[COVID-19 from the perspective of a gynecological endocrinologist].

The infectious respiratory disease coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) shows striking differences in its course and severity depending on the gender of affected patients. The incidence in women is higher than in men, whereas severe forms of the disease are significantly more common in men as well as the mortality; however, premenopausal and postmenopausal women again present a dimorphism in the course depending on hormonal status. Premenopausal women have lower rates of hospitalization and need respiratory support less often.

Cytogenetically normal uterine leiomyomas without MED12-mutations - a source to identify unknown mechanisms of the development of uterine smooth muscle tumors.

Background: Recent findings on genetic changes in uterine leiomyomas suggest these benign tumors being a heterogeneous group of diseases in terms of molecular pathogenesis with those showing karyotype alterations as well as those characterized only by cytogenetically invisible mutations of mediator subcomplex 12 (MED12). Herein, five uterine leiomyomas (UL) with an apparently normal karyotype that lacked MED12-mutations were investigated by copy number variation arrays along with their matching myometrium to search for small genomic imbalances.

Results: Of five tumors one showed chromothripsis-like phenomena with numerous gains and losses of small segments mainly clustered to five chromosomal regions i.

[Autofluorescence and endometriosis optical trap or new hope in dianosis of endometriosis?].

Laparoscopic autofluorescence imaging of endometriosis is a new method to properly detect the disease. Autofluorescence in contrast to conventional white light laparoscopy enables us to visualize the entire extent of disease and to recognize extremely small or occult lesions. Autofluorescence imaging in fact reveals a world behind the world, a substantial new representation of endometriosis, which will have much impact on our future therapeutic strategies.

Fluorescence staining of human ovarian cancer tissue following application of 5-aminolevulinic acid: fluorescence microscopy studies.

Background And Objectives: Application of 5-aminolevulinic acid (ALA) for fluorescence-guided second-look laparoscopy has been shown to be a promising new procedure in the early diagnosis of ovarian carcinoma metastases. However, for assessing the reliability of this method, information on the microscopic distribution of protoporphyrin IX (PP IX) in the tissue is needed. Additionally, the selectivity of PP IX uptake is essential for a potential photodynamic therapy (PDT) of ovarian cancer metastases.

The use of cryopreserved mature and immature spermatozoa in assisted reproduction.

Treatment of severe male subfertility has become available since the intracytoplasmic injection of a single sperm into an oocyte was successfully applied for the first time in 1992. Moreover, with the use of fresh and cryopreserved epididymal and testicular spermatozoa for this procedure, fertilization and pregnancies could be accomplished. This review addresses the development and performance of these techniques and discusses achievements and problems as well as future aspects of the feasibility of early spermatid injection.

Laparoscopic fluorescence detection of ovarian carcinoma metastases using 5-aminolevulinic acid-induced protoporphyrin IX.

Background: The aim of the current clinical study was to evaluate the in vivo fluorescence detection of ovarian carcinoma metastases in a second-look laparoscopic procedure after intraperitoneally applied 5-aminolevulinic acid (ALA).

Methods: Five hours before laparoscopic surgery, ALA was applied intraperitoneally via short infusion in a concentration of 30 mg/kg bodyweight in a sterile, 1% solution. Application of ALA resulted in the endogenous production of the fluorescent photosensitizer, protoporphyrin IX (PP IX).

Clinical and endocrine follow-up of patients after testicular sperm extraction.

Objective: To evaluate the risk of testicular damage from testicular biopsies that are carried out for testicular sperm extraction (TESE) in infertile men.

Design: Prospective controlled clinical study.

Setting: Academic hospital.

Preimplantation genetic diagnosis in Germany - ethical responsibility and law.

Preimplantation diagnosis (PGD) can be judged as early or brought forward prenatal diagnosis and brings up the ethical question in Germany whether potential selection of embryos and intentional killing of a human conceptus, showing a defect not or almost not compatible with life, is reconcilable with human dignity. Whereas prenatal diagnosis and its consequences are socially accepted in Germany, PGD is not compatible with the Embryo Protection Law and is still under debate since >5 years. On the other hand abortion is not subject to prosecution because the legal status of the mother outweighs that of the embryo or fetus.

Will GnRH antagonists assist in the treatment of benign gynaecological diseases?

While GnRH agonists have become well-established tools for preoperative treatment of uterine fibroids or postoperative treatment in endometriosis for 3-6 months, GnRH antagonists seem to offer important advantages due to their specific pharmacological mode of action. Avoiding any flare-up effect, it seems to be possible to reduce treatment time to about only 2-4 weeks in the case of fibroids to obtain a clinically relevant reduction in size. Furthermore, due to the classic competitive receptor blockade induced by GnRH antagonists, it is feasible to preserve residual oestradiol secretion for a period of 8 weeks in patients with endometriosis.

Preoperative reduction of uterine fibroids in only 16 days by administration of a gonadotrophin-releasing hormone antagonist (Cetrotide).

Ten premenopausal women with symptomatic uterine fibroids confirmed by magnetic resonance imaging (MRI) were treated with four injections (s.c.) of 3 mg of the gonadotrophin-releasing hormone (GnRH) antagonist cetrorelix every 4 days, starting on the first day of cycle.

Use of GnRH antagonists in the treatment of endometriosis.

Endometriosis is an oestrogen-dependent disease that is treatable by oestrogen withdrawal, a therapy that has been effectively provided by the use of a gonadotrophin-releasing hormone (GnRH) agonist. Complete oestrogen withdrawal results in unacceptable side-effects, in particular in accelerated bone density loss. This problem has been effectively overcome with 'add-back therapy' using low-dose oestrogens and progestins in combination with a GnRH agonist to limit these side-effects, while still allowing regression of endometriotic lesions.

Comparison of poor responders with good responders using intentionally frozen-thawed epididymal spermatozoa in subsequent ICSI cycles.

Purpose: To compare the outcome of intracytoplasmic sperm injection (ICSI) cycles performed with frozen-thawed epididymal spermatozoa between patients who respond poorly and patients who respond well to ovarian stimulation.

Methods: 17 patients suffering from obstructive azoospermia underwent microsurgical retrieval of epididymal spermatozoa (MESA) and the spermatozoa were frozen. The frozen-thawed spermatozoa were used in subsequent ICSI cycles.

The use of cryopreserved mature and immature testicular spermatozoa for intracytoplasmic sperm injection: risks and limitations.

Treatment of severe male subfertility has become available since the intracytoplasmic injection of a single sperm into an oocyte was successfully applied for the first time in 1992. Moreover, with the use of fresh and cryopreserved epididymal and testicular spermatozoa for this procedure, fertilization and pregnancies could be accomplished. This review addresses the development and performance of these techniques and discusses achievements and problems as well as future aspects of the feasibility of early spermatid injection.

Fibrosarcoma associated with a benign cystic teratoma of the ovary.

Objective: A case of ovarian fibrosarcoma associated with a benign cystic teratoma is described.

Methods: A 32-year-old patient with an ovarian tumor detected by routine gynecological examination was referred to our hospital. In addition to histopathological examination of the resected tumor, immunohistochemical studies as well as a cytogenetic analysis by comparative genomic hybridization were carried out.

High deletion frequency of the complete AZFa sequence in men with Sertoli-cell-only syndrome.

We have developed a rapid screening protocol for deletion analysis of the complete AZFa sequence (i.e. 792 kb) on the Y chromosome of patients with idiopathic Sertoli-cell-only (SCO) syndrome.

Prospective, randomized study to evaluate the success rates using hCG, vaginal progesterone or a combination of both for luteal phase support.

Background: A prospective study was done to compare the efficacy of luteal phase support (LPS) using either three times hCG (group I, n=77), hCG on the day of embryo transfer (ET) in combination with daily vaginal progesterone (group II, n=62) or vaginal progesterone only (group III, n=70).

Method: All patients were treated using the long luteal protocol for controlled ovarian stimulation in an IVF (in vitro fertilization) cycle. Patients were randomized to one of these groups when estradiol was <2500 pg/ml and less than 12 oocytes were retrieved (low risk groups).

Outcome of ICSI cycles using frozen-thawed surgically obtained spermatozoa in poor responders to ovarian stimulation: cancellation or proceeding to ICSI?

Objective: To investigate the ICSI outcome of the patients who produced four follicles or less after ovarian stimulation using frozen-thawed surgically obtained spermatozoa.

Study Design: The patient cohort of this study was composed of a carefully selected group of 20 men suffering from obstructive and non-obstructive azoospermia and in whom spermatozoa had been seen in their harvested epididymal aspirates and testicular tissues and the cryopreserved specimens had been used for subsequent ICSI cycles. This group of men represent those in whom the female partners produced only four follicles or less after ovarian stimulation.

ICSI outcome in patients of 40 years age and over: a retrospective analysis.

Objective: To report and analyse our experience with ICSI treatment in infertile women >/=40 years of age, with the intention of contributing to current debates on the effect of aging on the reproductive potential.

Study Design: 107 infertile couples in which the female partner was aged >/=40 years and who received ICSI treatment between January 1996 and December 1998.

Results: A total of 107 women underwent 171 treatment cycles during this period.

Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection.

Objective: To determine the feasibility of using frozen-thawed testicular spermatozoa for intracytoplasmic sperm injection.

Design: Prospective clinical study.

Setting: A university hospital.

[Limitations of reproduction medicine in male subfertility. Treatment of severe spermatogenesis disorders].

Treatment of severe male subfertility has become available since the intracytoplasmic injection of a single sperm into an oocyte was successfully applied for the first time in 1992. Moreover, also with the use of testicular spermatozoa for this procedure fertilization and pregnancies could be accomplished. This review addresses the development of these techniques and discusses achievements and problems as well as future aspects of the feasibility of early spermatid injection are stressed.

A simple, inexpensive and effective artificial cycle with exogenous transdermal oestradiol and vaginal progesterone for the transfer of cryopreserved pronucleated human oocytes in women with normal cycles.

Supernumerary pronucleated stage oocytes (PN) are usually cryopreserved. PN are transferred in spontaneous, stimulated or artificial cycles. In this study, an artificial cycle with a transdermal therapeutic system was used for oestradiol release (Estraderm TTS 100) in combination with a targeted drug delivery system for vaginal progesterone release (Crinone 8%).

Transcervical falloscopic dilatation of proximal tubal occlusion. Is there an indication?

Proximal tubal occlusion (PTO), until recently a domain of microsurgery, can also be treated by a transcervical balloon dilatation and/or tubal recanalization. The aim of our study was to evaluate the possibility of transcervical tubal dilatation during transcervical Falloposcopy. Transcervical Falloposcopy and tubal dilatation was performed under laparoscopic control.

Intracytoplasmic injection of round and elongated spermatids from azoospermic patients: results and review.

Microinjection is established as the method of choice in the treatment of severe male factor infertility as well as in azoospermic patients. Recent studies have shown that fertilization and cleavage can be achieved by injection of ejaculated as well as testicular elongated spermatids into oocytes. Here we report on the two first pregnancies worldwide resulting from elongated spermatid injection from frozen-thawed testicular tissue.