Secondary side-effects often occur in women undergoing hormonal stimulation treatment with clomiphene citrate. In general 10.4% of women experience hot flushing, 5.5% have complaints caused by enlargement of the ovaries and 3.5% experience central nervous symptoms (nervousness, sleeplessness, headaches, visual disturbances, vertigo). During ovarian stimulation with clomiphene citrate for in-vitro fertilization, a 32 year old patient developed psychotic symptoms, commencing 3 days after initiation of treatment. Hospitalization in the psychiatric ward became necessary when severe formal and rational thought disturbances arose together with perceptory and sensory delusions. Under neuroleptic treatment the symptoms improved. Nevertheless, follow-up psychiatric care on an outpatient basis was deemed necessary. The infertility treatment was continued with human menopausal gonadotrophin stimulation. Psychiatric instability occurred neither at this point nor during the 2 year follow-up observation period. Both an exogenous psychosis (ICD F23.9) as well as the exacerbation of an endogenous psychosis (ICD F29) may be considered for the differential diagnosis. The stimulation with clomiphene citrate in connection with the physical and psychic stress of the infertility therapy can be regarded as the trigger factor. For patients with evidence of psychiatric illness in their case history, ovulation-inducing substances such as clomiphene citrate should be implemented with particular care.

In order to study psychosomatic considerations of the male IVF patient, three issues were investigated. First, the personality traits of sterile males (n = 180) were recorded. Male IVF patients were found to have largely the same personality traits as the general population although they tended to have more dominant and retentive traits. Second, in examining the specific stress experiences during IVF, the individual treatment steps were ranked as being similarly stressful by both partners. Males felt the waiting periods (fertilization? pregnancy?) to be clearly more unpleasant than the physical aspects of treatment (e.g. masturbation). Third, an individual comparison of sperm parameters taken during the diagnostic phase with those measured during the IVF attempt, showed that density and morphology were significantly different. Some practical recommendations to reduce the stress that men experience during IVF include his presence during the treatment steps that the female must undergo, as well as his participation in a self-help discussion group.

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Zusammenfassung Kasuistik: Eine 38-j?hrige Patientin w?nschte nach Erstdiagnose eines invasiv duktalen Mammakarzinoms eine Kryokonservierung unbefruchteter Eizellen. Die Stimulation wurde am 26.?Zyklustag begonnen mit t?glich 300 IE hMG s.?c. und einem GnRH-Antagonisten (Cetrorelix 0,25?mg s.?c.). Zus?tzlich wurde w?hrend der ersten 5 Stimulationstage ein Aromatasehemmer (Letrozol 5?mg p.?o.) appliziert. Die Ovulationsinduktion erfolgte am 11. Stimulationstag mit HCG?(10?000 IE s.?c.) und einem GnRH-Agonisten (Triptorelin 0,2?mg s.?c.). Bei der Punktion wurden 17 Oozyten gewonnen und 11 kryokonserviert. W?hrend der Stimulation setzte trotz Cetrotide (GnRH-Antagonist) keine Luteolyse ein, sodass am 11. Stimulationstag ein Schwangerschaftstest durchgef?hrt wurde. Dieser zeigte einen positivenWert (??HCG 3493 mIU/ml). Zeitgleich wurde intrauterin eine Fruchth?hle sichtbar. Die Patientin befand sich zu dem Zeitpunkt in der 5?+?0 SSW p.?m. Morphologisch handelte es sich trotz der hohen Progesteronwerte w?hrend der Stimulation gr??tenteils um normal reife Eizellen (Metaphase II). Die Patientin entschloss sich vor Beginn der adjuvanten Chemotherapie zur Abruptio. Zusammenfassung: Diese Kasuistik zeigt eine Stimulation mit Kryokonservierung von Eizellen bei einer im gleichen Zyklus unmittelbar vor Beginn der Stimulation spontan entstandenen intrauterinen Schwangerschaft. Die Stimulationwurde innerhalb kurzer Zeit in Kombination mit GnRHAntagonisten und einem Aromatasehemmer zur Gew?hrleistung m?glichst niedriger ?strogenspiegel durchgef?hrt. Die Qualit?t der Eizellen scheint durch die hohen Progesteronwerte in der Fr?hschwangerschaft nicht negativ beeinflusst.