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Biomedical subjects

K Diedrich

Publications and source records attributed to K Diedrich.

At least 235 records · Page 13Linked to original sources
PubMed1992

The effect of 17 alpha-hydroxyprogesterone caproate/oestradiol valerate on the development and outcome of early pregnancies following in vitro fertilization and embryo transfer: a prospective and randomized controlled trial.

A prospective and randomized study was performed to investigate the effect of supportive hormones on the development and outcome of early pregnancies following in vitro fertilization and embryo transfer. Immediately after pregnancies were confirmed endocrinologically on day 15 after oocyte collection, 17 alpha-hydroxyprogesterone caproate and oestradiol valerate (PC/EV) was administered to half of the patients in a randomly controlled trial. One group received supportive treatment until the twelfth week of gestation, whereas the other group received no treatment at all. Both groups were followed up by measurements of serum levels of human chorionic gonadotrophin (HCG), oestradiol and progesterone every three days until day 35, when a first ultrasound examination was carried out to confirm fetal vitality. Subsequently, pregnancies were monitored sonographically at regular intervals. In cases of miscarriage, dilatation and curettage was performed and histology analysed. A total of 120 pregnant patients entered the study: 55 of them received hormone treatment and 65 patients were controls. Within the treatment group 48 (89%) clinically ongoing pregnancies were observed, five (9%) miscarriages occurred after the seventh week of gestation and one preclinical pregnancy was noted. In the control group, 38 (59%) ongoing pregnancies were observed, nine (14%) miscarriages occurred and 17 (27%) preclinical pregnancies were recorded. Two ectopic pregnancies, one in each group, were excluded from evaluation. A significantly higher percentage of pregnancies were intact at 7 weeks of gestation after treatment with PC/EV (p less than or equal to 0.01).

17 alpha-Hydroxyprogesterone Caproate↗
PubMed1992

Indications for in-vitro fertilization and results.

During the last few years, many healthy children have been born after in vitro fertilization and embryo transfer, fulfilling the wish for a child for many couples who had often nearly given up hope. Because of in vitro fertilization and other related methods developed subsequently (gamete intra-Fallopian transfer, intratubal embryo transfer), progress in the diagnosis and treatment of involuntary childlessness took place and has helped many patients. Furthermore, by dealing with these methods, new knowledge about ovarian function, fertilization and early embryonic development could be gained. This has also led to better treatment of childless couples. Despite the broad diagnostic and therapeutic possibilities of reproductive medicine, its limits must also be taken into account. These limitations have been recognized early by physicians and scientists dealing with this subject and also by society. Guidelines and laws have been drawn up which now give a clear framework.

Embryo Transfer↗
PubMed1992

Transcervical access and intra-luminal imaging of the fallopian tube in the non-anaesthetized patient; preliminary results using a new technique for fallopian access.

A study was performed to evaluate a new transcervical, Fallopian tube access system for use in falloposcopy procedures without the need for conventional hysteroscopy or uterine distension. Visualization was accomplished by the use of a 0.5 mm falloposcope which was delivered to the Fallopian tube by a new linear everting catheter. The linear everting catheter allows access to the Fallopian tube by means of a flexible, tubular rolling membrane which can safely negotiate the tortuous anatomy from the ostium to the ampulla. Concurrent laparoscopy was performed solely for supervision purposes and not for tubal manipulations in 13 Fallopian tube access procedures in 10 patients. The ostia were visualized in 12 cases and the Fallopian tube was accessed in all 12 without complications. As a precursor for future gamete and embryo transfer procedures, intra-tubal insemination was performed by visualizing the ostia, accessing the Fallopian tubes, and obtaining successful isthmic-ampullary, intra-luminal images.

Catheterization↗
PubMed1992

Cryopreservation of rabbit zygotes.

Rabbit embryos at the pronuclear stage (n = 480) were frozen using a mixture of propanediol and sucrose. The survival rate was 71% according to their morphological features shortly after thawing. The viability rate after 5 days of culture was 10% according to the number of embryos that reached the blastocyst stage, while the rate of formation of blastocysts from freshly collected and cultured pronuclear embryos was higher (59%). The implantation rate was higher (24%) if the frozen/thawed zygotes were directly transferred to foster mothers after 2-4 hours of culture, whereas with zygotes cultured for 24 hours (4 to 8-cell stages) the implantation rate was poor (4%). Both rates were low compared with the implantation rate (52%) achieved with freshly collected and directly transferred pronucleate embryos.

Animals↗
PubMed1992

Chlorinated hydrocarbon content of fetal and maternal body tissues and fluids in full term pregnant women: a comparison of Germany versus Tanzania.

Chlorinated hydrocarbons are distributed worldwide and due to their lipophilic properties and chemical stability they accumulate in the foodchain. The concentrations of 19 different chlorinated hydrocarbons (hexachlorohexane (HCH), DDT and various metabolites and nine different polychlorinated phenyl (PCB) congeners were detected in various body tissues and fluids (maternal and fetal serum, adipose tissue, placenta, amniotic fluid) of full term pregnant women from Germany and Tanzania. Great variation of total toxin burden and toxin distribution within the different body compartments was found. This was in part due to local differences of exposure to some of the chlorinated hydrocarbons. Comparing samples from Germany and Tanzania, typical distribution patterns reflected the specific economic situation of the two countries with a high burden of insecticides (DDT and Dieldrin) in the agricultural country and high levels of constituents of industrial products (hexachlorobenzene (HCB) and PCBs) in Germany. Different chlorinated hydrocarbons seem to show different distribution patterns in body tissues, probably due to their chemical structure, the lipid content of the compartment and the overall toxin burden of the individual. A 10 to 100 fold accumulation of chlorinated hydrocarbons was observed in maternal adipose tissue compared with the other compartments. The concentrations of certain toxins in fetal cord serum and placenta were higher than in maternal serum.

Adipose Tissue↗
PubMed1992

In vitro fertilisation in capillary tubes for male factor infertility.

In 26 patients with severe factor infertility (total spermatozoa per ejaculate 0.8-6.3 million) in vitro fertilisation was performed using a capillary tube culture system. Spermatozoa were concentrated and incubated with oocytes in a very small volume (10-20 microliters) within capillary tubes. In seven out of 26 patients (27%) at least one oocyte could be successfully fertilised (overall fertilisation rate 11.6%, 22/190 oocytes) and in two patients a pregnancy with the birth of a healthy child could be observed. If sperm progression was only of grade 2 or less no fertilisation could be observed in 10 patients with a total of 75 oocytes. The described capillary technique for in vitro fertilisation using very small volumes for sperm-oocyte culture may be useful in cases of severe oligozoospermia or before considering extreme therapies such as donor insemination of sperm microinjection.

Fertilization in Vitro↗
PubMed1991

Transvaginal intratubal embryo transfer: a new treatment of male infertility.

Intratubal embryo transfer is a new method in the treatment of human infertility. Following transvaginal sonographic oocyte retrieval, in-vitro fertilization (IVF) is performed and embryos are transferred into the Fallopian tube transvaginally. In comparison with gamete intra-Fallopian transfer (GIFT), fertilization under in vitro conditions offers the advantage that the success of the fertilization process can be examined. Therefore, this method can give important diagnostic information, especially in cases of poor sperm quality or unexplained infertility. After fertilization in vitro and transfer into the tube, embryonic development occurs in the physiological milieu of the oviduct. Transvaginal intratubal embryo transfer was performed in 95 patients with male factor infertility. In 29 cases (31%), a pregnancy was achieved. One abortion, but no ectopic pregnancy was observed. This method combines the advantages of IVF and GIFT and offers a successful procedure for the treatment of infertility.

Embryo Transfer↗
PubMed1991

[Locoregional ascites therapy with cytostatic drugs and immune modulators in gynecologic neoplasms].

35 ovarian cancer patients with ascites have been treated intraperitoneally with mitomycin C or mitoxantrone or interferon beta or tumor necrosis factor (TNF). We observed nor or a little bit ascites in 87.5 per cent after TNF and in 66.5 per cent after mitoxantrone. In addition we applied a systemic monochemotherapy. After mitomycin C or interferon beta only in 40 per cent each an effect could be observed. TNF to day is the most effective substance for treating ascites with moderate toxicity.

Ascites↗
PubMed1990

Cellular sensitization against spermatic and seminal plasma antigens in women after intrauterine insemination.

Using an indirect lymphokine-assay, the leucocyte-migration-inhibition-test (LMI-test), the cellular sensitization of fertile and infertile patients before and after homologous and heterologous intrauterine insemination (IUI) was investigated. In this assay several preparations of spermatozoa ("washed"-, "swim-up"- and "pellet"-spermatozoa) in different concentrations (1, 5 and 10 x 10(6) sperms/ml culture medium) and seminal plasma were tested as antigen. In all investigated groups a cellular immune response against spermatic antigen was demonstrable and seemed to be dose dependent. In contrast to fertile women who reacted with an enhancement of the macrophage migration for low concentrations the same concentration of antigen induced an inhibition of macrophage migration in fertile patients. For high concentrations of spermatic antigens there was a difference in the intensity of cell-mediated immune response between fertile and infertile women. Since infertile patients demonstrated an increased level of cell-mediated immune response it is possible that infertility may be caused by this altered immunological reaction. This response changes after multiple IUI-treatment and that change might be caused by the high concentration of spermatic antigens as there was a difference in the intensity of cell-mediated immune response between fertile and infertile women. Since infertile patients demonstrated an increased level of cell-mediated immune response it is possible that infertility may be caused by this altered immunological reaction. This response changes after multiple IUI-treatment and that change might be caused by the high concentration of spermatozoa. The immunological response of infertile patients seems to be similar in those receiving husband and donor IUI.

Adult↗
PubMed1990

Basic and clinical aspects of GnRH-agonists in reproduction.

Within recent years GnRH agonists have gained increasing importance in the treatment of reproductive failure. Their use as a pretreatment for in vitro fertilization increases the pregnancy rate at least under certain conditions. In cases of endometriosis and uterus myomatosus, GnRH agonists achieve high remission rates and may avoid or at least postpone the need for surgical intervention. The physiological basis and current clinical strategies are discussed.

Endometriosis↗
PubMed1990

The comparison of early follicular and midluteal administration of long-acting gonadotropin-releasing hormone agonist.

Long-acting GnRH-a (D-Trp6 microcapsules, 3.2 mg) was intramuscularly injected, either in early follicular phase (group A) or midluteal phase (group B). Two hundred sixteen cycles were randomly allocated. Ovarian suppression was significantly more prompt in group B. Follicle cysts were diagnosed in 19% and 16% of groups A and B, respectively; their appearance and regression were significantly more rapid in group B cycles. More ampules of human menopausal gonadotropin were needed in group B. The number of oocytes retrieved was not significantly different between the groups. However, in group A more mature oocytes and more embryos with good morphology were achieved in the patients. Cancellation rate was 2.8% in groups A and B. Pregnancy rate and outcome were similar in both groups.

Adult↗
PubMed1990

[Chemosensitivity studies with soft agar culture systems in ovarian cancer].

Since 1982, chemosensitivity studies have been conducted in our laboratory with 181 tumour samples from 132 woman patients suffering from carcinoma of the ovaries, using the colony test and capillary assays. Colonisation rates were 67% and assay rates between 60 and 47%; in 36 cases the in vitro result was compared with the course of the disease observed in vivo. Whereas in 11 of 12 patients it was possible to correctly assess chemoresistance (in vitro growth inhibition less than or equal to 49%) pretherapeutically, chemosensitivity (growth inhibition greater than or equal to 50%) proved more difficult to confirm, 15 predictions being true and 9 false. To assess the prognostic significance of the test results, survival curves were calculated from the data of 33 patients. With a p-value of 0.49, the courses of disease of "in vitro resistant" and "in vitro sensitive" patients differed only slightly from one another. We can conclude from our experiments, that an important indication for performing the colony test in ovarian carcinoma should always be assumed in patients with a poor prognosis, e.g. in women having a large postoperative residual tumour. If, in such cases, the possibility of chemosensitivity testing via the colony test is considered, this examination may offer the chance of sparing the patient additional strain due to the side effects of a treatment with cytostatics if the latter is most likely to be of no significant use.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Effect of sequential embryo transfer on pregnancy following in vitro fertilization].

In this study, the influence of sequential embryo transfers in an in-vitro fertilisation programme was examined. After in-vitro fertilisation, a maximum of 6 fertilised oocytes were cultured. In cases with more than 6 fertilised oocytes, the rest was cryopreserved in the pronucleus stage. At day 2 after an oocytes retrieval, three embryos with the best morphological appearance were replaced and the remaining embryos (1-3) were cultured for further 3 days. At day 5 after oocytes collection, second a embryo transfer was performed, if one of these embryos had reached the blastocyst stage. In a total of 106 patients, 40 pregnancies (38%) could be observed. No statistical difference in the pregnancy rate could be seen between the group with a second embryo transfer (n = 38; 42%) and the group without second transfer (n = 68; 35%). The incidence of multiple pregnancy was not statistically different between both group and no high-rank multiple pregnancy (greater than Triplete) were observed. Out of 300 cultured embryos, only 59 embryos (17%) reached the blastocyst stage. In the group, in which a second embryo transfer was performed, 22 patients received one blastocyst and 13 patients two blastocysts during the second transfer. The second transfer did not have a significant effect on the pregnancy rate in this series. The most important factor for the induction of pregnancy seems to be the quality of the embryos transferred on day 2 following oocyte retrieval.

Embryo Transfer↗
PubMed1990

Preliminary results on transvaginal tubal embryo stage transfer (TV-TEST) without ultrasound guidance.

IVF procedures have been increasingly used in male subfertility for both therapeutic and diagnostic purposes. As we assume a positive influence of the tubal milieu on the early embryonal development, any therapy should aim at intratubal embryo transfer. In this respect, only invasive techniques such as laparoscopy or laparotomy have been available hitherto (Asch et al., 1986; Balmaceda et al., 1988; Diedrich et al., 1989). Transvaginal intra-tubal embryo stage transfer (TV-TEST) was performed in 15 patients. After stimulation with clomiphene/HMG, HMG or GnRHA/HMG, patients with a follicle size of 18 mm were given 10000 IU HCG. Thirty six hours later, the transvaginal oocyte retrieval was performed without anaesthesia. Altogether, 109 oocytes were recovered. A fertilization rate of 30.3% yielded 33 embryos. Forty-eight hours after oocyte retrieval, the TV-TEST was performed without anaesthesia, in the course of which a maximum of three embryos in the 2- to 8-cell stage were transferred into one tube. Six of these patients are now pregnant.

Catheterization↗
PubMed1990

Significance of cumulus oophorus in in-vitro fertilization and oocyte viability and fertility.

Fertilization and cleavage rates of human cumulus-intact oocytes incubated in vitro for 36-48 h with normal spermatozoa tended to be higher than those which were cumulus-denuded (73 versus 68%; 68 versus 56%, respectively); however, the difference was not significant. Nor were these differences significant when using sperm samples of various qualities (normozoospermic samples: 75 versus 70% fertilized oocytes; asthenozoospermic: 66 versus 64%; oligozoospermic: 64 versus 56%; oligoasthenozoospermic: 35 versus 33%). The beneficial effect of the human cumulus oophorus on the binding of human spermatozoa to denuded hamster oocytes and on head decondensation of human spermatozoa observed after 2 h of incubation (9.3 versus 7.0 bound spermatozoa per oocyte, P less than 0.05; 0.5 versus 0.3 decondensed sperm heads per oocyte, P less than 0.02) disappeared after 6 h. A protective effect of the cumulus oophorus on hamster oocytes preincubated in medium containing 50% human preovulatory follicular fluid was observed in the sperm penetration assay (fertilization rate of cumulus-intact: cumulus-denuded oocytes, 26 versus 13%, P less than 0.05) and confirmed using fluorescein diacetate stain (cumulus-intact oocytes: 86 versus 100% vitality, non-significant; cumulus-denuded oocytes: 64 versus 100%, P less than 0.01). These data suggest the accelerating effect of the human cumulus oophorus on fertilization in its early stages. Furthermore, the cumulus plays an important part in protecting the oocyte against adverse environmental influences.

Animals↗