Endometrial receptivity and window of implantation – secret of concieving?

U postupku in vitro fertilizacije i prijenosa zametka kontrolirana stimulacija jajnika gonadotropinima dovodi do suprafiziološkog porasta koncentracije steroidnih hormona u folikularnoj i luteinskoj fazi menstruacijskog ciklusa. Takav izmijenjeni hormonski status utječe na funkcionalne te morfološke karakteristike endometrija i kaskadu aktivacije molekularnih medijatora koji definiraju razdoblje receptivnosti endometrija u ciklusu liječenja, poznato kao „implantacijski prozor“. Brojna dosadašnja istraživanja nisu u potpunosti razjasnila ovaj jedinstveni događaj u reprodukciji ljudske vrste. Potrebna su daljnja istraživanja molekularnih medijatora koji sudjeluju u implantaciji kako bi se usavršio postupak IVF/ET i povećala učinkovitost liječenja neplodnosti postupcima medicinski pomognute oplodnje.In the process of in vitro fertilisation and embryo transfer, the controlled ovarian stimulation with gonadotrophins leads to the supraphysiological increase of steroid hormone concentration in the follicular and luteal phase of the menstrual cycle. Such altered hormone levels significantly affect the morphological and functional characteristics of the endometrium in the treatment cycle and the activation cascade of the molecular mediators that define the preiod of the endometrial receptivity, known as the „implantation window“. Until today, the number of previous studies have not fully clarify this unique event in the human reproduction. Further researches are needed to reveal new molecular mediators involved in the implantation in order to optimise the IVF/ET procedures and to maximize the effectiveness of infertility treatment in assisted reproduction

Polycystic Ovary Syndrome Phenotypes and Infertility Treatment

The polycystic ovary syndrome (PCOS) includes different clinical, endocrine, metabolic, and morphological criteria in women of reproductive age and consequently different health risks in later life of a woman. Controversy and debates related to diagnostic criteria are constant and current worldwide. As a result of many proposals for PCOS diagnostic criteria, clinicians recognize four phenotypes of PCOS. PCOS is a frequent cause of infertility with an overall prevalence of 5–15% and counts for approximately 70% of all cases of ovulation disorders. There are many aspects of studying differences between PCO phenotypes and problems in infertility treatments. Ovulation induction is often used to treat anovulatory patients with PCOS, but many of these women fail to conceive and the next step in the treatment is assisted reproduction. The contribution of oocyte health to reproductive potential varies and largely depends on the PCOS phenotype and comorbidities associated with PCOS. Contrary to the previous one, PCOS phenotype is not significantly associated with the morphological quality of oocytes. It seems that a combination of hyperandrogenism and chronic anovulation is associated with a negative impact on the cumulative pregnancy rate in medically assisted reproduction

Endometrial receptivity and window of implantation – secret of concieving?

U postupku in vitro fertilizacije i prijenosa zametka kontrolirana stimulacija jajnika gonadotropinima dovodi do suprafiziološkog porasta koncentracije steroidnih hormona u folikularnoj i luteinskoj fazi menstruacijskog ciklusa. Takav izmijenjeni hormonski status utječe na funkcionalne te morfološke karakteristike endometrija i kaskadu aktivacije molekularnih medijatora koji definiraju razdoblje receptivnosti endometrija u ciklusu liječenja, poznato kao „implantacijski prozor“. Brojna dosadašnja istraživanja nisu u potpunosti razjasnila ovaj jedinstveni događaj u reprodukciji ljudske vrste. Potrebna su daljnja istraživanja molekularnih medijatora koji sudjeluju u implantaciji kako bi se usavršio postupak IVF/ET i povećala učinkovitost liječenja neplodnosti postupcima medicinski pomognute oplodnje.In the process of in vitro fertilisation and embryo transfer, the controlled ovarian stimulation with gonadotrophins leads to the supraphysiological increase of steroid hormone concentration in the follicular and luteal phase of the menstrual cycle. Such altered hormone levels significantly affect the morphological and functional characteristics of the endometrium in the treatment cycle and the activation cascade of the molecular mediators that define the preiod of the endometrial receptivity, known as the „implantation window“. Until today, the number of previous studies have not fully clarify this unique event in the human reproduction. Further researches are needed to reveal new molecular mediators involved in the implantation in order to optimise the IVF/ET procedures and to maximize the effectiveness of infertility treatment in assisted reproduction

Serous borderline tumor of the fallopian tube presented as hematosalpinx: a case report

BACKGROUND: Compared with their ovarian counterparts, serous borderline tumors of the fallopian tube are uncommon, with limited experience about their clinical behaviour. We present a case of serous borderline tumor of the fallopian tube with unusual presentation and summarise all the published cases to date. CASE PRESENTATION: A case of serous borderline tumor of the fallopian tube in a 34-year old patient is presented, incidentally found during routine gynecologic examination. At laparoscopy the tumor was unusualy presented as hematosalpinx and was treated by salpingectomy. Cell-cycle analysis of the tumor tissue revealed a diploid DNA content and a low S-phase fraction. There was no evidence of the disease during the follow-up period of 4.6 years. CONCLUSION: The current case and review of the literature suggest salpingectomy as the optimal treatment for patients with serous borderline tumor of the fallopian tube

FERTILITY PRESERVATION, ASSISTED REPRODUCTION AND MALIGNANT DISEASE

Sažetak Cilj rada: Prikazati suvremeni pristup očuvanja plodnosti u sklopu liječenja malignih bolesti te suvremene metode u uporabi i njihovu kliničku vrijednost. Metode: Pregledom objavljene literature u radoblju od 1985.- 2006. godine i online baza podataka sagledane su problematika očuvanja plodnosti u bolesnika oboljelih od malignih bolesti, metode očuvanja plodnosti, njihova klinička vrijednost te mogućnosti primjene u našim uvjetima. Rezultati: Maligna bolest sve je češća u mlađim životnim dobima, a učestalost preživljenja je sve veća. Istovremeno je u porastu i učestalost rađanja u starijim životnim dobima žena, kada i učestalost raka u populaciji raste. Maligna bolest i njeno liječenje mogu rezultirati smanjenom plodnošću, što ovisi o mnogim čimbenicima kao što su: vrsta lijeka, veličina i lokalizacija radijacijskog polja, doza, gustoća doze, način primjene (oralno ili intravenozno), dob, spol, kao i plodnost bolesnika prije liječenja. Rano sagledavanje mogućnosti utjecaja na plodnost u sklopu liječenju malignoma i informiranje bolesnika, ključni su za predlaganje i planiranje metode za očuvanje plodnosti. Krioprezervacija sjemena i zamrzavanje embrija dvije su najuspješnije metode u očuvanju plodnosti. Konzervativni kirurški pristup kao i transpozicija ovarija izvan polja zračenja također mogu očuvati plodnost u sklopu liječenja određenih malignoma. U ovom trenutku sve ostale metode treba smatrati eksperimentalnima. Iako su podatci ograničeni, izgleda da nema povećanog rizika od recidiva maligne bolesti povezanog s metodom očuvanja plodnosti i trudnoćom. Nema ni dokaza da maligna bolest, njeno liječenje ili zahvati u sklopu očuvanja plodnosti povećavaju rizik od kongenitalnih anomalija u potomaka. Zaključak: Krioprezervacija sjemena i embrija najuspješnije su metode očuvanja plodnosti u muškaraca i žena oboljelih od malignih bolesti. Donošenje zakonskih propisa te izrada kliničkih smjernica temelj su za sustavnu primjenu ovih metoda na nacionalnoj razini.abstract Aim: To show modern aproach in perserving fertility during cancer treatment, modern methods in use and their clinical value. Methods: Systematic review of the literature from 1987 to 2005 was performed including a search of online databases to study modern aproach in perserving fertility during cancer treatment, methods in use and their clinical value, and possibility of their implementation regarding our current conditiones. Results: Malignat disease is becoming more common in population of young women and survival rate is higher. At the same time, birth incidence is shifted to the older women population when the incidence of the cancer is increast. Malignant disease and its treatment may result in decreast fertility, which depends on many factors like: drug or size/location of the radiation field, dose, doseintensity, method of administration (oral versus intravenous), disease, age, sex and pretreatment fertility of the patient. To preserve the full range of options, fertility preservation approaches should be considered as early as possible during treatment planning. Sperm cryopreservation and embryo cryopreservation are the two most successful methods in perserving fertility. Conservative surgical approach and transposition of ovaries outside radiation field may also perserve fertility during treatment of some cancers. At the time, all other methods should be considered investigational. Although the data is limited, it seems that there is no increased risk of disease recurrence connected with the method of fertility perservation or pregnancy. There is no evidence that malignant disease, its treatment or methods of perserving fertility increase the risc of congenital anomalies in the progeny. Conclusion: Sperm cryopreservation in men and embryo cryopreservation in women are the most successful methods of perserving fertility in men and women undergoing treatment for cancer. Development of guidelines thogether with quality legal solutions are crucial for their implementation on the national level

PREGNANCY AND DELIVERY OUTCOME AFTER ASISTED REPRODUCTIVE TECHNOLOGY

Sažetak Cilj: Utvrditi tijek i ishod trudnoća nakon 22. tjedna gestacije u žena koje su rodile tijekom desetgodišnjeg razdoblja u našoj ustanovi, a začele su klasičnom in vitro fertilizacijom (IVF/ET) ili intracitoplazmatskom injekcijom sjemena (ICSI). Metode: Provedeno je retrospektivno pretraživanje računalne baze podataka koja se odnosi na tijek trudnoća i poroda 30 553 hospitaliziranih žena u našoj ustanovi u desetgodišnjem razdoblju. Skupina žena koja je zanijela nakon MPO (N = 102) uspoređena je s općom populacijom hospitaliziranih žena. Rezultati: Tijek trudnoća u žena koje su začele nakon MPO bio je obilježen znatno češćim komplikacijama već od prvog tromjesečja trudnoće i nadalje. Elektivni i hitni carski rez kao način dovršavanja trudnoće i poroda znatno je češće odabran u ovoj skupini. Zaključak: Ovim istraživanjem utvrdili smo višestruke razlike u tijeku trudnoća začetih nakon postupaka potpomognute oplodnje i načinu dovršenja poroda u odnosu na spontano začete trudnoće, stoga je ova skupina trudnica i rodilja rizična, te zahtijeva drugačiji pristup u nadzoru trudnoće, kao i planiranje vremena i načina porođaja.Abstract Aim: The aim of our study was to compare pregnancy and labor outcome of IVF/ET – ICSI pregnancy after 22 weeks of gestation with those spontaneous conceived and delivered in our hospital during ten years period. Methods: The study included 102 IVF/ICSI pregnant woman delivered in our hospital during ten years period and 30 553 pregnancies from the registry of the hospital as control parturient population. Maternal databases were retrospectively analised and compared. Results: The pregnancy outcome after assisted reproductive technology was complicated including first trimester of pregnancy, also. Pregnancy and delivery was terminated more freqently as elective or urgent caesarean section. Conclusion: In our study we found a number of significantly differences between IVF/ICSI and general population pregnancies and delivery. Those pregnancies and delivery are high-risk and management should be different from general population

Pregnancy and delivery outcome in young and older primigravidae

Cilj istraživanja: Utvrditi i usporediti ishod trudnoće i poroda na početku i pri kraju reproduktivne dobi. Materijal i metode: U istraživanje je uključeno 59 prvorotkinja mlađih od 18 godina i 233 prvorotkinje starije od 35 godina, koje su rodile u našoj ustanovi tijekom dvogodišnjeg razdoblja (od 2006. do 2007. god.). Podaci su prikupljeni retrospektivno, pretraživanjem medicinske dokumentacije i rađaoničkog protokola hospitaliziranih rodilja. Rezultati: U starih prvorotkinja značajno je povećan broj medicinskih zahvata u trudnoći kao i učestalost komplikacija u trudnoći (36,48% vs. 16,94%, p<0,05). U starih prvorotkinja značajno je češća i učestalost operativnog dovršenja poroda carskim rezom (23,60% vs. 8,47%, p<0,05) iako nije uočena značajna razlika u nepravilnostima rađanja. Mlade prvorotkinje znatno češće rađaju uz epiduralnu analgeziju (32,20% vs. 25,32%, p<0,01). Ne postoji značajna razlika u trajanju gestacije, u srednjoj vrijednosti rodne mase, niti razlika u Apgar score novorođenčadi. Zaključak: Mlade i stare prvorotkinje su rizične skupine rodilja koje zahtijevaju posebnu opstetričku skrb i planiranje načina rađanja. Negativan učinak životne dobi na ishod trudnoće jače je izražen u starijih prvorotkinjaAim: Tto determine and compare the frequency of the risk of pregnancy and delivery outcome at the beginning and ending of reproductive age. Methods: The study included 59 nulliparous adolescents younger than 18 years and 233 nulliparous women 35 years and older in the period of two years (2006-2007). Birth records and patient files were retrospectively analised and compared. Results: In the primiparae of 35 years or more, medical interventions during pregnancy were higher, and the risk of chronic diseases which complicated their pregnancies increased (36,48% vs. 16,94, p<0,05). The incidence of cesarean section was statistically higher in pregnancies above 35 years (32,20% vs. 25,32 % p<0,01). Birth weight, APGAR scores and, incidence of premature birth, were not significantly different between groups. Conclusion: Both adolescents and women of advanced reproductive age comprise distinct groups of obstetrics patients. Each has special needs and is susceptible to different obstetric risks. Nulliparous women of 35 years and older have higher risk of negative effect of age on their pregnancies

Pregnancy and delivery outcome in young and older primigravidae

Cilj istraživanja: Utvrditi i usporediti ishod trudnoće i poroda na početku i pri kraju reproduktivne dobi. Materijal i metode: U istraživanje je uključeno 59 prvorotkinja mlađih od 18 godina i 233 prvorotkinje starije od 35 godina, koje su rodile u našoj ustanovi tijekom dvogodišnjeg razdoblja (od 2006. do 2007. god.). Podaci su prikupljeni retrospektivno, pretraživanjem medicinske dokumentacije i rađaoničkog protokola hospitaliziranih rodilja. Rezultati: U starih prvorotkinja značajno je povećan broj medicinskih zahvata u trudnoći kao i učestalost komplikacija u trudnoći (36,48% vs. 16,94%, p<0,05). U starih prvorotkinja značajno je češća i učestalost operativnog dovršenja poroda carskim rezom (23,60% vs. 8,47%, p<0,05) iako nije uočena značajna razlika u nepravilnostima rađanja. Mlade prvorotkinje znatno češće rađaju uz epiduralnu analgeziju (32,20% vs. 25,32%, p<0,01). Ne postoji značajna razlika u trajanju gestacije, u srednjoj vrijednosti rodne mase, niti razlika u Apgar score novorođenčadi. Zaključak: Mlade i stare prvorotkinje su rizične skupine rodilja koje zahtijevaju posebnu opstetričku skrb i planiranje načina rađanja. Negativan učinak životne dobi na ishod trudnoće jače je izražen u starijih prvorotkinjaAim: Tto determine and compare the frequency of the risk of pregnancy and delivery outcome at the beginning and ending of reproductive age. Methods: The study included 59 nulliparous adolescents younger than 18 years and 233 nulliparous women 35 years and older in the period of two years (2006-2007). Birth records and patient files were retrospectively analised and compared. Results: In the primiparae of 35 years or more, medical interventions during pregnancy were higher, and the risk of chronic diseases which complicated their pregnancies increased (36,48% vs. 16,94, p<0,05). The incidence of cesarean section was statistically higher in pregnancies above 35 years (32,20% vs. 25,32 % p<0,01). Birth weight, APGAR scores and, incidence of premature birth, were not significantly different between groups. Conclusion: Both adolescents and women of advanced reproductive age comprise distinct groups of obstetrics patients. Each has special needs and is susceptible to different obstetric risks. Nulliparous women of 35 years and older have higher risk of negative effect of age on their pregnancies

Inositols in the Treatment of Polycystic Ovary Syndrome in Reproductive Age

Polycystic ovary is part of an endocrine syndrome in which different pathophysiological mechanisms lead to a similar reproductive outcome: anovulation, irregularity of the menstrual cycle, and infertility. Hormonal and metabolic disorders are associated with reproductive adverse outcomes, which represent a vicious circle with dysfunctional ovaries. Hyperandrogenemia, disorder of carbohydrate metabolism, and sex hormone synthesis led to reproductive abnormalities. One of the most crucial questions still remains, whether the polycystic ovary is the cause or the consequence of all known disorders. Inositols are in the treatment of PCOS capable of restoring ovulation with the impact on the carbohydrate metabolism, by increasing the sensitivity of cells to insulin, which releases the sex hormones-binding protein and improves hyperandrogenemia. Nine stereoisomers of inositol are known, myo-inositol and chiro-inositol are the most studied in the reproductive age. By normalizing the level of androgens in the blood, the growth of and the balance of sex hormones is established. A variety of metabolic pathways of these molecules are recognized in different tissues, such as fat, muscle, or ovarian tissue. Still, it is not clear which isomer has better reproductive or metabolic effects, and there are controversies about their effectiveness in the treatment of reproductive disorders