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Using the immunoperoxidase technique with monoclonal antibodies the ejaculates of 20 infertile and 15 fertile men were examined for lymphocyte subsets and activation markers to know more about the cellular mucosal immunity in the male genital tract. The results have shown that there are small differences of T-helper (CD4), T-suppressor (CD8), B- (CD19) and Natural Killer cells (CD57) between both groups. The number of monocytes (CD14), activated T- and B-cells and macrophages (CD25), the LCA-positive cells (CD45) and the HLA-DR-positive cells were remarkably increased in fertile patients. It has been established that the number of NK-cells (CD57) correlated with mycoplasma infection and the B-cells (CD19) correlated with the testosterone level. It seems that the increased testosterone value improved the cellular immunity. Infertile men have a disturbed mucosal immunity and a higher rate of genital infections.

The effect of hormone replacement therapy on cellular immunity of postmenopausal women was studied by flow cytometry (FACS). Lymphocyte subsets in peripheral blood before and after hormonal replacement therapy (HRT) were measured. After 6 months of HRT with the sequential combined drug Klimonorm(R) (2 mg estradiol valerate and 0,15 mg levonorgestrel) the cytotoxic T-cells (CD8) were reduced and the CD4/CD8 ratio was increased significantly (p < 0,05).

The presence of T-lymphocyte subsets in human endometrium and tubal mucosa in correlation to the menstrual cycle was investigated by the immunoperoxidase technique. The main cell populations were the pan T-cells (CD 3) and T-suppressor cells (CD 8). The T-helper cells (CD 4) and the B-lymphocytes (CD 22) were sparsely distributed. Significant differences between the phases of menstrual cycle could not be observed.

The knowledge about the ontogenicity of the human immune system based on animal experiments. In this study expulsed fetus of women with sponeous and arteficial abortions were analysed because of the content of T4(+)-lymphocytes in the lymphatic tissues. The thymus, spleen, and a piece of the bone marrow were dissected, homogenised and the lymphocytes were separated. The identification of the T4+ cells was performed by the cytochemical staining of dideptidyl peptidase IV (DP IV). It could established that from the 15th to the 26th week of gestation the number of T4+ cells increased in the thymus and spleen but not in the bone marrow. In cases with rubella infection was the number of T4+ cells in the spleen increased if the fetus have had no signs of embryopathy.

Primary melanoma of the vagina is a rare tumor associated with a poor prognosis. We report on a 82 years old woman with a malignant melanoma of the vagina. The treatment performed was the removal of the vaginal tumor and a hemivulvectomy followed by a chemotherapy over 6 month. A recurrence of the tumor and the development of metastases in the brain and in the lungs was observed 3 weeks after the end of the chemotherapy. The patient expired 10 month after the primary treatment.

Seventeen patients with a primary Fallopian tube carcinoma have been treated in the Landesfrauenklinik Magdeburg between 1961 and 1990. Initial therapy consisted of surgery alone. The adjuvant postoperative therapy was radiation or combined chemotherapy. The overall 5-year survival rate was 56%, of stage I 75%, of stage II 40% and 35% of stage III.

Symptoms, tumor morphology and clinical course were reviewed in 15 cases of granulosa cell tumors of the ovaries. The main symptoms were irregular menstrual bleedings. In 2 cases were found signs of glandular cystic hyperplasia additionally and in one case an adenocarcinoma of the endometrium. The appropriate treatment was the hysterectomy with bilateral salpingo-oophorectomy performed in most of the cases, followed by additional irradiation and polychemotherapy in 4 cases each.

The quantitative distribution of peripheral T cells, monocytes/granulocytes, natural killer cells and B cells was estimated in aborting women using the peroxidase-antiperoxidase technique with monoclonal antibodies. 30 women with spontaneous abortions were included in the study and 30 fertile and 50 healthy pregnant women as control groups. It could established that the normal pregnancy has no influence on the distribution of mononuclear cells. In cases with threatened abortions was the number of monocytes/granulocytes and of natural killer cells increased if the loss of pregnancy occurred. The differentiation of mononuclear cells may be helpful for the prognosis of abortions.

There are demonstrated two cases of advanced cervical carcinoma with unusual localization of metastases. One patient showed a scalp metastasis and the other one had a ulcerated inguinal lymph node metastasis. X-ray therapy caused a sufficient remission of the metastatic tumors.

The present work was done to examine the type and frequency of benign and malignant gynecological tumors in patients treated during the 5 years period from 1982 to 1986 in the Gondar College of Medical Sciences. The different pathohistological findings were compared with the history and chief complaints of the patients. A total number of 208 patients with benign and of 93 patients with malignant tumors could be analyzed. In the group of benign tumors we observed most frequently breast tumors (25.5%), endometrial and cervical polyps (24.5%), and myoma uteri (23.1%). Patients with benign ovarian tumors were treated in 40 (19.2%) cases. In the group of malignant tumors we have seen breast carcinomas (31.2%) and cervical carcinomas (34.4%) most frequently followed by the endometrial (13.0%) and ovarian (11.8%) neoplasms. Comparison with the data of the literature has shown that the mean age of our patients is lower and the number of women with advanced carcinomas is higher than in other reports.

Ascension and penetration tests were applied to 60 sterile patients for assessment of spermatozoan migration. Ascension tests were positive in 16 cases and penetration tests in 22. Ten sterile women produced positive responses to either test. Pregnancy rates were high in the cases with positive ascension tests, but highest when both tests were positive. Negative test results were attributable primarily to andrological factors, pathological conditions in the cervix or to impaired tubal patency on account of adhesions.

A review is given about the actual knowledge of sperm antigens and antibodies. For the detection of sperm antibodies a great number of tests exists with different value for the clinical work. The penetration tests are suitable for screening investigations. It has been established that in the last time the direct mixed antiglobulin reaction (MAR test), the immunobead binding technique, and the panning procedure were involved in the searching of antibodies bounded on the sperm cells. For the evaluation of circulating sperm antibodies in serum, cervical mucus, and seminal plasma the agglutination tests, the immobilization test, and the indirect MAR test are recommendable. The determination of immunoglobulin class of sperm antibodies is important because the IgA globulins are more effective than IgG in these cases.

The content of total protein and immunoglobulin in the saliva of pregnant women has been determined quantitativly by the biuret-method and radial immunodiffusion. IgA has been ascertained in all samples of saliva, whereas was appears IgG in 78,55% and IgM only 52,50% of the samples. It was discussed the importance of salive-IgA during the pregnancy.

Described in this paper is a new penetration chamber in which to test the penetration capacity of spermatozoa in cervical mucus. The technique has proved to be highly suitable for penetration testing practice and is likely to provide valuable information for diagnosis.

Sera from 150 infertile and 50 fertile couples were examined for circulating anti-genital organ antibodies by indirect immunofluorescence test on unfixed cryostat sections from various organs and methanolfixed smears of spermatozoa. -- Antibodies to spermatozoa showed an acrosomal, equatorial, postnuclear or tail immunofluorescence pattern. -- Antibodies to the ovary were directed to theca folliculi and to stromal antigens. Antibodies to the Fallopian tube reacted with the apical parts of the epithelial cells. Antibodies to endometrium and cervix were directed to glandular epithelium or mucosal stroma and antibodies to placenta reacted with trophoblast cells or amnion epithelium. Testicular antibodies were directed to tunica propria or the germinal epithelium. -- Antibodies to epididymis stained the mucous membrane epithelium, basal cells, the tunica propria or epididymal spermatozoa. Antibodies to the prostate and seminal vesicles reacted with glandular epithelium or stroma. -- Autoimmune mechanisms may play diverse roles in the pathogenesis of dysfunction of female and male genital organs.

The aetiology of carcinomas is not yet clear and the existence of tumour-specific antigens is not undoubtedly demonstrated but it is certain that the tumours are in near correlation with immunological mechanisms. It is established that certain immunophenomena exist in patients with malignomas. The tumour-associated antigens have a practical importance as tumour markers especially for the course of the disease and the recognizing of recidivation of certain carcinomas. The successes of immunotherapy of malignant tumours are not satisfactory. Better results will be expected by the use of monoclonal antibodies.

Hydrotubation is a conservative method to cope with complete or partial tubal occlusion. Hydrotubation was applied postsurgically to 60 women and as primary treatment to another 72 women, all patients suffering from primary and secondary sterility. - Minor complications, including abdominal pain, were recorded from 15 patients. Pregnancy occurred to 13, among them eleven who had received postsurgical hydrotubation.

Deformations of intrauterine contraceptive devices in the uterine cavity and their consequences are reported. In a period of 16 years we observed two partial perforations and two tuboovarian abscesses with this method of contraception in 3753 women. The value of IUD as a contraceptive of the second range is not degraded by these rare complications.

Male infertility is common. It usually is attributable to impaired maturation of germinal cells. The causes are related to the following factors: 1. Defective development of the gonadal ridge; 2. Abnormality of chromosomes; 3. Disorders in pituitary function; 4. Exogenous effects; 5. Unknown aetiology. -- Differentiation is difficult between those causes which often cannot be discovered at all. Therefore, assessment of male infertility is undertaken with reference to findings obtained from seminal, histological, immunological, cytogenetic, and hormonal tests as well as from electron microscopy.

An overlook is given about the theory of penetrating tests. The assay of tests depends from some biological factors concerning sperms, spermplasma and the cervix mucus itself. The penetrating tests are important in functional disorders in the area of cervixsperm. In negative results hormonal defects and immunological factors have to be considered.

IgG, IgA and IgM in the extracts of homogenised cervical tissue were measured with the help of radial immunodiffusion of Mancini et al. IgG IgA were found to vary crith periods. On account of low concentration IgM could not be evaluated.

Meiosis examinations in semen have been aspired in 106 patients of an andrologic outpatient clinic. Diakinesis and metaphase could be represented in 15 per cent. No meiosis analysis was possible in 12 per cent of the males. The increase of the immature spermatozoa count from 8 per cent in case of normozoospermia to 55 per cent in oligozoospermia III. degree was highly significant. Better quality of meiosis representation correlated to the increasing number of spermatogenesis cells.

The development of contraceptive vaccines is matter of international research. Among antigens possible unique to the reproductive process, sperm antigens, antigens of seminal plasma and of the ovum, antigens of placental hormones and of placenta specific proteins appear suitable targets of the production of fertility regulating vaccines. High specifity of these vaccines can prevent cross reaction with other body cells.

Autoimmunity may play a role in the pathogenesis of infertility. To explore this possibility biopsy specimens of ovaries, endometrium and tests from infertile couples were examined immunohistologically. Cryostat cut sections of biopsies were treated with fluorescein-conjugated antibodies to demonstrate tissue-bound IgG, IgA, IgM, IgD, C3, C4 and fibrinogen. Tissue-bound antibodies, complement or fibrinogen could be detected in 8 (13,3%) of 60 ovarian, 14 (16,3%) of 86 cervical, 18 (19,6%) of 92 corporal and 12 (14,1%) of 85 testicular biopsies. Moreover 20 (23,5%) specimens of the testicular biopsies showed fibrinogen fluorescence only.--The results suggest that autoantibodies against different genital organ antigens may be implicated in the pathogenesis of some cases of infertility.

The intrauterine pressure was determined by means of endoradiosonde in 42 pregnant women before induced abortion. It was measured the tonus and after stimulation with oxytocin the liminal value the basic tonus and the highest increase of pressure. The values of pressure were higher after artificial rupture of the amnion than before. Telemetering of intrauterine pressure is an advantageous method.

Sera of 100 infertile women and of 100 patients with early pregnancy as control group were investigated for antibodies to zona pellucida by the indirect immunofluorescence. Zonae of oocytes from pigs were used for the procedure. A positive control serum with a high titer was produced by immunization of rabbits with an antigen from pig zonae. The frequency of antibodies to zona pellucida was 29% for infertile patients and 18% in the control group. The titers of these autoantibodies were higher in infertile than in fertile women. There was no increase of these antibodies if the age increased and no relation to the menarche and the ovulation. Antibodies to zona pellucida were demonstrated frequently in patients with disturbances of cycle, free Fallopian tubes, secondary infertility, and ovarian and unknown origin of infertility.

Immunoreactive diseases in pregnancy are not frequent and it is important to guarantee an optimal and interdisciplinary treatment. The herpes gestationis is a pregnancy-specific disease of the skin with unknown origin and a good prognosis for mother and child. The progressional lupus erythematodes visceralis has a high risk for mother and child, but the rheumatoid arthritis shows remissions during pregnancy. The Basedow's disease and the autoimmune thyroiditis are needed a pregnancy-associated therapy to prevent a hyperthyreotic syndrome of newborns. The autoimmune haemolytic anemia and the thrombocytopenia have a high fetal risk although by intensive management. Myasthenia gravis may cause a transient neonatal syndrome.

The causes of male infertility generally fall into three categories: pretesticular, testicular and posttesticular causes. The pretesticular causes are extragonadal endocrine disorders, such as those originating in the pituitary or the adrenals, which have an adverse effect on spermatogenesis. The testicular causes of infertility are conditions in which the primary defects reside in the testes. The posttesticular causes of infertility consist mainly of obstructions of the ducts leading away from the testes. Testicular biopsy is an important method in the diagnosis and management of male infertility.

The therapeutical results of patients suffering from cervical cancer have been proofed in a clinical retrospective study in two groups with and without preoperative lymphography. 321 patients operated on by abdominal and vaginal route in the years 1976-1981 were included. It could be demonstrated, that survival rate is not better after lymphography independent from histological type and stage or postoperative irradiation. Therefore the value of preoperative lymphography may be doubtful.

The immunglobulins IgA, IgG and IgM in the extracts of homogenised cervical tissue from pregnant women were measured with the help of radial immunodiffusion of Mancini et al. The values of IgA and IgG increased during investigation. The low concentrations of IgM could not be evaluated quantitatively.

The content of immunoglobulins IgG, IgA and IgM and total protein in amniotic fluid and foetal serum of healthy pregnant women and of pregnant women with anti-D-antibodies has been determined by the single radial immunodiffusion and biuret method. IgG and IgA was detectable in all samples of amniotic fluid, whereas IgM was only present in 10 p.c. IgA increased in amniotic fluid to the end of pregnancy and it can indicate the maturity of fetus. The pregnant women with anti-D-antibodies have high IgG values in the amniotic fluid with the begin of 34th week of pregnancy.

The content of immunoglobulins in the cervical mucus has been determined quantitatively by the method of radial immunodiffusion. IgG and IgA has been ascertained in all samples, whereas IgM was not measurable. The concentrations of IgG and IgA in the cervical mucus was compared with those of mucous--membrane and of blood-serum. It was discussed the importance of periodical changes of cervical mucus for the penetration of spermatozoa.

Serum samples from 70 patients with two or more early spontaneous abortions and, for comparison, sera from 20 healthy and fertile women were assayed by indirect immunofluorescence for the presence of antibodies to sperms and genital organ antigens and for non-organ specific and organ specific antibodies. All sera were tested for thyreoglobulin antibodies by hemagglutination. The frequency of sperm antibodies and autoantibodies was significantly higher in patients with recurrent abortions than in the control group. There was no relation between the type or titer of antibodies and the clinical data of the patients.

The possible presence of a relationship between intra-uterine presentation and vestibular function was studied for this paper. -- Thermic and rotational balance tests as well as tests for vestibulospinal reaction and for spontaneous and provoked nystagmus were applied to 42 children in school age who had been born from breech and transverse presentations and to another 30 children who had been born from vertex presentations. The results seem to support the assumption that normal intrauterine presentation depends on intact condition of the vestibular system.

Determinations of immunoglobulins IgG, IgA and IgM were performed with serum and uterine blood of women who suffered from threatened abortion. In 40 of the examined women the pregnancy could be maintained and finished with normal delivery, and in 40 other women spontaneous abortion happened. Mean values of IgG, IgA and IgM of serum and uterine blood were significantly higher in women with spontaneous abortion than in women with delivery. Prognosis of threatened abortion is more unfavourable, if concentrations of immunoglobulins in serum and especially in uterine blood increase.

The results obtained from penetration testing of cervical mucus of 60 sterile couples are reported in this paper. Also, the presence of spermatozoal antibodies in the serum of both the female and male probands was detected by means of the immunofluorescence method. --Neither in the females nor males was any relationship detectable between the occurrence of spermatozoal antibodies and the results of penetration testing. Yet, spermatozoal antibodies were found to occur much more often in probands with sterility of unelucidated origin.

The histological results of 242 testicular biopsies in the period from 1974 to 1983 were evaluated with special consideration of the Leydig cells. Normal spermatogenesis was found in 9.5% of cases, hypospermatogenesis with and without maturation arrest in 76.4%, also Sertoli-cell-only and Klinefelter's syndrome in 11.6% and 2.5% respectively. Frequently an increase as well as a decrease of Leydig cells were observed in cases with pathological findings in these biopsies. In patients with Klinefelter's syndrome only an increase of Leydig cells could be seen. Ultrastructural investigations have shown that there were degenerative alterations of nucleus and cytoplasm in the Leydig cells of pathological biopsies, which could not be seen with light microscopy. In one patient with Klinefelter's syndrome needle-like crystalloid inclusions of unknown genesis were found in cytoplasm.

320 testicular biopsies were evaluated from the years 1974 to 1984 and in (5.9%) cases an orchiopexy in the history of patients were found. The orchiopexy was made in 14 cases on both and in 5 cases on one site. Average age was 8.1 years during the operations and it seems to be very high. The spermiograms of these cases showed severe oligozoospermia and azoospermia. Histological investigation of biopsies demonstrated mild to severe hypospermatogenesis with and without maturation arrest and Sertoli cell and Klinefelter's syndrome. In the testicular biopsy from one patient were found granulomas with foreign material as talc which induced regional fibrosis.

Male infertility is a far more prevalent problem than is perhaps generally realized. The evaluation of testicular biopsies allows various clinical syndromes of hypogonadism to be identified and a rational basis for therapy to be established. The morphological-anatomical classification of male infertility paralleling the clinical-biochemical classification divides the different varieties of male infertility into three categories: those due to pretesticular, testicular, and posttesticular causes. Testicular biopsy is an important method in the diagnosis and management of male infertility. The procedure is simple and safe in competent hands and yields information obtainable in no other way. The increasing use of this procedure permitts a rational classification of the testicular lesions responsible for infertility and provides an intelligent basis for the institution of corrective measures or the withholding of therapy in cases in which the biopsy indicates a hopeless prognosis for fertility.

In this study 67 workmen exposed to ions of heavy metals have been investigated because of their fertility. Concentrations of the noxious substances and their metabolites in blood and urine have been estimated and spermiograms were performed. The investigations demonstrated that a correlation exists between the concentrations of noxious substances in the place of employment, in the blood, and in the ejaculate, besides of zinc. An increased number of pathological spermiograms could be established especially in cases with an exceed of maximum permitted concentrations in the place of employment.

A 23 years old women was affected with oxyuriasis with development of peritoneal ascites. The problems of differential diagnosis are discussed.

A report is given on the spermatozoan and seminal plasma antigens and the possibilities of immunization of woman and man with these antigens. The occurence of sperm antibodies is demonstrable with more or less specific methods. The clinical importance of sperm antibodies for female fertility depends on quality of semen and many other factors. The local immune reactions to sperm and other reproductive antigens in the female genital tract has been inferred from the detection of higher titer of activity in tissue than was found in the circulation.

The content of total protein and immunoglobulins in the breast-milk has been determined by the biuret-method and radial immunodiffusion. The immunoglobulins IgG, IgA and IgM has been ascertained in all samples. The concentrations of total protein and of immunoglobulins are higher in the colostrum but in the breast-milk.

Sera from 150 infertile and 50 fertile couples were examined for organ-specific and non-organ-specific antibodies by indirect immunofluorescence tests on unfixed cryostat sections. Adrenocortical antibodies to zona fasciculata cells were found in 4 females and 2 males of infertile couples. Parietal cell antibodies were demonstrated in 4 females and 2 males of infertile couples. Parietal cell antibodies were demonstrated in 4 female and 3 male sera. Antibodies to mitochondria could be found in 14 fertile and 72 infertile couples. Antinuclear antibodies occurred in 2 fertile and infertile couples. Smooth muscle antibodies were found more often in infertile than fertile couples. Glomerular, skeletal muscle and reticulin antibodies were detected only in infertile couples. The detection of autoantibodies can help to elucidate immune reactions causing infertility.

In 246 patients with vulvar tumors of the Landesfrauenklinik Magdeburg from 1972 to 1982 we could find 5 women (2%) with tumors involving the clitoris. Two of the patients suffered from a carcinoma. The three other patients had benign lesions, one a hidradenoma, one a retention cyst and one a myxofibroma.

We analyzed the blood sera from 100 patients with EPH gestosis and from 50 women with normal pregnancy to explore the immunological reactions during gestosis. The sera of cord blood were included in the investigations. We determined the circulating immune complexes by conglutinin and C1q solid phase radioimmunoassay and by polyethyleneglycol precipitation. It has been established by conglutinin RIA that during pregnancy the women with gestosis have significant higher concentrations of immune complexes than the control group. During puerperium and in the cord blood the values are significantly lower than during pregnancy in both groups. The estimations of immune complexes by C1q RIA have shown that the differences between the two groups are insignificant and the lowest values are in the cord blood. The concentrations of immune complexes estimated by PEG precipitation were not significantly different between the two groups. It is concluded that immune complexes are in connection with the pathogenesis of preeclampsia.

The T cell subpopulations in normal human endometrium were investigated by the immunoperoxidase technique with monoclonal antibodies. The total number of 100 endometrial biopsies from different phases of menstrual cycle were analyzed. It could be established, that the number of T cells shows typical variations during the cycle. The T suppressor cells increase in the ovulation and late luteal phase and decrease in the early luteal phase. The T helper cells were rare and without typical changes. It is assumed, that the regulation of T cells in the endometrium is connected with the formation of an optimal environment for the immigration of sperms and the implantation of the blastocyst.

The content of total protein and immunglobulins in the parotid saliva and blood serum of pregnant women and healthy test persons has been determined by the biuret method and radial immunofiffusion. It was stated that total protein and IgG in the parotid saliva were higher in pregnant women than in healthy test persons, whereas the IgA-levels don't show any differences. IgM was not measurable in the parotid saliva. There was no relationship between saliva and serum immunglobulins. During the pregnancy show the parotid glands another typ of reaction than nonpregnant women.