Background and objective:To determine the prevalence of markers of inherited thrombophilia in patients with severe form of ovarian hyperstimulation syndrome (OHSS) Design and methods: Blood samples were analysed for markers of thrombophilia (mutation of factor V -Leiden, mutation of methylentetrahydrofolat reductase (MTHFR) C677T and mutation of prothrombin G20210A). The study group consisted of women who had undergone controlled ovarian hyperstimulation for IVF complicated by severe OHSS (group A, n = 50). Results were compared with two controls groups -women who underwent ovarian hyperstimulation for IVF without developing OHSS (group B, n = 93) and healthy pregnant women with no history of infertility (group C, n = 196).Results: We have found 7 out of 50 patients from group A positive for Leiden mutation (heterozygous) 11 out of 93 from group B (heterozygous), p = 0.71 OR 1.21 (0.39 3.70) and 10 out of 196 from group C (heterozygous), p = 0.03 OR 3.03 (0.97 9.28). Polymorphism of MTHFR 677T gene was detected in 17 out of 50 patients (heterozygous) from group A, in 36 out of 93 patients from group B (35 heterozygous, 1 homozygous) and in 93 out of 196 patients from the group C (86 heterozygous, 7 homozygous) with no statistical significance. Conclusions:We found an increased prevalence of factor V Leiden mutation in Czech infertile women. However carriers of Leiden mutation had no enhanced risk of development severe form of OHSS during stimulation.

Echocardiographic signs of mild pericardial irritation may appear also in patients with no clinical signs of OHSS. The incidence of these changes increases during stimulation procedure. Development of OHSS may not be preceded by the incidence of these warning signs. Consequently, routine echocardiographic examination during stimulation is not indicated, since significant pericardial effusion is rather a late sign of OHSS.

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Overview : Objective: The aim of the study CERES (CzEch REkovelle real life Study) was to gather experience with the use of a novel gonadotrophine, to evaluate the efficacy of follitropin delta in Czech clinical settings and to compare our results with the clinical trial ESTHER-1. Methods: Individualized follitropin delta daily dose in µg based on the patient’s anti-Müllerian hormone (AMH) level and body weight (AMH < 15 pmol/ L: 12 µg/ d; AMH > 15 pmol/ L: 0.10–0.19 µg/ kg/ d; max. 2 µg/ d). Results: A total of 85 women (aged 24–42 years) was included in the study. The average patient’s age was 32.9 years, the average body weight was 67.8 kg, and the mean level of AMH was 23.2 pmol/ L. There were initiated 85 controlled ovarian stimulations with follitropin delta and 84 egg collections. Forty patients (47%) had optimal number of retrieved eggs (8–14), 75 patients (88%) had embryotransfer, 10 patients (12%) had no embryo suitable for transfer, 65 patients had single embryo transfer and 10 patients had 2 embryos for transfer. There were reported 37 clinical pregnancies (43.5% cPR – clinical pregnancy rate), 30 live births (35.3% LBR – live birth rate), 3 (3.5%) early moderate ovarian hyperstimulation syndroms (OHSS) and no hospitalization due to the treatment. Conclusion: Individualized ovarian stimulation optimizes ovarian response, maintains treatment efficacy and improves safety by reducing OHSS incidence. The results of the Czech population study are fully comparable with the international, randomized, assessor-blinded trial ESTHER-1. Keywords: follitropin delta – controlled ovarian stimulation – anti-Müllerian hormone – ovarian response – ovarian hyperstimulation syndrome – personalized medicine