Objective: A review of current knowledge on the pathophysiology, dia gnostic and treatment options for chronic endometritis in infertile women. Methods and results: One of the major causes of failed in vitro fertilization (IVF) is undia gnosed intrauterine pathologies, including chronic infl ammation of the uterine mucosa - chronic endometritis. However, some authors relativize the negative impact of chronic endometritis on reproductive outcomes. The etiopathogenesis of chronic endometritis is due to qualitative and quantitative changes in the endometrial microbio me with abnormal multiplication of microorganisms naturally occurring in the uterine cavity or vagina. There is no uniform consensus on the most common pathogen causing chronic endometritis. It is characterized by infi ltration of plasma cells into the endometrial stroma outside the menstrual cycle, accompanied by hyperaemia and endometrial oedema. Clinical symptoms are very mild or absent. The diagnosis of chronic endometritis is often diffi cult because there is no specifi c clinical or laboratory dia gnostic method. The fol lowing investigative options are commonly used for the dia gnosis of chronic endometritis: dia gnostic hysteroscopy, histopathological examination of the endometrium including CD 138 immunohistochemistry and culture from the uterine cavity. However, standardised international hysteroscopic and histopathological criteria for accurate dia gnosis of chronic endometritis are still lacking. Empirically administered antibiotic therapy improves the success rate of pregnancy and delivery of a viable foetus in infertile patients with proven chronic endometritis. In addition to reviewing the current knowledge of chronic endometritis, this article discusses the importance of hysteroscopy in the dia gnostic process. Conclusion: Chronic endometritis is often a clinically silent dis ease with negative impact on reproduction in infertile women. Although there are still many unresolved issues, the introduction of hysteroscopy into the dia gnostic process is important for clinical practice; however, hysteroscopy even in combination with histological examination of the endometrium, often does not allow an unequivocal dia gnosis of chronic endometritis. Further prospective randomised studies in a selected group of women with proven chronic endometritis and repeated failure to implant proven euploid embryos should refi ne this knowledge.

INTRODUCTION:During the 30th symposium of assisted reproduction held on November 11, 2020 in Brno, the solved problems in reproductive medicine in the Czech Republic in 2020 were presented. The selected topics have concerned not only current issues in the field of clinical embryology and genetics as well as gynecology, but also legislation and ethics. Discussed topics: 1. How much time does the doctor have in the CAR (centrum of assisted reproduction) outpatient clinic per patient and how does the embryologist communicate with clients? 2. Reproduction and PGT-M in oncology patients and patients at risk with hereditary oncogenic mutations. 3. Non-invasive genetic testing of embryos from culture medium. 4. Genome editing. 5. What is the need to monitor hormonal levels in stimulation protocols? 6. Monitoring and embryo selection for transfer/kryo. 7. Is it time to change the law on donor remuneration?METHODS:The topics were prepared in advance by authorized members of our company with the task of elaborating theses, which they presented in a separate conference block. The presentation and the discussion were broadcast directly from the broadcast studio at Hotel International via an online connection. After the conference, all discussion topics and comments were incorporated.CONCLUSION:The work presents the state of the solved problems of reproductive medicine in the Czech Republic.

OBJECTIVES:To compare results after stimulation with corifollitropin alfa (Elonva) in unselected group of women entering for the first time in in vitro fertilization programme (IVF) with results from Phase III randomized trials with selected groups of women.DESIGN:Prospective study.SETTING:Sanatorium Pronatal, Praha.METHODS:40 unselected women with adequat ovarian reserve entering for the first time in IVF programme were stimulated with corifollitropin alfa and GnRH antagonists. Avarage age in the study group was 32,8 years (29-42 years), women younger then 36 and less then 60 kg received Elonva 100 µg , all others (age > 36 let, weight > 60 kg) Elonva 150 µg. Five days after egg retrieval one blastocyst was transferred (single embryo transfer - eSET). Our results were compared with the resuls in higly selected groups of women from Phase III randomized trials.RESULTS:After stimulation with corifollitropin alfa and GnRH antagonists on average 10,6 (9,2 ± 4,2) eggs could be retrieved, among them 7,3 (6,6 ± 3,9) were M II oocytes (68,9%) and fertilisation rate was 84,6%. After first embryo transfer ("fresh" embryos and embryos from "freeze all" cycles) 14 pregnancies were achieved (37,8%), three pregnancies were achieved later from transfer of frozen-thawed embryos (cumulative pregnancy rate 45,9%). There were three abortions. No severe hyperstimulation syndrom occured. Our results in unselected group of women stimulated for the first in an IVF programme with corifollitropin alfa are fully comparable with results published in randomized trials with selected group of patiens.CONCLUSION:Corifollitropin alfa in combination with daily GnRH antagonist can be successfully used in normal-responder patients stimulated for the first time in an IVF programmeKeywords: corifollitropin alfa, GnRH antagonists, ovarian stimulation, pregnancy.

Objective: To demonstrate successful restoration of ovarian function after ovarian transplantation in young woman with premature ovarian failure after gonadotoxic treatment of breast carcinoma and to discuss its possibilities.Design: Case report.Setting: Sanatorium Pronatal, Prague.Case report: We demonstrate successful ovarian transplantation and restoration of ovarian function in 33 years old woman after cryopreservation of ovarian tissue performed before chemotherapy and radiotherapy of breast carcinoma and discuss possibilities of this approach in women diagnosed with cancer and subsequent risk of ovarian silure.Conclusion: Cryopreservation of ovarian tissue is one of efficient options to preserve fertility in young patients facing gonadotoxic treatment.

The objective is to present an overview of trials and appreciate the relevant data on the effect of steroids pretreatment (oral contraceptives, 17β-estradiol and estradiol valerate) in assisted reproduction cycles. The subject of the study is to evaluate the clinical characteristics during steroids pretreatment cycles focused on the prevention of ovarian cysts, the positive contraceptive effect on the onset of regular period during long gonadotropin releasing hormone agonist protocol. In gonadotropin releasing hormone antagonist protocol the review is interested in supporting ovarian stimulation in low responders, the idea of cycle scheduling and improving treatment outcomes. The method is a review from MEDLINE/Pubmed database between 1994 and July 2012. We identified 15 randomised controlled trials (n = 3069 patients). One trail (n = 83 patients) assessed GnRH agonist protocol with or without steroids pretreatment, 8 trials (n = 1884 patients) assessed GnRH antagonist protocols with or without steroids pretreatment and 6 trials (n = 1102 patients) assessed GnRH antagonist protocols versus agonist ones with steroid pretreatment. Data demonstrates that oral contraceptives offer the effective prevention of functional ovarian cysts, the predictable onset of period during desensitisation. Existing data suggest that pretreatment with oral contraceptive pills or estradiol valerate give no advantage concerning number of oocytes or pregnancy rate. Pretreatment with oral contraceptive pills aiming to avoid weekend oocytes retrievals has to be more elucidated. In low responders oral contraceptive pill pretreatment may be beneficial in improving ovarian responses by reducing the amount of gonadotropins and the number of days required for ovarian stimulation. Current research indicates that also 17β-estradiol may be encouraging pretreatment in low responders and in cycle scheduling. This article is part of a Special Issue entitled ‘Pregnancy and Steroids’.

The guidlines are the recommendation for good laboratory practice in embryological laboratories. In this first part the requirements of the clean environment from the point of view of the oocytes, sperm, and embryos protection against infection and from point of view of the embryological laboratory staff health protection were described.

STUDY QUESTION Do the socio-demographic and fertility-related characteristics and motivations of oocyte donors differ in European countries? SUMMARY ANSWER The socio-demographic and fertility-related characteristics and motivations of oocyte donors differ considerably across countries. WHAT IS KNOWN ALREADY There have been no other international studies comparing the characteristics of oocyte donors. Regarding their motivations, most studies indicate mixed motives. STUDY DESIGN, SIZE, DURATION The proposed study was a transversal epidemiological study. Data were collected from 63 voluntarily participating assisted reproduction technology centres practising oocyte donation in 11 European countries (Belgium, Czech Republic, Finland, France, Greece, Poland, Portugal, Russia, Spain, UK and Ukraine). The survey was conducted between September 2011 and June 2012 and ran for 1-6 calendar months depending on the number of cycles of oocyte donation performed at the centre. The sample size was computed in order to allow an estimate of the percentage of a relatively rare characteristic (∼2%) with a precision (95% confidence interval) of 1%. The calculation gave 1118 donors. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 1423 forms were obtained from oocyte donors. All consecutive donors in these centres filled out an anonymous questionnaire when they started their hormonal stimulation, asking for their socio-demographic and fertility-related characteristics, their motivations and compensation. Population characteristics were described and compared by country of donation. Motives for donation and mean amount of money were compared between countries and according to the donors characteristics. MAIN RESULTS AND THE ROLE OF CHANCE The socio-demographic and fertility-related characteristics and motivations of oocyte donors varied enormously across European countries. The number of received forms corresponded with a participation rate of 61.9% of the cycles performed by the participating centres. Mean age was 27.4 years. About 49% of donors were fully employed, 16% unemployed and 15% student. The motivation in the total group of donors was 47.8% pure altruism, 33.9% altruism and financial, 10.8% pure financial, 5.9% altruism and own treatment and finally 2% own treatment only. About 15% of the donors were egg sharers (patient donors), mainly from the UK and Poland. Women were donating for the first time in 55.4% of cases, for the second time in 20.3% and for the third time in 12.8%. The motivation to donate was significantly related to being of foreign origin (P < 0.01), age (P < 0.001), living in couple or not (P < 0.01), level of education (P < 0.001) and number of donations (P < 0.001). The amount of compensation differed considerably between centres and/or countries. The general donor profile in this study was a well-educated, 27-year-old woman living with her partner and child who mainly donated to help others. LIMITATIONS, REASONS FOR CAUTION The selection of clinics in some countries and the limited participation rate may have led to a bias in donor characteristics. A possible effect of social desirability in the answers by the donors should be taken into account. WIDER IMPLICATIONS OF THE FINDINGS The diversity of the donor population reflects the differences in European legislation (for example, on anonymity and payment) and economic circumstances. The differences in systems of reimbursement/payment demonstrate the need to have a thorough discussion on the specific meaning of these terms. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the European Society for Human Reproduction and Embryology. The authors declare no conflicting interests.

OBJECTIVE:To evaluate the benefits and possibilities of the native cycle and/or minimal stimulation with subsequent use of methods of in-vitro fertilization.TYPE OF STUDY:Overview.SETTING:Pronatal, sro, Prague.METHODS AND RESULTS:Native or modified cycles with minimal stimulation now experiencing a renaissance, mainly due to the onset of antagonists of gonadoliberines. Except for the standard controlled ovarian hyperstimulation protocols we use for acquiring of oocyte other different methods - free native cycles, ovulation induction with antiestrogens and/or adding the minimum doses of gonadotropins. Concomitant use of antagonists prevents premature peak of luteinizing hormone, that was previously characteristic for these procedures. Native cycles we can use virtually for all the factors of infertility. Pregnancy rate per cycle is about 17%, but the cumulative pregnancy rate after three consecutive cycles reaches over 30%.CONCLUSION:Native cycle and its current modifications and subsequent in vitro fertilization offers the benefit of minimal consumption of drugs and the practical absence of side effects. It is characterized by short duration, lower price and the possibility of repetition each month. Virtually eliminates the occurrence of multiple pregnancies. Its efficiency is however limited and is characterized by a high number of cancellations. The cumulative pregnancy rate per embryo transfer is comparable with pregnancy rate of conventional stimulation protocols.

AIM OF THE STUDY:To assess the PGD results in couples with robertsonian and reciprocal translocations.DESIGN:Retrospective study.SETTING:Sanatorium Pronatal, Prague, accredited IVF unit.METHODS:94 infertile couples with translocation (44 couples with robertsonian and 50 couples with reciprocal translocations) were included in the study. The mean woman's age was not different: 33 +/- 4,4 in robertsonian vers. 33 +/- 3.9 in reciprocal translocations. The performance of FISH probes in specific cases was tested on patient's lymfocytes before the treatment was started. After ovarian stimulation (recombinant FSH or hMG + GnRH agonist, "long" protocol) and transvaginal oocyte pick-up, embryo biopsy of a single cell was performed 72 hours after fertilization. After blastomere fixation, translocated chromosomes + chromosomes 13, 18, 21, X and Y were tested using FISH. The maximum of two embryos euploid for detected chromosomes were transferred, supernumerary euploid embryos were frozen.RESULTS:From the total number of 629 embryos, 126 embryos (21.9%) were detected as normal or with balanced translocation--25.2% (68/270) in couples with robertsonian and 16.4% (59/359) with reciprocal translocation. Embryotransfer was performed in 30 cycles (68.2%) in robertsonian and 27 (54%) in reciprocal translocations. 24 pregnancies were achieved--15 (39% per cycle and 50% per ET) for robertsonian and 9 (19% per cycle and 33% per ET) for reciprocal translocation--this difference was statistically significant (p = 0.033). Only one pregnancy in each group ended as abortion.SUMMARY:IVF is a valuable option for couples with infertility problems and translocation. This technique allows in short-term a conception and delivery of a healthy baby with general better prognosis for couples with robertsonian translocation.

OBJECTIVETo compare clinical and embryological characteristics in donor cycles triggered for final oocytes maturation with Pregnyl 10 000 IU i.m. versus triptorelin 0.2 mg s.c. in the same patients in two sequential stimulation cycles. The aim of the study is to decrease the risk of the development of ovarian hyperstimulation syndrome (OHSS) at high response donors by the replacement of Pregnyl 10 000 IU i.m. vs. triptorelin 0.2 mg s.c. The administration of a single dose of gonadotropin-releasing hormone agonist (triptorelin 0.2 mg s.c.) induces release of LH from the pituitary gland similarly to a spontaneous LH surge.SUBJECTProspective cross-over trial.SETTINGSanatorium Pronatal, Praha.SUBJECT AND METHODFrom August 2009 to July 2010 we analysed 24 stimulation cycles in 12 egg donors treated with GnRH antagonist protocol with recombinant FSH (follitropin beta). We identified patients with more than 15 follicles during examination by transvaginal ultrasound. When at least 3 leading follicles reached 17 mm in diameter we administrated Pregnyl 10 000 IU i.m. for final oocytes maturation and triptorelin 0.2 mg s.c in the subsequent treatment cycle.RESULTSThe primary outcome measure was number of oocytes, proportion mature oocytes and fertilized oocytes. The secondary outcome were duration of FSH stimulation, total dose of gonadotropins and mean daily dose of gonadotropins. Data was analysed by paired t-test. We retrieved 17.2 +/- 8.6 vs. 15.8 +/- 5.3 (ns) oocytes, 12.6 +/- 7.3 vs. 13.0 +/- 5.4 (ns) metaphase II oocytes, proportion of metaphase II oocytes (%) was 73 vs. 83 (ns), number of fertilized oocytes 11.5 +/- 6.7 vs. 11.7 +/- 4.5 (ns), fertilization rate (%) 91 vs. 90 (ns) in Pregnyl's vs. triptorelin's group, resp. Duration of FSH stimulation (days) 12.2 +/- 0.8 vs. 12.4 +/- 0.7 (ns), total dose of gonadotropins (IU) 1744 +/- 277 vs. 1740 +/- 276 (ns), mean daily dose of gonadotropins (IU) 238 +/- 43 vs. 221 +/- 36 (ns), were not statistically different in both groups.CONCLUSIONSNumber of mature oocytes and subsequent embryonic cleavage is comparable to standard hCG treatment. There are no differences in clinical and embryological characteristics in both groups. Only one patient with administration of Pregnyl 10 000 IU i.m. was treated for OHSS grade II by vaginal paracentesis. Administration of triptorelin 0.2 mg s.c. is a safe and effective approach to achieve mature oocytes in egg donation programme, where we do not take care of implantation, which has got some limitations based on several studies.

OBJECTIVE:To present an overview of trials and discussion focused on the clinical characteristics of recombinant gonadotropins compared with urinary ones in ovulation induction.SUBJECT:Review article.SETTING:Sanatorium Pronatal, Prague.SUBJECT AND METHOD:The subject of the study is to compare the clinical characteristics of recombinant gonadotropins versus urinary ones focused on the daily dose of FSH achieving FSH threshold and the risk of multifollicular development in ovulation induction before intrauterine insemination, number of follicles and oocytes, the risk of ovarian hyperstimulation syndrome (OHSS), total consumption of FSH, cost effectiveness and expected pregnancy rate during in vitro fertilization technique. The method is a MEDLINE research of articles from 1994 to 2010.CONCLUSIONS:Data demonstrates that recombinant FSH (rFSH) offers higher ovarian response, less consumption of gonadotropins, lower risk of complications (multiple pregnancy and OHSS) compared with urinary FSH (uFSH). Expected pregnancy rate is probably comparable.

OBJECTIVE:To evaluate the results of single embryo transfers, on a set of patients, for a given period of time.DESIGN:Retrospective study.SETTING:Pronatal Sanatorium, Prague.METHODS:Between January 2008 and May 2010, we evaluated the results of all cycles with single embryo transfers in our workplace. There were four groups of patients: the first group with elective single embryo transfers (ESET, n=147), the second group with only a single embryo transfer without selection (SET n=269), the third group with transfer of one embryo derived from the native cycle (NC, n=70) and the last group with transfer of only one embryo examinated by preimplantation genetic diagnosis (PGD, n=104). All patients were monitored by age, length of cultivation of embryos, clinical pregnancy rate/transfer (CPR/ET), pregnancy loss (AB) and baby take home rate (BTR). Statistical evaluation was performed using the chi square test.RESULTS:The group with ESET achieved a significantly higher success rate (50% CPR/ET, p<0.001) compared to the other groups: 22% for SET, 7% of spontaneous cycles and 18% after PGD. A significant difference (p<0.001) was also apparent in the evaluation of BTR: ESET 41%, 16% SET, NC 4%, 12.5% of PGD. Patients that made ESET were significantly younger (p<0.001) compared to the other monitored groups (32.9 ESET, SET 35.2, NC 39.6, 39.1 PGD).CONCLUSION:We consider that assisted reproduction is only successful with the birth of one healthy child. For women 38 years old or younger the most successful treatment is to transfer a single high quality embryo and to therefore eliminate multiple pregnancy. The age of a woman and the quality of the embryo are major prognostic factors.

OBJECTIVE:To present an overview of trials and discussion focused on the diagnostic value of hysterosalpingography in the diagnosis of tubal disease.SUBJECT:Review article.SETTING:Sanatorium Pronatal, Prague.CONCLUSIONS:Hysterosalpingography may be a screening test for tubal patency. Data demonstrates high specificity of hysterosalpingography for diagnosis of proximal tubal occlusion or hydrosalpinx and low sensitivity in cases with peritubal adhesions. Routine use of diagnostic laparoscopy should be delayed for asymptomatic women. It is expected hysteroscopy and transvaginal hydrolaparoscopy for asymptomatic women may decrease indications for diagnostic laparoscopy with complete visualization of the pelvic cavity.