Christian Gnoth

green-ivf, Grevenbroich, Germany & Depart. Gyn/Ob University of Cologne, Germany

Purpose: There is an ongoing debate whether the source of sperm cells, the etiology or the extent of male factor infertility has influence on the outcome of ICSI cycles. Methods: The results of intracytoplasmic sperm injection (ICSI) according to the source of spermatozoa in patients with severe male factor infertility were compared in a retrosp...

Viele Krankheiten sind heute heilbar, und noch mehr Krankheiten sind zu lindern. Damit ist die Möglichkeit für betroffene Frauen schwanger zu werden ein Ausdruck der Errungenschaften der modernen Medizin und für Betroffene auch psychologisch wichtig. Nur selten ist eine Warnung vor einer Schwangerschaft oder gar ein Abraten nötig. Die Entscheidung...

Every 5th–7th couple experiences times of involuntary childlessness. After 6 months without conception subfertility has to be assumed. In the case of unexplained subfertility the chance of spontaneous conception is relatively high over longer time periods of expectant management. But this is inappropriate for women aged over 35 years. An early shif...

The possibility to independently and autonomically practice contraception enables many women and couples to have the feeling of individual freedom. The breakthrough was achieved by the introduction of the baby pill on 1 June 1961. Contraception is often carried out over many years with the help of ovulation inhibitors before the desire for children...

Purpose: Many physicians and other healthcare professionals are often asked questions on interfering factors for conception by couples with a desire for children. Such possible disturbances include, for example, the very common minor diseases, stress and also sexual intercourse during the suspected implantation period. Non-scientifically based sta...

Age and fertility are closely linked. Women under 30 years of age have high and homogenous fertility with a chance of conception in every fourth cycle. After that, natural fertility steadily declines, especially from the age of 35. At 40 only every 10th cycle is successful, while natural fertility is virtually exhausted by 45–47 years of age. This...

Bei der Beurteilung der Sinnhaftigkeit und Effektivität reproduktionsmedizinischer Maßnahmen spielen Fragen nach dem „normalen“ Zyklus und den natürlichen Schwangerschaftsraten eine wichtige Rolle. Leider ist heute das Wissen über den normalen Zyklus eher gering, da viele gängigen medizinischen Maßnahmen wie z. B. die Einnahme hormoneller Kontrazep...

Es gibt verschiedene NFP-Methoden, die unterschiedliche Zyklussymptome zur Bestimmung des fertilen Fensters benützen. Sie unterscheiden sich in ihrer Treffsicherheit. In dieser Beziehung schneiden Kalendermethoden am schlechtesten, derzeit am besten Double-check-Methoden (STM, Sensiplan) ab. Die einzelnen Methoden werden in diesem Kapitel dargestel...

Zyklusmonitoring mit Selbstbeobachtung führt zu einer Steigerung der Empfängniswahrscheinlichkeit. Bei einer 8-monatigen Wartezeit vor dem 1. ART-Therapiezyklus wurden 38 % der Frauen – OAT- oder beidseitiger Tubenverschluss ausgeschlossen – schwanger, im Gegensatz zu 21,6 % ohne fertility awareness training. Hilfsmittel in der NFP wie Zykluscomput...

Continuously, new cycle apps come to the market. Besides tracking the menstrual period, they indicate the fertile window in the female cycle. The present paper evaluates the plausibility of currently available apps to correctly identify the fertile window. They can be divided into three groups: 1. Forecast apps: they predict the fertile window base...

Viele Krankheiten sind heute heilbar, und noch mehr Krankheiten sind zu lindern. Damit ist die Möglichkeit für betroffene Frauen schwanger zu werden ein Ausdruck der Errungenschaften der modernen Medizin und für Betroffene auch psychologisch wichtig. Nur selten ist eine Warnung vor einer Schwangerschaft oder gar ein Abraten nötig. Die Entscheidung...

Objective: The aim of this study was to assess whether luteinising hormone (LH) surge characteristics influenced the likelihood of conceiving naturally. Methods: This was a single-cycle, home-based, observational, case-controlled study. Volunteers collected daily urine samples for one menstrual cycle. LH was measured and the basal levels, surge day...

Das Familienplanungsverhalten hat sich in den letzten Jahrzehnten wesentlich verändert. Schwangerschaften werden oft nach langjähriger Kontrazeption erst für das letzte Viertel der fertilen Jahre einer Frau geplant, in der die Fruchtbarkeit möglicherweise bereits gravierend nachgelassen hat. Verantwortungsvolle Familienplanung bedeutet, bei der Kon...

Generally, ovarian reserve (OR) describes follicle quantity at the time of measurement. However, in addition, commonly used markers for OR serve as a proxy for follicle quality. Therefore, the term functional ovarian reserve (FOR) or ovarian potential should be preferred. The potential for spontaneous conception is mainly determined by female age....

Bei der Beurteilung der Sinnhaftigkeit und Effektivität reproduktionsmedizinischer Maßnahmen spielen Fragen nach dem „normalen“ Zyklus und den natürlichen Schwangerschaftsraten eine wichtige Rolle. Leider ist heute das Wissen über den normalen Zyklus eher gering, da viele gängigen medizinischen Maßnahmen wie z. B. die Einnahme hormoneller Kontrazep...

Purpose: To analyze cumulative pregnancy rates of subfertile couples after fertility awareness training. Methods: A prospective observational cohort study followed 187 subfertile women, who had received training in self-observation of the fertile phase of the menstrual cycle with the Sensiplan method, for 8 months. The women, aged 21-47 years, h...

Die Geburtenraten steigen zwar wieder etwas an, aber etwa jedes fünfte Paar sieht sich mit dem Problem eines unerfüllten Kinderwunsches konfrontiert. Schwangerschaften werden heute meist genau geplant, häufig nach jahrelanger Kontrazeption. Damit fällt die Verwirklichung eines Kinderwunsches oft in das letzte Viertel der fertilen Lebensphase einer...

Background: The study aim was to validate Beckman Coulter's fully automated Access Immunoassay System (BC Access assay) for anti-Müllerian hormone (AMH) and compare it with Beckman Coulter's Modified Manual Generation II assay (BC Mod Gen II), with regard to cycle AMH fluctuations and antral follicle counts. Methods: During one complete menstrua...

Purpose: To analyze cumulative and single-cycle success rates of IVF and intracytoplasmic sperm injection (ICSI) separately in relation to female age, fertilization modality, and first-cycle outcome. Methods: The study involved 2997 patients and couples, respectively, who underwent 5339 fresh and 3006 cryo cycles using pronuclear-stage oocytes....

Background New cycle computers and fertility apps appear on the market almost daily, which promise to support women in the determination of their fertile days. Objective and methods In the study the credibility of cycle computers and apps was assessed according to certain criteria. The various cycle computers and apps were assessed based on the res...

Background As a result of altered family planning behavior, pregnancies are nowadays often planned after a period of long-term contraception. They often occur in the final quarter of the fertile years of women during which the fertility is already severely reduced. Objective and methods The aim of this article is to present the relationship between...

Objective: To assess menstrual cycle antimüllerian hormone (AMH) levels in reproductive age women and which/how many follicles substantially produce AMH. Design: Prospective study of menstruating women using mixed-effects models to analyze AMH variability and correlation of follicle counts/size classes to AMH levels. Setting: Clinic. Patient(...

Background Natural family planning (NFP) is a collective term for a variety of methods that differ considerably in efficacy, practicability and acceptability. The NFP methods are based on knowledge of the fertile window and the restriction of unprotected sexual intercourse to only non-fertile days. They are also known by the term fertility awarenes...

Objective: The aim of the study was to examine relationships and interindividual variations in urinary and serum reproductive hormone levels relative to ultrasound-observed ovulation in menstrual cycles of apparently normally menstruating women. Methods: This was a prospective study of normally menstruating women (no known subfertility), aged 18...

To determine whether an optimal method exists for the detection of the luteinising hormone (LH) surge onset in research datasets of urinary hormonal profiles of menstrual cycles. The scientific literature was searched to compare published methodologies for detection of the LH surge onset in urine. Their performance was tested using complete hormona...

Urinary hormone level analysis provides valuable fertility status information; however, previous studies have not referenced levels to the ovulation day, or have used outdated methods. This study aimed to produce reproductive hormone ranges referenced to ovulation day determined by ultrasound. Women aged 18–40 years (no reported infertility) collec...

Artificial oocyte activation has been proposed as a suitable means to overcome the problem of failed or impaired fertilization after intracytoplasmic sperm injection (ICSI). In a multicentre setting artificial oocyte activation was applied to 101 patients who were diagnosed with fertilization abnormalities (e.g. less than 50% fertilized oocytes) in...

Die Ursachen für das Ausbleiben einer gewünschten Schwangerschaft sind vielfältig und haben sich, wie das reproduktive Verhalten in den westlichen Gesellschaften, in der Vergangenheit erheblich verändert. Zur ersten Abklärung des unerfüllten Kinderwunsches gehört eine gynäkologische Anamnese mit detaillierter Regelanamnese, ein Basishormonstatus, g...

The first home pregnancy test was introduced in 1976. Since then, pregnancy tests have become the most common diagnostic assay used at home. Pregnancy tests use antibodies to detect human chorionic gonadotropin (hCG). It is an ideal marker of pregnancy since it rises rapidly and consistently in early pregnancy and can be detected in urine. The most...

Die Fruchtbarkeit einer Frau ist nicht allein am chronologischen Alter abzuschätzen. Das Alter korreliert zwar mit der Eizellqualität und auch -quantität, aber besonders Letztere – die soge-nannte "ovarielle Reserve" – kann deutlich vom Alter abweichen. Unter den hormonellen Para-metern sind der AMH(Anti-Müller-Hormon)-Wert und der sonografische an...

Hintergrund Bei Kinderwunsch findet die alleinige oder adjuvante Therapie mit Akupunktur einen immer breiteren Einsatz. Fragestellung Welche Evidenz gibt es für die Effektivität der Akupunktur? Material und Methoden Recherche in PubMed und der Cochrane Library nach Studien zum Thema und Analyse ihrer Aussagefähigkeit unter Einbeziehung von Übe...

Assessment of Ovarian Reserve and Fertility with Increasing Age. Female fertility depends not only on chronological age. Low AMH (< 1 ng/ml) or low AFC (< 10 in women ≤ 34 years, < 8 between 35-40 years) are a clear indication of decreased ovarian reserve. AMH is a more important marker of ovarian reserve than AFC. Combining both does not improve t...

Der Wunsch nach Gründung einer Familie fällt oft in die Zeit der bereits nachlassenden Fertilität eines Paares (▶ Kap. 1). Bereits 1934 errechnete der Berliner Versicherungsmathematiker Hans Münzer für eine 40-jährige Frau eine nur etwa 5 %ige Schwangerschaftswahrscheinlichkeit pro Jahr. Trotzdem wird nicht selten 20 Jahre lang in den “besten Jahre...

Einer Sterilitätstherapie wird im Mutterpass der Rang eines relevanten Schwangerschaftsrisikos eingeräumt, der die gesamte Schwangerschaft schließlich zur Risikoschwangerschaft machen kann. In Deutschland werden etwa 3 % aller Kinder nach Maßnahmen der assistierten Reproduktion geboren; nach Angaben des Deutschen IVF-Registers wurden von 1997 bis 2...

Kinderwunsch und spätere Schwangerschaft - Kompetente Beratung und Betreuung der Patientin und ihres Partners in jeder Situation Bis zu 25% aller Schwangerschaften gelten heutzutage als Risikoschwangerschaft. Deshalb sind besonders bei Frauen mit Vorerkrankungen schon bei der Planung und später während der Schwangerschaft besondere Maßnahmen zu be...

In the last 40 years, fertility rates in Western societies have been declining as a result of lifestyle and generative behavior. This review summarizes current evidence-based knowledge on natural infertility and epidemiological aspects of subfertility. A literature search on natural infertility and epidemiological aspects of subfertility was perfor...

Die Familienplanung hat sich infolge des Strukturwandels in entwickelten Gesellschaften erheblich verändert. Schwangerschaften werden oft genau und nach langjähriger Kontrazeption geplant, die Kinderzahl ist niedrig. Der Kinderwunsch fällt immer öfter in das letzte Viertel der fertilen Lebensphase einer Frau, in der die Fertilität möglicherweise gr...

Objective: To evaluate whether ovarian reserve tests (ORTs) add prognostic value to patient characteristics, such as female age, in the prediction of excessive response to ovarian hyperstimulation in patients undergoing IVF, and whether their performance differs across clinical subgroups. Design: Authors of studies reporting on basal FSH, antimülle...

Background: Gynecological endocrinology and reproductive medicine within the reproductive health systems of developing countries is underappreciated and methods to incorporate basic infertility workup and treatment needs to be addressed. However, most recommendations of how to proceed in particular, though, are very general. We exemplarily report o...

Anti-Müllerian hormone is a sensitive marker of ovarian reserve and is suitable for screening. This is important for all women whose age is not critical yet and who not started their "project of family planning". Looking up individual anti-Müllerian hormone levels in percentile normograms inform about the biological clock which might be put back or...

The German IVF-Registry (Deutsches IVF-Register, D·I·R) was established in 1982. Its main objective, from the beginning, was to lend transparency and openness to the newly established infertility treatment options. By 1996 electronic data collection was implemented, allowing the online check for data completeness and plausibility as well as ensurin...

Das Anti-Müller-Hormon (AMH) ist ein sensitiver Laborparameter zur Einschätzung der ovariellen Reserve und ein wichtiger Faktor zur Abschätzung des individuellen reproduktiven Potenzials. Die Höhe des AMH-Werts zeigt, ob die biologische Uhr bereits deutlich vor- oder möglicherweise nachgeht. Eine grobe Prognose des perimenopausalen Übergangs ist mö...

Cumulative pregnancy rates (CPRs) and live birth rates (CLBRs) are much better indicators of success in IVF programmes than cross-sectional figures per cycle or embryo transfer. They allow a better estimation of patient's chances of having a child and enable comparisons between centres and treatment strategies. A 10 year cohort study of patients un...

To our knowledge, this is the first analysis in which male and female weights have been combined. The registry dataset covering a 12-year period was analysed for all treatment cycles where an embryo transfer was reported. In all, 706,360 cycles were analysed. Treatments include IVF, ICSI, IVF/ICSI and CPE. The highest success rate in IVF cycles was...

To produce age-related normograms for serum antimüllerian hormone (AMH) level in infertile women without polycystic ovaries (non-PCO). Retrospective cohort analysis. Fifteen academic reproductive centers. A total of 3,871 infertile women. Blood sampling for AMH level. Serum AMH levels and correlation between age and different percentiles of AMH. Ag...

The German IVF-Registry (Deutsches IVF-Register, D·I·R) was established in 1982. Its main objective, from the beginning, was to lend transparency and openness to the newly established infertility treatment options. By 1996 electronic data collection was implemented, allowing the online check for data completeness and plausibility as well as ensurin...

Diminished ovarian reserve has become a major cause of infertility. Anti-Mullerian hormone (AMH) seems to be a promising candidate to assess ovarian reserve and predict the response to controlled ovarian hyperstimulation (COH). This prospective study was conducted to evaluate the relevance of AMH in a routine IVF program. Three hundred and sixteen...

The efficacy of fertility awareness based (FAB) methods of family planning is critically reviewed. The objective was to investigate the efficacy and the acceptability of the symptothermal method (STM), an FAB method that uses two indicators of fertility, temperature and cervical secretions observation. This paper will recommend a more suitable appr...

Das Reproduktionsverhalten der westlichen Gesellschaften hat sich in den letzten 2–3 Jahrzehnten dramatisch verändert. Elternschaft wird heute oft gezielt geplant. Es ist dabei von Bedeutung, dass immer häufiger einer 1. Schwangerschaft 20 Jahre der Verhütung vorausgehen können, d. h. es werden weniger als 25% der fruchtbaren Jahre einer Frau für d...

Die Datenerhebung des Deutschen IVF-Registers hat seit 1996 eine deutliche, in mehreren Etappen realisierte Veränderung durchlaufen. Wurden bis 1996 sowohl im Sinne summarischer, papiergestützter Abfragen, als auch unter Verwendung eines D-Base-basierten Softwareprogramms (IVFC, Medis-Programm, entwickelt von der Firma Seeberg) die Daten retrospekt...

Bei der modernen natrlichen Familienplanung beobachten Frauen die zyklischen Vernderungen des Zervixschleims und der basalen Krpertemperatur. Zur Bestimmung des Anfangs und Endes der fertilen Phase werden jeweils zwei Parameter herangezogen, die sich gegenseitig absichern (double-check). Wenn kein ungeschtzter Geschlechtsverkehr in der fertilen Pha...

The objective of the present paper is to review the main results of recent European cycle databases on ovulation detection and determination of the fertile window performed by the women themselves. The ongoing German Long-term Cycle Database currently comprises 32788 prospectively collected cycle charts of 1551 women, the I European Cycle Database...

A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Infertility may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor aff...

A common definition of sub- and infertility is very important for the appropriate management of infertility. Sub- fertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Inferti- lity may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor...

BACKGROUND: Although observational studies suggest that IVF is more effective than no treatment for women with Fallopian tube patency, this has not been tested rigorously in a randomized controlled trial (RCT). METHODS: Eligible consenting couples planning their ®rst treatment cycle in ®ve Canadian fertility clinics received either IVF, within 90 d...

Intercourse results in a pregnancy essentially only if it occurs during the 6-day fertile interval ending on the day of ovulation. The strong association between timing of intercourse within this interval and the probability of conception typically is attributed to limited sperm and egg life times. A total of 782 women recruited from natural family...

For patients with infertility problems, online sources of information have become increasingly important, especially chat rooms for discussing infertility-related problems. To close the gap between books (basic information) and the Internet (hot information updates and individual consultation), we wrote a new guidebook for patients with infertility...

A number of menstrual cycle monitors have been developed to detect the fertile window of the menstrual cycle, mainly for contraceptive purposes. Reliable data on most of these systems are still missing but are urgently needed because many women use them and the tested systems differ enormously in price and effectiveness. We suggest a new efficacy e...

The likelihood of spontaneous conception in subsequent cycles is important for a balanced management of infertility. Previous studies on time to pregnancy are mostly retrospective and biased because of exclusion of truly infertile couples. The study aim was to present a non-parametric estimation of cumulative probabilities of conception (CPC) in na...

BACKGROUND: The likelihood of spontaneous conception in subsequent cycles is important for a balanced management of infertility. Previous studies on time to pregnancy are mostly retrospective and biased because of exclusion of truly infertile couples. The study aim was to present a non‐parametric estimation of cumulative probabilities of conception...