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Biomedical subjects

F Fischl

Publications and source records attributed to F Fischl.

At least 19 recordsLinked to original sources

Cetrorelix in an oral contraceptive-pretreated stimulation cycle compared with buserelin in IVF/ICSI patients treated with r-hFSH: a randomized, multicentre, phase IIIb study.

BACKGROUND: The aim of this study was to assess the non-inferiority of an oral contraceptive (OC)-pretreated cetrorelix regimen and a buserelin regimen in IVF/ICSI patients treated with r-hFSH in terms of total number of oocytes retrieved. METHODS: Multicentre, randomized study. One hundred and eighty two patients were randomized to receive cetrorelix with OC pretreatment (n = 91) or to receive buserelin (n = 91). The cetrorelix group started with daily OCs on cycle day 5 and continued for 21-28 days. Cetrorelix (0.25 mg) was given daily from stimulation day 6 up to and including the day of r-hCG administration. The buserelin group started with buserelin (500 microg/day) for at least 10 days until down-regulation was achieved, after which the dose was reduced to daily 200 microg up to and including the day of r-hCG administration. r-hFSH was started in both groups on a Friday, in the cetrorelix group 5 days after the last OC pill intake. Both regimens were followed by a standard IVF or ICSI procedure. The primary efficacy endpoint was the number of oocytes retrieved per patient. RESULTS: Number of oocytes, cancellation rates, r-hFSH requirements, number of oocyte retrievals during the weekend or public holiday and number of pregnancies were similar in both groups. Both treatment regimens were well tolerated. CONCLUSIONS: Cetrorelix pretreated with OCs resulted in similar number of oocytes retrieved compared with a long buserelin protocol. Both regimens were well tolerated and allowed scheduling of the oocyte retrieval, with only small number of retrievals falling on a weekend or public holiday.

Adolescent↗

Recombinant luteinizing hormone in ovarian hyperstimulation after stimulation failure in normogonadotropic women.

The aim of this study was to examine the effect of an additional administration of recombinant luteinizing hormone (r-LH) to a gonadotropin-releasing hormone agonist (GnRHa) long protocol using recombinant follicle-stimulating hormone (r-FSH). In particular we determined whether such a stimulation protocol would be more effective in women (1) who respond poorly to stimulation with GnRHa long protocol using r-FSH only, and (2) whose LH concentrations after down-regulation in the cancelled cycle were low but above the values reported in the literature to be sufficient for folliculogenesis. After GnRHa desensitization 150 IU r-FSH and 75 IU r-LH were administered subcutaneously daily to six normogonadotropic women with low response to ovarian hyperstimulation using a GnRHa long protocol with r-FSH and low LH concentrations after down-regulation in the cancelled cycle. All six women had an oocyte retrieval and an embryo transfer after follicular stimulation. One women conceived but had a miscarriage in the eleventh week of gestation. Our results suggest that women with low response to a GnRHa long protocol with r-FSH, and whose LH concentration after down-regulation in the cancelled cycles were low, benefit from the additional administration of r-LH in a GnRHa long protocol using r-FSH. It seems that due to the additional administration of r-LH the LH concentration in the follicular phase is sufficient to support folliculogenesis.

Adult↗

Tibolone versus conjugated estrogens and sequential progestogen in the treatment of climacteric complaints.

OBJECTIVE: Tibolone has been shown to alleviate climacteric symptoms. This study was designed to compare the effect of tibolone (Livial, 2.5 mg daily) on different climacteric complaints and its impact on the endometrium, determined by vaginal ultrasound, with that of conjugated estrogens (Premarin, 0.625 mg daily) continuously for 6 months in combination with the progestogen medrogestone (Colpron, 2 x 5 mg daily for 12 days each month). METHODS: One hundred and twenty-nine postmenopausal women were recruited and the severity of climacteric symptoms as well as endometrial thickness were recorded at the pre-trial examination and after 1, 3, and 6 months. RESULTS: With the exception of vertigo, mood depression, mood disorder, loss of libido, and dryness of skin, where tibolone was found to be more effective than conjugated estrogens/medrogestone, climacteric symptoms improved significantly in both groups over the 6-month study period. Endometrial thickness did not increase significantly in the tibolone group, whereas in the conjugated estrogens/medrogestone group there was a highly significant increase after 1 month and still a trend towards significance after 6 months. Recurrence of vaginal bleeding occurred significantly less frequently in the tibolone group than in the comparison group. CONCLUSION: Tibolone seems to offer a complete treatment of the climacteric complaints whilst avoiding some of the problems associated with classical hormone replacement therapy.

Climacteric↗

[Infection with Chlamydia trachomatis in patients of an ambulatory sterility clinic].

In order to investigate a presumed association of certain anamnestic data with Chlamydia trachomatis infection of infertile women, appropriate specimens were examined from 100 patients of an infertility clinic. PCR and nucleic acid hybridization were positive in 5% of the patients, corresponding in both tests; IgG was found in 31% and IgA in 5% of patients. The prevalence was highest in the age-group of 26-35 years (21 of 55) and higher in patients who had been trying to conceive for > 2 years (12 of 37) as than those trying < or = 2 years (3 of 13). The proportion of IgG-positive women was significantly (p = 0.03) smaller in Turkish patients (3 of 22) than in those of other origin (11 of 33 from former Yugoslavia and 15 of 39 Austrian women). The prevalence was higher in patients with reported pelvic inflammatory disease (11 of 30) as compared to patients without (15 of 50). With a pathological state of the Fallopian tubes the prevalence was 12 of 25, with normal tubes 6 of 18 (p > 0.05). Thus, there seem to exist anamnestic hints as to chlamydial infections. Because of their high prevalence in patients with sterility we recommend screening for chlamydial infection prior to undertaking any invasive diagnostic procedure of the Fallopian tubes.

Adolescent↗

Development and influence of an endogenous serum luteinizing hormone surge after ovulation induction in stimulated cycles.

The aim of this study was to investigate whether the endogenous serum luteinizing hormone (LH) discharge in stimulated cycles--either simultaneously with or shortly after exogenous human chorionic gonadotropin (hCG) administration--is influenced by serum steroid hormones and follicle stimulating hormone (FSH). We also tested whether the LH discharge affects intrafollicular hormone metabolism and oocyte fertilization. In a group of 46 women with tubal pathology who were undergoing in vitro fertilization (IVF), follicular fluids were collected during oocyte retrieval. In addition blood samples were drawn daily, starting at cycle day 7 until the day of oocyte retrieval. LH, FSH, estradiol, progesterone, testosterone and prolactin were determined in all samples of serum and follicular fluid. Oocyte maturation was classified according to the morphology of the oocyte corona-cumulus complex. Of the 46 women studied, 15 showed no LH surge (group A) and 31 developed an endogenous LH surge (group B). Serum samples showed no significant differences between the two groups in follicular phase estradiol, progesterone, testosterone and prolactin. Only levels of serum FSH showed a significant difference between groups A and B (p < 0.0005). In follicular fluid samples LH (p < 0.05) and FSH levels (p < 0.005) were significantly different. Fertilization rate and cleavage rate, however, did not differ significantly. The late endogenous LH surge occurring simultaneously with or shortly after hCG application for ovulation induction did not affect intrafollicular steroid metabolism, oocyte maturation, fertilization rate or cleavage rate.

Adult↗

[Contraception in climacteric].

The problems of an adequate contraception around the age of 40 are not yet solved in our time. On one hand the women are afraid of unexpected pregnancies during this life period, at the other hand the hormonal contraceptives are not anymore optimal at this time. The various contraceptive methods with its positive and negative effects during this period are discussed in this paper.

Climacteric↗

The metoclopramid-provocation test for prediction of transient hyperprolactinemia during cycle stimulation.

The predictive value of the metoclopramid-provocation test to detect transient hyperprolactinemia during cycle stimulation was assessed. Patients developing hyperprolactinemia during cycle stimulation showed a significantly higher PRL response to the metoclopramid-provocation test before cycle stimulation. The current study confirms previous reports that hyperprolactinemia during cycle stimulation can interfere with follicular and oocyte maturation. The use of the metoclopramid-test can detect an enhanced responsiveness to PRL stimulators and offers the possibility of treatment during cycle stimulation.

Embryo Transfer↗

In vitro fertilization with spermatozoa from alloplastic spermatocele.

This case report describes successful IVF of oocytes of a 22-year-old female with epididymal spermatozoa aspirated from alloplastic spermatocele of the husband presenting with bilateral congenital absence of the vas deferens. Motile spermatozoa were aspirated from the reservoir 3 months after implantation. Abortion occurred 22 days after embryo replacement.

Abortion, Spontaneous↗

Evaluation of a simple and fast self-test for urine luteinizing hormone.

Ovulation can be predicted by measuring the midcycle urine luteinizing hormone surge with a simple 5-minute enzyme-immunoassay. This assay has proved to be suitable for self-tests with a sensitivity of about 90% and a specificity of 100% in unstimulated and clomiphene citrate stimulated cycles. Whereas a reference method (hemagglutination test) yielded better sensitivity, its specificity was markedly worse. Self-tests carried out by patients and control laboratory tests showed an excellent correlation. Patient compliance with self-tests should not be taken for granted.

Adult↗

[Hypophyseal suppression and subsequent cycle stimulation: experiences in an in vitro fertilization program].

Gonadotropin releasing hormone (GnRH) agonists can induce a hypogonadotropic state. We studied the effect of a long acting GnRH agonist on pituitary gonadotropin levels, the pattern of serum steroid levels in subsequent cycle stimulation, and whether such a protocol can improve the results of an in-vitro fertilization (IVF) program. 29 patients with tubal factor from our IVF program received 4 mg Decapeptyl CR intramuscularly and were subsequently stimulated with FSH/HMG/HCG (Group I). 35 patients were stimulated according to our standard protocol with HMG/HCG (Group II). After a single injection of Decapeptyl CR, serum levels of LH, FSH and E2 fell to more than half of pretreatment levels. In the subsequent cycle stimulation the gonadotropin dosage was increased threefold compared with the control group. In group I, progesterone levels were significantly higher. Though more oocytes were retrieved in group I, fertilization rates were significantly lower. After Decapeptyl and the subsequent stimulation, we observed short rises in urinary LH in 22/29 patients. In our experience, a single intramuscular injection of Decapeptyl resulted in sufficient pituitary suppression, however, we could not see an improvement in the results after IVF.

Estradiol↗

[Comparison of vaginosonographic, transabdominal sonographic and laparoscopic follicle puncture for the retrieval of oocytes within the scope of an in vitro fertilization program].

For follicular aspiration and oocyte retrieval for in-vitro-fertilization (IVF) laparoscopy, laparotomy and different ultrasound guided methods like transvesical and transvaginal puncture can be used. Sonographically guided follicular aspiration has become more important because this procedure is less invasive. In this study we compared the results of 28 laparoscopical, 35 transabdominal and 21 transvaginal follicle puncture after successful cycle stimulation. Performing transvaginal puncture 4.7, using laparoscopy 3.4 and performing transvesical puncture 2.0 oocytes per attempt were retrieved. The advantages of transvaginal follicle aspiration were a shorter operation time, a superficial anesthesia and compared to laparoscopy a less invasive and simple technique. Therefore this method is now commonly used for routine IVF procedures in our institution.

Female↗

Comparison of the results of vaginal and abdominal follicle scans.

The hormonal profile and sonographical assessing of the number and size of the follicles are important in hyperstimulated cycles. Follicular imaging obtained by abdominal scanning may be distorted by echoes from the intestine or by unfavourable location of the ovaries and patients must have a full bladder. We compared the number and size of the follicles at abdominal sonography with the results obtained by vaginal sonography in 37 patients. Vaginal sonography showed more follicles than abdominal sonography because of improved imaging of small follicles on early days of cycle. This might help one to tailor the hyperstimulation to an individual's endocrine response.

Adult↗