Martin Birkhäuser

Semen quality of male smokers and nonsmokers in infertile couples

OBJECTIVE To investigate the effect of cigarette smoking on main sperm variables. DESIGN Cohort study. SETTING Men attending the andrology laboratory in the context of infertility investigation in the couple. PATIENT(S) Eight hundred thirty-nine smokers and 1,266 non-smokers were enrolled; 655 smokers and 1,131 nonsmokers fulfilled the inclusion criteria and were compared. Standard clinical analysis of semen. RESULT(S) Cigarette smoking was associated with a significant decrease in sperm density (-15.3%), total sperm count (-17.5%), total number of motile sperm (-16.6%), and citrate concentration (-22.4%). The percentage of normal forms was significantly reduced in smokers, and sperm vitality, ejaculate volume, and fructose concentration were slightly but nonsignificantly affected. CONCLUSION(S) Cigarette smoking is associated with reduced semen quality.

IMS Updated Recommendations on postmenopausal hormone therapy

The past decade has seen marked fluctuations inopinions concerning the merits and risks ofpostmenopausal hormone therapy. In July 2002,menopause management faced a major turningpoint when the first data from the Women’sHealth Initiative (WHI) trial were released. Thestudy was categorized as a primary preventiontrial for coronary heart disease, although the factthat mean age at recruitment was 63 years was notgiven enough importance at that time. WHIinvestigators concluded that hormone therapy(HT) was not cardioprotective, and, in fact, itsrisk–benefit ratio did not favor the use ofpostmenopausal hormones for prevention ofchronic diseases. As a result, there was a dramaticchange in prescription habits following recom-mendations to reserve HT for very symptomaticwomen, and to limit its use to the ‘shortestduration needed’ and ‘to the lowest effectivedosage’. This was the atmosphere in which theInternational Menopause Society (IMS) initiatedthe IMS Workshop held in Vienna (December2003) and the IMS Position Paper that was basedon the Workshop discussions. Looking at globalperspectives, and being independent of local orregional constraints imposed by official healthauthorities, this IMS Statement called for a morebalanced approach in the interpretation of thescientific data on hormone use that were availablein 2003. Since then, additional information hasbeen accumulated from both arms of the WHIstudy, observational trials and from other studies,allowing a more comprehensive review on allissues related to the use of hormones in thepostmenopausal period. In view of the above, theIMS Board decided that it is time to update the2004 Statement and to enlarge its scope tomenopause management and adult women’shealth in general. More than 30 experts from thevarious fields of menopause medicine reviewed thelatest information in a Workshop held in Budapestin February 2007.The following Recommendations express theviews of the IMS on the principles of hormonetherapy in the peri- and postmenopausal periods.Throughout the Recommendations, the term HTwill be used to cover all therapies includingestrogens, progestogens, combined therapies andtibolone.The previous IMS Statement in 2004 is stillvalid and serves as a basis for the current UpdatedRecommendations.We are aware of the geographical variationsrelated to different priorities of medical care,different prevalence of diseases, and country-specific attitudes of the public, the medicalcommunity and the health authorities towardmenopause management, which may all impacton hormone therapy. The following recommenda-tions, therefore, give a global and simple overviewthat serves as a common platform on issues relatedto the various aspects of hormone treatment.These Recommendations were reviewed and dis-cussed by representatives of more than 60National and Regional Menopause Societies fromall continents. These Recommendations can beeasily adapted and modified according to localneeds.

Updated practical recommendations for hormone replacement therapy in the peri- and postmenopause.

Henry Burger, Australia; David Archer, USA; David Barlow, UK; Martin Birkhauser, Switzerland; Joaquim Calaf-Alsina, Spain; Marco Gambacciani, Italy; Andrea Genazzani, Italy; Peyman Hadji, Germany; Ole Erik Iversen, Norway; Herbert Kuhl, Germany; Rogerio A. Lobo, USA; Thierry Maudelonde, France; Manuel Neves e Castro, Portugal; Morris Notelovitz, USA; Santiago Palacios, Spain; Tomasz Paszkowski, Poland; Eitan Peer, Israel; Amos Pines, Israel; Goran Samsioe, Sweden; John Stevenson, UK; Sven Skouby, Denmark; David Sturdee, UK; Tobie de Villiers, South Africa; Malcolm Whitehead, UK; Olavi Ylikorkala, Finland

Anti-Müllerian hormone and inhibin B as predictors of pregnancy after treatment by in vitro fertilization/intracytoplasmic sperm injection

OBJECTIVE To evaluate anti-Müllerian hormone (AMH) as a marker of reproductive outcome after IVF/intracytoplasmic sperm injection (ICSI). DESIGN Longitudinal study. SETTING University hospital. PATIENT(S) Two hundred seventy-six consecutive women undergoing IVF/ICSI. INTERVENTION(S) Ovarian stimulation, oocyte retrieval, IVF, ICSI, embryo transfer, AMH, and inhibin B determinations in serum and follicular fluid (FF). MAIN OUTCOME MEASURE(S) The AMH and inhibin B concentrations in 276 matched FF/serum pairs have been determined. Different outcome groups have been compared and set in relation to the oocyte count, morphological parameters, and steroid hormone levels. RESULT(S) The concentrations of AMH and inhibin B in both serum and FF were significantly higher in the group of women who became pregnant in the corresponding treatment cycle than in those who did not conceive. Positive correlations were observed between serum inhibin B concentrations and embryo morphology (r = 0.126, 95% confidence interval 0.026-0.284). Serum and FF AMH or inhibin B correlated positively with the oocyte count and negatively with the pretreatment cycle day 3 FSH level and the total administered gonadotropin dose. CONCLUSION(S) The AMH and inhibin B levels on the day of oocyte retrieval are correlated to reproductive outcome.

Long term influence of different postmenopausal hormone replacement regimens on serum lipids and lipoprotein(a) : a randomised study

Objective To assess the influence of three different postmenopausal hormone replacement therapies on levels of serum lipids and lipoprotein(a) [Lp(a)].

Differential impact of conventional oral or transdermal hormone replacement therapy or tibolone on body composition in postmenopausal women

To compare the effects on body composition and body weight of tibolone vs two different sequential oral or transdermal oestrogen‐progestogen hormone replacement therapies versus no therapy.

Guidelines for hormone treatment of women in the menopausal transition and beyond

Recent communications regarding estrogen or estrogen + progestin treatment and clinical cardioprotection, breast cancer risk and cerebral aging have produced considerable confusion and concerns among women, care-givers and the media. The actions of the United States’ Food and Drug Administration (FDA) and other National Safety of Medicine Boards, such as the European Medicine Evaluation Agency (EMEA), in response to publication of data from the Women’s Health Initiative (WHI) and the Million Women Study (MWS), have also raised concerns. The Executive Committee of the International Menopause Society (IMS) has considered position statements presented at the Fourth Workshop of the IMS, December 2003 and reviewed all presently available information from observational studies, randomized controlled trials (RCTs) and preclinical research, and wishes to point out the following:

Depression, menopause and estrogens: is there a correlation?

Women have a higher incidence of depression than men. The lifetime incidence of endogenous depression in women is twice the incidence in males. Because depression in the elderly is an important public health concern, an eventual correlation between menopause and depression is of practical importance. The relevant literature is reviewed. There are suggestive data that estrogen deficiency may increase the susceptibility for depression. Furthermore, here is suggestive evidence from observational studies and a limited number of randomized, controlled trials that estrogen therapy after menopause improves mood and cognition. However, the clinical relevance of estrogen administration is unproved. There are weak data that estrogens might be considered for mild depressive symptoms attributed to hot flushes, sleep disturbances, or other climacteric symptoms. No hard data exist to indicate whether estrogen could be used as adjunct therapy for other depressive disorders during the menopausal transition or postmenopausal period, but newer findings suggest that estrogens may improve the effect of serotonin reuptake inhibitors.

New data confirming a circannual rhythm in spermatogenesis

Our study demonstrates a circannual rhythm in spermatogenesis by 2697 spermiograms of healthy probands and subfertile patients. This rhythmicity is valid both for fertile as well as for subfertile men. In both groups, the lowest values of sperm count occurred in the summer while the peak values occurred in the winter and spring. For basal diagnostic purposes in male hypofertility, spermiograms should be obtained before or after the summer months. In oligospermia seasonal fluctuation in sperm density should be taken into account in in vitro fertilization and in artificial insemination, homologous.

Comparison of two estradiol transdermal systems (Oesclim@ 50 and Estraderm TTS@ 50). I. Tolerability, adhesion and efficacy

OBJECTIVES The objectives were to compare the tolerability, adhesion and efficacy of a new matrix-type estradiol transdermal system, Oesclim 50, with those of Estraderm TTS 50, a reservoir-type system. METHODS This was an open, randomised, parallel-group, multi-centre clinical trial, performed in six European countries. A total of 143 healthy menopausal women were allocated to treatment with Oesclim 50 and 140 to Estraderm TTS 50. The transdermal systems were applied twice weekly for 24 days out of each 28-day cycle, over a period of four cycles. Oral progestogen treatment was taken by non-hysterectomised patients for the last 12 days of estrogen therapy in each cycle. RESULTS The local skin tolerability of the Oesclim 50 transdermal system was significantly better than that of Estraderm TTS 50. In the Oesclim 50 group, 4.2% of applications caused a reaction, compared with 9.5% in the Estraderm TTS 50 group (P < 0.001). Safety assessments showed both treatments to be well tolerated. Seven patients in the Oesclim 50 group, and 12 in the Estraderm TTS 50 group, discontinued due to adverse events. Of these discontinuations, one (0.7% of patients) in the Oesclim 50 group and seven (5.1% of patients) in the Estraderm TTS 50 group were due to application site reactions (P < 0.05). There was no statistically significant difference between the two groups in the percentage of patients with signs of hyperestrogenism (29 patients (20.3%) in the Oesclim group and 28 patients (20.0%) in the Estraderm TTS 50 group). Adhesion was significantly better for the Oesclim 50 transdermal system, with 6.0% of Oesclim 50 applications becoming detached compared with 11.3% of Estraderm TTS 50 applications (P < 0.001). The greater adhesion of Oesclim 50 was particularly apparent when the systems were exposed to water, with three times fewer Oesclim 50 systems becoming detached during a shower or bath (P < 0.001 in each case). Both treatments produced significant and comparable improvements in vasomotor symptoms, other menopausal symptoms and gynaecological assessments. A near-maximal effect on vasomotor symptoms was observed after approximately 1 month of treatment, and was maintained for the entire treatment period. CONCLUSION Overall, Oesclim 50 provided statistically significantly better local skin tolerability and adhesion than Estraderm TTS 50, together with comparable efficacy and safety.