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Objective: Various gonadotropins are used for ovarian stimulation (OS). This study investigated the cost-effectiveness of different gonadotropins based on real-world data from the French National Health Database (SNDS) over a 7-year follow-up of assisted reproductive technology (ART) treatments., Design: Cost-effectiveness analysis of different gonadotropins based on real-world data from the SNDS was conducted., Participants: Women from SNDS undergoing OS leading to oocyte pick-up registered between January 31, 2013, and December 31, 2018 (N = 245,534 stimulations), and receiving either recombinant human follicle stimulating hormone (r-hFSH alfa originator; 110,439), its biosimilars (12,287), or urinaries (mainly highly purified human menopausal gonadotropin [HP-hMG; 65,654] and marginally highly purified urinary-human follicle stimulating hormone [7,821]) were included (follow-up: December 31, 2019)., Settings and Methods: Clinical inputs for this model, including live birth (LB) and cumulative LB (CLB) were calculated from data as published in [Best Pract Res Clin Obstet Gynaecol. 2023;88:102308]. A decision-tree model was developed comprising pregnancy and live birth rate (LBR) states for a complete ART cycle, including one fresh and ≤4 frozen/thawed embryo transfers and related costs. Cost inputs included those of drugs, ART procedure, pregnancy and delivery, and adverse events. Cost per LB and CLB and incremental cost-effectiveness ratio (ICER) were assessed. Robustness of results was determined by comprehensive sensitivity analyses., Results: Overall, r-hFSH alfa originator was found to be associated with a lower cost per LB and per CLB (cost per LB: EUR 26,010; CLB: EUR 22,278) versus its biosimilars (cost per LB: EUR 28,037; CLB: EUR 23,807) and versus urinaries (cost per LB: EUR 26,636; CLB: EUR 23,335). Calculated ICERs with r-hFSH alfa for LB were EUR 5,538 and EUR 14,090, whereas for CLB were EUR 1,945 and EUR 13,742 versus biosimilars and urinaries, respectively. Cost-effectiveness acceptability curve showed that in a majority of iterations, r-hFSH alfa originator had a probability of being cost-effective at a hypothetical threshold of EUR 20,000/LB. Sensitivity analyses showed that the most important variable impacting the outcome in fresh transfers was the probability of birth for biosimilars and the probability of pregnancy for urinaries, while for cumulative transfers, it was the probability of pregnancy for biosimilars and the probability of birth for urinaries., Limitations: As the clinical data were obtained from a non-interventional study and not a randomized controlled trial, the results may still be susceptible to residual confounding or other biases., Conclusions: r-hFSH alfa originator is cost-effective compared to its biosimilars and to urinaries (mainly HP-hMG) and is associated with a lower cost per LB compared to these gonadotropins, where the main driver is the higher LB efficacy rate achieved with it., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Objectives: The objective of this study was to examine the prevalence of chronic endometritis (CE) in infertile women, its impact on reproductive outcomes, and the accuracy of hysteroscopy as a screening tool for CE., Design: This was a prospective observational study., Participants: Participants involved in this study were 514 asymptomatic patients with infertility., Setting: The review was conducted in a tertiary care center., Methods: The participants underwent a hysteroscopy and endometrial biopsy (EMB). Antibiotics were given for cases of CE. We investigated the prevalence of CE in patients starting assisted reproductive technologies (ART) as a primary outcome. Secondary outcomes were the clinical pregnancy rate (CPR) in the ART cycle after hysteroscopy, EMB, and antibiotic treatment in cases of CE; the cumulative CPR in the subsequent 2 years after hysteroscopy and EMB; the sensitivity and specificity of hysteroscopy as a screening tool compared to EMB as the "gold standard" for diagnosing CE., Results: CE was identified in 2.8% of patients starting ART (11/393). CPRs did not differ significantly between patients with CE and the entire cohort of patients without CE in the subsequent ART cycle (OR: 0.43; 95% CI: 0.09-2.02) or in the 2 years after EMB (OR: 0.56; 95% CI: 0.16-1.97). In a matched control comparison (with matching for age, basal FSH, and cause of infertility), CPR in patients with CE did not differ in the subsequent ART cycle (OR: 0.39; 95% CI: 0.09-1.61); however, their CPR in the 2 years after EMB was significantly lower (OR: 0.22; 95% CI: 0.13-0.38). The sensitivity and specificity of hysteroscopy as a screening tool for diagnosing CE were 8.3% and 90.1%, respectively., Limitations: Due to our cohort's low CE prevalence, we could not detect significant differences in CPRs., Conclusion: CE is rare in our studied population of asymptomatic patients starting ART. Hysteroscopy cannot replace EMB for diagnosing CE., (© 2023 S. Karger AG, Basel.)

Background: Fertility preservation before or during cancer treatment in young women has become an important health issue because of delayed motherhood and improved survival rates. This study evaluates the necessity and the efficacy of fertility preservation, with a focus on actual pregnancy wish and outcome after fertility preservation and cancer treatment., Patients and Methods: All consecutive patients who received fertility preservation in 2 university referral centers before or during cancer treatment were included. After a minimal follow-up of 3 years, pregnancy wish, pregnancy attempts and fertility outcome were assessed during a dedicated consultation or during a telephone interview., Results: A total of 159 patients received fertility preservation including hormonal protection with gonadotropin-releasing hormone agonist (n = 93, 58.5%), ovarian tissue cryopreservation (n = 44, 27.7%), and combined hormonal protection and ovarian tissue cryopreservation (n = 22, 13.8%). Among the 91 (57.2%) patients in remission after a mean follow-up of 61.5 months, 29 (31.9%) women actively attempted pregnancy. Patients who had received ovarian cryopreservation were more likely to attempt pregnancy (18/66) than those who only received hormonal protection (11/93, p = 0.02). Out of the 29 women who attempted pregnancy, 16 (55.2%) became pregnant, and most of them conceived spontaneously (87.5%, 14/16). Out of the 13 women who did not become pregnant, 1 patient adopted a child and 12 patients still wanted to become pregnant, including 1 patient who underwent a transplantation of her cryopreserved ovarian tissue without success., Conclusion: In one of the first studies reporting real-life experience in centers for fertility preservation, we found that, within 5 years following the end of cancer treatment, only one third of patients in remission attempted to become pregnant, with a pregnancy rate of 55%, mostly after spontaneous conception., (© 2017 S. Karger AG, Basel.)

Myeloperoxidase (MPO) is a proinflammatory enzyme and a marker for neutrophil activation and oxidative stress. Since oxidative stress and inflammation are linked to the pathogenesis of endometriosis, we hypothesized that the total, active, and specific (active/total) MPO levels were significantly different in plasma of women with and without endometriosis. Samples were selected from our biobank from women with endometriosis (n = 212) and controls without endometriosis (n = 121) across the menstrual cycle. Total MPO plasma levels were measured by immunoassay and MPO activity by enzymatic assay. Total and active MPO levels did not differ significantly among endometriosis cases and controls, whereas the specific MPO activity was significantly lower in women with endometriosis than that in controls (p = 0.0159). After the subdivision of control patients into women with a normal pelvis and women with other benign gynecological disorders, a significant difference was observed only between women with endometriosis and women with other benign gynecological disorders (p = 0.0266). In conclusion, systemic MPO levels may not be suited as a single biomarker for endometriosis. Our data support the involvement of MPO in other gynecological disorders but do not provide any evidence for an association with endometriosis., (© 2017 S. Karger AG, Basel.)

Background: Endometriosis in adolescent girls is often diagnosed after a long delay. This diagnostic delay can be associated with more advanced stages of endometriosis and with a higher likelihood of fertility problems at a later age., Material and Methods: A systematic review of literature and quality assessment was performed in order to identify questionnaires that were developed to identify adult women with endometriosis. Based on these questionnaires, specific questions that had been reported to be predictive for endometriosis were selected and included in a newly composed questionnaire with the aim to identify adolescents at risk of developing endometriosis., Results: Based on the literature, we identified 5 questionnaires developed to identify adult women with endometriosis; this questionnaire contained 6 questions that had been reported to be predictive for adult endometriosis. These questions query age of menarche, cycle duration, dysmenorrhea, pain descriptors, dyschezia and urinary symptoms and were combined into a new self-report questionnaire aimed to identify adolescents at risk to develop endometriosis., Conclusion: We developed a self-report questionnaire aimed to identify adolescents at risk to develop endometriosis based on questions from self-report questionnaires that have been reported to identify adult women with endometriosis., (© 2016 S. Karger AG, Basel.)

Aim: To investigate intra- and inter-observer variability in 2-dimensional (2D) follicular measurements among midwives sub-specialized in medically assisted reproduction (MAR), using a new 3D tool imitating real-life ovarian scanning., Methods: Six 3D ultrasound volumes from stimulated ovaries were recorded and stored on the ultrasound device (Voluson i, GE Healthcare). Two junior midwives (with 6-36 months' ultrasound scanning experience) and 5 seniors (>36 months' experience) assessed the number of follicles per ovary and the average size of each follicle ≥10 mm off-line. There were 2 time points of measurement by each midwife with a mean interval of 12.7 weeks (±10.7). Intra- and inter-observer variability in the number of follicles, the mean follicle size and the diameter of the largest follicle were investigated using the Wilcoxon signed-rank test and the Kruskal-Wallis test., Results: There was no significant intra- or inter-observer variability among midwives in the evaluation of the number of follicles, their diameter or the diameter of the largest follicle, even when juniors and seniors were compared., Conclusions: These data support the view that well-trained midwives can perform 2D follicle measurements to monitor MAR treatment in a reproducible way, and that prerecorded 3D volumes can also be used for quality control purposes., (© 2014 S. Karger AG, Basel.)

Multiple sclerosis (MS), a chronic inflammatory demyelina-ting and degenerative disease of the central nervous system, is a frequent cause of neurological disability in young adults. Female predominance has increased over the last decades. Although female gender carries a higher risk of developing relapsing remitting MS, being female and at child-bearing age also appears to provide some protection against cognitive decline and against progressive onset MS, an adverse predictive factor when considering long-term disability in MS. The risk of MS in women has been associated with an earlier age at menarche. In most studies, parity did not impact MS risk. However, the recently published association of higher parity and offspring number with a reduced risk of a first demyelinating event suggests a potential suppressive effect. Pregnancy in MS patients has been associated with a reduced relapse rate and a reduction of neurological symptoms, especially in the third trimester. Despite the increased relapse risk in the postpartum period, there is no indication of an adverse effect of childbirth on the long-term course of MS. Fertility treatment in MS has been associated with an increased relapse risk in the following 3-month period, especially when the procedure did not result in pregnancy and gonadotrophin-releasing hormone agonists were used. Altogether, there is substantial evidence to support a regulatory role of sex steroid hormones in MS. In the absence of correlations with single hormone blood levels, we can only speculate about the underlying mechanisms. In conclusion, the increased MS risk in women and the changes in relapse and progression risk in association with reproductive events suggest significant and complex interactions between immune, neuroendocrine and reproductive systems in MS., (Copyright © 2013 S. Karger AG, Basel.)

Aims: To evaluate the feasibility and the reliability of hysterosalpingo-foam sonography (HyFoSy) using gel foam in the assessment of tubal patency., Methods: Nonrandomized, observational, academic and single-center study of 20 women being investigated because of subfertility and scheduled for a laparoscopy with chromopertubation. A detailed description of HyFoSy with a newly developed gel foam is given in the way it proved to be most efficient in our hands. The results of HyFoSy are compared to the data regarding tubal patency testing during laparoscopy by chromopertubation., Results: All 20 HyFoSy were technically successful. Four of the 40 tubes, 1 right tube and 3 left tubes, were not patent at HyFoSy (3 tubes with proximal block and 1 tube with distal block). There was a 100% agreement between tubal patency data according to HyFoSy testing and laparoscopic chromopertubation testing., Conclusion: HyFoSy is both feasible and accurate in the diagnosis of tubal patency., (Copyright © 2012 S. Karger AG, Basel.)

Aims: To explore couples' experiences in the preconception phase of infertility treatment with donor gametes and how this may influence the disclosure process to the offspring and/or others., Methods: In-depth interviews with 10 recipient couples were analyzed using a grounded theory approach., Results: In the context of their infertility and a culture in which definitions of gender and family are fundamentally biologically based, participants reconsidered the significance and meaning of genetics, and social connectedness in family-building and parenthood. When couples emphasized the similarities with the biologically based definitions of parenthood and family, the question of disclosing the donor conception to the offspring seemed less relevant. When couples adapted their view on families and parenthood to an alternative family formation, long-term consequences became more relevant, including the disclosure question. Support from others was needed to manage the challenges of this stage, but this could be in conflict with their decision of non-disclosing the donor conception to the potential offspring., Conclusions: This study highlights the importance of couples' experiences in the preconception phase for their disclosure process. The treatment of infertility and a future-oriented, family-building approach should be addressed in a fertility program with donor gametes and valued as complementary., (© 2013 S. Karger AG, Basel.)

In 2007, the WHO initiated an organizational structure for the 11th revision of the International Classification of Diseases (ICD). Effective deployment of ICD-derived tools facilitates the use and collection of health information in a variety of resource settings, promoting quantitatively informed decisions. They also facilitate comparison of disease incidence and outcomes between different countries and different health care systems around the world. The Department of Reproductive Health and Research (RHR) coordinates the revision of chapters 14 (diseases of the genitourinary system), 15 (pregnancy, childbirth, and puerperium), and 16 (conditions originating in the perinatal period). RHR convened a technical advisory group (TAG), the Genito-Urinary Reproductive Medicine (GURM) TAG, for the ICD revision. The TAG's work reflects the collective understanding of sexual and reproductive health and is now available for review within the ICD-11 revision process., (Copyright © 2012 S. Karger AG, Basel.)

Aims: The EndoCost study aims to calculate the costs of endometriosis from a societal perspective., Methods: This multicentre, prevalence-based cost-of-illness analysis aggregates data on endometriosis costs and quality of life from a prospective hospital questionnaire and from both retrospective and prospective patient questionnaires. The EndoCost study comprises 12 representative tertiary care centres involved in the care of women with endometriosis in 10 countries. The sample includes patients with a laparoscopic and/or histological diagnosis of endometriosis and with at least 1 patient contact related to endometriosis during 2008. The EndoCost study measures direct healthcare costs (e.g. costs of medication, physician visits), direct non-healthcare costs (e.g. transportation costs), and indirect costs of productivity loss. Cost questions are developed specifically for the purpose of the EndoCost study. Quality of life is measured using the EuroQol-5D and relevant parts of the Global Study of Women's Health instruments. Both aggregate analyses and country-specific analyses are planned for total costs per patient. Costs are broken down into cost drivers and into the various payers that incur costs., Conclusions: The cost estimates provided by the EndoCost cost-of-illness analysis may be used to justify the prioritisation of future research in endometriosis., (Copyright © 2010 S. Karger AG, Basel.)

Background: Although intracytoplasmic sperm injection (ICSI) is now accepted as the treatment of choice for severe male infertility, concerns about its safety and the potential risks for the offspring remain. We reviewed the literature with respect to the prevalence of major congenital malformations after the ICSI technique and supplemented these data with the results of a prospective follow-up study performed in our center., Methods: From January 1994 till June 2000, 776 ICSI cycles were carried out at the Leuven University Fertility Center. The resulting pregnancies (n = 172) were followed for biochemical and obstetrical parameters, prenatal diagnosis and congenital abnormalities., Results: A total of 134/172 (78%) ongoing pregnancies resulted in 132 deliveries of 166 live born children. Two terminations of pregnancy were carried out due to the presence of major congenital anomalies, diagnosed at prenatal ultrasound. Prenatal diagnosis was carried out in 55 fetuses. Two de novo chromosomal aberrations were found. Major congenital abnormalities were observed at birth in 9/150 (6.0%) children. The total malformation rate was 6.5%., Conclusions: The prevalence of congenital abnormalities in children born after ICSI in our center (6.5%) was comparable to the prevalence of congenital abnormalities after ICSI reported in the literature., (Copyright (c) 2010 S. Karger AG, Basel.)

Background: The objective of this study was to explore the reasons why couples discontinue fertility treatment., Methods: A retrospective exploratory study was performed at the Leuven University Fertility Centre, a university hospital-based fertility center. Women who discontinued treatment between September 2000 and December 2001 were contacted in 2004-2005 by telephone for a standardized interview which covered 9 dropout reasons. For each reason, its importance on the decision to stop treatment was measured on an 11-point Likert scale., Results: On average, psychological burden (x = 5.96) had the highest impact on the decision to stop treatment followed by physical burden (x = 4.48) and female age (x = 3.64). Perceived lack of staff expertise (x = 1.84), negative impact on social contacts (x = 2.12) and financial burden (x = 2.16) had the lowest impact on the decision to stop treatment. Longer duration of infertility was significantly positively correlated with a higher rating of physical burden as a reason to discontinue treatment (r = 0.48; p < 0.05)., Discussion: On average, psychological burden appears to be most frequently named as the number one reason to discontinue infertility treatment, whereas financial burden had the lowest impact. Longer duration of infertility is associated with more externalizing reasons to discontinue treatment.

Infertility is an increasing problem all over the world, and it has been estimated that 10-15% of couples in fertile age have fertility problems. Likewise induced unsafe abortion is a serious threat to women's health. Despite advances made in assisted reproduction techniques, little progress has been made in increasing the success rate during fertility treatment. This document describes a wide range of projects carried out to increase the understanding in the field of embryo implantation research. The 'Fruitful' research network was created to encourage collaborations within the consortium and to describe our different research potentials to granting agencies or private sponsors., (Copyright 2006 S. Karger AG, Basel.)

Endometriosis is gynaecological disorder, characterized by the growth of endometrial tissue outside the uterine cavity. It is the most common cause of pelvic pain and occurs in 20-25% of women with infertility. Although Sampson first described endometriosis in 1927, studies on the prevalence of endometriosis among African women are still lacking. The current thinking is that endometriosis rarely affects women from the African origin. However, in African-American women in the USA, endometriosis is one of the commonest indications for major gynaecological surgery and hysterectomy, and is associated with long hospital stay and high hospital charges. There is also some evidence that endometriosis is more commonly found in African-American patients from private practice than in African-American patients treated in public hospitals. The prevalence of endometriosis in African-indigenous women with infertility seems low, possibly due to a different life style (early pregnancy, increased risk for PID and blocked Fallopian tubes) and due to lack of laparascopic facilities and specific training of African gynecologists to diagnose ascites caused by endometriosis appear to be more frequently observed in African-indigenous of African-American women than in women with other ethnic backgrounds.

To the best of our knowledge this is the first prospective study in nonhuman primates of proven fertility in the wild, which compares fertility between animals with spontaneous minimal endometriosis and those with a normal pelvis. During 7 months 13 female baboons were exposed to males and all pregnancies were terminated by hysterotomy. A diagnostic laparoscopy was performed to assess the presence of pelvic endometriosis at the end of the fertility trial. Sixty-one percent of the baboons became pregnant at least once and the cycle fecundity was 21%. No obvious difference was found between baboons with (n = 7) and without endometriosis (n = 6) in either pregnancy rate (57 and 67%, respectively) or cycle fecundity (18 and 24%, respectively). These data suggest that in baboons with spontaneous minimal endometriosis the cycle fecundity is not grossly reduced.

The histopathology of spontaneous endometriosis was studied on 20 pelvic implants biopsied at laparoscopy in 15 healthy baboons. Endometriosis was confirmed by histopathology in 10 of these animals (66%). Typical (n = 3) and subtle (n = 13) endometriotic lesions were confirmed by histopathology in 100 and 61%, respectively. Suspected disease-bearing lesions (n = 4) were confirmed in 50%. Implants could be classified as active (n = 5), inactive (n = 3), atrophic (n = 2) or stromal endometriosis (n = 3). The histological findings for typical and subtle implants were similar to those reported in humans.