Getting Pregnant Using Natural Family Planning

The Pregnancy Miracle

In Pregnancy Miracle Lisa Olson reveals her powerful system for getting rid of infertility without resorting to drugs or surgery and according to her claims in the Pregnancy Miracle book you will find a complete holistic system that you can use to reverse infertility and get pregnant quickly even if you are on your late 30s or 40s. The author explains that acupuncture has been used for centuries in China to exchange electrons with the body's meridians, or lines of energy running throughout the body. These lines of energy are, biologically speaking, the folds between cells that occur as we grow. The author goes into much more detail, discussing the various meridians and how they affect fertility. What I love about the Pregnancy Miracle is that it is a very rare, highly unique and potently powerful system for getting pregnant with very high success rate. I have read many similar books on this topic but most of them are incomplete. Either they dont tell how to correctly practice these techniques, or they do not tell what things to avoid. In this regard I found The Pregnancy Miracle to be quite complete. Read more...

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Lifestyle Modification in the Infertile Patient With PCOS

Several studies of lifestyle modification in obese women with PCOS have demonstrated that weight loss resulted in a reduction in hyperandrogenism ( 10), an improvement in ovulatory and conception rates (5,11,12), and a decrease in the miscarriage rates (11). Mild to moderate weight loss of only 2-5 of body weight often results in the restoration of regular vagina bleeding suggestive of normal ovulation (13). These results are often associated with decreased androgen levels, improved insulin sensitivity, and reduction of abdominal fat, although the degree of reduction of hyperinsulinemia seems to be the key factor responsible for the beneficial effect of weight loss on ovulatory dysfunction (13,14). Nevertheless, improvements in menstrual irregularity and ovulation rates with weight reduction do not occur universally in all obese women with PCOS (13-15). A recent study evaluating the effects of caloric restriction and dietary composition in women with PCOS observed that approximately...

Nuclear Transplantation into Immature Oocytes

In some cases of infertility, a limiting step for the assisted reproductive technologies (ARTs) is the availability of normal oocytes, and this has stimulated research into cryopreservation of oocytes at different maturational stages and freezing of the ovarian cortex for young women undergoing chemotherapy and or radiotherapy (85). One problematic cause of infertility is reflected in the higher incidence of oocyte aneu-ploidy in older women. Independently of the initial indication or the ART technique used to solve it, the pregnancy rate follows a downward slope with advancing maternal age starting at 35 years (86). Although such patients can only be treated by oocyte donation at the present time, more and more women are becoming interested in bearing their own

In Vitro Fertilization

In IVF and other assisted reproduction technologies, the ovaries are stimulated with gonadotro-pins, which contain follicle-stimulating hormone (FSH) with or without luteinizing hormone (LH). This leads to multiple follicular development, which results in increased numbers of oocytes being available for retrieval. Higher numbers of oocytes after fertilization generate higher numbers of embryos. This, in turn, allows for the selection of good-quality embryos for transfer and therefore higher pregnancy rates. Good-quality embryos may also be cryopreserved, allowing further attempts at pregnancy without the necessity of repeated ovarian stimulation and oocyte retrieval. Initially, oocyte retrieval was performed by laparoscopy, but today the transvaginal ultrasound-guided method is used (5). Different anesthesia and analgesia regimens can be administered. General or spinal anesthesia is not generally needed paracervical block with bupivacaine and mild sedation in combination with opioid...

Malefactor Infertility And Icsi

Since the first human birth following in vitro fertilization (IVF) in 1978, this procedure has been used extensively to treat infertility. However, in many cases of male-factor infertility spermatozoa cannot fertilize, and a number of micromanipulation techniques have been developed to overcome this inability. Micromanipulation of human gametes has not only allowed fertilization in cases of severe oligozoospermia, even by defective spermatozoa, but has provided a powerful tool for exploring the basic elements of oo-cyte maturation, fertilization, and early development. Micromanipulation techniques also now permit the diagnosis and sometimes even the correction of genetic anomalies, as well as optimization of implantation in certain cases. Intracytoplasmic sperm injection (ICSI) is now the primary micromanipulation technique used for treating male-factor infertility. It entails the mechanical insertion of a selected spermatozoon directly into the cytoplasm of a human oocyte. This...

Ovarian Stimulation for IVF in Polycystic OvaryPCOS

Ovarian stimulation with gonadotropins for IVF in polycystic ovaries and or PCOS is a particular problem and is indeed a challenge for the physician and patient. The long GnRH agonist-suppression protocol accompanied by pretreatment with combined oral contraceptive pills has been widely accepted as the most effective stimulation protocol for polycystic ovary PCOS patients (Fig. 2). Pituitary suppression takes longer for polycystic ovary PCOS patients (22). Although the optimal time to commence GnRH agonist is not clearly determined, commencement in the early follicular phase combined with oral contraceptive pills would avoid the risk of inadvertent administration during early pregnancy. The GnRH agonist protocol has been found to suppress elevated LH and androgen levels and prevent a premature LH surge, which appears to improve the pregnancy rate and reduce the miscarriage rate in PCOS patients undergoing IVF treatment (23-26). Patients with polycystic ovaries respond the same as...

Effect of Metformin on Anovulation and Infertility 2211 Metformin Monotherapy in PCOS

Clomiphene citrate has been the initial therapeutic option for the management of anovulatory infertility for many years. Metformin was directly compared to clomiphene in a recent double-blind, placebo-controlled trial in non-obese women (average body mass index BMI 27 kg m2) with PCOS (24). After progesterone-induced withdrawal bleeds, 100 women with PCOS were randomized to metformin (850 mg twice daily) or clomiphene citrate (150 mg for 5 days on a monthly basis) for 6 months. Although there was no difference in ovulation rates between the metformin and clomiphene groups, the pregnancy rate was higher (15.1 vs 7.2 p 0.009) and spontaneous abortion rate lower (9.7 vs 37.5 p 0.045) in the metformin group. There was also a favorable trend for the live-birth rate with metformin compared to clomiphene (83.9 vs 56.3 p 0.07).

Pregnancy Rates

Most early studies were of an observational nature and have also been reported in the context of large reviews (2,3). An unfortunate feature of many of the papers that describe laparoscopic treatment wedge resection is the poor characterization of the patients such that many appear to have been ovulating prior to treatment. Furthermore, as the polycystic ovary becomes more sensitive to either endogenous or exogenous FSH after LOD, many practitioners have taken a pragmatic approach by commencing ovarian stimulation with either clomiphene or gonadotropins if ovulatory activity is not immediately induced (30,31). The first RCT suggested that LOD was as effective as routine gonadotropin therapy in the treatment of clomiphene-insensitive PCOS (29). In this study 88 patients were randomized prospectively to receive either human menopausal gonadotropin, FSH, or LOD. There were no differences in the rates of ovulation or pregnancy between the two groups, although those treated with LOD had...

Concerns About Icsi

A concern in considering the use of suboptimal spermatozoa for ICSI is the potential for transmitting the genetic abnormalities responsible for male infertility (4, 5, 7, 10, 29, 36-41). Despite this, ICSI is accepted as the only therapeutic option for patients with congenital absence of the vas deferens, associated with a gene deletion labeling these individuals as carriers of cystic fibrosis (42, 43). Similarly, infertile patients with Kartagener's syndrome or other ciliary dyskinesia that renders spermatozoa immotile may transmit this condition to their offspring. In these cases, genetic screening and patient counseling is crucial, and preimplantation genetic testing as well as prenatal evaluation should be considered. Liebaers et al. (44) reported only 1 of sex chromosomal anomalies after ICSI, and in our ICSI program (n 2190) there was a 1.8 incidence of congenital abnormalities compared to 3.0 in babies born as a result of standard IVF and compared to 3.6 in Table 5.5. In Vivo...

Indications For Icsi

Despite agreement in some areas, no universal standards for patient selection have emerged in regard to ICSI. There is a general consensus that ICSI should be performed following fertilization failure in standard IVF with putatively normal oocytes, and where an appropriate sperm concentration was used even in microdrops useful criteria for all male-factor patients, even those who have not been treated before. Although oocytes that failed to fertilize with standard IVF techniques can sometimes be reinseminated successfully by ICSI, this introduces a risk of creating embryos from aged eggs (19). In our own limited experience, six of eight pregnancies established by micromanipulation of such oocytes miscarried, and cytogenetic studies performed on the aborted fetuses provided evidence of chromosomal abnormalities. Thus, notwithstanding a recent report of normal pregnancies (20), we currently reinseminate unfertilized oocytes only for research purposes. In regard to sperm numbers, a count...

Conception rates

Conception rates depend upon so many different factors that it is impossible to arrive at an overall average conception rate for cooled semen. In general, conception rates for cooled semen stored for any period in excess of 24 h (Francl et al., 1987 Pickett et al., 1987 Squires et al., 1988) are lower than those attained for insemination with fresh semen. Conception rates ranging from 50 to 80 are regularly reported for cooled semen, in comparison with rates of 70-76 for fresh semen insemination (Hughes and Loy, 1970 Palmer et al., 1984 Van der Holst, 1984 Francl et al., 1987 Silva Filho et al., 1991b Jasko et al., 1993b Heiskanen et al., 1994a). However, wide variations exist. Lower conception rates, nearer to 30-40 , have been reported for single oestrus inseminations (Domerg, 1984), whereas conception rates of 72-77 have been reported for mares inseminated twice using semen from four stallions that has been kept at 4 C for 72 h (Yurdaydin et al., 1993). Heiskanen et al. (1993,...

IVF in PCOS

Exercise Pco Treatment

PCOS is the most common cause of anovulatory infertility. As described in Chapters 35 and 37, the treatment of anovulation comprises lifestyle modification through diet, exercise, and weight loss, insulin sensitizers, oral ovulation induction agents, surgical treatments, and gonadotropins. Patients who have not conceived with other treatment approaches or couples who have additional infertility factors may require IVF. In vitro fertilization treatment outcomes for PCO PCOS patients may even be better than for patients with normal ovaries. After three cycles of IVF treatment, the odds of achieving a pregnancy with polycystic ovaries were 69 higher than those of a woman with normal ovaries (9). PCOS has been shown to exist in 4-10 of the general population and can be found in even higher incidences in certain populations. Polycystic ovary is a morphological definition based on ultrasound without any manifestation of the syndrome and can be defined as the presence of 12 or more follicles...

In Vitro Maturation

Transvaginal Oocyte Recovery

The recovery of immature oocytes (Fig. 4) followed by IVM and IVF is an attractive alternative to conventional IVF treatment in which controlled ovarian stimulation with gonadotropins is used to increase the number of available oocytes and embryos (41). Significant progress has been made in improving implantation and pregnancy rates from in vitro matured oocytes (Fig. 4). The high numbers of antral follicles in patients with polycystic ovaries or PCOS make them prime candidates for IVM treatment, even if the appearance of polycystic ovaries in the scan is not associated with an ovulation disorder. Indeed, the main determinant of clinical success rates of IVM treatment is antral follicle count (42). When hCG priming is used before oocyte retrieval, it has been found that immature oocytes retrieved from normal ovaries, polycystic ovaries, or women with PCOS have a similarly high maturation, fertilization, and cleavage potential (43). However, although the implantation rate was lower,...

Procedures in earlymidpregnancy

Cervical suture (Shirodkar or McDonald cerclage) is performed to reduce the incidence of spontaneous miscarriage when there is cervical incompetence. Although it can be done before conception or as an emergency during pregnancy, the procedure is usually performed electively at 12-16 weeks' gestation it generally takes 10-20 minutes and is performed transvaginally on a day-case basis. A nonabsorbable stitch or tape is sutured in a purse-string around the cervical neck at the level of the internal os this requires anaesthesia since the procedure is at best uncomfortable, although the suture can usually be removed easily without undue discomfort (usually at 37-38 weeks' gestation unless in preterm labour) spontaneous labour usually soon follows.

Problemsspecial considerations

Women undergoing cervical suturing may be especially anxious since previous pregnancies have ended in miscarriage. Otherwise anaesthesia is along standard lines, bearing in mind the risks of anaesthesia in the pregnant woman and monitoring of, and possible effects of drugs on, the fetus (see Chapter 7, Incidental surgery in the pregnant patient, p. 12).

Section 1 Preconception and Conception

There have been rapid developments in the treatment of infertility. The anaesthetist may be involved in many aspects of the patient's treatment, which may be complex. The harvesting of oocytes needs to take place within a defined period of time, or ovulation will have occurred and oocytes will be lost. Couples presenting for infertility treatment are generally anxious and often the women are emotional at the time of oocyte retrieval. It is therefore particularly important for the anaesthetist to understand the couple's anxieties and to be able to explain the effects of the anaesthetic technique that is to be used.

Subject Head Public Health Primary Care and Thames Valley University

Debby trained as a nurse and midwife before studying for a degree in Social Science and Administration at the London School of Economics. She then qualified as a Health Visitor and worked in North-West London. During this time she became interested in adolescent sexual health, working in a unit for pregnant schoolgirls and as a family planning nurse. She moved into nurse education in 1989, teaching pre- and post-registration nurses. She has been at Thames Valley University since 1994, at first as the programme leader for the BSc Health Promotion and the family planning course. During this time she completed her Master's degree in Health Studies and completed a small research project on young people's perceptions of family planning clinics as part of the course. Since 2000 she has been the Subject Head for the Public Health and Primary Care subject group. Her subject team run programmes and short courses in primary care, public health and health promotion, sexual health and the care of...

Consultant Nurse in Sexual Health and HIV St Marys NHS Trust

Matthew qualified as a nurse in 1992 at the age of 20, being one of the youngest students to qualify from the Brent and Harrow School of Nursing and Midwifery. Initially, he worked as a staff nurse in Trauma Orthopaedics, before moving into Sexual Health in 1994. Since starting as an outpatient Staff Nurse in GUM and HIV in 1994 he has worked in various roles Health Adviser, Nurse Practitioner, Senior Nurse for Sexual Health and HIV and Advanced Nurse Practitioner. He has broad experience in sexual health, HIV and family planning and also has experience working with patients with sexual dysfunction. Matthew has undertaken various courses, including genito-urinary medicine (ENB 276), HIV AIDS (ENB 934), Family Planning (ENB 901),Teaching and Assessing (ENB 998), and Research (ENB 870),as well as the BASHH course in STIs and HIV. He completed a BSc (Hons) Professional Studies - Nursing in 2002 from Thames Valley University and is an independent (extended and supplementary) nurse...

Nurse Practitioner Praed Street Project The Jefferiss Wing St Marys NHS Trust

Jennifer's first post in sexual health was at St Thomas' Hospital, London, where she gained a solid foundation in sexual health and completed the ENB 934, the HIV and AIDS course. She then worked as a staff nurse at Archway Sexual Health Clinic for three years where she started to find her niche in sexual health, working with CLASH (Central London Action Street Health) based in Soho, a project set up to work with male and female sex workers and street homeless.At Archway Sexual Health Clinic she achieved the ENB 8901, reproductive and family planning course and the ENB 276, sexual health course. Jennifer moved to Barnet Hospital where she held the position of Sister Outreach Worker for SHOC (Sexual Health On Call) for two and a half years.There she enjoyed a varied role, providing outreach services to local flats and brothels, establishing satellite blood-borne virus clinics in the local drug dependency service and working within the main sexual health clinic. She worked closely with...

Asymmetric Divisions in Embryogenesis

Maize and tobacco zygotes produced by in vitro fertilization also develop into asymmetrical two-celled embryos that consist of a small cyto-plasmic rich apical cell and a large vacuolated basal cell (Kranz et al. 1995 Okamoto et al. 2005 Ning et al. 2006). The maize zygotes can eventually develop into fertile plants (Kranz and Lorz 1993). These studies then suggest extrinsic maternal factors are not required for the asymmetric division of the zygote making a case for intrinsic regulation of asymmetry.

Analytic Studies Case Control Studies

Notwithstanding their limitations, policy decisions regarding preventive and therapeutic interventions based on information from case-control studies may be necessary because results from observational cohort studies will not be available for many years and or because randomized trials are too small to detect true associations with rare events. For example, FDA approval to market diethylstilbestrol (DES) as an agent to prevent miscarriage was rescinded after case-control studies showed that DES exposure during pregnancy was associated with a markedly elevated risk of cancer of the vagina in the offspring of mothers who took it during pregnancy (Herbst et al. 1971 Greenwald et al. 1974).

Preimplantation Genetic Diagnosis

IVF and the biopsy of polar bodies from oocytes, blastomeres from cleavage-stage embryos, or trophectoderm cells from blastocysts followed by single cell diagnosis has enabled us to help couples who are at risk of transmitting inherited diseases to their children and to improve pregnancy rates for certain groups of IVF patients. These procedures are used in a technique called preimplantation genetic diagnosis (PGD) (1). PGD was developed in 1990 to offer an alternative treatment for couples at risk of transmitting an inherited disease to their offspring. The main option for such couples is to become pregnant naturally and undergo prenatal diagnosis between 12 and 16 weeks of pregnancy (either by chorionic villus sampling or amniocentesis). The main drawback of prenatal diagnosis is that if the fetus is affected by the disease, the couple have to decide whether to continue the pregnancy or terminate the pregnancy. This is obviously not an ideal option for any couple trying to have a...

Relapsing polychondritis

A rare, autoimmune, systemic inflammatory disease in which there is gradual destruction of the cartilage of the nose, ears,joints, larynx, and trachea. Inflammation, oedema, and scarring of the tracheal rings results in tracheal narrowing and dynamic airway obstruction.The condition usually presents between the ages of 40 and 60 years.Anaemia, early-onset, laryngotracheal stricture, saddle nose and systemic vasculitis are associated with a poor prognosis (Trentham & Le 1998).Anaesthesia may be required for surgical reconstruction of the nose or ear, or occasionally for treatment of upper airway obstruction, or lower airway collapse. In severe cases endobronchial stenting may be required (Faul et al 1999). Occasionally, patients with relapsing polychondritis become pregnant. In a series of 25 pregnancies in 11 patients, although about 30 of patients had a flare up of the disease that required treatment, none had significant involvement of the respiratory tract (Papo et al 1997).

Anaesthetic problems

With aggressive treatment, more patients are surviving to become pregnant (Canney et al 1991). In a survey of 38 pregnancies in 25 patients, pregnancy was found to be well tolerated by most. However, the patients in this study had less severe disease, since half were pancreatic sufficient. In other series, mother and fetus fared less well. Maternal complications included pulmonary, liver, cardiac, and pancreatic insufficiency.There was poor fetal nutrition and oxygen delivery, and an increased perinatal mortality. Edenborough et al (1995) reported that an FEV1 of < 60 predicted was associated with an increased risk of premature delivery, Caesearean section, loss of lung function, and early maternal death. Recurrent infections may

Implications of Nuclear Transplantation

In contrast, some genetically abnormal oocytes can develop into embryos of normal appearance that would be considered suitable for uterine transfer (88). However, the large majority of chromosomally abnormal embryos probably do not implant, and even when they do, the fetus generally does not survive to term. The decline in the ability to conceive with maternal age (86) appears to be primarily related to an increased incidence in oocyte aneuploidy (89). In accordance with this, 37.2 of morphologically normal eight-cell embryos in the 40-45 maternal age group were found to express chromosomal aberrations (88). The risk of conceiving an aneuploid fetus has been reported to increase from 6.8 for women 35-39 years old to about 50 in women 45 years or older (90). Nevertheless, much older women have become pregnant after replacement of embryos derived from young donor oocytes.

Preoperative abnormalities

Occasionally patients become pregnant, in which case the commonest complications are hypertension and diabetes (Aron et al 1990, Prihoda & Davis 1991).A patient with Cushing's syndrome and a phaeochromocytoma underwent laparoscopic adrenalectomy at 17 weeks' gestation (Finkenstedt et al 1999).

Von Willebrands disease

Section may be considerable.There is an increased incidence of miscarriage, postabortion bleeding, and primary and secondary postpartum haemorrhage, particularly when factor levels are < 50 iu dl-1. Bleeding associated with surgical delivery or perineal damage usually occurs postpartum because of the rapid decline in FactorVIII and vWF levels after delivery (Walker et al 1994).

Contraindications

Surgical treatment of biliary colic in pregnant patients is usually deferred until the postpartum period unless symptoms are too severe or there is gestational weight loss. When cholecystectomy is to be undertaken, the second trimester is typically the preferred time. Miscarriage rates are lower in the second than the first trimester and preterm labor rates are lower in the second than third trimester. Modern series of pregnant patients with biliary pancreatitis, however, have challenged the notion that the second trimester should be the preferred time for biliary surgery or that it should carry significant maternal or fetal risk. Cholecystectomy may prove to be a safe procedure at any time during pregnancy so long as obstetric involvement is obtained early and fetal monitoring is performed (22).

Thromboprophylaxis in pregnancy

Increasing numbers of women are being given prophylaxis against arterial or venous thrombosis in pregnancy. Some women have a hereditary or acquired thrombophilia or a past medical history of thrombosis. In addition, some obstetricians treat women with a strong history of stillbirth, intrauterine death and miscarriage with prophylactic doses of antithrombotics such as aspirin, heparin or both. Other women require continuation of pre-pregnancy therapeutic doses of antithrombotics, such as those with prosthetic heart valves.

Gonadotropin Ovulation Induction

Inappropriately elevated serum LH levels are found in up to 70 of women with PCOS (106). This persistent elevation in serum LH during the follicular phase has been correlated with decreased pregnancy and increased spontaneous abortion rates. These complications were also related to the higher LH levels commonly seen in women with PCOS (46). Consequently, it has been suggested that purified uFSH would be more effective than hMG for ovulation induction in PCOS. However, a recent meta-analysis including 14 randomized, controlled trials did not find any differences in pregnancy rates between women with PCOS receiving uFSH or hMG (107). The incidence of OHSS was lower, however, in women using uFSH compared with hMG (OR 0.20 95 CI 0.08-0.46). In this study no conclusions could be drawn regarding the relative effect of these preparations on miscarriage and multiple pregnancy rates because of insufficient reporting of these outcomes in the trials (107).

Breast Cancer Associated with Pregnancy

The physiologic changes and engorgement that occur in the breast during pregnancy often hinder early detection of breast cancer. This results in a diagnosis at more advanced stages in pregnant and lactating women. Comparisons to nonpregnant women matched for similar age stage of breast cancer and reproductive capacity do not suggest a worse prognosis for the pregnant patients with breast cancer.28,29 von Schoultz30 performed a comparison of women diagnosed with breast cancer 5 years before pregnancy to women without a pregnancy during the same time period. There was no survival disadvantage to the women who were pregnant 5 years prior to the diagnosis of breast cancer. These and other studies have discouraged the practice of prohibiting breast cancer survivors from becoming pregnant on clinical grounds. Subsequent pregnancies do not negatively affect survival outcomes. (stages I to III). Equivalent survival outcomes were reported by von Schoultz30 for breast cancer patients with no...

Should Everyone Be Tested

One of the first appealing hypotheses was proposed 30 years ago. Dr. Alfred Knudsen, who now works at the Fox Chase Cancer Center in Philadelphia, calculated that the unusually high prevalence of the CF allele could be explained if healthy persons who carried one copy of it were on average just 2 more fertile than were those who did not. That would be enough to maintain the allele at high levels despite the deaths of affected children. What aspect of the CF allele might confer a reproductive advantage on carriers There have been several creative guesses, such as that by a scientist who suggested that in women who are carriers the vaginal fluids might have a different viscosity that would facilitate the movement and survival of sperm, increasing the chances of becoming pregnant. Recently, studies in India have shown that CF carriers are more likely than are non-carriers to survive cholera. Since cholera has been sweeping through human populations for millennia (it devastated the United...

Addisonian crisis or acute adrenocortical insufficiency see

E) Patients with adrenocortical insufficiency may be subfertile. Cardiovascular collapse occurred in a young woman undergoing infertility investigations under general anaesthesia (personal observation). Sudden death occurred a week later, in a period of steroid withdrawal, during adrenocortical investigations.

Hormonal Abnormalities

As would be expected, stallions with low circulating testosterone levels have depressed DSO as well as decreasing libido. As mentioned previously, testosterone, hCG and GnRH therapy have been used with mixed success to address this problem. The lack of success may well be due to the fact that depressed pituitary function is the cause of infertility in only 1 of cases (Boyle et al., 1991 Roger and Hughes, 1991). Abnormal hormone levels may be associated with hypothyroidism, resulting in delayed puberty, smaller testes, decreased spermatozoan production and decreased libido. Feminization of the genitalia may also be observed. It has been postulated that changes in thyroid function may be the cause of stallion summer infertility associated with elevated environmental temperatures (Brachen and Wagner, 1983).

Dysfunctional Uterine Bleeding

Ovulatory causes may result from an inadequate luteal phase that occurs if there is an insufficient peak in progesterone. This is usually a result of a reduced amount of follicle-stimulating hormone being secreted. This syndrome may be associated with irregular bleeding and infertility.

Preoperative identification

Known history of anaphylaxis to latex. It does not always occur to patients that their rubber allergy might be of relevance to the anaesthetist. Two patients who denied allergies developed delayed responses of intraoperative hypotension and flushing. Both had increases in tryptase levels (10.4 mgl-1 and 8.5 mgl-1 normal 2 m gl-1), and positive skin prick tests to latex. Only at this stage did each patient declare their cutaneous reactions to latex (Fisher 1997).Another had hives after the use of gloves and sneezing during vaginal examinations (Ballantine & Brown 1995). She had undergone IVF for infertility, which involved regular use of a latex-covered vaginal probe.

Sex Preselection and Prefertilization Genetics

Certain trends are now emerging in attempts to solve other infertility disorders in human reproduction. Many are linked to genetic issues such as complete spermatogenetic arrest and oocyte aging, while others relate to sex-linked diseases. The only validated technology is based on the well-known difference in the DNA present in X and Y sperm in humans, representing a difference in mass of 2.8 . This incorporates modified flow cytometry to sort X- and Y-bearing sperm, and published results clearly prove the effectiveness and efficiency of the current sexing process in a broad range of applications (58-60). Resulting populations of X or Y sperm are generally used in conjunction with IVF or intrauterine insemination. Improvements in the production rate of sexed sperm, high-speed sorting is one of the newer technological advances to increase sorted sperm throughput. Initially this approach allowed the sorting of 350,000 sperm h, but now 6 x 106 of each sex h are sorted, under routine...

Therapy of Extensive Disease

Sulfasalazine may be started at 1 g daily with an increase in the dose by 1 g each day up to the target dose of 3 to 4 g d, if tolerated. The complete blood count should be checked after a week to look for toxicity, especially leukopenia. However, there are several drawbacks to using sulfasalazine instead of one of the newer 5-ASA preparations. Sulfasalazine should not be used in patients with a history of sulfa allergy. Besides allergic reactions, some patients develop headaches, nausea, anorexia, and other dose-related adverse effects. Sulfasalazine may cause reversible male infertility, which does not occur with the other oral 5-ASA medications.

Integrating The Relaxation Response Into Health Care

The relaxation response has been associated with improvements in many medical conditions including hypertension, cardiac arrhythmias, chronic pain, insomnia, side effects of cancer therapy, side effects of AIDS therapy, infertility, and preparation for surgery and X-ray procedures. It is also important to indicate that more recently, the overall implications of integrating relaxation response in routine clinical treatments has been examined. Some relevant examples will be discussed.

Genital Anomalies Fertility and Sexual Problems

There is little information about fertility in patients with ARM. In the series of Rintala et al. of 83 adult patients 62 with low malformations, 47 (57 ) had offspring of their own. In the same study, 54 of the healthy controls of similar age and sex distribution had children of their own. On the other hand, in another study from the same institution concerning high malformations, only 39 of the patients had children, which was significantly less than the healthy controls (60 ) 83 . In Hendren's 92 large series of cloaca patients, 7 out of 24 adults have had children of their own. Obviously, the low frequency of offspring in patients with high anomalies reflects true infertility in a significant percentage of patients. Ejaculatory duct obstruction has been reported in males 95 , some have weak or missing erections, or retrograde ejaculations 83 , and some females have Mullerian structure agenesis 90 . On the other hand, some patients may avoid sexual contacts because of defective...

Small round viruses See Norwalklike viruses

Smedi A syndrome (stillbirths, mummification, embryonic death and infertility) in pigs caused by porcine enterovirus. Smedi enteroviruses are only clinically apparent when they infect the fetus, and the pathological effects depend on the stage of gestation. At early stages, there may be embryonic death and return to estrus. Fetuses infected between 40 and 70 days die, and those infected later may

Surgically Retrieved Spermatozoa

From a total of 309 cycles performed with epididymal spermatozoa and 159 cycles with testicular spermatozoa, we observed that cryopreservation clearly impaired motility parameters (p < .0001) and pregnancy outcome (p < .001), though the ICSI fertilization rate was unaffected (Table 5.3). The fertilization and pregnancy rates after ICSI Table 5.2. Fertilization and Pregnancy Rates According to Semen Origin Table 5.2. Fertilization and Pregnancy Rates According to Semen Origin

Polymerase Chain Reaction

To add to the difficulty in amplifying DNA from single cells, PCR for PGD is complicated by contamination and a phenomenon known as allele dropout (ADO) or preferential amplification (8). Contamination can occur in any PCR reaction, not just in single cell PCR. However, it is more important in single cell PCR because it may lead to a misdiag-nosis. Contamination may be caused by cumulus cells or sperm attached to the zona pel-lucida, which may become dislodged during the embryo biopsy procedure. Therefore it is essential to remove all cumulus cells before the biopsy and to use ICSI for fertilization to ensure there are no sperm embedded in the zona. Contamination can also be caused by DNA in the atmosphere or from cells from laboratory staff. A number of PGD misdiag-nosis have been reported, and in most cases this was probably caused by contamination (1). Therefore, polymorphic markers can be used to determine if the DNA being amplified is from the parents (16, 17). A similar method...

Ejaculated Spermatozoa

A total of 3360 ICSI cycles were performed with ejaculated spermatozoa 355 cycles where the semen parameters were normal and 3005 with abnormal parameters according to the World Health Organization and Kruger's strict criteria. After injection, 94.4 of 28,478 oocytes survived, and 75.3 displayed two pronuclei. Though the group sizes varied greatly, the origin of the semen sample when mature spermatozoa were used (fresh or cryopreserved spermatozoa obtained by masturbation, electroejaculation, or bladder catheterization) did influence fertilization rate (p .0001 Table 5.1). When the fertilization and pregnancy rates of ejaculated spermatozoa were compared with surgically retrieved spermatozoa, a significant difference was found (p .0001 Table 5.2).

Preliminary Results with Nuclear Transplantation

For similar human studies, GV oocytes were obtained, as described earlier, from consenting patients undergoing ICSI (4, 10, 29, 36). Immediately before ICSI, corona cells were removed by enzymatic and mechanical treatments, and the denuded oocytes were examined under an inverted microscope to assess their integrity and maturation stages (4, 10, 29, 36). The nuclear transplantation procedure is shown in Figures 5.85.11. The reconstituted immature oocytes were cultured and were examined at 24 and 48 h after electrofusion to evaluate nuclear maturation, characterized by disappearance of the GV and extrusion of the first PB. In the mouse, nuclear transplantation into GV-stage oocytes followed by extrusion of a PB revealed an overall efficiency of 80 . Interestingly, this aggressive technique appears not to increase the incidence of chromosomal abnormalities (103). Human oocytes were reconstituted with an efficiency of 73 , with a lower maturation rate of 62 following reconstitution,...

Why Has The Person Come For A Checkup

People may come forward for a health screening for a number of reasons. These may include the fact that they have never had a screen and feel it is time that they did that they have a partner with whom they wish to stop using condoms, so that they have both agreed to undergo screening that they now have symptoms that they don't usually have, and are therefore worried that they have had a recent exposure and want peace of mind or they may be engaging in screening prior to fertility treatment or prior to taking out a mortgage or an insurance policy or their partner may have been at risk, and they have come in for screening as a contact (Presswell & Barton, 2000).

Extenders for use with fresh semen

Details on the types of extenders that are used have already been given. As regards their success rate when specifically used with fresh semen, the following conclusions may be drawn. When semen is extended in two of the more common extenders and inseminated immediately, cream-gel extender is reported to yield the highest 50-day pregnancy rates (95.8 ), compared with raw semen (91.7 ) and semen extended in TRIS diluent (75 ) (Pace and Sullivan, 1975). This generally poor performance of TRIS extenders has been attributed to the fact that TRIS is a hydrogen ion extender and to the common inclusion of glycerol in TRIS extenders (Pickett et al., 1975a Pace and Sullivan, 1975 Demick et al., 1976). With short-term storage these figures remain excellent throughout but TRIS extenders still remain relatively poor (Pace and Sullivan, 1975). Comparative work with cream-gel, skimmed milk and skimmed milk-gel yielded lower conception rates than those reported by Pace and Sullivan (1975), but they...

Zonafree hamster ova penetration assay

Zona-free hamster oocytes have been used successfully to indicate the viability of human spermatozoa (Yanagimachi et al., 1976 Binor et al., 1980 Overstreet et al., 1980 Hall, 1981) and bovine spermatozoa (Amann, 1984). The ability of a spermatozoon to penetrate a zona-free hamster oocyte depends upon its successful completion of capacitation and the acrosome reaction, resulting in the formation of the male pro-nucleus. The zona-free hamster assay indirectly assesses the spermatozoa's ability to carry out these reactions in a coordinated sequential fashion and thereby indirectly assesses the spermatozoon's viability. Alternatively, spermatozoon capacitation and the acrosome reaction can be induced artificially and full penetration and fertilization of the oocyte assessed, instead of just attachment. Some work on the use of the zona-free hamster oocyte test in stallions has been reported (Samper et al., 1989 Zhang et al, 1990a Padilla et al., 1991). Pitra et al. (1985) failed to...

Importance Of Embryo Assessment

The need to identify the most viable embryo is of fundamental importance. In particular, human IVF clinics have faced this problem because stimulation protocols (1) generate more embryos to choose from and because of the increase in IVF-related multiple births (2, 3). Many methods have been suggested to evaluate embryo viability in both animal models and in human IVF programs. In human IVF clinics, a limiting factor is that these measurements need to be noninvasive and not time consuming. Routinely, the embryos selected for transfer are chosen on the basis of their morphology and rate of development in culture.

Posttest discussion points when giving an HIVpositive result

Newly diagnosed patients may require immediate assistance in attaining additional counselling for emotional distress, peer support, assistance with financial concerns, future planning, child-care issues, housing, or other practical concerns. Such patients may also require referrals to services related to family planning. Where available, you should refer patients to appropriate community organisations, social agencies, peer support groups, and other resources near to the area in which they live or work. However, some patients may wish to travel further afield. Patients who test negative may also require referrals to family planning, healthcare, counselling, or social services. All patients, positive and negative, should be provided with condoms, counselling on prevention, and information about where to obtain additional condoms.

Surveys Of Selected Subpopulations

Categories 4-13 in Table 3.6 represent populations at all levels of risk. For example, the seroprevalence in newborns ranges from 0.00 to 0.58 among 39 states (Table 3.6), and within Massachusetts, levels range from 0.8 for inner-city hospitals to 0.09 for suburban and rural hospitals (Hoff, Berardi, Weiblen, et al., 1988). Tremendous variation is also seen among women in clinics for family planning and prenatal care, among patients being treated for non-HIV related illness in sentinel hospitals, in prison populations, and among university students (Table 3.6).

Impact of Genetic Results on Clinical Evaluation of Patients with ARVCD

In a family member who does not carry a genetic mutation, genetic analysis provides a definitive and rewarding answer. As a consequence, subjects do not need to be followed. Moreover, they may lead a normal life and family planning, being assured that they will not transmit ARVC D to their children.

Flight results come in

The sea-urchin fertilisation experiment, designed to shed light on problems that could be associated with human reproduction on multi-generation space flights, did not go quite according to plan. The sea-urchin eggs somehow disintegrated during the flight, although those that had been fertilised prior to the flight continued to develop normally.

Single Cell Diagnosis

Two techniques are used for single cell diagnosis in PGD. PCR is used for the diagnosis of single gene defects, including specific diagnosis of X-linked disease, autosomal recessive and dominant disorders, and the triplet repeat diseases (8). FISH is used to examine chromosomes and so is used for sexing embryos for X-linked disease (9, 10) and for chromosome analysis, in the case of translocations, insertions, and so on (11-13). More recently, FISH has also been used to check for the chromosomes commonly involved in aneuploidy (chromosomes 13, 18, 21, X and Y) in embryos from patients undergoing routine IVF procedures as a method to improve IVF pregnancy rates (14).

Techniques And Principles

PGD is based on the progress of IVF, micromanipulation and biopsy of gametes and embryos, and on the progressive achievements in the genetic analysis of single cells. Micromanipulation techniques have been widely used to biopsy mammalian embryos to successfully remove genetic material and analyze it without affecting the viability of the embryo (32). This technique was applied for the first time in humans in 1989 by Handyside and colleagues for diagnosing X-linked diseases (15). In 1990 the first children born as a result of biopsying human embryos showed no detectable birth defects, which indicated that embryo biopsy was a safe and efficacious tool to use for PGD in humans (15).

Fluorescent in Situ Hybridization

In recent years, several groups have reported the use of embryo biopsy and FISH to examine oocytes or embryos from couples undergoing IVF, with the view of trying to improve the chance of pregnancy. For older patients undergoing IVF, one group has used polar body analysis (22), and the other group has used cleavage-stage biopsy (14). This procedure may also be useful for patients experiencing recurrent miscarriages, even though their chromosomes are normal (23).

Cryopreservation of Biopsied Embryos

Cryopreservation of biopsied embryos is becoming a necessity with patients who have a greater number of normal embryos than those transferred. Experiments in mice have shown promising results in achieving successful cryopreservation of biopsied embryos (51, 53, 93). Cryopreservation of biopsied human embryos would not be as simple as methods applied for unbiopsied embryos due to the presence of a hole in the zona (which acts as a protective barrier to regulate the inflow of toxic cryoprotectant). To date, few groups have attempted freezing biopsied embryos. One of the first reports by Joris et al. (74) tried freezing biopsied day 3 embryos using a slow freeze thaw procedure with DMSO. Survival in the biopsied group was significantly lower than in intact controls. Nevertheless, in biopsied embryos that did survive the freeze thaw procedure, blasto-cyst formation was seen in a small percentage. Similar results were confirmed by Magli et al. (95). This suggests that although survival...

Factors affecting success rates of frozen semen

One of the major sources of variation which is reputed to have a considerable effect upon post-thaw spermatozoan viability, regardless of all other factors, is season. For reasons of management, it is much more convenient to collect semen destined for freezing outside the normal covering season. In the northern hemisphere this means collection from August to November, and for the southern hemisphere collection from February to May. This is practised because the increase in ejaculation frequency required if collection for insemination is to be carried out during the normal covering season may compromise both pregnancy rates for natural service and the quality of spermatozoa collected. Collection of semen for freezing, especially if it is intended for export, will require veterinary regulations to be met these normally involve a series of blood tests, swabs and possibly semen culture. There may also be a period of quarantine for the stallion prior to collection. Satisfying these...

Cultures to Obtain Mature Oocytes

Developmental competence of oocytes grown and matured in vitro (IVG IVM) and those grown in vivo and matured in vitro (in vivo-grown IVM). The top panel shows the percentage of mature oocytes that cleaved to the two-cell stage after insemination, and the bottom panel shows the percentage of two-cell stage embryos that developed to the blastocyst stage. No common letters on or over the bars indicate a difference of > 95 confidence level. Fewer oo-cytes grown in serum-free medium underwent cleavage to the two-cell stage than those grown in the presence of FBS or those grown in vivo. Likewise, the percentage of embryos derived from oocytes grown in serum-free medium that were competent to complete the two-cell stage to blas-tocyst transition was significantly lower than embryos derived from oocytes grown in medium supplemented with FBS (but not FBS plus FSH). Reprinted from Eppig and O'Brien (41), with permission from Elsevier Science. Figure 1.6. Developmental competence...

Oviductal epithelial cell explant test

The reaction of spermatozoa to oviductal epithelial cell monolayers may be tested in the form of a cytofluorescent assay. The effect of spermatozoa on oviductal epithelial cell activity, including protein secretion, is reported to have a high correlation with spermatozoon morphology, and to be a possible prognostic test for in vitro fertilization (Thomas et al., 1995b Thomas and Ball, 1996). The number of spermatozoa bound to explants may also be used as an indicator of spermatozoan viability (Thomas et al., 1995a). However, there is apparent variation in the number of spermatozoa bound, depending on the place from which the explant was extracted and the stage of the mare's oestrous cycle (Thomas et al., 1994a). Little work has been carried out to date to investigate any correlation between spermatozoon-oviduct cell adhesion and subsequent fertilization, though it has been speculated that a correlation may exist (B.A. Ball, California, 1998, personal communication).

Future Avenues Of Investigation

Several unresolved questions exist concerning the use of metformin in PCOS, and these may serve as future investigative directions, including (a) the efficacy of metformin in large-scale trials in increasing clinical pregnancy, live-birth rates, and its effects in multiparity (b) ovulation induction with combination therapy of metformin and gonadotropins (c) prospective studies of metformin in decreasing EPL (d) whether metformin enhances the quality of eggs retrieved for in vitro fertilization (e) whether measurable biological factor(s) exist that can be used to predict response to insulin sensitizers (f) the effects of metformin on birth defects, pre-eclampsia, and gestational diabetes in large-scale studies (g) the development of a more potent and optimal insulin-sensitizing drug for PCOS and (h) large prospective trials evaluating the chronic use of metformin in women with PCOS for long-term cardiovascular and diabetes risk reduction.

Genedriven Approaches

The molecular screening of ENU mutagenized mice or ES cells has also become an important topic (Beier 2000 Chen et al. 2000a Chen et al. 2000b Munroe et al. 2000 Coghill et al. 2002 Vivian et al. 2002 Chen et al. 2003). The basic strategy is to create a library by collecting genomic DNA from several thousand mutagenized G1 mice. At the same time, sperm is harvested from the mice and cry-opreserved. The genomic DNA is screened by PCR amplification and sequencing, so that mice heterozygous for mutations in a particular gene of interest can be identified. Live mice are recovered by thawing the frozen sperm and performing in vitro fertilization. Mice are then intercrossed to generate homozygous mutants and phenotyping is performed. If a large enough library were to be constructed, one could conceivably recover a series of mutations in any particular gene.

Advantages and Disadvantages of Polar Body Biopsy

Polar Body Biopsy

Another disadvantage is that the oocyte zygote is subjected to two manipulations in cases of sequential biopsy of the first and second polar body rather than to a single manipulation at the cleavage stage. In addition, ICSI has to be carried out in between regardless of the type of diagnosis, as insemination by IVF could lead to polyspermy and sperm contamination for PCR diagnosis. Cleavage-stage biopsy of embryos derived from these manipulated zygotes has also been reported to confirm diagnosis (38). This is highly labor intensive and can be detrimental to the embryo.

Wiesner G. Vaz M. Collier G. Y Col. Leptin Is Released From The Human Brain Influence Of Adiposity And Gender. J. Clin.

Hartz AJ, Barboriak PN, Wong A, Katayama KP, Rimm AA. The association of obesity with infertility and related menstrual abnormalities in women. Int J Obes 1979 3 57-77. 32. Fedorcsak P, Dale PO, Storeng R, Tanbo T, Abyholm T. The impact of obesity and insulin resistance on the outcome of IVF or ICSI in women with polycystic ovarian syndrome. Hum Reprod 2001 16 1086-1091.

Options for Hormonal Therapy

(2) inhibition of androgen production by the ovary or adrenal gland, or (3) in the future, inhibition of androgen metabolizing enzymes in the skin may be possible (see 'Enzyme inhibitors' section below). It is important to note that hormonal therapy is absolutely contraindicated in women who want to become pregnant due to the risk for sexual organ malformation in a developing fetus.

Acquired thrombophilia

Of women with recurrent miscarriage (three or more), 15 have persistently positive results for phospholipid antibodies. If untreated, 90 will have spontaneous abortions or stillbirths in subsequent pregnancies. It is possible that lupus anticoagulant (30 of cases) and anticardiolipin antibodies (70 of cases) are the same autoantibody identified in different assays. Clinical features of the antiphospholipid syndrome are recurrent fetal loss, thrombosis (arterial and venous), thrombocytopenia, haemolytic anaemia, hypertension, pulmonary hypertension and livedo reticularis. Antiphospholipid syndrome is associated with a 5 incidence of thromboembolism or cerebrovascular accident in pregnancy.

Anovulation Is A Characteristic Feature Of Pcos. It Manifests As Menstrual Disturbance 80 Amenorrhoea Oligoamenorrhea

Patient With Hyperandrogenism

Patients with PCOS may present complaining of irregular or unpredictable menstrual cycles, unwanted hair growth, acne or scalp hair loss, or unexplained weight gain or overweight (see Section 2.1.4.). Another frequent presenting complaint of PCOS may be infertility, possibly associated with recurrent first trimester miscarriages. Approximately 30-50 of PCOS patients will complain of infertility at the time they are seen for their first visit (1,2). PCOS accounts for 75 of patients with anovulatory infertility (8,9), 30-40 of secondary amenorrhea, and 85-90 of women with oligomenorrhea (10). In turn, ovulatory dysfunction affects a high proportion of patients with PCOS (80-100 , depending on criteria), and in a large series of patients diagnosed by varying criteria 75-85 of PCOS women demonstrated clinically evident menstrual irregularity (2,11,12). In agreement, in a prospective study of PCOS patients diagnosed among 400 unselected women from the general population, approximately 60...

Physical Abnormalities

Horse Cryptorchid Testis

Testicular degeneration refers to the condition of underdeveloped testes which has developed post birth. That is, testicular development did originally occur to some extent but some subsequent problem has resulted in a degeneration of the tissue. The germinal epithelium of the testis is highly sensitive to extrinsic factors, as discussed previously. As such, testicular degeneration is a major cause of infertility in the stallion. Unlike hypoplasia, degeneration is an acquired condition, but stallions suffering from hypoplasia do have an increased chance of also suffering from degeneration and reducing still further their chances of producing viable spermatozoa (Varner and Schumacher, 1991). Degeneration may be temporary or permanent, its severity depending upon the severity and duration of the causative agent. It may be unilateral (the cause being localized in origin) or bilateral (a systemic cause) (McEntee, 1970). The condition is also evident as a shrinking of the testes, often...

Grainne Cooney BSc Hons Rgn Rm Asymptomatic Screening Nurse

On her return Grainne qualified in Family Planning Nursing at Middlesex University in 2000 and worked in Northwick Park Sexual Health Clinic for two years. During this time she completed her sexual health training at Thames Valley University. Travelling was still on the agenda, and in 2002 Grainne took a year out to travel and work as a midwife in Australia. In 2003 she commenced working in the John Hunter Clinic at the Chelsea and Westminster Hospital. She is currently working there as a Trainee Nurse Practitioner in Sexual and Reproductive Health, with a special interest in Family Planning.

Vaginal Reconstruction

Vaginal Reconstruction

With regular dilatation or intercourse. When dilatation is possible, the outcome for sexual intercourse appears satisfactory in the small number of cases that have been reported in one series all of three women with congenital adrenal hyperplasia (CAH) were able to have satisfactory intercourse and two became pregnant. In contrast, 50 of patients (none of whom had CAH) who had various forms of reconstruction complained of bleeding with intercourse 23 .

Acute Acalculous Cholecystitis

Cholecystitis Algorithm

Treatment algorithm for acute cholecystitis. Abx antibiotics CBC complete blood count IVF intravenous fluids LFT liver function tests NPO nil per os. FIGURE 131-3. Treatment algorithm for acute cholecystitis. Abx antibiotics CBC complete blood count IVF intravenous fluids LFT liver function tests NPO nil per os.

Metabolic Pathway Activity

Emp Pathway Krebs

The early development of the mammalian embryo is directed by its inherent genetic programming and affected by its environment. Both the genetic program and the environment act as stimuli to the early embryo to induce developmental responses, initially in its intracellular biochemical activity, and ultimately in cell division, differentiation, and function. Techniques for manipulating gene expression and development, such as gene transfer, cloning, IVF, ICSI, and culture, similarly act as stimuli to induce the desired biochemical and developmental responses. In addition to determining the general pattern of energy metabolism during early development of the cattle embryo (20), my colleagues and I have shown that glucose metabolism is related to the sex of the early cattle embryo (21) and viability following cryopreservation of cattle blastocysts (22) and is increased by early exposure to glucose in culture (23). We have also studied the patterns of energy metabolism in cattle oocytes...

Other major components within extenders

The four main types of extender for use with stallion semen have been considered. However, much work has been carried out on the addition of other components to improve what are still relatively poor and very variable conception rates. This section will consider some of the other types of extenders used and the components included. Bovine serum albumin (BSA) has also been used quite effectively as a component of stallion (Kreider et al., 1985), boar (Dixon et al., 1980) and ram (Harrison et al., 1982 Klem et al., 1986) semen extenders. It is reported that BSA, like citric acid, may act as an antiperoxidation agent, reducing the deleterious effects of membrane lipid peroxidation. Inclusion of 3 BSA in a skimmed milk extender, or even the addition of 3 BSA to a raw semen sample, is reported to help to maintain motility (Pickett and Voss, 1975 Padilla and Foote, 1991). Addition to skimmed milk seems particularly successful in terms of motility over the first 6 h of cooled storage...

Sideeffects Of Typical Antipsychotics

Acute Dystonia

The effect of D2 blockade on the neuroendocrine system produces hyperprolactinemia by reducing the negative feedback on the anterior pituitary. High serum levels of prolactin produce galactorrhea, amenorrhea and infertility. Neuroendocrine effects Amenorrhea Galactorrhea Infertility

Crosssectional imaging

Pelvic Imaging Measurement

In approximately 90 of cases, endometrial cancer is well-differentiated adenocarcinoma which typically presents with postmenopausal bleeding. Histopathological diagnosis is usually confirmed by hysteroscopy and curettage, which despite a small false negative rate of 2-6 remains the 'gold standard' for differentiating benign from malignant endometrium. At presentation 75 of women have tumour confined to the endometrium (stage IA) for whom the 5-year survival rate is 80 following total hysterectomy (Creasman et al., 1987). The International Federation of Obstetrics and Gynaecology (FIGO) committee recommends staging by total hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy. An office endometrial biopsy is the initial investigation of postmenopausal bleeding pelvic ultrasonography may be used to select patients in whom hysteroscopy, dilatation and curettage are indicated. The normal endometrium is visualized as a highly reflective band in the centre of the uterus....

Causes and Symptoms of Smell Disorders

Currently we distinguish between congenital anosmia occurring as an isolated defect or occurring within the context of a syndrome 191 . Isolated congenital anosmia seems to occur more often than previously believed. Apart from the typical patient history of no odor memories, only MR imaging leads to a more definitive diagnosis 192, 193 . In the frontal imaging planes just tangential to the eye bulbs, hypoplastic or aplastic olfactory bulbs can be visualized. This plane also allows an evaluation of the olfactory sulcus which is flattened if the olfactory bulb is absent or aplastic. This is a useful indicator of congenital anosmia, especially since the bulb is not always easy to identify. Among cases of congenital anosmia as part of a syndrome, the Kallmann-Syndrom 194 is the disorder in which it is most frequently encountered. This is an anosmia associated with hypogonado-tropic hypogonadism clinically characterized by infertility and anosmia, where infertility can be reversed by...

Risk Factors in the Development of Cloacal Exstrophy

Review of 78 exstrophy-epispadias cases at Johns Hopkins, 4 children were conceived by in-vitro fertilization (IVF). Based on an extrapolation of birth data in the USA over a 4-year period, it has been postulated that IVF predisposes to the development of complex body wall defects 21 . The International Clearinghouse for Birth Defects, in an analysis of 6.3 millions births from 10 registries, has postulated that mothers 20 years and below, those with a parity of more than 3, and low-birth-weight babies ran an increased risk of cloacal exstrophy 15 . In conjunction with data discussed earlier, it may be reasonable to assume that there is a bimodal risk for cloacal exstrophy namely, very young mothers (less than 20 years of age) and old mothers (more than 30 years of age).

Pharmacological Options for Ovulation Induction in PCOS

In women with PCOS who are not obese or overweight, who are obese but unable to lose weight, or who fail to ovulate despite weight loss, ovarian stimulation with pharmacological agents is the next step in the treatment of oligo-ovulatory infertility. Clomiphene citrate is currently the first-line pharmacological therapy for ovulation induction, although metformin appears to also be a promising agent for first-line therapy, at least in some patients. Studies are currently ongoing to address which first-line agent (clomiphene or metformin) is of greater benefit and or which subpopulations of patients with PCOS will benefit from either treatment alone or in combination. Alternatively, glucocorticoids do not result in consistent ovulation and have significant side effects. Patients who

Assessment Of Metabolism To Select Embryos

Relationship between cell number and blastocyst development on day 3. The filled circles represent IVF patients, the open circles represent the oocyte donors. There is a significant linear trend between cell number and blastocyst development from the two- to eight-cell stage for both groups of patients (linear regression r .96, p < .01). (From Langley et al. 32 , with permission of the European Society of Human Reproduction and Oxford University Press.) Figure 4.6. Relationship between cell number and blastocyst development on day 3. The filled circles represent IVF patients, the open circles represent the oocyte donors. There is a significant linear trend between cell number and blastocyst development from the two- to eight-cell stage for both groups of patients (linear regression r .96, p < .01). (From Langley et al. 32 , with permission of the European Society of Human Reproduction and Oxford University Press.)

What is kyphoplasty Would it help my spinal fractures

Spine Exercise

Alcohol should be avoided by those who can't restrict the number of drinks they take, pregnant and breastfeeding women, women of childbearing age who may become pregnant, children and adolescents, those who are taking medications that are dangerous to take with alcohol, and those with certain medical conditions.

Extenders for use with frozen semen

A sugar-based extender with the addition of raffinose has been used with success in Japan (Table 7.13). This extender may be used without the 10 glycerol as a primary extender for centrifugation, or with the addition of the 10 glycerol as a freezing extender. Motility rates of between 49 and 73 were reported post thaw in 80 of the samples frozen, resulting in up to 100 conception rates in small trials (Nishikawa, 1975). Good success has been reported with the use of trehalose as a cryoprotectant within a skimmed milk-egg yolk extender. It is suggested that trehalose has a stabilizing effect on the spermatozoon plasma membrane (Steinmann, 1996). In France a As mentioned previously in the context of fresh and cooled semen storage, hydrogen ion extenders may also be used. Examples are given in Table 7.16. They may be used as primary extenders as they are, or as secondary extenders with the addition of 2-7 glycerol. Of these extenders, TCA 325 was reported to provide the best conception...

New Foods and New Factories

The ten-year battle over injecting genetically engineered bovine growth hormone into cows to increase milk production shows how difficult it can be to allay consumer concerns about unfamiliar changes to staple products. Dairy farmers have been striving (with great success) to increase milk production in herds for several hundred years. Long before Darwin offered the intellectual explanation for why what they did worked, farmers routinely selected the cows that were the best milk producers to mother their next generation of calves. A major advance occurred in the 1950s when dairy farmers began to use artificial insemination with semen from prize bulls, but even those production gains pale before the gains with bovine growth hormone. Genzyme Transgenics operates a factory of the future Instead of computer-programmed robots, its tools are several hundred purebred goats imported from New Zealand. Since 1990 Genzyme scientists at a farm in central Massachusetts have been creating...

Estimating the Economic Burden of PCOS

The overall costs associated with the treatment and, if appropriate, the diagnosis of the various morbidities evident in the premenopausal women with PCOS are outlined in Table 3. This conservative estimate of the health care-related economic burden of premenopausal women with PCOS exceeded 4 billion annually in the United States alone. Approximately 40 of the burden is a result of the increased prevalence of diabetes associated with PCOS 30 arises from the treatment of the associated menstrual dysfunction AUB, 14 from the treatment of hirsutism, and 12 the provision of infertility services. Notably, the costs of the diagnostic evaluation of all patients accounted for a relatively small portion of the calculated economic burden, about 2 . The calculated economic burden of patients with PCOS during their reproductive years is about threefold that of hepatitis C ( 1 billion in 1998) (65) and about one-third that of morbid obesity ( 11 billion in 2000) (66).

Acute Salpingitis And Pelvic Inflammatory Disease Pathogenesis and Microbiology

Mycoplasmae have frequently been recovered from the lower genital tract of females with salpingitis and is associated serologically with salpingitis and tubal factor infertility (41). Hinonen and Miettnen recovered C. trachomatis significantly more frequently from the fallopian tubes among cases with severe PID (42), thus confirming role of C. trachomatis as the leading cause of PID in both laparoscopically mild and severe PID.

Have early menopause What does this mean for my bones and will I need treatment

A very small percentage of women (1 ) experience natural menopause before the age of 40. It is not known why these people stop having their periods. Idiopathic ovarian insufficiency or premature ovarian failure is a condition that usually occurs in women under the age of 40 and causes menopause. Idiopathic ovarian insufficiency is usually caused by autoimmune and genetic disorders, Addison's disease (disorder of the adrenal glands, which manufacture steroid hormones), or hypothyroidism (an underactive thyroid gland). The loss of ovarian function (and therefore fertility) in a woman under the age of 40, resulting in menopause. It is usually associated with other health conditions, and can sometimes be temporary. Also called premature ovarian failure.

Can We Improve the Gene Pool

In 1949, when she was 15 years old, Betsy Stark, a poor girl who lived in a small town near Lynchburg, Virginia, and who had dropped out of school a year earlier, got pregnant. Shortly after she had the baby, whom she placed for adoption, Betsy was committed (at her father's request) to a large state institution for the mentally retarded in Lynchburg. As part of the admission process, a staff psychologist gave her an IQ test on which she scored 72, considered to be at the border between low-normal intelligence and mental retardation. A few weeks later, after conducting a routine physical exam, a surgeon at the state facility told Betsy that she needed to have her appendix out. Just two weeks after the operation, with no more explanation than she had been given for her admission, Betsy was discharged from the Lynchburg Colony. Fifteen years later, then married and working in a local factory, she learned that the infertility, with which she and her husband had struggled for several...

Epididymis Vas and Ejaculatory Ducts

There is an increased incidence of epididymitis in ARM boys and this is seen prior to and after surgical closure of rectourinary fistula 8,35 . The exact mechanism for this is unknown, but abnormalities such as urethral strictures, ectopic ureters, diverticulum at the previous fistula site, and a neurogenic bladder may all be contributory factors. Ectopia of the vas has been reported 28 , and Wolffian duct abnormalities are more common on the same side as renal anomalies 23 . The vas and seminal vesicles are prone to iatrogenic injury in patients with prostatic and bladder neck fistulas 11 . Holt et al. reported a high incidence of male infertility in adult males treated for ARM. Half of the groups studied were azospermic and there was a high incidence of ejaculatory problems 23 . This highlights the importance of treating recurrent epididymitis, performing early orchidopexy, and referring these patients to adolescent urology for assessment in early adult life.

Metformin Weight Loss and PCOS

The initial use of metformin in the treatment of PCOS has now been widely accepted to be a valuable and inexpensive therapeutic modality. Recent systematic reviews have indicated that metformin is highly effective in inducing ovulation and increasing pregnancy rates (8,9). The numbers needed to treat for ovulation are around four patients, and there is an improvement in serum insulin levels and a reduction in free testosterone in response to metformin. The drug appears to be safe in early pregnancy with respect to congenital abnormalities, although it is controversial whether miscarriage rates are reduced. The predictors of success of metformin have not been established, although there is some evidence that patients who are substantially overweight do not respond as well. Side effects of metformin include nausea, vomiting, diarrhea, and other forms of gastrointestinal intolerance, and patients need to be warned about the interaction between metformin and alcohol. The ovulatory...

Laughing Gas Ether And Surgical Anesthesia

Laughing Gas Surgical Operation

The changing nature of surgical practice must have been rather painful to those who had established their reputation through speed and strength and now saw surgeons developing a deliberate and subtle touch. Practitioners who had struggled to attain the professional detachment (or callousness) needed to operate in the pre-anesthetic era had taken great pride in their achievements. Like the librarian who objects to people taking books from neatly ordered shelves, the master surgeon might resent the trick that obviated the need for his painstakingly acquired skills. Some doctors believed that inhalation of anesthetic agents would poison the blood, promote hemorrhages, cause convulsions, nausea, intoxication, prolonged stupor, cerebral excitement, asphyxia, bronchitis, pneumonia, inflammation of the brain, paralysis, insanity, depression, local or systemic infection, miscarriage, or damage to the fetus. Anesthetics might damage nerves and muscles or interfere with wound healing. Many...

Midwives And Medical

Parto Eucharius Lin

Throughout much of European history, religious authorities exerted considerable influence over the selection of midwives character and piety were essential criteria for obtaining approval. Midwives were forbidden to perform abortions or conceal a birth. They were expected to make the mothers of illegitimate infants reveal the name of the father. If an infant seemed likely to die before proper baptism, a qualified midwife could perform an emergency baptism. Should the mother die in labor, the midwife might attempt baptism in utero or cesarean section. According to the Dominican inquisitors Heinrich Kramer and Jakob Sprenger, the authors of the infamous Malleus Maleficarum (The Hammer of Witches, 1486), midwives were among the most pernicious of all witches. Midwives were accused of inducing miscarriages and offering newborn infants to Satan. The products of miscarriages and abortions, stillborn infants, the umbilical cord, and the afterbirth (placenta) played a notorious role in the...

Ovarian Hyperstimulation Syndrome

Ovarian Hyperstimulation Syndrome

OHSS is a potentially serious iatrogenic complication of ovarian stimulation with gonadotropins. A controlled study comparing patients with and without polycystic ovaries undergoing IVF showed that 10.5 of the polycystic ovary patients developed moderate severe OHSS compared with none of the controls (13). OHSS is characterized by increased vascular permeability and transudation of protein-rich fluid from the vascular space into the peritoneal cavity. The incidence of severe OHSS ranges between 0.6 and 1.9 but may occur as frequently as 6 in women with polycystic ovary PCOS (34-36). Severe OHSS is characterized by ascites, plural effusion, and electrolyte imbalances. While there is no successful strategy to completely predict and prevent this potentially life-threatening complication, patients are commonly identified when the serum E2 concentration is high (10,00015,000 pmol L) and the number of ovarian follicles is greater than 20. Although follicular puncture 3. Coasting When E2...

Glucocorticoids for Ovulation Induction

Dexamethasone in doses ranging from 150 to 250 mg day appears to enhance clomiphene ovulation induction in patients who are resistant to clomiphene alone. Pregnancy rates have ranged from 8 to 69 (49,51,59,60). While some investigators used higher dosages for short intervals (e.g., 2 mg day from days 5-14 of the cycle) (59), other investigators have used a continuous lower-dose (0.25-0.5 mg day) regimen (49,51). Clomiphene-resistant women with PCOS who responded to the combination of dexamethasone and clomiphene generally had higher mean circulating DHEAS levels than nonresponders (51), although not all investigators agree. In a randomized, double-blind, placebo-controlled clinical trial, Parsanezhad and colleagues studied 230 women with PCOS and normal DHEAS levels who failed to ovulate after a routine protocol of clomiphene citrate the treatment group received 200 mg of clomiphene citrate from day 5 to day 9 and 2 mg of dexamethasone from day 5 to day 14 of the menstrual cycle, for...

Insulin Sensitizers and Pregnancy Outcomes

Although ovulatory dysfunction is an important etiological feature of the infertility of PCOS, ovulation is only one aspect of fertility. In addition to ovulatory problems, women with PCOS suffer a high rate of early pregnancy loss (EPL) during the first trimester (30-50 in PCOS vs 10-15 in normal women) (38-42). It is possible that insulin resistance may contribute to EPL by adversely affecting the endometrial environment and or endometrial function. A recent retrospective study compared the pregnancy outcomes of women with PCOS who became pregnant but were not exposed to metformin with those who became pregnant while taking metformin and remained on metformin throughout pregnancy (53). These were nondiabetic women with PCOS who were seen at an academic endocrinology clinic in Caracas within a 4.5-year period. Among these women, 65 became pregnant using metformin, while 31 women never exposed to metformin became pregnant. The EPL rate in the metformin group was 8.8 (6 of 68...

The Evolution of Human Longevity

What were the evolutionary forces which resulted in the emergence of long-lived hominids from ape-like species The key is successful adaptation to the environment. As adaptation improves, mortality falls and the result is that individuals in the community tend to survive longer. Both the great apes and humans reproduce quite slowly. The interbirth interval is often 2-3 years, but this depends on infant survival. The infant mortality rate is about 25 in natural populations in the great apes, and in the absence of lactation females become pregnant quite quickly. However, the successful suckling of an infant suppresses fertility, so the interbirth interval is extended. In humans, reproduction usually starts at 16-18 years, depending in part on the health and nutrition of the individual. The average interbirth interval is about 2 years, and a female that survived to 28 years, would produce, again on average, about 6 offspring. With these reproduction parameters it is possible to calculate...

Cirsium setosum Willd MB Fam Asteraceae

Cirsium Setosum

For impotence due to Deficiency of Kidney Yang, it is used with Radix Rehmanniae Preparata (Shu Di Huang), Semen Cuscutae (Tu Si Zi), and Fructus Schisandrae (Wu Wei Zi). For infertility due to depletion of the Vital Essence and Blood, it is used with Colla Cornus Cervi (Lu Jiao Jiao), Radix Rehmanniae Preparata (Shu Di Huang), Radix Angelicae Sinensis (Dang Gui), and Placenta Hominis (Zi He Che). For coldness and pain in the lower back and knee, it is used with Radix Morindae Officinalis (Ba Ji Tian), Rhizoma Dioscoreae (Bi Xie), and Cortex Eucommiae Ulmoidis (Du Zhong).

When Should Insulin Sensitizers Be Used for Ovulation Induction

In order to establish the optimal therapy or combination of therapies to achieve pregnancy most efficiently, the National Institutes of Health's Reproductive Medicine Network is conducting the Pregnancy in Polycystic Ovary Syndrome (PPCOS) study. The PPCOS study is a randomized, doubleblind controlled trial comparing three regimens in women with PCOS desiring pregnancy (a) monotherapy with extended-release metformin (metformin XR), (b) clomiphene citrate monotherapy, and (c) a combination of metformin XR and clomiphene citrate. In addition to the usual inclusion criteria for PCOS women (elevated serum testosterone and eight or fewer menstrual cycles per year), partners of these women with PCOS must have normal sperm counts, and the enrolled subjects must agree to have intercourse two to three times per week during the study. The primary endpoint is the number of live births. Thirteen U.S. centers are participating in the clinical trial, and enrollment for this study has been completed...

Pelvic Inflammatory Disease

As has been indicated earlier, Pelvic Inflammatory Disease may be either acute or chronic. PID is a common cause of morbidity, and accounts for 1 in 60 consultations by women under the age of 45 (Simms et al., 2000). It has been reported that a delay of a few days in receiving appropriate treatment can increase the risk of sequelae, which include infertility, ectopic pregnancy and chronic pelvic pain (Hillis et al., 1993). Faculty of Family Planning Guidelines (2004), recommend that there is no need to remove an intrauterine device unless symptoms fail to resolve.

Loss of Function of Surrounding Genes

Expanded CTG repeats were shown to alter chromatin structure and have regional effects on gene expression (Otten and Tapscott 1995 Wang et al. 1994). The CTG expansion in the DMPK 3'UTR are located immediately upstream of the SIX5 promoter region and were shown to lower SIX5 expression (Gennarelli et al. 1999 Inukai et al. 2000 Klesert et al. 1997 Thornton et al. 1997). Six5 is a transcription factor required for eye development in Drosophila, and the mouse homologue is implicated in distal limb muscle development (Harris et al. 2000). Six5 knockout mice develop ocular cataracts and infertility resembling some features of DM1 (Klesert et al. 2000 Sarkar et al. 2000). Cardiac conduction abnormalities were also noted in Six5 knockout mice (Wakimoto et al. 2002). However, the most common symptoms of DM1 such as muscle weakness, wasting, and myotonia were not reproduced in Six5 knockout mice (Klesert et al. 2000 Sarkar et al. 2000). The identification of a second locus causing DM2 reduced...

Forming and maintaining relationships

Now imagine this same 3-year-old Gail, just as alert and intelligent and again with a mother who has taken some time out of her career to have children. However, she was less keen on having children and became pregnant with Gail by accident. There are times when she enjoys Gail's company but other times when she resents having to be at home, particularly when she sees her contemporaries forging ahead with their careers.

Are there treatments for loss of genital sensation

Artificial insemination Clinics dealing with spinal cord injuries, such as VA hospitals, are able to help with this problem. By using techniques that are similar to those used in animal husbandry, semen can be harvested for successful use in artificial insemination. Personnel in spinal cord units at VA hospitals and universities should be contacted for help in this regard. I have had many miscarriages and have no children. Before I was diagnosed with MS, I thought I felt good during pregnancy because of emotions ofjoy and anticipation, and badly after a miscarriage, again because of emotions, albeit ones of grief and loss. Although emotions certainly played a part, I now understand that, as is often the case with MS, I had flare-ups after pregnancy.

Insulin Sensitizing Agents

There has been increasing interest in the use of metformin for the treatment of PCOS since the first report by Velazquez et al. (75) in 1994. Recently, the effects of metformin for ovulation induction were assessed in a meta-analysis including 13 randomized controlled trials and 543 participants (73). The dose range of the metformin used in these trials was 1500-1700 mg day. There was a significant effect of metformin in achieving ovulation in women with PCOS, with odds ratios (OR) of 3.88 (95 confidence interval CI 2.25-6.69, p < 0.00001) for metformin vs placebo and 4.41 (95 CI 2.378.22, p < 0.00001) for metformin plus clomiphene vs clomiphene alone (73). The overall ovulation rate achieved by metformin, or metformin and clomiphene, was reported as 57 . The data from this meta-analysis suggested that metformin acts relatively quickly to improve ovulation, with significant treatment effects reported after 2 months. We should note that there was a significant correlation between...

100 Pregnancy Tips

100 Pregnancy Tips

Prior to planning pregnancy, you should learn more about the things involved in getting pregnant. It involves carrying a baby inside you for nine months, caring for a child for a number of years, and many more. Consider these things, so that you can properly assess if you are ready for pregnancy. Get all these very important tips about pregnancy that you need to know.

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