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BACKGROUND: In Germany, embryo screening programmes combined with elective embryo transfer are illegal, but there is controversial debate about their legalization. Studies about the attitudes of infertile couples towards multiples, elective embryo transfer and multifetal reduction may help to illuminate how this law shapes patient choices. METHODS: A survey of 265 German infertile couples was conducted. Different logistic regression analyses were performed to assess independent factors associated with the parity for multiple births, approval for elective embryo transfer and multifetal reduction. RESULTS: Despite prior information about the risk of multiple births, 81% of respondents saw no risk in twin pregnancies and a sizable minority saw no risk even in triplet pregnancies. Eighty-nine percent of the respondents rated a twin pregnancy as desirable, whereas 35% rated a triplet birth as desirable. When presented with a choice of having multiple births versus having no biological children, 99% of the respondents endorsed twins, 84% triplets and 58% quadruplets. Seventy-four percent of the respondents approve of legalizing embryo screening programmes to select a good-quality embryo combined with elective embryo transfer. Ninety-two percent of the respondents rejected fetal reduction of twins. CONCLUSIONS: German infertile couples might conceivably be more willing to accept elective embryo transfer if screening for viable embryos was permitted.

BACKGROUND: In Germany, preimplantation genetic diagnosis (PGD) is currently not legal, but there is still a controversial debate about legalization. Studies about the attitudes of infertile couples towards PGD are rare. METHODS: A survey was conducted with 265 German infertile couples about knowledge, attitudes and prospective use of PGD. The influence of independent variables associated with approval of PGD is analysed by binary logistic regression. RESULTS: Sixty percent of respondents have heard about PGD. Eighty-seven percent support a general legalization of PGD in Germany for severe, early-onset genetic diseases. Seventy-four percent consider PGD morally acceptable. Sixty percent supported legalizing PGD for HLA-matching. But only a minority approved PGD to test for non-health-related traits. Respondents with a higher education level were the least supportive to all uses of PGD. CONCLUSIONS: Our results suggest that German infertile couples are as liberal towards PGD for health-related uses as in other western countries. They would legalize and use PGD to raise the rates to get pregnant and to avoid severe diseases of the offspring. Taking the opinions of German infertile couples into consideration could help redefine and reframe the public debate towards legalization of PGD and the moral status of the embryo in Germany.

Die Anzahl kinderloser Paare wird in Deutschland auf mehr als 1,5 Mio. geschatzt. Eine Schwierigkeit besteht darin, zwischen gewollter und ungewollter Kinderlosigkeit zu unterscheiden [2]. Kinderlosigkeit im Spiegel unterschiedlicher Datenquellen war auch Thema eines Workshops »Ein Leben ohne Kinder? Kinderlosigkeit in Deutschland« des Max-Planck-Instituts fur demographische Forschung des Rostocker Zentrums zur Erforschung des demographischen Wandels am 6. und 7. Oktober 2005. Gewollte Kinderlosigkeit wird im Wesentlichen durch den Wertewandel, die Individualisierung, die Unvereinbarkeit von Kind und Beruf, den fehlenden Partner sowie den Aufschub und endgultigen Verzicht determiniert [18].

Investigation of the reasons for the transfer of women from a birth centre to a hospital in the course of childbirth as well as modalities and effects.In the prospective investigation from September 1, 1999 to August 31, 2001, information was collected for all women in Berlin and Bavaria transferred intrapartum from a birth centre to a hospital concerning the reason for the transfer, stage of delivery at the start of transfer, details of the transport, accompaniment, state of mother and medical diagnosis on arrival at the hospital, further progress of delivery, and the condition of the baby postnatum. Comparison groups were formed by all birth centre deliveries in Berlin and Bavaria 1999/2000 (n = 3060) and hospital deliveries in Berlin and Bavaria 1998/1999 (selected data, n = 89 696 births).Three hundred and sixty transfer cases could be evaluated, and a majority of these were nulliparous. The most frequent reasons for transfer were prior premature rupture of membranes and failure to progress in labor. Fifty-seven percentages of the women who were transferred subsequently delivered spontaneously, with an episiotomy rate of approximately 30%. 1-min Apgar valueor = 7 were frequently in nulliparous and multiparous patients in the transfer group than in the comparison groups, as were 5-min Apgar valuesor = 7 and pH7.10 in arterial cord blood in particular for nulliparous in the transfer group. Hospitalisation of neonates born to the transfer group and in particular the nulliparous was significantly more common.Women delivering in a birth centre represent in general a low-risk group as a result of careful preselection by the centres. However, some neonatal data and the high rate of operative deliveries (cesarean section, forceps, and vaginal extraction) indicate that the intrapartum-transferred women, in particular when nulliparous, represent than a special high-risk group.

The majority of catamnestic studies on successful IVF treatment deal with the development of the children and the parent-child-relationship. Far fewer studies pay attention to the changes within the relationship of couples that become parents. This particular study focused on the transition from partnership to parenthood with assessments at different measuring points (T1: the last trimester of pregnancy; T2: 3 months after birth; and T3: 12 months after birth) and compared 47 IVF couples with 45 couples that conceived naturally. The couples were observed with psychodynamic couple interviews and standardized as well as non-standardized questionnaires. The most striking result of our study was the inconspicuousness of IVF couples and their parent-child-relationship. Partnerships featured a high degree of satisfaction among the couples; the progress of pregnancy was described as very satisfying and free of complaints. Surprisingly these descriptions were given despite more frequent and longer hospital stays by the IVF women during their pregnancy. However, IVF couples acted less openly in the interviews and expressed their own feelings less often, especially the more negative ones. In the partnerships we found that IVF women displayed more avoiding tendencies in their relationships 1 year after the birth of their child/children.

Das Mehrlingsproblem ist gegenwartig eines der schwerwiegendsten der assistierten Fortpflanzung. Zur Reduktion der Mehrlingsraten mussen die Einstellungen und das Wissen von Kinderwunschpaaren zur Mehrlingsproblematik vermehrt Eingang in die reproduktionsmedizinische Behandlung finden. In einem Review werden die Ergebnisse aktueller empirischer Studien zu Einstellungen und Wissen von Kinderwunschpaaren zur Mehrlingsproblematik und -reduktion sowie zum Single-Embryo-Transfer dargestellt. Dazu wurden im Anschluss an eine Recherche in Medline, Psyndex und ausgewahlten deutschsprachigen Zeitschriften 9 Studien analysiert, die zwischen 1990 und 2004 publiziert wurden. Die Analyse ergab: 1. Kinderwunschpaare haben eine sehr hohe Praferenz fur eine Zwillingsschwangerschaft und eine hohe bis mittlere Praferenz fur eine Drillingsschwangerschaft. 2. Mit steigendem Alter der Frau nimmt die Praferenz fur eine Mehrlingsschwangerschaft zu. 3. Kinderwunschpatienten haben ein Informationsdefizit bezuglich den Folgen einer Mehrlingsschwangerschaft.

The purpose of this investigation is to find any differences between important maternal and infantile perinatal data from a clinic and a birth center group. Is the perinatal and/or maternal mortality in the birth center group higher? What influence do different socioeconomic factors have on the clinic group?We have carried out a retrospective comparison of the obstetric parameters from all birth center deliveries in the states Berlin and Bavaria for the years 1999 and 2000 (n = 3,060) and the perinatal data investigations of selected clinical groups of both states (n = 55,875).Objective parameters in both groups regarding week of potation at delivery, parity, age of pregnant women, infantile measures, primi- and multiparae and Apgar scales were comparable. There are significant differences in the delivery mode (spontaneous deliveries: birth centersclinics; operative deliveries: birth centersclinics), in blood loss over 1,000 ml (birth centersclinics), in the episiotomy and perineal tear rate (birth centersclinics), in the infantile transfer rate to a neonatology unit (birth centersclinics) and in the frequency of necessary neonatological measures in the neonate (birth centersclinics). The perinatal and maternal mortality in the groups were similar. Within the clinical group the socioeconomic status and a background of immigration had no significant influence on the perinatal data.The retrospective data show that the more "invasive" clinical obstetrics leads to a similar postnatal condition of the neonates in comparison to the birth house group. Further comparative studies over several years are necessary to make statements about the occurrence of rare risks and maternal mortality in the free-standing birth center groups.

Was sind die Bedurfnisse der Frauen mit Kinderwunsch, und welche Verantwortung haben die Frauenarzte in der Reproduktionsmedizin? Primares Bedurfnis der Frauen ist es, ein (gesundes) Kind zu bekommen. In der Sterilitatsbehandlung sind die begrenzte Aussicht auf Erfolg, die Problematik von Fehlgeburten und Mehrlingsgeburten, aber auch unzureichende Information, Aufklarung und Beratung wesentliche Hindernisse, um den Bedurfnissen der Frauen gerecht zu werden. Gesetzliche Restriktionen im Embryonenschutzgesetz, wie das Verbot der Eizellspende oder der Embryoselektion widersprechen ebenfalls den primaren Bedurfnissen von Frauen in der Reproduktionsmedizin.

In this review we discuss the pathophysiological mechanisms and diagnostic criteria of chronic pelvic pain in women. The psychosomatic correlations and important somatic reasons of this complicated disease picture is discussed. For a large number of the patients the diagnostic criteria of somatoform pain disorder are fitting. The therapeutic approaches, which to a large extend are based on experience, are described. Psychosomatic knowledge is very helpful in the management of chronic pelvic pain in women and contributes to a satisfying doctor-patient-relationship.

Die Erfahrungen — insbesondere in der gynakologischen Praxis — zeigen, das die Kontrazeption selbstverstandlich Probleme beseitigt, aber auch neue schafft.

Although cultural diversity in German metropolises is rapidly increasing, immigrant patients are rarely included in clinical studies. Specific needs of these patients are hardly known. In a comparative study, 320 German and 262 Turkish immigrant women, respectively, were interviewed via bilingual questionnaires to assess their expectations from and their satisfaction with provided health care services. While no significant differences could be found between basic expectations concerning anticipated health care standards between the two study groups, women of Turkish origin were markedly less satisfied with provided health care services. High expectations of immigrant patients towards information during their stay, communication with doctors and nurses and psychosocial services were only insufficiently met. The results indicate that specific health-relevant factors, such as social and educational status, knowledge of German language and health knowledge together with structural deficiencies of a health care service that is not prepared to correspond properly to patients of different social and cultural backgrounds, have a negative impact on patient satisfaction for migrant women.

Summary Background Docetaxel (Taxotere®) has demonstrated high antitumour activity in first- and second-line treatment of metastatic breast cancer. This study analysed the efficacy and toxicity of docetaxel given weekly. Patients and methods Thirty-five patients with metastatic breast cancer received docetaxel, 35 mg/m2 weekly for six weeks, followed by two weeks without treatment. Additional cycles (three weeks’ treatment, two weeks’ rest) were given until disease progression. All patients had received prior chemotherapy: 32 and 5 patients had received prior anthracycline-containing and taxane-containing regimens, respectively. Docetaxel was administered for a total of 359 doses (median 9, range 6–22). Results There was one complete response (3%), 11 partial responses (31%), 17 patients with stable disease (49%) and six with disease progression (17%). Overall response rate was 34% (95% confidential interval (95% CI): 18%–51%). Median survival was 307 days; median progression-free survival was 2.6 months (range 1.5 to ≥ 5.5 months). Three patients showed grade 3 neutropenia. 14 showed grade 3 alopecia, and various grade 1–2 non-haematological toxicities were observed. Treatment was delayed in two patients due to haematotoxicity, and stopped in one patient due to painful nail toxicity. Conclusion Weekly administration of docetaxel at a dose of 35 mg/m2 is effective and of low toxicity in patients with metastatic breast cancer.

Caesarean section on request of the mother turned out lately to be very actual in obstetrical discussions. To come to rational decisions the scientific results of several medical disciplines should be taken into consideration. There is no scientific evidence for benefits of such elective c-section in paediatrics and psychosocial medicine. The obstetricians view shows both benefits and disadvantages, the later overweighing the first. In the light of these data, elective caesarean without other indication but the mothers request does not show to be an acceptable routine procedure.

We examined the possible connection between mood state of patients during IVF/ICSI-treatment and pregnancy rate. Which influence does the patient's age and the social support have on the mood state?Questionnaires were handed out to 100 patients of our fertility center during an IVF/ICSI-treatment-cycle. We used the standardized Leipziger Stimmungsfragebogen (LSB), a visual analogue-scale for free indication of mood state and the questionnaire for social support (SOZU).Per oocyte pick up 32 women became pregnant (32.7%), 58 women did not become pregnant (59.2%). Lower rating on the aggressivity-scale showed a tendency (p = 0.085) and higher rating on the balance-scale showed a trend toward higher pregnancy rates. There was no significant relation shown on the visual analogue-scale as well as on the LSB-scales grief, activity and fatigue. There was no correlation between age and mood state or between social support and pregnancy rate.We could not show a significant relation between general mood state and pregnancy rate. Yet there was a tendency concerning certain components of mood. Increasing age of the patient does not have a negative influence on the mood state either. The individual situation and adjustment seem to be decisive.

320 German and 262 Turkish immigrant patients of the gynaecological units of the Virchow Women's Clinic in Berlin were questioned, to compare their knowledge and opinion on menopause and possible cultural influence factors. The results showed that 70% of the migrant vs. 90% of the German women regarded menopause as a normal phase in a women's life and more Turkish than German women (35% vs. 7%) associated complaints with menopause. However the immigrant women knew noticeably less about health risks related to menopause (10% vs. 50%).

A couple is presented suffering from primary sterility for 20 years and who were selected for an IVF test, since conservative methods failed to induce a pregnancy. The ejaculate of two semen samples revealed exclusively round-headed spermatozoa in each sample. Contrary to this diagnosis, however, asthenoteratozoospermia had been diagnosed in previous investigations and the patient had been treated with tamoxifene. However, no therapy exists for the phenomenon of round-headed spermatozoa, because this defect is genetic of origin and correlates with irreversible infertility.

Wenn Leben, wie Heidegger sagt, Sein zum Tode ist, dann setzt der Tod ein Sein voraus. Wenn eine schwangere Frau ihr Kind verliert, wenn es stirbt, bevor es ist, was betrauern wir dann, einen Tod ohne Sein, ein Nicht-Ereignis, wie in den 70er Jahren Levin postulierte?

Eine Hyperandrogenamie kann durch die folgenden Ursachen hervorgerufen werden: a) PCO-Syndrom (PCO-S) mit funktioneller ovarieller oder adrenaler Hyperandrogenamie; b) ovarielle oder adrenale Enzymdefekte; c) androgensezernierende Tumoren; d) andere endokrine Erkrankungen wie Cushing-Syndrom, Hyperprolaktinamie, Akromegalie.

Das Mammakarzinom ist die haufigste Krebserkrankung bei Frauen. Eine Senkung der Mortalitat ist derzeit nur durch eine Verbesserung der Fruhdiagnostik zu erzielen. Bislang galt die Mammographie als einzige Methode, die eine Fruherfassung des Mammakarzinoms erlaubt. Die hierdurch zu erzielende Senkung der Mortalitat wurde in den letzten dreisig Jahren weltweit durch zahlreiche Mammographie-Screeningstudien belegt [1]. Insgesamt erlaubt die Mammographie eine Mortalitatssenkung um etwa 30 % im Screening-Kollektiv. In einigen Studien wurde nach pra- und postmenopausalen Patientinnen gesondert untersucht. Bei Frauen ab dem 50. Lebensjahr zeigt sich ein noch deutlicherer Screeningerfolg. Dagegen erzielt die Mammographievorsorge bei Frauen vor dem 50. Lebensjahr keine Effektivitat. Dies liegt daran, das bei jungen Frauen das Drusengewebe meistens dichter ist und eine hohere Strahlenabsorption aufweist. Dadurch verbergen sich haufig tumorose Verdichtungen und sogar MikroVerkalkungen. Dies reduziert die Sensitivitat der Mammographie bei pramenopausalen Frauen [10].