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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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