[Antibody detection after antepartal rhesus prophylaxis: normal values or sensitization]. / Antikörper-Nachweis nach antepartaler Rhesus-Prophylaxe: Normalfall oder Sensibilisierung?

Antibody screening tests were performed in 29 unsensitized pregnant women after antepartum Rh immune prophylaxis, using the indirect Coombs test (ICT) and a more sensitive ID-microtyping-system (IDM). With the ICT, anti-D antibodies were detected in 85% for at least 4 weeks and at most 8 weeks after immunisation. The maximum titer was 1:8. With the IDM, 97% showed antibodies against 'D' for at least 4 weeks and at most 11 weeks with a maximum of 1:16. The IDM titer was always 1 to 3 steps more sensitive than the ICT. After postpartum Rh immune prophylaxis, anti-D titers were again positive in many of the patients (ICT: 42%; IDM: 60%). In conclusion, it is nearly always possible to measure antibodies against 'D' after antepartum Rh immune prophylaxis and IDM was superior in comparison to ICT. However, maternal isoimmunisation to the rhesus antigen cannot be excluded for sure and patients have then to be controlled. As isoimmunisation could not be confirmed in any of our patients, postpartum Rh immune prophylaxis has to be administered even after detection of an antibody titer against 'D' after antepartum Rh prophylaxis.

[Clinical aspects of prenatal prevention of rhesus incompatibility]. / Klinische Aspekte der antenatalen Rhesus-Prophylaxe.

The postnatal treatment with anti-D immunoglobulin to prevent rhesus sensitization is successful in about 90% of all rhesus-negative mothers at risk. Failures derive mostly from large fetomaternal hemorrhages during the last months of pregnancy. Studies from Canada, Great Britain and Sweden have shown that the injection of an additional dosage of anti-D during the 28th to 34th week of pregnancy results in a further 90% reduction of the failure rate. Although there is only a limited number of cases of hemolytic diseases in the newborn, the cost-effect ratio of this prophylactic treatment calculated for the Federal Republic of Germany shows not only a medical but also an economic benefit.

[Rate of early abortion after in vitro fertilization and embryo transfer]. / Frühstabortrate nach In-vitro-Fertilisation und Embryotransfer.

The high rate of implantation failures in infertile patients after in vitro fertilization must be regarded as the major problem of the kind of treatment. Usually, no information on the development of the embryo can be obtained for the time between embryo replacement and rising beta-hCG levels. Own studies on the early pregnancy factor (EPF) showed a positive reaction few hours following the contact of a fertilized oocyte with the endometrial surface. Therefore, we used the EPF as a marker for the viability of the embryo in 82 patients after in vitro fertilization and embryo transfer. Within two days after embryo transfer the EPF was positive in 52 (63%) patients and negative in 30 (37%) patients. In these women the embryos may have been lost during handling or may have discontinued further development. Between day 3 and day 12 after transfer the EPF turned to negative values in 35 patients--especially between day 6 and 10. These cases must be regarded as true implantation failures. After day 12 following embryo transfer, rising beta-hCG levels could be measured in 17 women (21%), but only in 12 patients (15%) could a growing embryonic sac be detected by ultrasound. From these figures, we may conclude, that about half of the embryos are lost already during the step of embryo transfer and the other half during implantation. Therefore, more attention should be given to the handling of the embryos to increase the pregnancy rate after in vitro fertilization.

[Successful prevention of adhesions using peat and humic acids]. / Erfolgreiche Adhäsionsprophylaxe durch Anwendung von Moor und Huminsäuren.

In order to verify the adhesion preventing capability of peat and peat components, 180 female rats were subjected to therapeutic bathing after standardised lesions had been placed on both uterine horns and the peritoneum of the anterior abdominal wall. From the 3rd and 7th day after surgery, respectively, randomized groups of animals consisting of 20 animals each were bathed in tap water, pure fresh peat, peat solution after pressing, centrifugation and filtration, and a solution of humic acids extracted from peat, all at the same temperature. One week after bathing for three weeks, the rats were relaparotomized, and quality and degree of the adhesions found were documented. Significant less and minor (p less than 0.001) adhesions were found in animals bathed in humic acid solution compared to the animals which had not been bathed at all. Peat solution and fresh peat reduced the formation of adhesions significantly, too, while warm water baths did not show any antiadhesive effect. Our results suggest humic acids to be the most effective component of peat with regard to the prevention of adhesions.

[Immunological factors in extracorporeal fertilization. The role of antibodies against spermatozoa and zona pellucida antigen]. / Immunologische Faktoren bei extrakorporaler Befruchtung. Die Bedeutung von Antikörpern gegen Spermatozoen und Zona-pellucida-Antigen.

Immunologic disturbances must be considered a major cause of unexplained infertility. To evaluate the influence of sperm antibodies (SPAB) and zona pellucida antibodies (ZPAB) on the pregnancy rate, we have screened patients treated by in-vitro fertilization (IVF) and embryo transfer (ET) in the Department of Obstetrics and Gynecology of the School of Medicine, Hannover, for the presence of sperm antibodies and zona pellucida antibodies in the serum, cervical mucus and uterine secretions, and also in the serum and ejaculate of the husbands. After embryo transfer the concentrations of progesterone and beta-hCG in the sera were determined to evaluate the luteal phase and to detect early pregnancy. Among 122 women 11 clinical pregnancies were achieved; 8 of these pregnant women showed negative antibody reactions, while only 3 women with significant positive reactions for SPAB or ZPAB became pregnant. Only one pregnancy occurred in 24 women with high ZPAB titers. In conclusion, determinations of SPAB- and ZPAB-titers in serum and genital secretions are highly recommended in the evaluation of infertile couples.

[Spermatozoal antibodies in cervical mucus and in the luminal fluid of the uterus in sterile patients]. / Spermatozoen-Antikörper im zervikalen Mukus und in der luminalen Flüssigkeit des Uterus bei Sterilitätspatientinnen.

Poor postcoital tests in infertile patients may be due to dysmucurrhoea, low sperm count, or specific antibodies against spermatozoa. Using a latex agglutination test ("Sperm-antibody-slide-test", Fa. Biotec, Hannover), we examined the cervical and uterine secretions of the patients for sperm antibodies. The results showed a close correlation between a positive sperm-antibody-test and a poor postcoital test, especially in those couples with regular sperm quality. Also in cases with normal postcoital tests, positive sperm-antibody titers can be observed. Therefore, the sperm-antibodies may disturb fertilization in infertile patients even without causing immobilization or agglutination of the spermatozoa in the female genital tract fluids. The determination of the spermatozoa-antibody content in the cervical and uterine secretions must be regarded as an improvement in the diagnostic procedure in human infertility.

[Tubal pregnancies: early pregnancy factor, progesterone, beta-HCG and vaginal sonography as differential diagnostic parameters]. / Tubargraviditäten: early pregnancy factor, Progesteron, beta-HCG und Vaginalsonographie als differentialdiagnostische Parameter.

By anamnestic, clinical, biochemical (beta-HCG), and ultrasonographical data, only a portion of ectopic pregnancies can be diagnosed early enough to allow conservative surgery. In the present study, the diagnostic value of the Early Pregnancy Factor (EPF), progesterone, and endosonography was investigated in 142 patients with suspected tubal pregnancy. beta-HCG and Progesterone serum levels had been in the lover range of or below normal values in most cases of tubal pregnancy compared to intrauterine pregnancies. The EPF was found to be negative in 94% of all cases of ectopic or disturbed intrauterine pregnancies, while all these patients showed a positive pregnancy test (HCG). By abdominal ultrasonography, only 73.7% of all tubal pregnancies could be detected, while transvaginal scanning increased the rate of verified diagnoses up to 90.6% of these cases. Our results suggest that EPF measurement and endosonography are valuable supplements for precise and rapid diagnosis of ectopic pregnancies.

[Early abortion rate in sterility patients: early pregnancy factor as a parameter]. / Untersuchungen zur Frühstabortrate bei Sterilitätspatientinnen: EPF als Parameter.

To evaluate the diagnostic value of Early Pregnancy Factor (EPF) measurements in infertile patients, we performed a modified rosette inhibition test in 58 women after follicular stimulation and/or homologous artificial insemination (AIH). The patients were grouped according to the main diagnosis as cervical hostility, poor semen quality, and anovulation. While the overall fertilization rate in our patients was 39.6%, which is considerably lower than in comparable studies of fertile women, the pregnancy rates per EPF positive cycle in the various groups were 25.0%, 30.8%, and 50.5%, respectively. As the process of fertilization can be detected by EPF measurement within 48 h after ovulation, a distinction can be made between failure of fertilization and of implantation. Thus, a valuable diagnostic tool has become available for treatment of infertile patients.

Early pregnancy factor as a marker for the earliest stages of pregnancy in infertile women.

Early pregnancy factor (EPF) is known to be detectable in sera of pregnant women within 24 to 48 h after conception. To examine the incidence of early embryonic loss after hormonal treatment and homologous artificial insemination, we screened the sera of our patients for the presence of EPF by means of a rosette inhibition test. Our results show a considerably lower conception rate as described in appropriate studies on fertile women. If reduced sperm quality is the indication for insemination, the abortion rate in the first 2 weeks of gestation is significantly increased in relation to the rest of our patients. Infertility because of an impaired development of the embryo, especially if repeated EPF-positive cycles do not result in a pregnancy, may be due to chromosomal defects or malformations and a chromosomal analysis is recommended. In patients in whom EPF is never found to be positive, indicating a disorder of conception, we regard IVF/ET to be the treatment of choice.