Objectives: The present study should clarify whether the dramatic decrease in the treatments of infertility -drop of over 50% in 2004 compared to 2003 -is caused through the changes of reimbursement situation in 2004. This new reimbursement situation means for the patients that they must now co-pay 50% of the costs.Methods: 68 phone interviews were conducted between July and November 2006 with patients who visited a medical practice between November 2003 and March 2006 for a first consultation with a wish for a child, but who did not start the treatment in this practice.Results: Two third of the respondents who were informed during a first consultation about the possible therapies and related costs either decided against a treatment or are still hesitating. The main reasons for this are merely financial: three quarters of all respondents who did not undergo a treatment as yet state that they would start the treatment if the costs were lower.Conclusions: Just half of the patients who are untreated as yet would start the therapy under full reimbursement condition only. Just one third would start the treatment if their own contribution per cycle were cut down to 200 -500 euros. The treatment disposition decreases drastically with a co-payment of over 1000 euros per treatment cycle. However, according to the respondents, their effective own contribution amounts to 1800 euros on average which most of them feel as being clearly too high. Thus the current rate of the co-payment leads to a cost-related treatment barrier.

Ziel: Die hier vorliegende Studie soll klären, ob der drastische Rückgang der Behandlungen bei Infertilität, nämlich ein Rückgang um über 50 % in 2004 gegenüber 2003 [1], auf die seit 2004 veränderte Erstattungssituation zurückzuführen ist. Diese veränderte Erstattungssituation bedeutet für die Patienten, dass sie nun 50 % der Behandlungskosten selbst zahlen müssen. Methode: Zwischen Juli und November 2006 wurden 68 Telefoninterviews durchgeführt mit Patientinnen, die im Zeitraum zwischen November 2003 und März 2006 zu einem Erstgespräch über Kinderwunschbehandlung in einer Arztpraxis erschienen sind, aber dann die Behandlung in dieser Praxis nicht angetreten haben. Resultate: Zwei Drittel der Befragten, die in einem ersten Gespräch über Therapiemöglichkeiten und Kosten informiert wurden, haben sich gegen eine Behandlung entschieden oder sind noch unentschlossen. Die Hauptgründe sind finanzieller Natur: Drei Viertel aller Befragten, die bisher keine Behandlung durchgeführt haben, gaben an, dass sie die Behandlung beginnen würden, wenn sich die Kostensituation günstiger gestalten würde. Fazit: Knapp die Hälfte der bisher nicht Behandelten würde die Therapie nur bei voller Kostenerstattung beginnen. Ein knappes Drittel würde die Behandlung beginnen, wenn der Eigenanteil pro Zyklus auf 200 bis 500 € abgesenkt würde. Bei einem Eigenanteil von über 1000 € pro Behandlungszyklus sinkt die Behandlungsbereitschaft drastisch ab. Der aktuelle Eigenanteil liegt jedoch laut Angaben der Befragten bei durchschnittlich 1800 € und wird vom Großteil der Befragten als eindeutig zu hoch empfunden. Die aktuelle Höhe des Eigenanteils führt daher zu einer kostenbedingten Behandlungsbarriere.

Within the last few years, quite a lot of knowledge-based approaches for special tasks within CIM have been proposed. These changes in functionality and data-modelling within the different CIM-components provide new and improved opportunities for the integration of CIM and office information systems. Within this paper we will present some aspects of a knowledge-based enhancement for CAD and will identify some concepts for the integration with concrete office tasks especially the preparation of tenders for technical products and technical documentation. The improved opportunities for integration primarily result from an enhanced functionality of CAD by including also significant parts of conceptual design. Additionally, the technique of feature-based design together with the explicit modelling of different views on the product facilitate the integration of database technology thus also providing a technical basis for the integration with office information systems.

In this paper we propose a knowledge-based enhancement of conventional CAD that meets the requirements of complex mechanical design tasks. This enhancement is based on the explicit representation of design knowledge. Special attention is directed towards representing, evaluating, and inferring dependencies restricting design alternatives. The second major aspect is the determination and classification of relevant knowledge within a design process. The derived concept will be discussed by using the design of rotational parts as an example. Above all, we go into the integration of the knowledge-based systems with conventional software as, e.g., CAD, calculation and simulation modules in more detail.

Through an optimal treatment of testicular cancer the life expectancy of patients is improved, but more early and late complications were observed after different therapeutic procedures and mainly fertility problems come to the fore. In 70% of the patients (n = 30) an abnormal spermiogram was found prior to treatment. At this time 54% of all patients with testicular cancer (n = 61) were 20 to 30 years old and 43% of these patients wish to have a child. After radical retroperitoneal lymph node dissection in 71% of cases (n = 45) a total or partial loss of ejaculation was found. The cytostatic chemotherapy and radiation treatment are the cause of reversible or irreversible reduction in spermatogenesis and possibly mutagenic alterations. There are several alternatives to treat the infertility problems of cured testicular cancer patients and autologous insemination is favoured by the half of these patients. In our experience with cryopreserved sperm (n = 22) only patients with appropriate sperm quality (greater than 10 Mill. sperms/ml, greater than 30% mobile sperms, greater than 30% thaw motility) are suited to this method. In consideration of these parameters only 25% of testicular cancer patients are suited for long-term sperm preservation. The technical problems of sperm preparation, storage and autologous insemination are described in detail.

Nach radikaler RLA und hochdosiertem Alkylantieneinsatz ist mit der Infertilität des Hodentumorpatienten zu rechnen. Partielle RLA-Techniken und moderne Zytostatika lassen in zunehmendem Maße geheilte und wieder fertile Patienten erwarten. Damit gewinnen Fragen der mutagenen Wirkung von Zytostatikaeine vordergründige Bedeutung. Bei einer Patientenserie (n = 31) wurden vor, während und nach der zytostatischen Therapie die Chromosomenaberrationsraten bestimmt. Mit Hilfe der Methode der Lymphozytenkulturen konnten pro Patient 100-200 Metaphasen ausgewertet werden.