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15.01.2000
 
Newsletter No. 1
 
1. The uterus is a "highly intelligent" organ.
2. In the event of endometriosis, there is a disorder in semen transport by the uterus and this is one of main causes for an inhibited pregnancy in the presence of endometriosis.
3. Do you know when is the ideal time during your cycle to become pregnant?
4. How frequently do early miscarriages normally occur?

1. The uterus is a "highly intelligent" organ. In addition to many functions it has a peristaltic pump. It is the uterus that carries the sperm to the right location. Even the very best of sperm would not manage this on their own.

Kunz and members of Professor Leyendecker's study group at the Klinikum Darmstadt have recently been able to show that it is not the sperm with its own mobility that itself makes the relatively long way from the outer cervix through the uterus into the Fallopian tubes. Semen transport is an activity performed by the uterus. As this transport function can be disturbed, resulting in infertility, we can deduct that the active semen transport by the uterus constitutes a fundamental function in the reproduction process. In their studies, the scientists placed tiny, radioactively marked protein balls the size of sperm (so-called macrospheres) directly in front of the cervix and traced their path with the aid of a special camera that measures radioactivity. According to these studies, it takes the uterus one minute after ejection of the semen to transport the sperm through the channel of the cervix, the length of the uterine cavity into the Fallopian tube on that side where ovulation will take place. This targeted semen transport into the Fallopian tube that will receive the ovum upon ovulation is carried out by a special organ inside the uterus, the archimetra (see the glossary), whose function is controlled by the ovary

For more information, please look up the article "Endometriosis"at www.Ferticonsult.de.

What this means for your daily life: You can save yourself the trouble of taking a vaginal douche if you want to prevent a pregnancy after intercourse – many of the sperm will have long since been sucked up into the uterus and the Fallopian tubes by the archimetra.

Reference List

Kunz, G., Beil, D., Deininger, H., Wildt, L., Leyendecker, G. (1996) The dynamics of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hysterosalpingoscintigraphy. Hum. Reprod. 11: 627-632 Kunz, G., Beil, D.,Deininger, H., Einspanier, A., Mall, G., Leyendecker, G. (1997) The uterine peristaltic pump - normal and impeded sperm transport within the female genital tract. Advances in Exp. Med. Biol. 424:267-277 Kunz G.1), Herbertz, M.2), Noe, M.1), Leyendecker, G (1998). Sonographic evidence for the involvement of the utero-ovarian counter current system in the ovarian control of directed uterine sperm transport. Hum. Reprod. Update 4: 667-672 Kunz G, Noe M, Herbertz M., Leyendecker, G. (1998) Uterine peristalsis during the follicular phase of the menstrual cycle. Effects of oestrogen, antioestrogen and oxytocin. Hum. Reprod. Update 4: 647-654 Noe, M., Kunz, G., Herbertz, M., Mall G., Leyendecker, G.(1999) The cyclic pattern of the immunocytochemical expression of oestrogen and progesterone receptors in human myometrial and endometrial layers: Characterisation of the endometrial-subendometrial unit. Hum. Reprod. 14: 101-110 Leyendecker G, Kunz G, Noe M, Herbertz M, Beil, D, Huppert P, Mall G. (1999) Die Archimetra als neues morphologisch-funktionelles Konzept des Uterus sowie als Ort der Primärerkrankung bei Endometriose. Reproduktionsmedizin 15: 356-371

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2. When women suffer of endometriosis, there is a disorder in the uterus' ability to transport semen, and this is one of the main reasons why endometriosis prevents pregnancy.

Many women with endometriosis experience inhibited fertility. Endometriosis is the term used when the mucous tissue of the uterus grows outside the uterus, for example on the peritoneum and in the ovaries, on the bladder and on the intestines. Endometriosis causes pain, it also leads to adhesion of the Fallopian tubes, which in turn can disturb the function of receiving the ovum upon ovulation, with the result of infertility. Yet even women with minimal endometriosis (with only a few endometriosis lesions on the peritoneum) i.e., without adhesions limiting the function of the Fallopian tubes have difficulty becoming pregnant. Some time ago, Hull et al. and Adamson and Pasta as well as Goordts were able to prove that a treatment of such endometriosis lesions with hormones or surgery by scabbing also fails to improve fertility. Sterility in the event of minimal endometriosis remained a mystery. Recently Leyendecker and his study group were able to prove that irrespective of the degree of endometriosis, women with this disease had a disorder in the semen transport effected by the uterus. The sperm simply do not arrive at their destination, so that the ovum cannot be fertilized. Further studies by the same study group showed that in the event of endometriosis, the mucous tissue grows into the muscle tissue underneath the mucus and destroys the muscle layer responsible for semen transport. Simultaneously, the mucous tissue in the uterus is increasingly populated with carrier cells (macrophages), which kill the sperm not transported into the Fallopian tubes..

For more detailed information , please log-in to www.Ferticonsult.de de and read the article "Endometriosis" .

What this means in practice: Hormone therapy against minimal endometriosis is pointless and even a waste of time if it is intended to increase the probability of becoming pregnant.

Reference List

Adamson, G.D., Pasta, D.J. (1994) Surgical treatment of endometriosis-associated infertility: Meta analysis compared with survival analysis. Am J Obstet Gynaecol 171: 1488-1505 Hull ME, Moghissi KS, Magyar DF, Hayes MF (1986) Comparison of different treatment modalities of endometriosis in infertile women. Fertil. Steril. 47:40 Gordts S (1989) Steriltätstherapie bei Endometriose. Gynäkologe 22:315 Leyendecker, G., Kunz, G., Wildt, L., Beil, D., Deininger, H. (1996) Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid sperm transport in patients with endometriosis and infertility.Hum. Reprod. 11: Leyendecker G, Kunz, G, Noe, M, Herbertz, M, Mall G (1998) Endometriosis: A dysfunction and disease of the archimetra. Hum. Reprod. Update Leyendecker G, Kunz G, Noe M, Herbertz M, Beil, D, Huppert P, Mall G. (1999) Die Archimetra als neues morphologisch-funktionelles Konzept des Uterus sowie als Ort der Primärerkrankung bei Endometriose. Reproduktionsmedizin 15: 356-371 Kunz G, Beil D, Huppert P, Leyendecker G (2000) Structural abnormalities of the uterine wall in women with endometriosis and infertility visualised by vaginal sonography and magnetic resonance imaging. Hum. Reprod. 15 (in press) Leyendecker G (2000) Endometriosis is an entity with extreme pleiomorphism. Hum Reprod. 15 (in press) Leiva MC, Hasty LA, Lyttle CR (1994) Inflammatory changes of the endometrium in patients with minimal-to-moderate endometriosis. Fertil. Steril. 62:967-972

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3.Do you know the ideal time during your cycle to become pregnant?

Many couples who wish to have children "time" their intercourse for a number of different reasons. Both are fully occupied with their work or live in different locations. Often he or she will jet from Berlin to Frankfurt, only so as not to miss the optimum point in time. What a hassle !! What a relief if these couples could relax a bit and take things a little easier. To become pregnant, a live and vigorous sperm has to hit a fresh ovum, penetrate its membrane and add its genetic material to that of the ovum. The assumption today is that a sperm remains able to fertilize for a period of approximately 96 hours (= 4 days) and that after ovulation, an ovum remains capable of being fertilized for approximately 9 hours. This data was confirmed and expanded in a manner that is as simple as it is impressive. Several hundred women with proven fertility and who wished to have more children collected urine daily during their cycle and made a note of the day when they had unprotected intercourse. Examinations of the hormone levels in the urine made it possible to determine the time of the ovulation and whether or not a pregnancy had occurred. The same tests also made it possible to determine how much time had passed between the last intercourse and ovulation with ensuing pregnancy. The following data was obtained: Pregnancies only occur if intercourse takes place within five days before ovulation and on the day of the ovulation. If the last intercourse was 6 days before or only on the day after the ovulation, there is no chance of a pregnancy. The probability of becoming pregnant on the day of the ovulation is 35 %. The same probability rate applies for intercourse one or two days before ovulation. If the last intercourse was three, four or five days back, the probability rate clearly drops, amounting to only 5 % for the fifth day prior to ovulation. A reassuring fact is that if the last intercourse took place up to 48 hours (i.e. 2 days) before ovulation, the probability of pregnancy does not decrease.

What this means in practice: If you know the day of your ovulation, you have an optimum probability period of conceiving ("conception window") of 72 hours, ending on the day of your ovulation. This should contribute substantially towards reducing stress. If your cycle is regular with an ovulation around the 13th to 14th day after the onset of menstruation, and you then have intercourse every two days beginning on the 10th day to the 14th , or the 11th to the 15th day, making three times, you will not be missing any chances. Of course, this presupposes that the semen and everything else is as it should be.

And incidentally : : Regardless of the day on you which you first or last had intercourse in relation to the ovulation: the ratio of baby boys to baby girls is always the same. The relegates once and for all to the realm of myth the notion that intercourse immediately prior to ovulation is more likely to produce a boy.

Reference List

Wilcox A J, Weinberg C R, Baird D D (1995) Timing of sexual intercourse in relation to ovulation - effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med 333: 1517-1521

4. How frequently do early miscarriages normally occur?

In most cases, miscarriages are quite a shock for the woman or couple concerned. After the first joy upon hearing the good news, there is frequently worry at the onset of heavier bleeding, and then the bitter disappointment when the foetus passes, or when the physician finds indications of a malformation in the foetus that will lead to miscarriage. The couple will then anxiously ask whether the miscarriage was an event that can simply happen, or whether they have a basic defect that will or can always lead to miscarriages. There are, in fact, disorders which increase the probability of miscarriage, and these need to be established or excluded. Our question here concerns the frequency with which miscarriages occur with completely healthy couples. They are astonishingly frequent and have no bearing on future pregnancies. This fact is certainly reassuring for couples who have experienced such a miscarriage. Wilcox et al. have made a study of several hundred healthy women who wanted to have children. They collecting the women's urine daily over several cycles (a total of 707 cycles) and determined the time of ovulation and the increase and further course of the pregnancy hormone, human chorionic gonadotropin (HCG), by measuring the hormone levels in the daily urine samples. They furthermore recorded the appearance, duration and severity of menstruations. 198 pregnancies occurred, of which a total of 59 (= 31 %) ended as miscarriages. In 43 cases the miscarriages occurred before the pregnancies had been clinically diagnosed by sonogram (earliest miscarriage). In many cases the women did not even know they had been pregnant. The only thing they had noticed was that menstruation had set in a little later and was also more severe. The only indication of a brief pregnancy were the temporarily positive HCG levels in the urine, which was established later. In 9 % of the women, the miscarriage took place after the pregnancy had already been clinically established. 95 % of the women with a very early miscarriage became pregnant again within the following two years, suffering no further complications. A large number of these miscarriages is certainly due to the fact that approximately 50 % of all ovae have a genetic defect. These results were obtained from women whose ovaries were stimulated with medication. However, much information points to the assumption that this also holds true for the ovae in a natural cycle. There are many obstacles to be overcome between fertilization and an intact pregnancy. From in-vitro fertilization we know that a large number of fertilized ovae do not develop into embryos which can successfully implant in the mucous tissue of the uterus. This state clearly increases with the age of the women. In such cases the ovum dies before implanting in the uterus. In some cases it just manages to settle, but does so later than usual. A delay in the rise of the pregnancy hormone levels in the blood and the urine after ovulation is an indication of delayed implantation or delayed embryonic development already prior to implantation, and the greater the delay, the greater the likelihood that the pregnancy will end as a miscarriage. What this means in practice: It is nothing out of the ordinary to have one or two miscarriages. More frequent miscarriages, however, can hide a problem that should be recognized at an early stage.

Reference List

WrambsbyH, Fredga K, Liedholm P (1987) Chromosome analysis of human oocytes recovered from preovulatory follicles in stimulated cycles, N Engl J Med 316:121-124 Wilcox AJ (1988) Incidence of early loss of pregnancy. 319: 189-194 Wilcox A J, Baird D D, Weinberg C R (1999) Time of implantation of the conceptus and loss of pregnancy. N Engl J Med 340: 1796

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Gerhard Leyendecker