[Ovarian stimulation with pure FSH in an in vitro fertilization program]

The therapeutic efficacy of stimulating ovarian follicular development by pure urinary FSH in an IVF programme was determined and compared with results of other therapeutic regimes. 43 patients selected for extracorporeal fertilization were treated with pure FSH after stimulation with clomiphene or HMG had proven not be successful. Only in 5 patients (12%) treatment had to be discontinued before follicular puncture. In 32 women an embryo transfer was performed, and 7 patients conceived. This result demonstrates that, applying pure FSH stimulation, favourable conditions can be created for an in-vitro fertilization in patients with impaired follicular maturation following conventional stimulation with clomiphene or HMG. On the strength of the values determined for progesterone and estradiol during the luteal phase one has to conclude that a normal corpus luteum function was achieved in all our patients following FSH-stimulation.

[Fertilization of human ova in capillary tubes with a very small number of spermatozoa. A new treatment possibility in severe oligospermia?]

In contrast to the in vivo situation the current in vitro fertilization techniques require large numbers of spermatozoa per oocyte to achieve successful fertilization. In this study a culture system was developed in which successful fertilization was performed in haematocrit capillary tubes (75 mm length, 0.8-0.9 mm inner diameter) even if only low numbers of spermatozoa were used. Oocytes were fertilized in 5-10 microliters of different sperm suspension containing a total number of 500, 1000, 2000 and 4000 spermatozoa per oocyte (0.1-0.4 X 10(6) sperms/ml). In 10 patients participating in an in vitro fertilization programme 32 oocytes were fertilized in capillary tubes and 32 oocytes were cultured using standard methods (1 ml culture medium in tissue culture tubes, 0.1-0.2 X 10(6) spermatozoa/ml). The overall fertilization rate of oocytes cultured in tissue culture tubes was 78% (25/32) and the fertilization rates in capillary tubes using 4000, 2000, 1000 or 500 spermatozoa per oocyte were: 71% (5/7), 86% (6/7), 60% (6/10) and 50% (4/8), respectively. The fertilization rate of mature oocytes was higher compared to immature oocytes when fertilization was performed in culture tubes (83% and 63%) or in capillary tubes (74% and 44%). Fertilization in capillary tubes using a volume of the sperm oocyte suspension of 10 microliters compared to 5 microliters seems to provide better culture conditions resulting in higher fertilization and cleavage rates (75 and 91% versus 62.5 and 60%). These preliminary results indicate that fertilization of human oocytes under in vitro conditions can be achieved even with very low numbers of spermatozoa.(ABSTRACT TRUNCATED AT 250 WORDS)

Leucospermia and the fertilizing capacity of spermatozoa

Ejaculates obtained from men attending an in vitro fertilization (IVF) program were analyzed to determine the effect of the presence of leucocytes in semen on the ability of sperm in that semen to fertilize oocytes. The mean (+/- S.E.) concentration of leucocytes in 103 ejaculates was 0.62 X 10(6)/ml (+/- 0.09) with a range of 0.1 X 10(6) or less per ml to 7.0 X 10(6)/ml. The leucocyte concentration demonstrated a significant (p less than 0.05) but inverse relationship with the fertilizing capacity of spermatozoa. Though not statistically significant, the leucocyte concentration also demonstrated an inverse relationship to sperm motility and normal morphology. These results suggest that the presence of leucocytes in an ejaculate cannot be used as the sole indicator of the fertilizing capacity of spermatozoa in that ejaculate.

[Improved implantation rate following embryo transfer in an in vitro fertilization program]

In spite of the efforts made in in-vitro fertilization and embryo transfer in recent years, little progress has so far been made with regard to the pregnancy rate. While embryo transfer rates of over 80% are now being attained, the pregnancy rate achieved with extracorporal fertilization in the majority of study groups is well under 20%. Between 1981 and May 1986, 1088 laparoscopies were performed in our study group with the aim of follicle puncture and subsequent in-vitro fertilization and embryo transfer. A total of 171 pregnancies resulted from 832 embryo transfers. The pregnancy rate has been increased since 1981 to 21.2% at present (1986). Since April 1986 we have been using a modified embryo transfer procedure: in 25 patients embryo transfer has been accomplished under barbiturate anesthesia. Twelve of these patients have become pregnant, i.e., 48% of the embryo transfers. There are signs that this embryo transfer method will lead to a distinct improvement in the pregnancy rate. An attempt should be made to confirm these provisional results in a larger collective.

[Initial results of the cryopreservation of human oocytes]

As a part of an IVF project, "superfluous" ova were frozen, then thawed and fertilized under in-vitro conditions. Altogether 133 oocytes of varying quality, from 22 patients, were frozen. To date, 57 ova have been thawed and 47 oocytes have been found. The survival rate after thawing was 34%, the in-vitro fertilization rate 75%. Out of a total of seven embryo transfers performed there was one pregnancy following transfer of a six-cell embryo.

Successful in-vitro fertilization of frozen-thawed rabbit oocytes

The objective of this study was to evaluate the capacity of frozen-thawed rabbit oocytes to be fertilized in vitro. After superovulation with FSH a total of 1040 oocytes was obtained by puncturing the follicles 6 or 9 h after the injection of LH or by flushing the oviducts 12 h after LH application. 1.5 M dimethylsulphoxide (DMSO) was used as cryoprotective agent and the oocytes were transferred into 0.25 ml French straws and cooled in a methanol bath to -30 degrees C and transferred to liquid nitrogen. After 1-14 days of storage the oocytes were thawed rapidly in a 15 degrees C water bath and DMSO was diluted in a stepwise manner. Subsequently the oocytes were cultured in Ham's F-10 + 10% fetal calf serum at 37 degrees C and 5% CO2 for 14, 7 and 4 h according to the time of oocyte collection. The survival rates of the oocytes based on morphological criteria were 5.4, 20.0 and 28.8%, respectively. For chromosomal analysis, morphologically intact frozen-thawed oocytes were fixed and stained using the technique described by Tarkowski. In 44 successful chromosomal preparations, 2 of 2, 10 of 19 and 22 of 23 preparations of oocytes collected 6, 9 and 12 h after LH application were in metaphase-II, respectively. Furthermore, the viability of the oocytes was also examined by using fluorescein diacetate. Out of 52 morphologically intact oocytes, 50 showed a positive intracellular fluorescence.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation between human sperm swelling in hypoosmotic medium (hypoosmotic swelling test) and in vitro fertilization

Human ejaculates (n = 83) were analyzed for standard sperm parameters (concentration, motility, and morphology), as well as for the ability of the spermatozoa to react (swell) in a hypoosmotic medium (Jeyendran et al, 1984). Subsequently, the fertilizing capacity of the spermatozoa was tested by their ability to fertilize human oocytes in vitro. Although the sperm concentration was adjusted for in vitro fertilization, no adjustments were made for sperm motility and morphology. Correlation of the in vitro fertilizing capacity of the spermatozoa with the hypoosmotic swelling test (r = 0.56) was much higher than with standard sperm parameters (r varied from -0.04 to 0.25). Complete overlap was noted with standard semen parameters whether the ejaculate did or did not fertilize oocytes and ranged from very low to very high values in both cases. By contrast, all the semen samples that fertilized oocytes showed a 60% or higher reaction in the hypoosmotic swelling test, whereas the majority of the "infertile" semen samples showed less than 60% swelling. It therefore appears that, under the conditions of our studies, the hypoosmotic swelling test is a more accurate predictor of successful in vitro fertilization outcome than the conventional semen parameters. A combination of all parameters, however, is likely to be most useful. The hypoosmotic swelling test is simple and economical, and it is recommended that this test be further scrutinized for its value as an additional tool in the assessment of the in vivo fertilizing capacity of ejaculated spermatozoa.

[Induction of secondary labor in triplet pregnancy]

After premature birth of the first triplet we successfully delayed the delivery of the remaining triplets for 21 days until the 29th week of gestation. The 36 year-old patient from Africa (Uganda) was suffering secondary sterility due to bilateral salpingectomy. After transfer of four in-vitro fertilised eggs, triplets were diagnosed ultrasonographically in the 7th week of gestation. In the 26th week, despite tocolysis, premature labour led to the delivery of a 740 g female foetus who died 2 days later. Immediately after delivery cerclage was performed under halothane anaesthesia. Further treatment consisted of tocolytics, antiseptics locally, antibiotics systemically, and rest in bed. In the 29th week a caesarean section had to be performed because of uncontrollable contractions and threatening asphyxia of the second triplet. Both infants, 1100 and 1150 g, were female, both survived without handicaps.

Ovarian hyperstimulation for in-vitro fertilization controlled by GnRH agonist administered in combination with human menopausal gonadotrophins

Surges of luteinizing hormone (LH) in serum that result in luteinization, but occur prematurely with respect to the diameter of the leading follicle, frustrate attempts to induce multiple follicular maturation for in-vitro fertilization (IVF) in a number of women. We examined the possibility of blocking premature LH surges by the administration of D-TRP6-LH-RH, a potent agonistic analogue of gonadotrophin-releasing hormone (GnRH). Six patients who had repeatedly shown premature LH surges were treated for 10 days, beginning between days 1 and 3 of the cycle with daily s.c. injections of 500 micrograms D-Trp6-LH-RH followed by a daily injection of 100 micrograms of the analogue until the day of administration of human chorionic gonadotrophin (HCG). When pituitary and ovarian suppression had occurred, ovarian stimulation with human menopausal gonadotrophin was started and adjusted in dose according to the ovarian response. HCG was injected when the dominant follicle had reached a diameter of at least 18 mm and oestradiol levels were above 300 pg for each follicle greater than 15 mm. Oocyte collection was performed 36 h later via laparoscopy, followed by IVF and embryo transfer. The six patients studied to date responded to therapy and treatment could be completed up to embryo transfer. Two patients became pregnant; one of the pregnancies, however, resulted in abortion. Combined treatment with GnRH analogue for suppression of pituitary gonadotrophin secretion followed by the administration of gonadotrophins thus seems to be a promising method for ovarian stimulation in patients who frequently exhibit premature LH discharges and therefore fail to complete treatment.

[Effect of human follicular fluid on the maturity of rabbit ova by in vitro conditions]

The influence of human follicular fluid from mature and immature oocytes on the maturation of rabbit oocytes under in-vitro conditions was examined. The human follicular fluids were obtained in the course of laparoscopies for extracorporeal insemination and separated into the categories mature and immature ova. In cases of normal early embryonal development the follicular fluid was termed "follicular fluid of a mature ovum"; if the ova were immature or degenerated the fluid was termed "follicular fluid of an immature ovum". Rabbit oocytes were obtained 3 hours after administration of P-LH and immediately cultivated in 3 different culture media for 7 hours. Only 6 out of 50 rabbit oocytes cultivated in Brackett's Defined Medium with the addition of 20% follicular fluid from an immature human ovum for 7 hours reached prometaphase II to metaphase II. This corresponds to a rate of 12%; on the other hand, with the addition of follicular fluid from a mature ovum 18 out of 50 oocytes reached the same phase, i.e., a rate of 36%. This difference is statistically significant (p less than 0.01). Brackett's Defined Medium with no fluid added was used as a control. Only 5 out of 50 oocytes managed to reach prometaphase II to metaphase II. The rate in this case was 10%. In order to prove that the rabbit oocytes were in the chromatin consolidation phase, they were fixed immediately after being obtained (3 hours after P-LH administration) and stained in 5% Giemsa solution. All of the oocytes (31) were in the chromatin consolidation phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Polyspermy in in vitro fertilization of human oocytes: frequency and possible causes

In an IVF program a total of 585 oocytes (180 patients) were examined for the presence of pronuclei 16 to 20 hours after the addition of spermatozoa. The overall fertilization rate was 71%, and in 58 (10%) of the fertilized oocytes, three or more pronuclei, indicating a failure of the block to polyspermy, could be observed. The frequency of polyspermy was related to the maturity of the oocyte, determined according to morphologic criteria. Immature oocytes showed a higher percentage of polyspermic fertilization (32%) compared to that of mature oocytes (6%). Preincubation of oocytes (for 0.5-1.5, 2-4, and 5-8 hours) prior to the addition of spermatozoa increased the fertilization rate (to 67%, 70%, and 83%, respectively). The polyspermy rate, however, was not significantly different between the various preincubation intervals (13%, 14%, and 19%, respectively). The polyspermy rate was affected by the number of spermatozoa used for in vitro fertilization. Insemination with 0.5-0.8, 1.0, or 1.5-2.0 X 10(6) spermatozoa/oocyte resulted in a polyspermy rate of 6%, 20%, and 32%, respectively. The appearance of polyspermic fertilization was not related to the age of the patient (which ranged from 20 to 45 years) nor to the method of ovarian stimulation (clomiphene, hMG, or clomiphene/hMG). Because of the high incidence of polyspermy under in vitro conditions it seems to be important to routinely examine the oocytes in the pronuclear stage. Reduction of the number of spermatozoa used for in vitro fertilization and the exact timing of insemination according to the maturity of the oocyte might reduce the occurrence of polyspermic fertilization.

Effects of granulosa cells and gonadotrophins on maturation of rabbit oocytes in vitro

Rabbit oocyte maturation was induced by i.v. injection of 100 mU/HCG. Six hours later the animals were sacrificed, their granulosa cells cultured 7-10 days and their oocytes incubated in different media for 5-6 h. The oocytes were then examined microscopically. The appearance of a polar body was taken as an indication that maturation had progressed. The results presented show that maturation of rabbit oocytes can be inhibited by granulosa cells in vitro (OMI = oocyte maturation inhibitor), the activity of OMI is influenced by gonadotrophins and cumulus cells have a facilitatory effect on OMI. The results give the first indication that OMI exists in rabbits and may contribute to the discussion about the existence of OMI in other species (e.g. the pig).

[Postmenopausal bleeding following the application of an estrogen-containing hair lotion--concomitant endocrine changes]

Application of a commercially available hair lotion containing high concentrations of oestradiol led to uterine bleeding in a 76-year old patient. Histological examination of the endometrium showed typical proliferation. Oestradiol blood levels were in the normal range of the follicular or luteal phase, LH- and FSH-serum concentrations were suppressed. After discontinuing the application of the assay used (20 pg/ml) and gonadotrophins rose to normal postmenopausal levels. These findings prove that after local application of oestradiol on the scalp, percutaneous resorption of the steroid is significant and systemic oestrogen effects have to be taken into account.

[Polyploidy occurring during in-vitro fertilization of human oocytes: frequency and possible causes]

In an IVF-program a total of 585 oocytes (180 patients) was examined for the presence of pronuclei 16 to 20 hours after the addition of spermatozoa. The fertilization rate was 71% and in 58 (10%) of the fertilized oocytes three or more pronuclei, indicating a failure of the block to polyspermy with polyspermic fertilization, could be observed. The frequency of polyspermy was related to the maturity of the oocyte, determined according to morphological criteria. Immature oocytes showed a higher percentage of polyspermic fertilization (32%) compared to mature oocytes (6%). Preincubation of oocytes (0-1.5, 2-4, 5-8 hours) prior to the addition of spermatozoa increased the fertilization rate (67%, 70%, 83%, respectively). The polyspermy rate seemed to increase (13%, 14%, 19%). The observed frequency, however, was not significantly different between the various preincubation intervals. The polyspermy rate was affected by the number of spermatozoa used for in-vitro fertilization. Insemination with 0.5-0.8, 1.0 or 1.5 X 10(6) spermatozoa/oocyte resulted in a polyspermy rate of 6%, 20%, 32%, respectively. The appearance of polyspermic fertilization was not related to the age of the patient (20 to 45 years) nor to the method of ovarian stimulation (Clomiphene, hMG, Clomiphene/hMG). Because of the high incidence of polyspermy under in-vitro conditions it seems to be important to examine the oocytes in the pronuclear stage on a routine basis. Reduction of the number of spermatozoa used for in-vitro fertilization and the exact timing of insemination according to the maturity of the oocyte might reduce the occurrence of polyspermic fertilization.

[Performance of laparoscopic follicle puncture and oocyte recovery for in-vitro fertilization]

In-vitro fertilisation of human egg cells and subsequent embryonal transfer offers a possibility to sterile women with oviducts incapable of functioning, to become pregnant after all. This article describes the performance of laparoscopic follicular puncture and extraction of egg cells for in-vitro fertilisation. Laparoscopic follicle puncture as described here was performed from July 1982 to March 1983 on 130 patients at the Gynaecological and Obstetric Hospital in Lübeck. 585 follicles were punctured and 404 egg cells obtained, 210 of which met the criteria of a pre-ovulatory egg cell. Of the 210 pre-ovulatory egg cells, 177 could be fertilised. In 95 patients, embryo transfer was effected in the 2-cell to 8-cell stage. The fertilisation rate obtained was 84%, with an embryo transfer rate of 71%. Since this patient group also included andrological causes of sterility, this figure can be considered quite satisfactory, which is decisively due, among other things, to the puncture technique described here. Pregnancy was attained in 14 cases so far. It is certain that the pregnancy rate can be improved still further.

[Ovarian stimulation in an in-vitro fertilization programme]

The in-vitro fertilization of human ova and the subsequent transfer of the embryo are a possibility for infertile patients with damaged fallopian tubes to achieve a pregnancy. The results of different methods of ovarian stimulation in an in-vitro fertilization programme are described. The Clomiphen/hCG treatment and the overlapping Clomiphen/hMG/hCG treatment were used. Between July 1982 and March 1983, 130 patients had a laparoscopic aspiration of ovarian follicles at the Department for Obstetrics and Gynaecology in Luebeck. 585 follicles were aspirated and 404 ova retrieved. 210 showed the criteria of a preovulatory ovum. Of these 210, 177 were fertilized. In 95 patients an embryo transfer at the 2-8 cell stage was carried out. Inspite of the good fertilization rate of over 80% and the good embryo transfer rate of over 70%, pregnancy was achieved only in 13 cases. The number of follicles and of the retrieved preovulatory ova as well as the fertilization rate were best in the group which received combined Clomiphen and hMG. The pregnancy rate was not different compared to the other group. The first delivery of a healthy infant following laparoscopic aspiration of a follicle and in-vitro fertilization and embryo transfer in Luebeck occurred in March 1983.

A new method of evaluating fetal lung maturity: the enzymatic lecithin determination in amniotic fluid

The concentration of phospholipids is well suited as indicator for the prognosis of a possibly postnatal respiratory distress syndrome. The method used most frequently up to now has been the determination of the lecithin/sphingomyelin ratio (L/S ratio) by thin layer chromatography. We have developed a specific assay for the quantitative determination of lecithin in amniotic fluid, which yields absolute concentration values and does not require the determination of a concentration ratio. Lecithin is hydrolized by phospholipase C and alkaline phosphatase. Choline is determined afterwards by a highly specific choline kinase from yeast. The total time required is less than 2 h. The usual lecithin concentration present in the 35th to 38th wk of gestation can be determined with a coefficient of variation of 2-3% (n=30). Fetal lung maturity can be expected at a lecithin concentration above 4.7-5.1 mg/100 ml. The method compares well with the L/S ratio. Detailed data about clinical significance will be presented. Good precision accuracy and simple handling make enzymatic lecithin determinations suitable for routine use.

[In-vitro fertilization of human eggs and embryo transfer]

This is a first report on experience with in-vitro fertilization of human eggs and embryo transfer. The follicle was aspirated to obtain eggs in 24 patients. A successful fertilization of the oocytes with obvious formation of a pronucleus was observed in 3 cases. In 9 more cases cell divisions were obtained and the embryos were transferred at the 4-cell stage. In spite of the unfavourable female patient population a good fertilisation and embryo transfer rate was achieved.

[Enzymatic lecithin determination in amniotic fluid for antepartal diagnosis of lung maturity - a multi-center study (author's transl)]

A new test-combination for the enzymatic determination of lecithin in amniotic fluid for the assessment of fetal lung maturity has been developed by Boehringer Mannheim. This test was evaluated by 12 hospitals and has been compared with the L/S ratio, the foam-test or the densitometric determination of lecithin. The assay is based on the hydrolysis of lecithin by phospholipase C which starts an enzymatic chain reaction in which NADH consumption if measured photometrically. The intra- and interassay precision were characterized by CV values below 10%. Average recoveries of lecithin were 95-102%. It is recommended to centrifuge the samples (10 min, 700 g) and to start the analysis as soon as possible after receipt of the specimen. The total amount of time required is 2 hours for a single determination. Batches of up to 10 samples require little extra time. An opened test-combination can be used for a maximum of 30 single determinations. Comparison of the quantitative enzymatic lecithin determination with other methods showed that the critical value for lecithin is 5.0 mg/100 ml. Above 5.1 mg/100 ml no case respiratory distress syndrome was observed. The good precision accuracy and the simple handling make the enzymatic lecithin determination suitable for routine use.

[The antepartum evaluation of pulmonary maturity in high risk pregnancies (author's transl)]

In normal pregnancies the determination of the L/S ratio permits a reliable ante-partum evaluation of fetal maturity. Good correlation between ante-partum determination and the condition of the newborn is obtained. In the 566 L/S ratios obtained from abnormal pregnancies the method was also reliable. There was 217 Rh incompatabilities, 51 pre-eclampsias, 31 diabetic patients, 112 premature labours, 78 placental insufficiencies and 77 premature ruptures of the membranes. In patients with diabetes the ante-partum diagnosis of pulmonary maturity is doubtful. In some patients with diabetes pulmonary maturity appears to be delayed. A difference between the abnormal pregnancies was not recognized. In the different types of high risk pregnancies no acceleration or retardation of pulmonary maturity was detected with statistical significance. However, in some cases of premature rupture of the membranes, premature labour and placental insufficiency, pulmonary maturity appears to be accelerated.

[Caudal anaesthesia in obstetrics (author's transl)]

The advantages of caudal anaesthesia in obstetrics far outweigh the few disadvantages. The perinatal mortality of premature infants is reduced under caudal anaesthesia. Breech deliveries are easier under caudal anaesthesia. In these cases regional anaesthesia is considered an obstetrical indication. It is possible to carry out all vaginal and abdominal procedures with this anaesthesia. The elimination of pain during labor and delivery permits a more intensive experience of labor and delivery for the mother under caudal anaesthesia.

[Measurement of fluorescent polarisation in the amniotic fluid to assess fetal lung maturity (author's transl)]

A new method for determining fetal lung maturity is discussed. Molecular mobility can be determined spectrophotometrically by measuring the fluorescent polarisation (FP) in lipid solutions. This method of determining the microviscosity in lipid solutions can now be applied also in the amniotic fluid. Measurement of FP by means of an electro-optical microviscosimeter is proportional to the lipid concentration in the amniotic fluid and is in good correlation with fetal lung maturity. FP was measured between the 17th and 41st weeks of gestation in 147 amniotic fluid samples. During pregnancy the FP value drops significantly from 0.350 to 0.200. A FP value of 0.290 was fixed as the limit value beyond which RDS may be expected to occur. With a limit value of 0.290, the RDS identification probability was calculated at 94%, whereas the calculated probability of RDS was 81% and the exclusion probability of RDS 97%. At the same time, the probabilities, calculated on the parallel determination of the L/S ratio, yielded a slightly more unfavourable result. The drop in the FP level correlates significantly with the increase of the L/S ratio in the investigated amniotic fluid samples (correlation coefficient 0.77). The method, which requires very special equipment, offers many advantages: it is very accurate, simple, well reproducible and can be performed within half an hour at relatively low laboratory cost.

[Clinical experimental studies in the treatment of ovarian dysfunction with bromo-ergocryptin (pravidel) (author's transl)]

Among 62 patients with galactorrhoea a corpus luteum deficiency or anovulatory cycles were found in 35 cases by serum progesterone determination, endometrial biopsy or basal body temperature records. 27 patients had a hyperpro-lactenemic amenorrhoea-galactorrhoea syndrome. During treatment with 2.5-5 mg. of Pravidel daily the basal body temperature was recorded, the concentrations of serum FSH, LH, Prolactin and progesterone were determined by radioimmunoassay. Other possible reasons for infertility were investigated. 10 of the 19 patients with normal serum prolactins in the group with deficient corpus luteum or anovulation became pregnant after a short duration of treatment, whereas only 2 of the 16 patients with hyperprolactenemia became pregnant. Among 27 patients with secondary amenorrhoea 11 became pregnant. All these patients had increased serum prolactins. During treatment with Pravidel all patients showed a significant increase of FSH and LH concentrations and a decrease of the prolactin concentrations. The outcome of the pregnancy of the 58 patients who became pregnant during treatment with Pravidel was also reported. 14 of the 58 pregnancies occured following additional treatment with Dyneric or HMG/HCG. Up to now there were 18 term deliveries following uneventful pregnancies. There were no fetal anomalies. The abortion rate was not higher than in the general population. All results show that euprolactinemia is not alone characterized by normal prolactin concentration. The clinical signs and symptoms of galactorrhoea without increase of prolactin over 20 ng/ml. in conjunction with ovarian dysfunction must be classified as dysprolactinemia.

[The determination of surface tension in amniotic fluid as a simple method for the diagnosis of fetal lung maturity (author's transl)]

For the past several years it is possible to determine the maturity of the fetal lung from the amniotic fluid. Towards the end of the pregnancy the content of surface active substances for instance Lecithine, increases in the amniotic fluid. It is therefore possible to determine the maturity of the fetal lung directly by measurements of the surface tension in the amniotic fluid. In 265 patients from 17 to 42 weeks gestation a total of 340 determinations of the surface tension in the amniotic fluid were carried out. A simple commercial interfacial tensiometer was used. The clinical value of the measurements was determined by the occurrance of a respiratory distress syndrome which was objectively evaluated by the so called Hobel Score. The determination of the surface tension for the amniotic fluid is valuable as a screening test prior to the determination of the relatively expensive L/S ration. The test was compared with the Clements Test which is also a screening procedure.