The genitourinary syndrome of menopause (GSM) affects up to 84% of postmenopausal women and may significantly reduce the quality of life in some. For symptom relief, there are several non-hormonal and hormonal vaginal products available. In Europe, vaginal estriol (E3) is the most frequently chosen estrogen for GSM treatment. The aim of this systematic review was to assess the impact of vaginal E3 on serum sex hormone levels, an outcome that has been previously used to assess safety in similar products. In our review, we did not find any alterations in serum estrone, estradiol, testosterone, progesterone and sex hormone binding globulin levels after vaginal E3 application. In contrast, some studies showed a minimal and transient decrease in serum gonadotropin levels, which however remained within the postmenopausal range. Similarly, only a few studies reported a minimal and transient increase of serum E3 levels, with the rest reporting no changes. The lack of clinically relevant long-term changes in serum sex hormone levels supports the current literature providing evidence about the safety of vaginal E3 products.

Despite increasing life expectancy, the age of onset of natural menopause has not significantly changed in recent decades. Thus, women spend about one-third of their lives in an estrogen-deficient state if untreated. There is a need for appropriate treatment of acute symptoms and prevention of the sequelae of chronic estrogen deficiency. International guidelines call for the use of the lowest effective hormone dosage for vasomotor symptom relief, the major indication for menopausal hormone therapy (MHT). In 2011, an oral continuous combined ultra-low-dose MHT was approved in Switzerland. This publication was elaborated by eight national menopause specialists and intends to review the advantages and disadvantages of ultra-low-dose MHT after the first years of its general use in Switzerland. It concludes that, for many women, ultra-low-dose MHT may be sufficient to decrease vasomotor symptoms, but not necessarily to guarantee fracture prevention.

As a result of advances in oncologic treatment, a growing number of women diagnosed with cancer may envisage cure. Young women diagnosed with cancer often have a desire to fall pregnant in the future or may even be diagnosed with cancer in the process of family planning. The potential gonadotoxic effect of certain chemotherapeutic agents is well described. Therefore, it is essential that all women concerned about their fertility receive counselling from a reproductive medicine specialist to discuss the fertility preservation options. Currently, ovarian stimulation with cryopreservation of oocytes or fertilized oocytes is the treatment of choice. However, other options such as in vitro maturation or ovarian tissue cryopreservation should be discussed if ovarian stimulation is contraindicated.

Current in vitro fertilisation (IVF) practice requires synchronisation between the environment of cultured oocytes and embryos and the surroundings to what they would have been exposed to in vivo. Commercial, sequential media follow this requirement but their exact composition is not available. We have compared two widely used IVF culture media systems using the two choriocarcinoma cell lines JEG-3 and BeWo. The two hormones hCG and progesterone were determined in the culture supernatants as endpoints. In both cell lines, but in a more pronounced way in JEG-3, progesterone rather than hCG production was stimulated, and a higher hormone release was observed in the fertilisation than in the cleavage media. Differences between manufacturers were small and did not favour one system over the other. We conclude that both sequential media systems can be equally well used in current IVF laboratory practice. (C) 2012 Elsevier Masson SAS. All rights reserved.

Due to constant progress in oncology, survival rates of patients (children and adults) with cancer are increasing. Consequently, the reproductive future of young cancer patients needs to be addressed carefully. Fertility preservation techniques are available and issues such as the time available for fertility treatments, patients' age, presence of a partner and patients' personal wishes have to be considered. In Switzerland, a first therapeutic network (Réseau Romand de Cancer et Fertilité), was created in the French speaking part of Switzerland in 2006. Since 2010, a global Swiss network (FertiSave) has been created. The goal of these networks is to maximise the safety and efficacy of fertility preservation options offered to cancer patients without compromising their oncological prognosis. Patients' needs have to be identified, the therapeutic options evaluated rapidly and the optimal treatment promptly implemented in these urgent situations. This article reviews the fertility preservation options currently available and makes recommendations for different specific cancer situations, consistent with the latest scientific evidence and in general agreement with international recommendations.

e19599 Background: Infertility secondary to adjuvant chemotherapy is a major problem in young women with breast cancer. We developed a multidisciplinary-multicenter network, the "RRCF", aiming to offer a medically assisted procreation program (MAP) without delaying the systemic treatment. We analyzed if this goal was achievable. METHODS Patients (pts) were referred from the French-speaking part of Switzerland. After multidisciplinary assessment and discussion with the pts we proceeded with urgent MAP, when indicated. Oktay's protocol (Oktay et al, J Clin Endocrinol Metab. 2006;91:3885-3890.) was used for oocytes collection and ovarian biopsies (OB) were considered for selected cases. Data were collected prospectively: characteristics of the patients and tumors, chronology of events, material collections, estradiol and baseline anti-Müllerian hormone (AMH) levels. RESULTS Among 44 pts referred between Oct 2006 and Feb 2010, 26 opted for urgent MAP (median age 32.5; range: 25-40) and 18 declined (median age 36; range: 28-42). Three pts had OB and 23 pts had controlled ovarian hyperstimulation (COH). First MAP visit occurred before (85%) or after (15%) surgery. COH succeeded in 22 pts with the collection of 2-52 oocytes/pt (median 10.5). Median baseline AMH level was 15.7 pmol/L (range <1-450). Median antral follicle count was 13 (range 3 to 21). The means of estradiol levels at day 5 and at ovulation were 0.39 nmol/L (<0.09-1.57) and 1.73 nmol/L (0.36-3.97), respectively. The median time from final surgery for breast cancer to the start of adjuvant chemotherapy was 31 days (range 18-56). CONCLUSIONS Urgent fertility preserving measures organized by a dedicated multidisciplinary network is feasible without unduly delaying the start of adjuvant chemotherapy. The letrozole-based ovarian stimulation protocol is effective at collecting oocytes while maintaining plasma estradiol levels close to the physiological limits.

Objective: To analyze the vascularization of the endometrium via hysteroscopy and to assess its correlation with angiogenic factor gene expression and embryo implantation rate.Design: Cross-sectional study.Setting: Public university hospital.Patient(s): Patients undergoing hysteroscopy for supposed infertility.Intervention(s): Endometrial quality assessment according to Sakumoto-Masamoto, performed in the early secretory phase of the cycle. Collection of an endometrial tissue biopsy.Main Outcome Measure(s): RNA extraction, reverse transcription, and determination of gene expression of angiogenesis- and implantation-relevant factors using quantitative polymerase chain reaction. Retrieval of pregnancy information from the medical records.Result(s): Good quantity/quality RNA with infertility history was obtained from 63 participating women. Those with a "good" endometrium and subsequent pregnancy showed increased gene expression for placenta growth factor when compared with patients with a "bad" endometrium and who did not succeed with pregnancy to date. Nonpregnant women with a "good" endometrium presented an intermediate result. No significant differences were observed for several other genes tested, but trends in the same direction were observed.Conclusion(s): This study demonstrates for the first time that endometrial PLGF expression corresponds to the hysteroscopic appearance of the endometrium, and therefore has potential as a clinically relevant prognosticator for infertility treatment success. (Fertil Steril (R) 2011;96:663-8. (C)2011 by American Society for Reproductive Medicine.)

There are many negative impacts of obesity on fertility. Obese couples present decreased sperm count, decreased ovulation and conception rates, increased erectile dysfunction and spontaneous abortion rate as well as increased maternal and foetal complications of pregnancy. Moreover, obesity tends to decrease response to fertility treatments. Fortunately, intensive lifestyle modifications can restore fertility while decreasing pregnancy complications risk. With the increasing trend of obesity to affect young populations, taking care of these infertile couples rapidly is capital to restore fertility and decrease its related pregnancy complications.