Záková J

Prevention of ovarian function damage by a GnRH analogue during chemotherapy in Hodgkin lymphoma patients

BACKGROUND Frequent negative consequence of chemotherapy (CHT) is ovarian damage and premature ovarian failure (POF). Aim of this prospective case-control study is evaluation of GnRH analogue (GnRH-a) administration to patients with Hodgkin lymphoma (HL) during CHT and prevention of ovarian damage depending upon CHT regimen. METHODS Study group consists of 72 patients in fertile age (18-35 years) with HL diagnosis treated in 2004-2005 by curative CHT together with GnRH analogue (Triptorelin) administration according to a standardized protocol. Patients were divided into three groups according to the stage of disease and treated by three types of CHT regimens (A,B,C) with increased cytotoxicity. Ovarian function of all patients was assessed by gonadotrophin levels (FSH, LH) analysis from peripheral blood before treatment and also 6 and 12 month after it. The number of women with POF after CHT in study group was compared with control group (n = 45, age 18-35 years) of patients treated in 2002-2003 according to the same protocol but without protective GnRH analogue application. RESULTS In study group with GnRH analogue administration during CHT, there was significantly (P < 0.001) fewer cases with POF 6 and 12 month after the end of CHT (37.5% and 20.8%, respectively) than in control group (73.3% and 71.1%, respectively). Comparative analysis depending on cytotoxicity of CHT regimen used showed significant differences in percentage of patient with acquired POF between study and control group only in less aggressive CHT protocols. CONCLUSIONS Study showed a significant reduction of ovarian failure risk in women with HL treated with less aggressive CHT regimens plus a GnRH analogue.

Survival and infertility treatment in male cancer patients after sperm banking

OBJECTIVE To evaluate the relationship between sperm pathology and cancer diagnosis, determine the mortality rate, and evaluate the outcomes of the use of frozen sperm from the sperm bank. DESIGN Prospective study. SETTING University fertility center. PATIENT(S) A total of 619 male patients were referred for sperm freezing before gonadotoxic therapy from 1995 to 2006. INTERVENTION(S) Semen analysis, data verification in the National Oncologic Register, assisted reproduction technologies, and statistical evaluation. MAIN OUTCOME MEASURE(S) Cancer diagnosis and sperm pathology analysis, survival of patients, and infertility treatment success. RESULT(S) Malignant testicular cancer was diagnosed in 43.6% of patients, and malignant neoplasms of the lymphatic and hematopoietic tissues were found in 31.7% of patients. Azoospermia or severe oligospermia (<or=1 million/mL) was detected in 9.7% and 22.6% of patients, respectively. To date, 32 patients (5.2%) sought infertility treatment. Cryopreserved semen was used in 28 couples (87.5%), and 44 intracytoplasmic sperm injection (ICSI) cycles resulted in 13 pregnancies. In total, 74 deaths (11.9%) were reported, 61 of them (82.4%) within 30 months of the cryopreservation of their sperm. CONCLUSION(S) A significant number of patients survived. Intrauterine insemination and ICSI with cryopreserved sperm resulted in deliveries.

Intraindividual variability of homocysteine and related thiols concentrations in follicular fluid

PurposeTo determine intraindividual variability in concentrations of homocysteine and related thiols in follicular fluids of particular follicles after ovarian stimulation and assess the differences between follicles with/or without oocytes.MethodsHPLC-FD analysis of plasma and follicular fluid cysteine, homocysteine, cysteinylglycine and glutathione in women undergoing IVF.ResultsIn blood plasma, the homocysteine, cysteine, and cysteinylglycine concentrations decreased significantly during stimulation with rec FSH (p < 0.001). We found significant differences in concentrations of cysteine and glutathione between follicles with or without retrieved oocytes. High intraindividual variability in concentrations of thiols was determined.ConclusionsThe concentration variability of thiols between single follicles is very high and we recommend mean at least from 3 follicles with/or without oocytes for characterization of each woman. It is the best to examine individual follicles for further research and analysis of fertility outcomes.

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.

Analysis of male and female smoking in women pregnant after IVF/ET

Former smokers had significantly lower effects of their infertility treatment using the IVF methods. Treatment of current smokers was compleetely unsuccessful.