H. Janisch

Could aspiration of the Graafian follicle cause luteal phase deficiency

Luteal phase quality was evaluated in 32 patients wih nonstimulated cycles after laparoscopic oocyte recovery for in vitro fertilization. A luteal phase deficiency occurred in two cases (6.2%), the mean duration of the luteal phase was 13.5 +/- 1.3 days in 30 patients, and two patients developed amenorrhea of 23 and 43 days respectively after laparoscopy in spite of normal progesterone values 7 and 9 days after oocyte recovery. Six embryo transfers were performed after fertilization and regular cleavage of the obtained oocytes. No pregnancy resulted from the embryo transfers, although the patients had apparently normal luteal phases. In one patient there was a transient beta-subunit human chorionic gonadotropin (beta-hCG) elevation in serum. Luteal phase deficiency should not be main cause of a nonsuccessful embryo transfer. However, a prophylactic luteal phase support after oocyte recovery and embryo transfer in nonstimulated cycles is proposed.

Measurement of eicosanoids in menstrual fluid by the combined use of high pressure chromatography and radioimmunoassay

Methods are described for the quantification of various eicosanoids (cyclooxygenase products: 6-KETO, TXB2, PGE2, PGF2 alpha, DHK; lipoxygenase products: 5-, 12-, 15-HETE, LTB4, LTC4, LTD4, LTE4) in menstrual blood collected by tampons. Samples were extracted with acidified ethanol. After purification by SEP-PACK C18 columns, the compounds were separated by reversed phase HPLC using a ternary gradient system. The eicosanoid concentrations of the fractionated eluents were measured by radioimmunoassay and corrected for recovery. 12-HETE was the most prominent metabolite of arachidonic acid in menstrual blood (mean: 1174 ng/g blood). With the exception of PGF2 alpha and TXB2 (mean: 343 and 212 ng/g blood, respectively) other eicosanoids were detected in remarkable lower concentrations.

Wertheim radical hysterectomy 1921–1986: Changes in urologic complications

SummaryIn order to assess the incidence and type of urologic complications associated with Wertheims radical hysterectomy we studied all 154 patients undergoing radical hysterectomy at our department between 1980 and 1986. More than 2/3 of patients had stage I carcinoma of the cervix, the mean age was 46.9 years (range 27–73 years). Various intraoperative reconstructive procedures were required in 5%. A comparison with the experience of Wertheim (before 1919) and that of a subsequent time period (1952–1967) showed that while the incidence of intraoperative injury to the lower urinary tract remained stable, the incidence of postoperative fistula formation decreased significantly (from 6.4% to 0.6%), possibly due to changes in the operative technique. We conclude that Wertheims radical hysterectomy now involves only a very low risk of injury to the bladder or to the ureter.

Relationship between the steroid and prolactin concentration in follicular fluid and the maturation and fertilizaton of human oocytes

Seventyeight follicles and their follicular fluid were aspirated from 46 women undergoing in vitro fertilization (IVF) procedures after stimulation of the ovaries with a low-dose human menopausal gonadotropin/human chorionic gonadotropin stimulation regimen. The concentrations of estradiol (E2), progesterone (P), testosterone (T), and prolactin (PRL) were measured in follicular fluid and related to the maturation of the oocyte-corona-cumulus complex (OCCC) and the fertilization of oocytes. Follicles containing mature oocytes had significantly higher follicular fluid E2 and P levels than follicles with intermediate and immature oocytes. A constant decrease in PRL and T values with advancing follicular maturation was observed. Similar results were obtained when the fertilizing ability of the oocytes was examined. The gradual decline in follicular fluid PRL and T levels during follicular development was connected with increasing E2 and P biosynthesis and therefore seems to be an important precondition for normal follicular and oocyte maturation.

Endosonographic staging of carcinoma of the uterine cervix

SummaryThe advantages of a new endosonic technique for staging carcinoma of the cervix are demonstrated. Using this method virtually all palpable findings can be objectified, and in most cases, assessing the size of the tumor inside the cervix seems to allow further differentiation in stage Ib. By imaging the parametrium, rectal sonography provides an important diagnostic aid for making the differentiation between stages Ib, IIb and IIIb. For assessment of the extent of vaginal infiltration, rectal ultrasound diagnosis and in particular vaginosonography can be used. Rectal and especially transurethral sonography are useful for detecting an infiltration of the bladder wall and for further evaluation of cystoscopically visible vesicula-ted oedema.

The behavior of LH, FSH, PRL, T, P, estradiol and cortisol under different kinds of general anesthesias during laparoscopic oocyte recovery for in vitro fertilization

Abstract The effects of different anesthetic drugs on LH, FSH, prolactin, progesterone, 17β-estradiol, cortisol and testosterone were tested during and after oocyte recovery for in vitro fertilization. No major changes of LH, FSH, progesterone, 17β-estradiol and testosterone were noted, whereas prolactin levels in all patients and under all anesthesias showed a highly significant increase, followed by a decrease after 2 h. Also distinct changes were observed in cortisol levels. Among the different anesthetic drugs a diminished increase of PRL under thiopental and halothane was observed when compared with the other drugs.

Results of Laparoscopic Recovery of Preovulatory Human Oocytes From Nonstimulated Ovaries in an Ongoing in Vitro Fertilization Program

The technique and results of 50 laparoscopies performed on sterility patients to obtain mature oocytes from Graafian follicles with a view to carrying out in vitro fertilization are described. In 32% of all laparoscopies and in 52% of all punctured follicles it proved possible to obtain a mature oocyte. Different diameters of puncture needles as well as different suction intensities are compared. As a result of increasing experience and improved technique, the exact time for the intervention was correctly determined in 92% of cases. The recovery rate for oocytes was also increased to 58% with respect to laparoscopies carried out.

Heat flux from the fetal scalp during labor and fetal outcome

SummaryIn 40 deliveries a new variable, heat flux from the fetal scalp, was recorded and correlated with fetal outcome. The heat flux from the fetus, which reflects the temperature gradient between the warmer fetus and the mother was measured by a transducer attached to the fetal scalp after rupture of the membranes. In the last 20 min before delivery we found a statistically significant correlation (p < 0.05) between heat flux from the fetus and pH of umbilical artery blood. Heat flux in the group with higher pH differed significantly from those with lower pH. We conclude that heat flux measurements could be developed and used for fetal monitoring.

Hormonal parameters in follicular fluid and the fertilization rate of in vitro cultured oocytes

SummaryOocytes and matched samples of follicular fluid were obtained from 52 preovulatory follicles aspirated laparoscopically for in vitro fertilization (IVF). Follicular fluid concentrations of estradiol (E2), progesterone (P), testosterone (T), prolactin (HPRL), prostaglandin F2α (PGF2α), prostaglandin E (PGE), protein content, and collagenolytic activity were measured and related to the fertilization rate of oocytes cultured in vitro. High concentrations of P and low levels of T and HPRL were associated with mature, fertilizable oocytes. Levels of PGF2α, PGE, and follicular fluid protein concentrations were similar in both groups. Mean collagenolytic activity was increased in the fertilized oocytes, although no significant difference could be observed. Our data demonstrate a close association between follicular fluid steroid and HPRL concentrations and successful fertilization of oocytes.

Detection of antibodies in pregnancy serum reacting with isolated placental basement membrane collagen

Summary. Adsorption of human IgG from pregnancy sera to placental basement membrane collagen could be demonstrated by an in‐vitro assay. Polystyrene tubes were coated with purified type IV collagen and incubated with serum samples. Bound human IgG was detected using 125I labelled antihuman IgG. Median adsorption levels were 4000 (interquartile range 2500–9500) cpm/ml serum in 25 uncomplicated pregnancies and 21000 (interquartile range 14500–44500) cpm/ml serum in 14 pre‐eclamptic women. Specifity of the adsorption reaction could be demonstrated using uncoated tubes and collagenase treated coated tubes, which all showed low binding. In competition experiments with dissolved collagen fractions (type I, III, IV) most effective displacement of binding was observed with type IV collagen. This indicates collagen selectively of the adsorption reaction of human IgG to basement membrane collagen. Our in‐vitro studies support immunohistological findings of IgG binding to trophoblastic basement membranes and their ultrastructural abnormalities detected in pre‐eclamptic placenta.