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In a patient, suffering of apituitarism after the surgical removal of a cranyopharyngeoma at the age of 14, was treated with various doses of human urinary gonadotropin preparations for in vitro fertilization and embryo transfer. The first five treatments were performed without the additional administration of recombinant growth hormone, but due to the administration of increasing doses of exogenous gonadotropins a pregnancy was finally achieved leading to the birth of a healthy girl. Later, as the couple desired a second baby, the treatment was repeated using a low dose of gonadotropins in combination with recombinant growth hormone. This combined treatment was immediately successful, leading to the birth of a healthy boy. The present communication offers a complete survey of the existing literature about the use of recombinant growth hormone in support of ovarian stimulation with gonadotropins. The ongoing controversy is caused by the lack of an established methodology for the diagnosis of growth hormone deficiency. Whereas the efficacy of the additional use of recombinant growth hormone in support of ovarian stimulation with gonadotropins is established in patients without any endogenous growth hormone secretion, its use in patients with less defined hormonal disturbances remains controversial.

In 118 successive infertile women (aged 22-40 years, median 30 years) with longstanding infertility from our infertility clinic we performed an endocrinological (TRH-test, TT3, TT4, TBG, antibodies) as well as a morphological thyroid examination (sonography and 99mTc-scintigraphy. The same endocrinological investigations except TRH-test and a thyroid sonography was performed in the control group (50 fertile women, aged 24-39 years, median 33 years). Two patients were hyperthyroid and one patient had primary hypothyroidism. Antibodies against thyroglobulin (TgAK) and thyroid peroxidase (TPO) or microsomal antibodies (MAK) were found in 19 patients (19%). The incidence of biochemical immunological thyroiditis was not significantly different from the control group. But thyroid volume was significantly higher in patients (21 versus 15.6 ml, p < 0.03). Goitre (> 18 ml) was diagnosed in 52% (n = 57) of the patients, although 43 had normal TRH-test results with delta TSH 2.5-12.5 microU/ml. So-called subclinical (latent) hypothyroidism (delta TSH > 12.5 microU/ml) was found in 29 patients; 18 of these infertile women had no goitre. Iodine avidity (99mTc-uptake) increased significantly with the increase in thyroid volume, but showed a tendency to lower values with increasing delta TSH-values and higher iodine avidity in women with thyroid enlargement (n = 109). During follow-up of 12-24 months 10 women with goitre conceived spontaneously after initiation of iodine and/or L-thyroxine 100 micrograms treatment. These data support recent studies, that factors other than TSH cause thyroid enlargement.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro bovine cervical mucus penetration tests (Penetrak) were performed in 30 patients from our fertility clinic and in 33 healthy volunteers with normal semen characteristics. After 90 minutes maximum penetration by sperm (mm) was measured using a capillary filled with bovine midcycle cervical mucus. At the same time classical (sperm motility [%], concentration [mill/ml] and morphology [% oval heads] ) and computerized semen analyses (Cell Soft) were performed (mean velocity [micron/s], lateral head displacement [micron], beat frequency [Hz] and mean linearity). Multiple regression analysis of the depth of sperm penetration in cervical mucus (mm) yielded those semen parameters which allowed correct prediction of the penetration test in 54% of cases. Sperm concentration, morphology, motility and mean velocity alone accounted of 53% of the predictions. In 46% of cases the outcome of the cervical mucus penetration test could not be predicted, regardless of whether classical or computerized semen analysis was performed. This suggests that factors other than those described above must play a role in this aspect of sperm function.