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A cytogenetic-cytological study was performed on unfertilized human oocytes (first polar body visible) after intracytoplasmic sperm injection (ICSI) with respect to the rate of prematurely condensed sperm chromosomes (G1-PCC). Out of 163 prepared oocytes derived from 41 ICSI cycles, 133 (approximately 82%) could be analysed successfully. a total of 60 oocytes (45.1%) showed metaphase II chromosomes in the haploid range along with an intact sperm head and 27 oocytes (20.3%) were missing the sperm head, but two of them showed an approximately diploid set of chromosomes; 38 oocytes (28.4%) exhibited the maternal metaphase II chromosomes as well as G1-PCC of the sperm nucleus showing a remarkable variation in the degree of condensation. Ten ICSI cycles (each followed by an embryo transfer) were characterized each by 2-3 oocytes demonstrating G1-PCC. It is concluded that the main cause of failed fertilization after ICSI is the failure of oocyte activation. When the sperm nucleus is able to act with the chromosome condensing factors and the oocyte does not become activated, this will lead to the induction of PCC. Absence of the sperm head might be due to injection or ejection of the spermatozoon in the perivitelline space except for two cases in which fertilization might have occurred. Finally, the observation of both a single chromatin region (n = 6) or two chromatin regions (n = 2) indicated oocyte activation which, however, was followed by developmental arrest.

A retrospective study was carried out to compare the results of in vitro fertilisation (IVF) in 20936 patients with different sperm parameters who underwent IVF in Germany between 1990 and 1993. The study was designed to evaluate prognostic factors for IVF outcome, such as sperm parameters and pre-treatment diagnosis. The percentage of subfertile sperm parameters (10 millions sperm per ml and/or30% progressive mobility and/or30% normal morphology) increased from 31.4% in 1990 to 51.1% in 1993. The fertilisation rate per puncture varied between 87.9% in patients with normozoospermia and 38.7% in patients with severe oligo-astheno-teratozoospermia (OAT). The fertilisation rate in patients with tubal indication was significantly higher than in patients with male indication and comparable spermatozoa. The pregnancy rate per embryo transfer was 23% in patients with normozoospermia and 13.8% in patients with "severe OAT syndrome" in the IVF semen parameters. On the other hand, patients with male sterility as pre-treatment diagnosis showed significantly higher chances of pregnancy than patients with a tubal factor (24% versus 20%, p0.05). Comparing percoll and swim-up preparation techniques, we found significantly higher fertilisation rates in normozoospermia and significantly higher pregnancy rates in subfertile patients after percoll sperm preparation. The results of the study demonstrated that patients with moderate subfertile sperm parameters have good chances of fertilisation and pregnancy following conventional IVE. It seems reasonable to set the boundary at a sperm count of 10 millions sperm/ml with 30% progressive motility and 30% normal morphology. Below these limits intracytoplasmic sperm injection shows better IVF outcome.

We present a case of a 24 year old woman who became pregnant (twins) after human menopausal gonadotrophin (HMG)-induced ovarian stimulation, in-vitro fertilization (IVF) and subsequent embryo transfer. She developed a right internal jugular vein thrombosis as a complication of severe ovarian hyperstimulation syndrome (OHSS) 28 days after embryo transfer. The thrombosis developed in spite of anticoagulation with low-dose heparin. Later a resistance to activated protein C (APC) or Dahlback disease was diagnosed. Due to a new test procedure (accelerin inactivation test), the diagnosis was possible even under anticoagulation treatment. The coincidence of hyperstimulation and internal jugular vein thrombosis with the concurrent diagnosis of resistance to APC has not been published previously. The benefit of general screening for resistance to APC before admission to the IVF programme should be weighed. Targeted selection of a group of high-risk women would therefore be made possible.

Modern reproductive medicine offers a wide variety of invasive types of therapy such as insemination, in vitro fertilisation (IVF) and intracytoplasmatic sperm injection (ICSI). The problem which arises here is that the couple cannot easily understand the implications of each method. Diagnostic and treatment procedures involve many steps and each step requires the taking of blood samples, injections, ultrasound examinations, etc. The outcome of any of these stages can determine whether treatment should continue or should be stopped. These procedures are so complex that even trained doctors would be overtaxed withouth the aid of experts from other fields. From the other perspective, there is the couple, and the female patient in particular is the one suffering from being sterile. It is she who wants to become pregnant by entering into active therapy and to whom nearly everything can be offered.

Although the implantation of a human trophoblast cannot be directly observed, in-vitro fertilization permits examination of the factors accompanying the nidation of the trophoblast. Against this background, the question arises: at what point in time does the nidation of the human embryo take place in the endometrium of the uterus? In this study, we investigated 104 pregnancies which had resulted from in-vitro fertilization. The course curves of the HCG serum concentration were drawn up and then set in relation to the course of the pregnancy. By means of a regression analysis, we established the time point at which nidation occurred. In pregnancies carried through to delivery, the implantation happens, on the median, 6.6 days after the follicle puncture. The implantation window lies between 5.9 and 7.5 days (25th to 75th percentile). In the case of abortions, the median is 7,0 days (after follicle puncture), and for extra-uterine pregnancies it is 8.1 days (after follicle puncture). This shows that implantations in pathological pregnancies take place at a larger point in time.

All oocytes from a patient who had undergone four unsuccessful in-vitro fertilization attempts showed neither a polar body nor pronuclei when examined for fertilization. In 19 inseminated oocytes that were spread for karyotypic analysis, one haploid set of metaphase II chromosomes and a remarkable condensed structure were found. Hormonal and morphological criteria implied that the oocytes had been mature at the time of retrieval. Since non-inseminated oocytes contained only one set of metaphase II chromosomes, the condensed structure appeared to represent the sperm chromatin in the state of premature chromosome condensation due to a block in oocyte maturation. Since the first and second polar body, as well as their chromatin, were undetectable in all the patient's oocytes, a rapid maturation to metaphase II before retrieval and prolonged arrest in this state before fertilization, accompanied by degeneration of the first polar body, appear to be responsible for the condition. In accordance with this notion, degenerate spindles (typical of post-ovulatory aged oocytes) and separating chromosomes (probably representing presegregating chromatids) were observed by antitubulin immunofluorescence.

Meanwhile the attendance of fathers in the labour room is common. From 1. 7. 90-15. 10. 91 510 German fathers were interviewed before and 45' after labour. In comparison a smaller number (n = 56) of fathers were questioned who had decided not to attend. The evaluated data was split in the following three categories: 1. pre-post comparison; 2. "participants" and "non-participants" comparison; 3. special problems. The most mentioned reason for participation (over 85%) was the positive influence on the women. More then 70% of the attendants even wanted to support their wives during complicated delivery and surgical interventions. Approximately 5% of the fathers attending a clinic delivery would then prefer a home delivery because they more or less felt as a substitute to medical personnel. Non participants evidently were anxious due to missing preparation and information about the parturition. Sometimes the women desired no participation of their partners. About 23% of the men decided to attend labour just before birth. Practical recommendations are given and the change in the point of view of the fathers during course of labour is presented in this paper.

Die meisten regelmasigen Gesprache zwischen Patientin und Arzt finden wahrend der taglichen Stationsvisite statt. Das die Visiten weitestgehend nicht patientenorientiert verlaufen, soll anhand von Erkenntnissen aus der Visitenforschung erlautert werden. Die durchschnittliche Visitendauer betragt pro Patient 3,5 min. Wahrend der Arzt einen Gesprachsanteil von 60% hat, entfallen auf den Patienten 30%, der Rest verteilt sich auf die ubrigen Teammitglieder. Der groste Teil der Patientenauserungen ist wiederum reaktiv, d.h. sie bestehen zu etwa 80% aus Antworten auf Arztfragen. In einer durchsschnittlichen Visite stehen 11 Arztfragen einer Patientenfrage gegenuber. Von Seiten des Arztes wird der Dialog mit dem Patienten durch Themen bestimmt, deren Relevanz sich aus dem schulmedizinischen Krankheitsmodell ableitet. Symptome mussen z.B. moglichst objektiv (nicht individuell) beschrieben werden, um zu Syndromen zusammengefast und diagnostischen Klassifikationen zugrunde gelegt werden zu konnen (Uexkull).

Nowadays, in vitro fertilisation can be judged as a relatively successful treatment in special cases of sterility. Success cannot be defined only by induction of pregnancy, but must also be taken into consideration the couple's and the "IVF-children's" personal situation. The main problem of IVF is the high multiple rate of nearly 20%, resulting in a higher frequency of preterm deliveries. This leads to higher perinatal mortality and more longterm deficiencies in these children. The women's attitude during pregnancy can be considered to be responsible. From a psychosomatic point of view (the husband's presence during delivery, breast feeding etc.) there are favourable preconditions for the "birth of the family." In most cases, the couples give a contented or good view of their partnership (self-assessment). Nearly 5% of them seem to be "disappointed" after the birth of the baby. The method of IVF is positively assessed from an overall point of view. But only half of the women do not keep this special method of procreation secret.

In order to study psychosomatic considerations of the male IVF patient, three issues were investigated. First, the personality traits of sterile males (n = 180) were recorded. Male IVF patients were found to have largely the same personality traits as the general population although they tended to have more dominant and retentive traits. Second, in examining the specific stress experiences during IVF, the individual treatment steps were ranked as being similarly stressful by both partners. Males felt the waiting periods (fertilization? pregnancy?) to be clearly more unpleasant than the physical aspects of treatment (e.g. masturbation). Third, an individual comparison of sperm parameters taken during the diagnostic phase with those measured during the IVF attempt, showed that density and morphology were significantly different. Some practical recommendations to reduce the stress that men experience during IVF include his presence during the treatment steps that the female must undergo, as well as his participation in a self-help discussion group.

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.

Unser Wissen zur Methodik der In-vitro-Fertilisation (IvF) ist gros. Die Literatur zu Stimulationsverfahren, zur Oozytenpunktion, zur Kultur menschlicher Embryonen ist umfangreich. Einiges ist erforscht, was die Frage IvF und Psychosomatik betrifft. Aber was wissen wir von den Kindern? Und was wissen wir uber die Paare, die nunmehr „ihren Lebenswunsch“ — ein eigenes Kind — erfullt bekommen haben?

At our hospital a 32 year old patient with a cystic ovarian had been operated. Because sonography was without pathological findings and the patient showed a sterility type, laparoscopy was indicated. Histological findings showed invasive growth of a tubulopapillary carcinoma. Laparotomy with hysterectomy, bilateral adnexa removal, omentectomy as well as pelvic and para-aortic lymphadenectomy was examined. Histologic and immunohistochemical investigations led to coexistence of ovarian endometroid carcinoma and to an endometrial carcinoma, both tumors being of different antigenicity.

Fur alle Paare in Sterilitatsbehandlung haben wir seit 1987 eine Gesprachsgruppe eingerichtet, die sich einmal im Monat trifft. An den etwa 60–90 Minuten dauernden Sitzungen nehmen zwischen 4–15 Patientinnen oder Paare teil. Die Leitung der Gruppe liegt bei einem Arzt mit psychosomatischer Grundkompetenz. Eine besondere Empfehlung zur Teilnahme geht an Paare mit invasiven Therapiemasnahmen (Insemination, GIFT, IVF), an Paare mit idiopathischer Sterilitat, sowie an Paare mit „uberwertigem Kinderwunsch”.

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.

This paper goes into the question as to how greatly mother and father desire an individualised kind of delivery, how this wish is realised, and how it is valued many years later. The basic demand was a safe delivery-safe for both mother and child. For the purpose of analysis and study, 170 women were asked to register their opinion before being admitted to the labour ward, on the following points: for example, presence of the partner, free mobility during the first stage of labour, avoidance of analgesics, positioning the baby on the mother's belly, use of the obstetric chair, rooming-in, breast feeding, etc. Changes in the mother's behaviour during birth, as well as the interaction between mother, child and partner were observed. During the puerperium the delivery was critically assessed by the mother, and her ideas regarding delivery at a future time were recorded. It is possible to show that under the conditions of a safe, monitored birth (uncorrected perinatal mortality 1980-1983 0.71%) the individual wishes of the patients can be met. All mothers whose partners had been present during delivery, assessed this fact positively. Likewise, 100% of the mothers whose baby had been positioned on their belly after birth, considered this to be pleasant. 77% of them actively caressed the newborn in this position. 68% of the mothers talked to the child within the first 15 minutes. 86% kept the newborn for more than an hour in their bed. Of the fathers present during delivery, 55% caressed the newborn, and 50% talked to it within the first 15 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Die ambulante Geburt wirkte sich nicht negativ auf die kindliche und mutterliche Morbiditat aus. Durch die nicht optimale medizinische Betreuung wahrend des hauslichen Wochenbettes entsteht fur das Neugeborene ein etwas hoheres Gefahrenmoment. Bei einem verantwortungsbewusten Verhalten der Eltern ist dies zu vertreten, vor allem im Hinblick auf die manningfaltigen psychosomatischen Vorteile. Die ambulante Geburt stellt fur die Mutter und ihr Kind eine praktikable alternative zur Haus-und Klinikentbindung dar. Zwei Verbesserungsvorschlage wurden aus dieser Arbeit entwickelt

Developmental arrest of 18 ova (about 5%) of 362 fertilized oocytes showing formation of two pronuclei was observed after in-vitro fertilization. In 7 ova the pronuclei were still visible 40 hrs after insemination. Five ova were degenerated after formation of the pronuclei. Cytological analysis of the ova revealed that the arrest of development had occurred at different stages of the cell cycle (interphase to metaphase of the first mitotic division) with one ovum being characterized by a tetraploid chromosome set. Asynchronous development of the pronuclei, which is obviously a cause of early developmental arrest, was observed in 4 ova. According to our observations we would rather transfer fertilized oocytes after cell cleavage (in the 2- to 6-cell stage) than in the pronuclei stage.

The extent to which mothers and fathers choose, realize and later evaluate individualized childbirth procedures is investigated. the safety of the mother and child during and after birth was a primary precondition. One hundred and seventy women were admitted for delivery. It is their ideas and preferences concerning childbirth procedures which are investigated, e.g., presence of partner at delivery, freedom of movement during the dilatation phase, avoidance of medication for pain, use of the delivery chair, placing the baby on the abdomen of the mother, rooming-in, breast feeding, etc. the extent of actual realization of these factors was then observed as well as the interaction between mother, child and partner. Within 1 week post partum, the delivery procedure was critically assessed by the mother, and her ideas concerning future births were recorded.It can be shown that under the conditions of a safe, monitored delivery (uncorrected perinatal mortality from 1980 to 1983, 0.71%), it is possible to respe...

During an in-vitro fertilization programme, 320 inseminated oocytes showing neither formation of pronuclei nor cell cleavage were studied cytogenetically. Fourteen of 17 oocytes exhibiting no extrusion of a polar body were characterized by an approximately diploid set of metaphase II chromosomes with four of these oocytes also showing an additional set of prematurely condensed sperm chromosomes of the G1-phase (G1-PCC). These chromosomes were single chromatids. Among 211 oocytes characterized by polar body extrusion, the same type of chromosomes were found in 22, along with metaphase II chromosomes in the haploid range. This phenomenon can be explained by the permanent arrest of the oocytes at metaphase II after sperm penetration, which allows the presence of cytoplasmic chromosome condensing factors to remain, leading to the induction of PCC in the sperm nucleus. In single cases, PCC was also observed in fertilized eggs that had formed two or three pronuclei. In these cases, PCC resulted either from distinct pronuclear asynchrony or interchromosomal asynchrony within the chromosome set.

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.

This paper goes into the question as to how greatly mother and father desire an individualised kind of delivery, how this wish is realised, and how it is valued many years later. The basic demand was a safe delivery-safe for both mother and child. For the purpose of analysis and study, 170 women were asked to register their opinion before being admitted to the labour ward, on the following points: for example, presence of the partner, free mobility during the first stage of labour, avoidance of analgesics, positioning the baby on the mother's belly, use of the obstetric chair, rooming-in, breast feeding, etc. Changes in the mother's behaviour during birth, as well as the interaction between mother, child and partner were observed. During the puerperium the delivery was critically assessed by the mother, and her ideas regarding delivery at a future time were recorded. It is possible to show that under the conditions of a safe, monitored birth (uncorrected perinatal mortality 1980-1983 0.71%) the individual wishes of the patients can be met. All mothers whose partners had been present during delivery, assessed this fact positively. Likewise, 100% of the mothers whose baby had been positioned on their belly after birth, considered this to be pleasant. 77% of them actively caressed the newborn in this position. 68% of the mothers talked to the child within the first 15 minutes. 86% kept the newborn for more than an hour in their bed. Of the fathers present during delivery, 55% caressed the newborn, and 50% talked to it within the first 15 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

The case of a patient with recurrent abortions and one premature deficient birth is described. The underlying condition was an immunocoagulopathy caused by a lupus anticoagulant, leading to a tendency to thrombosis and in pregnancy to abortions, stillbirths, and deficient births. The diagnostic and therapeutic procedure is described and discussed.

Developmental arrest of 18 ova (about 5%) of 362 fertilized oocytes showing formation of two pronuclei was observed after in-vitro fertilization. In 7 ova the pronuclei were still visible 40 hrs after insemination. Five ova were degenerated after formation of the pronuclei. Cytological analysis of the ova revealed that the arrest of development had occurred at different stages of the cell cycle (interphase to metaphase of the first mitotic division) with one ovum being characterized by a tetraploid chromosome set. Asynchronous development of the pronuclei, which is obviously a cause of early developmental arrest, was observed in 4 ova. According to our observations we would rather transfer fertilized oocytes after cell cleavage (in the 2- to 6-cell stage) than in the pronuclei stage.

Dieser Beitrag gilt einem Thema, dem trotz seiner zahlenmasigen Bedeutung bislang nur wenig Aufmerksamkeit zuteil wurde, namlich den psychischen Auswirkungen von Schnittentbindungen auf die Eltern und das Neugeborene sowie daruber, wie Geburtshelfer damit umgehen.

Um zum Kern des Themas „Was macht Auslanderinnen krank und welche Stellung haben wir Arzte dabei?“zu kommen, sind einige Vorbemerkungen notwendig: 1. Unsere Realitat der teuren Behaglichkeit in diesem Luxushotel der Berliner City (Tagungsort des Kongresses) ist nicht die Wirklichkeit der Auslander. 6 km von diesem Tagungsort entfernt — in Berlin-Kreuzberg — lebt ein groser Teil der 240 000 Auslander Berlins. Hier gibt es noch die dunklen Hinterhofe, die Kellerwohnungen, die Enge der Behausung fur eine Grosfamilie, kaum Spielmoglichkeiten und eine hohe Luftverschmutzung. Die soziale Wirklichkeit der Turken in Kreuzberg ist nicht unsere. 2. Der Schriftsteller Gunter Wallraff hat durch seinen Bestseller Ganz unten Betroffenheit erzeugt [40]. Er hat Zustande offengelegt, die viele leugneten oder nicht wahrhaben wollten. Die Lebens- und Arbeitssituation der Auslander geriet in den Mittelpunkt der Diskussion — hoffentlich nicht nur vorubergehend. 3. Auslander sind nicht nur Turken. 1981 lebten 4,6 Mio. Auslander in der Bundes-republik Deutschland. Davon waren 1,5 Mio. (ein Drittel) Turken [39]. Auslander sind aber nicht nur die sudeuropaischen Gastarbeiterfamilien, sondern auch Asylanten aus Ubersee, Amerikaner, Japaner. Zudem sind die Turken keine homogene Gruppe, was ethnischen Ursprung (z.B. Kurden) und soziale Schicht angeht. 4. Im Jahre 1986 wachst die 3. Generation der Auslander heran. Nach der Anwerbungswelle in den 50er und 60er Jahren sind in der Zwischenzeit eine ganze Reihe von Familienangehorigen nachgefolgt. Ein Teil hat wieder die Bundesrepublik verlassen, und es wachsen nun schon Erwachsene heran, die die Turkei nur vom Sommerurlaub kennen, und fur die Turkisch eine Fremdsprache ist.

Die IVF-Behandlung ist fur das Paar mit Stres verbunden. Die psychische Anspannung (Warten, Hoffen) ist bedeutsamer als die korperliche Beeintrachtigung (Stimulation, Punktion). Der mitunter uberwertig erscheinende Kinderwunsch kann das Motiv zur IVF-Behandlung sein. Psychosomatische Untersuchungen zeigen, das IVF-Patientinnen eher geringere psychosomatische Beschwerden haben als andere Sterilitatspatientinnen. Im psychoanalytisch orientierten Giesen-Test ergeben sich keine Unterschiede zu anderen Sterilitatspatientinnen. Ziel einer Betreuung der IVF-Paare muB die individuelle, medizinische und psychosomatisch orientierte Therapie sein, die das Gesprach uber Verzicht auf weitere Therapie mit einschliest.

Vor einem Jahr haben wir auf der 13. Fortbildungstagung fur psychosomatische Geburtshilfe und Gynakologie in Frankfurt uber erste Erfahrungen mit der extrakorporalen Fertilisation berichtet (Stauber et al. 1985). Im Mittelpunkt unseres Vortrags standen: — die Entwicklung unserer psychosomatisch orientierten Arbeitsgruppe (wir hatten vor der Aufnahme dieser Behandlungsmethode in unserer Fertilitatssprechstunde eine lange Phase des Nachdenkens uber die neue Dimension dieses Verfahrens und deren patientenorientierten Durchfuhrung); — mogliche Kontraindikationen von psychosomatischer Seite, z. B. psychogene Sterilitat oder die Ambivalenz eines Partners; — die Forderung von Rahmenbedingungen fur dieses Verfahren, um schon fruhzeitig einem moglichen Misbrauch vorzubeugen.

In der UFK Charlottenburg wurden seit November 1987 27 Patientinnen zur folgenden in-vitro-Fertilisation (IVF) mit dem GnRh-Analogon Decapeptyl- Depot (Ferring/Kiel) vorbehandelt und anschliesend mit HMG stimuliert. Die vorwiegend tubensterilen Patientinnen wiesen vorzeitige LH-peaks, basale LH- Erhohungen und evtl. zusatzlich ein PGO-Syndrom auf. Das Durchschnittsalter betrug 34,2 Jahre.

Several questions need to be answered before covering the subject of emotional support and guidance of IVF patients. These include what we actually know about the desire for a child, the emotional characteristics typical of infertility patients and especially of IVF patients, how IVF patients justify their motivations for their desire for a child, cope with the anguish caused by infertility, and how much we know about the stress surrounding IVF treatment. These questions will be discussed in the following article.