Transient hyperprolactinemia during cycle stimulation: influence on the endocrine response and fertilization rate of human oocytes and effects of bromocriptine treatment.

The effect of transient hyperprolactinemia and its treatment during cycle stimulation on the endocrine response and fertilization rate of human oocytes was studied. Fifty stimulated cycles were included in the study and divided into three groups: group I consisted of 18 cycles with serum prolactin (PRL) levels less than or equal to 25 ng/ml; group II contained 15 cycles, where patients developed PRL levels greater than 25 ng/ml; group III consisted of 17 cycles, where patients, who already developed hyperprolactinemia in a previous cycle, were treated by 3.75 mg bromocriptine daily. The serum estradiol (E2), progesterone (P) and PRL levels 1, 2, and 3 days before and at oocyte retrieval were evaluated. The E2 decrease at oocyte retrieval was significantly steeper in groups I and III. Follicular luteinization was more effective in groups I and III. The fertilization rate in groups I and III was significantly higher than in group II. High serum PRL levels seem to interfere in follicular and oocyte development. The treatment of transient hyperprolactinemia improved the patients' endocrine response and the fertilization rate of oocytes.

Follicular aspiration for in vitro fertilization: sonographically guided transvaginal versus laparoscopic approach.

Laparoscopy is the most commonly used procedure for oocyte retrieval in an in-vitro fertilization (IVF) program. In this study we compared the results of 21 laparoscopic and 21 sonographically guided transvaginal oocyte retrievals using a vaginal probe. Laparoscopically 3.7 and transvaginally 4.8 oocytes per patient were recovered. Overall 6 pregnancies were achieved, giving a pregnancy rate of 14.1% per patient. Vaginal follicular aspiration resulted in a higher oocyte recovery rate. The advantages of the method were a shorter operation time, a superficial anesthesia and, compared to laparoscopy, a less invasive and simpler technique. Therefore this method is now commonly used for routine IVF procedures in our institution.

[Intrauterine pregnancy following intratubal gamete transfer--a case report]. / Intrauterine Schwangerschaft nach intratubarem Gametentransfer--ein Fallbericht.

Since the beginning of 1986 gamete intrafallopian transfer (GIFT) has been used in the treatment of infertile couples. Only patients in whom tubal patency has been ascertained are included in the programme. After hormonal stimulation of the ovaries and laparoscopic follicular aspiration oocytes and semen are transferred by means of catheterisation into the fallopian tubes. The first pregnancy in our department established by gamete intrafallopian transfer--and the first in Austria to our knowledge--is reported.

Platelet specific proteins (beta-thromboglobulin and platelet factor 4) in normal pregnancy and in pregnancy complicated by preeclampsia.

Pregnancy is accompanied by significant alterations of platelet function. Platelet activity can be determined by measurement of plasma levels of secreted platelet proteins. In this study we determined plasma levels of beta-Thromboglobulin (beta-TG) and Platelet Factor 4 (PF4) simultaneously in 35 women with uncomplicated pregnancy and in 15 patients with preeclampsia in third trimester of gestation. Additionally, PF4 plasma levels were measured using a commercially available Radio Immunoassay (RIA) and an Enzyme Immunoassay (EIA) simultaneously and values obtained were compared. Platelet count and creatinine were in the normal range in both groups; however, significantly higher levels of beta-TG (P less than 0.0005) and PF4 (P less than 0.0001) were found in case of preeclampsia. High levels of platelet proteins emphasize the active role of the platelets in the alterations of hemostasis in cases of preeclampsia.

[Recurrence of gynecologic malignancies after combined and primary radiotherapy. Incidence and lapse of time until the diagnosis is made]. / Rezidive gynäkologischer Malignome nach kombinierter und primärer Strahlentherapie. Häufigkeit und Zeitraum bis zur Diagnosestellung.

A group of 1018 patients with gynecological malignancies after a combined or primary radiation therapy was studied for frequency and space of recurrence. In the first three years after therapy in cases with cervical cancer 95%, in cases with endometrial cancer 82% and in cases of ovarian cancer 98% of all recurrences were diagnosed. In cases of cancer of the vagina, the tube and vulva all recurrences were observed within the first three years. By results obtained it is put up for discussion to replace "five-years-rate" by "three-years-rate" in cases of gynecological malignancies with exception of mammary carcinoma. Thereby the value of a model of therapy could be realized earlier than hitherto.

Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy.

We first performed a vaginosonic scan and then determined the serum human chorionic gonadotropin (beta-hCG) concentration (Second International Standard) in 52 women at an early gestational age to establish criteria for the earliest possible identification of an intrauterine pregnancy by this new ultrasound technique. The smallest diameter of a gestational sac detected was 2 mm, and the lowest beta-hCG concentration was 141 mIU/ml when an intrauterine pregnancy was correctly diagnosed. Between 50 and 280 mIU/ml, six out of eight pregnancies in this range were not seen. However, all pregnancies associated with beta-hCG concentrations greater than 300 mIU/ml were correctly identified. Taking into account the rapid growth of the conceptus and the exponential increase of serum beta-hCG by a factor of 1.7 per day at this early gestational age, we presume that a gestational sac at beta-hCG concentrations of 750 mIU/ml should not be missed by vaginosonography (safety margin of the discriminatory zone), even in instances of a retroverted uterus. No false-positive vaginosonographic findings were observed in this study. A vaginosonographic examination is a short and well-tolerated procedure that can be performed in a physician's office. The use of a 5 MHz transducer placed in the vagina provides better resolution and image quality. This overcomes imperfect anatomy and other physical factors that interfere with good imaging. The vaginosonographic examination provides information on the anatomic location of the gestational sac, with the highest reliability and accuracy around the time a woman misses her menstrual period. It can be very useful in the differential diagnosis of an ectopic pregnancy.

[Effect of serum prolactin on cycle stimulation and fertilization of human oocytes]. / Der Einfluss des Serum-Prolaktins auf Zyklusstimulation und Fertilisierung menschlicher Eizellen.

During cycle stimulation for in-vitro fertilisation (IVF) some patients develop hyperprolactinaemia. Since prolactin (PRL), being an aromatase inhibitor, can interfere with follicular fluid steroid metabolism, we examined the influence of high serum PRL levels on the endocrine response and fertilisation rate of oocytes. 33 consecutive patients stimulated by hMG/hCG for IVF were included in this study. Two groups of patients were established: Group 1 consisting of 18 patients with serum PRL levels less than or equal to 25 ng/ml, and group 2 containing 15 patients, who developed PRL levels greater than 25 ng/ml during cycle stimulation. The serum oestradiol (E2), progesterone (P) and PRL levels 3, 2 and 1 day before and at the day of follicle puncture were evaluated. The decrease of E2 levels at the day of oocyte retrieval was significantly steeper in group 1. The P levels 2 days before oocyte retrieval were significantly higher in group 1 indicating the onset of preovulatory luteinization. Luteinization after the hCG injection was more effective in group 1 resulting in significantly higher P levels. Fertilisation and cleavage rates were significantly higher in patients with normal PRL levels. High serum PRL levels therefore might indicate an interference in follicular and oocyte development leading to oocytes of inferior quality.

[Comparison of vaginosonographic, transabdominal sonographic and laparoscopic follicle puncture for the retrieval of oocytes within the scope of an in vitro fertilization program]. / Vergleich von vaginosonographischer, transabdomineller sonographischer und laparoskopischer Follikelpunktion zur Gewinnung von Eizellen im Rahmen eines In-vitro-Fertilisierungsprogrammes.

For follicular aspiration and oocyte retrieval for in-vitro-fertilization (IVF) laparoscopy, laparotomy and different ultrasound guided methods like transvesical and transvaginal puncture can be used. Sonographically guided follicular aspiration has become more important because this procedure is less invasive. In this study we compared the results of 28 laparoscopical, 35 transabdominal and 21 transvaginal follicle puncture after successful cycle stimulation. Performing transvaginal puncture 4.7, using laparoscopy 3.4 and performing transvesical puncture 2.0 oocytes per attempt were retrieved. The advantages of transvaginal follicle aspiration were a shorter operation time, a superficial anesthesia and compared to laparoscopy a less invasive and simple technique. Therefore this method is now commonly used for routine IVF procedures in our institution.

Comparison of the results of vaginal and abdominal follicle scans.

The hormonal profile and sonographical assessing of the number and size of the follicles are important in hyperstimulated cycles. Follicular imaging obtained by abdominal scanning may be distorted by echoes from the intestine or by unfavourable location of the ovaries and patients must have a full bladder. We compared the number and size of the follicles at abdominal sonography with the results obtained by vaginal sonography in 37 patients. Vaginal sonography showed more follicles than abdominal sonography because of improved imaging of small follicles on early days of cycle. This might help one to tailor the hyperstimulation to an individual's endocrine response.