Summary. Bacteriospermia requiring medical treatment were diagnosed in more than 70% of the subfertile patients who had since 1988 attended the gynecological clinic at the RWTH hospital in Aachen. In 23% of all cases specific treatment with antibiotics did not reduce the concentrations of bacteria in sperma. Thirty‐six patients with bacteriospermia resistant to antibiotic therapy were then subjected to dental examination. A high incidence of potential dental foci was found in all patients. In a test group of 18 patients these sources of potential infection were eliminated. Between dental operations and therapy swabs were taken to determine bacterial levels and bacteriological composition. It could be demonstrated that the bacterial spectrum of the intraoral samples was almost identical with the spermiograms. Six months following completion of dental treatment a further spermiogram analysis was carried out. In the test group about two thirds of the spermiograms proved sterile. Spermatological parameters, such as motility, density and morphology, had also clearly improved. In the control group the findings of the spermiogram remained poor. This study indicates that a direct causal relationship exists between bacterial colonies (dental foci) and therapy‐resistant bacteriospermia which probably leads to subfertility.
105 adolescent girls with mean age of 17.3 (11-19) years had laparoscopy/pelviscopy between 1996 and 1997. In 37 cases, endometriosis was diagnosed (35.2%). The majority of the girls (32.4%) presented with endoscopic endometriosis classification (EEC) stage I. 2.8% of the girls had stage EEC II. The lesions involved one site or pelvic organ (64.8%) with a mean age of 18.7 (14-19) years. In 35.2% of cases, the lesions were at multiple sites with a mean age of 16.9 (11-19) years. Indications for laparoscopy included chronic or acute pelvic pain and right-sided lower abdominal pain. Endometriotic lesions were found in the pouch of Douglas (64.8%), uterosacral ligaments (37.8%), and ovarian fossa (24.3%), 42.8% of directed biopsies were positive. Endocoagulation of the endometriotic lesions was performed in 91.9% of cases.
The second set of statistics on pelviscopy in Germany included information on 269,603 pelviscopies done in 322 general hospitals, and 22,859 pelviscopies done in private clinics between 1978 and 1982. In general hospitals the rate of serious complications was 1.9% and in private clinics 2.0%. Injuries to large blood vessels headed the list of complications. The main technique for tubal sterilization was the bipolar high-frequency current method with 75% in general hospitals and 73.1% in private clinics, followed by the endocoagulation technique according to Semm (36.8%). Sterilization failures were reported in 2.6%. Most failures were reported after sterilization with the bipolar electrocoagulation technique, followed by the clip technique. The rate of post-sterilization ectopic pregnancies was 1.06%. The highest rate of ectopic pregnancies was reported after using the bipolar tubal sterilization method (1.4%).
Zusammenfassung In der vorliegenden Arbeit werden die Minimalanforderungen für Ejakulate definiert, die im Rahmen der in vitro‐Fertilisation für die Insemination menschlicher Eizellen verwandt werden sollen. Aufgrund der bisher vorliegenden Untersuchungsergebisse fordern wir eine Gesamtspermatozoenkonzentration von > 5 Mill. Spermatozoen/ml, wobei mindestens 30% der Spermatozoen eine normale Motilität zeigen sollten und im Differentialspermiozytogramm als morphologisch unauffällig einzustufen sind. Die Gesmatiejakulatmenge sollte dabei 1 ml möglichst nicht unterschreiten. Weiterhin ist zu gewähreleisten, daß die für die Insemination verwandten Spermaproben möglichst frei von pathogenen Mikroorganismen sind. Bei der bakteriologischen Routineuntersuchung dieser Ejakulate konnten wir in 40% der Fälle Bakterienkonzentrationen von > 105 ermitteln. Insbesondere wurden gehäuft Enterokokken und Mykoplasmen nachgewiesen. Als ein zusätzliches Beurteilungskriterium für die Spermatozoenqualität wird das zona‐pellucida freie Hamstereizellsystem beschrieben. Bei der Austestung von 91 Ejakulatoproben unterschiedlicher Qualität wiesen wir eine statistisch signifikante Korrelation zwischen der Höhe der Penetrationsrate menschlicher Spermatozoen in zona‐pellucida freie Hamstereizellen und der Spermaqualität nach. Durch Zusatz von L‐Ascorbinsäure und Douglas‐Aspirat konnte eine positive Beeinflussung der Penetrationsraten erzielt werden, sie ließen sich im Mittel um 12 bzw. 17% steigern. Durch Zusatz von Kallikrein zum Inkubationsmedium war keine Beeinflussung der Penetrationsraten möglich. Wenn für die Insemination der Hamstereizellen Ejakulate verwandt wurden, die primär hohe Leukozytenkonzentrationen enthielten, wurden deutlich fallende Penetrationsraten nachgewiesen. Bei Leukozytenkonzentrationen > 10% lagen die Penetrationsraten bei 0%. Gleiches konnten wir auch für in hoher Konzentration (> 105) pathologische Mikroorganismen enthaltende Ejakulate feststellen. Bei Zusatz von spermaantikörper‐haltigen Seren weiblicher Patientinnen zu dem Inkubationsmedium wurde ebenfalls eine deutliche Reduktion der Penetrationsraten in Abhängigkeit vom Agglutinationstiter, der Menge an zugesetzten Antikörpern, der Motilität der Spermatozoen in der Ejakulatprobe, sowie der Höhe der primär erreichten Penetrationsraten festgestellt.
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