Time-efficient consultation hours in the department of gynecological endocrinology.

BACKGROUND: The aim was to conduct a benchmark pilot study to find the best practice for consultation hours in the field of gynecological endocrinology. Suitable benchmarking participants were found in China, Germany, Greece, and Switzerland. Specifically, the study aimed to find the most time-efficient and beneficial consultation type in gynecological endocrinology focused on menopause and whether a shorter face-to-face consultation correlates with lower patient satisfaction. METHODS: This was an observational study. To analyze the processes of all benchmarking participants three tools were used: a measurement of time needed for the different consultation types, a questionnaire for patients and one for physicians. The primary endpoint was the time measurement of first consultations. Secondary endpoints were the time measurements of follow-up consultations and phone consultations and patient satisfaction. RESULTS: The mean overall duration of a first consultation differed from 20.4 min to 39.7 min (p = 0.003), mainly based on differences of the mean time to acquire the patient history, 5.6 to 21.6 min (p < 0.001). The percentage of patients who felt they had enough time to discuss questions ranged from 70% to 100% (p < 0.001). The percentage of patients who felt fully understood by their physician ranged from 62.5% to 92% (p = 0.006). The duration of a first consultation did not correlate with patients feeling well consulted (r=-0.048, p = 0.557). CONCLUSIONS: A concise patient history that concentrates on the most relevant points can reduce the total consultation time. Reducing consultation time can be made without compromising how well patients feel consulted.

Are WHO Recommendations to Perform 2 Consecutive Semen Analyses for Reliable Diagnosis of Male Infertility Still Valid?

PURPOSE: We evaluated whether a second semen analysis as suggested by the WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction would improve diagnostic reliability in the evaluation of male infertility. MATERIALS AND METHODS: We analyzed a total of 5,132 semen samples from 2,566 men who underwent at least 2 consecutive semen analyses at a university fertility center. Reproducibility and correlation between the first and second analyses were evaluated for sperm concentration, motility and morphology according to the WHO criteria as well as the total motile sperm count. RESULTS: Altogether 51.2% of the second analyses confirmed the initial findings according to WHO criteria and 60% confirmed them when applying total motile sperm count criteria. After finding normozoospermia on the initial analysis 27% of the second semen analyses were pathological. Following a first pathological semen analysis 23% of the second analyses were normal and 77% were pathological. The coefficient of variation ranged from 0.23 to 0.60. The Spearman correlation coefficient was high for sperm concentration (rs = 0.84) and normal morphology (rs = 0.80) but lower for progressive motility (rs = 0.57). The discriminating capacity of each semen parameter to distinguish between men with a normal vs a pathological second semen analysis was rather limited (ROC AUC 0.72 to 0.79). CONCLUSIONS: In accordance with WHO recommendations 2 consecutive semen analysis should be performed.

Diurnal and seasonal changes in semen quality of men in subfertile partnerships.

Circadian and circannual rhythms influence not only the environment, but also human physiology. In times of increasing numbers of couples struggling with infertility, and thus increasing demand for successful assisted reproduction, the aim of our study was to evaluate circadian and circannual rhythms and their association with semen quality. A total of 12 245 semen samples from 7068 men, collected at the andrology laboratory of the Department of Reproductive Endocrinology, University Hospital Zurich, between 1994 and 2015, were uniformly analysed in terms of sperm concentration, total sperm count, progressive motility and normal morphology. On the basis of these four parameters, we retrospectively examined the circadian and circannual changes of semen quality. The Mann-Whitney U test and multiple linear regression analysis were used for the statistical evaluation. The semen samples collected in the early morning before 7:30 a.m. showed the highest levels in sperm concentration, total sperm count and normal morphology, all with statistical significance. Progressive motility did not show any significant alterations based on circadian rhythm. Furthermore, a significant increase in sperm concentration and total sperm count was found in spring, with significant decreases in the summer. The highest percentage of normal morphology was found in summer. For progressive motility, no significant seasonal variation could be demonstrated. Male semen quality varies with both circadian and circannual rhythms. Collection of semen in the early morning, where semen quality was highest, can be used to improve natural fertility as well as fertility resulting from assisted reproduction.

Intrauterine device continuation rates and reasons for discontinuation in a Central European clinic with a high standard of care and ultrasound follow-up: a retrospective cohort study.

OBJECTIVES: The aims of the study were to conduct an analysis of intrauterine device (IUD)-related outcomes, including continuation rates, reasons for discontinuation, rates of dislocation and risk factors for dislocation, in a clinical setting with regular ultrasound monitoring of the IUD position. METHODS: A retrospective chart review was carried out of all IUD insertions over a period of 5 years. RESULTS: A total of 755 IUDs were inserted over the study period. The overall observation time was 1572 woman-years. The removal rate was highest in the first year after insertion and did not differ between devices: the 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS; 18%) and third generation copper-T (Cu-T) IUDs (20%). Most removals were related to dislocation; fewer dislocations were seen with the LNG-IUS compared with the Cu-T IUDs (p< .001). More removals of the LNG-IUS were carried out because of amenorrhoea, pain and hormone-related adverse events (20% of all removals). The discontinuation rate was higher in young women (age <25 years; p< .03), demonstrating the limitations of long-acting reversible contraception in this age group. The dislocation rate for devices replaced after dislocation was 31% in women receiving a Cu-T IUD and 38% in women receiving an LNG-IUS. CONCLUSIONS: The first year after IUD insertion is crucial with regard to discontinuation. Most removals were attributed to dislocation and affected mainly younger women. Dislocations occurred more rarely in LNG-IUS users and the rate decreased over time. We recommend follow-up within the first 6-12 months, especially in young women. Structured counselling and consideration of risk factors for dislocation may reduce removal rates for adverse events and dislocations.