. dan otpuštena iz bolnice, dva tjedna kasnije je klinički i ultrazvučni nalaz uredan, a betahCG negativiziran.Cervical pregnancy is a rare but very dangerous site of ectopic pregnancy. In the past cervical pregnancy was treated by various surgical methods that often ended with hysterectomy. Today cervical pregnancy is treated conservatively, mainly with local or systemic application of methotrexate. We present a case of 33 years old nullipara who was admitted to our department with clinical and ultrasonographic finding of cervical pregnancy in 6 weeks of gestation. Inside the cervix we found the gestational sac with the embryonic echo 4 mm with positive heart beats. The betaHCG level was 9970 IU/L and we started with administration of methotrexate, 75 mg iv in infusion followed by Leucovorin. The same therapy was given on Day 8 and Day 17. After the first dose of methotrexate betaHCG was higher (12650 IU/L) followed by a continious drop until Day 33 when was 52,6 IU/L. The patient was discharged from the hospital on day 36 and two weeks thereafter had normal clinical and ultrasonographic findings and negative betaHCG

Modification of conservative treatment of heterotopic cervical pregnancy by Foley catheter balloon fixation with cerclage sutures at the level of the external cervical os: a case report

<p>Abstract</p> <p>Introduction</p> <p>Conservative treatment of a heterotopic cervical pregnancy was performed with a modification of the fixation of a Foley catheter at the level of the external cervical os, followed by the ligature of the descending cervical branches of the uterine arteries and systemic methotrexate application.</p> <p>Case presentation</p> <p>A 34-year-old Caucasian woman was diagnosed with double gestation after 6 weeks of <it>in vitro </it>fertilization treatment. A gynecological examination and color Doppler ultrasound scan revealed intra-uterine and cervical gestational sacs both containing live fetuses. A Foley catheter balloon was inserted into the cervical canal, inflated and fixed by a cerclage suture at the level of the external cervical os, followed by ligation of the descending cervical branches of the uterine arteries. Systemic methotrexate was applied. Three days after removal of the Foley catheter, an evacuation of the intra-uterine gestational sac was performed. Hemorrhage from the implantation site was controlled immediately and a pregnancy termination was successfully performed. The procedure was uneventful and our patient was discharged with a preserved uterus.</p> <p>Conclusions</p> <p>Conservative treatment of cervical pregnancy using a Foley catheter balloon is more efficacious if the Foley catheter balloon is attached in the correct position with a cerclage suture at the level of the external os, followed by ligation of the descending cervical branches of the uterine arteries, thereby exerting maximal pressure on the bleeding vessels.</p