An initial comparison of coagulation techniques of sterilization.

For nearly 50 years reports have been published on laparoscopic sterilization techniques. However, the different procedures vary greatly with regard to the extent of the tube destroyed and the magnitude of damage to the mesosalpinx. In 1981 we proved that a clear relationship exists between the extent of destruction of the circulation and nervous system within the mesosalpinx and the occurrence of menstrual disorders as well as menopausal symptoms. Because two-thirds of the ovarian blood supply passes through the ramus tubarius of the ateria uterina, after destruction of larger areas of the mesosalpinx striking disturbances within the ovarian metabolism must be expected. With numerous animal experiments we are currently studying the expansion of the coagulated area following the use of mono- and bipolar high-frequency current, endocoagulation and CO2 laser coagulation. With the aid of conventional histologic techniques, in addition to enzyme histochemical and electron microscopic examinations, attempts are being made not only to determine the extent of the destroyed zone but also to gain additional information on damage of the vascular and nervous systems of the tubes and ovaries. Although these studies have not yet been completed, it is possible at this time to state that the unipolar high-frequency coagulation technique, because of its tremendous primary and secondary complications, should not be used for laparoscopic female sterilization.

Effect of monoclonal antisperm antibodies on the penetration rates of human spermatozoa in zona-pellucida-free hamster oocytes.

The penetration rate of human spermatozoa in zona pellucida-free hamster oocytes was reduced by four monoclonal antisperm antibodies (A-24, B-20, III3 and VII-5) of six tested. The other two (VI-1 and VI-16) left the penetration rates virtually unchanged. The extent of the penetration rate reduction depended on the concentrations of antibodies A-24, B-20, III-3 and VII-5; if undiluted, they produced a significant reduction in the penetration rates; the largest average reduction was almost 50% with undiluted antibody A-24. Decreasing concentrations of the monoclonal antisperm antibodies resulted in significantly smaller reductions in the sperm penetration rates. The reason for the reduced penetration rates observed might have been a blockage of receptors on the sperm surface by the antibodies. That can inhibit enzyme reactions of the spermatozoa or interfere with the interaction between oocyte and spermatozoon membranes. Only antibody III-3 caused agglutination of human spermatozoa in the micro sperm agglutination and immobilization tests. Therefore, the agglutination or immobilization of spermatozoa might not be responsible for the reduced penetration rates after the addition of monoclonal antibodies, in contrast to findings with polyclonal antibodies.

Significance of sperm bacteriology for the in vitro fertilization of human and mouse oocytes.

The mouse oocyte was used to determine whether T-mycoplasma or Escherichia coli affects the fertilization and embryonal development of oocytes. Ureaplasma urealyticum (T-mycoplasma) in the mouse oocyte system had little influence on the fertilization rates achieved in vitro; however, in all the experiments there was a marked reduction of embryonal development after in vitro fertilization (IVF) of spermatozoa infected with Ureaplasma. Even in oocytes incubated with Ureaplasma only after having reached the two-cell stage, there was reduced development into blastocysts. Changes in the Ureaplasma concentration and incubation time had no major influence on the development into blastocysts. During IVF of mouse oocytes with spermatozoa infected with E. coli concentrations of 10(3)/mL, there were no changes in the fertilization or culture rate as compared to the control group. However, after insemination with 10(6) bacteria/milliliter there was no change in the IVF rates in the mouse oocyte; however, the culture rates were considerably reduced (19.5% as compared to 64.4% in the control group). Whether there are additional changes in the pregnancy rate after the transfer of blastocysts obtained after insemination of oocytes with infected spermatozoa remains a matter for future investigation.

Ovarian failure phenomena after hysterectomy.

Previous studies have shown that simple hysterectomy with both ovaries left intact may cause ovarian failure. Questionnaires on climacteric symptoms were mailed to 243 patients between 27 and 42 years old who had been hysterectomized during the past ten years in the Kiel University obstetrics and gynecology clinic. From the 164 replies we found typical signs of ovarian failure in 39%. Some of the patients were asked to undergo endocrinologic investigation, which showed biphasic cycles in most cases. However, the average progesterone and estrogen concentrations in the suspected luteal phases were lower than in healthy women in the same age group.

Endocrine findings in rabbits after sterilization with electrocoagulation.

CO2 pelviscopy or laparotomy was performed on 370 New Zealand white rabbits and followed by coagulation of the distal uterine horns with unipolar or bipolar coagulation, endocoagulation or CO2 laser coagulation. After 1, 2, 4, 8 or 12 weeks, laparotomy was done. After a macroscopic description was done, photographic documentation and measurement of the destroyed area were done, and the uterine horns were excised. In addition to the normal histologic and electron microscope evaluation, 5 microns-thick cryostat sections were screened for the presence of nine enzymes. Progesterone levels were determined in 47 rabbits before and after stimulation with 50 IU HCG administered intravenously. As we reported at the Tenth Meeting of the American Association of Gynecologic Laparoscopists in 1981, we found a definite correlation between the type of coagulation technique and the extent of the destruction. The average progesterone levels of the animals coagulated with the monopolar high-frequency technique were significantly lower than in the endocoagulation, bipolar coagulation and control groups.

Late complications of sterilization according to method.

By using a patient questionnaire, we checked the effects of two tubal sterilization procedures (high-frequency [HF] and endocoagulation techniques) in relation to late complications. In the years following high-frequency sterilization, 23 women (8.9%) had hysterectomies; in the endocoagulation group only 9 patients (2.3%) underwent hysterectomy. Patients sterilized by the unipolar high-frequency technique required one to three curettages in 7.8% of cases, whereas only 2.1% of the endocoagulation group required this procedure. Seventy-nine patients in the high-frequency group (30.9%) exhibited menstrual disorders as compared to only 45 (11.7%) in the other group. The combination of menstrual irregularities and menopausal complaints was found in 7.4% of the HF group, while only 2.8% of the endocoagulation group experienced these problems. Menopausal complaints only, without menstrual disorders, occurred in 4.7% and 3.9% of the women, respectively. Eighty-five percent of 330 patients sterilized by the Semm endocoagulation technique had no menstrual complaints or menopausal symptoms; in the HF group this was the case for 160 women (62%). Our results demonstrate that late postoperative complications arise less often in patients sterilized by endocoagulation.

Pelviscopy/laparoscopy and its complications in Germany, 1949-1988.

The fourth German pelviscopy/laparoscopy statistical report includes survey data on a total of 219,314 laparoscopies from 354 clinics and 40,892 laparoscopies from 161 private practices. Clinics' response rate was 44.7%; 98.9% of them reported performing laparoscopies; and the number of serious complications requiring laparotomy or control laparoscopy was 492 (2.2/1,000). For private practices, the comparable figures were 66%, 90.8% and 123 (3/1,000), respectively. Compared with data from the third laparoscopy statistical survey, the data show a slight increase in serious complications, most of which were mechanical lesions of blood vessels in the abdominal wall or in the mesosalpinx, followed by mechanical lesions of the intestine. As shown by the previous survey, 16.5% of the complications were burns. For tubal sterilization, bipolar techniques were still predominant; approximately equal numbers of departments used this method, with or without subsequent transsection of the tubes. Endocoagulation by the method of Semm was the second most popular procedure; the use of clips and rings was of little significance. Monopolar high-frequency (HF) current was still used with transsection by 4.1% of clinics (4.7% of private practices) and without transsection by 2.5% (5.3%). Sterilization failure rates remained the same as those previously reported (4.6/1,000 in clinics, 5.3/1,000 in private practices); the highest rates were observed after the use of monopolar HF techniques. Sixty-six percent of the clinics and 41% of the private practices reported their intention to increase the use of endoscopic operational methods.

Techniques for the detection of leukocytospermia in human semen.

During the cytological evaluation of 1200 spermiocytograms, we used prestained microscope slides (Testsimplets) in 200 cases as a screening method. In 50 cases, a check was made to determine whether leukocytospermia could be detected with aid of Cytur-Test. The findings were compared with smears that were routinely stained by the Papanicolaou technique and subsequently differentiated. The cytological examination of human sperm with the aid of Testsimplets provides a technically simple and rapid procedure that has sufficient informative value to permit the diagnosis or exclusion of the leukocytospermia and the sperm morphology. Leukocytospermia could also be detected by the use of Cytur-Test. The presence of larger numbers of spermatogenic cells does not lead to a blue coloration of the Cytur-Test areas. In cases of leukocytospermia there is a clear blue coloration. These two rapid techniques are useful for the diagnosis of leukocytospermia.

[Special types of spermatophages in human ejaculates]. / Uber den Nachweis einer speziellen Art von Spermatophagen im menschlichen Ejakulat.

Since Wegelin introduced the notion of spermatophagocytosis in 1921 numerous elaborations on this subject have been published. But up to now there is no complete agreement on the origin of the individual spermatophages. Mononuclear as well as polynuclear spermatophages have been described. While for decades it has been clear that leucocytes in the female genital tract are able to phagocyte spermatozoa, these phagocyte types have hardly been described in human ejaculates.

[The post-laparoscopic pain syndrome (author's syndrome)]. / Das postpelviskopische-(laparoskopische) Schmerzsyndrom.

Following laparoscopy 18.5% of 200 patients had sub-phrenic pain on the day of operation and 28% had shoulder pain. During the night following the operation or on the first post-operative day 30.5% of the 200 patients had sub-phrenic pain and 54.5% had shoulder pain. A total of 63% of the patients had shoulder pain and 37.5% of the patients had sub-phrenic pain. 31.5% of the patients had a combination of both types of pain. Most of the sub-diaphragmatic pain was on the right side. In 93% of all patients the post-operative radiological investigation of the chest showed subphrenic gas. The remaining gas was aspirated and measured by infrared spectroscopy. All the remaining gas was carbon dioxide. The previously suggested absorption rates for carbon dioxide are probably too high. The transition of anaesthetic gas (e.g. N2O) through the peritoneum into the abdominal cavity as suggested by Hodgson, McClelland, and Newton was not detected in these measurements. The most likely cause of the post-laparoscopic pain syndrome is the effect of the volume of the remaining gas of the phrenic nerve.

[Clinical and endocrinologic studies of the treatment of ovarian insufficiency manifestations following hysterectomy with intact adnexa]. / Klinische und endokrinologische Untersuchungen zur Therapie ovarieller Ausfallserscheinungen nach Hysterektomie unter Belassung der Adnexe.

60 hysterectomized patients under 40 years old, who all had at least one intact ovary and still complained of climacteric symptoms, were treated with estriol, conjugated estrogens, estrogen-gestagen sequential therapy or an extract from cimicifuga racemosa after randomized distribution into 4 equal groups. Therapy was controlled after 4, 8, 12 and 24 weeks with a modified Kupperman-Index that also included trophic disorders of the genitals, and also by serum-FSH and -LH measurement. In all groups, the modified Kupperman-Index became significantly lower, the parallel decrease of gonadotropins could not be confirmed statistically, however. There were no significant differences between groups concerning therapy success.

Morphology of rabbit ovaries after sterilization by uterus horn coagulation or section.

UNLABELLED: Tubal sterilization of women may lead to menstrual cycle changes and climacteric complaints. Interference with ovarian metabolism, caused by impaired vascular and/or neural supply of the ovaries is held responsible for this. To obtain a histopathologic equivalent of these ovarian alterations in an animal model, we coagulated resp. cut the uterus horns of 316 white New Zealand rabbits by pelviscopy resp. by laparatomy. The pelviscopic method used was endocoagulation acc. to Semm in 80 cases, monopolar high frequency coagulation in 94 cases, and bipolar high frequency coagulation in 109 cases. The uterus horns of 23 rabbits were cut with a CO2-laser by laparotomy, a control group consisted of 10 animals. After 1, 2, 4, 8 or 12 weeks, the rabbits' ovaries were exstirpated by laparotomy and examined morphologically. RESULTS: The increase of the average ovary diameter as well as the decrease of tertiary follicle numbers per ovary were significant by analysis of variance; however, a dependence on the operation method used could not be detected.

[Diseases of the masticatory system as possible causal factors in infertility]. / Erkrankungen des mastikatorischen Systems als mögliche Kausalfaktoren einer Infertilität.

In this study 36 subfertile patients between 25 and 43 years, in whom asymptomatic bacteriosperms with a concentration of 10(5)/ml or higher could be shown despite an antibiotic directed therapy in which no count reduction was observed, were examined in the Dept. for Dental Prosthetics. A lot of intraoral foci were found, which got eliminated. Intra-operational bacterial specimens were taken and evaluated by a special diagnostic technique in the Dept. of Microbiology. It was shown, that the bacterial spectrum of the intraoral specimens and the spermiograms were identical. 6 months after completion of the dental therapy and intensive oral hygiene instructions a new andrological examination was performed. Two thirds of the spermiograms were already sterile. A direct causal relationship between dental primary diseases and asymptomatic bacteriosperms, which probably leads to subfertility, must be concluded.

[The effect on penetration rate of human spermatozoa into the zona pellucida free hamster oocyte system of monoclonal antibodies against human spermatozoa]. / Die Beeinflussung der Penetrationsrate humaner Spermatozoen im zona pellucida-freien Hamster-Oozyten-System durch monoklonale Antikörpern gegen humane Spermatozoen.

The penetration rate of human spermatozoa in zona pellucida-free hamster oocytes was reduced by 4 monoclonal anti-sperm-antibodies (A-24, B-20, III-3, and VII-5) out of 6 tested. The other 2 (VI-1 and VI-16) left the penetration rates virtually unchanged. The extent of penetration rate reduction depended on the concentrations of antibodies A-24, B-20, III-3, and VII-5; if undiluted, they produced a significant reduction of penetration rates, the largest average reduction being almost 50% with undiluted antibody A-24. Decreasing concentrations of the monoclonal anti-sperm-antibodies resulted in significantly smaller reductions of sperm penetration rates. The reason for the reduced penetration rates observed may be a blockage of receptors on the sperm surface by the named monoclonal anti-sperm-antibodies. This can inhibit enzyme reactions of the spermatozoa, or interfere with the interaction between oocyte and spermatozoa membranes. It is noted that only the antibody III-3 caused agglutination of human spermatozoa in the micro-sperm-agglutination and immobilization tests. Therefore, the agglutination or immobilization of spermatozoa may not be held responsible for the reduced penetration rates after addition of monoclonar antibodies, as opposed to the findings with polyclonal antibodies (Steinberg - 1985&).

[Possibilities and significance of using lasers in gynecology]. / Möglichkeiten und Bedeutung der Laseranwendung für die Gynäkologie.

Since 1973 laser technology has found its way into gynecology as well as other branches of medicine. CO2-, Neodym-YAG-, and argon-laser have been used. Experience has been made with the laser treatment of benign and precancerous lesions of the vulva, vagina, and cervix uteri. The laser is also being used increasingly for infertility operations, adhesiolysis and treatment of endometriosis. Since 1979, the laser has also been applied pelviscopically for these indications. As an advantage of laser techniques the possibility of operating atraumatically and relatively bloodlessly has been named. Disadvantages have been found in the high cost of the equipment, the special training required of the physician, and the possible danger for the patient and the operation theatre staff. Until now, there has been no definite proof that laser technology gives better results in the various operations mentioned than conventional methods.

[The effect of forskolin on sperm motility. In vitro experiments with bull sperm]. / Wirkung von Forskolin auf die Spermienmotilität. in-vitro-Versuche unter Verwendung von Bullensperma.

We have investigated the effect of Forskolin, a substance that stimulates c-AMP, on the motility of freshly thawed bull-sperm. Forskolin was added in amounts of 25.78 and 2.57 micrograms. In control samples we employed saline. An amount of 25.78 micrograms Forskolin increased significantly the procentage of motile spermatozoa compared with 2.57 micrograms Forskolin or saline. The mean velocity of the motile sperm is decreased slightly, but constantly, over a period of 130 minutes by Forskolin (25.78 micrograms), but not by 2.57 micrograms Forskolin or saline. With respect to progressive motile sperm and their mean velocity, there were no significant differences detectable. The usefulness of Forskolin in reproductive medicine needs further evaluation.

[Late sequelae of appendectomy with special reference to adhesions in the lower abdomen, chronic abdominal pain and sterility]. / Spätfolgen nach Appendektomie unter besonderer Berücksichtigung von Unterbauchverwachsungen, chronischen Unterbauchbeschwerden und Sterilität.

Analyzing the medical history and operation protocols of 2,465 female patients undergoing pelviscopy for different reasons we found that 1,743 patients (71%) reported a previous appendectomy in their anamnesis. 657 patients presented adhesions after previous appendectomy. In 41.5% these adhesions were located in the middle right abdomen. In comparison to a collective of 308 patients without adhesions there were no correlations between the occurrence of adhesions post appendectomy and chronic lower abdominal pain. In conclusion it is to point out that laparotomy--especially appendectomy--correlates in 70% with postoperative adhesions. These adhesions correlate in 30% of cases with chronic abdominal pains and in 40 to 50% we were able to prove periovarian and peritubal adhesions in cases of sterility. In order to prevent unnecessary appendectomy or other unnecessary laparotomies with later formation of adhesion it is very important to use laparoscopy in all questionable cases.

[Retrospective study of pelviscopic adhesiolysis for treatment of chronic lower abdominal pain (January 1996-December 1997)]. / Eine retrospektive Studie zur Bedeutung der pelviskopischen Adhäsiolyse für die Behandlung chronischer Unterbauchbeschwerden (Januar 1996-Dezember 1997).

A report is given about 486 patients, who were operated because of suspicion of adhesion in 74 cases (15.2%), of an adnexal tumor 116 (23.9%), endometriosis 9 (1.9%), infertility 24 (4.9%), irreversible contraception 42 (8.6%) or chronic abdominal pain in the lower abdomen 221 (45.5%). 89.1% of them suffered preoperatively of chronic abdominal pain. 350 (72%) patients had to be laparotomized once or several times. 326 women only had adhesions; adhesions and an adnexal tumor were found in 107 patients; 53 women had adhesions and endometriosis. Among the 326 women with adhesions only were about 45% with adhesions of first and just as many with second graduation, adhesions of third graduation were found in 10% of the patients. Adhesions of first graduation were solved completely in all cases, such of second graduation could be solved in 43% of cases completely and in 54% at least incompletely. Adhesions of third graduation were solved in most of the cases (74%) incompletely. 221 (67.8%) of the patients with adhesions only answered the questionnaires 8-10 months later. Two third of them were free from pain or stated a clear improvement. After complete adhesiolysis 70% of the women stated a positive result of operation, 57% after incomplete adhesiolysis.