[Highly purified FSH for stimulation of down regulated cycles in the in vitro fertilization program]. / Hochgereinigtes FSH zur Stimulation downregulierter Zyklen im IVF-Programm.

Highly purified FSH (Fertinorm HP) was used for follicle stimulation during one cycle of IVF in each of 112 women. In all cases, stimulation was begun with 150 IU FSH per day s.c. after pituitary down-regulation with a GnRH analogue in a Long protocol. Sixteen (14.3%) of the 112 treatment cycles started were stopped before follicle aspiration. The reasons for stopping stimulation were elevated progesterone values with premature luteinisation in 9 (8.0%) patients, inadequate follicle stimulation in 4 (3.6%) cases and threatened overstimulation in 3 (2.7%) cases. The mean duration of stimulation was 11.8 days with 7.8 oocytes obtained per aspiration by the transvaginal rute. Embryo transfer was possible in 77 (68.7%) patients, with a mean of 2.3 embryos per transfer. A total of 23 clinical pregnancies resulted, with a pregnancy rate of 20.5% and 29.9% per cycle and embryo transfer, respectively. There were three cases of multiple pregnancy (13.0%), two (8.7%) miscarriages occurred and one patient (4.3%) had a tubal pregnancy. The rate of successful pregnancies was thus 17.9% per cycle. Five patients (5.2%) required treatment for overstimulation. There were not other treatment complications. These results show that highly purified FSH can also be used successfully in IVF after pituitary down-regulation. The remaining endogenous LH activity in these cases may be regarded as sufficient for follicular development and steroid synthesis. Highly purified FSH can therefore be used for all stimulation protocols in patients with normal gonadotrophin levels. The relatively low rate of miscarriages with this treatment is noteworthy.

[Vaginal reconstruction in vaginal aplasia by a Vecchietti modified laparoscopic operation--further simplification of the method]. / Scheidenbildung bei Scheidenaplasie durch eine nach Vecchietti modifizierte laparoskopische Operation--weitere Vereinfachung der Methode.

We describe on a case of a patient with Mayer-v. Rokitansky-Küster-syndrome the formation of a vagina by a laparoscopic modification of the Vecchietti-procedure. A further simplification of this procedure is the use of a laparoscopic needle-holder to tense the strings above the abdominal wall. We even abandoned the use of a prothesis after finishing the tension phase. Instead, we allowed early intercourse on the third day of extraction of the vaginal phantom.

Transvaginal gamete intra-fallopian transfer and embryo intra-fallopian transfer.

This study describes the conduct and results of a recently developed technique for transvaginal catheterization of the Fallopian tube in order to transfer gametes or early embryos. Transvaginal gamete intra-Fallopian transfer (TV-GIFT) was performed in 46 patients after stimulation with human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG) and transvaginal oocyte retrieval. This resulted in 11 (23.9%) pregnancies. Eight patients delivered healthy children, including one set of twins. Two patients had abortions at 8 and 11 weeks of gestation and one had an ectopic pregnancy. In a first series of 11 women, oocytes were fertilized in vitro and a maximum of three embryos at the 2- to 8-cell stages were transferred into one tube. Three of the 11 cycles with tubal embryo-stage transfer' (TV-TEST) resulted in clinical pregnancy.

[Severe hydrops fetalis in a first trimester pregnancy with Ulrich-Turner syndrome]. / Schwere hydropische Entwicklung der Schwangerschaft im ersten Trimenon bei Ulrich-Turner-Syndrom.

We report about a case of abundant hydropic evolution of a fetus in the first trimester of gestation. Already in the 8th week of gestation we diagnosed the first references of failure with transvaginal ultrasound. In the following three weeks we observed the progression of the hydrops. The genetic research of fetal tissue after induced abortion show the karyotype 45 X0.

Fallopian tube catheterization and recanalization under ultrasonic observation: a simplified technique to evaluate tubal patency and open proximally obstructed tubes.

OBJECTIVE: To test a sonoscopic technique developed for transvaginal catheterization and recanalization of the fallopian tube. DESIGN: In a feasibility study, catheterization was performed with the use of laparoscopic control. Patients with bilateral proximal tubal obstruction underwent fallopian tube recanalization under ultrasonic observation. SETTING: This study represents patients evaluated for primary or secondary infertility at Humboldt University Hospital. PATIENTS, PARTICIPANTS: Proximal tubal obstruction had been diagnosed on previous hysterosalpingogram and with laparoscopy. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Tubal patency was assessed by hydrotubation under ultrasonic observation. RESULTS: Transvaginal catheterization was successful in 31 (91.2%) of the 34 tubes. In 19 patients with proximal tubal obstruction, patency of both or at least one tube was achieved in 16 (84.2%) women. Five (31.6%) of 16 patients successfully recanalized were found to have an intrauterine pregnancy at a 6-month follow-up interval. CONCLUSION: This catheterization technique should be investigated for possible use in diagnostic schedule early in the evaluation of the infertile patient. Also, the transvaginal recanalization of proximally obstructed tubes calls into question the application of microsurgical treatment of a selected group of patients.

[Development of a method for transuterine gamete transfer--initial results]. / Entwicklung einer Methode zum transuterinen Gametentransfer (GT)--erste Ergebnisse.

A new method for gamete intra fallopian transfer is described by which the tubes can be catheterised via vagina, through the endometrial cavity, in order to place gametes directly to the ampullary portion of the fallopian tube without the need for an operation or anaesthesia. In a first series two clinical pregnancies resulted from 8 transuterine transfers.

[Vaginal sonography in the diagnosis of early pregnancy]. / Vaginosonographie zur Diagnostik der frühen Schwangerschaft.

In this study is reported on 401 transvaginal sonographic examinations in first trimenon of pregnancy. There were interpreted biometrical and functional findings. With 5 weeks p.m., chorion cavity can be identified by a transvaginal scan probe reaching a diameter of 3-8 mm. The vital embryo is recognized by its cardiac action with a embryonic length of 3 mm at the end of 6 weeks post menstruation. Thus with transvaginal sonography, details of embryonic development in the first trimester are visible 1-2 weeks earlier than with abdominal ultrasound examination. It is possible to estimate embryonic and trophoblastic structures of early gestation and to recognize non-viable early pregnancies.

[Vaginal sonography in the diagnosis of premature rupture of fetal membranes]. / Vaginosonographie zur Diagnostik des vorzeitigen Blasensprunges.

68 patients have been examined by vaginal scanning one time in the second and third trimester of pregnancy. Chorion and amnion could be correctly identified in 89.7%. It was possible to recognize rupture of the membranes using a vaginal scan probe in 17 patients.

[Initial experiences with transvaginal vagino-sonographically controlled follicle aspiration in an in vitro fertilization program]. / Erste Erfahrungen mit der transvaginalen vaginosonographisch gesteuerten Follikelaspiration im IVF-Programm.

From March to May 1987 41 sonographically guided follicular punctures have been performed vaginally. Altogether 208 follicles were aspirated and 149 oocytes (71.7%) could be found. No complications like of bleeding or pelvic inflammatory disease have been observed after puncture. The sonographically guided aspiration technique has proved to possess several advantages in respect of its applicability.