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Since postmenopause unopposed oestrogen replacement therapy (ERT) increases the incidence of endometrial carcinoma, the addition of a progestin in non-hysterectomised women is mandatory for hormonal substitution. On the other hand, progestins have a negative influence on serum lipids and may thus put in question the benefits of the ERT with regard to the cardiovascular risk. Progestins lower HDL and increase LDL in a dose-dependent way according to their chemical structure. In the present non-randomised study, the influence of a cyclic combined oestrogen progestin substitution on the serum lipids has been measured. From a total of 90 apparently healthy postmenopausal patients, 59 received a transdermal ERT with 17 beta-Estradiol (Estraderm TTS 50), whereas 31 women obtained a daily dose of 0.625 mg conjugated equine oestrogens (CE) perorally. Additionally all patients were given 10 mg medroxyprogesterone-acetate (MPA) daily during the first 10 days of each month. After 6 months of therapy, the following changes of serum lipids, expressed as percentage of initial values, were measured: total cholesterol in the transdermal group -2.3% (n.s.), in the peroral group -11.8% (p < 0.00001); triglycerides -3.7% (n.s.) resp. +8.6% (n.s.); HDL cholesterol + 0.2% (n.s.) resp. -1.8% (n.s.); LDL cholesterol +1.3% (n.s.) resp. -14.8% (p < 0.00001). The calculated atherogenic indices showed a decrease in the peroral substituted group of -6.5% (n.s.) for the HDL/total cholesterol ratio and -14.8% (p < 0.002) for the LDL/HDL ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

In a two-years period, we treated 58 infertile couples for a total of 213 cycles with artificial homologous insemination (AIH). We considered a indication for AIH low sperm quality or a pathological postcoital test (PCT). Couples with idiopathic infertility did not receive AIH. If possible, AIH was performed by intrauterine insemination (IUI), following concentration of the motile sperms by "swim-up" method. Out of 213 cycles "swim-up", preparation could not be done in 46 cases (21.6%) because the initial sperm quality was below technical limits (sperm count below 1 Mio/ml). Out of 58 treated couples 4 became pregnant during AIH therapy (7%) among, them 2 couples conceiving twice after spontaneous early abortion. The total pregnancy rate per cycle was 2.8%. In the cycles after "swim-up", the monthly pregnancy rate through IUI was 3.6%. In the presence of andrological factors was the pregnancy rate only 0.9% compared to 6.8% in cases of pathological PCT with normal sperm quality. Thus, it can be concluded, that IUI is not successful on the basis of low sperm quality. Only in cases of unfavourable cervical factor expressed by a pathological PCT accompanied with a normal spermiogramm, moderate success can be expected.

Operation, retroperitoneal lymphadenectomy, irradiation and chemotherapy may reduce the fertility potential of young male patients suffering from a malignant tumour. Prediction of the reversibility is difficult. Cryopreservation is a possibility to maintain the fertility of such patients. Unfortunately, the quality of the sperm is often reduced beforehand. The sperm motility is noticeably reduced by the freezing process. But the sperm preservation may help to reduce the psychological stress of the patients, thus improving their quality of life. Therefore, we recommend the use of the method liberally, although only few patients will make use of their sperm later. There has been no known teratogenicity to date. We report on our own experience with cryopreservation in 39 patients.

Endocrinically active genital tumors are indeed rare; however, their correct classification and treatment is rather difficult. If ovarian tumors coincide with abnormal hormonal activity, thorough consideration of differential diagnosis is necessary. The WHO has agreed upon a classification of endocrinically active ovarian tumors. This grouping, which is internationally accepted, is the base of the explanations, and to these, remarks about uterine HCG-producing trophoblast diseases are added. Symptomatology of endocrinically active ovarian tumors is nonuniform, depending on the tissular origin of the tumor and the pattern of its endocrine activity. Prognosis is also quite variable. This must be taken into account for therapy. E.g., operative therapy with conservation of fertility is possible--in particular in young women--with granulosa cell tumors or androblastomas; dysgerminomas are strikingly sensitive to irradiation; chorion carcinomas respond well to chemotherapy. More difficult are clear therapeutic recommendations for the very rare forms of endocrinically active genital tumors which stem from sex cords or which are composed of different components of the complex ovarian blastema. In a supplement, the relevant literature (121 quotations) is cited.

The Polycystic Ovary Syndrome (PCO) is characterised by an elevated ratio of serum LH to FSH in presence of an intrafollicular deficiency of FSH activity. Ovulation induction by "pure" FSH seems therefore a reasonable approach to longstanding chronic anovulation in infertile patients suffering from PCO. 68 treatment cycles have been conducted in 30 patients with PCO and chronic clomiphene-resistant anovulation. Ovulation has been induced by HCG in 57 of the 68 cycles. The pregnancy rate was 58.6% per patient, the success rate 46.7% per patient. Clinical abortions occurred in 17.6% of the pregnancies obtained. 3 twins and 2 triplets have been delivered at term. A hyperstimulation syndrome (HSS) of grade I (WHO) has been observed in 19.1%, a HSS of grade II (WHO) in 8.8% of the treatment cycles. 46.3% of the 54 analysed cycles presented a premature LH-surge leading to an atresia of the dominant follicle. Considering the high incidence of a premature elevation of endogenous LH, an additional administration of exogenous LH should be avoided. This consideration as well as the good success rate in the present series speak in favour of using "pure" FSH for induction of follicular maturation in clomiphene-resistant PCO.

The two percutaneous tuberculin tests Tine test (TT) (old tuberculin) and Monotest (MT) (PPD-tuberculin) were compared simultaneously with the standard intradermal reaction (Mantoux [MX] 1:1000 = 10 EPPD-RT23-tuberculin) in 119 unselected 16-81 year old outpatients (general medicine) in an open trial. The tests were read after 48 and/or 72 h. Indurations of greater than or equal to 10 mm (MX), greater than or equal to 2 mm (MT) and greater than or equal to 5 mm of one papule or confluescent papules (TT) were considered to be positive. 6-9 mm for MX and 2-4 mm for TT were considered doubtful. The overall agreement with MX (69.7% positive, 27.7% negative reactions) was 92.4% for MT and 68.1% for TT. Regarding sensitivity (false negative reactions), MT provided far better results than TT (8.4% vs. 44.6%). TT performed equally well when the doubtful reactions were reclassified as positive (8.4% false negative). It is recommended that the limit for a positive TT be lowered to greater than or equal to 2 mm, as other authors have suggested. MT always produced easily palpable and measurable indurations, whereas the borderline TT reactions (2-4 mm) were difficult to read and the size of the four papules varied considerably in most instances. Only MT showed significantly more positive readings after 72 h compared to 48 h. MT was better tolerated subjectively than TT with regard to application and skin reaction. The Monotest can be recommended as tuberculin screening test for general practice.

The TSH response to exogenous TRH may be diminished or absent not only on overt hyperthyroidism but also in other situations, e.g. obesity, old age, multinodular goiter and depression. To elucidate the possible role of dopaminergic control of the TSH response to TRH in such patients, the oral TRH test (40 mg) was performed with and without simultaneous administration of metoclopramide (10 mg i.v.) in 20 patients known to have diminished or absent response to oral TRH (delta TSH < 1.0 mU/l). All patients had euthyroid basal levels of FT4-index and T3, and may thus be assumed to have "preclinical hyperthyroidism" (TSH suppression syndrome). In 11 patients the history suggested they were free of symptoms of mental depression, while 9 patients were considered by two independent examiners to have various degrees of depression. The TSH response to TRH in depressive patients was significantly increased when the dopamine-receptor-blocker metoclopramide (MCL) wad added. The delta TSH rose from 0.6 +/- 0.3 mU/l (SEM) without MCL to 8.8 +/- 1.8 mU/l with MCL (p < 0.002). In contrast, MCL failed to enhance the TSH response in non-depressive patients: the delta TSH was 0.7 +/- 0.3 mU/l without MCL, and with MCL 2.1 +/- 0.9 mU/l (n.s.). Thus the dopaminergic system appears to play a major role in modulating the sensitivity of the pituitary to TRH stimulation. In clinically doubtful situations, the combined metoclopramide-TRH test may be used to distinguish patients with a diminished or absent TSH response as a consequence of depression (central dopaminergic suppression) from patients with "preclinical hyperthyroidism" where the TSH response is suppressed by feedback control of TSH by thyroid hormones (thyroid autonomy).

This comparison of the common and distinctive signs of male and female hypogonadism is intended to acquaint the non-specialist practitioner with some general trends in andrology and gynecologic endocrinology. The author deliberately omits any presentation of rare clinical entities or precise guidelines for investigation and treatment of infertility.