# Potpomognuta oplodnja > Potpomognuta oplodnja > Zakoni o medicinski potpomognutoj oplodnji (MPO) >  linkovi na teme iz stručnih časopisa - molim ne postati

## pino

Hjela bih započeti temu gdje ćemo skupljati teme iz stručnih časopisa ili sličnih autoritativnih izvora (ne o politici, već samo statistike, stručne studije, pravna mišljenja i slično)

http://humrep.oxfordjournals.org/cgi...full/25/6/1361

*Cross border reproductive care in six European countries*

*Hum. Reprod. Advance Access  originally published online on March 26, 2010                  * 
 Human Reproduction 2010 25(6):1361-1368;  doi:10.1093/humrep/deq057 



> BACKGROUND: The quantity and the reasons for seeking cross border  reproductive care are unknown. The present article provides a  picture of this activity in six selected European countries  receiving patients.   METHODS: Data were collected from 46 ART centres, participating  voluntarily in six European countries receiving cross border  patients. All treated patients treated in these centres  during one calendar month filled out an individual  questionnaire containing their major socio-demographic  characteristics, the treatment sought and their reasons for  seeking treatment outside their country of residence. 
>   RESULTS: In total, 1230 forms were obtained from the six countries:  29.7% from Belgium, 20.5% from Czech Republic, 12.5% from  Denmark, 5.3% from Slovenia, 15.7% from Spain and 16.3% from  Switzerland. Patients originated from 49 different countries.  Among the cross border patients participating, almost  two-thirds came from four countries: Italy (31.8%), Germany  (14.4%), The Netherlands (12.1%) and France (8.7%). The mean  age of the participants was 37.3 years for all countries  (range 21–51 years), 69.9% were married and 90% were  heterosexual. Their reasons for crossing international  borders for treatment varied by countries of origin: legal  reasons were predominant for patients travelling from Italy  (70.6%), Germany (80.2%), France (64.5%), Norway (71.6%) and  Sweden (56.6%). Better access to treatment than in country of  origin was more often noted for UK patients (34.0%) than for  other nationalities. Quality was an important factor for patients  from most countries. 
>   CONCLUSIONS: The cross border phenomenon is now well entrenched. *The  data show that many patients travel to evade restrictive  legislation in their own country, and that support from their  home health providers is variable.* There may be a need for  professional societies to establish standards for cross  border reproductive care.

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## pino

Zanimljiva studija na seoskom stanovništvu u Palestini. 205 tek vjenčanih parova koji namjeravaju zatrudniti bilo je praćeno tokom 12 mjeseci da se vidi kolika je prirodna stopa plodnosti i koliko im treba do začeća. Ova populacija nije imala seks prije braka (religiozni i kulturni faktori). Dob žene je u prosjeku bio 22 godine, a muškarca 28 godina. *71% je zatrudnilo u prvih 6 mjeseci, a 13.4% nije zatrudnilo u godinu dana.* 

http://humrep.oxfordjournals.org/cgi...bstract/deq133

*Fecundability among newly married couples in agricultural villages  in Palestine: a prospective study*


* Hum. Reprod. Advance Access published online on June 2, 2010                    * 
Human Reproduction,  doi:10.1093/humrep/deq133 



> BACKGROUND: The validity of studies on fecundability in Western  countries has been questioned. The complexity of societal and  cultural factors makes it difficult to dissect pure  biological impact. Our aim was to assess couple fecundability  in a population which to a large degree is unaffected by the  same socio-cultural influences.   METHODS: We conducted a prospective study on time-to-pregnancy (TTP),  with a complete follow-up between 2005 and 2007, among 205 newly  married couples in two Palestinian agricultural villages. The  couples had never had premarital sex and all planned to become  pregnant. We followed the couples from the date of marriage until  pregnancy was recognized by a pregnancy test, or at maximum 12  months. 
>   RESULTS: Overall fecundability was 0.17. Unexpectedly, cycle  fecundability increased during the first cycles from 0.16  (cycle 1) to 0.25 (cycle 5), after which the expected decline  started. The initial increase in fecundability was  restricted to couples with teenage brides. A total of 70.7%  of the couples conceived within 6 cycles, 13.4% did not  conceive during follow-up. Prolonged TTP was associated with  the oldest age category for both genders. Educated women appeared  to be highly fecund. 
>   CONCLUSIONS: The fecundability result is probably uninfluenced by the  societal and cultural factors seen in Western populations,  because premarital sex is a taboo in this Muslim population.  The increase in fecundability during the first months  following marriage is difficult to interpret, but could be  due to either behavioural or biological influences.

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## pino

Zanimljiva studija iz Australije na ogromnom broju IVF ciklusa - čak 34,000 - između 2004 i 2007, a istražuje koje su razlike u stopama kliničkih trudnoća (i stopama zdravih beba, definiranih kao porođajna težina > 2,500g rođene iza 37. tjedna i bez anomalija) za 4 kategorije transfera: 
1. elektivni SET - postoji više zametaka od kojih birati, a transferira se samo jedan zametak
2. nonelektivni SET - postoji samo jedan zametak za transfer (ne može se birati)
3. elektivni DET - postoji više zametaka od kojih birati, a transferiraju se dva  zametka
4. nonelektivni DET - postoje točno dva zametka za transfer (ne može se birati) 
I sve to stratificirano po godinama žene. 

*Rezultati* (% trudnoća po transferu) za mlade žene tj. <35 godina: 
1. 40%  za trodnevni transfer,  54% za transfer blastocista     ; % zdravih poroda po transferu : 38%
2. 25% za trodnevni transfer,  37% za transfer blastocista    ; % zdravih poroda po transferu : 25%
3. 49% za trodnevni transfer,  56% za transfer blastocista    ; % zdravih poroda po transferu : 21%
4. 35% za trodnevni transfer,  37% za transfer blastocista    ; % zdravih poroda po transferu : 20%

Podsjetimo se - transfer jednog zametka je u Hrvatskoj nemoguć jer se ne smiju zamrzavati zametci. A to bi bilo dobro za bebu kao što ova studija dokazuje.  

http://humrep.oxfordjournals.org/cgi...bstract/deq145 
*Transfer of a selected single blastocyst optimizes the chance of a  healthy term baby: a retrospective population based study in Australia  2004–2007*


*Hum. Reprod. Advance Access published online on June 2, 2010                    * 
Human Reproduction,  doi:10.1093/humrep/deq145




> BACKGROUND: The practice of single embryo transfer (SET) is highly  accepted by clinicians in Australia. This study investigates  whether the SET of blastocysts results in optimal perinatal  outcomes.   METHODS: This retrospective population-based study included 34 035  single or double embryo transfer cycles in women who had  their first fresh autologous treatment in Australia during  2004–2007. Pregnancy, live delivery and ‘healthy baby’ (live  born term singleton of 2500  g birthweight and survived for at least 28 days without a  notified/reported congenital anomaly) rates per transfer  cycle were compared in four groups: selective single embryo  transfer (SSET), unselective single embryo transfer (USSET),  selective double embryo transfer (SDET) and unselective double  embryo transfer (USDET). Live delivery and ‘healthy baby’  rates per transfer following SSET were further compared by  number of embryos available. The analysis was stratified by  woman's age and stage of embryo development. 
>   RESULTS: The highest rates of live delivery and ‘healthy baby’ per  transfer cycle (46.2 and 38.0%) were achieved with transfer of  a single blastocyst in women aged younger than 35 years. In  women aged younger than 40 years, SSET had a significantly higher  rate of ‘healthy baby’ per transfer cycle than did SDET  regardless of stage of embryo development. In woman aged  younger than 35 years who had SSET, there was no significant  difference in live delivery and ‘healthy baby’ rates per  transfer cycle whether two, three, four or five embryos were  available. For all of these women, SSET of a cleavage embryo had  significantly lower rates of live delivery and ‘healthy baby’  per transfer cycle compared with SSET of a blastocyst where  only two blastocysts were available. 
>   CONCLUSIONS: Consultation with the patient with respect to the advantage  of extended culture and selective single blastocyst transfer  will result in better success rates following assisted  reproductive technology treatment in Australia.

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## ina33

> Podsjetimo se - transfer jednog zametka je u Hrvatskoj nemoguć jer se ne smiju zamrzavati zametci. A to bi bilo dobro za bebu kao što ova studija dokazuje.


Znam da se ne smije postati, ali ne znam gdje da se nadovežem s informacijom koja mi se čini da ide nastavno na ovo istraživanje. U Sloveniji su mi rekli da je budućnost IVF-a SET (transfer jednog embrija) odnosno SET odmrznutog embrija. Razlozi zašto će, po Slovencima, struka ići u smjeru više zamrzavanja embrija, a ne manje zamrzavanja embrija su:

- strateški cilj smanjivanja blizanačkih trudnoća u MPO-u na oko 5%, a ne oko 20% što je sada slučaj (razlozi: zdravlje beba, veći su rizici iznašanja blizanačke trudnoće i teže (skuplje po zdravstvo) je saniranje kasnijih možebitnih posljedica za rođenu djecu, od blažih (sustav fizijatrijskog ili logopedskog ili takvo nekog praćenja), do težih));
- uočeno je da je kod nekih žena jako teško postići optimalnu usklađenost starosti embrija s fazom razvoja endometrija u stimuliranom (svježem) ciklusu. Kod nekih žena je to varijanca oko 2 dana i zato je kod njih čak i veći postotak uspjeha sa zamrznutim embrijima, jer sa svježima ne dolazi do trudnoće - neće se moći implantirati, premda su odlične kvalitete.

Ako sam out of place - molim moderatore da me izbrišu, ali ne mogu se uključiti na način pino, nemam takvog linka, imam samo riječi stručnjaka onako kako sam ih ja razumjela.

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## ina33

Ovo što sam čula odnosilo se na blastociste, znači podrazumijevalo je da su to embriji koji se prirodno selekcioniraju i prežive do 5. dana. 

Sasvim je različito od strategije koju su sad uzeli naši stručnjaci, a ta je da se uvodi dvodnevni transfer, kojoj je isto u podlozi neka logika (ne kužim koja je), vjerojatno to što je 2. i 3. dan situacija slična, a ionako ne mogu ići na blastociste, ali mora i tu bit neki članak (stranjski?) u podlozi... Pa ako neko nađe, nek zalijepi ovdje zašto bi se u zemljama restriktivnog zakonodavstva eventualno išlo na 2 day transfer, a ne na 3 day transfer...

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## Mali Mimi

Ina na VV su i lani dok nije bilo ovog zakona masovno vraćali na 2.dan, ne kužim ni ja zašto ne treći meni su npr. u Rijeci vraćali 3. dan al ovdje ne i tako skoro svima kojima nisu išli na blastice.

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## pino

Jedna stara vijest - 11.9.2008. - Njemački liječnici zalažu se za novi zakon o medicinski potpomognutoj oplodnji u Njemačkoj. "Najbolje šanse za trudnoću dobijaju se kad se može kultivirati nekih šest zametaka". 

http://www.bionity.com/news/d/86955/ 




> *Mediziner für ein neues  Fortpflanzungsmedizingesetz*
> 
>    11.09.2008 -     (dpa) Ärzte und Bioethiker fordern ein neues  Fortpflanzungsmedizingesetz, das moderne Methoden der künstlichen  Befruchtung berücksichtigt. Das zur Zeit in Deutschland erlaubte  Verfahren sei nicht mehr auf dem neuesten Stand der Wissenschaft und  gefährde damit die Gesundheit von Mutter und Kind, heißt es in dem  Gutachten, das im Auftrag der SPD-nahen Friedrich-Ebert-Stiftung von  einem Expertengremium erstellt und in Berlin präsentiert wurde.     Anzeige
> 
>  
> 
> 
>  Derzeit schreibt das Embryonenschutzgesetz von 1991 vor,  dass nur drei Embryonen künstlich erzeugt und diese dann allesamt der  Mutter eingesetzt werden. «Die Aussichten auf eine gelingende  Schwangerschaft ist aber viel größer, wenn etwa sechs Embryonen erzeugt  werden und dann nur der mit der höchsten Überlebenschance eingesetzt  wird», sagt Prof. Klaus Diedrich (Universitätsklinikum Lübeck). «Aber es  muss gesetzlich geregelt werden, was mit den überzähligen Embryonen  geschehen soll», betont Diedrich.
> 
> ...

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## gupi51

možda će vam ovo biti zanimljivo: LIJEKOVI U TRUDNOĆI

http://www.pharma.hr/download.aspx?f...%20trudnoi.ppt

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## pino

Stručne smjernice ESHRE-a o dijagnozi i tretmanima kod ponovljenih spontanih pobačaja iz 2006. : 
http://www.eshre.eu/binarydata.aspx?...0os45/2216.pdf




> Recurrent miscarriage (RM; ³3 consecutive early pregnancy losses) affects around 1% of fertile couples. Parental
> chromosomal anomalies, maternal thrombophilic disorders and structural uterine anomalies have been directly
> associated with recurrent miscarriage; however, in the vast majority of cases the pathophysiology remains
> unknown. We have updated the ESHRE Special Interest Group for Early Pregnancy (SIGEP) protocol for the
> investigation and medical management of RM. Based on the data of recently published large randomized controlled
> trials (RCTs) and meta-analyses, we recommend that basic investigations of a couple presenting with recurrent
> miscarriage should include obstetric and family history, age, BMI and exposure to toxins, full blood count,
> antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies), parental karyotype, pelvic ultrasound
> and/or hysterosalpingogram. Other investigations should be limited to particular cases and/or used within
> ...

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## pino

Ovo nije iz stručnog časopisa nego s YouTube-a, ali je fenomenalna 3D animacija (bazirana na stvarnim MRI slikama odsjeka za embriologiju University of Michigena) 

razvoj zametka u embrio (1. trimestar, od oplodnje do 56.dana razvoja (8 tjedana razvoja, 10 tjedana trudnoće), kao embrio postaje fetus)

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## gupi51

http://humrep.oxfordjournals.org/cgi/reprint/19/10/2395

jedan zanimljiv rad: An increase in the absolute count of CD56dimCD161CD691
NK cells in the peripheral blood is associated with a poorer
IVF treatment and pregnancy outcome

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## pino

Ovo je interpretacija njemackog Zakona o zastiti embrija (ESchG) direktorice instituta za kriminologiju sveucilista u Kiehlu, Monike Frommel:
http://www.kup.at/kup/pdf/6371.pdf
J Reproduktionsmed Endokrinol 2007; 4 (1): 27–33.

Da podsjetimo, njemacki zakon dopusta oplodnju svih jajnih stanica, te definira zametak (u clanku 8) kao oplodjenu jajnu stanicu od trenutka spajanja jezgri, s dokazanim potencijalom za razvoj unutar 24 sata od spajanja jezgri. Tocke 3 i 5 o kojima raspravlja ovaj clanak su sljedece:
_Članak 1, stavak 1:_
_Kaznit će se s do tri godine zatvora ili novčanom kaznom onaj tko:_ 
_3. vrati ženi više od tri zametka unutar jednog ciklusa_
_5. oplodi više jajnih stanica nego što može biti vraćeno unutar jednog ciklusa_




> A Novel Algorithm of ART in Germany by Adequate Interpretation of the German Embryo Protecting Act (Deutsches Embryonenschutzgesetz,
> ESchG). The German ESchG (from 1991) is considered one of the most restrictive ART laws according to the related 1998 and 2006 guidelines of
> the German Medical Association (Bundesärztekammer, BÄK). *This conservative interpretation is associated with an increased triplet rate and at
> the same time with a pregnancy rate which does not sufficiently reflect the quality potential of reproductive medicine in Germany. It can be
> demonstrated that the German ESchG is more flexible than expected.* § 1, 1.5 ESchG must be considered independently from § 1, 1.3 ESchG and
> should be interpreted individually and case by case. § 1, 1.3 ESchG permits the transfer of not more than 3 embryos and § 1, 1.5. ESchG intends
> the prohibition of stockpiling. The prospective evaluation of whether embryos are capable of development (ECDs) is not forbidden. This interpretation
> was discussed at the “Mannheimer IMGB-DVR Workshops 2005–2006” and adopted in the following 4-level algorithm (F. Geisthövel):
> 1. any desired number of gametes are brought together; 
> ...


Dakle, i Njemacka ima zakon koji dozvoljava individualnu procjenu broja potrebnih oplodjenih jajnih stanica u cilju dobijanja dvije blastociste i istovremeno minimizira broj zamrznutih zametaka.

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## pino

Članak o postocima subfertilnih parova koji uspiju zatrudniti spontano, izgube trudnoću i kasnije opet zatrudne: 

http://www.fertstert.org/article/S00...752-3/abstract
*Time to pregnancy after a previous miscarriage  in subfertile couples*

38 klinika u Nizozemskoj, 
5,663 subfertilnih parova
1,098 (19%) ih je zatrudnilo spontano
199 od njih (18%) je izgubilo spontanu trudnoću; 
177 je bilo uspješno praćeno tokom 24 mjeseca nakon gubitka trudnoće
95 od 177 (54%) ih je ponovo zatrudnilo za to vrijeme
86 od 95 (91%) imalo _ongoing_ trudnoću (vjerojatno iza prvog trimestra).

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## pino

Članak o tome koliko ljudi koji su koristili donirane j.s. (u Europi postupaka s doniranim j.s. 2006. bilo ispod 3% od svih postupaka) kažu ili namjeravaju reći svojoj djeci i okolini o svom biološkom porijeklu - studija iz Finske. U samo desetak godina *udvostrucio* se broj ljudi koji namjerava reci bilo djeci bilo drugim ljudima o njihovom bioloskom porijeklu. Nadam se da će i u HR sve više taj bauk nestajati. 
*Increasing openness in oocyte donation families regarding disclosure over 15 years*

http://humrep.oxfordjournals.org/cgi...bstract/deq194

oko 160 parova s 230 djece starih između 1 i 14 godina
oko 60% ih namjerava reći djeci
26% roditelja s djecom starijom od 3 godine je već reklo djeci
85% majki je već reklo drugim ljudima
83% roditelja s djecom između 1-3 godine namjerava reći u usporedbi s 44% s djecom između 13-14 godina




> BACKGROUND: Worldwide there is an increasing number of families created by oocyte donation (OD). The aim of this study was to gather information about parents' plans of disclosure to their child and to other people, as well as parents' attitudes and level of satisfaction up to 15 years after their OD treatment.   METHODS: A questionnaire with separate material for each partner was sent to all parents (167 mothers, 163 fathers) who had had a child after treatment with donated oocytes at Väestöliitto Fertility Clinics in Helsinki during 1992–2006. These parents had a total of 231 children aged 1–14 years. Parents were asked if they had told or intended to tell their child about his/her origin and how and when they had done so and about the reasons to disclose or not. Other questions were about openness towards other people, concerns about donor characteristics, counselling and feelings towards the child. 
>   RESULTS: Of the mothers, 61.1%, and of the fathers, 60.0%, had told or intended to tell the child of his/her conception. Of children over 3 years of age, 26% had already been informed. There was a statistically significant difference between parental telling in different age groups of children (_P_ = 0.011, 2). In the youngest age group (1–3 years), 83.3% of parents were inclined to disclosure compared with 44.4% in the oldest age group (13–14 years). A high proportion of mothers (86.7%) and fathers (71.0%) had told other people about the nature of their child's conception. The majority of parents did not have much concern about the characteristics of the donor. A higher proportion of the mothers (24%) compared with fathers (11%) thought that the psychological support had been insufficient. They thought that discussions with health professionals should be arranged routinely after delivery or when it was time to inform the child. 
>   CONCLUSIONS: Parents with young OD children are clearly more inclined to disclosure compared with parents with older children.

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## pino

Rezultati o provedbi postupaka MPO u Europi 2006. Hrvatske nema na popisu. 

http://humrep.oxfordjournals.org/cgi...nt/full/deq124
*Assisted reproductive technology in Europe, 2006: results generated from European registers by ESHRE*

Analiza tih rezultata na hrvatskom: http://potpomognutaoplodnja.info/ind...ike&Itemid=115

Ukupno postupaka: IVF 117 tisuća, ICSI 233 tisuća, FET 86 tisuća - rođeno više od 65 tisuća djece
Stopa uspjeha po transferu je oko 33%  (u Hrvatskoj po novom zakonu oko 26%, čak tri godine kasnije)
Stopa otkazanih postupaka je oko 14% (u Hrvatskoj po novom zakonu oko 27%, čak tri godine kasnije)





> BACKGROUND: In this 10th European IVF-monitoring (EIM) report, the results of assisted reproductive techniques from treatments initiated in Europe during 2006 are presented. Data were mainly collected from existing national registers. 
> 
> METHODS: From 32 countries, 998 clinics reported 458 759 treatment cycles including: IVF (117 318), ICSI (232 844), frozen embryo replacement (FER, 86 059), egg donation (ED, 12 685), preimplantation genetic diagnosis/screening (6561), _in vitro_ maturation (247) and frozen oocytes replacements (3498). Overall this represents a 9.7% increase in activity since 2005, which is partly due to an increase in registers (seven more countries with complete coverage). European data on intrauterine insemination using husband/partner's (IUI-H) and donor (IUI-D) semen were reported from 22 countries. A total of 134 261 IUI-H and 24 339 IUI-D cycles were included. 
> 
> 
> RESULTS: In 20 countries, where all clinics reported to the IVF register, a total of 359 110 assisted reproductive technology (ART) cycles were performed in a population of 422.5 million, corresponding to 850 cycles per million inhabitants. For IVF, the clinical pregnancy rates per aspiration and per transfer were 29.0 and 32.4%, respectively. For ICSI, the corresponding rates were 29.9 and 33.0%. After IUI-H the delivery rate was 9.2% in women below 40. After IVF and ICSI the distribution of transfer of one, two, three and four or more embryos was 22.1, 57.3, 19.0 and 1.6%, respectively. Compared with 2005, fewer embryos were replaced per transfer, but significant national differences in practice were apparent. The proportion of singleton, twin and triplet deliveries after IVF and ICSI combined was 79.2, 19.9 and 0.9%, respectively. This gives a total multiple delivery rates of 20.8% compared with 21.8% in 2005 and 22.7% in 2004. IUI-H in women below 40 years of age resulted in 10.6% twin and 0.6% triplet pregnancies.
> 
> 
>   CONCLUSIONS: Compared with previous years, the reported number of ART cycles in Europe has increased, pregnancy rates have increased marginally, even though fewer embryos were transferred and the multiple delivery rates have declined.

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## Jelena

Postala sam na općenite, budući da nisam išla do izvornika, ali evo linkam na tekst da još nije moguće optičkim metodama odrediti kvalitetu js
link

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## pino

Jelena, evo cijelog članka
http://humupd.oxfordjournals.org/cgi.../full/dmq029v1
* Predictive value of oocyte morphology in human IVF: a systematic review of the literature*

* Laura Rienzi1,*,  Gábor Vajta2 and  Filippo Ubaldi1 

*


> BACKGROUND: Non-invasive selection of developmentally competent human oocytes may increase the overall efficiency of human assisted reproduction and is regarded as crucial in countries where legal, social or religious factors restrict the production of supernumerary embryos. The purpose of this study was to summarize the predictive value for IVF success of morphological features of the oocyte that can be obtained by light or polarized microscopic investigations. 
> 
> METHODS: Studies about oocyte morphology and IVF/ICSI outcomes were identified by using a systematic literature search. 
> 
> 
> RESULTS: Fifty relevant articles were identified: 33 analysed a single feature, 9 observed multiple features and investigated the effect of these features individually, 8 summarized the effect of individual features. Investigated structures were the following: meiotic spindle (15 papers), zona pellucida (15 papers), vacuoles or refractile bodies (14 papers), polar body shape (12 papers), oocyte shape (10 papers), dark cytoplasm or diffuse granulation (12 papers), perivitelline space (11 papers), central cytoplasmic granulation (8 papers), cumulus–oocyte complex (6 papers) and cytoplasm viscosity and membrane resistance characteristics (2 papers). None of these features were unanimously evaluated to have prognostic value for further developmental competence of oocytes.
> 
> 
>   CONCLUSIONS: No clear tendency in recent publications to a general increase in predictive value of morphological features was found. These contradicting data underline the importance of more intensive and coordinated research to reach a consensus and fully exploit the predictive potential of morphological examination of human oocytes.

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## Kadauna

Evo ja opet koristim priliku da* pozdravim našeg ministra Milinovića i njegovog tajnika Golema* koji su upravo tvrdili suprotno, a to je da se može prepoznati kvalitetne jajne stanice i od dobivenih odabrati 2-3 najbolje. Očito imaju neku metodu koju svijet još ne poznaje pa ih pozivam da ga obznane ostatku svijeta. 

Isto tako p*ozdravljam sve doktore i biologe* koji u svojim bolnicama provode novi zakon na način da kažu da zamrzavaju samo jajne stanice dobre kvalitete !?

ŽIVJELA HRVATSKA!

Sorry na off topicu, ali nisam mogla odoljeti  :Razz:

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## pino

Dobar i friški članak o uzrocima spontanih pobačaja, odnosno u kolikoj su mjeri oni izazvani genestskim nepravilnostima.  Ispitali su plod nakon kiretaže tj. spontanog pobačaja za kromosomske nepravilnosti, kod tri grupe -  IVF, ICSI i spontano začeće, sve zajedno oko 400 pacijenata. Postotak kaže koliko je spontanih pobačaja bilo uzrokovano genetskim nepravilnostima (u kromosomima):

za IVF - 55.3%
za ICSI - 54.3%
spontano začeće - 48.4%
ICSI kod muškog faktora - 65.8%  (ovo nije iznenađujuće - ako spermiji imaju problema, zameci će u većem broju biti nepravilni)




> BMC Med Genet. 2010 Nov 3;11(1):153. [Epub ahead of print]
> *Chromosomal abnormalities in spontaneous abortion after assisted reproductive treatment.*
> 
> Kim JW, Lee WS, Yoon TK, Seok HH, Cho JH, Kim YS, Lyu SW, Shim SH.
> *Abstract*
> 
> ABSTRACT:
> BACKGROUND: We  evaluated cytogenetic results occurring with first trimester pregnancy  loss, and assessed the type and frequency of chromosomal abnormalities  after assisted reproductive treatment (ART) and compared them with a  control group. We also compared the rate of chromosomal abnormalities  according to infertility causes in ICSI group.
> METHODS: A  retrospective cohort analysis was made of all patients who were  referred to the Genetics Laboratory of Fertility Center of CHA Gangnam  Medical Center from 2005 to 2009 because of clinical abortion with a  subsequent dilation and evacuation (D&E) performed, and patients  were grouped by type of conception as follows: conventional IVF (in  vitro fertilization) (n=114), ICSI (intracytoplasmic sperm injection)  (n=140), and control (natural conception or intrauterine insemination  [IUI]) (n=128). Statistical analysis was performed using SPSS software.
> ...

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## pino

Zanimljiva studija iz Australije: skoro 1.000 žena bilo je pitano u bolnici o reproduktivnoj povijesti
24% je imalo problema sa začećem
26% je imalo bar jedan spontani
58% onih koji su imali problema je zatražilo pomoć liječnika, uglavnom specijalista

Od onih koji su potražili pomoć:
22% je imalo samo konzultacije, edukaciju ili testove,  
20% MPO uglavnom IVF
41% samo lijekove - najvećim dijelom samo klomifen




> *BACKGROUND* In  Australia, fertility treatment is partly or wholly reimbursable under  federal benefits schemes, without restrictions on                         age, number of treatment cycles or existing  family size. In this study, we aimed to characterize the potential need  for and                         use of fertility treatments in a  population-based cohort of young Australian women.                      
> 
> *METHODS* We conducted  structured interviews with 974 members of a cohort constructed by  tracing all female infants born at a single                         general hospital in Adelaide between 1973 and  1975. The main outcome measures were pregnancy history, difficulty  becoming                         pregnant and assistance sought to become  pregnant.                      
> 
> *RESULTS* Of 657 women  aged 30–32 who had sought pregnancy, 24% reported difficulty becoming  pregnant and 26% had lost at least one                         pregnancy. Ovulatory problems (16%) and male  fertility problems (13%) were common among those with difficulty. Over  half of                         the women who had difficulty conceiving (58%)  sought assistance, largely from specialists (53%). Consultations, tests  and                         education only were common (22%), as were  IVF/ICSI (17%). Close to a third (28%) of those seeking assistance were  treated                         only with clomiphene, as were two-thirds (67%)  of women with ovulatory problems.                      
> 
> *CONCLUSIONS* In this  study, almost a quarter of women in their early 30s reported difficulty  conceiving, and over a quarter reported pregnancy                         loss. This suggests that a significant  proportion of young women experience substantial difficulties becoming  pregnant. Our                         findings highlight the need to continue to  document the range of women's reproductive experiences and to monitor  fertility                         and treatment-seeking trends.

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## Jelena

http://ts-si.org/biology/27021-which...-human-fetuses

http://www.sciencedaily.com/releases...1003205930.htm

Tko želi više može s naslovom googlati _"Non-invasive imaging of human embryos before embryonic genome activation predicts development to the blastocyst stage"_

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## Jelena

Nekako sam stekla dojam u razgovorima s "iskusnjačama" s foruma da nam se biolog čini glavnom facom. Ne znam u čemu je fora, ali:
http://www.ncbi.nlm.nih.gov/pubmed/16983520
veli:
PURPOSE: To evaluate the effect of the individual physician performing embryo transfer, on clinical pregnancy rates.
METHOD: Data  from a total of 485 consecutive embryo transfers performed on 485 women  aged 23-37 years were prospectively collected for this study. All  patients underwent a standard downregulation long protocol for ovarian  stimulation. Oocyte recovery was performed at 36 h after hCG  administration. Embryo transfer took place at 48 h after insemination.  The patients were matched in two groups that have been linked to two  different ET providers (A and B). The same method of loading embryos  into the embryo transfer catheter was used.
RESULTS: Clinical  pregnancy rates varied significantly (p< or =0.01) between the two  providers: *36.1%* in group A and *20.6%* in group B. The number and quality  of embryos transferred did not differ between the groups.
CONCLUSION: *The results suggest that the physician factor may be an important variable in embryo transfer technique*.

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## gupi51

Možda će vas zanimati, objavljene su *nove referentne vrijednosti Svjetske zdravstvene organizacije (SZO) za ispitivanje i obradu ljudske sperme*. 
Ukratko, donje granice normalnih vrijednosti su: volumen sperme 1,5 ml (1,4-1,7); ukupan broj spermtozoida po ejakulatu 39 milijuna (33-46); koncentracija spermatozoida 15 mil/mil (12-16); vitalnost spermatozoida 58% živih (55-63); progresivna pokretljivost 32% (31-34), morfološki normalni oblici 4% (3,0-4,0) 
Ovdje možete pročitati cijeli članak http://humupd.oxfordjournals.org/content/16/3/231.long

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## gupi51

Možda će vas i ovo zanimati: 
http://www.ncbi.nlm.nih.gov/pubmed/21315341 
Fertil Steril. 2011 Feb 10. [Epub ahead of print]
*Follicle-stimulating  hormone administered at the time of human chorionic gonadotropin  trigger improves oocyte developmental competence in in vitro  fertilization cycles: a randomized, double-blind, placebo-controlled  trial.*
Lamb JD, Shen S, McCulloch C, Jalalian L, Cedars MI, Rosen MP.
Department  of Obstetrics, Gynecology and Reproductive Sciences, Division of  Reproductive Endocrinology and Infertility, University of California,  San Francisco, California.

*Abstract*
OBJECTIVE: To  determine whether an additional follicle-stimulating hormone (FSH)  bolus administered at the time of the human chorionic gonadotropin (hCG)  trigger can improve the developmental competence of the oocyte.
DESIGN: Randomized, double-blind, placebo-controlled, clinical trial.
SETTING: Academic medical center.
PATIENT(S): Women undergoing a long agonist suppression in vitro fertilization (IVF) protocol for treatment of infertility.
INTERVENTION(S): FSH bolus at time of hCG trigger versus placebo.
MAIN OUTCOME MEASURE(S): Primary  outcome; fertilization; secondary outcomes: oocyte recovery,  implantation rate, and clinical and ongoing pregnancy/live birth rates.
RESULT(S): A  total of 188 women (mean age: 36.2 years; range: 25 to 40 years) were  randomized. Fertilization (2PN/#oocyte) was statistically significantly  improved in the treatment arm (63% vs. 55%) as was the likelihood of  oocyte recovery (70% vs. 57%). There was no statistically significant  difference in clinical pregnancy rate (56.8% vs. 46.2%) or ongoing/live  birth rate (51.6% vs. 43.0%).
CONCLUSION(S): Improvements  in IVF success rates have largely been due to optimization of embryo  culture and stimulation protocols; less attention has been directed  toward methods to improve induction of final oocyte maturation. This was  the first randomized, double-blind, placebo-controlled trial to modify  the ovulation trigger to improve oocyte competence, as demonstrated by  the statistically significant improvement in fertilization.


http://www.ncbi.nlm.nih.gov/pubmed/20542507
Fertil Steril. 2011 Feb;95(2):538-41. Epub  2010 Jun 9.
*Pressure changes during embryo transfer.*
Grygoruk C, Sieczynski P, Pietrewicz P, Mrugacz M, Gagan J, Mrugacz G.
Center for Reproductive Medicine BOCIAN, Bialystok Technical University, Bialystok, Poland. cezary.grygoruk@gmail.com
*
Abstract*
OBJECTIVE: To investigate the pressure changes in the transferred load during mock ET.
DESIGN: Experimental setup.
SETTING: Academic Research Institute of Mechanical Engineering and private centers of reproductive medicine. PATIENTS(S): None.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Laboratory simulations of ET into a rigid transparent uterine model equipped with a pressure sensor.
RESULT(S): Injection  of a transferring load during mock ET could increase pressure locally  up to 155 mm Hg in <0.1 seconds. The recorded pressure increase slope  reached values as high as 72,000 mmHg/s, and the pressure decrease  slope reached 144,000 mmHg/s. The pressure buildup in the transferred  liquid was proportional to the ejection speed of the transferred load.
CONCLUSION(S): ET  can cause rapid pressure fluctuations in the transferred liquid.  Therefore, it is advisable to transfer the embryo gently with minimum  ejection speed, to avoid exposing the embryo to the steep pressure  gradient.

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