We report on 12- and 14-year old sisters with a 46, XY chromosome constitution, normal female external genitalia, and absence of gonadal tissue. Except for omphalocele, right renal agenesis and malrotation of the colon in the elder sister, the internal organs were normal. Both were mentally retarded, of short stature, and had extremely retarded bone age. In addition, they had an almost identical pattern of minor anomalies: peculiar face, hypodontia, short neck, inverted nipples, thoracolumbar scoliosis, "dysplastic" hips, partial clino-/syndactyly of toes. The occurrence of a basically similar set of malformations in two sisters and the first cousin consanguinity of the parents suggests autosomal recessive inheritance. The conserved region of the SRY gene ([high mobility group] HMG box) was sequenced in the elder sib and was normal. No consistent malformations are observed at present in agonadal patients. This supports the idea that several autosomal genes have the potential of influencing the sequence of events of sex determination.

Between October 1987 and January 1990, 60 patients with unruptured ectopic pregnancy in the ampullary portion of the tube were treated with linear salpingotomy, using the argon laser laparoscopically. In all cases, salpingotomy was performed by the "bare-fiber" technique, with a power of 3-6 watts. The same fiber was used for incision and coagulation either with a contact or a non-contact technique. There were no instrument-related intra- or postoperative complications. Twenty-four patients were evaluated by second-look laparoscopy or hysterosalpingography for tube patency and possible formation of adhesions. In all of these patients the tubes were patent. In one patient, the tube failed to close, resulting in a fistula. Four patients had filmy adhesions, covering the tube near the incision site. There were no adhesions covering the distal part of the tube.

As contradictory results have been obtained previously concerning the usefulness of tamoxifen in treatment of male infertility, we reevaluated its effects on 29 men presenting with idiopathic oligozoospermia. To determine whether a possible increase in sperm concentration might be correlated with an improvement of sperm quality, the hamster ovum penetration (HOP) test and the hypo-osmotic swelling (HOS) test were including as additional tests of sperm function. Patients were treated with tamoxifen (20mg/day) for 3 months. After already 4 weeks and continuing until the end of the study, tamoxifen had a significant effect (P less than 0.001) on blood levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), and estradiol (E2). Prolactin (PRL) concentrations were not altered significantly (P greater than 0.05) after 3 months. There was no significant improvement (P greater than 0.05) of conventional semen parameters (volume, concentration, motility, morphology), and of HOP and HOS test results. Due to this lack of correlation between a rise in hormone levels and improvement of sperm quality, tamoxifen treatment of patients with idiopathic oligozoospermia is of questionable value.

Nineteen infertile women with the typical clinical and endocrinological features of polycystic ovarian disease underwent laparoscopic CO2-Laser vaporization of the ovaries. Before laser treatment, six patients were amenorrhoeic, oligomenorrhea and monophasic temperature charts were observed in the remaining group. All were non-responsive to clomiphene citrate treatment. By contrast 80% of the postoperative cycles showed a bisphasic temperature pattern and high progesterone levels indicative of ovulation. Eight pregnancies were achieved in 7 patients. Measurement of basal hormone levels before and after the operation revealed a decline of androgens (androstendione: präop.: 2.77 +/- 1.0 ng/ml, postop.: 2.16 +/- 0.68 ng/ml, p less than 0.05).

The efficacy of three different laser systems for linear salpingotomy was tested in an animal model. For that purpose, the uterus horns of 22 white New Zealand rabbits were incised with the CO2-Laser, the Nd: YAG contact laser and the argon laser using the "bare fiber" technique. The length of uterotomy was between twice and three times of the diameter of the uterine horn. Secondary healing of the incision site was investigated macroscopically (patency, fistulas, formation of adhesions) and microscopically (quantity and quality of the scars) six weeks after the operation. Despite the different primary tissue effect of the laser systems we did not find any significant difference in our postoperative controls.

Between 1985 and 1989 115 non-ruptured tubal pregnancies were operated upon, using a pelviscope and preserving of the tube. For the purpose of prophylactic haemostasis 2,5 I.U. ornipressin (Por 8) were injected into the mesosalpinx. The tube was opened (linear salpingotomy) by using various instruments. This method was used in 49 patients by means of the thermocoagulator and hooked scissors; with the remaining 66 patients the following laser systems were employed: CO2-laser (n = 13); Nd: YAG-laser by the contact method (n = 22); argon-laser (n = 31). No intraoperative complications were noted. Postoperative rebleeding occurred in three patients requiring subsequent treatment, and pelviscopy had to be repeated in two patients, because of incompletely removed trophoblastic tissue. The tubal condition (patency; occurrence of adhesion) was checked in 53 (47%) of the patients by means of hysterosalpingography (n = 15) or second-look pelviscopy (n = 38). Tubal patency/peritubal adhesion were found after conventional surgery in 64%/55% of the controlled cases and after laser salpingotomy in 90%/11%, respectively. Summing up, we can say, that the various laser systems are suitable for operating non-ruptured pregnancies due to their accurate incision and simultaneously coagulating effect. Due to the lower postoperative tubal occlusion rate and lower tendency to adhesion, it appears, that the laser systems are superior to the conventional endoscopy instruments, although the rate of complications was highest after CO2-laser application.

Auf dem Gebiet der extrakorporalen Befruchtung sind in den letzten 10 Jahren enorme Fortschritte erzielt worden. Einige Teilbereiche dieses Therapieverfahrens wie z. B. die hormonelle Stimulation, die Follikelpunktion oder die Vorbe-handlung der Spermatozoen, erfuhren einerseits eine weitgehende Standardisierung, andererseits aber auch eine technische Vereinfachung oder Optimierung. Eine Stagnation der technischmethodischen Entwicklung ist dagegen im Bereich der Oocytenkultur zu verzeichnen, deren Prinzip seit 10 Jahren praktisch nicht verändert wurde. Eine neue Methode der In-vitro-Fertilisation wurde 1987 von Ranoux beschrieben [4]. Bei diesem Verfahren der intravaginalen Kultur (IVC), werden Eizellen zusammen mit den präparierten Spermatozoen in einer Plastik-kapsel in der Vagina der Patientin inkubiert. In der vorliegenden Arbeit möchten wir über eigene Erfahrungen mit diesem neuen Verfahren berichten.

In this study, we present further experiences with the intravaginal culture (IVC) of oocytes and cleavage stages. IVC is a new technique for in-vitro fertilization, its principle consisting of fertilization of oocytes in an air-free plastic capsule which is placed into the maternal vagina. In a total of 45 patients, 22 were treated by IVC and 23 by a conventional in-vitro fertilization technique (IVF). The pregnancy rates for IVC and IVF amounted to 22.7% (5/22) and 17.4% (4/23), respectively. Our results indicate that IVC is a valuable new method for treatment of special cases of sterility. Furthermore, extracorporal stress factors such as light and low temperature can be minimized by IVC. We also consider the psychological factor for the patients as very important since the mother can actively participate in the early development of the conceptus.

The hamster ova penetration test (HOPT) was performed in 82 patients simultaneously with in vitro fertilization of homologous oocytes (IVF). A penetration rate of greater than 20% of inseminated ova was considered to represent a positive test result. The results of HOPT correlated completely with the IVF in all couples with male factor sterility. In couples with female sterility only and in couples with a combination of female and male factors HOPT was falsely negative in 22 and 20% respectively. Despite a negative HOPT in vitro fertilization with formation of two pronuclei 12 to 18 hours after insemination occurred in these patients. Obviously, the interpretation of HOPT is dependent upon the definition of the cut-off point (in our case 20%). Our results support the opinion that there should be no exclusion from an IVF programme based only on a negative HOPT. It appears that any penetration rate greater than 0% should be considered as a sign of potential fertility.

Recently, direct immunofluorescence staining has been reported as a new tool for detection of Chlamydia trachomatis. This assay is based on monoclonal antibodies directed against a protein present in all serological variations of Chlamydia known to date. In order to evaluate whether immunofluorescence staining could substitute for the time-consuming, expensive tissue culture technique, urethral and cervical swabs of 131 patients treated for sterility were examined for infection with Chlamydia by both methods. The tissue culture technique, based on cultivation of Chlamydia in mammalian cells, was regarded as 100% sensitive and specific. Employing this method, we demonstrated infection with Chlamydia in 20 patients (15.3%). Colonization of both, cervix and urethra was found in 11.5%, whereas solitary colonization of cervix and urethra was found in 2.3 and 1.5% respectively. However, the immunofluorescence assay applied ("Micro-Trak", Syva Company) showed positive results in only 6 out of 20 cases as determined by tissue culture, thus yielding a sensitivity of 30%. Out of 111 patients with negative results in the tissue culture, 108 were detected by immunofluorescence staining, amounting to a specificity of 97.3%. With special regard to the low sensitivity of the direct immunofluorescence assay, our results indicate a superior, yet unequalled role of the tissue culture technique for detection of Chlamydia trachomatis.

Oligoamenorrhea is a consequence in ~30% of women running long distances. Altered hypothalamic episodic GnRH release as well as decreased steroid conversion due to reduced body fat have been reported as causes. 7 healthy women with regular cycles (age 20-25 years) participated in the study: Basal values were obtained during three hours of rest (R) followed by a long distance run (E) at 30% below anaerobic border with extensive (lactate 1-2 mMol/1) or intensive (2-3 mMol/1) energy drain. A final exhaustive run (eE) over 15 min up to anaerobic lactate levels was followed by a 30-min rest for normalization (N). Blood was drawn every 15 min for determination of LH, FSH, prolactin, estradiol (E2), β-endorphin, norepinephrine, (NE), adrenaline (AD) and dopamine (DA).

We have investigated the synthesis in vitro of calcitonin (CT) by human placenta at term. Separate placental tissue samples were incubated in culture medium with various Ca concentrations for 6 h. The CT concentrations in the medium were determined by radio-immunoassay. In addition the effect of DB-cAMP on the synthesis was also studied. We could demonstrate CT secretion in all experiments. The CT concentrations were determined by two different antibodies. Both antibodies registered the CT secretion. Addition of DB-cAMP to the culture medium stimulates the synthesis.

We investigated the in vitro transfer of three parathyroid hormone (PTH) fragments (amino acids 35-84, 44-68 and 65-84) through human placenta at term. The perfused and transferred fragments were measured radioimmunologically and identified by three different methods: high-pressure-liquid chromatography (HPLC), preparative flat-bed electrofocusing (PEGG), and gel filtration (GF). The study demonstrated that PTH fragments traverse the human placenta. The transferred and perfused fragments were identical. We observed a significant degradation of the perfused hormone during the passage through the placenta in both fetal and maternal directions. In addition, we measured the PTH concentrations on forty samples of maternal and umbilical cord artery and vein plasma obtained immediately after delivery. A highly significant correlation of PTH concentrations in the maternal and umbilical cord vessels was observed. These findings support the contention that human placenta at term is permeable for PTH fragments.