Search PubMed⌕ Search

Biomedical subjects

K Diedrich

Publications and source records attributed to K Diedrich.

At least 217 records · Page 12Linked to original sources
PubMed1995

[Morphology in intracytoplasmic sperm injection].

OBJECTIVE: Was to determine if severe morphological defects of spermatozoa in Oligo-Astheno-Teratozoospermia (OAT) have any impact on the fertilization process in intracytoplasmic sperm injection (ICSI) and, if there are any specific morphological characteristics of unfertilized oocytes after the ICSI procedure. METHODS: Ejaculates of males with severe subfertility and unfertilized oocytes after the ICSI procedure were investigated by transmissionelectronmicroscopy. RESULTS: ICSI provided a fertilization rate of 66% in cases of severe defective spermatozoa. The ultrastructure revealed severe head and neck alterations in particular. The ultrastructure of the unfertilized oocyte displayed mostly no signs of activation and lack of decondensation of sperm chromatin. CONCLUSIONS: Our findings support the hypothesis that not severe sperm defects but the lack of intracytoplasmic sperm-oocyte interaction displays the most critical role in the fertilization process in intracytoplasmic sperm injection.

Female↗
PubMed1995

New approaches to male infertility: IVF and microinjection.

The male factor represents a major problem in the treatment of infertility. New methods of assisted fertilization such as partial zona dissection (PZD), subzonal sperm injection (SUZI) and intracytoplasmic sperm injection (ICSI) are described and discussed in terms of their potential benefits for infertility treatment in comparison to classical in-vitro fertilization (IVF) and intra-uterine insemination (IUI).

Fertilization in Vitro↗
PubMed1994

[GnRH agonist treatment for in vitro fertilization in hyperandrogenemia].

Luteinising hormone (LH) is essential for steroidogenesis and folliculogenesis. In hyperandrogenic patients, however, an increased androgen production with the consecutive development of polycystic ovaries is caused by elevated LH levels. Suppression of androgens by the use of a GnRH agonist (a) may be a causal therapeutic approach. Therefore, we initiated a study comparing the combined GnRHa/HMG stimulation with HMG alone in hyperandrogenic patients undergoing in-vitro fertilisation (IVF). Altogether, 62 cycles were treated. Group 1 (n = 33) received a single depot injection of 3.6 mg goserelin on cycle day 22 followed by individualised HMG stimulation 14 days later. Group 2 (n = 29) started with the HMG stimulation on cycle day 3. In group 1, a pregnancy rate per transfer of 36.4% was achieved compared to only 20% in group 2. There was a strikingly lower abortion rate in group 1 that resulted in a significantly higher on going pregnancy rate. The results are in favour of the combined GnRHa/HMG stimulation as a first line therapy for hyperandrogenic IVF patients.

Adult↗
PubMed1994

[Ovarian stimulation with various FSH/LH concentrations in an in vitro fertilization program].

Various stimulation regimes have been tried to induce multiple follicular development for in-vitro fertilisation and embryo transfer. Human menopausal gonadotrophins have been widely used to induce follicular growth. To evaluate the role of the FSH: LH-ratio and the importance of LH concentrations, the results of a randomised assessor-blind group comparative efficacy and safety study are described. The effects of preparations, comprising FSH: LH-ratio of 3:1 and FSH: LH-ratio of 1:1 respectively, in stimulation of the ovaries for in-vitro fertilisation in infertile women are compared. Patients under 38 years of age with regular menstrual cycle (27 +/- 3 days and 32 +/- 3 days) are included. Sperm parameters have to be in normal range, according to WHO criteria. Follicular and luteal hormone parameters, ultrasound measurements, oocyte quality, fertilisation, cleavage and pregnancy rates are reported. The outcome of in-vitro fertilisation after the administration of preparations containing different ratios of FSH:LH leads to comparable results. However, the rate of ovarian hyperstimulation syndrome and the abortion rate after embryo transfer seems to be lower in patients stimulated with FSH dominant gonadotrophins.

Dose-Response Relationship, Drug↗
PubMed1994

[Suppression of endogenous LH increase in ovarian stimulation with the GnRH antagonist Cetrorelix].

Surges of LH in serum, which result in luteinization, but occur prematurely with respect to the diameter of the leading follicle, frustrate attemps to induce multiple follicular maturation for in-vitro fertilisation in a number of women. We examined the possibility of blocking premature LH-surges by the administration of Cetrorelix, a potent antagonist of gonadotrophin releasing hormone. Twenty patients, who had repeatedly shown premature LH surges, were treated with human menopausal gonadotrophins from the 2nd day onwards. From the 7th day until the induction of ovulation by HCG, the GNRH-antagonist Cetrorelix was given daily. HCG was injected when the dominant follicle had reached the diameter of at least 18 mm and oestradiol levels were above 300 pg for each follicle and more than 15 mm. Oocyte collection was performed 36 hours later by transvaginal ultrasound puncture, followed by IVF and embryo transfer. The hormone profiles of these patients and the results of in-vitro fertilisation and embryo transfer are discussed. It could be demonstrated in this study, that combined treatment with gonadotrophins and the GNRH-antagonist seems to be a promising method for ovarian stimulation in patients, who frequently exhibit premature LH discharges and therefore fail to complete treatment.

Adult↗
PubMed1994

Suppression of the endogenous luteinizing hormone surge by the gonadotrophin-releasing hormone antagonist Cetrorelix during ovarian stimulation.

Surges of luteinizing hormone (LH) that result in luteinization but occur prematurely with respect to the diameter of the leading follicle, prevent attempts to induce multiple follicular maturation for in-vitro fertilization (IVF) in a significant number of women. We examined the possibility of blocking premature LH surges by the administration of Cetrorelix, a potent antagonist of gonadotrophin-releasing hormone (GnRH), in a study including 20 patients, some of whom had previously shown premature LH surges. All patients were treated with human menopausal gonadotrophins (HMG) starting on day 2. From day 7 until the induction of ovulation by human chorionic gonadotrophin (HCG) the GnRH antagonist Cetrorelix was given daily. HCG was injected when the dominant follicle had reached a diameter of > or = 18 mm and oestradiol concentration was > 300 pg/ml for each follicle having a diameter of > 15 mm. Oocyte collection was performed 36 h later by transvaginal ultrasound puncture, followed by IVF and embryo transfer. The hormone profiles of these patients and the results of IVF and embryo transfer are comparable to those treated with GnRH agonists and HMG. However, less time and especially less HMG is needed in comparison to patients stimulated with a long agonist protocol. Hence, treatment with Cetrorelix proved to be much more comfortable for the patient. In this study we showed that combined treatment with gonadotrophins and the GnRH antagonist Cetrorelix is a promising method for ovarian stimulation in patients who frequently exhibit premature LH surges and therefore fail to complete treatment.

Adult↗
PubMed1994

Seven-day administration of the gonadotropin-releasing hormone antagonist Cetrorelix in normal cycling women.

In contrast to gonadotropin-releasing hormone (GnRH) agonists, GnRH antagonists do not show any stimulatory effect on the pituitary but their clinical usage was precluded by severe side effects and high dose requirements. We report here on a 7-day treatment using the potent GnRH antagonist Cetrorelix ([Ac-D-Nal(2)1, D-Phe(4Cl)2, D-Pal(3)3, D-Cit6, D-Ala10]GnRH) on five women 23-33 years old. All women were ovulatory and were studied during three consecutive cycles: a control cycle, a treatment cycle and a post-treatment control cycle. Throughout the control cycles blood samples were obtained daily during cycle days 8-18 and on days 21 and 23 during the remainder of the control cycles. On the eighth day of the treatment cycle women were hospitalized at 07.00 h for 26 h. Repeated blood samples were drawn at 15-min intervals during the entire period. Subjects received 3 mg of Cetrorelix sc for the first time at 09.00 h on the eighth day of the cycle and daily at 08.00 h for the following 6 days. Blood samples were obtained daily over a period of 25 days and every third day throughout the remainder of the treatment cycle. Twenty-four hours after the first application of Cetrorelix, luteinizing hormone (LH) and estradiol were in the subnormal range and remained subnormal until the end of medication. The suppressive effect of Cetrorelix compared to pretreatment values lasted at least 6 days for LH and FSH and 11 days after the last Cetrorelix injection for estradiol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Transcervical tubal transfer of gametes and embryos.

The benefit of intrafallopian transfer techniques is still disputable in assisted reproductive techniques. On this background, alternatives to laparoscopic transfer procedures are in development. Current transcervical intrafallopian transfers of gametes and embryos are lacking success and reproducibility of results. New developments in catheter techniques and optical systems are offering new concepts for more successful transcervical approaches and preparing the basis for truly prospective studies.

Embryo Transfer↗
PubMed1993

[In vitro fertilization. Prognostic factors].

Multiple factors influence the outcome of in vitro fertilisation and embryo transfer (IVF-ET). In our prospective study different factors have been subject of examination concerning their effect on the outcome of in vitro fertilisation and embryo transfer. 1237 couples undergoing 1675 consecutive treatment cycles between 1.1.1990-31.12.1991 were included in this study. Prior to treatment, couples were divided into "good" and "poor" prognosis groups. Cycles were prospectively labelled as carrying a potentially "poor prognosis", if one or more of the following factors were noted: 1) female age > 35; 2) an existence of male factor; 3) couples with more than 3 previous unsuccessful treatment cycles. Couples with none of these factors were assigned to the "good" prognosis group. The pregnancy rate per cycle in the "poor" prognosis group was 5.96%, compared with 17.92% per cycle in the "good" prognosis group (p < 0.001). The most important factors determining pregnancy rates were female age and male factor, and we observed that the rate of pregnancy declined after the third treatment cycle. An explanation may be seen in lower fertilisation rates after the age of 35 and cases of poor semen quality. Both will result in poor embryo quality.

Adult↗
PubMed1993

[Modern diagnostics of the breast].

A diagnosis of breast cancer as early as possible is most important for a good prognosis. Among previous imaging modalities (mammography, sonography, DSA, thermography, CT) only mammography was able to prove a significant reduction of mortality, but unfortunately only for women above 50 years of age. Magnetic resonance mammography (MRM) is under technical and clinical evaluation for more than 8 years. Special surface coils and a variety of measurement sequences have been tested. By using "dynamic MRM", i.e., the repetitive imaging of the same slices before and at short time intervals after the injection of contrast medium, a high sensitivity (97.3%) and specificity (96.9%) was found in detecting breast cancers of different histology. In this study especially clinically or mammographically difficult cases were included in order to test the efficacy of dynamic MRM. Breast cancer can be proven or excluded with a very high degree of confidence. Conventional mammography had been yielding a vast number of false positive findings. With MRM, therefore, the number of biopsies can be substantially reduced. The remarkable uniformity of the maximum rate of signal enhancement in carcinomas may be explained by the changed vascularisation of malignant tumours based on early tumour angiogenesis. This change in vascularisation can be detected by combining the use of contrast medium with a high contrast sensitive measurement technique. This method seems to be much more reliable than mammographic or sonographic procedures. MRM needs further technical improvements. Since breast cancer is still the most frequent cause of cancer in women in the Western hemisphere, MRM should be used in all cases where is a discrepancy among radiographic, sonographic or clinical findings. However, MRM examinations should be performed only by experienced examiners, since a variety of pitfalls must be avoided.

Adenofibroma↗
PubMed1993

[Diaplacental transmission of varicella zoster virus antibodies after chickenpox at the time of birth].

A pregnant woman with post-term birth developed a varicella rash on the day, when birth was to be initiated. The date was then postponed, until varicella zoster virus (VZV) IgG-antibodies could be proved in the mother, so as to allow the child to achieve an adequate diaplacental passive immunisation. Cesarean section was performed on the 7th day after the rash, but a comparison of the child's blood (from the umbilical cord) with the mother's blood showed, that the VZV antibodies developed by the mother during this time were only present in a tenfold reduced amount in the child. Antibodies to herpes simplex virus, already present in the mother's blood before the VZV infection, also increased because of the close relationship of the virus to VZV. Similar to the VZV antibodies, these antibodies did not increase in the baby as in the mother. Our results show that maternal antibodies are not transferred rapidly to the baby, and therefore it seems reasonable, that in the case of chickenpox at the time of delivery, the birth should be delayed, not only until seroconversion in the mother's blood, but - if possible - a few days longer.

Adult↗
PubMed1993

Histological findings in a falloposcopically retrieved isthmic plug causing reversible proximal tubal obstruction.

We present the case of a 33-year-old woman with a 10 year history of infertility. Transvaginal falloposcopy revealed a proximal tubal occlusion (PTO) on the right due to a tissue plug. The plug was removed during dilatation of the tubal lumen. After the procedure patency for dye was restored. Histological and immunohistochemical findings--for the first time, to the best of our knowledge, performed in a falloposcopically retrieved plug--revealed the diagnosis of an inflammatory polyp arising from the tubal mucosa with focal calcifications. Local obstructive inflammatory residues of a previously treated tubal endometriosis, which was accompanied by features of salpingitis isthmica nodosa, are considered the most likely cause for this condition. Other possible aetiological factors responsible for PTO are discussed.

Adult↗
PubMed1992

Indications and outcomes of assisted reproduction.

Since 1978 many healthy children have been born after in vitro fertilization and embryo transfer, fulfilling the wishes of many previously childless couples. In vitro fertilization and subsequently developed methods (GIFT, intratubal embryo transfer) have contributed to progress in the diagnosis and treatment of unwanted childlessness. Furthermore these techniques have improved knowledge of ovarian function, fertilization and early embryo development.

Embryo Transfer↗
PubMed1992

[Intrauterine pregnancy with uterine myoma after downregulation with GnRH analogs].

GnRH analogues are widely used for the reduction of uterine fibroids. This case report describes the therapy of a 27-year-old woman, whose uterus had a diameter of about 13 cm. After 7 injections of Zoladex Depot (ICI Pharma, Heidelberg, Germany), the uterus was reduced to normal size carrying dorsally a myoma of the same size. After only 7 weeks of medroxyprogesterone acetate (5 mg twice daily, Clinofem, Upjohn, Heppenheim, Germany) the uterus had grown again, so that therapy was changed to Zoladex Depot for another 3 months. On the 27th day of the first spontaneous cycle, the patient ovulated and conceived. Up to the 29th week of gestation (Aug '91), the foetal growth and development was normal, the uterus was normal in size, a childhead sized myoma being situated unproblematically behind the foetus.

Adult↗
PubMed1992

[Incidence and type of premenstrual symptoms in relation to experienced infertility: a comparative study].

Using the symptomatological criteria of "Late Luteal Dysphoric Disorder" according to DSM-III-R, the frequency and type of premenstrual symptoms were investigated in a group of 405 infertile women (participants in an in-vitro-fertilisation programme at the University of Bonn) and a control group of 101 female medical students. 84% of both groups of women reported premenstrual psychological and/or physical changes. 52% of the infertile patients and 42% of the students fulfilled the symptomatological criteria of late luteal dysphoric disorder. Comparing both groups, it was found, that infertile women reported significantly more often mood lability, anger/irritability, anxiety/tension and loss of interest.

Adult↗