Papers by Christian Geyter
Human Reproduction, 2002
BACKGROUND: The purpose of this study was to propose a new method for imaging the uterine cavity ... more BACKGROUND: The purpose of this study was to propose a new method for imaging the uterine cavity and Fallopian tube patency by three-dimensional dynamic magnetic resonance hysterosalpingography (3D dMR-HSG) and to analyse if, by using a higher viscosity contrast solution, direct visualization of the Fallopian tubes may be achieved by this new technique. METHODS: 10 consecutive infertile women underwent 3D dMR-HSG and conventional HSG as gold standard. 3D dMR-HSG consisted of injection of 20 ml of a gadolinium-polyvidone solution into the uterine cavity while acquiring five consecutive three-dimensional (3D) T1-weighted MR-sequences. RESULTS: In three patients the catheter became dislodged during 3D dMR-HSG. However, in one of these patients the examination was still partially diagnostic. Imaging findings of 3D dMR-HSG showed good correlation with conventional hysterosalpingography and allowed 3D imaging of the uterine cavity and of Fallopian tube patency in 8/10 patients and direct visualization of the Fallopian tubes in 5/7 patients. CONCLUSION: 3D dMR-HSG represents a new and promising imaging approach to female infertility causing less pain and avoiding exposure of the ovaries to ionizing radiation. By using a higher viscosity MR-contrast agent it allows not only visualization of uterine cavity and Fallopian tube patency but also direct visualization of Fallopian tubes.
![Research paper thumbnail of [Comorbidity in infertile couples]](https://attachments.academia-assets.com/49471653/thumbnails/1.jpg)
Therapeutische Umschau, Dec 1, 2009
Die Entstehung und das Fortbestehen einer intakten Schwangerschaft ist nur dann möglich, wenn ein... more Die Entstehung und das Fortbestehen einer intakten Schwangerschaft ist nur dann möglich, wenn eine Vielzahl komplexer prä-, peri-und postkonzeptioneller Prozesse beim Mann und bei der Frau reibungslos ablaufen. Vereinfachend formuliert braucht es dafür intakte und funktionelle Keimzellen von Mann und Frau, eine Befruchtung sowie einen gesunden Uterus, in dem sich der frühe Embryo implantieren kann. Allein diese essentiellen Gegebenheiten können schon durch viele verschiedene Faktoren und Krankheiten gestört sein, wobei nur ein kleiner Teil dieser Störmechanismen bekannt ist und damit diagnostiziert werden kann. Je nach Intensität der Diagnostik bleibt bei 5 -25 % der unge-Begleitende Morbidität bei Sterilität Das Eintreten einer Schwangerschaft ist ein hochkomplexer Prozess, der auf mehreren Ebenen und durch mannigfaltige Störungen behindert werden kann. Mediziner verschiedener Fachrichtungen sind in ihrem Praxisalltag zunehmend mit Paaren konfrontiert, die unter ungewollter Kinderlosigkeit leiden. Diese Entwicklung ist hauptsächlich darauf zurückzuführen, dass immer mehr Paare die Gründung einer Familie in die späte reproduktive Lebensphase verschieben, wenn beide Partner sich schon sozial und/oder beruflich etabliert haben.
Therapeutische Umschau, Apr 12, 2013
Schweizerische Ärztezeitung|Bulletin des médecins suisses |Bollettino dei medici svizzeri |2009;9... more Schweizerische Ärztezeitung|Bulletin des médecins suisses |Bollettino dei medici svizzeri |2009;90: 43
Andrology, 2010
Page 1. E. Nieschlag et al. (eds.), Andrology, DOI: 10.1007/978-3-540-78355-8_23, © Springer-Verl... more Page 1. E. Nieschlag et al. (eds.), Andrology, DOI: 10.1007/978-3-540-78355-8_23, © Springer-Verlag Berlin Heidelberg 2010 469 Contents 23.1 Assisted Reproduction as a Treatment of Infertility ..... ...
![Research paper thumbnail of [Present-day reproductive medicine and future possibilities]](https://attachments.academia-assets.com/49471647/thumbnails/1.jpg)
Therapeutische Umschau. Revue thérapeutique, 2009
Despite the controversial discussions, which have accompanied it since its first introduction of ... more Despite the controversial discussions, which have accompanied it since its first introduction of into clinical medicine particularly in Switzerland, assisted reproductive medicine has come to acquire a firm standing in present-day society. This broad acceptance is the logical consequence of the availability of efficient methods of family planning which started with the introduction of oral contraception in the early sixties. Over time assisted reproductive medicine has grown with a considerable degree of efficacy due to improvements in the culture conditions in the embryology laboratory and due to sophisticated ovarian hyperstimulation. In conjunction with steadily rising treatment numbers the latter has contributed to a high incidence of multiple deliveries, which now is considered a complication of assisted reproduction and current opinion demands that multiple pregnancies must be avoided as much as possible. The experience in various countries has demonstrated that through the se...
Swiss medical weekly, Jan 11, 2007
The interest in long-term storage of uninseminated oocytes through cryopreservation has seen a re... more The interest in long-term storage of uninseminated oocytes through cryopreservation has seen a recent upsurge, because it provides the potential to assist young women to postpone childbirth after having overcome a malignant disease or delaying childbirth until after management of a professional career. The low fertilisation rate of frozen/thawed oocytes in earlier feasibility trials can now be improved by using intracytoplasmic sperm injection (ICSI) for assisting the penetration of the spermatozoon through the oocyte's hardened zona pellucida. Another reason for the reported low success rates of oocyte cryopreservation in earlier studies may have been the low developmental potential of spare oocytes, which were available for experimental cryopreservation. Oocytes retrieved from supernumerary follicles in women treated with gonadotropins for ovulation induction and intrauterine insemination can be used for the optimisation of cryostorage of uninseminated oocytes. We intended to ...
Journal of assisted reproduction and genetics, 1998
Our purpose was to demonstrate the feasibility of the routine aspiration of supernumerary follicl... more Our purpose was to demonstrate the feasibility of the routine aspiration of supernumerary follicles in infertile patients with imminent polyovulation after ovulation induction with gonadotropins and to examine its effect on the frequency of cycle cancellation and on the (multiple) pregnancy rate. The data on 796 treatment cycles, performed between 1989 and 1996 on 410 infertile couples, were analyzed retrospectively. From October 1992, whenever necessary, supernumerary ovarian follicles were selectively aspirated transvaginally under ultrasound guidance to prevent the ovulation of more than three follicles. Thereafter, intrauterine insemination was performed. After the adoption of transvaginal ultrasound-guided aspiration of supernumerary follicles into the treatment protocol in October 1992, the number of canceled cycles (P < 0.0001) and the multiple pregnancy rate (P < 0.01) were significantly reduced compared to those previously. The overall pregnancy rate remained stable. ...
Therapeutische Umschau, 2009
The differentiation potential of embryonic stem (ES) cells seems to be higher when compared to ad... more The differentiation potential of embryonic stem (ES) cells seems to be higher when compared to adult stem cells, which mainly differentiate into certain tissue types only. ES cells have the potential to play an important role in regenerative medicine as demonstrated with murine ES cells. However, with human embryonic stem cells (hESC) several obstacles still have to be overcome, when these are to be used in clinical applications. The expansion of hESC, safety issues as well as the immune-tolerance after transplantation are all problems that still have to be solved. Since 2005 the derivation of hESC lines from super-numerous embryos has become permitted in Switzerland, albeit under strictly restrictive guidelines. In 2008 the Basler hESC laboratory was successful in derivating the first hESC line with a normal chromosome complement in Switzerland (CHES2). Now, new applications allow the personalized establishment of immune-tolerant stem cells, which lead to the replacement of therapeutic cloning by induced pluripotent stem cells (iPS).
Therapeutische Umschau, 2009
Currently, there is a rising trend to consider a multiple delivery as a genuine complication of a... more Currently, there is a rising trend to consider a multiple delivery as a genuine complication of assisted reproduction, which can be prevented by the replacement of one single, selected embryo. Particularly previously infertile women due to their poor reproductive function are at risk of complications during gestation leading to premature delivery. Cerebral palsy is the most common consequence of multiple gestation and a significant cause of disabling among the offspring. Particularly Swedish specialists in reproductive medicine have been at the forefront of the development of single embryo transfer (denominated SET), which has become the main therapeutic strategy in IVF since 2004. In Sweden, approximately 70 % of all treatment cycles with assisted reproduction are now being performed with SET. Despite the transfer of fewer embryos per cycle, acceptable pregnancy rates are being achieved thereby reducing the multiple delivery rate to approximately 5 %. In Switzerland, however, legal restrictions ban the selection of embryos, so that all available embryos (not more than three) are still being transferred.
Therapeutische Umschau, 2009
Pregnancy is the result of a series of highly complex processes, which can be deranged by multipl... more Pregnancy is the result of a series of highly complex processes, which can be deranged by multiple disturbances on many different levels. Physicians are increasingly dealing with couples suffering from infertility. This rise in case numbers is mainly due to the fact that couples are more and more delaying childbearing until a later phase of their reproductive life, when their social and professional careers are established. The increasing mean age at the first birth has a negative impact on fertility by deteriorating quality and reducing the quantity of oocytes. With increasing age systemic diseases are becoming more coincidental, which in turn tend to exert negative effects on fecundity and fertility both in males and females. This review highlights some associations between infertility and various common systemic diseases. Both general practitioners and gynecologists should counsel young women about the finity of the reproductive phase of their life. Young couples are to be informed, that a &amp;amp;amp;amp;amp;amp;quot;healthy lifestyle&amp;amp;amp;amp;amp;amp;quot; without smoking, sexual transmitted diseases and without metabolic diseases as diabetes and obesity can have a positive effect not only on their general health but also on their fertility and the outcome of future pregnancies.
Die Diagnostik der Infertilität führt nur selten zur umfassenden Klärungsämtlicher Infertilitätsu... more Die Diagnostik der Infertilität führt nur selten zur umfassenden Klärungsämtlicher Infertilitätsursachen (▸ Kap. 20). Dazu kommt, dass manche aufgedeckte Infertilitätsursache nicht mehr reversibel ist. Eine wirksame kausale Therapie aller diagnostizierten Infertilitätsursachen kann daher nur in wenigen Fällen eingesetzt werden. Grundsätzlich wäre eine kausale Behandlung der ungewollten Kinderlosigkeit vorzuziehen, bei der die Infertilitätsursache ohne unmittelbare Beeinflussung des Prozesses der Schwangerschaftsentstehung beseitigt
Molecular and Cellular Endocrinology, 1996
The follicle-stimulating hormone (FSH) is essential for normal gametogenesis. In females FSH is r... more The follicle-stimulating hormone (FSH) is essential for normal gametogenesis. In females FSH is required for ovarian development and follicle maturation whereas in males FSH determines Sertoli cell number and quantitatively and qualitatively normal spermatogenesis. FSH action is mediated by a G-protein coupled receptor expressed solely in granulosa and Sertoli cells. The FSH-receptor (FSHR) gene is localized on chromosome 2 p21 and spans a region of 54 kb. It consists of ten exons; exon one to nine encode the large extracellular domain and the transmembrane domain is comprised of exon ten. Mutations in the FSHR gene could severely affect gametogenesis and result in infertility. Therefore screening programs have been initiated, in which patients with disturbed fertility were searched for mutations in the FSHR gene. Several Finnish families were identified displaying an inherited pattern of ovarian dysgenesis, a disease leading to streaky underdeveloped ovaries and primary amenorrhea. By genetic linkage the locus of the genetic defect was confined to chromosome 2 ~21. Analysis of the FSHR gene resulted in the identification of a mutation (Ala189Val) homozygous in all affected females. Functional studies revealed that the mutation affects the proper protein folding and thereby inactivates the receptor. In a male patient hypophysectomized because of a pituitary tumor, who despite undetectable serum gonadotropins had normal semen parameters, we hypothesized an activating mutation of the FSHR. Screening of exon ten of the FSHR gene resulted in the identification of a Asp567Gly transition in the third intracytoplasmatic loop. Functional studies resulted in a 1.5-fold increase in basal CAMP production compared to wild type FSHR, indicating that the heterozygous mutation leads to a ligand-independent constitutive activation of the FSHR. This patient provides an exceptional model of nature defining the role of FSH in human spermatogenesis. Mutations of the FSHR might have differential effects in each gender. For example activating mutations have not been described in women, therefore it is not clear whether the constitutive activity of the receptor could disturb normal follicular development resulting in certain infertility.
The Journal of Clinical Endocrinology & Metabolism, 2004
Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, chronic anovulation, and i... more Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, chronic anovulation, and insulin resistance; long-term consequences include diabetes mellitus type 2. The aim of this randomized, double-blind, controlled trial was to investigate whether the thiazolidinedione derivative pioglitazone diminishes insulin resistance and hyperandrogenism and enhances ovulation rates in women with PCOS. Forty premenopausal women with PCOS were randomly allocated to treatment with either pioglitazone (30 mg/d) or placebo for periods of 3 months. Administration of pioglitazone resulted in a remarkable decline in both fasting serum insulin levels (P < 0.02) and the area under the insulin response curve after an oral glucose load (P < 0.02). This represented an increase in insulin sensitivity and a decrease in insulin secretion (P < 0.05). Furthermore, pioglitazone increased serum SHBG (P < 0.05), resulting in a significant decrease in the free androgen index (P < 0.05 compared with placebo). Treatment with pioglitazone was also associated with higher ovulation rates (P < 0.02). Thus, pioglitazone significantly improved insulin sensitivity, hyperandrogenism, and ovulation rates in women with PCOS, thereby providing both metabolic and reproductive benefits. (J Clin Endocrinol Metab 89: 3835-3840, 2004)
The Journal of Clinical Endocrinology & Metabolism, 2005
Background: Inflammatory markers and insulin resistance are independent cardiovascular risk facto... more Background: Inflammatory markers and insulin resistance are independent cardiovascular risk factors and are thought to be influenced by sex steroids. We investigated changes of inflammatory markers and estimates of insulin resistance during the menstrual cycle, their variances, and their relationship to each other, sex steroids, and regional body fat distribution.
The Journal of Clinical Endocrinology & Metabolism, 2005
Background: It is controversial whether the polycystic ovary syndrome (PCOS) per se increases low... more Background: It is controversial whether the polycystic ovary syndrome (PCOS) per se increases low-grade chronic inflammation and whether this relates to central fat excess. In addition, the association between circulating sex hormones and body fat distribution in premenopausal women is debated.
Journal of Assisted Reproduction and Genetics, 1996
Purpose: Reactive orygen species (ROS) including HzOz producedby spermatozoahave been suggested, ... more Purpose: Reactive orygen species (ROS) including HzOz producedby spermatozoahave been suggested, on one hand, to be associated with idiopathic male infertiliry and, on the other hand, to stimulate certain spenn futrction leading to fertilization. The influence of ROS onfertilizationwas inves' tigated in 75 NF patients by cotelating fertilization rates with the production of ROS and the H2o2-scavenging activiry of swim-up sperm.atozoa prepared in parallel with the NF samples. Resulß: Low rates of ROS production by the swim'up sperm was detected by the luminol'dependent chemiluminescence assay. They were not correlated with fertilization rates. The hydrogen peroxide scavenging capacity of these spernntozoa, measured as the removal of exogenous HzOz assayed spectrophotometrically, decreased stepwise in groups of patients achieving higher fertilization rates, suggesting a positive ffict of this ROS on fertilization. An alternative explanation of this correlation is plausible in view of the as s o c iat i o n of b o th hi gh s c av e n g in g ac t iv it i e s and p o o r fe rt il' ization rates with poor sperrn morphology. Conclusion: ROS produced by spermatozoa selected by swim-up plays no negative, if not a positive, role in fertilization.
Human Reproduction, 2002
BACKGROUND: The preovulatory rise of progesterone is important for ovulation, but both its regula... more BACKGROUND: The preovulatory rise of progesterone is important for ovulation, but both its regulation and its origin are controversial. Three experiments were performed to determine whether follicular phase progesterone arises from the ovary, the adrenal cortex or both. METHODS: The first study was performed in patients scheduled for assisted reproduction, who received a long-acting GnRH agonist either during intake of an oral contraceptive or during the luteal phase of an otherwise untreated menstrual cycle. The second study was also performed during downregulation with a GnRH agonist: some patients with elevated progesterone levels received dexamethasone (DXM). Others with similarly elevated basal progesterone levels and those with low progesterone levels were not treated with DXM and served as controls. Finally, adrenocorticotrophic hormone (ACTH) tests were performed in normocyclic volunteers both during early and late follicular phase and during intake of a contraceptive pill. RESULTS: During the suppression of endogenous gonadotrophin secretion progesterone levels rose after the administration of ACTH, but not of GnRH. DXM did not prevent the preovulatory rise of the serum progesterone concentration. The ACTH-stimulated concentration of progesterone and of 17α-hydroxyprogesterone were significantly reduced during intake of ethinyl estradiol. CONCLUSIONS: Progesterone arises in the adrenal cortex during most of the follicular phase, whereby its function is modulated by an unknown ovarian factor, which is suppressed by ethinyl estradiol. The source of progesterone shifts towards the ovaries prior to ovulation.
Gynecological Endocrinology, 2007
During the final days of follicular development, exogenously administered follicle-stimulating ho... more During the final days of follicular development, exogenously administered follicle-stimulating hormone (FSH) produces a rise in serum progesterone level. The aim of the present study was to investigate the possible source and regulation of this preovulatory progesterone surge. Four sets of matching treatments with gonadotropins for in vitro fertilization and intracytoplasmic sperm injection were selected from a cohort of 953 treatments in 244 couples. Half of these four sets of treatments were selected based on the unusual course of the progesterone concentration during follicular development. The first set of 11 cycles with early termination of gonadotropin administration for prolonged coasting were compared with a set of 12 cycles with similar estradiol levels but with uninterrupted ovarian stimulation. Another set of 12 cycles with low preovulatory progesterone levels (52 nmol/l) were matched with ten cycles with normal preovulatory progesterone levels (42 nmol/l). The sera of these four selected sets of treatments were stored for subsequent measurement of the concentrations of inhibin A, inhibin B, activin A and leptin. During ovarian hyperstimulation serum levels of inhibin A correlated significantly with those of progesterone (p 5 0.001), whereas this correlation disappeared after the withdrawal of FSH administration. The rapid fall of progesterone levels during prolonged coasting contrasts with the continuing rise of estradiol concentration and indicates that the theca interna, not the granulosa, is the major source of preovulatory progesterone. Women failing to produce any increment of progesterone levels at the end of follicular development had significantly lower levels of inhibin A (p 5 0.05), indicating that inhibin A may well be involved in mediating the signal of FSH from the granulosa to the theca interna.
Fertility and Sterility, 2000
To investigate the effect of differences in endometrial thickness and pattern as visualized with ... more To investigate the effect of differences in endometrial thickness and pattern as visualized with present-day high-resolution transvaginal ultrasound equipment on the outcome of assisted reproductive treatment. Design: Prospective cohort study. Setting: Two large infertility units in university hospitals. Patient(s): The endometrial characteristics of 981 patients during 1,600 assisted reproductive treatment cycles were compared with those of 205 untreated women. In addition, abnormal echogenic patterns of the endometrium were characterized histologically in 44 patients. Intervention(s): None. Main Outcome Measure(s): Pregnancy rates.
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Papers by Christian Geyter