Response to the Comment by the Board of the German IVF Register.

Deutsche Version unter: http://dx.doi.org/ 10.1055/s-0042-108897 1. We welcome the fact that the Board of the D.I.R rated 4 of the 5 criticisms as “not altogether wrong” and repeatedly indicated that our criticism was justified (“Kadi and Wiesing pointed out [...] rightly...”). That the Board has again stated that the approach of the D.I.R is “considered exemplary, also by international standards” surprised us. 2. Number of participting centers: When the Board of the D.I.R says that “[o]ut of a total of 132 IVF centers known to us in Germany, 131 centers (99.2%) are members of the D.I.R”, this simply reveals the extent of the crisis. How many centers are not known to the Board of the D.I.R? Does the D.I.R have a basis which allows them to be sure they are aware of all the centers? 3. Prospective data entry: The Board of the D.I.R vehemently rejects our statement that “it cannot be precluded that all data is only entered after some delay” which would mask retrospectively entered data as prospectively entered data. One of the anonymous reviewers pointed out this possibility of manipulation to us: “At present, the prospective entry of data is controlled by the necessity of entering the start of stimulation before entering the ‘successful outcome’, i.e. hCG positivity. But this does not preclude the possibility, for example, that cycles may not be entered at all or that they are entered at a later point in time, so that the start of stimulation along with the entire cycle is only entered after the fact. The authors (Kadi/ Wiesing) are therefore right to demand that the entry of data should be controlled” (quoted from the reviewerʼs report). Instead of “strongly” repudiating this possibility, the D.I.R should be able to effectively rule out this manipulation –which it is currently unable to do. 4. Reference to the D.I.R guideline: The Board of the D.I.R rightly points out that responsibility lies with the respective medical associations of