Prolonged exposure to wood preservatives induces endocrine and immunologic disorders in women.
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Adrenal Cortex Diseases↗
Biomedical subjects
B Runnebaum
Publications and source records attributed to B Runnebaum.
Characterization of leukotriene C4 binding in anterior pituitary membrane preparations.
Pituitary cells produce leukotrienes (LTs) and respond to exogenous administration of LTs by releasing gonadotropins. Specific high affinity leukotriene C4 (LTC4) binding has been found in membrane preparations of bovine anterior pituitaries. Unlabelled LTC4 displaced specific [3H]LTC4 binding. Other leukotrienes (LTB4, LTD4, LTE4, LTF4) did not compete with [3H]LTC4 for binding sites when administered at increasing concentrations together with a constant amount of radioligand indicating that the binding is highly specific for LTC4. Scatchard analysis of binding data obtained from saturation studies revealed a single binding site for [3H]LTC4 with a Kd of 8.95 +/- 5.53 nM and a B max of 15.44 +/- 6.93 pmol per mg of membrane protein. Glutathione S-transferase, a possible LTC4 binding site, did not display activity in the membrane fraction although the two glutathione derivates S-octylglutathione and S-decylglutathione competed with LTC4 in binding experiments. As leukotrienes are potent stimulators of gonadotropin secretion and modulators of gonadotropin-releasing hormone (GnRH)-induced gonadotropin release it is concluded that leukotrienes may be involved in the signal transduction pathway of GnRH and that they may act via a specific and high affinity receptor.
Animals↗
[Effect of the GnRH analog buserelin on sex hormone serum level in relation to treatment onset and duration].
Changes of serum estradiol, progesterone, LH, FSH, prolactin, testosterone, androstendione, DHEA and DHEAS levels during a GnRH-analogue (buserelin) treatment have been analysed retrospectively taking account of effectiveness of treatment and its relation to the beginning and duration of treatment. 1200 micrograms/day buserelin were administered intranasally from the first day of the menstrual cycle (n = 30) or the 7th hyperthermic day of the cycle (n = 22). The results proved, that the administration of buserelin to sterile women inhibits the ovarian (estradiol, progesterone) and pituitary (LH, FSH) hormone secretion during the first 10-14 days of treatment. The adrenal hormone secretion (DHEA, DHEAS) remained unaffected, whereas the androgens of ovarian origin (testosterone, androstendione) were suppressed during the GnRH analogue treatment. The serum prolactin level increased during the first two weeks of treatment and returned to pretreatment values within the following two weeks. On the basis of the faster suppression of estradiol secretion with buserelin treatment, beginning in the middle of the luteal phase, this therapy is recommended for ovarian suppression.
Adult↗
Relationship between local anti-sperm antibodies and sperm-mucus interaction in vitro and in vivo.
Sperm-mucus interaction under in-vitro or in-vivo conditions can be affected by local anti-sperm antibodies (ASA). In a prospective study, a mixed antiglobulin reaction (MAR) test, using immunoglobulin-coated red cells and spermatozoa, was used to detect the presence of IgG and/or IgA on the spermatozoal surface in 209 males of infertile partnerships. The results of direct MAR tests range from 0 to 100% and a significant correlation between MAR % IgG and MAR % IgA (r = 0.74) was found. MAR positive semen samples were significantly more frequent in the group of patients with an inadequate outcome of postcoital testing (PCT). The sperm-mucus interaction in vitro, evaluated by means of the in-vitro sperm-cervical mucus penetration test (SCMPT) with cervical mucus (CM) of patients' partners, was particularly related to spermatozoal surface antibodies of the IgA class: MAR IgA positive ejaculates were seen in 13.9% of males with inadequate SCMPT versus 4.4% when SCMPT was adequate. The significant correlation between MAR IgA and the sperm penetration ability in vitro could also be proven when donors' CM was taken for the SCMPT, but not when a non-human material was used for in-vitro penetration testing. Microbial colonization of semen specimens did not interfere with the outcome of MAR testing. The pregnancy rate after 12 months was 23% (48/209) and was significantly lower when greater than 30% of spermatozoa were covered with surface ASA of the IgG or IgA class.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Thyroid and ovarian function in infertile women.
The aim of this study was to examine more closely the interaction between thyroid function and pituitary--ovarian axis in infertile women. In 185 infertile women without clinical signs of thyroid dysfunction, TRH-tests (TSH basal and 30 min after 200 micrograms TRH i.v.) were performed in the early follicular phase in addition to routine hormonal checks (gonadotrophins, oestradiol, DHEAS, testosterone, prolactin). The women were classified as euthyroid (n = 74; TSH stim 5-20 mU/l), latent hyperthyroid (n = 31; TSH stim less than 5 mU/l), and preclinical hypothyroid (n = 80; TSH stim greater than 20 mU/l). From frozen serum, the following determinations were performed: TSH IRMA, laevothyroxine (T4), thyroxine binding globulin (TBG), microsomal (Mab) and thyroglobulin (Tab) antibodies. Various correlations between the thyroid parameters and the pituitary--ovarian axis were demonstrated. With increasing TBG concentrations, the interval between menses decreased. Overall and spontaneous pregnancy rates were highest in women with normal (less than 75th perc.) basal and stimulated TSH, high (greater than 75th perc.) T4 and low (less than 25th perc.) Mab. Women with normal Tab or high TBG experienced the highest delivery rate (77 versus 30%), while in women with low Tab or high Mab abortion and tubal pregnancies were most frequent. As only 25 women exhibited elevated Mab (greater than 500 U/ml) or Tab (greater than 200 U/ml) which correlated with elevated TSH and normal T4, the routine determination of thyroid antibodies was not necessary. The TRH-test, however, should be included in infertility work-up.
Female↗
High preovulatory serum luteinizing hormone level is unfavorable to conception.
Serum estradiol, progesterone and luteinizing hormone (LH) levels of 16 pregnant and 58 non-pregnant stimulated in vitro fertilization-embryo transfer (IVF-ET) or gamete intrafallopian transfer (GIFT) cycles have been compared with regard to their predictive value for achievement of pregnancy. Serum estradiol and progesterone pattern of the pregnant and non-pregnant group did not show any significant difference. Around the time of ovulation induction by human chorionic gonadotropin (hCG) the serum LH values proved to be higher in the non-pregnant group than in the pregnant one. In spite of having a permissive function, preovulatory serum estradiol and progesterone seem not to have a predictive value with regard to pregnancy. Elevated preovulatory serum LH is detrimental for pregnancy, therefore the measurement of serum LH beyond hCG administration also, and the cancellation of cycles with high serum LH levels shortly before oocyte retrieval is recommended.
Adult↗
Thyrotropin-releasing hormone (TRH) and metoclopramide testing in infertile women.
Thyroid stimulating hormone (TSH) determinations before and after thyrotropin-releasing hormone (TRH) stimulation were obtained in 834 infertile women, from 1982 until 1985. Thyroid function disturbances were seen in 20% of the women, in accordance with the prevalence in South Germany. Postcoital tests were significantly poorer in women with subclinical hypothyroidism than in euthyroid patients. Spontaneous conception was more frequent in euthyroid (16%) than in hypothyroid (6%) women. During the same period, prolactin was determined after TRH stimulation in the early follicular phase and after metoclopramide stimulation in the luteal phase, in 759 women. The pregnancy rate was not improved by administration of dopamine agonists in women with an exaggerated response to TRH or metoclopramide. Our results suggest that subclinical hypothyroidism as well as disorders of prolactin secretion may play a role in infertility. The TRH test is proposed to rule out thyroid dysfunction. Neither the TRH nor the metoclopramide test was useful for the prognostic differentiation of prolactin secretion disorders.
Dehydroepiandrosterone↗
[Combined treatment with a GnRH-analog and gonadotropins in IVF-ET/GIFT patients after previously unsuccessful pure HMG stimulation].
Clinical results of a combined GnRH-analogue (buserelin, long protocol) + HMG stimulation of 44 IVF-ET or GIFT patients with previously failed pure HMG stimulation have been analysed. The cancellation rate and the incidence of premature LH surge was found to be lower in the buserelin + HMG group than in the control HMG group (30% vs. 40% and 16% vs. 51%). There was no significant difference between the buserelin + HMG and the control HMG group, neither in the number of retrieved and fertilized oocytes and transferred embryos nor in the fertilization and pregnancy rate. The combined GnRH-analogue and gonadotropin therapy led to a decrease of the cancellation rate and of premature LH surge in patients with previously failed pure HMG stimulation. In this group of patients the use of buserelin leads to treatment results comparable to results of pure HMG stimulated patients without previously failed stimulation cycles. Thus the GnRH-analogue + HMG stimulation is recommended for patients with previously unsuccessful pure HMG stimulation.
Adult↗
Differences in luteinizing hormone release stimulated in rat anterior pituitary cells by leukotriene C4 and by gonadotropin-releasing hormone in vitro.
Continuous administration of leukotriene C4 (LTC4, 10(-10) M) to superfused rat anterior pituitary cells increased LH release for 40 min only, whereas in a parallel experiment gonadotropin-releasing hormone (GnRH, 10(-9) M) evoked a continuous increase in hormone secretion. In contrast to GnRH, LTC4 did not desensitize rat anterior pituitary cells. The secretory action resulting from the administration of LTC4 (10(-10) M) was abolished for 40 min after previous stimulation. The results documented the dual action of LTC4 on LH exocytosis.
Animals↗
Exogenous action of 5-lipoxygenase by its metabolites on luteinizing hormone release in rat pituitary cells.
The stimulatory effect of exogenously administered potato 5-lipoxygenase (0.1-0.3 U/2 ml) on luteinizing hormone (LH) release was demonstrated in rat anterior pituitary cells in a superfusion system. Nordihydroguaiaretic acid (NDGA), an inhibitor of 5-lipoxygenase, abolished the effect of the enzyme on LH secretion. The secretory effect on LH after 5-lipoxygenase administration was biphasic and dependent on Ca2+ indicating that 5-lipoxygenase affects LH release through its oxygenation reaction. Another series of experiments demonstrated that activation of 5-lipoxygenase, expressed as production of leukotriene (LT) B4 and C4 (728 +/- 127 pg/10(6) cells and 178 +/- 23 pg/10(6) cells, respectively) occurs in rat pituitary cells after addition of Ca2+ ionophore A23187. However, LTB4 and LTC4 were not formed by pituitary cells that had previously been desensitized by gonadotropin-releasing hormone (GnRH), the physiological ligand of LH release. These results are consistent with a role of 5-lipoxygenase metabolites in the mechanism of GnRH-induced LH secretion.
Animals↗
Compliance with short-term high-dose ethinyl oestradiol in young patients with primary infertility. New insights from the use of electronic devices.
The objective of the study was to investigate patient compliance with ethinyl oestradiol therapy. Medication was prescribed to be taken in 20-micrograms doses four times daily for seven days. Oestrogens are prescribed for standardization of the cervical mucus before the sperm cervical-mucus penetration test (SCMPT) is performed. Relation of drug compliance with adverse drug reactions reported by the patients. The methodology used in this study was continual microprocessor-based monitoring by means of the Medication Event Monitoring System, MEMSTM. Adverse drug reactions were recorded by means of standardized interviews. Investigations were carried out on thirty female patients, mean age: 28.8 years (range 21 to 36 years), with primary infertility, mean duration of infertility: 3.9 years (range 9 months to 8 years). The results showed that individual patients' compliance was remarkably variable, ranging from 14.3% up to 136%. The average compliance was 65%. Less than 30% of the prescribed doses were taken on schedule. Administration of oestrogens was effective in all but one patient. High cervical indices were documented irrespectively of the dose taken. In answer to the questionnaire, 24 out of 30 women reported side effects, of which 79% were rated by the patients as being mild. The lower the drug compliance was, the more adverse reactions were reported. In patients who took more than 65% of the drug, this inverse relationship was statistically significant (r = -0.71, p = less than 0.01). Our conclusion is that the empirically fixed daily dose of 80 micrograms of ethinyl oestradiol for seven days appeared to be too high in regard of the observed dose response, i.e. cervical mucus quality. A dose finding study, including compliance monitoring, seems to be reasonable. Within further studies, a simpler dosage regimen should also be taken into account. The observed association between patients' reports of adverse effects and drug compliance deserves further investigation.
Adult↗
Chlamydial infection--a female and/or male infertility factor?
After screening a large series (n = 491) of asymptomatic males of infertile partnerships for chlamydial immunoglobulin (Ig) G antibodies (Chlam AB), no significant influence of past chlamydial infection was found with regard to semen analysis, postcoital testing, in vitro sperm-cervical mucus penetration tests with hormonally standardized cervical mucus, circulating antisperm antibodies (detected with three different methods), local IgG and IgA antibodies (detected by means of the mixed antiglobulin reaction test) on the sperm surface, the sperm-cervical mucus contact test, and a microbial screening of semen samples for mycoplasmas and other potentially pathogenic micro-organisms. However, when the findings were correlated with infertility factors of patients' female partners and the subsequent pregnancy rate in a prospective study, a significant positive correlation of male Chlam AB with a tubal factor in their wives as cause of the couple's infertility was found. The results suggest that the main influence of Chlamydia trachomatis on male fertility is based on sexual transmission and negative influence on tubal function of female partners, but not on reduced sperm functional capacity.
Antibodies, Bacterial↗
[Incidence and prerequisites for therapy-independent pregnancy in sterile patients].
15.6% of 857 women who had been treated because of sterility in the infertility centre of the Department of Gynaecology of the University of Heidelberg between May 1982 and June 1985, became pregnant up to June 1986, independent of the therapy. Favourable conditions for the occurrence of pregnancy were provided by secondary sterility and miscarriages in the previous history (in case of non-hormonal disturbances only). Younger women and those whose wish for a child was more recent, had a better chance to experience pregnancy--without any difference between the spontaneously pregnant women and those who became pregnant during treatment. ("Spontaneous pregnancy" signified women who became pregnant either during diagnostic procedure or after having discontinued medical treatment for more than 3 months, in case of tubal microsurgery 12 months). Depending upon the aetiology of surgery, the proportion of spontaneous pregnancies was between 12 and 75%. The rate of spontaneous pregnancies was highest in case of reduced tubal patency (44%), disturbances of hormonal control mechanisms (62.5%) and endometriosis (75%). The spontaneous pregnancy rate was comparable to the overall pregnancy rate (39.4%) in women with uterine malformations (31.4%), immunologic infertility (33.3%), hyperandrogenemia (33.3), hyperprolactinaemia (31.2%) and PCO syndrome (37.5%). The percentage of spontaneous pregnancies was lowest in hypothyroidism (20%), primary ovarian insufficiency (12.5%) and disturbances of the hypothalamic-pituitary axis (16.7%).
Adult↗
[Diagnosis, incidence and clinical significance of premature LH rise/peak in patients of an in vitro fertilization and gamete transfer program].
In this study we analysed the prevalence and the clinical relevance of premature (related to the day of ovulation induction with HCG) LH rise (LH greater than or equal to 180%, but less than 300% of the mean of all previous values) or peak (LH greater than or equal to 300% of the mean of all previous values): 12% (2/16) of the conception cycles showed a premature LH peak, 44% (7/16) a premature LH rise and 44% (7/17) showed neither a premature LH rise nor a premature LH peak. The pregnancy rate of cycles with premature LH peak was found to be 10% (2/21), without premature LH peak 37% (7/19). These results indicate, that the premature LH peak represents an unfavourable condition for achievement of pregnancy; the cancellation of such stimulations before oocyte retrieval is recommended. On the other hand, cycles with premature LH rise need not be cancelled. The fertilisation rate was independent of an LH rise/peak (no LH rise/peak: 55%, LH rise: 62%, LH peak: 46%): it is supposed, that the premature LH peak causes submicroscopical injury of the oocyte and although fertilisation is possible, further embryonic development will be hindered. The use of the GnRH analogue Buserelin in combination with HMG leads to a significantly (p less than 0.001) lower prevalence of the premature LH peak (16%; 7/44 versus 51%; 48/95); the combined Buserelin + HMG stimulation is recommended for treatment of premature LH peak.
Adult↗
[Benzalkonium chloride for vaginal contraception--the vaginal sponge].
From March 1986 to December 1987, a vaginal contraceptive, not yet commercially available in Germany, was studied in 56 women. The substance benzalconium chloride (BZC) was contained in vaginal sponges (n = 46), pessaries (n = 4) and cream (n = 6) at a dose rate of 1.18%. BZC is a surfactant of the ammonium series that ruptures the spermatozoal membrane. It is also a powerful bactericide and viricide. The advantages of the vaginal sponge (intercourse is safe immediately after insertion for the next 24 h and for multiple intercourses) made it pleasant for the women. The rate of transitory local side effects (16%) was acceptable. The vaginal contraception did not interfere with the sexual life. In 645 months of use 10 pregnancies occurred of which 9 happened with the sponge (PI 20.3). Its fixation before the cervix and the release of the spermicide is not reliable enough, so that we cannot recommend the sponge as a safe vaginal contraceptive.
Adult↗
Analysis of hormonal changes during combined buserelin/HMG treatment.
Changes of serum oestradiol, LH and progesterone have been analysed in view of the effect of the GnRH analogue buserelin on the late follicular and early luteal phase of cycles stimulated with combined buserelin/HMG (n = 31) in an IVF-ET/GIFT programme. Patients undergoing cycles with HMG only (n = 57) served as the control group. With the use of the GnRH analogue buserelin, a significantly higher amount of HMG (25 versus 20 ampoules; P less than 0.001) for a significantly longer stimulation period (10 versus 8 days; P less than 0.001) was necessary to achieve the same oestradiol response as seen in HMG cycles. Serum progesterone levels during a three day period before ovulation induction tended to be lower in the combined buserelin/HMG cycles than in cycles with HMG stimulation only. We did not observe any significant difference in the luteal phase progesterone levels of the buserelin/HMG and the HMG group. On the other hand, we found that an inadequate luteal phase in buserelin/HMG cycles could be avoided by HCG administration during the luteal phase. Both the elevation of basal serum LH and a premature LH rise could also be avoided by the use of buserelin.
Adult↗
Value of endometrial biopsies and serum hormone determinations in women with infertility.
Premenstrual endometrial biopsies were performed in 324 infertile women. Their hormonal status was established in the early follicular phase of the same cycle (FSH, LH, oestradiol-17 beta, testosterone, DHEAS, TSH and prolactin, the latter two both basally and following TRH stimulation). In the luteal phase, oestradiol-17 beta and progesterone concentrations were determined three times between the fifth and tenth hyperthermic days, as was prolactin, both basally and following metoclopramide stimulation. All pregnancies occurring before January 1986 were recorded. Seventy-five per cent of the biopsies were evaluated on the expected ovulation date from the basal temperature charts, 77% according to the next onset of menstruation. Twenty-six per cent of the biopsies were out of phase, and 7% displayed abortive secretion. A significant correlation existed between endometrial profiles and the characteristics of the cycle, stimulated TSH and prolactin levels, and with testosterone and FSH concentrations. No correlation of the endometrial status with midluteal oestradiol or progesterone concentrations was found. While various hormones of both the follicular and luteal phases correlated significantly with the pregnancy rate, the same was not demonstrated for the state of endometrial biopsy. Therefore, following exclusion of organic explanations of infertility in women with biphasic cycles, the determination of progesterone and oestradiol-17 beta in the luteal phase was considered. In women with reduced concentrations of these hormones, androgens, gonadotrophins, prolactin and TSH should be determined. Endometrial biopsy is valuable only if pregnancy fails to occur, despite therapeutically normalized hormone concentrations.
Adolescent↗
The use of hens' egg white as a substitute for human cervical mucus in assessing human infertility.
Semen samples from 179 patients with longstanding infertility were allowed to penetrate capillaries filled with a fraction of fresh hens' egg white (HEW) as a substitute for cervical mucus (CM) for the in-vitro sperm-cervical mucus penetration test (SCPMT). Results were correlated with those obtained from human CM (HCM) used in parallel on the same semen sample, compared to results of sperm analysis and post-coital testing (PCT) and analysed for their prognostic value for a subsequent pregnancy in a prospective study. The overall pregnancy rate after 6 months was 26.3% (47/179). Whereas routine semen analysis (semen volume, pH, sperm count, progressive motility, morphology and fructose concentration) did not differentiate between patients who achieved pregnancy and those who did not, significant differences were found for the penetration distance (P less than 0.02) and the motility grade of sperm in HEW (P less than 0.02). Although the mean sperm velocity in HEW was reduced compared to HCM, a close positive correlation was found between the sperm density and the penetration distance (P less than 0.001). The percentage of samples with good HEW penetration increased significantly in parallel with better results of post-coital testing (P less than 0.001). The results indicate that, when fresh human CM is not available, HEW can be used as a medium for the SCPMT as a valuable adjunct to semen analysis which provides information about sperm functional capacity.
Animals↗