M. Kupka

Stress relief after infertility treatment--spontaneous conception, adoption and psychological counselling.

OBJECTIVE In this study, we sought to evaluate characteristics of couples with spontaneous conceptions after treatment with assisted reproductive technologies (ART). STUDY DESIGN Data from 254 couples who underwent 1127 therapy cycles between November 1987 and February 1997, were analyzed. Chi-Square (chi(2)) test and Students t-test were used. P<0.05 was considered significant. RESULTS Spontaneous pregnancies occurred in 14% of all treated couples. Psychological counselling only was performed in 21% but was observed significantly more frequently among patients without later spontaneous conception. Ten percent of all treated couples applied for adoption. The miscarriage rate was significantly higher in the group of treatment dependent pregnancies compared to the group of patients with later spontaneous conception (27% versus 9%). The spontaneous conception rate differed significantly depending on womens age and normal semen analysis. CONCLUSION Appearance of spontaneous conception after ART-procedures should be taken into account in the first patients interview. Depending on womens age and andrological parameters, treatment-success will differ. The positive impact of psychological counselling for stress relief during and after therapy should also be noted, even though a statistically significant impact could not be demonstrated in the present study. Adoption should be discussed as an alternative to overcome infertility.

Impact of reproductive history on in vitro fertilization and intracytoplasmic sperm injection outcome: evidence from the German IVF Registry ☆

OBJECTIVE To evaluate the effect of reproductive history on the outcome of different procedures in assisted reproductive technologies (ART) comparing IVF, ICSI, and cryopreserved embryo transfer (CPE). DESIGN Prospective registration of ART cycles and their outcomes. SETTING One hundred three reproductive programs in Germany. PATIENT(S) Women undergoing 174,909 ART procedures from January 1998 through December 2000. INTERVENTION(S) Data analysis of reproductive history collected by the German IVF Registry; multiple logistic regression modeling of success rates. MAIN OUTCOME MEASURE(S) Effect of type of conception and outcome of previous pregnancies, duration of infertility, females age, and type of ART on clinical pregnancy rate per retrieval. Odds ratios with 95% CIs are reported. RESULT(S) More than one previous pregnancy was negatively correlated with outcome of IVF, ICSI, or CPE. This association disappeared when female age was restricted to a maximum of 35 years. A previous pregnancy achieved by spontaneous conception had less impact on outcome of IVF, ICSI or CPE outcome than did a previous assisted conception. Previous live births and miscarriages demonstrated a statistically significant increase compared with ectopic pregnancies and induced abortions. CONCLUSION(S) Reproductive history must be considered when counseling subfertile couples. Female age, method of conception, and previous pregnancy outcome have a significant effect on IVF, ICSI, and CPE outcome.

Paraneoplastic neurological syndrome: patient with anti-Yo antibody and breast cancer: a case report

Abstract. Presented here is the case of a paraneoplastic cerebral degeneration (PCD) in a female patient with breast cancer and the indication of anti-Yo antibodies in the cerebrospina fluid (CSF) and serum. The patients primary indications were dizziness and a severe gait ataxia. The indication of anti-Yo antibodies led to the conclusion of the existence of a paraneoplastic cerebral degeneration. The antibodies in question are anti-Purkinje-cell autoantibodies acting against the antigens common to tumor and Purkinje cells which occur in association with a certain percentage of breast or ovarian cancers. The diagnosis of the primary tumor, that is clinically undetectable with conventional imaging processes, is performed with the aid of positron emission tomography (PET) to detect the presence of axillary lymph node metastases. The micro-invasive mammary carcinoma was able to be localized with the aid of MR mammography and, after MR mammography marking, was removed. The patient subsequently received adjuvant treatment with epirubicine and cyclophosphamide. This treatment failed to influence the paraneoplastic neurological symptoms.

Easy and effective – web-based information systems designed and maintained by physicians: experience with two gynecological projects

Abstract. It is well established that medical information sources develop continuously from printed media to digital online sources. To demonstrate effectiveness and feasibility of decentralized performed web-based information sources for health professionals, two projects are described. The information platform of the German Working Group for Information Technologies in Gynecology and Obstetrics (AIG) and the information source concerning the German Registry for in vitro fertilization (DIR) were implemented using ordinary software and standard computer equipment. Only minimal resources and training were necessary to perform safe and reliable web-based information sources with a high correlation of effectiveness in costs and time exposure.

Pro und Contra der Blastozystenkultur

Nach erfolgter in-vitro Fertilisation werden die Embryonen in der Regel im 4—8 Zellstadium am Tag 2 oder 3 in den Uterus transferiert. Es ist bekannt, dass nicht alle Embryonen das Stadium der Implantations-fahigen Blastozyste am Tag 5/6 erreichen. Daraus entwickelte sich die Vorstellung, dass nach einer verlangerten Kultur in vitro am Tag 5 oder 6 die vitalsten Embryonen fur den Embryotransfer erkannt werden konnen. Allerdings zeigen Embryonen wahrend ihres Wachstums unterschiedliche Bedurfnisse hinsichtlich der Zusammensetzung des Kulturmedium. Die Erforschung dieser Zusammenhange fuhrte zu der Entwicklung der sogenannten sequentiellen Kulturmedien [3]. Mit diesen gelang es bis zu 50% der Embryonen bis zum Blastozystenstadium zu kultivieren und mehrere Studien berichteten von sehr hohen Schwangerschaftszahlen nach dem Transfer von selektierten Blastozysten am Tag 5 [1, 3].