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Zollner U.,Universitats Frauenklinik Wurzburg | Schwarz T.F.,Zentrallabor und Impfzentrum
Deutsche Medizinische Wochenschrift | Year: 2011

Human papilloma viruses are responsible for a large number of benign and malignant lesions of the skin. HPV 6 and 11 cause up to 90% of condylomata. Almost each cervical cancer is associated with HPV. HPV 16 und 18 induce up to 70% of cervical neoplasias. The vaccination against HPV is internationally implemented and should be applied to young girls aged 12 to 17 according to STIKO criteria. The vaccination may reduce the rate of cervical cancer by 70% and the rate of cervical intraepithelial neoplasia by 50%. Many studies demonstrated the efficacy and safetyness of both vaccines. Gardasil® offers protection against HPV 6, 11, 16 and 18, Cervarix® against HPV 16 and 18. Protection against condylomata is offered by the quadrivalent vaccine in 90%. The bivalent vaccine has demonstrated type-specific protection against the five most frequent cancer inducing types (16, 18, 31, 33, 45). The production of VLPs is an innovative technology. A comparison of both vaccines, Cervarix® and Gardasil®, showed a higher immunogenicity for Cervarix®. In Germany the immunization rates are still low comparing to other countries. As a method for secondary prevention of cervical cancer the PAP smear is still an effective method. © 2011 Georg Thieme Verlag KG Stuttgart · New York. Source

Zollner U.,Universitats Frauenklinik Wurzburg | Bischofs S.,Evangelisches Krankenhaus Hamm | Lalic I.,Sapient In Vitro Pty Ltd. | Zollner K.-P.,Kinderwunschzentrum Amberg
Asian Pacific Journal of Reproduction | Year: 2012

Objective: There is strong evidence that the cytokines leucemia inhibitory factor (LIF) and tumor necrosis factor (TNF) alpha are related to embryo development and implantation. The aim of this study was to determine the levels of LIF and TNF alpha in embryo culture media and to assess its relationship to the outcome of in-vitro fertilization and embryo transfer. Methods: A total of 99 patients were included in this prospective trial and underwent either IVF or ICSI procedure. A total of 865 oocytes were collected. Embryos were cultured in sequential media until day 5. A standardized morphology evaluation of all embryos, including a detailed pronuclear scoring, was performed daily during this period followed by the replacement of one or two selected embryos. Collected embryo culture fluids of days 3 and 5 were analysed for LIF and TNF alpha on days 3 and 5. Results: Mean TNF alpha concentration in culture media on day 3 was 0.54 and 0.37 pg/mL on day 5 and was significantly lower in women conceiving than in not conceiving (0.43 pg/mL versus 0.59 pg/mL on day 3). Mean LIF concentration on day 3 was 31.5 pg/mL and 35.5 pg/mL on day 5 and was significantly higher in women conceiving (56.2 pg/mL versus 22.2 pg/mL on day 3). Conclusions: The results indicate that LIF could have a function in early embryogenesis and as a factor required for embryo implantation. High TNF alpha concentrations seem to be predictive of implantation failure. © 2012 Hainan Medical College. Source

Griesinger G.,University of Lubeck | Schultz L.,University of Lubeck | Bauer T.,IVF Zentrum Augsburg | Broessner A.,Universitatsklinikum Magdeburg | And 2 more authors.
Fertility and Sterility | Year: 2011

Objective: To prospectively study ovarian hyperstimulation syndrome (OHSS) incidence and cumulative live birth rate in a cohort of patients at risk of OHSS undergoing ovarian stimulation in a GnRH antagonist protocol and receiving a GnRH agonist triggering followed by cryopreservation of all two pronuclei (2PN)-stage zygotes by two methods, vitrification or slow-cooling, for later ET. Design: Prospective, clinical cohort study. Setting: Five IVF centers in Germany; time frame: June 2008 to June 2010. Patient(s): Fifty-one female patients undergoing IVF considered at risk of developing severe OHSS (≥20 follicles ≥11 mm and/or E2 level ≥4,000 pg/mL) after ovarian stimulation in a GnRH antagonist protocol. Intervention(s): Triptorelin (0.2 mg SC) for triggering final oocyte maturation. All 2PN-stage zygotes were cryopreserved by vitrification or slow-cooling for later repetitive frozen-thawed ET. Main Outcome Measure(s): Severe OHSS incidence and cumulative live birth rate per patient. Result(s): Of 51 patients, 1 patient (2%, 95% confidence [CI] 0.3%-10.3%) had zero oocyte retrieved, 1 patient did not undergo frozen-thawed ET, and 1 patient had no surviving oocyte after thawing. Thus, 48 patients underwent at least one frozen-thawed ET. The cumulative live birth rate was 37.3% (19/51, 95% CI 25.3%-51.0%). The live birth rate per first frozen-thawed ET was 5.9% (1/17, 95% CI 10.0%-27.0%) and 19.4% (6/31, 95% CI 9.2%-36.3%) in the slow-cooling and vitrification group, respectively (difference: 13.5%, 95% CI of the difference: -9.9%-31.1%). Three cases of OHSS II (3/51, 5.9%, 95% CI 2.0%-15.9%) and one early-onset case of OHSS III (1/51, 2%, 95% CI 0.3%-10.3%) occurred. Conclusion(s): Agonist triggering with cryopreservation is efficacious and safe, although a single case of a severe early-onset OHSS occurred. © 2011 by American Society for Reproductive Medicine. Source

Zollner U.,Universitats Frauenklinik Wurzburg | Specketer M.-T.,Frauenklinik der Krankenhaus Nordwest GmbH | Zollner K.-P.,Kinderwunschzentrum Amberg | Dietl J.,Universitats Frauenklinik Wurzburg
Asian Pacific Journal of Reproduction | Year: 2012

Objective: To assess the role of the uterine artery blood flow in the prediction of implantation in women undergoing embryo transfer during the periimplantation period. Methods: A total of 233 couples were included in this prospective study. All patients had embryo transfer, 125 were performed in in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and 108 in cryo cycles. Ultrasound measurements were performed immediately before transfer. The pulsatility index (PI), Resistance index (RI) and the peak systolic velocity (PSV) were measured in both uterine arteries using endovaginal ultrasound. Results: In IVF/ICSI cycles the doppler parameters PI (2.48 vs. 2.15), RI (0.78 vs. 1.30) and PSV (60 vs. 63) did not differ significantly between the pregnant and non-pregnant group. The pregnancy rate per transfer was similar in women showing an unilateral (24%), bilateral (33%) or no (27%) notch in the uterine blood flow. In cryo cycles the uterine artery blood flow parameters PI (3.2 vs. 3.0), RI (0.9 vs. 0.9) and PSV (53.2 vs. 51.2) did not differ either between pregnant and not pregnant patients. Conclusions: Previous studies were aiming at the measurement of arterial doppler parameters during the follicular phase which may not be adequate for the prediction of implantation. However, our results show that doppler studies during the early luteal phase of assisted reproductive technology cycles are not indicative for the likelihood of pregnancy, too. © 2012 Hainan Medical College. Source

Zollner U.,Universitats Frauenklinik Wurzburg | Zollner U.,University of Wurzburg | Specketer M.-T.,Frauenklinik der Krankenhaus Nordwest GmbH | Dietl J.,Universitats Frauenklinik Wurzburg | Zollner K.-P.,Kinderwunschzentrum Amberg
Archives of Gynecology and Obstetrics | Year: 2012

Purpose: The success of artificial reproductive techniques not only depends on the quality of oocytes and spermatozoa but also on the receptivity of the endometrium. The aim of this study was to assess the value of measurement of endometrial volume by three-dimensional (3D) in comparison to 2D-ultrasound in the prediction of implantation in women having transfer of cryopreserved embryos. Methods: One hundred and eight couples were included in this prospective study. All patients underwent the IVF or ICSI program and had transfer of cryopreserved embryos. Sixty-eight transfers were done in a spontaneous cycle and 40 in an artificial cycle. Endometrial thickness, pattern and three-dimensional volume were measured immediately before embryo transfer. Results: Twenty clinical pregnancies were achieved (PR 18.5 % per transfer), the PR being similar in spontaneous (22.1 %) and artificial (12.5 %, ns) cycles. Three to five days after ovulation (spontaneous cycles) or after the endometrium reached a thickness of at least 8 mm (artificial cycles), a median of three embryos were replaced. In spontaneous cycles, there were no significant differences in endometrial thickness or volume between pregnant (11.9 mm, 2.9 ml) and non-pregnant women (10.7 mm, 3.4 ml). In artificial cycles, the endometrial volume (3.9 vs. 2.5 ml, p<0.05), but not endometrial thickness (10.7 vs. 10.2 mm, ns) was significantly higher in pregnant than in non-pregnant women. Conclusions: In artificial cycles, a low endometrial volume is associated with a poor likelihood of implantation. Endometrial volume measured by 3D-ultrasound is an objective parameter to predict endometrial receptivity. © Springer-Verlag 2012. Source

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