Glossary

Reproductive medicine

Artificial semen transfer (intrauterine insemination - IUI)


This procedure is particularly appropriate when insufficient or mainly poorly motile semen cells are present. In this case, egg cell maturation is first promoted by administering fertility hormones. The semen is collected by masturbation and qualitatively processed in the laboratory. With the aid of a flexible thin plastic tube, the semen is then introduced into the uterine cavity, as close as possible to the egg. The advantage of this method is that very many semen cells are able to approach very closely to the egg cell.


Hormonal therapy for the woman


If the cause of inability to conceive lies in a hormonal disorder in the woman (for example, malfunction of the thyroid gland or oversecretion of male hormones), medicines with specific modes of action can be used. If, despite normal level of hormones, the function of the ovaries is inadequate, clomiphene tablets or injections of FSH (egg cell maturation hormone) and, if appropriate, LH (ovulation hormone) can stimulate the natural cycle.


Fertilisation outside of the body (in vitro fertilisation - IVF)


Fertilisation outside of the body can be achieved using different procedures. Basically, it is begun by stimulating egg cell maturation by administering fertility hormones. The difference from conventional stimulation is that by administering hormones, several egg cells can be matured and harvested so that they can be fertilised outside of the body. In order to be able to collect as many mature egg cells as possible, the hormonal stimulation must be appropriately adapted. After fertilisation, the embryos are inserted into the uterus.


Microinjection (intracytoplasmic sperm injection - ICSI)


If sperm motility and quantity are limited, another form of IVF can be done. Here, too, initially several eggs are harvested using hormonal stimulation and follicular puncture. Since the small number of motile sperm makes fertilisation in the test tube a bit iffy, another method must be selected. Under a special microscope a single sperm is sucked up into a fine hollow glass tube and injected directly into the egg cell. This micro-injection thus imitates the natural process of penetration of one semen cell into the egg cell. The fusion of the cell nucleus of the semen cell and the egg cell is not affected by the process. If fertilisation and cell division has taken place, the embryo, as in the IVF procedure, will be introduced into the uterus in five days.


Assisted hatching of the embryo


Under certain conditions (for example, multiple unsuccessful embryo transplants), the attempt will be made to increase the chances of a pregnancy by making it easier for the embryo to slip out of the egg membrane. When this is done, immediately before the embryo is introduced into the uterus, a tiny opening is made in the external envelope of the embryo using a laser, for example. However, there is no scientific evidence to date that documents an improvement in the outlook for success using this method.


Freezing egg cells (cryopreservation)


When, in the context of IVF treatment, the sperm have penetrated more than three egg cells, but fusion of the genetic material has not yet occurred, it is possible to keep these egg cells (in the pro-nuclear stage) for several years by freezing them. The advantage offered by this procedure is that hormonal stimulation and egg cell harvesting does not have to be repeated if pregnancy has not occurred in a treatment cycle. The procedure is proven and safe but does result in a low pregnancy rate. This is therefore important that you make clear to us in advance whether any supernumerary egg cells in the pro-nuclear phase should be frozen.

 


Gynaecological endocrinology


Developmental disorders in young girls


Early (before 9 years of age) and late (after 12 years of age) onset of the menstrual cycle must be looked at and treated where necessary. This also applies to poor or excessive growth. Negative effects on later life are often prevented if treated early.


Family planning


Because of the numerous options available for family planning, there is always a demand for competent advice, especially when existing methods become problematic.


Abnormal bleeding


Disorders in the normal cycle can not only be a cause of discomfort, but could also lead to health disorders. They may also be indicative of hormonal disorders which in turn may affect other organs. To examine these disorders we use the most up to date procedures in diagnosing and providing treatment. The procedures followed are entirely dependent on the individual situation. We offer a full range of treatment options beginning with regulating hormones, performing surgery to preserve the organs, up to performing a hysterectomy. We place great emphasis on preserving the uterus to allow for possible pregnancy.


Pre-menstrual syndrome (PMS)


PMS is associated with a number of problems in the days leading up to the menstrual period. Typical symptoms range from headaches (migraines) to mood swings. These are indicators of hormone imbalances or more specifically low hormone levels. In many cases simple procedures are followed to alleviate these problems.


Excessive hair growth / Hair loss


Excessive hair growth may be an indicator of a disorder in the change of pre-hormones into female sex hormones. Further indicators of such a disorder may be irregular menstrual cycles, cessation of periods, infertility or metabolic disturbances. Treatment, which is subject to each individual situation, could involve hormone or operative treatment.


Loss of hair may also be due to hormone disorders. Diagnosis can only be made in conjunction with dermatologists. Hormone treatment may be appropriate.


Endometriosis


Endometriosis is a benign but often chronic and progressive illness in women of reproductive age. Symptoms include increasingly painful periods, pelvic pain and irregular bleeding. Endometriosis also leads to infertility. In severe cases it could lead to ovarian cysts and damage to other organs (bowels, bladder).


Treatment is tailored to each individual’s situation. A laparoscopy is usually performed in order to make accurate diagnosis and to possibly remove some tissue. Following this, hormone therapy is given, followed by further laparoscopy. In general it can be said that the treatment for endometriosis is long-term, in cases where the uterus and ovaries need to be preserved.


Uterine fibroids


Uterine fibroids are benign tumours of muscle that develop within the uterine wall. Not all fibroids need to be removed. Should they cause discomfort or cause irregular menstrual bleeding, grow in size or be the cause of infertility, surgery should be considered. Other treatments are available but surgery is considered to be the standard treatment of fibroids. This could involve either removing the fibroids or the uterus. In the case of younger women or where the uterus should stay intact, fibroids need to be removed. Depending on the size, position and number of fibroids, we perform laparoscopic surgery (Minimal invasive surgery) and where necessary surgery by abdominal incision. In cases where women wish to have children, the aim is always to preserve the uterus.


For older women who no longer wish to have children, an alternative method has been available for a number of years. This method involves cutting off the blood supply to the arteries (Uterine artery embolization) causing the fibroids to starve and die. Although this treatment is still being tested in Germany, the data accumulated in Frankfurt in conjunction with the Institute for Diagnostic and Interventional Radiology (Head : Prof. Dr. Vogl) show that many patients have been treated effectively with this minimal invasive treatment.


Uterine fibroids that grow into the inner cavity of the uterus, can be successfully removed by laparoscopic surgery. Occasionally hormone treatment precedes this surgery.


Menopause


In the past doctors only concentrated on relieving the signs and symptoms of menopause (the most well known symptom of which is hot flushes). Gynaecologists now also look at protecting the bone tissue, heart and circulation. This is also due to the fact that higher life expectancy means that women are now spending one third of their lives post menopause. Media reports that criticise the use of hormone replacement therapy often do not bear in mind that the benefits of hormone therapy far outweigh the disadvantages. This is especially true where modern hormone replacement substances can be used. The aim here is to provide individual treatment and to give as low a dosage as possible.


Repeated miscarriages


Unfortunately, 20% of all pregnancies result in miscarriage. Couples experiencing three or more miscarriages should be appropriately diagnosed in order to provide relevant treatment. Diagnosis and therapy is often extensive and therefore expensive. Consequently there are only very few centres who can help couples effectively. Fortunately treatment is successful in most cases.