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To study trends regarding the use of contraceptive methods and digital health modalities and to identify target groups of natural family planning (NFP).Using an online questionnaire specifically developed for this study in German (utilizing the online tool at 'www.surveymonkey.com'), we analysed the attitude towards NFP -methods and -apps, the need for contraceptive effectiveness in general, the perceived contraceptive effectiveness of NFP methods, and differences between NFP users and non-NFP users among 779 sexually active German-speaking women of fertile age (18-50 years) from November 2019 to October 2020.Participants used NFP more frequently than they did five years ago. Women aged 30 years and older, with higher levels of education, who are living with a partner and have children, seem to be the target group for NFP methods. Concerning the wish for contraceptive effectiveness we found significant (

Polycystic ovary syndrome (PCOS) is diagnosed according to the Rotterdam criteria, where two of the following three criteria must be met: Anovulation, hyperandrogenism, and characteristic morphology by sonography. Women diagnosed with PCOS are at higher risk for diabetes and impaired glucose tolerance. Therefore, these women should be carefully counselled about lifestyle measures and improvements in fertility and pregnancy outcomes. Some women benefit from metformin, which needs to be clarified by off-label use. For fertility, mild stimulation is possible in women with unovulatory cycles, whereas women with PCOS need to be monitored more closely for the development of gestational diabetes, preeclampsia or hypertension during pregnancy.

Aims The aim of this official guideline published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG) in cooperation with the Austrian Society for Gynaecology and Obstetrics (OEGGG) and the Swiss Society for Gynaecology and Obstetrics (SGGG) was to provide consensus-based recommendations for the diagnosis and treatment of endometriosis based on an evaluation of the relevant literature. Methods This S2k guideline represents the structured consensus of a representative panel of experts with different professional backgrounds commissioned by the Guideline Committee of the DGGG, OEGGG and SGGG. Recommendations Recommendations on the epidemiology, aetiology, classification, symptomatology, diagnosis and treatment of endometriosis are given and special situations are discussed.

To investigate the advantages of cryopreserved medulla-containing ovarian cortex grafts with those of commonly used sole cortex grafts for fertility preservation by analyzing tissue quality, neovascularization processes, and the number of vital follicles.Experimental setting of cryopreserved bovine ovarian cortex tissue grafts with or without medulla tissue.Laboratory animal research at Ulm University, Ulm, Germany.Bovine ovaries and fertilized chicken eggs.Experimental setting of bovine ovarian tissue samples grafted on the chicken chorioallantoic membrane (CAM) after cryopreservation and thawing to examine histologic tissue integrity, apoptosis and proliferation immunohistochemically, blood vessel counts and determine the presence of neutral red-stained vital follicles.We used hematoxylin and eosin staining to visualize tissue structures, immunohistochemistry with anti-caspase 3 to detect apoptosis, anti-Ki67 to examine proliferation, blood vessel count on the chicken CAM to investigate neovascularization processes, and neutral red staining to evaluate vital follicles.We demonstrated that in all analyzed tissue samples, after cryopreservation, thawing, and grafting on the chicken CAM, there was excellent tissue integrity and quality, as shown by extremely rare apoptosis processes analyzed using immunohistochemical caspase 3 staining (sole cortex, 0.54%; thin medulla-containing cortex, 0.43%; thick medulla-containing cortex, 0.13%; and sole medulla, 2.82%). Moreover, we detected increased neovascularization in the vicinity of medulla and medulla-containing grafts (small blood vessels: cortex 8.7, thin medulla-containing cortex 9.9, thick medulla-containing cortex 9.7, and medulla 9.8; very small blood vessels: cortex 7.0, thin medulla-containing cortex 13.0, thick medulla-containing cortex 12.0, and medulla 15.0), with higher Ki67-detected proliferation (cortex, 17.58%; thin medulla-containing cortex, 20.28%; thick medulla-containing cortex, 20.56%; and medulla, 29.9%). Additionally, we identified an increased number of vital follicles in medulla-containing cortex grafts compared with the number of vital follicles in sole cortex tissue (cortex, 256.1; thin medulla-containing cortex, 338.2; thick medulla-containing cortex, 346.6; and medulla, 8.1).In this experimental setting, bovine medulla-containing cortex tissue had excellent tissue structure and quality after cryopreservation and thawing and increased neovascularization and an augmented vital follicle count after grafting than the commonly used sole cortex tissue. Therefore, we suggest reconsidering the current cryopreservation and grafting processes in humans for fertility preservation by favoring retain medulla tissue at the ovarian cortex.

Introduction Supporting and counselling couples with fertility issues prior to starting ART is a multidisciplinary diagnostic and therapeutic challenge. The first German-language interdisciplinary S2k guideline on “Diagnosis and Therapy Before Assisted Reproductive Treatments (ART)” was published in February 2019. The guideline was developed in the context of the guidelines program of the German Society of Gynecology and Obstetrics (DGGG) in cooperation with the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Aim In one third of cases, the cause of involuntary childlessness remains unclear, even if the woman or man have numerous possible risk factors. Because the topic is still very much taboo, couples may be socially isolated and often only present quite late to a fertility center. There is no standard treatment concept for these patients at present, as there are currently no standard multidisciplinary procedures for the diagnostic workup and treatment of infertility. The aim of this guideline is to provide physicians with evidence-based recommendations for counselling, diagnosis and treatment. Methods This S2k guideline was developed on behalf of the Guidelines Commission of the DGGG by representative members from different professional medical organizations and societies using a structured consensus process. Recommendations This second part of the guideline describes the hematological workup for women as well as additional diagnostic procedures which can be used to investigate couples and which are carried out in cooperation with physicians working in other medical fields such as andrologists, geneticists and oncologists.

Bei vielen Neoplasien besteht heutzutage eine hohe Heilungschance. Somit ruckt das Thema „Kinderwunsch“ insbesonders bei jungen Frauen mit Krebs zunehmend in den Vordergrund. Jede pramenopausale Frau sollte somit vor Beginn einer Chemotherapie oder Bestrahlung des kleinen Beckens uber Moglichkeiten des Fertilitatserhaltes informiert werden.

Nach einem kurzen Uberblick uber die Geschichte der Reproduktionsmedizin – HMG (humanes Menopausengonadotropin), IVF (In-vitro-Fertilisation) und ICSI (intrazytoplasmatische Spermieninjektion) – werden der State of the Art, etwa beim Fertilitatserhalt vor onkologischen Behandlungen, und aktuelle Forschungsvorhaben dargestellt. Diskutiert werden Methoden der assistierten Reproduktion nicht nur unter medizinischen, sondern auch unter gesellschaftlichen und psychologischen Aspekten („social freezing“, Eizellspende).

Purpose Official guideline of the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (ÖGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). The aim of this guideline was to standardize the diagnosis and treatment of couples with recurrent miscarriage (RM). Recommendations were based on the current literature and the views of the involved committee members. Methods Based on the current literature, the committee members developed the statements and recommendations of this guideline in a formalized process which included DELPHI rounds and a formal consensus meeting. Recommendations Recommendations for the diagnosis and treatment of patients with RM were compiled based on the international literature. Specific established risk factors such as chromosomal, anatomical, endocrine, hemostatic, psychological, infectious and immunological disorders were taken into consideration.

Because of substantial toxicities in older adults, chemotherapy is often omitted while the frequency of radiotherapy changes only minimally. In this study, we addressed the value of different assessments for predicting fatigue after radiotherapy in older breast cancer patients. We included 74 women with primary breast cancer over the age of 65 years treated with radiotherapy (26 % with additional chemotherapy). Assessments were conducted before adjuvant treatment and after radiotherapy. The assessments included the Vulnerable Elders Survey (VES-13), the Karnofsky Performance Status (KPS), the EORTC Quality of Life assessment (EORTC-QLQ-C30), a cancer-specific comprehensive geriatric assessment (cancer-specific CGA), and the Fried frailty score. Multiple linear regression analyses were used to assess correlations with the FACIT-fatigue scale. Patients were on average 71 years old (range, 65–86 years). Most tumors (n=62) were classified as intermediate risk according to the St. Gallen consensus. The cancer-specific CGA was best associated with fatigue (p

Work–life balance is an upcoming issue for physicians. The working group “Family and Career” of the German Society for Gynecology and Obstetrics (DGGG) designed a survey to reflect the present work–life balance of female and male gynecologists in Germany. The 74-item, web-based survey “Profession–Family–Career” was sent to all members of the DGGG (n = 4,564). In total, there were 1,036 replies (23 %) from 75 % female gynecologists (n = 775) aged 38 ± 7 (mean ± standard deviation [SD]) years and 25 % male (n = 261) gynecologists aged 48 ± 11 years. Statistical analyses were performed using the mean and SD for descriptive analysis. Regression models were performed considering an effect of p ≤ 0.05 as statistically significant. 47 % women and 46 % men reported satisfaction with their current work–life balance independent of gender (p gender = 0.15). 70 % women and 75 % men answered that work life and private life were equally important to them (p gender = 0.12). While 39 % women versus 11 % men worked part-time (p gender 0.05). At least 37 % women and men neglected both their partner and their children very often due to their work. Female physicians often described their work situation similar to male physicians, although important differences regarding total work time, overtime work and appreciation by supervisors were reported. Work life affected private life of women and men in a similar way.

For several years there is an evidence for a relationship between the polycystic ovary syndrome (PCOS) and of insulin resistance; therefore metformin, an insulin sensitizer, is used for the treatment for more than 10 years. However, the evidence for metformin is assessed controversially. This review will give an overview about the data published on this topic.

PURPOSE: Cryopreservation, the most important stage of the cryobanking of ovarian tissue, can be carried out using one of two methods: conventional (“slow”) freezing, and vitrification (direct and immediate immersion into liquid nitrogen). For human oocytes and embryos vitrification is more effective compared to conventional freezing. However, these comparative data are limited for human ovarian tissue. The aim of this study was to compare conventional freezing of ovarian tissue with vitrification. MATERIAL AND METHODS: Ovarian tissue from 5 patients was transported to the laboratory within 20 min at 32 to 34 °C, divided into smaller pieces (1 × 1 to 1,5 × 0,7 to 1 mm) and randomly distributed into three groups: Group 1: control (fresh tissue), group 2: pieces after vitrification/warming, Group 3: pieces after conventional freezing/thawing. All pieces were cultured in vitro for 12 days. The viability of the tissue was evaluated by the development of the follicles and GAPDH gene expression after in vitro culture. Results: 93, 74 and 78 % of the follicles of groups 1, 2 or 3 were morphologically normal. Molecular analysis showed that the intensity of GAPDH gene expression in the tissue after conventional freezing was greatly increased compared to after vitrification. CONCLUSION: It was concluded that for the cryopreservation of human ovarian tissue conventional freezing is more suitable than vitrification.

To determine whether the prescribing practice of physicians with regard to estrogen replacement therapy (ERT) in symptomatic women with previous endometrial cancer is consistent with the available evidence.A descriptive survey was conducted among physicians in Germany, using a questionnaire containing two hypothetical cases of endometrial cancer patients ('low-risk' and 'high-risk' disease) and menopausal symptoms. Physicians were asked about their prescribing practice concerning moderate to severe menopausal symptoms.Four hundred and twenty questionnaires were sent out, with an overall response rate of 39.8%; 45.6% in the 'low-risk' case and 75.4% in the 'high-risk' case (p0.0001) stated that ERT is contraindicated. Only 12.9% were willing to prescribe ERT; 81.9% preferred to prescribe non-estrogenic alternatives (44.8% phytoestrogens, 29.0% selective serotonin reuptake inhibitors).Despite the evidence that ERT does not increase the risk of recurrence of endometrial cancer, many physicians are reluctant to prescribe ERT in women suffering from moderate to severe menopausal symptoms.

Objective To investigate whether sphingosine-1-phosphate (S1P), an apoptosis-inhibitor, would be able to protect ovarian follicles from chemotherapy-induced cell death in vivo. Design Animal study. Setting Academic medical center. Animal(s) Twenty female mice. Intervention(s) Twenty mice were randomly assigned into three groups: in group A (n = 8), each mouse received an injection of low concentration of S1P (A1: 0.5 mM), prepared in a vehicle (PET) into the bursa of one ovary and a high concentration (A2: 2.0 mM S1P) to the contralateral ovary. In group B (n = 8), only PET was injected to both ovaries. Afterwards, both groups received 100 μg Dacarbazine (Medac, Hamburg, Germany) IV. The control group C (n = 4) received no chemotherapy. After 2 weeks, the ovaries from group C and from 4 mice from group A and B were evaluated histologically. The remaining mice from group A and B were allowed 3 mating attempts at 4, 8, and 12 weeks after chemotherapy. Main Outcome Measure(s) Primordial/primary and pre-/antral follicular density, pregnancy rates. Results Chemotherapy caused a significant reduction in the mean number of primordial follicles of mice treated with only PET or with low concentration of S1P (1.86/field of view [C] vs. 1.17 [B] and 0.98 [A1]; P =.006 and P P =.918, not significant). Furthermore, three mice (75%) from group A became pregnant at the first mating attempt, in contrast to group B, in which only one mouse (25%) became pregnant and only after the third mating attempt. Conclusion(s) Local application of S1P protects ovarian follicles from chemotherapy-induced cell death, thereby preserving fertility.

Background: Fertility preservation by ovarian cryopreservation and heterotopic ovarian transplant is hampered by ischemic damage of the transplanted graft and poor oocyte viability. Design: Two longitudinal experiments were done - phase A: to evaluate if the administration of gonadotrophins (hMG) or vascular endothelial growth factor (VEGF) increases follicular survival after heterotopic autologous ovarian transplantation, and phase B: to determine if the administration of hMG enhanced neovascularization by increase in microvessel density in the heterotopic xenologous ovarian transplant. Methods: A: In three sheep, ovaries were removed and immediately transplanted into the abdominal wall. In one sheep, VEGF was administered at the transplantation site during surgery, the second was treated with hMG after transplantation for 2 weeks, and the third sheep served as control. B: The ovaries from two other sheep were removed, prepared in tissue pieces, and immediately grafted into the subcutaneous space of several combined immunodeficient (SCID-)mice (n=20). Following the transplantation, 10 of these mice (group 1) were treated with hMG until they were sacrificed, the other 10 untreated mice (group 2) served as controls. In each group, two mice were sacrificed at intervals of 2,4,6,10, and 14 days after grafting to permit histologic examination of the grafted tissue. Results: A: Whereas VEGF had no effect on follicular survival after transplantation (12.0% vs. 7.4%.),the administration of hMG increased follicular survival (12.0% vs. 29.0%). B: The use of hMG resulted in significantly higher numbers of microvessels per mm 2 (mean) at all of the time points studied - at 2 days 22 vs. 13 (p < 0.001), 4 days 22 vs. 13 (p < 0.001), 6 days 17 vs. 13 (p = 0.006), 10 days 28 vs. 12 (p < 0.001), and 14 days 35 vs. 16 (p

Male infertility factors are identified in approx. 40% of infertile couples. This is partially due to genetic aberrations, infections or endocrine disorders. However in approx. 30% of the cases there is no clear evidence of an underlying disease. These cases are classified as unexplained or idiopathic infertility. As the reason for infertility in these cases is unknown, there is no causal treatment available. This review provides an update on empirical treatment options for idiopathic male infertility.

Thank you for your response [1] to our manuscript [2]. Indeed we agree with the dilemma of satisfaction with work–life balance. It is very interesting, that young students choose to be a gynecologist because of the expectation of having a work–life balance but then realize that this is not the case. I think this is the biggest problem, which we need to be concerned of and need to address in future. The question is—WHY does the expectation for a good work– life balance does not come true? Is it the amount of time, which needs to be spent at work? Is it the scarce opportunity for part-time work? Or is it the total number of ‘‘on duty’’-calls? Or even the kind of work, that itself is not what young professionals expected? Is it the heavy responsibilities in obstetrics and/or the amount of emergencies? We need to address all these questions in future to find a solution on how to improve the work–life balance and raise the attractiveness of the gynecologic profession. Otherwise I expect, we will not find committed young physicians who choose the profession of gynecology and obstetrics.

Acute abdominal pain during pregnancy is rare and mostly caused by contractions. Since ileus during pregnancy is extremely seldom it is often overlooked and right management often starts too late. Only the correct diagnosis and subsequent operation will improve the prognosis for mother and child. Likewise the life-threatening risk for the mother needs to be weighed up against the risk of preterm birth for the child.

Conjoined oocytes derived from binovular follicles have been suspected to play a role in producing dizygotic twins, mosaicism, tetraploidy or chimeras. This issue is discussed by presenting three examples for conjoined oocytes observed in our programme of human assisted reproduction and by including a review of corresponding cases. Our material comprises two associated immature oocytes and two cases in which an immature oocyte was attached to a mature oocyte. One of the mature oocytes was fertilized and transferred after cleavage without resulting in pregnancy. In the literature, another fifteen descriptions of conjoined oocytes were found. Here, simultaneous fertilization of both gametes occurred only once and there was no evidence for pregnancies arising from binovular follicles. These data suggest that binovular follicles do not cause dizygotic twins or genetic abnormalities.

The aim of this study was to investigate whether sphingosine-1-phosphate (S1P), an apoptosis-inhibitor would be able to protect ovarian follicles from hypoxia-induced cell death in ovarian transplantation.In four sheep, both ovaries were removed and immediately transplanted back into the abdominal wall. In two of them, one ovary was treated with S1P locally by injection and incubation after dissecting the ovarian cortex. The contra lateral ovary of both sheep and both ovaries of the remaining sheep served as controls. After 2 weeks, all grafts were evaluated histologically.Although the mean number of apoptotic cells were increased after grafting compared with fresh tissue, we were not able to demonstrate a significant difference regarding the follicular density in tissue with S1P treatment (mean number of follicles per field of view: 0.21 vs. 0.23, p = 0.909).Apoptosis seems to play a role in follicular loss during ovarian transplantation; however, local application of S1P does not prevent primordial/primary follicles from hypoxia-induced cell death in cortical grafts in our study.

The uterosacral ligaments are an important part of the pelvic support system and connective tissue alterations are thought to contribute to the development of pelvic organ prolapse (POP). The objective of this study was to compare the expression of matrix metalloproteinases (MMPs) 1 and 2 in these ligaments in women with and without POP. We analyzed the tissue samples obtained from left and/or right uterosacral ligaments of 17 women with POP and 18 controls by immunohistochemistry. There was no difference in MMP-1 expression between women with POP and those without. In contrast, the MMP-2 expression was significantly related to the presence of POP (p=0.004) rather than to age or parity. There was no difference in MMP-1 and MMP-2 expression between left and right uterosacral ligaments in women with POP compared to controls. Our findings strongly indicate that increased MMP-2 expression in uterosacral ligaments is associated with POP.