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Biomedical subjects

I Gerhard

Publications and source records attributed to I Gerhard.

At least 55 records · Page 3Linked to original sources
PubMed1990

Chlamydial infection--a female and/or male infertility factor?

After screening a large series (n = 491) of asymptomatic males of infertile partnerships for chlamydial immunoglobulin (Ig) G antibodies (Chlam AB), no significant influence of past chlamydial infection was found with regard to semen analysis, postcoital testing, in vitro sperm-cervical mucus penetration tests with hormonally standardized cervical mucus, circulating antisperm antibodies (detected with three different methods), local IgG and IgA antibodies (detected by means of the mixed antiglobulin reaction test) on the sperm surface, the sperm-cervical mucus contact test, and a microbial screening of semen samples for mycoplasmas and other potentially pathogenic micro-organisms. However, when the findings were correlated with infertility factors of patients' female partners and the subsequent pregnancy rate in a prospective study, a significant positive correlation of male Chlam AB with a tubal factor in their wives as cause of the couple's infertility was found. The results suggest that the main influence of Chlamydia trachomatis on male fertility is based on sexual transmission and negative influence on tubal function of female partners, but not on reduced sperm functional capacity.

Antibodies, Bacterial↗
PubMed1990

[Incidence and prerequisites for therapy-independent pregnancy in sterile patients].

15.6% of 857 women who had been treated because of sterility in the infertility centre of the Department of Gynaecology of the University of Heidelberg between May 1982 and June 1985, became pregnant up to June 1986, independent of the therapy. Favourable conditions for the occurrence of pregnancy were provided by secondary sterility and miscarriages in the previous history (in case of non-hormonal disturbances only). Younger women and those whose wish for a child was more recent, had a better chance to experience pregnancy--without any difference between the spontaneously pregnant women and those who became pregnant during treatment. ("Spontaneous pregnancy" signified women who became pregnant either during diagnostic procedure or after having discontinued medical treatment for more than 3 months, in case of tubal microsurgery 12 months). Depending upon the aetiology of surgery, the proportion of spontaneous pregnancies was between 12 and 75%. The rate of spontaneous pregnancies was highest in case of reduced tubal patency (44%), disturbances of hormonal control mechanisms (62.5%) and endometriosis (75%). The spontaneous pregnancy rate was comparable to the overall pregnancy rate (39.4%) in women with uterine malformations (31.4%), immunologic infertility (33.3%), hyperandrogenemia (33.3), hyperprolactinaemia (31.2%) and PCO syndrome (37.5%). The percentage of spontaneous pregnancies was lowest in hypothyroidism (20%), primary ovarian insufficiency (12.5%) and disturbances of the hypothalamic-pituitary axis (16.7%).

Adult↗
PubMed1990

[Benzalkonium chloride for vaginal contraception--the vaginal sponge].

From March 1986 to December 1987, a vaginal contraceptive, not yet commercially available in Germany, was studied in 56 women. The substance benzalconium chloride (BZC) was contained in vaginal sponges (n = 46), pessaries (n = 4) and cream (n = 6) at a dose rate of 1.18%. BZC is a surfactant of the ammonium series that ruptures the spermatozoal membrane. It is also a powerful bactericide and viricide. The advantages of the vaginal sponge (intercourse is safe immediately after insertion for the next 24 h and for multiple intercourses) made it pleasant for the women. The rate of transitory local side effects (16%) was acceptable. The vaginal contraception did not interfere with the sexual life. In 645 months of use 10 pregnancies occurred of which 9 happened with the sponge (PI 20.3). Its fixation before the cervix and the release of the spermicide is not reliable enough, so that we cannot recommend the sponge as a safe vaginal contraceptive.

Adult↗
PubMed1990

Value of endometrial biopsies and serum hormone determinations in women with infertility.

Premenstrual endometrial biopsies were performed in 324 infertile women. Their hormonal status was established in the early follicular phase of the same cycle (FSH, LH, oestradiol-17 beta, testosterone, DHEAS, TSH and prolactin, the latter two both basally and following TRH stimulation). In the luteal phase, oestradiol-17 beta and progesterone concentrations were determined three times between the fifth and tenth hyperthermic days, as was prolactin, both basally and following metoclopramide stimulation. All pregnancies occurring before January 1986 were recorded. Seventy-five per cent of the biopsies were evaluated on the expected ovulation date from the basal temperature charts, 77% according to the next onset of menstruation. Twenty-six per cent of the biopsies were out of phase, and 7% displayed abortive secretion. A significant correlation existed between endometrial profiles and the characteristics of the cycle, stimulated TSH and prolactin levels, and with testosterone and FSH concentrations. No correlation of the endometrial status with midluteal oestradiol or progesterone concentrations was found. While various hormones of both the follicular and luteal phases correlated significantly with the pregnancy rate, the same was not demonstrated for the state of endometrial biopsy. Therefore, following exclusion of organic explanations of infertility in women with biphasic cycles, the determination of progesterone and oestradiol-17 beta in the luteal phase was considered. In women with reduced concentrations of these hormones, androgens, gonadotrophins, prolactin and TSH should be determined. Endometrial biopsy is valuable only if pregnancy fails to occur, despite therapeutically normalized hormone concentrations.

Adolescent↗
PubMed1990

The use of hens' egg white as a substitute for human cervical mucus in assessing human infertility.

Semen samples from 179 patients with longstanding infertility were allowed to penetrate capillaries filled with a fraction of fresh hens' egg white (HEW) as a substitute for cervical mucus (CM) for the in-vitro sperm-cervical mucus penetration test (SCPMT). Results were correlated with those obtained from human CM (HCM) used in parallel on the same semen sample, compared to results of sperm analysis and post-coital testing (PCT) and analysed for their prognostic value for a subsequent pregnancy in a prospective study. The overall pregnancy rate after 6 months was 26.3% (47/179). Whereas routine semen analysis (semen volume, pH, sperm count, progressive motility, morphology and fructose concentration) did not differentiate between patients who achieved pregnancy and those who did not, significant differences were found for the penetration distance (P less than 0.02) and the motility grade of sperm in HEW (P less than 0.02). Although the mean sperm velocity in HEW was reduced compared to HCM, a close positive correlation was found between the sperm density and the penetration distance (P less than 0.001). The percentage of samples with good HEW penetration increased significantly in parallel with better results of post-coital testing (P less than 0.001). The results indicate that, when fresh human CM is not available, HEW can be used as a medium for the SCPMT as a valuable adjunct to semen analysis which provides information about sperm functional capacity.

Animals↗
PubMed1990

Effects of kallikrein on sperm motility, capillary tube test, and pregnancy rate in an AIH program.

From 1984 to 1986, 172 couples were enrolled in an artificial insemination homologous (AIH) program, because of negative postcoital test, fair PT, positive PT with unexplained infertility, and impotentia coeundi. Patients were randomly assigned to the following procedures: AIH with native semen (N, n = 68), washed sperm (V, n = 50), semen mixed with kallikrein (K, 5 IE/ml semen, n = 45), and timed intercourse. The overall pregnancy rate (PR) was 22% per couple (13% inseminations, 9% spontaneous). PR from insemination (spontaneous) was 13% (8), 13% (13), 23% (0) in PT negative, fair, and positive patients, respectively, and 18% (9), 13% (7), and 11% (9) in AIH groups N, V, and K. Among in vitro studies with K added semen, an improvement of sperm motility was demonstrated in half of the specimens. In the capillary tube test (CTT), with wives' cervical mucus, a deterioration was more frequently seen than an improvement after 2 h, independent of the early effect of K in semen, K induced changes of CTT were less pronounced when donors' cervical mucus was used. The results of the in vitro studies offer an explanation for the low PR in the AIH program with K.

Adult↗
PubMed1989

Pregnancy-maintaining antibodies: workshop report (Giessen, 1988).

To analyse the nature of antibodies which are purported to be essential for the maintenance of normal human pregnancy, six centers participated in a workshop of "blind" tests on 19 allosera. Fc-receptor dependent assays detected antibodies with specificity only for HLA. In addition to cytotoxic antibodies, the Fc-receptor dependent immune phagocytosis inhibition test revealed two non-cytotoxic alloantibodies with HLA specificity. These antibodies had high titers and may, therefore, be essentially non-cytotoxic. Murine monoclonal antibodies to HLA-A, B, C or DR (W6/32 and 2MC3) were used to evaluate the methods. These antibodies inhibited immune rosette formation as well as immune phagocytosis. Diluted to concentrations below the threshold of complement-dependent cytotoxicity, the monoclonal antibodies still inhibited the mixed lymphocyte reaction and the immune phagocytosis. A human monoclonal immunoglobulin M with specificity for monomorphic non-HLA lymphocyte antigens inhibited the mixed lymphocyte reaction. The immune rosette inhibition test exhibited several false positive reactions, e.g. three out of four with a serum that did not contain alloantibodies to blood cells. Non-cytotoxic antibodies were therefore rare in the selected sera of the workshop and they exhibited HLA specificity only. No participant was able to identify pregnancy-maintaining non-HLA-antibodies.

Abortion, Habitual↗
PubMed1989

Clinical significance of crossed in vitro sperm-cervical mucus penetration test in infertility investigation.

To evaluate the clinical significance of in vivo and in vitro testing of sperm ability to penetrate cervical mucus (CM), postcoital testing (PCT) and in vitro sperm-cervical mucus penetration testing were compared in a prospective study. Both in vivo and in vitro tests were standardized and performed after an oral course of estrogen therapy. Crossed in vitro sperm-cervical mucus penetration test, evaluated in 277 couples with CM of patients' wives and additionally with CM and semen of fertile donors, revealed that the male factor contributed to a significantly higher extent to deficient sperm-mucus interaction than the cervical factor. The overall pregnancy rate after 6 months was 23% (64/277). Whereas the outcome of PCT did not significantly predict subsequent fertility (PCT good pregnancy rate 24%/PCT poor 20%), significant differences were found for the sperm-cervical mucus penetration test with CM of patients' wives (pregnancy rate, 30.5% versus 8.5%) and for in vitro testing with donors' CM, but not for the mucus penetration test with donors' spermatozoa. Routine sperm analysis did not prove to be of prognostic value for a subsequent pregnancy. The results suggest that the in vitro sperm-cervical mucus penetration test is a good parameter of sperm function and, in particular, when performed as a cross-matching penetrability test, a valuable adjunct to PCT with regard to fertility prognosis.

Cervix Uteri↗
PubMed1989

Prognostic value of in vitro sperm penetration into hormonally standardized human cervical mucus.

To analyze the prognostic value of the sperm cervical mucus penetration test (SCMPT), fresh semen samples of 99 male patients under infertility investigation were exposed to capillary tubes filled with freshly obtained cervical mucus (CM) of the patients' wives (WCM), fertile donors (DCM), and bovine CM (BCM). The quality of the human CM was standardized by oral administration of estrogens. The overall pregnancy rate after 6 months was 17.2% (17/99), and was significantly different in couples with poor and good SCMPT with WCM (1/44, 2.3% versus 16/55, 29%; P less than 0.001) in a prospective study. Human CM was superior to BCM as a penetration medium in providing more information about sperm function. The results suggest that in vitro sperm penetration testing with hormonally standardized CM of female partners adds an important dimension to sperm analysis with regard to fertility prognosis.

Cervix Uteri↗
PubMed1989

Circulating antisperm antibodies and fertility prognosis: a prospective study.

In a prospective study performed on 235 couples with long-standing infertility (median 5 years), circulating antisperm antibodies (ASA) were determined with both a standard trayagglutination test (TAT) and a radioimmunoassay (RIA). Serum levels were correlated with results of sperm analysis (SA), postcoital testing (PCT) and in-vitro sperm--cervical mucus penetration testing (SCMPT), performed with cervical mucus and spermatozoa of patients and in parallel with material of fertile donors. A simultaneous microbial screening included Chlamydia trachomatis, mycoplasmas, Herpes simplex virus, gonococci, other potentially pathogenic aerobic and anaerobic bacteria and yeasts. The pregnancy rate 12 months after determination of ASA in the serum samples was 27% (64/235). Between ASA-positive and -negative male and/or female patients (TAT as well as RIA), no significant difference was found for any of the tested variables of SA, PCT, crossed SCMPT and colonization of genital secretions with microorganisms. Patients who later achieved pregnancy and those who did not did not differ with regard to serum antibody status (TAT as well as RIA). The findings suggest that the clinical significance of circulating ASA determined with the currently available methods is low. ASA in serum samples of infertile female and/or male patients do not influence the fertility prognosis.

Agglutination Tests↗
PubMed1989

[Topical one-time therapy with ketoconazole: a double-blind randomized study in vaginal mycosis].

In a double-blind clinical study 90 women with vaginal candidosis were randomly assigned to treatment with either single-dose ketoconazole (400 mg or 800 mg) or placebo vaginal suppositories. Microscope checks of vaginal fluid and mycological cultures were performed one week and four weeks after the treatment. The four weeks observation period gave no evidence for any significant differences among the three groups regarding symptoms reported as well as clinical picture and microscopy findings. Cure rate after one week, as determined by fungal cultures, was significantly lower in the placebo group (43%) than in the 400 mg (60%) and 800 mg groups (76%; p = 0.031). The mycological cure rate after four weeks did no longer show a significant difference between the groups tested, being 47% in the placebo group and 67% in each of the ketoconazole groups. Treatment of the sexual partner as well as predisposing factors did not influence the therapeutic effect. Due to the low ketoconazole serum concentrations after absorption of single vaginal doses, topical ketoconazole treatment can be applied in pregnancy. It remains to be tested, however, whether repeated vaginal application over three to five days will render higher and longer-lasting cure rates.

Administration, Intravaginal↗
PubMed1988

[Significance of Chlamydia trachomatis for female fertility with special reference to prevalence in the endometrium].

144 patients with longstanding infertility (mean duration of infertility 4.9 years) were screened for endometrial infection with Chlamydia trachomatis by means of endometrial biopsy and McCoy cell-culture. The same day blood was taken for detection of Chlamydia IgG antibodies in serum samples. During a 1 year's period, all new patients of a large infertility clinic without complaints or clinical symptoms of infection of the lower genital tract were consecutively submitted to the study. Elevated titers of IgG antibodies in serum samples (Chlam. AB greater than or equal to 1/256) revealed previous chlamydial infection of 26% of patients, but Chlamydia trachomatis was detected in endometrial biopsies in only 5/144 (3.5%). There was a strong correlation of previous chlamydial infection and reduced tubal patency (p 0.001) and a lower pregnancy rate after 6 months. The results suggested that infections with Chlamydia trachomatis, influenced by demographic and socio-economic aspects, are of minor importance as an actual infection in asymptomatic patients with longstanding infertility. Previous chlamydial infections, however, are of great importance because of their negative influence on tubal function.

Adult↗
PubMed1988

[Possibilities of therapy by ear acupuncture in female sterility].

Following differentiated endocrinologic-gynecologic diagnosis auricular acupuncture was used in 15 women with oligoamenorrhea and 12 women with luteal body insufficiency who had come for hormone consultation because of sterility. In both groups the subsequent incidence of pregnancy was comparable to that achieved by drug therapy. The greatest successes were in cases of amenorrhea with positive gestagen test and normal basal hormones or hyperandrogenemia, while there was less improvement in cases with negative gestagen test, anorexia and luteal insufficiency. Even though it is time-consuming, acupuncture deserves to be more widely used, considering the lack of side effects, the low abortion rate and its positive influence on the patient's general condition.

Acupuncture Therapy↗
PubMed1988

Pulsatile gonadotrophin releasing hormone therapy in patients with hyperandrogenaemia or hypothalamic amenorrhoea.

From 1984 to 1985, 18 patients with infertility and oligomenorrhoea were treated with pulsatile GnRH administration (Zyklomat). According to the hormone levels and the ultrasonographic observation of the ovaries, they could be divided into two categories, group A (n = 11), patients with hyperandrogenaemia, and group B (n = 7), patients with hypothalamic amenorrhoea. As in hyperandrogenaemic patients a pathological LH-secretion pattern was suspected, assessment of LH-pulsing (5 ml blood samples at 10 min intervals over 6 h) was performed in this group of patients followed by an oestrogen-gestagen (E-Ge) suppression. One day before discontinuation of this medication, the GnRH pump was applied intravenously. Ovulation induction was more successful in group B than in group A. Hyperandrogenaemic women, in whom ovulation could be induced by the GnRH pump, exhibited higher basal concentrations of FSH, LH, LH/FSH ratio, oestradiol- 17 beta and testosterone (T) than the women not responding to pulsatile GnRH administration. The suppression of T and LH/FSH ratio with E-Ge treatment was more pronounced, while the non-responders had higher basal prolactin concentrations as well as after E-Ge therapy and a significantly greater body weight. The results indicate that GnRH therapy in hypothalamic amenorrhoea is more successful than in hyperandrogenaemia. Overweight hyperandrogenaemic patients appeared to be unsuitable for GnRH treatment, even after previous suppression of the hypothalamic pituitary ovarian axis with E-Ge.

Adult↗
PubMed1988

Effects of antimicrobial therapy on sperm-mucus interaction.

Sperm-mucus interaction under in-vitro or in-vivo conditions might be affected by microorganisms colonizing the reproductive tract. In order to study the influence of antimicrobial therapy, an extensive microbial screening was performed including Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Neisseria gonorrhoeae, a broad spectrum of potentially pathogenic aerobic and anaerobic bacteria, Trichomonas vaginalis, herpes simplex virus and yeasts. One-hundred-and-six couples with a mean duration of infertility of 5.5 years (range 1-12 years) and with isolation of potentially pathogenic microorganisms in semen samples and/or cervical swabs were submitted to a prospective pilot study. None of the patients displayed signs or symptoms of infection in the lower genital tract. Before and after specific therapy, based on antimicrobial susceptibility testing, sperm analyses and in-vitro sperm penetration meter tests (SPMT) (Kremer) were performed. SPMT was evaluated with cervical mucus of patients' wives, collected after a standardized oral treatment with oestrogens and, additionally, in a crossed manner with cervical mucus and spermatozoa of fertile donors. The success of antimicrobial therapy was controlled by repeating the same microbial screening and was 96%. However, there was a marked change in the microbial pattern. A comparison of the results of sperm analyses before and after treatment revealed neither significant differences for sperm volume, sperm count, propulsive motility, morphology, vitality, pH, fructose concentration or number of round cells, nor was there a significant influence on the cervical index and the number of leukocytes in cervical mucus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Weight percentile at birth. I. Clinical data of pregnancy and relevance for early childhood development.

The influence of the weight percentile at birth on childhood development was examined in a prospective study of 847 singleton pregnancies. In the first two years of life significant relationships between the birth weight percentiles and the infant's development could be proven, while at the age of four social factors were predominant. Though various clinical data in pregnancy and delivery were related to fetal growth, such as weight of the mother, previous abortions and diseases, additional biochemical and biophysical information is desirable for early recognition of intrauterine growth disorders.

Birth Weight↗
PubMed1987

Weight percentile at birth. II. Prediction by endocrinological and sonographic measurements.

In a prospective study of 847 singleton pregnancies, the importance of various endocrine methods (serum estriol, HPL, SP1, beta-HCG, estradiol-17 beta, urinary estrogen excretion) and of two sonographic measurements (biparietal and thoracic diameter) for the diagnosis of growth retardation in the third trimester was studied. HPL and estriol determinations were best suited for the diagnosis of growth retardation. The thoracic diameter correlated most closely with the birthweight of the newborns. Sensitivity in relationship to growth retardation was between 17 and 35% for the HPL and estriol determinations as well as for both sonographic methods. Specificity was around 90% for these methods. The validity for all methods improved as the time of birth approached. Through the simultaneous measurement of one of the hormones and the thoracic diameter, an antepartal diagnosis of up to 50% of the hypo- and hypertrophic growth disorders was achieved. In the first two years of life a relationship between development and the HPL and estriol concentrations could be observed which was independent of the weight percentile at birth.

Birth Weight↗