Papers by Markus Nitzschke
Geburtshilfe Und Frauenheilkunde, Sep 1, 2008
Geburtshilfe und Frauenheilkunde, 2008
Archives of Gynecology and Obstetrics, Apr 29, 2010
Archives of Gynecology and Obstetrics, Dec 6, 2009
Purpose To determine the protective eVect of gonadotropinreleasing hormone analogs (GnRHa) using ... more Purpose To determine the protective eVect of gonadotropinreleasing hormone analogs (GnRHa) using several ultrasound and endocrine markers to detect ultrastructural ovarian damage in Hodgkin's lymphoma patients. Methods Ten patients who had been treated for Hodgkin's lymphoma and had received GnRHa to protect ovarian function were matched with patients at similar age, who had received the same chemotherapy regimens without GnRHa. In addition, ten healthy women at the same age were matched to the study groups to compare ovarian markers. Blood samples were drawn to determine anti-Müllerian hormone, Inhibin B, follicle-stimulating hormone and transvaginal ultrasound scans were performed to determine antral follicle count and ovarian volume. All women were asked about their menstrual cycle pattern. Results No diVerence was found when comparing the ovarian parameters of both study groups. Compared with healthy women, all ovarian parameters in the Hodgkin's lymphoma patients were signiWcantly diVerent. Conclusions The results of this study demonstrate ultrastructural ovarian damage in Hodgkin's lymphoma patients irrespective of GnRHa co-treatment. These Wndings do not support previous studies, showing GnRHa to protect ovarian function.
IVF lite, 2014
Objectives: In general, patients with the low ovarian reserve are difficult to manage and have a ... more Objectives: In general, patients with the low ovarian reserve are difficult to manage and have a relatively poor prognosis. Hormonal changes due to ovarian insufficiency can influence and change the individual menstrual cycle pattern of each patient over time, which may result in difficulties in conceiving naturally. We observed the menstrual cycle pattern of patients with low ovarian reserve in order to distinguish the different stages of ovarian insufficiency. Then, we developed treatment approaches for each patient group based on the natural cycle in vitro fertilization (IVF). Materials and Methods: In 2011, menstrual cycle patterns of 10 patients with anti-mullerian hormone Results: Based on our observation, we could identify four different stages of ovarian insufficiency. A total of 33 natural cycles were initiated. Premature ovulation occurred in three cycles (9.0%) and no retrieval was attempted in these. Among the attempted 30 oocyte retrievals, 21 (70.0%) were successful. Out of those 21 oocytes, 11 oocytes (36.6% per retrieval) were mature. Intracytoplasmic sperm injection resulted in eight fertilizations (72.7% per mature oocyte). Out of eight transfers, 3 (37.5%) resulted in biochemical pregnancy. Two patients delivered (25.0%), one patient had a miscarriage at 8 weeks of pregnancy. Conclusion: Our experience shows that ovulation can successfully be controlled by the use of CC and does not necessarily require gonadotropin releasing hormone analogues for pituitary suppression. This knowledge opens new scope for development of alternative protocols respecting the patient's own physiology with no need for heavy stimulation. Patients with ovarian insufficiency may benefit from this approach, which can be offered before referring them to egg donation.
JBRA Assisted Reproduction, 2013
Objective: In general, patients with low ovarian reserve nosis. Using traditional stimulation pro... more Objective: In general, patients with low ovarian reserve nosis. Using traditional stimulation protocols like the long GnRH agonist protocol or the GnRH antagonist protocol in these patients often results in low ovarian response and poor pregnancy rates. In natural menstrual cycles without ovarian stimulation, every month the female body naturally selects the best possible oocyte for ovulation. neverthe-culties to conceive naturally. We observed the menstrual cycle pattern of patients with low ovarian reserve in order we were able to describe the different stages, we developed new treatment approaches for each patient group based on natural Cycle IVF. methods: In 2012, the menstrual cycle pattern of 10 patients with AMH <1.0 nmol/L were observed. Patients were 22-42 years old (average 39.3). Blood samples were drawn to determine AMH, FSH, LH, E2 and transvaginal ultrasound scans were performed on different days of the cycle. Depending on the cycle pattern of each patient, we offered individualized treatment approaches based on natural Cycle IVF using Clomifen citrate to control ovulation, GnRH agonists to induce ovulation and either Ethinyl-Estradiol or combined oral contraceptive pills to regulate the cycle. Embryos cial cycles. Patients were informed about off label use of the medication and informed consents were signed. Results: Based on our observation, we could describe four perform oocyte retrievals and embryo transfers in all 10 patients. A total of 33 natural cycles were initiated. Premature ovulation occurred in 3 cycles (9.0%) and no retrieval was attempted. Among the attempted 30 oocyte retrievals, 21 (70.0%) were successful. Out of those 21 oocytes 11 (36.6% per retrieval) were mature and 10 (33.3% per retrieval) were immature. ICSI resulted in 8 fertilizations (72.7% per mature oocyte). Out of 8 transfers, 3 (37.5%) resulted in biochemical pregnancy. Two patients delivered (25.0%), one patient had a miscarriage at 8 weeks of pregnancy. Conclusion: Our experience shows that ovulation can successfully be controlled by the use of Clomiphene citrate and does not necessarily require GnRH analogues for pituitary suppression. This knowledge opens new space for development of alternative protocols respecting the patients' own physiology with no need for heavy stimulathis approach, which can be offered before referring them to egg donation.
Gynäkologische Endokrinologie, 2009
JBRA Assisted Reproduction, 2013
Objective: In general, patients with low ovarian reserve nosis. Using traditional stimulation pro... more Objective: In general, patients with low ovarian reserve nosis. Using traditional stimulation protocols like the long GnRH agonist protocol or the GnRH antagonist protocol in these patients often results in low ovarian response and poor pregnancy rates. In natural menstrual cycles without ovarian stimulation, every month the female body naturally selects the best possible oocyte for ovulation. neverthe-culties to conceive naturally. We observed the menstrual cycle pattern of patients with low ovarian reserve in order we were able to describe the different stages, we developed new treatment approaches for each patient group based on natural Cycle IVF. Methods: In 2012, the menstrual cycle pattern of 10 patients with AMH <1.0 nmol/L were observed. Patients were 22-42 years old (average 39.3). Blood samples were drawn to determine AMH, FSH, LH, E2 and transvaginal ultrasound scans were performed on different days of the cycle. Depending on the cycle pattern of each patient, we offered individualized treatment approaches based on natural Cycle IVF using Clomifen citrate to control ovulation, GnRH agonists to induce ovulation and either Ethinyl-Estradiol or combined oral contraceptive pills to regulate the cycle. Embryos cial cycles. Patients were informed about off label use of the medication and informed consents were signed. Results: Based on our observation, we could describe four perform oocyte retrievals and embryo transfers in all 10 patients. A total of 33 natural cycles were initiated. Premature ovulation occurred in 3 cycles (9.0%) and no retrieval was attempted. Among the attempted 30 oocyte retrievals, 21 (70.0%) were successful. Out of those 21 oocytes 11 (36.6% per retrieval) were mature and 10 (33.3% per retrieval) were immature. ICSI resulted in 8 fertilizations (72.7% per mature oocyte). Out of 8 transfers, 3 (37.5%) resulted in biochemical pregnancy. Two patients delivered (25.0%), one patient had a miscarriage at 8 weeks of pregnancy. Conclusion: Our experience shows that ovulation can successfully be controlled by the use of Clomiphene citrate and does not necessarily require GnRH analogues for pituitary suppression. This knowledge opens new space for development of alternative protocols respecting the patients' own physiology with no need for heavy stimulation. Patients with can be offered before referring them to egg donation.
IVF Lite, 2014
Objectives: In general, patients with the low ovarian reserve are difficult to manage and have a ... more Objectives: In general, patients with the low ovarian reserve are difficult to manage and have a relatively poor prognosis. Hormonal changes due to ovarian insufficiency can influence and change the individual menstrual cycle pattern of each patient over time, which may result in difficulties in conceiving naturally. We observed the menstrual cycle pattern of patients with low ovarian reserve in order to distinguish the different stages of ovarian insufficiency. Then, we developed treatment approaches for each patient group based on the natural cycle in vitro fertilization (IVF). Materials and Methods: In 2011, menstrual cycle patterns of 10 patients with anti-mullerian hormone Results: Based on our observation, we could identify four different stages of ovarian insufficiency. A total of 33 natural cycles were initiated. Premature ovulation occurred in three cycles (9.0%) and no retrieval was attempted in these. Among the attempted 30 oocyte retrievals, 21 (70.0%) were successful. Out of those 21 oocytes, 11 oocytes (36.6% per retrieval) were mature. Intracytoplasmic sperm injection resulted in eight fertilizations (72.7% per mature oocyte). Out of eight transfers, 3 (37.5%) resulted in biochemical pregnancy. Two patients delivered (25.0%), one patient had a miscarriage at 8 weeks of pregnancy. Conclusion: Our experience shows that ovulation can successfully be controlled by the use of CC and does not necessarily require gonadotropin releasing hormone analogues for pituitary suppression. This knowledge opens new scope for development of alternative protocols respecting the patient's own physiology with no need for heavy stimulation. Patients with ovarian insufficiency may benefit from this approach, which can be offered before referring them to egg donation.
International Journal of Gynecology & Obstetrics, 2009
International Journal of Gynecology & Obstetrics, 2009
Introduction: An increasing number of patients is treated by GnRH-a to protect ovaries from chemo... more Introduction: An increasing number of patients is treated by GnRH-a to protect ovaries from chemotherapies, even though data on the efficiency of GnRH-a are still limited and study results are controversial. This is in part due to the fact that the efficiency of GnRH-a has also exclusively been studied by analysing the risk of secondary amenorrhoea. This carefully designed pilot study was set up to analyse the efficiency of AMH and Inhibin B to detect minor ovarian damages, caused by chemotherapies and to study the protective capacity of GnRH-a. Materials and Methods: 10 patients (mean age 24y) who had received chemotherapies for Hodgkin Lymphoma (Group A) were matched first with patients at a similar age who had received exactly the same chemotherapy and who were co-treated with GnRH-a to protect ovarian function (Group B) and second with healthy patients at the same age (Control Group). AMH, Inhibin B, FSH, AFC and ovary volume were compared in the three patient groups to study first minor ovarian damages, caused by chemotherapies and second to analyse the protective effect of GnRH-a. Results: 10% of the patients in group A and B developed a secondary amenorrhoea. In group A and B versus control, the following parameters were significantly different: FSH 14.6U/l vs. 5.3U/l, AMH 1.5 vs. 3.9 ng/ml, Inhibin B 23.7 vs. 64.9 pg/ml, AFC 6.2 vs. 11.6 follicles und ovary volume 6.4 vs. 9.7 cm3. No difference was found by the comparison of these parameters in patients with or without co-treatment with GnRH-a. Conclusions: AMH and Inhibin B are sensitive parameters to analyse ovarian damage, caused by chemotherapy. The results of this study do not support previous studies, showing GnRH-a to protect ovarian function.
Archives of Gynecology and Obstetrics, 2010
Intrauterine Insemination, 2014
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Papers by Markus Nitzschke