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Biomedical subjects

I Gerhard

Publications and source records attributed to I Gerhard.

At least 19 recordsLinked to original sources
PubMed1998

Heavy metals and fertility.

Heavy metals have been identified as factors affecting human fertility. This study was designed to investigate whether the urinary heavy metal excretion is associated with different factors of infertility. The urinary heavy metal excretion was determined in 501 infertile women after oral administration of the chelating agent 2,3-dimercaptopropane-1-sulfonic acid (DMPS). Furthermore, the influence of trace element and vitamin administration on metal excretion was investigated. Significant correlations were found between different heavy metals and clinical parameters (age, body mass index, nationality) as well as gynecological conditions (uterine fibroids, miscarriages, hormonal disorders). Diagnosis and reduction of an increased heavy metal body load improved the spontaneous conception chances of infertile women. The DMPS test was a useful and complementary diagnostic method. Adequate treatment provides successful alternatives to conventional hormonal therapy.

Adult↗
PubMed1998

Activated autologous blood therapy in recurrent spontaneous abortion--results of a pilot study.

This study was undertaken to investigate the influence of activated autologous blood therapy on immunological parameters and on the clinical outcome in patients with recurrent spontaneous abortion. In a prospective trial, 36 women with recurrent spontaneous abortion were treated with intramuscular reinjections of extracorporally haemolysed and ultraviolet irradiated autologous blood. A comprehensive immunological investigation revealed significant changes in lymphocyte subpopulations, plasma complement levels, mitogen stimulation and immunoglobulin levels during the treatment period. No side-effects were reported by the patients. From June 1994 to November 1995, 22 intrauterine and one extrauterine pregnancies occurred, resulting in 19 (86%) live births, two (9%) spontaneous abortions and one (4%) artificial abortion compared with a 64% live birth rate in the historical control group. We conclude that activated autologous blood therapy has detectable effects on the immune system, and seems to be promising for further investigation concerning the treatment of idiopathic recurrent spontaneous abortion.

Abortion, Habitual↗
PubMed1998

Mastodynon(R) bei weiblicher Sterilität.

Mastodynon(R) for Female Infertility. Randomized, Placebo-Controlled, Clinical Double-Blind Study OBJECTIVE AND DESIGN: The effects of Mastodynon(R), an Agnus castus-containing preparation, were investigated in 96 women with fertility disorders in a prospective, randomized, placebo-controlled, double-blind study. PATIENTS AND METHODS: 38 women with secondary amenorrhoea, 31 women with luteal insuffciency and 27 women with idiopathic infertility received 30 drops of Mastodynon or placebo twice a day over a period of 3 months. OUTCOME MEASURE AND RESULTS: The outcome measure, which was pregnancy or spontaneous menstruation in women with amenorrhoea and pregnancy or improved concentrations of luteal hormones in both other groups, was achieved in 31 out of 66 women who were suitable for evaluation. It was achieved more often in the Mastodynon group compared to the placebo group (57.6% versus 36.0%, p = 0.069). 15 women conceived during the observation period (n = 7 with amenorrhoea, n = 4 with idiopathic infertility, n = 4 with luteal insufficiency). In women with amenorrhoea or luteal insufficiency, pregnancy occurred in the Mastodynon group more than twice as often as in the placebo group. Under therapy no hormonal changes were found at a 5% significance level. Only very few undesirable drug effects were observed. CONCLUSION: In women with sterility due to secondary amenorrhoea and luteal insufficiency, a treatment with Mastodynon can be recommended over a period of 3 to 6 months.

Journal Article↗
PubMed1998

Chlorinated hydrocarbons in women with repeated miscarriages.

This study was conducted to investigate a possible etiological role of chlorinated hydrocarbons in the pathogenesis of repeated miscarriages. The blood levels of chlorinated hydrocarbons [CHCs: pentachlorophenol, hexachlorocyclohexane, hexachlorobenzene, the dichlorodiphenyltrichloroethane (DDT) group, polychlorinated biphenyls] were determined in 89 women with repeated miscarriages, who were referred to the University Hospital of Obstetrics and Gynecology of Heidelberg for investigations between 1989 and 1993, and compared to a previously investigated reference population. In more than 20% of the women, at least one of the CHC levels exceeded the reference range. CHC levels did not differ significantly between women with primary or secondary and early or late miscarriages; neither did they differ between women with hormonal or immunological disorders as causes of repeated miscarriages or women with idiopathic repeated miscarriages. No significant associations were detected between CHC levels and further conceptions or the outcome of further pregnancies. As significant associations were found between increasing CHC blood concentrations and immunological and hormonal changes, CHCs may have an impact on the pregnancy course in certain cases.

Abortion, Habitual↗
PubMed1997

Impact of waist-hip-ratio and body-mass-index on hormonal and metabolic parameters in young, obese women.

BACKGROUND: To investigate the impact of predominantly upper body fat localisation on the hormonal and metabolic profile in obese, infertile women. DESIGN: Prospective observational study of premenopausal women with obesity, infertility and menstrual dysfunction. SETTING: Department of Endocrinology and Reproduction of the University Hospital of Obstetrics and Gynaecology of Heidelberg. SUBJECTS: Eighteen women with android type obesity (waist-hip-ratio = WHR > 0.85, group 1) and 22 women with gynoid type obesity (WHR < or = 0.85, group 2) in a group of 58 premenopausal obese women (median age 28 y) with infertility. Twenty-nine women took part in a weight reducing program lasting 32 +/- 14 (mean +/- s.d.) weeks. MEASUREMENTS: BMI, WHR and blood pressure. Plasma lipids and liver enzymes. Blood glucose, insulin, C-peptide and different steroid and pituitary hormones during oral glucose loading. RESULTS: In the total group of 58 obese women, WHR was directly correlated to plasma triglycerides, AST, ALT and cholesterol/HDL-cholesterol-ratio. WHR correlated inversely with HDL-cholesterol. Insulin resistance was greater with increasing WHR. Systolic blood pressure, glucose, insulin, C-peptide, triglycerides, cholesterol/HDL-cholesterol-ratio, aspartate (AST) and alanine aminotransferase (ALT) were significantly greater in group 1. Group 2 had greater HDL-cholesterol levels. One subject in group 1, five women in group 2 conceived spontaneously after weight reduction. CONCLUSIONS: Determination of the WHR is a simple measurement to identify obese patients who are at a greater risk of developing the metabolic syndrome. WHR is important in preventive medicine, as typical metabolic profiles are already present in young women before clinical manifestation. Women with android obesity seem to be more prone to develop menstrual irregularity and infertility. The hyperinsulinaemia may be the pathway.

Adolescent↗
PubMed1996

Effects of weight loss on the hormonal profile in obese, infertile women.

This study was designed to investigate the effects of weight loss in obese, infertile women with special interest in changes of blood hormones, menstrual function and pregnancy rate. Blood glucose, insulin, C-peptide and different steroid and pituitary hormones during oral glucose loading were determined in a group of 58 obese women with menstrual irregularities. Of the 58 women, 35 took part in a weight-reducing programme lasting 32 +/- 14 weeks (mean +/- SD) with a weight loss of 10.2 +/- 7.9 kg (therapy group). At the time of first oral glucose tolerance testing, insulin resistance was a feature in 85% of the women in the therapy group, and 22% were hyperandrogenaemic. Weight loss resulted in a significant reduction in blood glucose, insulin, androstenedione, dihydrotestosterone and oestradiol concentrations. The pregnancy rate was 29% in this group and of them, 80% showed an improvement of their menstrual function. Thus, weight reduction is the appropriate treatment for women with obesity-related endocrine derangement, menstrual irregularity and infertility.

Adolescent↗
PubMed1996

CD8+ lymphocyte decrease in HIV disease: association with anti-CD4+ but not with anti-CD8+ lymphocyte autoantibodies.

HIV+ patients form autoantibodies against CD4+ and CD8+ lymphocytes. It was shown that anti-CD4+ lymphocyte autoantibodies are associated with the depletion of CD4+ cells. In the present study we analyzed the relationship of anti-CD4+ and anti-CD8+ autoantibodies with the CD8+ lymphocyte decrease commonly observed during HIV disease. IgM and IgG antibodies as well as complement fragments were determined on the surface of CD4+ and CD8+ lymphocytes using double fluorescence flow cytometry. Anti-CD8+ lymphocyte autoantibodies were found more often in HIV + hemophilia patients (75/105 = 71%) than HIV- hemophilia patients (13/37 = 35%; p < 0.0001), patients with pharyngeal carcinoma (20/44 = 45%; P = 0.002), habitual abortions (3/13 = 23%; p = 0.0009) or healthy individuals (93-223 = 42%; p < 0.0001). Anti-CD8+ antibodies, mostly of the IgM type, occurred significantly more frequently than anti-CD4+ antibodies in healthy controls (p < 0.0001), patients with pharyngeal carcinoma (p = 0.0001), or HIV- patients (p = 0.01). In HIV+ patients, however, anti-CD4+ autoantibodies were found more often than anti-CD8+ antibodies (85 vs 71%; p = 0.02). 70 of 104 (67%) HIV+ patients had autoantibodies on both CD4+ and CD8+ lymphocytes and the IgG/IgM/C3d autoantibody pattern was identical in 31 (44%) of the patients. Interestingly, peripheral blood CD8+ cell counts were significantly associated with anti-CD4+ (p = 0.01) but not with anti-CD8+ lymphocyte autoantibodies. It is hypothesized that the inhibition and depletion of CD4+ cells by anti-CD4+ autoantibodies is associated with a loss of regulatory functions that leads to a depletion of antiviral cytotoxic CD8+ lymphocytes.

Autoantibodies↗
PubMed1996

[Results of long-term follow-up in treatment of endometriosis with the GnRH agonist leuprorelin acetate depot (Enantone-Gyn monthly depot)].

In a previous study 198 patients with histologically confirmed endometriosis underwent a "three-step" therapy, where surgical removal of endometriosis implants was followed by a 6 months treatment with 3.75 mg leuprorelinacetate depot as monthly subcutaneous injections and a second look laparoscopy with removal of residuals. In the following report long-term follow-up data generated in 112 of the above 198 patients on the post-treatment effect in respect to symptoms and pregnancy outcome in infertility are reported. For this purpose a special questionnaire was used. The follow-up period was up to 60 months with a median time of 33.5 months. Out of 112 patients 91 complained of infertility. 43 out of these 91 (47.3 %) became pregnant during the follow-up period, resulting in 55 pregnancies and 36 newborns. More than half of these patients conceived spontaneously, whereas in the rest stimulation programs became necessary. Recurrence of dysmenorrhoea, dyspareunia and pelvic pain was defined as recurrence of disease. During the follow-up period 70/112 (62.5 %) of the patients complained recurrence of symptoms with median first onset at 11 months. In two third symptoms were still less severe than at admission and classified as mild and moderate. The r-AFS score at first and second look laparoscopy did not differ in patients with and without recurrence of disease (p = 0.311 and 0.750). Only 28.6 % (20/70) of patients required an additional medical or surgical treatment. A subgroup of 51 patients could be evaluated in respect to quality of life and improvement of subjective conditions. Regain of quality of life and improvement of subjective conditions were reported in 54.9 % (28/51) and 52.9 % (27/51) respectively. The study results suggest that although the physiological effects of leuprorelin acetate treatment as suppression of ovarian function is rapidly reversible, the therapeutic effects linger, as evidenced by ongoing reduction of symptoms from baseline, leaving many patients asymptomatic or much improved longer than 1 year after treatment has ended. Besides long term relief and/or sustained reduction in symptom severity, the high pregnancy rate in infertility, as well as regain of quality of life and well being favour this therapeutic approach in endometriosis.

Adult↗
PubMed1995

The Euro-Team Early Pregnancy (ETEP) protocol for recurrent miscarriage.

The underlying causes and rationale for treatment of recurrent abortion are not entirely clear. The Euro-Team early pregnancy protocol was developed as a diagnostic work-up based on the evaluation of risk factors. Possibilities for therapy can be based only on the expectancy that elimination of some risk factors may improve the prognosis.

Abortion, Habitual↗
PubMed1994

[Treatment of endometriosis with the GnRH agonist leuprorelin acetate depot (Enatone-Gyn monthly depot): a multicenter study].

In an open, non-randomized prospective phase-III-study the clinical and endocrine efficacy as well as the safety of leuprorelin acetate depot (Enantone-Gyn Monats-Depot) were investigated. The therapeutic results of 198 patients, gathered from 5 university institutions and two city hospitals, are reported. Endometriosis was classified by the revised American Fertility Society score (r-AFS) before and at the end of treatment. Serum levels of LH, FSH, prolactin, estradiol, progesterone, androstenedione, testosterone and leuprorelin acetate were determined by radioimmunoassay. The mean total r-AFS score changed as follows: before surgical intervention during first-look laparoscopy 21 +/- 24 at the end of first-look laparoscopy 15 +/- 19 at the end of the GnRH-treatment 8 +/- 14 During leuprorelin acetate treatment the r-AFS stages changed as follows: [table; see text] Using the scoring system 85.2% of the patients improved. Relief of dysmenorrhoea could be achieved in 95.4%, relief of dyspareunia in 64% and of pelvic pain in 69.4% of patients. Baseline hormone levels dropped sharply during treatment. [table; see text] Androstenedione, testosterone, blood pressure, body weight, haematological parameters, liver enzymes, creatinine, electrolytes and HDL-/LDL-cholesterin remained more or less unchanged. Side effects being hot flushes, sweating, sleeplessness, headache, nausea, depression and vaginal dryness were due to estradiol deprivation. In 135 patients resumption of menstruation occurred in 95.6% within the first three months post-treatment. 23 patients of whom 21 were judged as infertile, became pregnant immediately after treatment was finished. The study results confirm the efficacy of leuprorelin acetate depot in the treatment of even advanced stages of endometriosis.

Adolescent↗
PubMed1993

[Toxic pollutants and fertility disorders. Solvents and pesticides].

It is demonstrated by means of extensive reference studies, as well as own results, that organic solvents and pesticides can be accountable for intoxications and various complications during pregnancy (e.g. abortion, stillbirth, intrauterine growth retardation). An initial stimulation of the adrenal cortex (hyperandrogenaemia) can result in partial insufficiency of the adrenal cortex with symptoms like alopecia and feeling of sickness. Consequences can be hypo- and hyperthyroidism. The immunological system is affected (e.g. abortion, susceptibility to infections). Neurovegetative and neuropsychological concomitant symptoms are numerous. Toxic contaminants affect men at different levels of the semen producing organs (e.g. oligospermia, azoospermia). Indications regarding diagnosis of toxic substances related illnesses as well as therapeutic and prophylactic potentialities are presented.

Abortion, Habitual↗
PubMed1993

The induction of ovulation with pulsatile gonadotrophin-releasing hormone (GnRH) administration in hyperandrogenic women after down-regulation with buserelin or suppression with an oral contraceptive.

The hypothalamic-pituitary axis of 22 hyperandrogenic infertile women had suppression with either the gonadotrophin-releasing hormone (GnRH)-analogue buserelin (n = 12) or with an oestrogen-gestagen compound (Diane; n = 12). This was followed by pulsatile GnRH application for inducing ovulation (Zyklomat). In terms of ovulation and pregnancy rates the buserelin pre-treatment was more effective than the steroid pre-treatment, especially in hyperandrogenic non-polycystic ovaries (PCO).

Adult↗
PubMed1993

[Clinical results of pediatric gynecologic consultation at the Heidelberg University Gynecologic Clinic].

During the research period from January 1984 through June 1991 649 patients between the age of 0 and 16 were examined. Divided into 13 diagnostic groups the vulvovaginitis occurred most frequently with 30.6%. The predominant causal agents were E. coli (18.1%) and streptococci B (11.5%). Almost 24% did not show any agents. Aside from malformations of the genitals (6%), the genital bleedings (8.3%), genital tumours (2.7%), the search for anticonceptives (7.5%), examinations by specialists (8.1%) and borderline surgical problems, cycle disorders (14.7%) were most frequent. Among the cycle disorders dysmenorrhea and oligomenorrhea were predominant. The hormonal inhibition of growth was also checked very carefully. Thus the necessity of well-aimed training of children's gynaecology becomes dear. Our results stress the importance of an intensive disciplinary contact between gynaecologists who are interested in pediatrics and pediatricians.

Abortion, Induced↗
PubMed1992

[Harmful substances and infertility. Substances of abuse].

Contaminants exercise an influence on different levels of reproduction, resulting in disturbances of the cycle, abortion and diverse complications during pregnancy among women, whereas, in the case of men, alterations of the spermiogram have been observed. Numerous unfavourable influences on reproduction are known from toxins such as alcohol, cigarettes and caffeine. By means of a survey of references and own results, these secondary effects are demonstrated in order to warn couples of the serious consequences with regard to the abuse of toxins, e.g. coffee, tobacco etc., when seeking advice in questions of infertility and pregnancy.

Alcohol Drinking↗
PubMed1992

[Environmental pollutants and fertility disorders. Heavy metals and minerals].

So far, the influence of lead, cadmium and mercury on human fertility has hardly been considered. First experiences by the authors with the chelating agent 2,3 dimercaptopropane-1-sulfonate (DMPS), which mobilizes heavy metals deposited in the body, seem to favour an association between the body load of heavy metals and complications during the menstrual cycle and during pregnancy. By means of an extensive survey of references, the importance of heavy metals for reproduction is demonstrated. In addition, the deficiency of particular minerals and their interaction with heavy metals are considered. Indications are given for diagnosis and therapy of the exposure to heavy metals. The practical procedure is demonstrated by means of three case studies.

Abnormalities, Drug-Induced↗
PubMed1992

[Fetomaternal macrotransfusion after successful internal version from breech presentation by moxibustion].

In a primigravida with a fundal/anterior wall placenta, a successful cephalic version was noted at 39 weeks after repeated moxibustion of the point Zhiyin (bl 67). Since routine foetal heart rate monitoring showed a sinusoidal pattern with severe decelerations, immediate Caesarean section was performed. Foetomaternal macrotransfusion of about 300 ml of blood was found. In view of this complication, possible risks of the method are discussed. Moxibustion does not seem to be suitable as self-therapy without close medical follow-up.

Adult↗
PubMed1992

Clinical data which influence semen parameters in infertile men.

Spermiograms, Sims-Huhner postcoital tests, in-vitro sperm penetration tests and hormone stimulation tests, including gonadotrophin-releasing hormone, thyrotrophin-releasing hormone and the adrenocorticotrophic hormone (ACTH) test, were obtained in 225 infertile men. The present paper deals with the influence which anamnestic factors have on the spermiogram and on hormone levels. Adrenocortical function decreased with age. Blue-collar workers had poorer sperm parameters than white-collar workers. Smokers exhibited hormone alterations without significant changes in the spermiogram. Regular alcohol consumption was associated with elevated dehydroepiandrosterone-sulphate and oestradiol concentrations and poor postcoital test results. Emotional stress had a negative influence on sperm parameters. Environmental influences warrant additional attention in the evaluation of men with abnormal spermiograms.

Adrenal Cortex↗