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Stuttgart, Germany

Gnoth C.,Green ivf | Gnoth C.,Universitatsfrauenklinik Cologne
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz | Year: 2013

Background: In the last 40 years, fertility rates in Western societies have been declining as a result of lifestyle and generative behavior. Aim: This review summarizes current evidence-based knowledge on natural infertility and epidemiological aspects of subfertility. Methods: A literature search on natural infertility and epidemiological aspects of subfertility was performed and the available data were structured and put in context. Results: After six unsuccessful cycles, slight or potentially severe subfertility should be assumed. Female age, number of unsuccessful cycles, ovarian reserve, and the results of sperm analysis determine the reproductive potential of a subfertile couple. An early measurement of anti-müllerian hormone levels and a sperm analysis are recommended. Conclusions: Fertility awareness has gained increasing importance, not only in contraceptive use but also in optimizing individual fertility. © 2013 Springer-Verlag Berlin Heidelberg. Source


Gnoth C.,Green ivf | Gnoth C.,Universitatsklinik Cologne | Mallmann P.,Universitatsklinik Cologne
Gynakologische Endokrinologie | Year: 2016

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 natural fertility and fulfilling the desire to have children. With this in mind a literature search was carried out. Results: By making an early start to family planning more than 90 % of couples ultimately succeed in having a live birth. The chances of becoming pregnant are determined by the age of the woman, the ovarian reserve, the number of previously unsuccessful monthly cycles and the quality of the ejaculate. Most spontaneous pregnancies occur after intercourse in the highly fertile period and within the first six cycles. After six cycles a subfertility of only 50 % of full fertility is present for every second couple. Above the age of 30 years subfertility must already be assumed for approximately 50 % of all couples; therefore, the timely determination of the ovarian reserve is important, e.g. by testing anti-mullerian hormone levels. Fertility awareness is an important method for perception and appreciation of the cycle and fertility by couples themselves. Conclusion: Fertility awareness can be utilized not only for contraceptive use but also for optimizing individual chances for conception. In this context extended diagnostic options, such as early recognition of cycle disturbances can be included. Reproductive medicine can nowadays restore even severely limited perspectives for conception as a result of fertility disorders back to natural fertility levels; however, it cannot exceed these levels. © 2016, Springer-Verlag Berlin Heidelberg. Source


Freundl G.,Sektion Naturliche Fertilitat SNF | Gnoth C.,Green ivf | Krahlisch M.,Zietmann Krahlisch GbR
Gynakologische Endokrinologie | Year: 2016

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 results of own published studies on this topic and publications on determination of the fertile window. Results: For some of the cycle computers own results are available, sometimes in comparative studies. New ways of recording intravaginal temperatures and continuous temperature measurement procedures have made the development of new devices possible but objective results generated by prospective studies on effectiveness are not available. For hormone computers efficiency data reported in the literature from Europe and the USA differ, sometimes greatly but comparative prospective efficiency studies are practically completely lacking. There is a similar situation with devices for measuring resistance. With apps there are principally two different versions available on the market: calender and symptom-based apps; however, no results from good effectiveness studies are available. Conclusion: Prospective efficiency studies must still be carried out for the majority of these developments. Otherwise the user will be consciously misled. © 2016, Springer-Verlag Berlin Heidelberg. Source


Gnoth C.,Green ivf | Gnoth C.,University of Cologne | Johnson S.,SPD Development Company Ltd
Geburtshilfe und Frauenheilkunde | Year: 2014

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 advanced home pregnancy test currently available assesses the level of hCG found in urine and claims to provide women with reliable results within just a few weeks of pregnancy. Today, over 15 different types of home pregnancy test are available to buy over the counter in Germany. Many tests claim to be highly accurate and capable of detecting pregnancy before the next monthly period is due, although claims such as 8 days prior to menstruation are unrealistic. However, users and healthcare professionals should be aware that, although all are labelled as CE, there are currently no standard criteria for testing performance and claims. This review provides an overview of the development of home pregnancy tests and the data on their efficacy together with an analysis of published data on the accuracy of hCG for the detection of early pregnancy and studies on the use of home-based pregnancy tests. Preliminary data on some home pregnancy tests available in Germany are presented which indicate that many results do not match the claims made in the package insert. Healthcare professionals and women should be aware that some of the claims made for home pregnancy tests are inconsistent and that common definitions and testing criteria are urgently needed. © Georg Thieme Verlag KG Stuttgart New York. Source


Friol K.,Green ivf | Gnoth C.,Green ivf | Dieterle S.,Witten/Herdecke University
Gynakologe | Year: 2014

Background: Acupuncture as a sole and adjuvant therapy is increasingly being applied in assisted reproductive technologies (ART).Study question: Is there evidence for the effectiveness of acupuncture in infertility therapy?Material and methods: The Pubmed and Cochrane Library databases were searched for literature on acupuncture in ARTs. Original articles and reviews were used to evaluate the significance of relevant study results.Results: Randomized controlled trials (RCT) on the effectiveness were only performed for adjuvant acupuncture in ARTs. The current evidence demonstrates no benefit of acupuncture on the outcome of ARTs. Importantly, the interpretation of the results requires caution due to the specific characteristics of treatment procedures such as acupuncture: Performing placebo acupuncture in the control group results in the comparison of two different kinds of acupuncture. The acupuncture protocols applied only examined endometrial receptivity but not oocyte or sperm quality. To date, studies dealing with this topic have only occasionally been considered. In traditional Chinese medicine (TCM), the individual diagnosis of the patient is used to develop a customized acupuncture protocol including corresponding acupuncture points and needle techniques. However, in the currently available studies the acupuncture points and needle techniques were standardized, contradicting traditional TCM concepts and possibly leading to misinterpretation of the outcome.Conclusion: Currently, there is no conclusive evidence for the effectiveness of acupuncture in infertility treatment; however, the absence of evidence does not compare with the absence of an effect. A possible reason for the lack of evidence could be that in the context of an individualized medicine, such as TCM, it is difficult to implement a meaningful RCT study concept. Therefore, it is essential to develop alternative study designs in order to investigate a possible role of acupuncture in successful ART therapy. © 2014, Springer-Verlag Berlin Heidelberg. Source

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