We determined the concentrations of tumour necrosis factor (TNF)-alpha, interleukins (IL)-1 beta, -6, -8 and -1-receptor antagonist (IL-1-ra) and of oestradiol and progesterone in the follicular fluid of 111 women undergoing in-vitro fertilization (IVF) and of six women with ovarian cysts in order to elucidate mid-cycle mechanisms causing dissociation of the follicle wall and local rupture of the ovarian tissue complex. Four stimulation protocols were administered: gonadotrophin releasing hormone agonist/human menopausal gonadotrophin (GnRHa/HMG), clomiphene citrate/HMG (CC/HMG), HMG and follicle-stimulating hormone (FSH). Concentrations of TNF alpha and IL-1 beta were below 15 and 3 pg/ml respectively. IL-6 (median 4.1, 3.5-4.4 pg/ml, 95% CI) was higher after stimulation with FSH (5.6 pg/ml) than with HMG (3.2 pg/ml, P < 0.05) or GnRHa/HMG (3.7 pg/ml, P < 0.05), and after stimulation with CC/HMG (5.5 pg/ml) than with HMG (P < 0.01) or GnRHa/HMG (P < 0.001). IL-8 ranged from 32 to 1241 pg/ml (147, 117-178 pg/ml) and IL-1-ra from < 31 to > 10,000 pg/ml (156, 109-192 pg/ml). Cytokine levels did not correlate to oestradiol or progesterone concentrations. The ovarian cysts contained similar IL-8 (14-540 pg/ml) and IL-1 beta (< 30 pg/ml), but higher IL-6 (13.6-> 500 pg/ml) and lower IL-1-ra concentrations. We assume that IL-6, IL-8 and IL-1-ra are involved in peri-ovulatory cellular interactions. Thus, ovulation appears to be a cytokine-regulated process of an 'inflammation' (IL-6 and IL-8) followed by 'anti-inflammatory' reactions (IL-1-ra).

During an in vitro fertilization (IVF) program 122 inseminated eggs showing polar body extrusion, but neither formation of pronuclei nor cell cleavage were analysed cytogenetically. Nine of these eggs showed prematurely condensed sperm chromosomes of the G1-phase (G1-PCC) besides the haploid set of maternal metaphase II chromosomes. This phenomenon can be explained by the permanent arrest of the oocytes at metaphase II after sperm penetration and hence the continuing presence of cytoplasmic chromosome condensing factors which lead to the induction of PCC in the sperm nucleus. The overall frequency of this aberrant type of fertilization was calculated to be in the order of 3-4% of all in vitro fertilized eggs.

Secondary side-effects often occur in women undergoing hormonal stimulation treatment with clomiphene citrate. In general 10.4% of women experience hot flushing, 5.5% have complaints caused by enlargement of the ovaries and 3.5% experience central nervous symptoms (nervousness, sleeplessness, headaches, visual disturbances, vertigo). During ovarian stimulation with clomiphene citrate for in-vitro fertilization, a 32 year old patient developed psychotic symptoms, commencing 3 days after initiation of treatment. Hospitalization in the psychiatric ward became necessary when severe formal and rational thought disturbances arose together with perceptory and sensory delusions. Under neuroleptic treatment the symptoms improved. Nevertheless, follow-up psychiatric care on an outpatient basis was deemed necessary. The infertility treatment was continued with human menopausal gonadotrophin stimulation. Psychiatric instability occurred neither at this point nor during the 2 year follow-up observation period. Both an exogenous psychosis (ICD F23.9) as well as the exacerbation of an endogenous psychosis (ICD F29) may be considered for the differential diagnosis. The stimulation with clomiphene citrate in connection with the physical and psychic stress of the infertility therapy can be regarded as the trigger factor. For patients with evidence of psychiatric illness in their case history, ovulation-inducing substances such as clomiphene citrate should be implemented with particular care.

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ZusammenfassungFragestellung: Sind Unterschiede zwischen den deutschen und den türkischstämmigen Frauen hinsichtlich der psychischen Befindlichkeit bei Klinikaufnahme nachweisbar? Ergibt sich ein differenziertes Bild innerhalb der Gruppe der türkischen Migrantinnen in Abhängigkeit von der Migrationsgeneration oder dem Akkulturationsgrad? Patientinnen und Methodik: Im Rahmen eines Public Health-Projekts zur Analyse der Versorgungssituation gynäkologisch erkrankter deutscher und türkischer Frauen im Krankenhaus wurden u. a. soziodemographische Faktoren, Angaben zu Migration und Akkulturation, Gesundheitswissen und -verhalten, subjektiver Krankheitstheorie und Lebenszufriedenheit erfasst. Die subjektive Beeinträchtigung der befragten Patientinnen durch körperliche und psychische Symptome wurde mit dem psychometrischen Fragebogen SCL-90-R (neun Skalen: Somatisierung, Zwanghaftigkeit, Unsicherheit, Depressivität, ¾ngstlichkeit, Feindseligkeit, phobische Angst, paranoides Denken, Psychotizismus) untersucht. Im Untersuchungszeitraum 3/97 bis 10/98 konnten 320 Patientinnen deutscher und 262 türkischer Herkunft mittels in deutscher und türkischer Sprache vorliegender mehrteiliger Fragebogensets am Beginn des stationären Aufenthalts auf den gynäkologischen Stationen des Virchow-Klinikums/Berlin befragt werden. Ergebnisse und Schlussfolgerungen: In die Auswertung des SCL-90-R einbezogen werden konnten 230 türkische und 264 deutsche Frauen (Rücklaufquote 88 bzw. 83%). Nach Bildung Abstract Question: Is there any evidence of differences between German women and those of Turkish origin in terms of psychological well-being on admission to the hospital? And do any distinctions arise within the ethnic Turkish group depending on the migration generation or the degree of acculturation? Patients and Methodology: The following were recorded in the context of a public health project analyzing hospitalized German and Turkish women with gynecological disorders: socio-demographic factors, details of migration and acculturation, knowledge of health matters and behavior, subjective theory about their own state of health and general satisfaction with life. The subjective complaints of the patients interviewed resulting from physical and psychological symptoms were investigated using the psychometric SCL-90-R symptom checklist questionnaire (nine scales: somatization, obsession, insecurity, depression, anxiety, hostility, phobic fear, paranoid thoughts, and psychoticism). During the period that the investigation took place (March 1997 to October 1998 questions were put to 320 patients of German and 262 of Turkish origin using multi-part questionnaires (both in the German and Turkish languages) at the start of hospitalization in the gynecological wards of the Rudolf Virchow hospital in Berlin. Results and Conclusions: A total of 230 Turkish and 264 German women were included in the SCL-90-R evaluation. After six socio-demographically similar groups had been created, the burden by psychological symptoms of the patients of Turkish origin Origi...