Fertility-preservation counselling and treatment for medical reasons: data from a multinational network of over 5000 women.

Fertility-preservation techniques for medical reasons are increasingly offered in national networks. Knowledge of the characteristics of counselled patients and techniques used are essential. The FertiPROTEKT network registry was analysed between 2007 and 2013, and included up to 85 university and non-university centres in Germany, Austria and Switzerland; 5159 women were counselled and 4060 women underwent fertility preservation. In 2013, fertility-preservation counselling for medical reasons increased significantly among nullipara and women aged between 21 and 35 years (n = 1043; P < 0.001). Frequency of GnRH applications slowly decreased, whereas tissue, oocytes and zygote cryopreservation increased. In 2013, women with breast cancer mainly opted for tissue freezing, whereas women with lymphoma opted for GnRH agonist. Women younger than 20 years predominantly opted for GnRH agonists and ovarian tissue cryopreservation; women aged between 20 and 40 years underwent a variety of techniques; and women over 40 years opted for GnRH agonists. The average number of aspirated oocytes per stimulation cycle decreased as age increased (< 30 years: 12.9; 31-35 years: 12.3; 36-46: 9.0; > 41 years: 5.7). For ovarian tissue cryopreservation, removal and cryopreservation of fewer than one ovary was preferred and carried out in 97% of cases in 2013.

Fertility preservation options in breast cancer patients.

The purpose of this review is to analyse current options for fertility preservation in young women with breast cancer (BC). Considering an increasing number of BC survivors, owing to improvements in cancer treatment and delaying of childbearing, fertility preservation appears to be an important issue. Current fertility preservation options in BC survivors range from well-established standard techniques to experimental or investigational interventions. Among the standard options, random-start ovarian stimulation protocol represents a new technique, which significantly decreases the total time of the in vitro fertilisation cycle. However, in patients with oestrogen-sensitive tumours, stimulation protocols using aromatase inhibitors are currently preferred over tamoxifen regimens. Cryopreservation of embryos and oocytes are nowadays deemed the most successful techniques for fertility preservation in BC patients. GnRH agonists during chemotherapy represent an experimental method for fertility preservation due to conflicting long-term outcome results regarding its safety and efficacy. Cryopreservation of ovarian tissue, in vitro maturation of immature oocytes and other strategies are considered experimental and should only be offered within the context of a clinical trial. An early pretreatment referral to reproductive endocrinologists and oncologists should be suggested to young BC women at risk of infertility, concerning the risks and benefits of fertility preservation options.

Fertility preservation for non-medical reasons: controversial, but increasingly common.

BACKGROUND Fertility-preserving measures for women are increasingly being performed for non-medical reasons in Germany. This is now a controversial matter. METHODS The authors searched the PubMed database for pertinent publications on the basis of their clinical and scientific experience and evaluated relevant data from the registry of the German FertiPROTEKT network (www.fertiprotekt. com). The various fertility-preserving measures that are available are described and critically discussed. RESULTS In most cases, the creation of a fertility reserve currently involves the cryopreservation of unfertilized oocytes, rather than of ovarian tissue. Most of the women who decide to undergo this procedure are over 35 years old. According to data from the FertiPROTEKT registry, most such procedures carried out in the years 2012 and 2013 involved a single stimulation cycle. The theoretical probability of childbirth per stimulation is 40% in women under age 35 and 30% in women aged 35 to 39. If the oocytes are kept for use at a later date, rather than at once, the maternal risk is higher, because the mother is older during pregnancy. The risk to the child may be higher as well because of the need for in vitro fertilization (IVF). Pregnancy over age 40 often leads to complications such as gestational diabetes and pre-eclampsia. IVF may be associated with a higher risk of epigenetic abnormalities. Ethicists have upheld women's reproductive freedom while pointing out that so-called social freezing merely postpones social problems, rather than solving them. CONCLUSION Fertility preservation for non-medical reasons should be critically discussed, and decisions should be made on a case-by-case basis.

The importance of phrenic nerve preservation and its effect on long-term postoperative lung function after pneumonectomy

OBJECTIVES The importance of phrenic nerve preservation during pneumonectomy remains controversial. We previously demonstrated that preservation of the phrenic nerve in the immediate postoperative period preserved lung function by 3-5% but little is known about its long-term effects. We, therefore, decided to investigate the effect of temporary ipsilateral cervical phrenic nerve block on dynamic lung volumes in mid- to long-term pneumonectomy patients. METHODS We investigated 14 patients after a median of 9 years post pneumonectomy (range: 1-15 years). Lung function testing (spirometry) and fluoroscopic and/or sonographic assessment of diaphragmatic motion on the pneumonectomy side were performed before and after ultrasonographic-guided ipsilateral cervical phrenic nerve block by infiltration with lidocaine. RESULTS Ipsilateral phrenic nerve block was successfully achieved in 12 patients (86%). In the remaining 2 patients, diaphragmatic motion was already paradoxical before the nerve block. We found no significant difference on dynamic lung function values (FEV1 'before' 1.39 ± 0.44 vs FEV1 'after' 1.38 ± 0.40; P = 0.81). CONCLUSIONS Induction of a temporary diaphragmatic palsy did not significantly influence dynamic lung volumes in mid- to long-term pneumonectomy patients, suggesting that preservation of the phrenic nerve is of greater importance in the immediate postoperative period after pneumonectomy.

A Note on Optimal Care by Wealth-Constrained Injurers

This paper clarifies the relationship between an injurer's wealth level and his care choice by highlighting the distinction between monetary and non-monetary care. When care is non-monetary, wealth-constrained injurers generally take less than optimal care, and care is increasing in their wealth level under both strict liability and negligence. In contrast, when care is monetary, injurers may take too much or too little care under strict liability, and care is not strictly increasing in injurer wealth. Under negligence, the relationship between injurer care and wealth is similar in the two formulations. However, when litigation costs are added to the model, the relationship between injurer care and wealth becomes non-monotonic under both liability rules.

Family Preservation: The Parents’ Perceptions

This research documents the perspective of 100 parents who had an open case with the Department of Children and Family Service’s (DCFS) regarding their family’s well-being, reasons for referral and satisfaction with services. Two DCFS services, Family Preservation (FP) and routine Family Maintenance (FM) were examined using standardized instruments. Parents’ responses regarding reasons for involvement with the system differed from DCFS administrative data. FP parents had more children, were more likely to be monolingual Spanish speakers, and perceived greater improvement in discipline and emotional care of children and housing than FM parents. FP parents reported being satisfied with services. Implications include supporting community based culturally competent FP programs.

Family Preservation Journal, 2007, Volume 10, Issue 1 (Entire issue)

Entire issue (large pdf file)

Editoriall: A Holistic View of Family Preservation Services

One of the hallmarks of family preservation services is that they are holistic and attend to multiple dimensions of family life. In that spirit, this issue of the Family Preservation Journal provides a holistic view of these services, by offering research from the perspective of children, parents, caseworkers, and students of social work. These articles focus on the effectiveness of services, parents' perceptions of services, and the knowledge, attitudes and behavior of child welfare caseworkers. There should be something here for everyone who serves children and their families.

Are Intensive Family Preservation Services Useful?: A Study in the United Kingdom

This evaluation of the first year of an Intensive Family Preservation Service in England is based on the analysis of eighty-six families: fifty-seven families who received the service and a comparison group of twenty-nine families who did not. The study considered whether the program was fulfilling its objectives of reducing the number of children and young people in the public care system; offering a safe, supportive service for children who need protection; integrating the program into family support services as a whole, and improving family functioning. The findings were complex to interpret. Child protection was improved but there was not a reduction in the number of children needing out of home care (indeed there was an increase) meaning that short term savings in costs could not be made. Nor were there lasting improvements in the children’s behavior. There were instead a number of more subtle, arguably more sensitive outcomes: parents’ capacity to tolerate their child’s behavior was greater and overall family functioning was better for most families who received the service. Also families were, on the whole, able to make better use of follow up services.

Parents Too Can Evaluate Family Preservation Services - or –Involving Parents In Evaluation of Family Preservation Services

In line with the long-standing emphasis in the human services on involving clients in program evaluation, in this essay I focus on principles and strategies for involving parents in evaluation of family preservation services. In particular, I delineate the crucial roles that parents can play as partners in the helping process within a family-centered context.

Family Preservation Journal, 2006, Volume 9, Issue 1. (Entire issue)

Entire issue (large pdf file)

Editorial: Family Preservation Issues

Editorial: Family Preservation Issues

Editorial: Family Preservation: Collaboration and Teamwork

Tis the season of the National Basketball Association finals and the beginning of the Professional Women's Basketball Association. The skills of collaboration and teamwork required to achieve the ballet of basketball is learned by players over a number of years. On school grounds everywhere, children are learning the techniques and skills necessary to play the game of basketball. Recently, I saw a coach on the sidelines screaming at a young player to make her free-throws, and if she missed, she would have to run laps. This reminded me of traditional services to families which threaten, or at best demand a certain level of performance of parents without providing any true "coaching". I often watch our college coach work from a strengths perspective with the team on minute techniques such as the match-up defense and in-bounds plays. This is the approach that family preservation must employ with families, programs, and their communities.

Family Preservation Journal, Summer 1995, Volume 1. (Entire issue)

Entire issue (large pdf file) Articles include: Family Preservation and Support: Past, Present, and Future. Katharine Hooper-Briar,C. Anne Broussard, John Ronnau, and Alvin Sallee An Examination of Treatment Fidelity in an Intensive Family Preservation Program. Marianne Berry Intensive Family Reunification Services: A Conceptual Framework and Case Example. Elaine Walton, Mark W. Fraser, Catherin Harlin, and Robert E. Lewis Intensive Family Preservation Services: Do They Have Any Impact on Family Functioning? Roy W. Rodenhiser, Joseph Chandy, Kazi Ahmed Institutionalizing Intensive Family Preservation Services: A Strategy for Creating Staffing Standards Based on Projections of At-Risk Children from Referral sources. Robert E. Lewis

Family Preservation in Child Welfare: Its Base and Its Future

This is the eleventh issue of the Family Preservation Journal, and we have chosen to focus this special issue on the use of family preservation services in child welfare. While family preservation services, as a philosophy and as a service model, are provided to families in a variety of service settings and sectors, including juvenile justice and mental health arenas, they have their basis and origin in services to children and families. We think it is time, in this 11th issue of the Journal, to take stock of the state of family preservation services in child welfare and assess where they might be heading.