E S C

European Society of Contraception and Reproductive HealthESC Central Office - Opalfeneweg 3 -1740 Ternat - BelgiumTel. + 32 2 582 08 52 - Fax +32 2 582 55 15info@escrh.eu - www.escrh.eu

Grant application form second half year 2014Seeking ESC support for a COURSE/MEETING

Introduction

The ESC will provide funding to support a regional or local course or meeting withinEurope related to the aims of the ESC.

ApplicationPlease use this application form. Note sections with a maximum word count. Forms willbe returned if the word count is exceeded.

Who can apply?Applicants must be paid-up ESC members.Applicants should be Europeans. However, a European applicant is allowed to submit agrant for a course that will take place outside Europe.

DeadlineApplications MUST be received at ESC Central office by 31 December 2014.

Budget35,000 euro for applications (projects and courses) received between 1 July and 31December 2014. The ESC may not be in a position to fully fund all applications.

Part A Name of the applicant requesting the funding

Name of applicant: Birute Zilaitiene

Job title: PhD, M.D, professor, endocrinologist

Address: Eiveniu str. 2, Kaunas, Lithuania, LT-50009

Tel No.: +370 686 49882

E-mail: zilaitiene@gmail.com

Date of submission of this form: 31 of December 2014

Part B Proposed course or Meeting

Name of the person responsible for the course/meeting (If different to the personnamed in box A):Birute Zilaitiene, PhD, M.D, professor, endocrinologist

Contact details of the person noted in this box B: name of person, job title, address,tel no. email:Eiveniu str. 2, Kaunas, Lithuania, LT-50009Tel. No. : +370 686 49882E-mail: zilaitiene@gmail.com

Part C Background of the course - narrative summary

Title of the course/meetingReproductive health and hormonal contraception

Comprehensive description of the course/meeting. (Max 200 words)This is an annual one-day interdisciplinary conference organized by Lithuanian Societyof Contraception. The aim of this conference is to quantify the potential effect ofhormonal contraception on the female's reproductive health. The use of long-termcontraceptives, including intrauterine devices, oral contraceptive pills and short-termcontraceptive methods, such as levonorgestrel emergency contraception are the mostcommonly used methods in Lithuania. However, it is known that hormonal contraceptionmay cause side effects such as worsening of sexual function and reproductivepossibilities. About 10 percent of couples in Lithuania are infertile, the numbers areincreasing terrifically. It is controversial whether female's fertility is influenced byhormonal contraception. The field remains hindered by the lack of the evidence basedinformation. Some studies have demonstrated a negatively linear association betweenduration of hormonal-contraception use and ovarian reserve parameters, while the othersshowed contrary results. The conference will focus on the different aspects ofcontraception and fertility control. Thus, t opics on reproductive health after cancertreatment and reproductive function of women suffering from rare endocrine disorderssuch as Turner' syndrome will be covered. Contraceptive use and the risk of ectopicpregnancy will be discussed as well. The information obtained during the lectures will beanalysed and practical recommendations how to improve fertility in hormonalcontraception users will be drawn.

When would it start / finish? (Max 20 words)9 of April 2014/9 of April 2014

Where will it take place - country / town, establishment? (Max 20 words)It will take place in Lithuania, Kaunas, "Park Inn Kaunas" Hotel, Conference centre,Donelaicio str. 27, LT-44240.

Objectives and needs identified. Who will be the audience? (Max 20 words)The conference is intended to obstetricians, gynecologists, general practitioners,endocrinologists, other specialties of physicians, residents, students, midwives, nurses.

Sector in the area of contraception, sexual and reproductive health.Family planning and reproductive health.

What outcomes will be measured? List. (Max 20 words)Hormonal contraception and female fertility; Reproductive health after cancer treatment;Contraceptive use and the risk of ectopic pregnancy ; Turner's syndrome and fertilitycontrol.

Do you foresee any reasons why this meeting may not happen? (Max 20 words)No.

Part D Financial related information

Are there other partners or organisations supporting this same course/meeting? Ifso, list.Pharmaceutical company "Gedeon Richter".

Have you requested funding from anyone else for this course/meeting? (If yes,please give details of all funding sources you have approached) (Max 20 words)Other pharmaceutical companies will be contacted in order to get additional funcing.

How much money are you requesting? A detailed budget must be provided.(Max 50 words)Two leading specialists from ESC in the field of contraception and reproductive healthissues will be invited (depending on the financial support and availability for the planneddate). The support is requesting for two lecturers' trip, living and honorarium expenses.

1s t lecturer's expenses1. Airline tickets to Vilnius (8 of April 2015 ) and from Vilnius (10 April 2015) 300

euro.2. 2 nights in a 4 star hotel 2x100 euro=200 euro3. Honorarium for lecture 500 euro

Total: 1000 euro2nd lecturer's expenses

1. Airline tickets to Vilnius (8 of April 2015 ) and from Vilnius (10 April 2015) 300euro.

2. 2 nights in a 4 star hotel 2x100 euro= 200 euro3. Honorarium for lecture 500 euro

Total: 1000 euro1 s t lector's expencies+2nd lector's expencies= 1000 euro+1000 euro= 2000 euro

Have you already obtained any funding towards this course/meeting? (If yes or stillawaiting a response, please give details) (Max 20 words)We already obtained 500 euro support from pharmaceutical company "Gedeon Richter"for hall's rent.

Who will oversee the budget & keep accounts?Virginija Vanagiene, the president of Lithuanian Society of Contraception.

Part E Follow-up

I / We, as responsible agents for this course/meetings, agree to the following 6 points:

I/We agree that all monies will be spent appropriately YES

I/We agree to advise you at the earliest time if this course/meeting is YESdelayed or cancelled

I/We agree to provide a report to the ESC within 6 months of the end of YESthe course/meeting

I/We agree to present the ESC treasurer with a detailed budget at the end YESof the course/meeting.

/We agree that if you need to make any significant changes to the funding YESof the project after it has been awarded, I/we will advise the ESCTreasurer.

I/We agree to acknowledge the ESC as a donor in any publications and YESoral communications resulting from this course /meeting.

Signed: Date: 31 of December 2014

Name: Birute Zilaitiene

Please return this form (by email) to:

ESC Central OfficeOpalfeneweg 3B- 1 740 Ternat, BelgiumTel +32 2 582 08 52Fax +32 2 582 55 15info(o),escrh.eu