I. Gerhard’s research while affiliated with Heidelberg University and other places

A sample of 225 men examined at the Infertility Service Unit of this hospital had spermiograms, standardized in accordance with WHO guide lines, and a hormone stimulation test with injection of gonadotropin releasing hormone, thyrotropin releasing hormone, and ACTH. The serum concentrations of the following hormones were assessed: follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, oestradiol (E), thyroid stimulating hormone, cortisol, 21-desoxycortisol, 17-hydroxypregnenolone, 17-hydroxyprogesterone, dehydroepiandrosterone, dehydroepiandrosteronesulphate, androstenedione, testosterone (T), and dihydrotestosterone. The results of the spermiograms were found to be related to the concentrations of the following hormones: FSH, LH, T, and E. Thyroid and adrenal function in men without signs of endocrinological diseases failed to influence spermatic parameters.

Zusammenfassung: 90 Patientinnen mit kulturell nachgewiesener Vaginalmykose wurden in eine doppeltblind randomisierte Studie aufgenommen. Sie wurden einmal topisch mit Ketoconazol behandelt: Jeweils 30 mit Suppositorion à 400 mg, 800 mg oder Plazebo. Kulturelle und mikroskopische Kontrollen erfolgten 1 und 4 Wochen nach der Therapie. In dem vierwöchigen Beobachtungszeitraum unterschieden sich weder subjektive noch objektive Symptomatik zwischen den drei Behandlungsgruppen. Auch anhand des mikroskopischen Bildes ließ sich kein signifikanter Unterschied zwischen den Gruppen nachweisen. Der kulturelle Pilznachweis 1 Woche nach der Therapie gelang signifikant seltener in den Verumgruppen (p = 0.031): Während in der Plazebo-Gruppe 43 % kulturell geheilt waren, waren es in der 400 mg Gruppe 60 % und in der 800 mg Gruppe 76 %. Nach 4 Wochen waren in der Plazebo-Gruppe 47%, in der 400 mg und in der 800 mg Gruppe je 67 % geheilt. Dieser Unterschied in der Häufigkeit positiver Pilzkulturen war nicht mehr signifikant. Das Beschwerdebild war zum Teil unäbhangig vorn Ergebnis der Pilzkultur. Partnerbehandlung und zu Mykosen prädisponierende Faktoren hatten keinen Einfluß auf den Heilungserfolg. Die niedrigen Ketoconazol-Serumspiegel nach topischer Anwendung erlauben diese Therapie auch in der Schwangerschaft. Bessere Heilungserfolge sind eventuell nach längerer Therapiedauer (3–5 Tage) zu erwarten.

This prospective observational pilot study investigated the effect of individualized homeopathy on male infertility based on sperm count, hormone values and general health. Forty-five subfertile men were treated with single homeopathic remedies for an average of 10.3 months. The drugs were prescribed on the basis of the overall symptomatic situation. The variables 'sperm density', 'percentage of sperm with good progressive motility' and 'density of sperm with good propulsive motility' improved significantly, especially in cases of oligoasthenozoospermia. The general health of patients improved significantly. The following factors emerged as positive predictors of therapy success: alcohol consumption below 30 g/day, non-smoking, the presence of less than five dental amalgam fillings, no exposure to noxious substances at the workplace and no previous inflammatory genital diseases. The factors stress, age above 36, high coffee consumption and long duration of unwanted childlessness did not have a negative impact on therapy outcome in this study. The rate of improvement in sperm count through homeopathic therapy is comparable to the improvement achieved by conventional therapy, so that individualized-homeopathic treatment may be considered a useful alternative to conventional treatment of subfertile men. For further investigation, a randomised, therapy-controlled clinical study with parallel group design would be useful (homeopathic therapy vs conventional andrological therapy).

Musk xylene (MX), musk ketone (MK), musk ambrette, musk moskene, and musk tibetene are synthetic fragrances. Between 1994 and 1996 these five nitromusk compounds (NMCs) were tested in the blood of 152 women who consulted the Endocrinological Department of the University Hospital of Obstetrics and Gynecology, Heidelberg, Germany, because of gynecological problems. The testing was conducted by gas chromotography with mass-specific detector and mass spectrometry in a retrospective cross-sectional study. MX was detected in 95% and MK in 85% of the blood samples (>20 ng per liter whole blood). The median concentration of MX was 65.5 ng/L and the maximum level of MX was 1183 ng/L; the corresponding values for MK were respectively 55.5 and 518 ng/L. The other three NMCs were found in only a few patients or not at all. Significant associations between MX and MK concentrations were found in blood and different clinical parameters of the endocrine system. MX and MK may act centrally as a disrupter of the (supra-) hypothalamic-ovarian axis, which may result in a mild ovarian insufficiency. On the basis of our data, a reproductive toxicity and an endocrine effect of NMCs in women cannot be ruled out. Further experimental and clinical studies should be conducted.

The aim of the study was to identify differences in psychological characteristics between couples with fertility disorders, especially idiopathic infertility, and a representative sample. A total of 564 couples was examined using psychological questionnaires pertaining to sociodemographic factors, motives for wanting a child, dimensions of life satisfaction and couple relationships, physical and psychic complaints, and a personality inventory. Specific to our sample was the high educational level of the couples, and the large number with idiopathic infertility (27% of all diagnoses). There were no remarkable differences in psychological variables between the infertile couples and a representative sample, except that the infertile women showed higher scores on the depression and anxiety scales. Couples with idiopathic infertility showed no remarkable differences in the questionnaire variables compared with couples with other medical diagnoses of infertility. A typical psychological profile for infertile couples could not be identified using standardized psychometric rating methods. This may be an effect of the specific characteristics of our sample. For some couples, the infertility crisis can be seen as a cumulative trauma, which indicates that these couples have a marked need for infertility counselling.

Increasing popularity and concomitant application of complementary and conventional methods by patients and doctors in Germany. INTENTION: To examine attitudes and patient contentedness. Open, retrospective, postal survey in 1,582 female patients treated with complementary methods between 1991 and 1996, using a structured trilateral questionnaire. Of 1,582 mailed questionnaires 808 (51%) were evaluable. About 50% of the patients in the survey felt that the results of their complementary treatment were 'very successful' (22%) or 'rather successful' (24%). 80% of the patients were 'very' oder 'rather satisfied' with the complementary treatment. This positive assessment was also found in patients without treatment success. 50% indicated a significant change in health behavior, more than two thirds indicated a change in life-style attitude. More than 90% of the patients would be ready to pay for part of their treatment. Half of the surveyed women used natural remedies without knowledge of their family doctor. Because of a low response rate of 50%, there is the possibility of selection bias which makes a cautious interpretation of these results necessary. Because of the approaches and methods applied, complementary medicine is particularly suited to induce patient treatment satisfaction. Further studies are necessary to verify positive long-term health effects of complementary interventions and treatment.

Summary Complementary Medicine and Patient Contentedness – a SurveyBackground: Increasing popularity and concomitant application of complementary and conventional methods by patients and doctors in Germany. Intention: To examine attitudes and patient contentedness. Method: Open, retrospective, postal survey in 1,582 female patients treated with complementary methods between 1991 and 1996, using a structured trilateral questionnaire. Results: Of 1,582 mailed questionnaires 808 (51%) were evaluable. About 50% of the patients in the survey felt that the results of their complementary treatment were ‘very successful’ (22%) or ‘rather successful’ (24%). 80% of the patients were ‘very’ oder ‘rather satisfied’ with the complementary treatment. This positive assessment was also found in patients without treatment success. 50% indicated a significant change in health behavior, more than two thirds indicated a change in life-style attitude. More than 90% of the patients would be ready to pay for part of their treatment. Half of the surveyed women used natural remedies without knowledge of their family doctor. Because of a low response rate of 50%, there is the possibility of selection bias which makes a cautious interpretation of these results necessary. Conclusion: Because of the approaches and methods applied, complementary medicine is particularly suited to induce patient treatment satisfaction. Further studies are necessary to verify positive long-term health effects of complementary interventions and treatment.

In a prospective, randomized, placebo-controlled, double-blind study, the effects of Phyto Hypophyson L (Steierl-Pharma GmbH, Herrsching, Germany), an Agnus castus-containing homeopathic preparation, were investigated in 67 women with fertility disorders. 37 women with oligomenorrhea and 30 women with amenorrhea received 50 drops of Phyto Hypophyson L or placebo 3 times a day over 3 months or 3 cycles. OUTCOME MEASURE AND RESULTS: The outcome measure being spontaneous menstruation, improved concentration of progesterone in the luteal phase, shortening of the cycle, earlier ovulation, and pregnancy was achieved in 38 out of 67 women. It was achieved more often from women with oligomenorrhea in the Phyto Hypophyson L group compared to the placebo group (82 versus 45%, p = 0.021). However, there was no significant effect when viewing the whole group. The baby take-home rate during the therapy and 6 months after the end of the therapy showed a ratio of 6 : 2 (18.7 : 6.4%). This result was not significant. Furthermore, in the oligomenorrhea verum group we observed a significant increase of progesterone during the luteal phase compared to the oligomenorrhea placebo group. Only very few undesirable drug effects were observed. In women with sterility and oligomenorrhea, a treatment with Phyto Hypophyson L can be recommended over a period of 3-6 months.

Phyto-Hypophyson(r) L for Female Infertility. Randomized, Placebo-Controlled, Clinical Double-Blind Study Objective and Design:In a prospective, randomized, placebo-controlled, double-blind study, the effects of Phyto Hypophyson L (Steierl-Pharma GmbH, Herrsching, Germany), an Agnus castus-containing homeopathic preparation, were investigated in 67 women with fertility disorders. Patients and Methods:37 women with oligomenorrhea and 30 women with amenorrhea received 50 drops of Phyto Hypophyson L or placebo 3 times a day over 3 months or 3 cycles. Outcome Measure and Results:The outcome measure being spontaneous menstruation, improved concentration of progesterone in the luteal phase, shortening of the cycle, earlier ovulation, and pregnancy was achieved in 38 out of 67 women. It was achieved more often from women with oligomenorrhea in the Phyto Hypophyson L group compared to the placebo group (82 versus 45%, p = 0.021). However, there was no significant effect when viewing the whole group. The baby take-home rate during the therapy and 6 months after the end of the therapy showed a ratio of 6 : 2 (18.7 : 6.4%). This result was not significant. Furthermore, in the oligomenorrhea verum group we observed a significant increase of progesterone during the luteal phase compared to the oligomenorrhea placebo group. Only very few undesirable drug effects were observed. Conclusion: In women with sterility and oligomenorrhea, a treatment with Phyto Hypophyson L can be recommended over a period of 3–6 months.