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Das Ziel dieser Studie ist es, den Einfluss des BMI auf die Ergebnisse einer IVF-Therapie am Ende der reproduktiven Phase zu untersuchen. Dazu wurden 3098 Frauen uber 38 Lebensjahre, die sich in den Jahren 1996–2010 einer IVF-ICSI-Therapie unterzogen haben, in diese retrospektive Analyse einbezogen. Alle Patientinnen wurden einer von sechs BMI-Kategorien zugeteilt. Ubergewichtige, Klasse-I- und Klasse-II/III-Adipositas-Patientinnen haben eine hohere Gonadotropindosis gebraucht im Vergleich zu normgewichtigen Patientinnen (2748,71 ± 1046 IU vs. 2577,21 ± 1046 IU; P = 0,001; 3006,68 ± 11,46 IU vs. 2577,21 ± 1046 IU; P 30 brauchten eine langere Stimulationszeit im Vergleich zu normgewichtigen Patientinnen (11,01 ± 3,5 vs. 10,27 ± 3,1 Tage; P 30 wurde gefunden und bekam statistische Relevanz, wenn die Lebendgeburtenrate zwischen Frauen mit BMI zwischen 30 und 34,9 und Frauen mit einen BMI ≥ 35 verglichen wurde sowie zwischen Patientinnen mit BMI zwischen 30 und 34,9 und normgewichtigen Patientinnen (15,3 % vs. 9,9 %; P = 0,029 bzw. 17,1 % vs. 9,9 %; P = 0,047). Altere ubergewichtige Patientinnen sollten nicht von IVF/ICSI-Behandlungen ausgeschlossen werden.

Background/purpose Inguinal hernia repair and orchidopexy are among the most common operations in boys. The impact on future fertility has not been conclusively defined. This study evaluates sperm quality after previous inguinal surgery. Methods Spermiograms of men with a desire to conceive children were analyzed. History of previous inguinal surgery (hernia repair, orchidopexy, varicocele ligation) was correlated with sperm quality. Other influential factors (age, BMI, chronic medication, tobacco use) were also tested. Results A total of 333 patients were included. Overall, 12.6% of the subjects had undergone previous inguinal surgery. Of these, 17 (43%) were inguinal hernia repairs, 8 (20%) orchidopexies, and 6 (15%) varicocele ligations, while 9 (22%) could not give an exact history. Abnormal spermiograms were found in 60% (n = 24) of those with previous inguinal surgery versus 48% in controls (p = 0.16). On multivariate analysis, pathologic spermiogram parameters were associated with previous inguinal surgery, orchidopexy, use of chronic medication, and smoking, but NOT with inguinal hernia or varicocele repair alone. Conclusions Previous inguinal hernia or varicocele repair does not seem to impact negatively on quality of sperm later in life. Orchidopexy, smoking, and use of chronic medication, however, were all associated with pathologic sperm quality parameters. Type of study Prospective comparative study. Level of evidence Level II.

Introduction For patients considering undergoing assisted reproductive techniques (ART), many concerns arise when persistent ovarian cysts are found. This large study aimed to determine how ovarian cyst removal affects success rates of IVF/ICSI therapies. Methods 550 patients who underwent an IVF/ICSI treatment between 2002 and 2011 with a persistent ovarian cyst ≤ 5 cm before treatment were analyzed retrospectively. 328 patientsʼ preference was to undergo a laparoscopic cystectomy and 222 patients opted for a conservative management. Control subjects included 13 552 patients undergoing IVF/ICSI at the same period of time without an ovarian cyst. Results After adjusting for age, patients with ovarian cysts without surgery needed a significant higher stimulation dose than the control group (2576.4 vs. 2207.5 IU, p Conclusions Ovarian cystectomy did not negatively impact the pregnancy rate or the live birth rate compared to controls.

Background and Objectives: The aim of the study was to investigate a potential association between previous childhood appendectomy, tube pathology, and female infertility. Methods: We reviewed patients seeking care at the fertility clinic of our university medical center between 2006 and 2016. The history of previous appendectomy was extracted from hospital documentation and by telephone follow-up. Tubal patency was assessed by diagnostic laparoscopy and chromopertubation. Results: In our study cohort (N = 237), 24.9% (n = 59) had a history of previous appendectomy. Previous appendectomy, therefore, was about 3-fold more prevalent in women seeking fertility treatment than in the general population. Patients with previous appendectomy had more intra-abdominal adhesions (P < .001) and patients with adhesions tended to have compromised tubal patency (P = .05). However, there was no direct correlation between a previous appendectomy and tube pathology (P = .727). Conclusion: Because previous appendectomy was associated with intra-abdominal adhesions, and these were in turn associated with tube pathology, but appendectomy was not directly associated with compromised tubal patency, previous appendectomy may indirectly affect female fertility through mechanisms other than direct tubal obstruction. This is one of the largest study analyzing laparoscopic chromopertubation in association with previous childhood appendectomy.

Background It 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. Methods The 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. Results 92.6% 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. Conclusion While 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.

Anti-Mullerian hormone has a regulative function in the activation of folliculogenesis and an influence on atresia rate. It is considered a marker for the ovarian reserve. We know that a relationship exists between AMH levels and oocyte retrieval numbers, antral follicle count, pregnancy rates and birth rates. The role of AMH as an efficient prognostic factor in determining the probability of pregnancy has been largely discussed in the literature. The aim of this study is to determine the role age and AMH levels play in success rates of IVF/ICSI therapies. To date, the sample group we examined was one of the biggest ever included in a single study of the subject. All patients who underwent an IVF/ICSI treatment with FSH stimulation in the Wiesbaden Kinderwunschzentrum between 2003 and 2010, were no older than 44 years old, and had an evaluation of serum AMH levels before treatment were included in this study. In total, 1287 patients were analysed retrospectively. Statistical analysis was performed with SPSS. Females’ mean age was 34.89, ranging from 21 to 44 years. The patients underwent between 1 and 11 IVF cycles. Younger women had significantly higher AMH levels (p = 0.001). Patients with higher AMH levels had significantly lower break-off rates (p

Intrauterine insemination (IUI) has latterly become less important in reproductive medicine. The aim of this retrospective analysis was to identify and evaluate the success rates of repeated insemination cycles in women of different ages. All women who underwent intrauterine insemination in the Wiesbaden Fertility Clinic between 1998 and 2010 were included in the analysis. Additional inclusion criteria were: not more than 45 years old, previous FSH stimulation and slight to moderate subfertility of the male partner. A total of 4246 insemination cycles in 1612 patients were included in the analysis. The average number of IUI cycles per patient was 2.24 (1-14). Patient age ranged from 19 to 45 years (mean: 33.9 years). Logistic regression analysis showed a drop in pregnancy rates with increasing age (p = 0.000). However, for the first three cycles the pregnancy rates for women aged 40 and 41 did not differ from those of women aged between 35 and 39 years. Overall pregnancy rates were stable in women up to the age of 40, even after several insemination cycles (7.5 and 10 %). Insemination is therefore still an effective procedure in selected patients. Stable pregnancy rates were recorded even after more than 3 cycles. After 3 cycles, the success rates for women aged 40 and 41 did not differ from those of women below the age of 40.Die intrauterine Insemination (IUI) hat in der Reproduktionsmedizin an Bedeutung verloren. Anhand einer großen Anzahl von Inseminationszyklen soll nun in der folgenden retrospektiven Analyse die Sinnhaftigkeit der wiederholten Insemination bei Frauen unterschiedlichen Alters herausgearbeitet werden. Dazu wurden von allen Patientinnen, die sich von 1998 bis 2010 im Kinderwunschzentrum in Wiesbaden einer homologen Insemination unterzogen, die in die Analyse eingeschlossen, die maximal 45 Jahre alt waren, die mit FSH stimuliert wurden und bei deren Partner eine leichte bis mäßige Subfertilität vorlag. Es handelte sich um 4246 Inseminationszyklen an 1612 Patientinnen. Die durchschnittliche Anzahl der durchgeführten IUI-Zyklen pro Patientin lag bei 2,24 (1–14). Die Patientinnen waren 19–45 Jahre alt (median 33,9 Jahre). In der logistischen Regression zeigte sich eine Verschlechterung der Schwangerschaftsraten mit zunehmenden Alter (p = 0,000). Dennoch unterscheiden sich die Schwangerschaftsraten der Patientinnen mit 40 und 41 Lebensjahren in den ersten 3 Zyklen nicht von den Patientinnen zwischen 35 und 39 Jahren. Insgesamt zeigen sich bis zum 40. Lebensjahr stabile Schwangerschaftsraten auch nach mehreren Zyklen (7,5 und 10 %). Die Insemination stellt bei passender Indikation nach wie vor ein effektives Verfahren dar. Auch nach mehr als 3 Zyklen sind noch stabile Schwangerschaftsraten zu verzeichnen. 40- und 41-jährige Patientinnen unterscheiden sich nach 3 Zyklen in ihrer Erfolgsrate nicht von den unter 40-Jährigen.

Although intrauterine insemination is one of the oldest techniques in reproductive medicine, its significance is still controversially discussed. Many factors have been reported as influencing pregnancy rates after IUI. The aim of this retrospective analysis is to evaluate the success rate of repeated inseminations depending on the type of ovarian stimulation. Patients who underwent intrauterine insemination in Wiesbaden Kinderwunschzentrum between 1998 and 2010, not older than 45 years of age, with male subfertility were included in this study. On the whole, 5,346 inseminations on 2,180 patients were analyzed retrospectively. Females’ mean age was 34.1, ranging from 19–45 years. In 433 cycles an insemination was performed during a natural cycle. 4,020 cycles were stimulated with recombinant FSH, 596 cycles with clomiphene, 194 with urinary FSH, 103 with HMG. The pregnancy rates range from 7.4 % in the clomiphene group to 14.4 % in the urinary FSH group. Clomiphene stimulation seems to offer the significantly lowest pregnancy rate (p = 0.03). The other types of stimulation do not differ significantly from each other concerning the pregnancy rate. Patients under 39 years of age do not profit from any ovarian stimulation. In 40 and more years of old patients, pregnancy rates are higher, if any stimulation was performed. To sum up, clomiphene stimulation showed to offer significantly lower pregnancy rates in comparison to the natural cycle, FSH stimulation and HMG stimulation in IUI treatment. While women younger than 40 seem not to profit from any ovarian stimulation, women over 40 do profit.

Fetuin-B wird in der Leber synthetisiert und kommt im Blut als Plasmaprotein vor. Seine Funktion war seit seiner Entdeckung im Jahre 2000 von Olivier, et al. bis vor kurzem unbekannt. 2013 wurde erstmals im Mausmodell gezeigt, dass Fetuin-B eine entscheidende Rolle bei der Fertilisation spielt (Dietzel et al., 2013). Fetuin-B fungiert als Ovastacin-Inhibitor und verhindert somit ein vorzeitiges Zona hardening. Erst nach Eindringen des Spermiums in die Eizelle und der darauffolgenden Kortikalreaktion werden grosere Mengen an Ovastacin ausgeschuttet, sodass es zum physiologischen Zona hardening kommt. Fetuin-B kommt ebenfalls beim Menschen vor. Da die Serumkonzentration vom Fetuin-B zyklusabhangig schwankt, wurde in dieser Arbeit untersucht, ob Fetuin-B ebenfalls in den Ovarien synthetisiert wird. Es wurde von Patientinnen, die sich einer Kinderwunschbehandlung unterzogen haben, Serum aus dem Blut, die Follikelpunktatflussigkeit und Zellkulturuberstande von Eizellen sowie von Granulosazellen untersucht. Es konnte Fetuin-B sowohl in der Follikelpunktatflussigkeit als auch im Zellkulturuberstand von Granulosazellen gemessen werden. Dies lasst die Vermutung aufkommen, dass die Granulosazellen ein moglicher weiterer Syntheseort von Fetuin-B sind. Dabei wurde beobachtet, dass mit zunehmender Verweildauer der Granulosazellen in Kultur, die Fetuin-B Konzentration abnimmt. Es konnte auch gezeigt werden, dass die eizellnahen Granulosazellen, auch Kumuluszellen genannt, starker Fetuin-B sekretieren als die Granulosazellen aus dem Follikelpunktat. Dies erscheint logisch, da das Fetuin-B an der Eizelle seinen Wirkungsort hat. Somit konnte zum ersten Mal gezeigt werden, dass Fetuin-B von Granulosazellen sekretiert wird. Dies konnte ein interessanter Ansatzpunkt fur Therapien von infertilen Paaren sein, wie z.B. als Prognosefaktor fur eine erfolgreiche IVF.

Das Time-lapse Imaging System (T-lIS) erlaubt eine morphokinetische Beurteilung der Embryonalentwicklung vom Zeitpunkt der Befruchtung der Eizelle bis hin zur Entwicklung zur Blastozyste am 5. Tag nach Fertilisation. Dadurch sollen moglichen aneuploiden Embryonen, die zu Aborten fuhren konnten, sich leichter identifizieren lassen. Ziel dieser Studie ist der pradiktive Wert des T-lIS in Kinderwunschtherapien festzustellen. Material und Methoden: Zwischen 06.2013 – 09.2014 wurden bei 107 Patientinnen die eine ICSI (intracytoplasmatische Spermieninjektion) erhalten haben, eine Inkubation im T-lIS Embryoscope durchgefuhrt. Davon wurde bei 67 Frauen (62,6%) eine Polkorperdiagnostik durchgefuhrt. Die Teilungszeitpunkte der Zellteilung bei der Patientinnen die schwanger und nicht schwanger geworden sind wurden verglichen, sowie das Teilungsverhalten der Eizellen bei denen eine genetische Information vorlag. Mittels logistische Regressionsanalyse wurde der Einfluss der Teilungszeitpunkte („in range“ wenn 25 – 75. Perz und „out of range“) auf die Schwangerschaftsrate getestet. Ergebnisse: Im Durchschnitt wurden 13,74 Eizellen gewonnen (3 – 26), und 9,19 fertilisiert (2 – 25). Die Fertilisierungsrate betrug 84,74%. Bei 23 Frauen (21,7%) ist eine Schwangerschaft eingetreten, 5 davon Mehrlinge (4,7%). 20 der 67 Frauen die eine Polkorperdiagnostik durchfuhrten sind schwanger geworden, 3 davon mit Mehrlinge. Es zeigte sich insgesamt eine schnellere Zellteilung bei den schwangeren Patientinnen (Zellteilung in range vom Einzeller zum Zweizeller OR 1,508; vom Vierzeller zum Funfzeller OR 1,201; vom Beginn der Blastolierung bis zur reifen Blastozyste OR 2,83) als bei der Nichtschwangeren, jedoch nicht signifikant. Ahnliche Tendenzen zeigten sich bei der schwangeren Patientinnen die zusatzlich eine Polkorperdiagnostik hatten. Zusammenfassung: Die erste Zellteilung, sowie das Erreichen einer Blastozyste haben einen entscheidenden Einfluss auf die Schwangerschaftsrate in Kinderwunschtherapien.

Multiple pregnancies are more often associated with complications than singleton pregnancies. In our retrospective study of 613 twin pregnancies the most important risk factors in twin pregnancies were premature labour before the 37th week of gestation and the premature rupture of the membrane. The increase of perinatal mortality and morbidity for twins might be primary the result of premature delivery.

Heute verzichtet praktisch keine Abteilung auf eine permanente Prasenz im Internet. Die hier eingesetzten Prasentationen unterscheiden sich allerdings erheblich im Aufwand, den eingesetzten Verfahren, der Gestaltung der Seite, der Eigenstandigkeit, den dahinter stehenden Motivationen und der Seriositat der verbreiteten Informationen. Nur durch eine zentrale Zertifikation der Inhalte besteht die Chance, dass auch zukunftig Patienten und Mediziner gleichermasen seriose und valide Informationen aus diesem Medium schopfen konnen.

Objective. Aggressive chemotherapy and radiotherapy or radical oncological surgery in young women with cancer has greatly enhanced these patients' life expectancy, but these treatments often cause infertility or premature ovarian failure due to a massive destruction of the ovarian reserve. The objective of this review is to discuss the effect of the various cancer treatments on fertility and present the various fertility sparing operations and fertility preservation strategies. Method. An extensive survey of the most up-to-date literature was performed. Results. This review discusses the impact of current cancer treatment on fertility potential and the various surgical and assisted-reproduction innovations available today for the most common cancers in young women. Although the ability to retain reproductive potential is becoming a major quality-of-life factor in an increasing number of young female cancer survivors, they are still being poorly counseled with regard to the negative impact of the treatment on their fertility and on their options for fertility preservation. Conclusion. As the emerging discipline of fertility preservation is steadily attracting increasing interest, developments in the near future promise to be very exciting. However, in everyday routine work, better interdisciplinary cooperation between gynecological and pediatric oncologists, surgeons, immunologists, and endocrinologists is necessary so that individualized options for fertility preservation can be offered in advance of surgical procedures or cancer treatments.

Background and question: Malignant cells characteristically possess high levels of proteases (e.g. plasminogen activator, cathepsin etc.), which should induce fibrinolysis. The DR-70 immunoassay quantifies the amount of fibrin degradation products (FDP) in the body. This test system has successfully been used for the detection of a number of cancers including lung, stomach, breast, rectum, liver, colon and uterus cancer. In this paper we tested the diagnostic validity of DR-70 relative to CA-125 as a tumor marker for the detection of ovarian carcinoma. Methods: We have simultaneously investigated the serum activities of DR-70 and CA-125 from 61 preoperative patients with histologically confirmed ovarian carcinoma. One hundred healthy blood donors served as control group. We measured the FDP utilizing the DR-70 ELISA as per test instructions of its manufacturer AMDL (Tustin, CA, USA). Results: Low levels of FDP measured by DR-70 have been detected in the serum of 100 apparently healthy persons (mean±S.D., 0.41 ±0.19 μg/ml). Among the 61 ovarian carcinoma patients, DR-70 mean value (±S.D.) was 7.0 ± 10.5 μg/ml in a range of 0.6 to 58.5 μg/ml. The cut-off level for DR-70® was set at > 1.2 μg/ml. The specificity was 100%, whereas the sensitivity was at 83.6%. Relative to CA-125 a cut-off level of > 65 U/ml was applied. The comparable sensitivity of DR-70 was higher by 13.1 %. Conclusions: Malignant cells with high levels of proteases are significant contributors to fibrinolysis. The DR-70 immunoassay has been designed to measure the level of FDP in the serum. DR-70 represents a tumor marker with which ovarian carcinoma can be diagnosed at levels of sensitivity and specificity which compare favorably to those measured with CA-125.

Purpose: Human papillomavirus (HPV)16 E6 and E7 oncoproteins that are required for cellular transformation represent candidate targets for HPV specific and major histocompatibility complex (MHC) class-I restricted CD8+ T-cell responses in patients with cervical cancer. In the present study, we identified HPV specific T-cells in different biological compartments (peripheral blood lymphocytes [PBL], tumor tissue, tumor-draining lymphnodes) using MHC-class I tetramers containing an appropriate HPV 16 E7 peptide. Material and Methods: FACS sorted (fluorescence activated cell sorting) CD8+T-cells isolated from healthy blood donors (n=10), patients with carcinoma in situ (n = 9) and invasive cervical cancer (n = 15) were obtained from PBL, tumor and pelvic nodes and evaluated for the presence of HPV 16 E7 specific effector CD3 + lymphocytes using the new tetramer technology. HPV DNA in tumor tissue was detected by PCR. All cervical cancer lesions could be identified as HPV 16 positive. PBL, tumor infiltrating lymphocytes (TIL), or T-cells from tumor-draining lymph nodes were isolated, gated on CD3 + CD8+T-cells as indicated and tested for the frequency of HPV 16 E7 using HLA-A2 tetramer complexes. All patients included showed an HLA-A2 haplotype. Results: 50% of healthy individuals, but less than 20% of patients (cervical intraepithelial neoplasia (CIN), invasive cancer) showed a specific cytotoxic CD8 + immune response to a defined HPV 16 E7 11-19 epitope (YMLDLQPET) in peripheral blood. HPV-reactive cytotoxic T-cells were detectable in tumor-draining lymph nodes in only one patient. Conclusions: The tetramer-sorting of CD8 + T-cells from different biological compartments in patients with HPV associated cancer lesions permits the determination of the target specificity of CD8 + effector T-cells without further need for in vitro manipulation. Furthermore, this new method helps to define the most appropriate target epitopes for novel vaccine designs.

OBJECTIVE: Are serum concentrations of the ovarian glycoproteins inhibin A, inhibin B, pro-alpha-C and activin A different in normotensive, chronical hypertensive or pregancies complicated by preeclampsia or HELLP-syndrome? What are the clinical consequences? METHODS: Serum concentrations of inhibin A, inhibin B, pro-alpha-C, and activin A of 99 women (37 normotensive patients, 23 patients with chronical hypertension, 25 women with preeclampsia and 14 patients with HELLP-syndrome) at different stages of pregnancy were determined by high specific ELISAS. RESULTS: During pregnancy serum levels of all parameters increased continually and fell rapidly within parturition. Activin A and inhibin B levels showed significant higher serum concentrations in patients with preeclampsia and - even more pronounced - in patients with HELLP-syndrome. Normotensive and chronically hypertensive patients were not different. CONCLUSION: Activin A and inhibin A appear to be viable candidates as laboratory parameters for detection of pregnancy induced hypertension. Maybe furthermore both parameters will allow the discrimination between chronic hypertension and hypertension induced by pregnancy.

Objective: To evaluate the impact of treatment for genital cancer on quality of life and body image to determine patients' therapy-related needs with respect to qualitative improvements of medical care before and after surgery. Methods: Between June 1993 and July 2003 129 women with cervical cancer were assessed before and 4 and 12 months after surgery by semistructured interviews and standardised questionnaires. Thanks to funding, since 1999 all patients with a diagnosis of genital or breast cancer can participate in this prospective study. In this paper we will focus on therapy-related changes in quality of life and body image in women with cervical cancer. The evaluation of quality of life (CARES) incorporated five aspects: physical and psychosocial health; marital and sexual status; medical interaction. With respect to body image (Strauss and Appelt) the attractiveness/self-confidence and sexual uncertainty were evaluated. Results: Before surgery, women with a Wertheim's procedure had significantly less problems with regard to the quality of life global score (p = 0.002) and several subscales compared to women with a pelvic exenteration. After surgery, both groups indicated that sexual problems were the greatest limitation in terms of quality of life, especially in women with non-reconstructive surgery as well as in women with adjuvant radio- and/or chemotherapy. With respect to body image, attractiveness/self-confidence was significantly reduced postoperatively compared to the preoperative status in both groups (p = 0.000), and also worsened with the extent of treatment. Conclusion: This on-going study demonstrates the interrelationship between the treatment and the patient's quality of life, especially with regard to sexuality and body image. Our results suggest not only providing reconstructive surgery if possible, but also integrating psychosocial information on future quality of life before surgery as well as offering psychosocial support related to the extent of treatment after surgery.

Purpose: The aim of this prospective study was to evaluate the age-related effect on the cyclical patterns of serum inhibin A, inhibin B and activin A in younger and elder fertile women and to compare them with concentrations of LH, FSH, estradiol and progesterone. Patients and Methods: 52 healthy women aged 18-45 years experiencing regular cycles participated in the study. Group I consisted of 28 women (median age: 23.6 years), group II consisted of 24 women (median age: 39.4 years). Serum inhibin A, inhibin B, activin A, LH, FSH, estradiol and progesterone were measured on day 3, 8 and 22 of the cycle. Results: There was a statistically significant difference in the concentration of FSH in both groups (p-value

There is common agreement about the importance of information management systems in obstetrics and gynecology. Those systems are necessary tools for medical quality management and are essential for the actual preparation for the age of the "diagnosis related groups" that will be introduced in Germany next year. Nevertheless there are only small scientifically activities to improve information management systems and to evaluate their performance. Great efforts are necessary to develop new features and not to loose the conflict between the needs of the physicians and their patients and the needs and demands of hospital administrative authorities.

Objective In response to antigenic stimulation, naive MHC-class I restricted and antigen-specific CD8+CD45RA+CD28+T-cells undergo clonal expansion and differentiate into CD8+CD45RO+ memory T-cells. Upon re- encounter with the nominal antigen, CD45RO+ T-cells are able to convert to CD8+CD45RA+CD28-T-cells displaying potent immune effector functions, including TNF-alpha production. This T-cell subpopulation constitutes a minor population in healthy individuals. In the present study we are currently evaluating whether this particular T-cell subset in PBL represents CD8+T-cells which may be able to recognize cervical cancer associated antigens provided by HPV 16 E7. Material and methods Flow-cytometric cell sorted CD8+CD45RA+CD28- and CD8+CD45RA+CD28-T-cells were obtained from patients with cervical cancer and tested for recognition of HLA-A2 restricted peptides derived from the human papillomavirus (HPV)16-E7 gene product using ELISA. HPV DNA in tumor tissue was detected by PCR. Results We show that the effector CD8+CD45RA+CD28-T-cell subset is expanded in peripheral blood lymphocytes (PBL) from patients with cervical cancer, but also in PBL from patients with an acute mycobacterial infection. CD8+T-cells from 3/6 cancer patients showed a peptide-specific immune response which could be segregated in peptide epitopes which elicited either a strong TNF-alpha production, or GM-CSF and IL-2 secretion. Peptide-reactivity could exclusively be detected in the ex vivo freshly isolated CD8+CD45RA+CD28-T-cell population. A similar situation was found to be true for HLA-A2 presented peptide epitopes derived from M. tuberculosis-associated antigens presented to T-cells obtained from patients with tuberculosis. Conclusions The sorting of CD8+CD45RA+CD28-T-cells enables to determine the fine specificity of CD8+ effector T-cells without the need for in vitro manipulation and aids to define the most appropriate target epitopes for novel vaccine designs.

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). Methods: Seventy-seven women who underwent ART were included in the study and were divided into two groups: (i) 46 women with sonographically documented follicular maturation; and (ii) 36 women who demonstrated inadequate follicle development. Blood samples were analyzed for inhibin A, inhibin B, pro-alpha-C, activin A and estradiol (E2) at day 3 of stimulation with recombinant follicle-stimulating hormone (rFSH) after pituitary downregulation. Results: Women with sonographically documented follicular maturation compared with those with inadequate follicle development showed a highly significant (P < 0.001), more than double, increase in inhibin B. The level of pro-alpha-C was 1.5-fold as high (P = 0.007), while E2, at a factor of 2.1-fold, exhibited a borderline significant increase (P = 0.028). Activin A and inhibin A levels exhibited no change under rFSH stimulation. Conclusions: The present study showed, in a small number of patients undergoing in vitro fertilization treatment with rFSH stimulation, that inhibin B acts as a reliable marker for biochemical monitoring at day 3 of stimulation with rFSH in ART.

In the present study, we examined die role of c-erbB-2 for chemoresistance in ovarian cancer. Overexpression of c-erbB-2 mRNA in tumor tissue was associated with a shorter survival of patients with primary ovarian cancer (P = 0.0001, N = 77) and was an independent prognostic factor in the proportional-hazard model (P = 0.035). A significant association between expression of c-erbB-2 mRNA und survival was obtained for the subgroup of patients who received a standard chemotherapy with carboplatin or cisplatin and cyclophosphamide (P = 0.0003). In addition, the application of a standard chemotherapy improved the survival of patients with relatively low c-erbB-2 expression (P = 0.013), but not of patients with overexpression of c-erbB-2 (P = 0.359). Expression of c-erbB-2 mRNA correlated with expression of topoisomerase IIalpha mRNA determined by a reverse semiquantitative PCR technique (P = 0.009), whereas expression of c-erbB-2 und topoisomerase IIbeta mRNA dit not correlate (P = 0.221). The data suggest that topoisomerase IIalpha, which correlates with c-erbB-2 expression, contributes to the resistance of c-erbB-2-overexpressing carcinomas.

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.Serum concentrations of ovarian proteohormones and estradiol.Academic clinical practice.30 women who underwent assisted reproductive techniques.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.Activin A levels did not change with recombinant FSH stimulation. In women with a sonographically detected leading follicle17 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.Inhibin A and pro alpha-C are effective markers of follicular development and may be effective additions to estradiol as a marker.

Internet presentations are common tools for better medical communication and better scientific work. Meanwhile a great number of gynecological and obstetrical institutions present data via the world wide web within a wide range of quality and performance. Specific HTML editors offer quick and easy presentations, but only advanced internet techniques enable interesting multimedia presentations. N-tier applications are the future standard and we must integrate them in general informatical systems. New Concepts, actual tools and general problems will be discussed and new principles similar to actual E commerce techniques are able to solve our special medical demands.

Rapid development and innovative research in medical computer science influences physicians work. Not only new hardware but also network implementation changed the way of decision making techniques in medicine. The main reason for acceptance and distribution of the internet is the possibility to present information in a reasonable and contemporary way. A self-labeling of medical information by web authors and systematic critical appraisal of health-related internet information by third parties may help to filter harmful health information and to positively identify and select high quality information. The German Work Group for Information Technologies in Gynecology and Obstetrics (AIG) informs physicians about health care issues related to computer science.

In 2003 diagnosis related groups (DRG's) will be established in Germany as a new system for describing costs of inpatient treatment. Principles of medical controlling are explained, the development from the system formerly used in Germany towards DRG's is described and computer-based assistance already available is pointed out and evaluated critically.

Medical and commercial data are essential for sufficient clinical management. While regional quality studies--for example the German Perinatal Data Study--are mighty tools to compare the quality of departments in total--the integration of evaluated individual quality indicators in data processing systems can highly improve clinical results and clinical management. The evaluation of quality indicators improves the benefit of quality management. Parameters monitoring the contentment of patients are extremely valuable information. Quality management and information management are closely linked.

Das Internet stellt einen universellen dezentralen Verbund der unterschiedlichsten Computer und Systeme dar, die ein einheitliches Kommunikationsprotokoll benutzen und den Zugriff auf gigantische Informationsmengen ermoglichen. Die Bedeutung des Internet fur die Frauenheilkunde steht auser Frage und wird in der nachsten Zeit weiter wachsen. Eine kritische Beurteilung aktueller Entwicklungen ist aber ohne Auseinandersetzung mit technischen und informationstheoretischen Aspekten unvollstandig, und eine realistische Einschatzung neuer Optionen fur die Informationsverarbeitung in der Frauenheilkunde kann prinzipielle Probleme – insbesondere bei Sicherheitsfragen – bereits in fruhen Projektphasen erkennen lassen. Als aktuelle Entwicklungen erscheinen eingebettete Webserverapplikationen, Intranet-Internet-Verknupfungen und plattformunabhangige Applikationen von besonderer Bedeutung zu sein, die in medizinischen Anwendungen in nachster Zeit vermehrt zum Einsatz kommen werden. Webbasierte Anwendungen beeinflussen zunehmend auch “Konventionelle Applikationen der medizinischen Informatik” wobei sich Webbrowser zum universellen Front-End entwickeln.

OBJECTIVE: The aim of the study was to compare the perinatal outcome of spontaneously conceived twins with those conceived after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). MATERIAL AND METHODS: A retrospective study was performed. Clinical data of 188 twin pregnancies was collected from the Department of Obstetrics and Gynecology, University Hospital of Mainz for the years 1996-2006. The twins were divided into 2 groups according to the manner of conception: spontaneously conceived twins (n = 142) and twins (n = 46) conceived after IVF and ICSI. In order to investigate the perinatal outcome of spontaneous twins and twins conceived by assisted reproductive technology (ART), we evaluated the following parameters: maternal age, fertility, nulliparity rate, gestational age, mode of delivery, fetal weight and Apgar score. RESULTS: No significant difference was found in maternal age, fertility and gestational age between spontaneous twins and IVF/ICSI twins. Maternal gestational age was 255 days in the spontaneous group and 254 days in IVF/ICSI group. Fetal weight and Apgar score were similar between the two groups. The nulliparity rate was higher in IVF/ICSI group. Obviously there were more cesarean sections in the IVF/ICSI group than in the spontaneous group (76.2 % and 42.5 %, respectively). CONCLUSIONS: Duration of gestation, neonatal birth weight and Apgar score were similar between IVF/ICSI twins and spontaneous twins. IVF/ICSI twins had a higher cesarean section rate.

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 (GTL2 gene than samples leading to a live birth. All 13 normozoospermic and 13 OAT samples leading to a child had GTL2 epimutations, whereas one (7%) of 14 normozoospermic and 7 (50%) of 14 OAT samples without pregnancy displayed 1–14% GTL2 epimutations.

Severe postmenopausal virilization is a rare event in clinical practice. To evaluate ovarian or adrenal hyperandrogenism endocrine tests and imaging are useful diagnostic tools. We report a case of a postmenopausal woman with hirsutism and androgenetic alopecia. A malignant cause for the present disorder could be excluded by imaging. Selective venous sampling was administered with increased testosterone level of the right adrenal vein. Right adrenalectomy and right oophorctomy was recommended.

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...

Personal digital assistants (PDAs) are increasingly used by many professional and private users. They replace and combine common calendars, directories, to-do-lists and much more. Supplemented by useful additional software they can assist the clinician in his daily routine work. This concerns typical medical information as well as administrative work but gets more importance with regard to the planned introduction of diagnosis related groups in Germany however. Exact coding of medical performance is essential for this future invoice system. How PDAs can be used convenient in this respect will be shown with examples from our department.

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.

The number of follicles were compared in different developmental stages after the cryopreservation of human ovarian tissue by open freezing system followed by xenotransplantation into severe combined immunodeficient (SCID)-mice under stimulation, with and without ovariectomy. Ovarian tissue, cryopreserved for fertility preservation was partly examined by LIVE/DEAD viability staining or was transplanted in the neck muscle of 32 SCID-mice. The development of follicles, estradiol production, vaginal cytology and uterus weight was assessed after 15 weeks under gonadotropin stimulation, with or without ovariectomy. Viable follicles were detected in all frozen/thawed specimens using the LIVE/DEAD assay. Ovariectomy caused a significant improvement of survival of follicles in the preantral and antral stages in the gonadotropin-stimulated animals (p0.001), whereas there was no significant effect on the primordial and primary follicle counts. In the non-ovariectomised group, only isolated primordial and primary follicles could be detected. The total follicle amount was significantly higher in the ovariectomised group (n=17, 9.2 +/- 7.8, mean +/-SD) than in the non-ovariectomized group (n=15, 0.3 +/- 1.0). This study demonstrates that ovariectomy of stimulated recipient SCID-mice is essential for the development of follicles after xenotransplantation of cryopreserved human ovarian grafts.