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Our knowledge of reproductive medicine has expanded rapidly since the birth of Louise Brown, the first baby to be conceived by in vitro fertilization, which was performed by Professors Patrick Steptoe and Bob Edwards in Oldham, Eng land, in 1978. Hardly a year goes by without the development of a new or a modification of an existing method of assisted reproduction. Within a relatively short period, in vitro fertilization has been introduced into the treatment of female infertility. Intracytoplasmic sperm injection has also created new opportunities for the treatment of male infertility. The first edition of this book was published in 1996. In the second edition most of the chapters have been updated and additional interest is focused on intracytoplasmic sperm injection (ICSI) in view of the risk of malformations in newborns. This manual addresses the techniques of assisted reproduction that are avail able today. Competent authors from various centers present, in a concise way, their tried-and-tested procedures, so that the latter can be readily implemented. Due to different legal regulations, the scope of assisted reproduction is much more limited in Germany than in many other countries. For example, whereas only three embryos may be created and transferred in Germany, such restric tions do not exist in several other European countries and the United States. Furthermore, heterologous fertilization, oocyte donation, and surrogate mother hood are banned in Germany."
Atrophy of gonadotrophin producing cells Exogenously LH synthesis administered androgens and release or anabolic steroids are decreased Prostate Testes Normal function. Testosterone synthesis in The deficit of endogenously Leydig cells is decreased. The synthesized testosterone is exogenously administered compensated for by the steroid is not able to exogenously administered compensate for the deficit of steroid endogenously synthesized testosterone Figure 2 Intratesticular and serum testosterone concentrations after treatment with andro gens or anabolic steroids in order to substitute for the peripheral androgen deficiency and to achieve azoospermia. Because this steroid is alkylated in position 17, toxic effects on liver function can not be excluded. Danazol offers no advantages as compared with other anabolic steroids; rather, disadvantages. Numerous experiments of this type have been performed during the last 40 or 50 years. The outcome in each case was more or less identical: with a certain dose of an androgen or anabolic steroid it is possible to inhibit spermatogenesis without interfering with other androgen-dependent func tions, including libido (potentia coeundi) and accessory sexual glands. On the basis of this pharmacological-endocrinological background, androgens and anabolic steroids can be used for male fertility control, and several clinical trials have been performed during the last 10-15 years. Some of 1 these studies 2-23 are mentioned in Table 2."
In 1920, Hirose demonstrated the luteinising effect of placental tissue and one year later, Evans and Long described luteinised ovaries in rats treated with hypophysial extracts. In 1926, Zondek and Aschheim as well as Smith, independently of each other, showed that a gonad-stimulating hormone was secreted by the adenohypophysis. In 1927, Aschheim and Zondek found their "Prolan" in human pregnancy urine and the first reliable pregnancy test was available. In the following years it could be demonstrated that the gonadotropic hormones from pituitary and from pregnancy urin were not of identical structure. During the years 1931 - 1933 Fevold and coworkers prepared follicle stimulating hormone from sheep pituitaries which were free of other hormone activities. Already in 1934, Collip found "antihormones" in animals treated with proteinhormones from animals of another species. It could be shown that they were antibodies against these hormones and this was the future basis for the immunological era starting in 1960. The quantitative determination of gonadotropins has been performed over several decades by difficult bioassays and since 1960 immunological and later radioimmunological assays became available. Since that time a new field was opened for the studies of gonadotropins. During this time, highly purified preparations of gonadotropins were available for research and clinical treatment. I recall the first successful attempt of inducing follicle growth and ovulation by Gemzell and coworkers 1958 as well as by Lunenfeld and Bettendorf at about the same time.
Seit EinfUhrung der hormonalen oralen Empfangnisverhiitung in den Vereinigten Staaten von Amerika durch PINKUS im Jahre 1958 und in Westdeutschland 1961, haben sich Wissenschaftler darum bemiiht, Nebenwirkungen dieser neuen Verhiitungsmethode kri- tisch zu registrieren. Die Anwendung der Pille erfolgte anfangs eher zogernd und mit Skepsis. Sie gewann schlieBlich an Popularitat und Verbreitung Ende der sechziger Jahre, als bereits zahlreiche Berichte iiber ernsthafte Nebenwirkungen insbesondere im kardio- vaskularen Bereich bekannt geworden waren. Erst prospektiv geplante groBe Studien in England, in den Vereinigten Staaten von Amerika und in skandinavischen Uindern iiber mogliche Nebenwirkungen konnten die Zusammenhiinge zwischen dem Auftreten veno- ser Thrombosen und der Ostrogendosis aufzeigen. Diese Ergebnisse fUhrten zur starken Dosisreduzierung der Ostrogene in oralen Kontrazeptiva. SchlieBlich fUhrten weitere pro- spektive Studien in den letzten Jahren zu der Erkenntnis, daB auch die Progestagene dosisabhiingig zahlreiche ungiinstige Nebenwirkungen auf den Kohlenhydrat-und Lipid- stoffwechsel, den Blutdruck und auf das arterielle GefaBsystem haben konnen. So1che Re- sultate veranlaBten die pharmazeutische Industrie in jiingster Zeit zur weiteren Dosisver- minderung sowohl der Ostrogene wie der Progestagene in der Pille. Der Dosisreduktion sind jedoch Grenzen gesetzt, da sowohl eine akzeptable Zykluskontrolle als auch die hohe kontrazeptive Sicherheit garantiert bleiben miissen. Somit diirfte fUr orale hormonale Kontrazeptiva vorerst eine Dosisgrenze erreicht sein. Die sog. Mikropille hat bei regel- maBiger Einnahme nach wie vor eine hohe Sicherheit und ist auch hinsichtlich der Ferti- litat nach Langzeitanwendung voll reversibel.
Die Empf: ingnisverhutung gehoert heute zu den weltweiten Anliegen einer praventiven Medizin, die in erster Linie dem Gesunden und nicht dem Kranken dient. Der Arzt wirkt in diesem Bereich zuerst einmal aufklarend. Er vermittelt dem anderen Menschen Wissen; denn Frau und Mann mussen schliesslich selbst daruber entscheiden, ob und in welchen Lebensphasen sie die Empf: ingnis verhuten und welche Me- thode sie ggf. verwenden wollen. Eine verantwortliche Aufkla- rung uber empfangnisverhutende Methoden setzt dement- sprechend auf seiten des Arztes ein umfangreiches Wissen voraus. Er muss auf die vielseitigen Fragen, welche sich ftir die Aufzuklarenden zum Teil auch aus der Umgebung und aus den oeffentlichen Medien ergeben, zuverlassige Antworten geben koennen. Er muss ausserdem berucksichtigen, dass fur die Akzeptierbarkeit einer empf: ingnisverhutenden Methode nicht nur sachliche Kriterien, wie die Wirkungsweise, die Ver- traglichkeit und die Nebenwirkungen, die Zuverlassigkeit, die Praktikabilitat und die Reversibilitat eine Rolle spielen, son- dern ebenso die jeweiligen kulturellen, religioesen und ethi- schen Bindungen des einzelnen Menschen. Diese Monographie enthalt eine umfassende und kritische Darstellung der sachlichen Grundlagen aller gegenwartig be- kannten empfangnisverhutenden Methoden bei der Frau und beim Mann. Sie entspricht gleichermassen wissenschaftlichen Anspruchen und den Bedurfnissen der Praxis. Sie ist in ho- hem Mass geeignet, dem Arzt auch in differenzierten Fragen der Kontrazeption als Berater zu dienen. Indirekt dient sie da- mit einer zuverlassigen Aufklarung der Menschen, die flir sich eine Kontrazeption wunschen oder erwagen. Prof. Dr. med. JosefZander Direktor der I.
In this scholarly exposition of the book of Amos, Rabe echoes the message of the prophets: a warning of judgment to come interspersed with promises of hope for a better tomorrow. (Motivation)
This manual provides insights into clinical and laboratory techniques used in assisted human reproduction, for example hormone therapy, in vitro fertilization, diagnostic and microsurgical techniques, cryoconservation, oocyte maturation etc.. Detailed information is given on the practical clinical value of the methods, as well as on their applications in basic research. This comprehensive manual covers the state of the art and prospects for future developments in assisted reproduction. The book is thus a quick and precise guide for clinical gynecologists and specialists in reproductive medicine.
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