Infertility Natural Treatments

The Pregnancy Miracle Book

Lisa Olson developed system for all those wives that want to conceive and want to give birth to beautiful child in natural way. The name of this system is called Pregnancy Miracle. If you are looking for the way to reverse your infertility and want to give birth to healthy baby then you must heard the name of Pregnancy Miracle. Lisa 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. Lisa goes into much more detail, discussing the various meridians and how they affect fertility. The results from the Pregnancy Miracle methods are not instant, but can often take significantly less time than other fertility options, generally about two to four months. The program comes with a 60 day money back guarantee. If the program does not work for you within the period, you can get a full refund, no questions asked. Continue reading...

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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...

Specific diseases affected by substantial weight loss 31 Infertility

The fertility of obese women compared with normal-weight women is lower in natural cycles and infertility treatment cycles (24-27). The role of obesity in menstrual disorders, as well as the beneficial effect of weight reduction on ovulatory function in overweight anovulatory women, have been described (28,29). As obesity is a known factor in infertility (30), weight reduction is frequently incorporated as a part of infertility treatment (31). The physiological mechanisms of fertility and weight loss are just beginning to be understood. Hollmann et al., from Germany, reported the effects of weight loss in obese, infertile women, describing the changes in hormone levels, menstrual function, and pregnancy rate. Of the 58 women in the study, 35 took part in a weight- reducing program lasting 32 14 wk with a weight loss of 10.2 7.9 kg (therapy group). At the time of first oral glucose tolerance testing, insulin resistance was a feature in 85 of the women in the therapy group, and 22 were...

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

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...

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...

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).

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...

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...

In Vitro Maturation

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,...

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...

IVF in PCOS

Ivf Protocols For Pcos

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...

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.

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).

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...

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.

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...

Perspectives For The Mental Health Professional

One of the most difficult situations occurs when counseling women who became pregnant as a result of rape and are prosecuting their attackers. Abortion providers who cooperate with local law enforcement agencies to provide fetal tissue for DNA comparison with the suspect's are not compensated by any agency providing victim services for those women seeking abortions. Women who are dealing with the emotional trauma of a sexual assault, incest, or both, who then find themselves pregnant as a result of that violation, are forced to tell their story over and over again, this time in order to qualify for financial assistance. They are victimized all over again. Beyond the women who are cooperating with the prosecution of their offenders, there are women too numerous to count who have been raped or coerced into having intercourse who do not report the attack but still find themselves pregnant. These women must now tell their stories to strangers once again, this time in hopes of receiving...

Federal Parental Notification Legislation

Studies have established that the majority of teenagers (60 -70 ) do talk to their parents when they become pregnant. Of those who don't, about one-third are at risk of physical or emotional abuse. The rest, like Becky, believe for myriad reasons that this is a problem they must face without their parents.

Indications for aPL Testing

APL should be tested routinely in all patients who are newly diagnosed with an autoimmune connective tissue disease especially SLE or Sjogren's syndrome, since the prevalence of aPL in these disorders ranges between 30 and 50 . The finding of aPL at disease onset may have significant consequences later in the disease course in terms of predicting morbidity and mortality. Patients who suffer thrombotic events at relatively young age should also be considered for testing. Patients with stroke, myocardial infarction, and venous thrombosis under the age of 50 may be at risk of further thrombotic events if they are aPL positive. Similarly, women with pregnancy morbidity, including miscarriage, fetal death, intra-uterine growth restriction, intra-uterine death still-birth, pregnancy-induced

Infection of an accidental target tissue leading to permanent damage despite efficient clearing

A variation on the theme of accidental destruction of neuronal targets by an otherwise relatively benign course of acute virus infection can be seen in rubella. This disease (also called German measles), which is caused by an RNA virus, is a mild (often asymptomatic) infection resulting in a slight rash. Although infection is mild in an immunocompetent individual, the virus has a strong tropism for replicating and differentiating neural tissue. Therefore, women in the first trimester of pregnancy who are infected with rubella have a very high probability of having an infant with severe neurological damage. Vaccination of women who are planning to become pregnant is an effective method of preventing such damage during a localized rubella epidemic.

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...

Beta Interferon Therapies Avonex Betaseron and Rebif 711 Efficacy

Injection site reactions usually subside within weeks. Management includes icing and rotation of site, topical application of anesthetics or corticosteroid, improved injection technique, and warming the medication or using autoinjectors. Flu-like symptoms are common dose titration, nonsteroidal anti-inflammatory drugs (NSAIDS) or acetaminophen may be helpful, though symptoms usually resolve by 3 months 70 . Symptoms occur within a few hours of each injection and last 12-24 h. Injections should be administered at night. Hematologic and hepatic function abnormalities may occur therefore, complete blood count and liver function test monitoring is recommended at baseline, 1 week, 1 month, 3 months and then every 3-6 months thereafter. Treatment-related depression may occur, and patients and their caregivers should report any mood changes. Women may experience menstrual disorders. Women of child-bearing age should practice contraception, and women planning to become pregnant should...

Mitoxantrone Novantrone

Cardiomyopathy is dose-dependent and may be as great as 6 in patients receiving 140mg m2 or less 47 . Prior to each infusion, patients should have an echocardiogram to evaluate their ejection fraction. Delayed effects of mitoxantrone on cardiac function have been reported. Antiemetic premedication (with ondansetron) may alleviate nausea during and for several days after infusion. Alopecia, amenorrhea, and infertility may also occur. Mitoxantrone is teratogenic. Leukemia occurs in approximately 1 of patients and generally responds to treatment.

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).

Example Gene Drive Strategies

Although, in the previous discussion only vector-based gene-drive strategies were outlined, interestingly, endo-symbionts and parasites also utilize their full genome in different gene-drive strategies. For instance, the bacterium Wollbachia is very effective at changing the gender and thus creating infertility in various insects 23 . A new concept here would be to use such endosymbiotic organisms against malaria disease 24 . In this case, bioinformatics may help in the choice and design for example, by a detailed genome analysis, to identify the optimum Wollbachia strain, in an effort to control the spread of the malarial vector, Anopheles gambiae.

Facts Not Myths About Womens Reproductive Health

The most serious and blatant error made by these so-called factual materials that are required to be available or actually distributed to women seeking abortion is the claim that there is a post-abortion syndrome that causes women psychological distress many years after they have an abortion. In fact, though, no psychological sequelae caused by having an abortion have been scientifically validated. We discuss the available research in Chapter 6. However, some women who have psychological issues prior to becoming pregnant and choose to terminate the pregnancy may have short-or long-term psychological reactions that are similar to what they might have when carrying a fetus to term and giving birth. These emotional issues are complex, and we discuss this further in Chapter 5 and Chapter 6. In this chapter we discuss information to assist counselors and therapists both in answering their clients' questions that require factual information and in helping their clients sort through the...

Is the United States the Only Country Permitting Legalized Abortion

Performed worldwide, mostly in developing countries, are not legal or safe. Although the legal right to an abortion is regulated by the laws of individual states and countries, the international community has issued proclamations that call for worldwide respect for women's reproductive rights and health. These proclamations appear in several arenas, most notably the World Health Organization (WHO) and the United Nations Declaration of Women's Rights. The Hyde Amendment that was passed in 1976 by the U.S. Congress and its subsequent additions does not permit the United States to give money to agencies that use those funds to pay for abortions unless the woman became pregnant through rape or incest. This means that poor women whose health services are funded by Medicaid, women with disabilities on Medicare, or even women in other countries whose health care depends on U.S. financial aid are unable to obtain an abortion unless they have their own funding. However, private foundations may...

Sexually Transmitted Diseases

The rapid spread of STDs is sometimes referred to as a silent epidemic because many of the diseases often have no noticeable symptoms in the early stages. But some of the potential consequences of STDs are serious infertility, heart disease, liver and brain damage, blindness, cancer, and even death. Babies whose mothers are infected with STDs may have birth defects or developmental problems.

Conclusions And Future Prospects

In summary, strategies employing screening of large chemical libraries and subsequent hit and lead optimization have resulted in the identification of new chemical entities that mimic or modulate the activity of endogenous gonadotropins. The availability of orally active drugs for the gonadotropin receptors will certainly be of great added value to the current portfolio of parenteral infertility drugs and hormonal, non-gonad-specific contraceptives. The coming decade will reveal whether these scientific promises can be realized. 61 Datamonitor, Commercial and pipeline insight Infertility, October, 2007.

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.

Women Who Abandon or Kill Their Babies

Studies indicate that the prospective mothers' attitudes toward their pregnancies will affect whether or not they emotionally bond with their babies. More on the capacity for emotional attachment is addressed in Chapter 5, but for here it is important to note that the research suggests that a large proportion of unwanted pregnancies will result in an inability of the mother to form an attachment with the baby, resulting in some form of child abuse or maltreatment even if it does not reach the point of homicide (Davis, 1994 David, Dytrych, & Matejcek, 2003 McKee, 2006). Obviously, family planning clinics are the first line solution to this dilemma, and there are many groups across the world that fund these clinics. Unfortunately, the U.S. laws, especially the Hyde Amendment, refuses to fund any family planning clinic that also provides abortions,

Prepregnancy Gender Issues

Another reason a woman may seek an abortion is to choose the sex of the baby. Sometimes parents want to select the sex to avoid known genetic sex-linked disorders, whereas others want to select the preferred sex. This latter reason is often thought to be less acceptable than others because the woman is not choosing whether or not to have a child but rather is using abortion as a way to select the sex of the child. It is assumed that if the fetus is a girl and the parents want a boy, then they will abort the girl and try to have a boy in the next pregnancy. As has been seen in some countries, such as China, under its one-child-per-family policy, sex selection is quite gender biased, with more families preferring to have boys than girls. However, in the Western world, reproductive technology is fairly sophisticated, and prepregnancy sex selection is more possible prior to impregnation. For example, it is known that X-chromosome-bearing sperm are somewhat heavier than...

Therapy And Prophylaxis

There is no specific antiviral therapy. In congenital rubella the disease manifestations at birth may require hospital treatment. Some of the malformations are treated surgically. High-titre rubella immunoglobulin seems to have a certain protective effect when given early after exposure. Administration of immunoglobulin may lead to asymptomatic infection and a prolonged incubation period. This has to be taken into account during the serological follow-up that should be carried out in these cases. The vaccine consists of live attenuated virus cultivated in a human fibroblast diploid cell line. Vaccination provides long-lasting immunity in about 95 of those vaccinated. Side-effects such as mild rubella symptoms are seen in 20 , and arthralgia occurs especially in women. There are no contraindications to vaccination other than those against the use of live virus vaccines in general immune deficiency, active infection and pregnancy. Fetal infection has been observed in a very few cases...

Neurotransmitters and Their Impact on Emotions

All of these medications produce side effects that might be overcome by getting used to them slowly. Sometimes people try to live with the side effects because the medication is important for proper functioning. Sometimes these medications are necessary to continue to regulate a person's emotions, and stopping them will cause serious emotional distress. Unfortunately, it is unknown how many of these medications may also have a teratogenic or toxic effect on the developing fetus, and therefore many should not be taken when a woman is pregnant. Some women who use these prescribed medications and who unintentionally become pregnant, wish to have an abortion as they do not want to take the risk that their fetuses are damaged by the medication.

Environmental Impact on Emotions

Other children or working long hours in difficult and stressful conditions, worry about immigration or minority status, and exposure to HIV are only some of the problems that low- or no-income women who become pregnant must deal with. Teens who come from these homes and become pregnant have additional problems including lack of family support, lack of interest on the boyfriends' or coconceivers' part in helping them, and lack of education or training necessary to earn money to support themselves all make life difficult for them. Their decision to abort a pregnancy may be the only way they can escape the poverty cycle they have grown up with in their own family. However, for many of them, they want to be different from their friends and families, which may cause them conflict about their decision to terminate a pregnancy. These teens may not get support from their families and even if they can get enough money to get an abortion, they still have to build up the courage to notify their...

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.)

Incest and Child Sexual Abuse

Young women who become pregnant as a result of incest are in a special category when it comes to emotions. It is important to remember that these young women have learned that the person who is responsible for their nurturance, love, and care also will take advantage of them through manipulation, fear, coercion, and maybe even physical abuse that accompanies the sexual abuse. Most of these girls understand that the sexual relationship with the incest perpetrator is dangerous and must be kept secret. They rarely discuss the sexual abuse with anyone, which is part of the accommodation pattern. This may affect their ability to form close personal friendships with other girls their age. It also makes it very difficult for the girl to report a pregnancy, partly because she may not realize that she is pregnant, especially if she hadn't yet begun to menstruate, or because she is afraid to trust anyone with her secret, fearing the disastrous consequences she has been warned about.

Emotions Specific To Termination Of Pregnancy

Given the various theories discussed in this chapter, it is important for a counselor to pay attention to the expectations and anticipated emotions that women who undergo abortions may experience. Most important is the assessment of the woman's emotional stability, which is done by examining her emotional history and her current emotional state. Obviously, those women who have become pregnant by a stranger or by a family member through incest or rape will need special care, as it can be anticipated that they are still dealing with the emotional aftermath of the incident.

Natural product analogs

Gossypol is a natural product derived from cottonseed extracts that causes male infertility and has been studied extensively in humans as a male contraceptive. This compound is cytotoxic to a variety of cancer cell lines and was advanced to human clinical trial on this basis even though its mechanism of action was not clear. More recently, gossypol was discovered in a natural product library screens to bind Bcl-XL 25 . Given its clinical history and this possible mechanistic rational, gossypol has been the focus of many recent investigations 25-30 . The (-)-enantiomer, 1, is responsible for the majority of both the cytotoxic and spermicidal activities. It binds both Bcl-XL (K 0.57 mM) and Bcl-2 (K 0.46 mM) and induces cytochrome c release, caspase activation and apoptotic death in numerous cell lines. (-)-Gossypol, 1, reverses the protection afforded by both Bcl-2 and Bcl-XL overexpression in Jurkat T leukemia cells with an IC50 of 18.1 mM and 22.9 mM, respectively, and dose...

Pas And Abortion Research A Review Of The Literature

The more recent disavowal by professional associations and federal health agencies to acknowledge the existence of PAS comes in light of earlier research purporting the claim that psychological distress is a concomitant to abortion. In reviewing historical literature, Brockington (2005) demonstrates a long-standing scientific tradition of connecting abortion, miscarriage, so-called criminal abortion, or even fetal death in utero to psychological instability. However, his methodology is flawed. Brockington cites minimally sampled studies (12 to 30 cases) of organic, psychogenic or shame-related, or manic psychosis stemming from an abortion incident that occurred between 1745 and 1917 (Brockington, 2005). The researcher goes on to cite studies comparing psychiatric admission rates between women who either took part in abortion or childbirth in California, noting higher rates of admission of the former. He used a sample of California Medicaid clients for this analysis without controlling...

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.

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).

Obstetric Manifestations

Human reproduction is inefficient, with an estimated 50 of conception failing the majority of these go unrecognized. Approximately 10-15 of pregnancies end in spontaneous abortions prior to 12-14 weeks' gestations (from last menses), most of which are pre-embryonic or embryonic in nature, and 5 of all pregnancies end in pregnancy loss from 14 weeks' gestation through term. Several mechanisms have been proposed in APS (Table 7.9 and 7.10). Miscarriages (before 10 weeks) Several studies have proved the strong association between aPL and pregnancy loss. Although in general population early miscarriages (< 10 weeks) are the most frequent pregnancy losses, second and third trimester fetal losses are the Sporadic miscarriage < 10 weeks' gestation Chromosomal abnormalities of the conceptus placenta Fetal loss Genetic relationship between reproductive partners (consanguinity) Family history of recurrent miscarriage or syndrome associated with embryonic or fetal loss Previous diagnostic...

Model Program for Post Abortion Counseling

Of course, unintended pregnancies occur due to many different factors including contraceptive failure during consensual sex with loving partners. These women rarely have emotional issues requiring counseling unless they are very young, in a nonsupportive relationship, or come from a very religious or unaccepting community. However, there are many life circumstances including prior mental health issues that could be a problem for women who might respond very well to counseling and therapy. Women often have been silenced and do not talk easily about abusive experiences, especially if incest or other childhood sexual abuse had occurred but has been buried for many years. Some of these women are not assertive enough to insist that a partner use contraceptives and therefore become pregnant. A current abusive partner is another high risk for unintended pregnancy. In this chapter we discuss the risk factors that may influence a woman's emotional reactions after abortion, preventive...

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.

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.

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).

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

Understanding Womens Cognitive Skills

Another cognitive skill area that is important to explore is the information the woman had before the abortion. Was she told that abortion is wrong or that it is murder that the pregnancy was not developed at all or that the pregnancy was fully developed that she would get cancer if she had an abortion that she would not be able to become pregnant again or other inaccurate information. Does she come from a culture that has many negative attributions about aborting a pregnancy Do you have adequate information about her culture Remember the earlier discussion in Chapter 1 and Chapter 2 about the inaccurate information that is

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.

Working Through Spiritual and Religious Issues

Feelings regarding abortion are often influenced by a woman's family, her religious beliefs, or both. Often women become pregnant and are faced with a decision that they never thought they would have to make. Their decision is influenced by their values and beliefs (both familial and religious). However, when the woman knows that she is unable to support a child, would have to drop out of school, or would be looked negatively upon for having intercourse, which led to her becoming pregnant, she may choose to exercise her constitutional right to have an abortion. Even when a woman knows this is the best option for her at the time, she may still be haunted by what she has been told by her family about abortion, or how her religion views abortion. Therefore, it is important to explore the woman's familial, cultural, and religious beliefs around abortion. Having a support system is important in life especially when faced with a difficult decision. The therapist should ask the woman if she...

Chlamydia trachomatis

Chlamydia trachomatis is the major causative agent of non-gonococcal urethri-tis, as well as epididymitis in men, and is the most common sexually transmitted bacterial pathogen worldwide. Genital C. trachomatis infection is a key global issue facing female reproductive health. It can cause cervicitis, pelvic inflammatory disease, infertility, and ectopic pregnancy. Asymptomatic infections are common in both men and women. Currently, routine screening for chlamydia are recommended by the Centers for Disease Control and Prevention on sexually active teenagers and adults of < 24 years (CDC, 2002). Because of the requirements for possible population-based screening, an accurate and sensitive laboratory test using noninvasive procedures for the diagnosis of chlamydia is often required.

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.

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,...

Mycoplasma and Ureaplasma

Men with NGU (Taylor-Robinson, 1996). Besides NGU, Mycoplasma hominis, M. genitalium, Ureaplasma parvum, and U. urealyticum are important etiological agents of postpartum fever, infertility, and pelvic inflammatory disease (Waites et al., 2003). A number of different approaches for detection of mycoplasmas and ureaplasmas have been developed, and each method has its advantages and disadvantages with respect to cost, time, reliability, specificity, and sensitivity. These methods commonly include culture (Jensen et al., 1996), antigen detection (Bebear et al., 1997), DNA probes (Razin, 1994 Yoshida et al., 2003) and PCR (Jensen et al., 1996 Mahony et al., 1997 Yoshida et al., 2002).

How Do You Think the Abortion Debate Impacts

It is easy to get caught up in the debate of Is abortion right Sometimes I just have to push that out of my mind to be part of the team at the center. And it is hard for me at times. I have to say that when I became pregnant myself, while working at the center, things changed a bit for me as I began noticing the changes in my own body and thinking about development. I had something growing inside of me. But I am quick to remember that this is about choice. Terminating a pregnancy is that woman's choice. I am here to help that woman be okay with the decision she wants to make and to help her figure out what is right for herself, her family, and her life at that point in time. I am here to help empower the woman to make the best decision for her.

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...

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.

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).

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...

Practical Clinical Applications

Review of the current applications beyond the scope of this chapter. Instead, a few remarkable examples demonstrating the breadth of possibilities are presented, including cancer and infectious diseases reviewed in 49, 74, 75 . Other topics of interest that are not covered include evaluating drug toxic-ities 76, 77 profiling of neuropsychiatric disorders such as schizophrenia, Alzheimer disease, and Parkinson disease reviewed in 78 immunopheno-typing of leukemias with a long-term goal of monitoring minimal residual disease 79 , and characterizing human spermatozoa surface antigens in relation to immunological infertility 25 .

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

What is kyphoplasty Would it help my spinal fractures

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.

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).

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...

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).

Emotional Regulation and Its Impact on Competency to Make Decisions

Perhaps the most frequently asked question is one that implicates certain kinds of emotional distress that allegedly come from having an abortion. We believe that it is easier to accept scientific evidence that the physical procedures used in terminating pregnancies are safe but it is more difficult to assess if there are lasting emotional aftereffects. Maybe it is the ambivalence that so many women feel about terminating a pregnancy that keeps the question of emotional harm from being resolved. Women demand that all women should have the choice of whether or not to become pregnant, which requires access to safe birth control methods and, if an unwanted pregnancy should occur, the choice of whether or not to carry the pregnancy. Over half of the pregnancies in the United States are unplanned, and over half of those are terminated since women have had the legal right to make these choices. Women have the right to control their bodies and their lives, as child-raising still falls mostly...

Abortion Counseling

Finally, in conclusion, it is clear that the women and men who have been working in the abortion centers for the past 30 years, since Roe v. Wade became the law, have been brave and courageous souls, many of whom have devoted their entire lives to keep the choice for women. It is time for all of us who are trained counselors and therapists to join this group so that every woman has the right to make the choice about whether and when she wants to become pregnant and raise a child. If each of us does a little, it will be less of a burden, and our contributions will bring us closer to a reality of necessary rights for all.

Are there treatments to prevent attacks and lessen risk of disability

In October 1997, I was feeling great. My MS was seemingly nonexistent. I was in New Jersey enjoying the fall leaves, biking, and picking raspberries I even thought about trying to teach in the spring term. I did not realize that I was pregnant and soon to miscarry. After the miscarriage, we called Dr. Sheremata, who asked when I was next going to be in Miami. I told him in a week, for my father's 65 th birthday. He warned us that it was likely that I would have a flare-up. As I enjoyed a long weekend in Florida, I felt a bit smug and a lot relieved that I had not had a flare-up and almost canceled my appointment with Dr. Sheremata for that Tuesday. Monday night I was tired but still okay. By Tuesday morning I could not see out of my right eye, and neither of my legs worked very well. My father and I went to see Dr. Sheremata we discussed ACTH, and Dr.

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...

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...

Multiple Endocrine Neoplasia Type

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant cancer syndrome that features tumors of the parathyroid, pituitary, and the islet cells of the pancreas. These tissues are part of the endocrine system, which produces and secretes various hormones. In response to different hormones, target cells control homeostatic processes, growth, development, and stress. Specifically, with regard to the sites of the MEN1 tumors, the parathyroid glands control levels of calcium and phosphate the pituitary glands regulate metabolic activities of other endocrine glands and growth and the pancreatic islet cells maintain blood glucose concentration. Depending on the site and the extent of the MEN1 tumors, symptoms may include excess calcium in the bloodstream (hypercalcemia), which causes kidney stone formation low blood sugar concentration (hypoglycemia), resulting in dizziness, confusion, weight loss, and glucose intolerance and disruption of the pituitary gland, accompanied by...

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...

Anabolic Androgenic Steroids

Anabolic-androgenic steroids have the same effect on the brain as natural testosterone. Thus, when steroid levels are high, the brain and pituitary gland stop producing the hormones that stimulate sperm production and testosterone secretion. In men, this leads to atrophy of the testes, impotence (inability to achieve or maintain an erection), low sperm count, and infertility. Ironically, anabolic-androgenic steroids have feminizing effects on men and masculinizing effects on women. Men may develop enlarged breasts (gynecomastia), while in some female users the breasts and uterus atrophy, the clitoris enlarges, and ovulation and menstruation become irregular. Female users may develop excessive facial and body hair and a deeper voice, and both sexes show an increased tendency toward baldness. Especially in men, steroid abuse can be linked to severe emotional disorders. The steroids themselves stimulate heightened aggressiveness and unpredictable mood swings, so the abuser may vacillate...

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...

Ovarian Selective Serms

Uterine leiomyomas, or fibroids, are the most common type of solid tumors in adult women, clinically apparent in at least 25 of those of reproductive age 24-26 . Abnormal menstrual bleeding, pelvic pain, and infertility are the most commonly experienced symptoms in these women. Uterine fibroids are the leading cause of hysterectomies performed in the United States, accounting for over 200,000 of these procedures each year. Other invasive surgical interventions for the treatment of uterine fibroids include myomectomy and uterine artery embolization. Leiomyomas are estrogen-responsive tumors that can be treated

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...

Spectrum of Disease

C. trachomatis infections have surpassed gonococcal* infections as a cause of sexually transmitted disease in the United States. Similar to gonococci, C. trachomatis is a cause of urethritis, cervicitis, bartholinitis, proctitis, salpingitis, epididymitis, and acute urethral syndrome in women. In the United States, 60 of cases of nongonococcal urethritis are caused by chlamydiae. Both chlamydiae and gonococci are m jor causes of PID, contributing significandy to the rising rate of infertility and ectopic pregnancies in young women. After only one episode of PID, as many as 10 of women may become infertile because of tubal occlusion. The risk increases drama* tically with each additional episode.

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.

Development to the Blastocyst Stage

Show Blastocyst

An interest in culturing human embryos to the blastocyst stage has always existed, in particular as there were always concerns as to the logic of transferring early-cleavage-stage embryos to the uterine environment. Limited data existed that indicated an improved pregnancy rate when placing blastocysts into the uterus. Buster et al. (21) recovered in vivo-developed human blastocysts by uterine lavage and transferred the same blastocysts to achieve a high implantation rate (3 5, 60 ), well above that currently observed in most IVF cycles. Similar implantation rates have now been published using sequential embryo culture media by a number of clinics (22-24). This theory has been further substantiated by a number of studies that adopted a scoring method for the blastocyst transferred. This is highlighted in the study by Gardner et al. (26), who showed that blastocysts of high quality led to the highest pregnancy and implantation rates. Blastocysts were scored according to the expansion...

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...

Lessons from spotted hyenas and prairie voles

As septal injections of AVP stimulate paternal responsiveness V1a antagonist injections reduce it (Wang et al., 1994a). The sex difference AVP innervation may contribute to the absence of sex differences in parental behaviour typically seen in other rodents (Lonstein and De Vries, 2000). As in other female rodents (Bridges, 1990), hormonal changes associated with pregnancy and parturition appear necessary to trigger parental behaviour in female prairie voles (Lonstein and De Vries, 1999b, Hayes and De Vries, 2007). As male prairie voles will never get pregnant let alone give birth, they need a different strategy to boost their parental responsiveness. This strategy may very well involve having a higher density of AVP innervation. In case of the prairie vole, therefore, the presence of a sex difference in AVP expression does not correlate with the size of sex differences in behaviour. The animal with the largest sex difference in AVP innervation reported to date shows the least...

Clinical Manifestations

Syphilis Penis

Example, gonorrhea or chlamydia infection in the male is usually obvious because of a urethral discharge, yet females with either or both of these infections may have either minimal symptoms or no symptoms at all. Also, the primary lesion of syphilis (chancre) can be unremarkable and go unnoticed by the patient. Therefore, the lack of symptoms does not guarantee the absence of disease. Unfortunately, these asymptomatic individuals can then serve as reservoirs for infection and unknowingly spread the pathogen to other individuals. Also, as in the case for asymptomatic infections in the female caused by N. gonorrhoeae or C. trachomatis, untreated infections can lead to serious sequelae such as pelvic inflammatory disease or infertility.

Std Sex Colleges Girling

Incidence in patients with vulvodynia. Journal of Reproductive Health 42 3 135-9 Faculty of Family Planning (2004) The copper Intrauterine Device as a long-term method of contraception. Journal of Family Planning and Reproductive Health Care 30 1 29-42 Friedrich EC Jr. (1987) Vulvar vestibulitis syndrome. Journal of Reproductive Medicine 38 9-13 www.rog.org.uk clingov1 Hay PE, Lamont RF, Taylor-Robinson D, Morgan DJ, Ison C, Pearson J (1994) Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. British Medical Journal 308 295-8 Hillis SD, Joesoef R, Marchbanks PA, Wasserheit JN, Cates W Jr., Westrom L (1993) Delayed care of pelvic inflammatory disease as a risk factor for impaired fertility. American Journal of Obstetrics and Gynaecology 168 1503-9 Hurskainen R, Teperi J, Paavonen J, Cacciatore B (1999) Menorrhagia and uterine artery blood flow. Human Reproduction 14 1 186-9 International Association for the Study of Pain (1986) in...

Metabolic Pathway Activity

Intracellular Metabolism

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...

Neisseria gonorrhoeae

Neisseria gonorrhoeae can cause cervicitis, urethritis, proctitis and pelvic inflammatory disease. It can lead to long-term sequelae like infertility and ectopic pregnancy and it can be implicated in chronic pelvic pain. Remarkably it can cause increased susceptibility to transmission of HIV infection (Fleming and Wasserheit 1999). Among the aetiological agents of treatable STIs, N. gonorrhoeae stands out because of the extent to which antibiotic resistance compromises the effectiveness of individual case management and disease control programmes. Neisseria gonorrhoeae continues to develop resistance to both older, less expensive antibiotics (penicillins, tetracyclines, spectinomycin) and more recently introduced agents (quinolones).

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.

Infections of the Reproductive Organs and Other Upper Tract Infections

Pelvic inflammatory disease (PID) is an infection that results when cervical microorganisms travel upward to the endometrium, fallopian tubes, and other pelvic structures. This infection can produce one or more of the following inflammatory conditions endometritis, salpingitis (inflammation of the salpinges), localized or generalized peritonitis, or abscesses involving the fallopian tubes or ovaries. Patients with PID often have intermittent abdominal pain and tenderness, vaginal discharge, dysuria, and possibly systemic symptoms such as fever, weight loss, and headache. Serious complications, such as permanent scarring of die fallopian tubes and infertility, can arise if PID is untreated.

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

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).

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...

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...

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).

Advantages and Disadvantages of Polar Body Biopsy

Advantages Polar Bodies

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.

Leptin in endometriosis

Pelvic endometriosis (PE) is one of the most common benign gynecological diseases, characterized by implantation and growth of endometrial tissue in the pelvic peritoneum and associated with infertility and pain (34,35). The most accredited pathogenetic theory of endometriosis considers the transport of endometrial tissue to the peritoneal cavity throughout the tubes (retrograde menstruation), adherence to the peritoneal wall, followed by proliferation and formation of endometriotic lesions (34). However, an abnormal peritoneal microenvironment is thought to be a permissive condition for implantation and growth of refluxed endometrium. In this context, local and systemic abnormalities in immune response have been described, such as increased frequency of autoimmune disorders and the presence of autoantibodies (34,35). Endometriosis is, in fact, an immune-related chronic inflammatory disease, characterized by production of

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...

Crisis Pregnancy Centers

This Congressional study authorized female investigators to pose as teenagers trying to make a decision on whether or not to have an abortion. The investigations contacted 23 out of the 25 CPCs in 15 states that had received grants through the 150 million Compassion Capital Fund, part of President Bush's faith-based initiatives. It was reported that 87 of the CPCs that were contacted provided false and misleading information linking abortion to breast cancer, infertility, and mental illness (Cramer, 2006).

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.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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