Rudolf Seufert

Cancer and fertility preservation: fertility preservation in breast cancer patients

Aggressive chemotherapy has improved the life expectancy for reproductive-age women with breast cancer, but it often causes infertility or premature ovarian failure due to destruction of the ovarian reserve. Many questions concerning fertility preservation in breast cancer patients remain unanswered – for example, whether fertility preservation methods interfere with chemotherapy, and whether subsequent pregnancy has negative effects on the prognosis. Fertility preservation is a critical factor in decision-making for younger breast cancer patients, however, and clinicians should address this. The present article reviews the incidence of chemotherapy-induced amenorrhea, and discusses fertility-preservation options and the prognosis for patients who become pregnant after breast cancer.

Concentrations of inhibins and activin in women undergoing stimulation with recombinant follicle-stimulating hormone for in vitro fertilization treatment

OBJECTIVE To investigate the influence of human recombinant follicle-stimulating hormone (FSH) on circulating serum concentrations of the ovarian proteohormones inhibin A, inhibin B, pro alpha-C, and activin A and serum levels of estradiol after down-regulation with GnRH analogue. DESIGN Serum concentrations of ovarian proteohormones and estradiol. SETTING Academic clinical practice. PATIENT(S) 30 women who underwent assisted reproductive techniques. INTERVENTION(S) Blood samples were analyzed for inhibin A, inhibin B, pro alpha-C, activin A, and estradiol during IVF treatment at points coinciding with pituitary down-regulation, stimulation with recombinant FSH, ovulatory triggering, and the luteal phase of the cycle. RESULT(S) Activin A levels did not change with recombinant FSH stimulation. In women with a sonographically detected leading follicle >17 mm in diameter, levels of inhibin A, pro alpha-C, and estradiol increased significantly (P<.05). The increase in inhibin B level was not statistically significant. In patients without adequate follicle development during FSH stimulation, serum levels of inhibins remained low and did not significantly deviate from values measured before stimulation. CONCLUSION(S) Inhibin A and pro alpha-C are effective markers of follicular development and may be effective additions to estradiol as a marker.

Epigenetic heterogeneity of developmentally important genes in human sperm: Implications for assisted reproduction outcome

The molecular basis of male infertility is poorly understood, the majority of cases remaining unsolved. The association of aberrant sperm DNA methylation patterns and compromised semen parameters suggests that disturbances in male germline epigenetic reprogramming contribute to this problem. So far there are only few data on the epigenetic heterogeneity of sperm within a given sample and how to select the best sperm for successful infertility treatment. Limiting dilution bisulfite sequencing of small pools of sperm from fertile donors did not reveal significant differences in the occurrence of abnormal methylation imprints between sperm with and without morphological abnormalities. Intracytoplasmic morphologically selected sperm injection was not associated with an improved epigenetic quality, compared to standard intracytoplasmatic sperm injection. Deep bisulfite sequencing (DBS) of 2 imprinted and 2 pluripotency genes in sperm from men attending a fertility center showed that in both samples with normozoospermia and oligoasthenoteratozoospermia (OAT) the vast majority of sperm alleles was normally (de)methylated and the percentage of epimutations (allele methylation errors) was generally low (<1%). However, DBS allowed one to identify and quantify these rare epimutations with high accuracy. Sperm samples not leading to a pregnancy, in particular in the OAT group, had significantly more epimutations in the paternally methylated GTL2 gene than samples leading to a live birth. All 13 normozoospermic and 13 OAT samples leading to a child had <1% GTL2 epimutations, whereas one (7%) of 14 normozoospermic and 7 (50%) of 14 OAT samples without pregnancy displayed 1–14% GTL2 epimutations.

Urinary excretion of 6-keto-PGF1α, TXB2, and PGE2 in pregnancy-induced hypertension and preeclampsia

Objective: Our intention was to investigate whether, in pregnancy-induced hypertension (PIH), preeclampsia is accompanied by an altered urinary excretion of 6-keto-PGF1α (a metabolite of prostacyclin PGI2), TxB2 (a metabolite of thromboxane A2) and PGE2.Methods: Our study included 59 PIH patients with a blood pressure > 140/90 mm Hg. Of them, 18 displayed a proteinuria > 300 mg/L and were classified as preeclamptic. As controls, 53 normotensive pregnancies were investigated. Urine samples were purified by solid-phase extraction and reversed-phase HPLC, and 6-keto-PGF1α TxB2, and PGE2 were quantified by radioimmunoassays.Results: Urinary excretion of vasodilatory prostaglandins in the third trimester was significantly reduced in hypertensive pregnancies compared to controls. Further reductions were observed in preeclamptic patients. Mean values > SEM are: 6-keto-PGFα: controls 926 ± 49 pg/mg creatinine (crea), PIH 694 ± 49 pg/mg crea, 0.01 < P < 0.001, preeclampsia 424 ± 65 pg/mg crea, P < 0.001; PGE2: con...

Blastocyst formation, pregnancy and birth (more than 10 years after the birth of the first child from the same IVF cycle), derived from human PN-stage cryopreserved for 10 years

IVF treatment is costly and psychologically stressful, with an uncertain outcome. Moreover, it bears the medical risk of potentially life-threatening ovarian hyperstimulation. The goal of therapy is having a baby with a few stimulation cycles. For this reason, eggs, PN-stages, embryos at the 4to 8-cell stage and blastocysts, which are not used for the transfer of the stimulation cycle were cryopreserved. Methods are the slow-freezing or vitrification protocol [1]. Several authors report the birth of children after longterm storage of cryopreserved oocytes [2], followed by ICSI or cryopreserved PN-stages embryos [3] or cryopreserved embryos [1] as part of egg or embryo donation. The problem of cryopreservation is to maintain cell integrity and the cellular function in terms of division and implantation The ability of a frozen PN-stage for further development is very important. The German Embryo Protection Act already requires to decide at the PN-stage which are the fertilized eggs with the possibility for development to an embryo. The selection of good-quality embryos, as of now, some common to fifth day, is restricted by the German Embryo Protection Act. The morphological criterias for assessment of embryo quality are not totally clear. On the other hand, there is only little information about long time cryostorage and the outcome of reproductive procedures. For this reason, we report about a birth after transfer of two blastocysts from 10-year cryopreserved embryos more than 10 years after the birth of the first child from the same IVF cycle.

Who is the gate keeper for treatment in a fertility clinic in Germany? -baseline results of a prospective cohort study (PinK study)-

BackgroundIt is estimated that 5-15% of all couples in industrialised nations are infertile. A perceived unfulfilled desire for a child or self-identification as infertile can lead to psychological strain and social isolation. About 53.000 women underwent assisted reproduction treatments in Germany in 2014. Little is known about the first medical consultation and patient needs prior to the first visit in a fertility clinic in Germany. The baseline survey of the prospective cohort study on couples undergoing fertility treatment in Germany (PinK Study) provides first results on this topic for Germany.MethodsThe baseline survey was conducted between 2012 and 2013. Self-administered questionnaires were handed out to patients of six fertility clinics at the beginning of treatment by clinic staff. At a participation rate of 31.0%, we were able to analyse data on 323 women and 242 men.Results92.6% of the women had their initial medical consultation on their unfulfilled desire for a child with a gynaecologist. After the urologist (44.2%), the general practitioner (12.0%) was the second most approached initial contact person for men. 36.4% of all men had no medical consultation on the unfulfilled desire for a child before visiting a fertility clinic. 46.9% of the respondents expressed the wish that the conversation about infertility should be initiated by a physician. Prior to their first visit to a fertility clinic, 11.2% of the men and 24.8% of the women were informed by a physician that infertility treatment can cause emotional strain.ConclusionWhile almost all women consult a gynaecologist prior to the first visit in a fertility centre, one out of three men do not consult any physician at that stage. For the remaining group of men, urologists and general practitioners are the most important contact persons. Gender-specific health care needs are evident. In order to close the health care gap for men in Germany, more opportunities for discreet access to consultation should be offered. Due to its low threshold and family-oriented approach, general practice could make an important contribution to this effect.

Concentrations of ovarian proteohormones as biological markers for the outcome of assisted reproductive technology

Objective: To assess whether the ovarian proteohormones inhibin A and B, pro‐alpha‐C and activin A could act as direct biological markers of a poorer or better response to ovulation induction or clinical conception through assisted reproductive technology (ART).

Urodynamische Befunde nach Radikaloperationen

In der Vergangenheit wurde den direkten Verletzungen des unteren Harntraktes und insbesondere den Fisteln eine grose Bedeutung nach Radikaloperationen im kleinen Becken beigemessen. Verbesserungen von Operationstechnik und dem perioperativen Management haben diese Komplikationen drastisch gesenkt. Heute gehoren die Storungen von Reservoir- und Entleerungsfunktion der Harnblase zu den haufigeren Komplikationen nach Radikaloperationen (2).

Präeklampsie bei Geminigravidität

Die Geminigraviditat geht mit einer erheblichen groseren fetalen und mutterlichen Gefahrdung einher und weist — insbesondere fur die Praeklampsie — eine Reihe spezifische Besonderheiten auf.

Experience with the Hellp-Syndrohe

A total of 13 patients with HELLP-Syndrome were treated between 1980 and 1986 at the Mainz University Gynecology Clinic. The course of disease, complications, and fetal outcome observed do not permit generalized recommendations concerning treatment of this syndrome. The treatment plan should rather be based on the Individual situation, whereby the cesarean section has proven to be the preferred mode of delivery in almost all cases.