New strategies in family planning and reproductive health: from new mini-pill to preserving fertility for longer

“40-50% of all pregnancies in Europe are unplanned,” estimated Prof. Christian Egarter, head of the Division for Gynaecological Endocrinology and Reproductive Medicine at MedUni Vienna and one of the chairs at the Congress of the European Society of Gynecology (ESG). “This phenomenon primarily affects young women. At the same time more and more women over the age of 35 are having difficulty conceiving naturally, which is why new family planning and reproductive strategies are so important, and one of the focuses of the ESG Congress,” Egarter explained.

Contraception using LARCs

There is an increasing mistrust among the general population of oral hormonal contraception. Between one third and half of all women who use the pill cease doing so within a year. Contraception experts recommend long-acting reversible contraceptives – or LARCs for short – such as copper and hormonal spirals, birth control shots that last three months, or subdermal implants. “The advantages are clear, as LARCs are more effective than oral contraceptives, and unlike sterilisation they are reversible and do not bring any increased risk of thrombosis,” Egarter summed up. Over a longer time period of three to five years, LARCs actually work out cheaper.

New mini-pill to kill two birds with one stone in future

As many women are still sceptical about long-acting reversible contraception, work is ongoing in parallel to develop a mini-pill that has significantly fewer side effects and does not carry any risk of thrombosis. Another highly interesting side effect observed in animal trials is that to some degree white fat was turned into brown fat, meaning that the mini-pill could prove effective in the face of increasing obesity rates. The current status of the research will be presented at the ESG congress, with the mini-pill set to make its Austrian debut soon.

One in 10 births attributable to in vitro fertilisation

While some people are focused on not getting pregnant, others are having more and more difficulty conceiving. “We have a significant problem for society here. While just 10 years ago the average first-time mother was a little over 20, they are now over 30. However, fertility starts to decline from the age of 35 and even more sharply from the age of 40. From about 45, natural pregnancy is only possible in a handful of cases,” Egarter explained. “Due to a range of constraints, one in ten births in Austria is the result of in vitro fertilisation – IVF – treatment,” the gynaecological endocrinologist estimated.

Risk increases with age

The older the woman, the higher risk of underlying illnesses that could have a negative impact on fertility. These also include endocrinological diseases. “Some of these endocrinological diseases, such as polycystic ovaries, respond well to hormonal treatment, enabling the prospective mother to conceive naturally. Unfortunately, in the case of other causes such as premature ovarian insufficiency – where the ovaries cannot do their job properly – success rates are still low,” Egarter noted.

Reproduction is a human right

“New family planning strategies also mean thinking one step ahead and helping people at difficult stages of their lives to preserve their fertility. After all, reproduction is a human right,” he stressed. This is another of the core topics in gynaecological oncology. Cancer patients are increasingly being offered options such as cryotechnology to help them preserve their fertility for as long as possible. This involves removing healthy eggs or ovarian tissue and freezing them before treatment begins, so that they can be used for IVF once the course of therapy ends. Preserving fertility is also an important consideration for transgender parents. As attitudes in society become more liberal, the number of transgender treatments is increasing and in 2018 around 700 men and 600 women received gender reassignment therapy at the MedUni Vienna transgender outpatient clinic.

ESG: taking a holistic look at women’s health

New family planning strategies are just one of several core focuses at this year’s congress. “Due to the broad range of areas covered by gynaecology, numerous specialisms have sprung up in the field of women’s health. The challenge for the ESG congress is to give an update on the entire medical discipline of gynaecology in the shortest period of time,” explained Prof. Kölbl, head of the Clinical Division for General Gynaecology and Gynaecological Oncology at MedUni Vienna, who is another of the ESG congress chairs. Prof. Egarter and Prof. Kölbl are joined as joint chairs by Prof. Johannes Huber, Prof. Peter Husslein and Prof. Christian Singer.

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