[In vitro fertilization in male subfertility--micromanipulation and special techniques for semen preparation]. / IVF bei männlicher Subfertilität--Mikromanipulation und spezielle Samenpräparationstechniken.

Poor semen quality is increasingly the reason for human infertility. For couples who cannot be helped by conventional in vitro fertilization (IVF) treatment, micromanipulation methods and special sperm preparation techniques in in vitro fertilization hold considerable promise to enhance fertilization of the egg. "Partial zona dissection" (PZD n = 59) or "subzonal insemination" (SUZI n = 36) were performed in 88 IVF cycles obtaining a fertilization rate between 12.2% and 34.8% depending on the micromanipulation technique applied and a pregnancy rate of 19.2% per embryo transfer. So far ten ongoing pregnancies have occurred and five healthy children have been born. In certain cases of male factor infertility micromanipulation and special sperm preparation techniques therefore represent the only possibility of conceiving.

Relationship of the individual uterine size and the endometrial thickness in stimulated cycles.

At present there is no agreement regarding the usefulness of monitoring the endometrial thickness in stimulated cycles. We tested prospectively the hypothesis of a linear relationship of the given individual uterine size and the endometrial thickness in stimulated cycles using a 240 degrees transvaginal sector scanner. There was a strong correlation of the uterine dimension with the endometrial thickness in the midfollicular and the early luteal phase. Our findings suggest that the endometrial thickness is determined by the individual uterine architecture and therefore not predictive of the likelihood of implantation.

[Is premature labor weather-dependent? Correlation of premature labor with meteorologic data]. / Besteht eine Wetterabhängigkeit der Frühgeburtlichkeit? Korrelation von Frühgeburten mit meteorologischen Ereignissen.

A preselected cluster of births (12351-4719 = 7632 = n) which was divided into 3 groups (delivery between 28-32 gestational weeks, 33-37 gestational weeks and > 37 gestational weeks) has been correlated with six major weather situations of the four meteorologically defined seasons. The correlation was made with the date of birth and with one day as well as two days before. The duration of pregnancy was longer by an average of 0.45 weeks (i.e. 3 days) when the major weather situation did not change for more than 8 days. The group with delivery 28-32 weeks is more sensitive to meteorological influences than the group with delivery 33-37 weeks. During cyclonic as well as during anticyclonic atmospheric drifts the groups 28-33 wks and 33-37 wks have been statistically over-represented. As far as the season is concerned over-representation is found in autumn. We conclude that pregnancies at risk of premature delivery should be followed up in short intervals during cyclonic and anticyclonic atmospheric drifts especially during the autumn season.

The use of fibrin sealant for embryo transfer: development and clinical studies.

Many embryo transfers after in-vitro fertilization may fail because of expulsion of the embryos from the uterus. Approximately 5-8% of pregnancies resulting from embryo transfer are ectopic. The aim of our study was to find a technique to avoid ectopic pregnancies and to improve the pregnancy rate. We used a two-component fibrin sealant which also contains a fibrinolysis inhibitor (aprotinin) at various concentrations. After gaining experience with mouse embryos, the sealant was used in human embryo transfer with great success. The results of a pilot study encouraged us to perform a prospective randomized study on 546 patients (270 with fibrin sealant, 276 conventional embryo transfers). There were 47 (17.0%) orthotopic pregnancies and 6 (2.2%) ectopic pregnancies in the control group, whereas there were 51 (18.9%) intrauterine and no ectopic pregnancies in the treatment group. The difference in ectopic pregnancies was statistically significant (P less than 0.05). With regard to the aprotinin concentration, there was a trend towards better results with 100-150 kIU (28.5% clinical pregnancies) in comparison to 250-300 kIU (19.2%) or no aprotinin (20.4%) (not significant). Further improvements of the technique may raise the pregnancy rate when fibrin sealant is used. As shown in our prospective randomized study, ectopic pregnancies may be completely avoided.