O. Richter

Stress relief after infertility treatment--spontaneous conception, adoption and psychological counselling.

OBJECTIVE In this study, we sought to evaluate characteristics of couples with spontaneous conceptions after treatment with assisted reproductive technologies (ART). STUDY DESIGN Data from 254 couples who underwent 1127 therapy cycles between November 1987 and February 1997, were analyzed. Chi-Square (chi(2)) test and Students t-test were used. P<0.05 was considered significant. RESULTS Spontaneous pregnancies occurred in 14% of all treated couples. Psychological counselling only was performed in 21% but was observed significantly more frequently among patients without later spontaneous conception. Ten percent of all treated couples applied for adoption. The miscarriage rate was significantly higher in the group of treatment dependent pregnancies compared to the group of patients with later spontaneous conception (27% versus 9%). The spontaneous conception rate differed significantly depending on womens age and normal semen analysis. CONCLUSION Appearance of spontaneous conception after ART-procedures should be taken into account in the first patients interview. Depending on womens age and andrological parameters, treatment-success will differ. The positive impact of psychological counselling for stress relief during and after therapy should also be noted, even though a statistically significant impact could not be demonstrated in the present study. Adoption should be discussed as an alternative to overcome infertility.

Impact of reproductive history on in vitro fertilization and intracytoplasmic sperm injection outcome: evidence from the German IVF Registry ☆

OBJECTIVE To evaluate the effect of reproductive history on the outcome of different procedures in assisted reproductive technologies (ART) comparing IVF, ICSI, and cryopreserved embryo transfer (CPE). DESIGN Prospective registration of ART cycles and their outcomes. SETTING One hundred three reproductive programs in Germany. PATIENT(S) Women undergoing 174,909 ART procedures from January 1998 through December 2000. INTERVENTION(S) Data analysis of reproductive history collected by the German IVF Registry; multiple logistic regression modeling of success rates. MAIN OUTCOME MEASURE(S) Effect of type of conception and outcome of previous pregnancies, duration of infertility, females age, and type of ART on clinical pregnancy rate per retrieval. Odds ratios with 95% CIs are reported. RESULT(S) More than one previous pregnancy was negatively correlated with outcome of IVF, ICSI, or CPE. This association disappeared when female age was restricted to a maximum of 35 years. A previous pregnancy achieved by spontaneous conception had less impact on outcome of IVF, ICSI or CPE outcome than did a previous assisted conception. Previous live births and miscarriages demonstrated a statistically significant increase compared with ectopic pregnancies and induced abortions. CONCLUSION(S) Reproductive history must be considered when counseling subfertile couples. Female age, method of conception, and previous pregnancy outcome have a significant effect on IVF, ICSI, and CPE outcome.

Bowenoid papulosis of the vulva—immunotherapeutical approach with topical imiquimod

Introduction.Bowenoid papulosis is a characteristic lesion of the ano-genital region and represents a form of squamous cell carcinoma in situ, very often associated to the oncogenic high-risk human papilloma virus (HPV) types 16, 18, 31 and 33. Therapies applied so far, in general, show high rates of relapse, and patients complain of pruritus and pain. Imiquimod cream is a topical immune response modifier with indirect antiviral and antitumor effects through the stimulation of local cytokine production and cell-mediated immune response.Case report.In the present paper we report on the topical application of imiquimod cream in a woman with a high-risk HPV-associated vulvar intraepithelial neoplasia grade III (VIN III) of the vulva.DiscussionIn addition a review of the literature is given.

Terminal ileitis with sealed perforation—a rare complication of intestinal endometriosis: case report and short review of the literature

IntroductionPerforation is a rare complication of intestinal endometriosis. We report on a 38-year-old patient with previously known rectovaginal and ileocecal endometriosis who was referred with an acute abdomen.Case reportOn abdominal plain film an ileus of small intestine was diagnosed. The patient had fever, and the C-reactive protein was markedly increased. Upon emergency laparotomy an acute terminal ileitis with omentum-sealed perforation and a stenosis of the anterior wall of the rectum due to endometriosis were found. Partial resection of the ileum with end-to-end anastomosis, appendectomy, and short segmental rectum resection were performed. The postoperative course was uneventful. Histological examination corroborated the intraoperative diagnosis of fistulas, perforation and deep ulceration of the intestine consistent with transmural endometriosis.DiscussionFor proper care of these patients excellent cooperation between gynecologists and general surgeons is desirable. A short review of the literature concerning intestinal endometriosis is given.

Digoxin, flecainide, and amiodarone transfer across the placenta and the effects of an elevated umbilical venous pressure on the transfer rate.

Clinical observations suggest that flecainide might pass the placenta more easily than digoxin, and that its transfer is less disturbed in case of hydrops fetalis than that of digoxin. The purpose of the study was to compare the materno-fetal transplacental transfer of digoxin, flecainide, and amiodarone, another antiarrhythmic agent used in the treatment of fetal tachyarrhythmia, and to assess the effect of an elevated umbilical venous pressure (UVP) on the transfer rate. Isolated lobules of 16 human placentas were dually perfused after spontaneous delivery or caesarean section. The transplacental transfer (area under the curve in the maternal compartment [maternal AUC], area under the curve in the fetal compartment [fetal AUC], kinetic parameters) of digoxin, flecainide, and amiodarone was calculated after these drugs were added to the maternal circuit. In five experiments, the effect of increased UVP on the transplacental transfer rate was assessed by elevating the UVP by 10 cm H2O. Flecainide efflux out of the maternal compartment was significantly greater than that of digoxin (maternal AUC 57.4% ± 5.1%/min vs 73.9% ± 1.5%/min), whereas the flecainide influx into the fetal circulation was smaller (fetal AUC 9.3% ± 4.1%/min vs 11.5% ± 2.0%/min). Only in 50% of the experiments were the smallest amounts of amiodarone detectable in the fetal compartment. An elevation of the UVP reduced the influx of digoxin and flecainide into the fetal compartment (fetal AUC) from 11.5% ± 2.0%/min to 7.4% ± 1.9%/min and from 9.3% ± 4.1% to 4.7% ± 1.4%/min, respectively. Materno-fetal transplacental transfer of digoxin, flecainide, and amiodarone decreases in this sequence. Fetal cardiac insufficiency accompanied by an elevation of the UVP might reduce the transplacental transfer of these drugs, although no significant difference could be found between the reduction of transfer of digoxin and flecainide.

Easy and effective – web-based information systems designed and maintained by physicians: experience with two gynecological projects

Abstract. It is well established that medical information sources develop continuously from printed media to digital online sources. To demonstrate effectiveness and feasibility of decentralized performed web-based information sources for health professionals, two projects are described. The information platform of the German Working Group for Information Technologies in Gynecology and Obstetrics (AIG) and the information source concerning the German Registry for in vitro fertilization (DIR) were implemented using ordinary software and standard computer equipment. Only minimal resources and training were necessary to perform safe and reliable web-based information sources with a high correlation of effectiveness in costs and time exposure.

Photoradiation of perfused placental tissue – a suitable in vitro model for photodynamic therapy?

Abstract Our aim was to evaluate the isolated placental lobule as a model to study the cytotoxic effects of photodynamic therapy (PDT) in vitro. Ten human placental lobules were dually perfused with a modified medium 199 for a 4-hour period. Photosan III was added to the fetal perfusate at a dose of 5 mg/kg tissue, and laser light (630 nm wavelength) provided by an argon-pumped dye laser was applied at 50 J/cm2 in the experimental group (n=5). Potassium and lactate dehydrogenase (LDH) release into the perfusate as well as the transplacental creatinine passage from PDT-treated placentas and control placentas (n=5) were compared, and light microscopic examinations of the placental tissue were performed after the experiments. Potassium release into the fetal perfusate was higher in the PDT-treated placental lobules (p<0.05), and weight gain during the artificial perfusion suggests the development of edema only in the photoradiated lobules (p<0.01). The release of the bigger molecules of the LDH however was comparable in the two experimental groups, and transplacental creatinine passage was not affected by photoradiation. Light microscopic examinations demonstrated lesions at the cytotrophoblast, the syncytiotrophoblast and the endothelium of the fetal vessels of the photoradiated placentas, although they were not specific and could also be found in the control tissue. We conclude that the isolated placenta may be used to study cytotoxic effects of photoradiation in vitro, but better specifity and sensitivity might be achieved if a. The perfusion time is prolonged to make the difference between the experimental and the control group clearer and b. Electron microscopic investigations are made to demonstrate intracellular lesions of the mitochondria and the endoplasmic reticulum.