Fertility Miracle

Pregnancy Miracle Book

Lisa Olson is a chinese medicine researcher, alternative health and nutrition specialist, health consultant and former infertility sufferer. The Pregnancy Miracle book by Lisa Olson is quite extensive pregnancy book (279 pages in total) which focuses on 100% natural method for getting pregnant quickly and healthy. The goal of this book is to increase your fertility and make it easier for you to conceive a baby. This is the exact 5-step process Lisa used to get pregnant twice at age 43 and 45 after battling infertility for more than a decade and being told by her doctors she would never have kids of her own. 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. Continue reading...

Pregnancy Miracle Overview


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Interstitial Deletions and Male Infertility

Interstitial deletions in male-specific regions on chromosome Yq are a major source of infertility (AZF) (32,33) (Table 1). Of the commonly affected regions (AZFa, AZFb and AZFc), AZFb and AZFc are located within an approx 8-Mb interval and are mostly comprised of five large IR (P1-P5), each consisting of a complex array of direct and inverted blocks harboring male-specific genes. Large (> 90 kb) regions of near-perfect identity exist among these IRs nevertheless, the breakpoints strongly cluster toward the IR spacers (i.e., the regions that separate the two inverted repeat sequences) where, in some cases, they took place between sequences that shared no homology. These features are consistent with a cruciform-mediated mechanism for the deletions (21,33).

Ovarian factor infertility

Clomiphene citrate (Clomid, CC) is the most cost-effective treatment tor the treatment of infertility related to anovulation or oligo ovulation, . The usual starting dose of CC is 50 mg day for 5 days, beginning on the second to sixth day after induced or spontaneous bleeding. Ovulation is expected between 7 and 10 days after the last dose of CC. CC is 5 to 10 . Approximately 33 of patients will become pregnant within five cycles of treatment. Treatment with CC for more than six ovulatory cycles is not recommended because of low success rates.

Pelvic factor infertility

Pelvic factor infertility is caused by conditions that affect the fallopian tubes, peritoneum, or uterus. Tubal factor infertility is a common sequela of salpingitis. Appendicitis, ectopic pregnancy, endometriosis, and previous pelvic or abdominal surgery can also damage the fallopian tubes and cause adhesion formation. 2. Endometriosis is another condition involving the peritoneal cavity that is commonly associated with infertility. Uterine abnormalities are responsible for infertility in about 2 of cases. Examples of uterine abnormalities associated with infertility are congenital deformities of the uterus, leiomyomas, and intrauterine scarification or adhesions (Asherman's syndrome). 3. The mainstay of treatment of pelvic factor infertility relies on laparoscopy and hysteroscopy. In many instances, tubal reconstructive surgery, lysis of adhesions, and ablation and resection of endometriosis can be accomplished laparoscopically.

Cervical factor infertility

Cervical factor infertility is suggested when well-timed PCTs are consistently abnormal in the presence of a normal semen analysis. Cervical factor infertility results from inadequate mucus production by the cervical epithelium, poor mucus quality, or the presence of antisperm antibodies. 2. Patients with an abnormal PCT should be screened for an infectious etiology. The presence of immotile sperm or sperm shaking in place and not demonstrating forward motion is suggestive of immunologically related infertility. Sperm-cervical mucus and antisperm antibody testing are indicated when PCTs are repeatedly abnormal, despite normal-appearing cervical mucus and normal semen analysis. sperm maturation, and sperm delivery. Intrauterine insemination is

Unexplained Infertility

The term unexplained infertility should be used only after a thorough infertility investigation has failed to reveal an identifiable source and the duration of infertility is 24 months or more. History, physical examination, documentation of ovulation, endometrial biopsy, semen analyses, PCT, hysterosalpingogram, and laparoscopy should have been completed. 2. Because couples with unexplained infertility lack an identifiable causative factor of their infertility, empirical treatment with clomiphene therapy increases the spontaneous pregnancy rate to 6.8 per cycle compared with 2.8 in placebo-control cycles. For optimal results, gonadotropins should be used for ovulation induction. Intrauterine insemination, in vitro fertilization and gamete intrafallopian transfer (GIFT) are additional options. References See page 146.

Frequency Of Infertility

It is estimated that about 15 of couples have difficulty in conceiving or are outright infertile. There are numerous contributing factors, some of which can be helped by resorting to Assisted Reproductive Technology or ART, which comprises artificial insemination, in vitro maturation (IVM) of oocytes, in vitro fertilization (IVF), embryo culture and embryo transfer. For presumptively infertile women aged up to about 37, the outcome of clinical IVF (in this general context meaning IVF together with embryo culture and transfer) is good, with an average of about 32 of treatment cycles in the United States resulting in a live birth (Wright et al., 2003). But for women approaching 40 or over, the efficiency of IVF drops sharply, to only about 5 after the age of 42 (Wright et al., 2003). Similarly, the incidence of natural conceptions falls progressively towards the age of 40, prior to overt menopause. The reasons for this precipitous drop in fertility are...


Infertility is defined as failure of a couple of reproductive age to conceive after 12 months or more of regular coitus without using contraception. Infertility is considered primary when it occurs in a woman who has never established a pregnancy and secondary when it occurs in a woman who has a history of one or more previous pregnancies. Fecundability is defined as the probability of achieving a pregnancy within one menstrual cycle. It is estimated that 10 to 20 of couples are infertile.

Male Infertility

According to three of four studies, oral vitamin E supplementation can effectively treat some forms of male infertility (Geva et al 1996, Kessopoulou et al 1995, Rolf et al 1999, Suleiman et al 1996). Doses used varied from 200 mg day to 800 mg day. As with many other conditions, treatment may be best suited to those individuals with elevated oxidative stress levels, although this requires further investigation.

Blastocyst Culture for Deriving Human Embryonic Stem Cells

Success in producing a human embryonic stem cell line depends largely on the quality of the 5-d-old embryo (blastocyst) used. Such blastocysts are grown from frozen-thawed d 1-3 surplus embryos left over from infertility clinics and donated for stem cell research with informed patient consent. Knowledge, therefore, of the culture conditions and embryo scoring systems that are used to generate high-quality blastocysts are crucial. This chapter describes an extended microdroplet culture protocol using two-stage sequential culture media with morphological and polarized optical parameters for embryo scoring for each day of embryonic growth to help produce high-quality blastocysts. 2 Bongso, A., Fong, C. Y., Mathew, J., Ng, L. C., Kumar J., and Ng, S. C. (1999) The benefits to human IVF by transferring embryos after the in vitro embryonic block alternatives to day-2 transfers. Asstd. Reprod. Revs. 1, 70-78.

Atypical glandular cells of undetermined significance AGUS

One-third of those for whom the report favors reactive will actually hsve dysplasia. For this reason, colposcopy, ECC (or cytobrush), and directed biopsies are recommended. If glandular neoplasia is suspected or persistent AGUS does not correlate with ECC findings, cold-knife conization perhaps with dilatation and curettage (D& C) is indicated. D& C with hysteroscopy is the treatment of choice for AGUS endometrial cells.

Management of glandular cell abnormalities

Atypical glandular cells of undetermined significance (AGUS) . Colposcopically directed biopsy and endocervical curettage is recommended in all women with AGUS smears, and abnormal endometrial cells should be investigated by endometrial biopsy, fractional curettage, or hysteroscopy.

Diseases of genomic imprinting

As assisted reproductive technologies (ARTs) are increasingly used to overcome infertility, there is concern that the children conceived may be susceptible to imprinting disorders involving chromatin modification (Maher et al., 2003). As yet, the evidence that ART may be associated with genetic imprinting disorders is inconclusive (Schieve et al., 2004). Parenthetically, Dnmtl overexpression causes genomic hypermethylation, loss of imprinting, and embryonic lethality (Biniszkiewicz et al., 2002). In addition, somatic cell nuclear transfer often results in multiple imprinting errors (Young and Beaujean, 2004). Loss of imprinting mechanisms can also be observed in many cancers involving reactivation of the normally silent allele of a growth-promoting

Immunosurgical Isolation of Inner Cell Mass

Donated human embryos are cultured according to standard IVF protocols to the blastocyst stage. The method of immunosurgery is performed as described by Solter and Knowles (9). It involves the removal of the zona pellucida followed by incubation of the embryo in antibody solution that binds to the proteins of trophectoderm cells but not to the inner cell mass cells then lysing trophectoderm cells with guinea pig compliment.

Greco Roman Medicine

From the vantage point of Western civilization, Greco-Roman medicine has been the major source of our medical tradition. The health hazards associated with obesity were clearly noted in the medical writings of Hippocrates, where he states, ''Sudden death is more common in those who are naturally fat than in the lean'' (58). These traditions also note that obesity was a cause of infertility in women and that the frequency of menses was reduced in the obese.

Other diagnostic tests

Uterine curettage is performed only when serum hormones indicate a non-viable pregnancy (progesterone < 5 ng mL or falling plateauing beta-hCG). Typically, chorionic villi are identified (by floating tissue obtained in saline) when a failed intrauterine pregnancy is present. When villi are not seen, diagnosis of completed miscarriage can still be made if the beta-hCG level falls 15 or more 8-12 hours after the procedure. When no villi are seen and beta-hCG levels do not fall, EP is highly suspected. Ectopic pregnancy is diagnosed in this situation if the beta-hCG plateaus or continues to rise after the procedure.

Potential Strategies For Improving The Health Of Sexual Minorities Groups In The City

The dominant strategy adopted to improve the access of LGBT people to appropriate, non-homophobic health care has been the creation and expansion of LBGT clinics. These clinics began as special sessions (principally treating STI's) within LGBT community centers or at free or community health clinics. Over time the combination of HIV AIDS funding and other third party reimbursement (public and private) for health services have caused these clinics to separate from (and in many cases eclipse in size) their home institutions. The largest LGBT health clinics - including Callen Lorde in New York City, Chase Brexton in Baltimore, Fenway in Boston, Howard Brown in Chicago, and the Los Angeles Gay & Lesbian Community Service Center - serve thousands of patients annually and provide services ranging from primary care and family planning to mental health and substance abuse counseling. A second, related strategy has been the development of LGBT-orientated specialty clinics - largely for HIV...

Genetic Counseling and Genetic Testing

The counselor helps the family interpret the genetic risks and explains various reproductive options that are available, including prenatal diagnosis, artificial insemination, and in vitro fertilization. A family's decision about future pregnancies frequently depends on the magnitude of the genetic risk, the severity and effects of the condition, the importance of having children, and religious and cultural views. The genetic counselor helps the family sort through these factors and facilitates their decision making. Throughout the process, a good genetic counselor uses nondirected counseling, which means that he or she provides information and facilitates discussion but does not bring his or her own opinion and values into the discussion. The goal of nondirected counseling is for the family to reach its own decision on the basis of the best available information. 4. An older woman becomes pregnant or wants to become pregnant. There is disagreement about the age at...

Agricultural Databases

The dairy industry supports an industry-level system to allow efficient use of artificial insemination with semen from elite sires. These systems allow real-time identification of cows and matching with sires that are suitable for mating based on a measure of inbreeding between the two individuals. Organizations, such as the National Dairy Herd Improvement Association (http www.dhia.org ), promote development of data standards and systems for integration of data across states.

What The Guidelines Cover

Blastocysts made for reproductive purposes and later obtained for research from IVF clinics. 2. Blastocysts made specifically for research using IVF. To provide local oversight of all issues related to derivation and research use of hES cell lines and to facilitate education of investigators involved in hES cell research, all institutions conducting hES cell research should establish an Embryonic Stem Cell Research Oversight (ESCRO) committee. The committee should include representatives of the public and persons with expertise in developmental biology, stem cell research, molecular biology, assisted reproduction, and ethical and legal issues in hES cell research. The committee will not substitute for an Institutional Review Board but rather will provide an additional level of review and scrutiny warranted by the complex issues raised by hES cell research. The committee will also review basic hES cell research using preexisting anonymous cell lines that does not require consideration...

Review of the Procurement Process

Regardless of the source of funding and the applicability of federal regulations, an Institutional Review Board or its equivalent should review the procurement of gametes, blastocysts, or somatic cells for the purpose of generating new hES cell lines, including the procurement of blastocysts in excess of clinical need from infertility clinics, blastocysts made through in vitro fertilization specifically for research purposes, and oocytes, sperm, and somatic cells donated for development of hES cell lines through nuclear transfer. To facilitate autonomous choice, decisions related to the production of embryos for infertility treatment should be free of the influence of investigators who propose to derive or use hES cells in research. Whenever it is practicable, the attending physician responsible for the infertility treatment and the investigator deriving or proposing to use hES cells should not be the same person. This recommendation should not be interpreted as a commentary on...

Estrogen Progesterone and Androgen Receptors

Reproductive and homeostatic systems, respectively. The sex steroid receptors ER, PR, and AR direct transcription of genes involved in sexual development, differentiation, and specification (Tables 3.4, 3.5). As a result of their growth-promoting activities in these processes, these receptors are pharmacologically targeted in a number of neoplastic reproductive tissues. Receptors ERa and ERjS are predominantly expressed in reproductive tissues, as well as in vasculature, cardiac muscle, and bone. Their activity is subject to estradiol availability, which is regulated by hormonal cascades generated from the ovary and other steroidogenic tissues. Confirmation of the role of ERs in the regulation of the reproductive tract was achieved by targeted deletion of ERa and ERjS alleles in transgenic mice, which develop normally but are infertile or suffer ovarian dysfunction, respectively.296,297 In addition to reproductive maintenance, specialized roles for ERs include regulation of bone...

Gender in Demography Increasing Attention

Attention to gender has also come from reproductive rights activists. Although such perspectives have been present for some time (Freedman and Isaacs 1993 Cook 1993 Dixon-Mueller 1993 Kabeer 1994), their voices were especially heard during and after the 1994 International Conference on Population and Development in Cairo. This conference, and the discussions surrounding it, put scholars and activists interested in gender, especially those from the Third World, onto the radar screen of demographers. Even in the disagreement of some mainstream demographers and in their concern of what was removed from the population agenda to make room for issues of women and gender (McIntosh and Finkle 1995), we see a new way of dealing with the issues surrounding gender. One of the most important contributions of the reproductive health activists has been the attention given to feminist projects. Feminist research is necessarily political, and the activist work relating to the Cairo conference made...

Preimplantation And Prenatal Testing For Hereditary Breast Cancer

Offit et al. raise the thorny issue of whether healthcare providers have a legal obligation to explain options for assisted reproduction to individuals with gene mutations associated with cancer syndromes, as part of their duty to warn (90). For example, it has been recommended that BRCA2 testing be offered to Ashkenazi Jewish reproductive-age partners of an individual with a BRCA2 mutation because of the observation that two deleterious mutations in this gene may be associated with Fanconi anemia, early onset brain tumors, and other malignancies (92). It is unclear whether there would be legal implications around the issue of wrongful birth if patients were not informed of available means to identify and potentially avoid the birth of a child with a cancer predisposition syndrome (90).

Identifying Resistance

We see another kind of resistance in Kenya. There, among the Luo, women's use of contraceptives may be undermining men's control over their families. In that setting, men's dominance has rested on their ability to control important material and symbolic wealth and the connections those various components of wealth and prestige could bring Cattle were used primarily as bridewealth, which legitimated control over the women who would produce the children that would perpetuate the husband's lineage'' (Watkins, Rutenberg, and Wilkinson 1997 216). While men continue their economic control and domination today, they have not been able to control women's reproduction in the same way. Watkins and her colleagues attribute this change to the new family planning programs, introduced by outsiders to the culture, which have made contraception easy to obtain. Consequently, Luo women have been able to make decisions about contraception and reproduction that their husbands may disagree with. While...

The Need For Guidelines

Since 1998, the volume of research being conducted with hES cells has expanded, primarily with private funds because of restrictions on the use of federal funds for such research. Those restrictions are both legislative and by executive order. Federal legislation forbids the use of federal funds for any research that destroys an embryo, that is, is nontherapeutic for the embryo. That effectively prevents any use of federal funds to derive hES cells from blastocysts. Research with established hES cell lines is further limited by presidential policy the policy announced by President George W. Bush in 2001 restricts federal funding of research with hES cells to use of specific federally approved cell lines already in existence before August 9, 2001. The policy states further that funding is available only for research with hES cell lines that were derived before August 9, 2001 from frozen human blastocysts that remained at infertility clinics and that were (1) generated for reproductive...

The Meaning of Motherhood

Inhorn's insights (1994, 1996) about childless women in urban Egypt is an example of research that is not part of mainstream demography but can inform demographic research. In this society, particularly among poor migrants who have moved from rural to urban centers, women's status and power are so powerfully tied to the bearing and raising of children that to be childless is a disaster. When these women moved to the city, they lost other sources of power, income, and even identity, and those losses made children even more important. Inhorn lived and talked with women who were searching for cures to their infertility and came to understand the cultural necessity of bearing children for women in this part of the world. She notes that ''indeed, it is from the study of infertility that issues of pronatalism, or child desire, are perhaps best understood. Namely, those who are missing children and who therefore have had much cause to reflect on their object of desire are often in the best...

Brief History Of Us Discussions And Policies Regarding Research Involving Human Embryos

Public debates and deliberations about embryo research have extended over the last 30 years. In 1975, the Secretary of the Department of Health, Education, and Welfare (DHEW) announced that the department would fund no proposal for research on human embryos or on IVF unless it was reviewed and approved by a federal ethics advisory board. IVF was still an experimental technique Louise Brown, the first IVF baby, was born in 1978 in the United Kingdom. The human subjects regulations that resulted from the work of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (National Commission) required review of such work by an Ethics Advisory Board (EAB) to be appointed by the DHEW Secretary (National Commission, 1975). In 1977, NIH received an application from an academic researcher for support of a study involving IVF. After the application had undergone scientific review by NIH, it was forwarded to the EAB. At its May 1978 meeting, the EAB...

Female Reproductive System Disorders

Premenstrual syndrome Interest in EPO supplements as a potential treatment for PMS began in the early 1980s, largely as a result of investigational work published by David Horrobin. In the Journal of Reproductive Medicine be reported on positive results obtained in three double-blind placebo-controlled studies and two open trials in women with premenstrual syndrome (Horrobin 1983).

Causes and symptoms

Prevalence of Type II diabetes in American society and for the appearance of Type II diabetes in children, previously a rarity. Because obesity promotes degenerative disease of joints and heart and blood vessels, it increases the need for some surgical procedures. At the same time, surgical complication rates are higher in obese patients. Obesity contributes to fatigue, high blood pressure, menstrual disorders, infertility, digestive complaints, low levels of physical fitness, and to the development of some cancers. The social costs of obesity that include decreased productivity, discrimination, depression, and low self-esteem, are less easily described and measured. Worldwide, obesity has reached epidemic proportions in the last thirty years, affecting both sexes and all ethnic, age, and socioeconomic groups. More than 50 of adults in the United States currently fall into overweight or obese classifications, and 22 of preschool children are classified as overweight. The increasing...

Of Vitamin A Supplementation in the Early 1970s

Out by the personnel of the primary health centers, maternal and child health centers, and family-planning centers (121). From 1973 to 1975, the government of Indonesia conducted a pilot program of high-dose vitamin A capsules every 6 mo to every preschool child in 20 selected subdistricts in the island of Java (122). In 1972, the Ten-Year Health Plan approved by the Third Special Meeting of Ministers of Health of the countries of the Americas adopted the formal goal to reduce the prevalence of vitamin A deficiency by about one-third and to promote legislation to enforce the fortification of foods with vitamin A (123). Vitamin A fortification of sugar was implemented in Guatemala in 1974 with the underlying rationale of improving growth and increasing resistance to infectious diseases in children (124). In the late 1970s, the Indonesian government also began to consider vitamin A fortification of wheat flour, sugar, or monosodium glutamate (MSG) (125). After further deliberation, of...

Penetrance expressivity and genetic modifiers

Infertility in male CF patients is due to obstructive azoospermia secondary to bilateral absence of the vas deferens. A similar autosomal recessive condition with no other CF manifestions is classified as congenital bilateral absence of vas deferens (CBAVD). Remarkably, 50-65 of patients with CBAVD have at least one mutated CFTR allele, whereas 10 have two mutated alleles. Furthermore, patients with six other milder pulmonary diseases that are subsets of the CF spectrum have been shown to have at least one CFTR mutation (Zielenski and Tsui, 1995). We must conclude that these phenotypes result from a dominant effect of the CFTR mutation, or that there is an undected mutation in the second allele - perhaps regulatory - or a mutation in another unlinked gene or

Nuclear Transfer To Generate Stem Cells

Most work on hES cells has taken place with a relatively small number of cell lines obtained from excess blastocysts donated from in vitro fertilization (IVF) programs. The genetic makeup of the cells is not controlled in any way, and genetic variation among lines needs to be considered when results from different lines are compared. Experience from research with mES cells shows that ES cell lines can differ markedly in their differentiation efficiencies. Being able to control the genotype of ES cells would be valuable for various reasons, most notably the desire to generate ES cells with genotypes known to predispose to particular diseases. In the case of single-gene defects, one could achieve that goal by deriving hES cells from discarded morulae or blastocysts that were identified with preimplantation genetic diagnosis (PGD) procedures (Verlinsky et al, 2005) as carrying mutations or by generating the appropriate mutation by gene targeting of established hES cell lines. However,...

Errors in Chromosome Number

We are all products of a sperm fertilizing an egg. Humans have twenty-two pairs of chromosomes, plus the sex chromosomes. After meiosis, the sperm should have twenty-two chromosomes plus either the X or Y chromosome, and the egg should have twenty-two chromosomes plus an X chromosome (see figure 7.1). But sometimes, errors occur in the process of meiosis, and a given gamete is either missing a chromosome or has more than one copy of a particular chromosome. . When this happens, and the egg or sperm that has an aberrant number of chromosomes is involved in making a new individual, of course, that individual will have a wrong number of chromosomes. Because there are so many genes on each chromosome, such errors would be expected to be very deadly. A great majority of fetuses with abnormal chromosome numbers do not survive to birth. Thus, chromosomal abnormalities explain some cases of infertility and pregnancy loss. Indeed, up to 50 percent of first-trimester spontaneous abortions are...

Sources Of Oocytes For Nt Es Cells

At current rates of success of generation of NT blastocysts and ES cells, one major limitation of expansion of this approach will be the availability of oocytes for NT. Current and possible future sources of such oocytes include excess oocytes and unfertilized oocytes from IVF procedures, oocytes matured from ovariectomies or fetal ovaries from pregnancy terminations, oocyte donation, derivation of oocytes from nonreproductive material, and use of nonhuman oocytes. Excess oocytes and unfertilized eggs from IVF procedures. During IVF, hormonal induction is used to generate oocytes for fertilization in vitro. Often, more oocytes are generated than are needed for reproductive purposes, and some oocytes may be available for research donation. In addition, after IVF, not all oocytes are successfully fertilized, and unfertilized oocytes would otherwise be discarded if not donated for research. Experiments to explore use of such oocytes for NT derivation of hES cells have been approved and...

Physical examination for the man

The cornerstone of any infertility evaluation relies on the assessment of six basic elements (1) semen analysis, (2) sperm-cervical mucus interaction, (3) ovulation, (4) tubal patency, and (5) uterine and (6) peritoneal abnormalities. Couples of reproductive age who have intercourse regularly without contraception have approximately a 25-30 chance of conceiving in a given menstrual cycle and an 85 chance of conceiving within 1 year.

Avian Models For Reproductive And Neuroendocrine Aging

Avian reproductive anatomy lends itself well to studies of basic mechanisms controlling female fertility and reproductive aging (Johnson, 2000 Holmes et al., 2003). Most adult female birds have only one functional ovary. Unlike the mammalian ovary, however, in which developing follicles are contained in a capsule, the avian ovary has a lobular structure like a bunch of grapes, with a yolky hierarchy of large preovulatory follicles readily accessible on the outside. This arrangement makes it practical to measure or administer hormones, growth factors or other substances directly from or into individual follicles.

Gillian K Reeves Emily Banks Timothy Ja

Tailed review of the relationship between both these types of hormonal preparations and cancer has been compiled by the International Agency for Research on Cancer (IARC).6 The latter review includes details of many of the individual studies and summarizes the results of the main collaborative reanalyses. Three large randomized controlled trials of postmenopausal hormone therapy have also published results with respect to breast cancer and their findings have been reviewed recently.7 Other specific types of exogenous hormone that have been examined in relation to breast cancer risk include diethylstilbestrol, which was commonly used during pregnancy in the 1950s, and fertility-enhancing drugs, such as clomiphene citrate, which have been used since the late 1960s.8 However, the amount of data on breast cancer risk in relation to these latter two types of hormonal preparation is substantially less than that available for hormonal contraceptives and post-menopausal hormone therapy.

Combined Oral Contraceptives

Figure 6.1 Relative risk (RR) of breast cancer in ever-users of combined oral contraceptives compared with never-users. Each relative risk estimate and its 99 confidence interval (CI) is plotted as a black square and a line. The area of each square is proportional to the amount of statistical information available for that particular estimate. Amer Canc Soc, American Cancer Society Canadian NBSS, Canadian National Breast Screening Study CASH, Cancer and Steroid Hormones FPA, Family Planning Association RCGP, Royal College of General Practitioners SE, standard error WISH, Women's Interview Study of Health WHO, World Health Organisation. (Adapted from the Collaborative Group on Hormonal Factors in Breast Cancer.3)

Infections in Females

In women, chlamydial infections may cause pelvic inflammatory disease, tubal infertility, chronic pelvic pain, and ectopic pregnancy. Chlamydial infection may also be linked to cervical cancer (Koskela et al., 2000). Chlamydial and gonococcal infections may increase susceptibility to and transmission of HIV in both men and women (Plummer et al., 1991). The definition of pelvic inflammatory disease is a sexually transmitted infection that ascends from the vagina and cervix to involve the uterus, ovaries, and peritoneal tissues as well as the fallopian tubes. Lower abdominal pain, usually bilateral, is the most common presenting symptom. Pain may be associated with an abnormal vaginal discharge, abnormal uterine bleeding, dysuria, dyspareunia, nausea, vomiting, fever, or other constitutional symptoms. It is more commonly present in a subclinical form that lacks the typical acute symptoms, but continues to lead to the associated long-term sequelae of infertility and ectopic pregnancy...

Equality of access and discrimination

Serious concerns have also been raised about the potential uses of PGD and genetic screening for non-therapeutic applications, like gender selection, and the possibility of its perpetuating or even amplifying gender discrimination. Accepting and endorsing the concept that perfectly healthy embryos would be discarded, or pregnancies terminated, merely because the fetus was the 'wrong' gender is prima facie unethical. Bioethi-cists, however, tend toward unanimous agreement that an argument exists in favour of gender selection when the motivation is the screening out of gender-linked genetic diseases (so-called 'therapeutic' selection). Some even propose that it might be an acceptable consideration for achieving gender-balanced family planning.80 80 The legal position in the United Kingdom on the use of PGD for family planning purposes, and in particular, the selection of a potential ''saviour sibling'' was determined by the House of Lords in the recent case of R ( on the application of...

Cardiovascular Complications

Chemotherapy, particularly alkylating agents like cyclophosphamide, can induce infertility and, in women, premature menopause, with its attendant problems of hot flashes, mood swings, vaginal dryness, and urinary incontinence. Cyclophosphamide is commonly used in breast cancer, but management of the menopausal symptoms is complicated by the fact that hormone replacement therapy is considered contraindi-cated in patients with a history of breast cancer. Consequently, other treatments must be used for hot flashes, such as antidepressants.52 This example illustrates the importance of both recognizing the symptoms related to ovarian failure in a cancer patient in which it would be otherwise unexpected, and having knowledge of the oncologic considerations of the therapies being chosen. In general, the younger a patient is, the more likely they are to have their fertility preserved after chemotherapy.53 However, breast cancer patients are usually advised to delay childbearing for at least 2...

Fertility Enhancing Drugs

Women who undergo treatment for infertility can be exposed to a variety of hormonally active drugs, including clomiphene citrate, human menopausal gonadotrophin, and gonadotrophin-releasing hormone. Studies examining the relationship between use of fertility drugs and breast cancer risk have been hampered by small numbers of women and the inability to adequately control for all important confounding factors. Bearing this in mind, their findings have been generally reassuring, showing no significant increase in the risk of breast cancer in infertile women treated with fertility drugs compared to infertile women who did not receive such treat-ment.24-27 However, a recent study reported a significant, transient excess of breast cancer in the 12 months following ovulation stimulation for in vitro fertilization compared to the general female population,25 and there remains considerable uncertainty about the effect of fertility drugs on breast cancer risk.

Theoretical Issues

Specifically, substantive behavioral explanations for fertility transition focus on at least one of three elements the nature of fertility decisions, the information and knowledge available to decision makers, and the institutional context for decision making. We first consider high fertility in pre industrial settings. Widespread evidence indicates that the high fertility of many populations coincided with a natural fertility'' regime, one in which potential decision makers did not limit their number of births via changed behavior at higher parities (Henry 1961). There are three possible reasons (1) decision makers were motivated to have as many children as possible, (2) decision makers did not know how to limit fertility, or (3) fertility control was not licit. Important behavioral theories focus on each alternative. The fertility transition's second stage views family size declines as resulting from conscious actions by decision makers, specifically decisions to curtail...

Nonculture Tests for C trachomatis

Recent prevalence studies of C. trachomatis infection in sexually active adolescent girls suggest that testing for C. trachomatis should be offered twice per year to this population (Johnson et al., 2002). A recent cost effectiveness study in women attending family planning clinics revealed that a strategy that combined use of PCR on cervical specimens in women receiving pelvic examinations, and PCR of urine in women with no medical indication for a pelvic examination prevented the most cases of pelvic inflammatory disease and provided the highest cost savings (Howell et al., 1998).

Empirical Findings

As noted earlier, natural fertility results if there are no attempts to control family size. In practice, however, natural fertility is frequently operationalized as involving no contraception or abortion (Henry 1961). Fertility is high in natural fertility populations but how high Females can have children as early as the midteens and can continue until the late 40s. Theoretically, women could have nearly one birth per year. Thus the theoretical maximum fertility, in the absence of all behavioral constraints, could be as high as 35 births On the other end of the natural fertility spectrum lie the Dobe Kung hunter-gathers, residents of the Kalahari Desert in Africa prior to 1975 (Howell 1979, 2000). The reported TFR for this natural fertility population was about 4.5 births per woman. Thus, the question, How can natural fertility populations be so different from each other, and why are even the highest observed rates much lower than the theoretical maximum '' In short, the...

Telomeric Rearrangements

Chromosomal anomalies may be numerical or structural. Structural changes result from the breakage and rearrangement of chromosome parts, and animal experiments have shown that they can be induced by a variety of exposures, including ionizing radiation and certain viral infections and toxic substances. They occur as duplications, deletions, translocations, insertions, or inversions of chromosome parts or as rings on selected chromosomes. Numerical anomalies arise through nondisjunction during meiosis or mitosis, through lagging of chromosomes at anaphase of cell division, or through fertilization by two sperm (i.e., triploidy). Chromosomal anomalies as a whole contribute more to fetal loss than to live births and MR. Kline, Stein, and Susser (1989) estimated that from 8 weeks after the last menstrual period, the proportion of chromosomal aberrations lost by miscarriage exceeds 90 for all but trisomy 21 (DS), XXX, XXY (Klinefelter syndrome), and XYY. In survivors after birth in...

Materials and Methods

This study included 305 women, participants of three studies involving MD, 97 were from a cross-sectional study (21), 7 from an isoflavone intervention study (22), and 201 from a soy intervention study (23). For the latter two studies, baseline mammograms and urine samples were used for the analysis. After the approval of the Committee on Human Studies at the University ofHawaii, all subjects provided informed consent. Women for all three studies were recruited at mammography clinics in Honolulu. Eligible women had no previous history of BC and required a normal mammogram at baseline. The subjects for the intervention studies were free of serious medical conditions, had regular menstrual periods, intact uterus and ovaries, were not on oral contraceptives or other hormones, and had no intention of becoming pregnant within a year. Due to the nature of the nutritional intervention, only women who reported a dietary consumption of< 7 servings of soy food...

Nonhuman Primates as Models for Reproductive Aging and Human Inferti ity

Nonhuman primates are invaluable models for a wide range of basic and applied studies related to human health. In vitro production (IVP) of preimplantation embryos makes them available in significant numbers for embryo manipulations and research aimed at a variety of biomedical applications. Rhesus monkeys (Macaca mulatta) are well established models for many biomedical research studies into diseases affecting humans. Their basic physiology and reproductive endocrinology are very similar to those of humans, and they are relatively easy to breed and manage in captivity. The rhesus monkey exhibits an approximately 28-day menstrual cycle, like that of humans. It is also a long-lived species, living up to 30 years, so that age-related diseases similar to those in humans are likely to appear. In these major respects, rhesus monkeys are a much more appropriate model for humans than rodents or other nonprimates that differ markedly in their susceptibility to human-related diseases and in...

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) represents a spectrum of infections and inflammatory disorders of the uterus, fallopian tubes, and adjacent pelvic structures. PID may include any combination of endometritis, salpingitis, tubo-ovarian abscess, oophoritis, and in its more extreme manifestation, pelvic peritonitis. One out of every 10 women will have at least one episode of PID during her reproductive years. At least one-quarter of women with PID will have major complications, including infertility, ectopic pregnancy, chronic pelvic pain, tubo-ovarian abscesses, and or pelvic adhesions.

Animal Models For Studying Infertilty

It is very difficult to study the etiology of chromosomal or mitochondrial defects in humans, or to relate such deficiencies to developmental outcomes, simply because the principal focus in humans is to help infertile women to become pregnant and have healthy babies. This goal is antithetical to basic research because the latter usually involves destructive analysis of oocytes and embryos. Human oocytes and embryos that are surplus to clinical needs and available for research are scarce, and may not be representative of developmentally competent oocytes and embryos. As a result, it is not surprising that the majority of research on oocyte and embryo function has been done with animal material, usually from rodents although sometimes with suitable domesticated animals, such as cattle and pigs. The problem with this approach, though it is logical, is that gamete physiology and even basic reproductive strategies can vary considerably in different mammals, so that it may be difficult to...

Availability Of Monkeys For Research

In spite of their great value as models for studying mechanisms of infertility in primates, macaque monkeys suffer from one major drawback they are not readily available in substantial numbers for this purpose. This is ironic, because the United States has the largest nonhuman primate research infrastructure in the world, in the form of the eight National Primate Research Centers supported by the NIH. Each of these centers has several thousand nonhuman primates, and rhesus monkeys comprise a large proportion of the total. However, the great demand for this species for AIDS-related research means that few animals are available for other kinds of research, including infertility studies. It may be time to ask if priorities for allocation of monkeys to research studies should be reassessed.

Nonhuman Primates as Models for Developing ART

Because the rhesus monkey is a good model for obtaining information about reproduction in primates, the use of ART procedures in this species might reveal details about preimplantation events, including age-related phenomena, that could be relevant to the problem of IVF failure in older human females. Ovarian stimulation, IVF and embryo culture, collectively known as ''in vitro production'' (IVP) are well-established techniques for a variety of species (Bavister and Boatman, 1993 Bavister, 1995). These ARTs are useful and even commercially viable in domesticated animals, and have long been employed in research with rodents and other species. The success of ART in addressing infertility problems in humans, though not as efficient as it could be, is well known (Olivennes and Frydman, 1998). In contrast, ART has been employed far less frequently or effectively with nonhuman primates, in spite of the huge potential benefits for biomedical and reproductive research. The techniques for...

Aneuploidy Causing Mechanisms

During mitosis will result in mosaicism of varying levels depending upon the embryonic developmental level at which the error occurs. Therefore, if mosaicism is not present, any aneuploidies can be assumed to be due to meiotic nondisjunction. Since reports indicate that there is over 50 aneuploidy and 30 or more mosaicism in human embryos after IVF (Munne et al., 2002), we can expect that both anomalies will also be present in macaques. It is also likely that the frequency of aneuploidy increases with age of the animals. This was not found in the study reported by Schramm et al. (2002), but probably insufficient numbers of oocytes were examined in this study. Both higher numbers of oocytes need to be examined as well as using more animals to assess the true frequency of aneuploidy, and especially the effect of age on aneuploidy frequency needs to be examined more rigorously. Cohorts of oocytes exhibiting high aneuploidy frequencies ought to produce embryos showing poor development,...

Clinical Presentation

Clinical features related to ovarian pathology are often non-specific and, in general with ovarian neoplasia, symptoms occur late in the course of the disease when the tumour has often spread beyond the ovary. Symptoms related to ovarian tumours include swelling or a feeling of fullness in the abdomen or pelvis, the presence of an abdominal mass, irregular uterine bleeding and abdominal or pelvic pain. There may be associated ascites, especially with ovarian malignancies, but also with some benign neoplasms such as fibromas. With ovarian endometriosis, pain and swelling may fluctuate depending on the stage of the menstrual cycle. In younger patients, ovarian pathology may be discovered during the course of investigations for infertility. Ovarian pathology may also be discovered incidentally during abdominal or pelvic imaging or as a result of an

The Special Status of the Human Embryo

Yet even in our own society, where many hold this view in a philosophical sense, it has not been adopted as a matter of cultural practice. For example, the natural loss of an embryo in normal human reproduction is not recognized as a death that requires a funeral, and the disposal of human embryos after completion of infertility treatments is not treated as murder by the legal system. Nonetheless, in the United States in particular, hES cell research is eligible for limited federal funding because the current administration wishes to acknowledge the view of some that the destruction of embryos required to obtain new cell lines gives such lines a moral taint.

Implications Of Mitochondrial Anomalies For

Mitochondrial dysfunction is suggested as a prime cause of low oocyte and embryo quality and hence the low efficiency of human ART on a per-embryo basis. Not surprisingly, attention has been drawn to possible effects of current ARTs on mitochondrial function. The coexistence of different mitochondrial genomes in the same cell is termed mitochondrial heteroplasmy. There is evidence that heteroplasmy in some infants resulted from ''ooplasm transfer,'' a technique involving injection of ooplasm from oocytes from young women into oocytes from older women patients in an effort to improve their developmental competence (Cohen et al., 1998). In this procedure, about 10 of the ooplasm from an oocyte of a presumptively fertile donor was microinjected into a recipient oocyte from an older, infertile patient with presumptively compromised oocyte quality (Cohen et al., 1998). However, this transfer would introduce numerous cytoplasmic components into the recipient oocytes, including proteins and...

Nonneoplastic Conditions

Endometriosis the ovary is the most common site of endometriosis, which is defined as the presence of endometrial tissue, usually both glands and stroma, outside the uterus. Most common in the reproductive age group, but occasionally encountered in postmenopausal women, the symptoms are protean and varied. Patients may present with a palpable abdominal mass, abdominal or pelvic pain, dysmenorrhoea, dyspareunia, irregular uterine bleeding or infertility.

Does He have an Endocrinological Cause to His ED

Androgen and prolactin levels are of particular concern. Hyperprolactinaemia occurs secondary to stress, drugs (such as neuroleptics and infertility treatments), cirrhosis, breast manipulation, or pituitary adenoma tumour. A high level of circulating prolactin causes inhibition of gonadotrophin releasing hormone which lowers levels of testosterone. Men with low testosterone levels may exhibit a decrease in sexual interest. Causes of low testosterone include renal failure, hypogonadism, bilateral cryptorchidism, other hypothalamic-pituitary-gonadal axis

Lymphovascular Supply

Clinical features related to uterine pathology are most commonly those of abnormal uterine bleeding. In premenopausal patients this may take the form of menorrhagia (heavy periods), dysmenorrhoea (painful periods) or a variety of other forms of abnormal uterine bleeding. In postmenopausal patients, the most common symptomatology is postmenopausal bleeding. This should always be taken seriously and uterine malignancy excluded. Other symptomatologies related to uterine pathology include a palpable abdominal or pelvic mass, pain within the pelvis or abdomen (often deep seated), a feeling of fullness within the abdomen and uterine prolapse. Uterine pathology may also be associated with symptoms such as constipation, urinary frequency or infertility.

DNA mismatch repair genes

MMR gene mouse models have been created but inactivation generally results in the development of lymphomas rather than gastrointestinal tumors (reviewed in Wei et al., 2002). Interestingly, the PMS1 mouse model does not display any tumor burden and a number of the other MMR knockouts have meiotic phenotypes resulting in reduced fertility or infertility, highlighting the role of these genes in gametogenesis. These models are helping our understanding of the other functions of MMR genes, which include methylation tolerance and hyper-recombination between divergent sequences (de Wind et al., 1995), a role in the cell-cycle checkpoint mechanisms (Koi et al., 1994) and

Prophylaxis of Venous Thromboembolism

Patients with a previous history of HIT may require an alternative anticoagulant to prevent venous thromboembolism if they require prolonged bed rest and or surgery or become pregnant. UFH cannot be used, particularly during the first 1 or 2 mo after the onset of HIT when HIT antibodies still circulate. Thereafter, although HIT antibodies are usually undetectable, and the risk of recurrent HIT is possibly relatively low (Warkentin and Kelton, 2001), most physicians are understandably reluctant to re-administer heparin in this situation.

Universal Leukoreduction

TRIM was cited as clinically important in patients undergoing renal transplantation and in women who have had multiple miscarriages (29). A multicenter, controlled study found no evidence of such an effect, however, and the authors recommended against allogeneic mononuclear infusions as a treatment for unexplained, recurrent miscarriage

Embryonic Stem Cells And Cloning

Manipulation or alternatively reproductive cloning (discussed later). Culture conditions are developed to induce ES cells to differentiate into functional somatic tissues cells and then transplanted. The technique requires a substantial number of donated eggs from an IVF laboratory and can be technically challenging. Infertile couples seeking to conceive a child by IVF face significant personal expense, and there is a high demand for oocyte donation to other infertile couples attempting to conceive. Thus, with current methodologies, these caveats are likely to limit this approach to the few privileged and capable of affording this technology. As mentioned earlier, although the goal of somatic cell nuclear transplantation is to generate cells, tissues, or organs for transplantation, the success of reproductive cloning in animals (such as Dolly the lamb (Wilmut et al., 1997)) brings new concerns regarding this technology. Prior to the cloning of Dolly, the rules governing stem cell...

Mitochondrial Fate After Scnt

If not actively eliminated, then to what degree might donor cell mitochondria in SCNT embryos be eliminated by attrition, persist at a low level, or assume a replicative advantage over endogenous mitochondria Mitochondrial heteroplasmy was not observed in sheep clones (Evans et al., 1999). In SCNT embryos made with Bos indicus, donor nuclei transferred to Bos taurus oocytes, donor cell mitochondria were nearly undetect-able in cloned fetuses (Hiendler et al., 2003) and calves (Meirelles et al., 2001). However, donor cell mitochondria were not eliminated in monkey-to-rabbit or panda-to-rabbit NT embryos (Chen et al., 2002 Yang et al., 2003). Mitochondrial heteroplasmy was also reported for nuclear transfers made between Holstein and Luxi Yellow cow (Han et al., 2004), and in other studies involving bovine species (Takeda et al., 2003 Steinborn et al., 2002). Embryonic blastomere nuclear transfer in Macaca mullatta produces offspring with mitochondria from both the recipient oocyte and...

Empirical Support Of Relationalcultural Theory

Data from empirical research increasingly supports the power of connection to protect and to heal. The literature on resilience shows that a connection with one adult (parent or teacher) is the single best protection against high-risk behaviors of drinking, violence, depression, and suicide in adolescents (Resnick et al., 1997). Students who felt connected were less likely to use cigarettes, alcohol, or drugs less likely to engage in early sexual activity, violence, or become pregnant and less likely to experience emotional distress. These studies do not point to personality traits or diagnostic categories as the best predictors of outcome they clearly and strongly point to the centrality of connection.

Regulation Of Procurement Of Gametes Somatic Cells And Blastocysts

Whether it involves receiving donated blastocysts that would otherwise be discarded after infertility treatment or procuring gametes and somatic cells to make blastocysts specifically for research purposes, the procurement process often requires oversight by an Institutional Review Board (IRB), whose membership and functions are described in Department of Health and Human Service (DHHS) regulations at 45 CFR 46.107-115 and in FDA regulations at 21 CFR 56.107-115.2 IRB

Decisionanalytic Model Of Genetic Screening

Consider genetic testing in utero (Campbell, 1992). Once the mother becomes aware she is pregnant, typically a range and sequence of tests are made available to her. Some are invasive (maternal blood serum tests, chorionic villus sampling, amniocentesis), and some are not (ultrasound scanning), and there are varying degrees of risk attached to each as well as varying degrees of expense. Assume for simplicity that expense constrains the range of tests available, but that the tests available are free to the mother and not rationed. So the main determinants affecting the choice the mother makes in respect of any given test are the risk attached to the test (e.g., the probability of miscarriage), the desire for the information, and the utility of that information. The latter two determinants are linked but separate, since a mother may not desire information because she will not act on it (if she is against all abortions in principle, for instance), or she may desire it even though she...

Deletion Mapping of AZF Loci on the Y Chromosome

Unique, but the results can be misleading when the sequences are present in multiple copies. Some regions of the Y chromosome are entirely multicopy and difficulties in deletion map interpretation underlie some of the problems discussed below. Individuals with cytogeneti-cally normal Ys and idiopathic infertility were characterized using this approach, and microdeletions were identified in a subset of them however, these did not all overlap (5). An extensive compilation of data from 370 men with azoospermia or oligozoospermia led to a widely held view that three nonoverlapping deletions, designated AZFa, AZFb, and AZFc in the order centromere to Yq telomere, could be defined (6). It was expected that further work would refine the locations of the individual genes within these intervals that were responsible for the spermatogenic failure, using a combination of finer deletion mapping and the subsequent detection of point mutations. Although this expectation has been largely fulfilled...

Early Clues to Yq Complexity

Surveys of infertile patients and controls (either fertile or normozoospermic individuals) provided further examples of deletions that were not associated with azoospermia, either because they were found only in controls, or were transmitted by the fathers of infertile patients. In one large-scale evaluation using 48 STSs and 920 fertile individuals, 11 men (1.2 ) were found to show deletions of single STSs that removed one of four different loci (12). One of these was Amelogenin on Yp, but the other three (sY207, sY269, and sY272) are repeated sequences with copies lying withinAZFb or AZFc, as defined at that time. These four deletions were assumed to represent polymorphisms, but in the same study, deletions of other single STSs (e.g., sY75, sY126) were found only in infertile patients. Are these related to the patient's infertility or not

Regulation Of hEs Cell And Nt Research In Other Countries

There is no international consensus yet on whether and how to pursue hES cell research. For example, in February 2005, a committee of the U.N. General Assembly abandoned attempts to craft a global treaty on NT research and satisfied itself with a plurality vote in favor of a nonbinding resolution calling for a ban on all forms of human cloning or genetics research that are contrary to human dignity, a phrase left to the interpretation of member countries.31 Thus, the regulation of hES cell research varies from country to country. In many cases, there is no law explicitly addressing such research. In some countries, such as Poland and Italy, the research is forbidden or substantially curtailed. In others, however, there seems to be a trend toward liberalization of the laws. France and Germany, for example, have taken steps to permit research on cell lines derived from surplus in vitro fertilization (IVF) blastocysts,32 and Japan33 and Sweden34 have lifted restrictions on making...

Fertility and Aging Men An Introduction to the Male Biological Clock

Data obtained in the past decade suggested a worldwide decline in male fertility. The increase in paternal age is both a personal problem for couples and a public health problem because of the simple fact that male fertility declines with age. Journal articles by Kidd and Ford demonstrate that men over the age of 35 are twice as likely to be infertile as men younger than 25. In addition, a study of couples undergoing fertility treatments found that the amount of time it takes for a man to achieve a pregnancy rises significantly with age. Although increasing maternal age has long been known to be associated with an increased incidence of birth defects, new data show that the age of the male does matter and the genetic quality of sperm does decline with age. Several studies have demonstrated that older men are at higher risk of fathering a child with various genetic diseases such as schizophrenia and Down Syndrome, to name a few. Additionally, there has been an increased risk of...

Deletions Encompassing the AZFb Interval

When overlapping deletions elsewhere in the genome result in similar phenotypes, it is usual to assume that the critical genes underlying the phenotype map to the region of overlap. This viewpoint has not been adopted for the overlapping AZFb AZFc deletions causing male infertility on Yq, probably for historical reasons. The overlap of the deletions contains only members of gene families and not entire families. Is loss of these members primarily responsible for the phenotype, with modifications by flanking genes, or do similar phenotypes arise from the loss of genes in the nonoverlapping regions

Neoplastic Conditions

Intratubular germ cell neoplasia (ITGCN) in situ stage of germ cell neoplasia seen in 90-100 of testes adjacent to germ cell tumours. There is an association with infertility (0.4-1.0 ), cryptorchidism (2-8 of patients) and in the contralateral testis in patients with prior testicular tumour (5 ). Fifty per cent progress to germ cell tumour in five years. Histology shows large seminoma-like cells present along a thickened hyalinised tubular basement membrane. Spermatogenesis is usually absent. There is positive staining with PLAP (97 of cases) and PAS without diastase (glycogen). It can be treated with low-dose radiation but watchful waiting (clinical, ultrasound examination and serum markers) is advocated by some.

Reproductive biology

Ual dimorphism is the result of female preference for larger males, as well as male-male competition. Larger males are able to provide better protection for the females and offspring in their group, minimizing the risk of infanticide. Female gorillas advertise their sexual receptivity through their behavior, rather than with any obvious physical changes. Females invite copulations by closely following a male, staring at him intently, and sometimes stimulating his genitals with their hand or mouth. Gorillas usually limit their sexual activity to the few days in each cycle when a female can become pregnant. Offspring are primarily dependent on the care provided by their mothers, although they may regularly interact with any of the other members of their group, including the dominant male.

Recruiting Donors and Banking hES Cells

The emergence of assisted reproductive technology (ART) more than 20 years ago has enabled many couples to overcome fertility problems. Nationwide, 107,587 ART procedures were performed in 2001 at 385 medical centers in the United States and U.S. territories they resulted in the birth of 40,687 infants from 29,344 pregnancies (Wright et al., 2004). Nationally, 75 percent of ART treatments used fresh, fertilized embryos from the patients' own oocytes 14 percent used thawed embryos from the patients' oocytes 8 percent used fresh, fertilized embryos from donor oocytes and 3 percent used thawed embryos from donor oocytes. Thus, procedures can involve gametes from the couples themselves or from donors. Various ART procedures result in the production of more embryos than are needed. Couples can choose to cryopreserve (freeze) and store these extra embryos for future attempts at establishing pregnancy. Embryos are often cryopreserved in in vitro fertilization (IVF) practices because transfer...

Directions For Future Research

What little research that has been done has focused on the time of the initiation of treatment, at the time of recurrence, or during the terminal phase of the disease.77 All three of the cancer sites reviewed can impact partners of a survivor, but at present there are very few studies on how couples overcome this challenge. In our review, several studies found major changes in sexual functioning even after 5 years after diagnosis. Only few have looked at interventions that can help the couples to deal with this experience.92-94 Men and women treated for Hodgkin's disease as well as younger women treated for breast cancer may have to cope with infertility. More research should be focused on the impact of cancer survivorship on family members. Interventions for family members who are at higher risk for getting cancer should be a priority as well as interventions to improve family resilience for persons at higher risk for poorer outcomes such as families in which...

Knowledge And Rationality

In the case of a test result revealing a certain genetic abnormality, the consequences for a person's freedom seem to be highly ambiguous, however (Quaid, 1994). On the one hand, a person clearly gains certain advantages from this knowledge with regard to life planning and family planning. He or she can adjust plans to the purported health expectations. On the other hand, with genetic knowledge a lot of uncertainties arise it cannot be predicted when the up-to-now asymptomatic person will start suffering from symptoms, how severe these symptoms will be, what the course of the disease in this individual case will look like exactly, etc. The mere knowledge of genetic status often does not lead to any concrete certainty about the future course of life. Difficulties arise in cases in which, by means of a genetic diagnosis, nothing but an elevated risk or a predisposition to a multifactorial condition has been stated. Thus, difficulties in adequately assessing and interpreting the results...

Establishment Of An Institutional Embryonic Stem Cell Research Oversight Committee

To provide oversight of all issues related to derivation and use of hES cell lines and to facilitate education of investigators involved in hES cell research, each institution involved in hES cell research should establish an Embryonic Stem Cell Research Oversight (ESCRO) committee. The committee should include representatives of the public and persons with expertise in developmental biology, stem cell research, molecular biology, assisted reproduction, and ethical and legal issues in hES cell research. It must have suitable scientific, medical, and ethical expertise to conduct its own review and should have the resources needed to coordinate the management of the various other reviews required for a particular protocol. A pre-existing committee could serve the functions of the ESCRO committee provided that it has the recommended expertise and representation to perform the various roles described in this report. For example, an institution might elect to constitute an ESCRO committee...

G Procurement Of Gametes Blastocysts Or Cells For hEs Generation

An IRB, as described in federal regulations at 45 CFR 46.107, should review the procurement of all gametes, blastocysts, or somatic cells for the purpose of generating new hES cell lines, including the procurement of blastocysts in excess of clinical need from infertility clinics, blastocysts made through IVF specifically for research purposes, and oocytes, sperm, and somatic cells donated for development of hES cell lines derived through NT or by parthenogenesis or androgenesis. 3.3. When donor gametes have been used in the IVF process, resulting blastocysts may not be used for research without consent of all gamete donors. 3.5. To facilitate autonomous choice, decisions related to the creation of embryos for infertility treatment should be free of the influence of investigators who propose to derive or use hES cells in research. Whenever it is practicable, the attending physician responsible for the infertility treatment and the investigator deriving or proposing to use hES...

Heres toMour Herbal Health

Exercise caution when trying an herbal formula, especially if it's meant to be taken internally. If you're pregnant, ingesting some herbs may increase the risk of miscarriage. These include comfrey, feverfew, mugwort, southernwood, tansy, and wormwood. If you're pregnant or undergoing medical treatment, consult a physician before trying any herbal formula.

Comparative Studies Evolutionary Origins of NAHR Hotspots

The likely dependence of NAHR rates on levels of sequence similarity between paralogs suggests that monitoring the evolution of this similarity may inform our understanding of the time-depth of NAHR hotspots. One recent study of NAHR between paralogous human endogenous retrovirus (HERV) proviral sequences, flanking the Y-chromosome Azoospermia Factor a (AZFa) locus that when deleted causes male infertility, provided evidence for several hominid-specific gene conversion events that may have rendered the associated hotspots better substrates for chromosomal rearrangements in humans than in either chimpanzees or gorillas (41). Gene conversion generates signatures of concerted evolution in alignments of comparative sequences (see Fig. 3) and in the AZFa-HERVs these signatures are coincident with the location of the NAHR hotspots. If we continue the premutation analogy, homogenizing permutations have occurred on the hominid lineage and become fixed in an ancestral species to modern humans....

The safety of sperm washing

The technique of processing sperm from HIV-positive men prior to the insemination of their HIV-negative partners was first published by Semprini et al. in 1992. The first inseminations with sperm, washed free of HIV, were carried out in Italy and Germany as early as 1989 and 1991, respectively. Up to mid 2003, more than 1,800 couples had been treated in about 4,500 cycles, applying various techniques of assisted reproduction. More than 500 children have been born with no single seroconversion reported in the centers closely following the protocol of washing and testing the sperm prior to assisted reproductive techniques. Most of the European centers that offer assisted reproduction to HIV-discordant couples, are part of the CREATHE-network, which aims to optimize treatment and safety of the methods as well as to compile an extensive database. There are high hopes that soon sufficient clinical cases can be reported to demonstrate the safety and reliability of sperm washing.

Compilation of Recommendations

To provide local oversight of all issues related to derivation and research use of hES cell lines and to facilitate education of investigators involved in hES cell research, all institutions conducting hES cell research should establish an Embryonic Stem Cell Research Oversight (ESCRO) committee. The committee should include representatives of the public and persons with expertise in developmental biology, stem cell research, molecular biology, assisted reproduction, and ethical and legal issues in hES cell research. The ESCRO committee would not substitute for an Institutional Review Board but rather would provide an additional level of review and scrutiny warranted by the complex issues raised by hES cell research. The committee would also serve to review basic hES cell research using preexisting anonymous cell lines that does not require consideration by an Institutional Review Board. To facilitate autonomous choice, decisions related to the production of embryos for infertility...

Modeling Human Disease through Targeted Overexpression

Several clinical studies have shown a correlation between hypersecretion of LH and functional ovarian hyperandrogenism (FOH), infertility, and miscarriage in women (Barnes et al., 1994 Ehrmann et al, 1995 Franks, 1995 Regan et al., 1990 Shoham et al., 1993), suggesting that chronically elevated LH impairs fertility. Unfortunately, no studies show a direct relationship between hypersecreted LH and reproductive abnormalities. Because LH is secreted in regulated pulses (Gibson et al., 1991) and its serum half-life is short (20-30 min Niswender et al., 1974), it is difficult to devise protocols for chronic administration of exogenous LH that mimic endogenous pulse patterns of LH. To circumvent this limitation, the authors devised a transgenic approach where elevated hormone levels are maintained chronically, without requiring multiple injections, supraphysiologic dosing, or appreciable dampening of the hypothalamic-pituitary-gonadal axis. In summary, a transgenic strategy has been...

Glaucoma Medical Therapy In Pregnancy

Although glaucoma is infrequently diagnosed in pregnant patients, occasionally patients with preexisting glaucoma become pregnant. Whenever medications are prescribed for glaucoma, the clinician considers the potential for systemic effects on the patient. In pregnant women, this concern extends to the developing child, as well. One major advantage to the use of topical medications for glaucoma is the reduced systemic absorption and coincident decrease in systemic symptoms. There is little literature demonstrating adverse events of topical medications during pregnancy.1,2

Bloodinjury And Injection Phobia

Only three studies using groups of subjects have been recorded (Ost, Fellenius & Sterner, 1991 Ost, Hellstrom & Kaver, 1992 Ost, Sterner & Fellenius, 1989), all by the same group. They have addressed both the fear of anticipated procedures and fall in blood pressure on exposure to blood. Applied tension enabled the subjects to raise their blood pressure. That, and in vivo exposure, reduced most measures of fear but was not successful in maintaining blood pressure on testing without applied tension. Subjects with comorbid disorders were excluded in all reports. However, impairment was partially addressed in all studies, most notably by Ost, Hellstrom and Kaver (1992) in whose study eight of 35 women allowed themselves to become pregnant and so endure venupunctures because they had overcome their fear of injections. However, the number of subjects who came to accept injections is not clear. This is disappointing given the need to enable some subjects, such as diabetics, to...

Placental Regulation Of Maternal Endocrine Function And Behavior

The placenta, developed from the cell lineage of fetal trophectoderm, exerts considerable influence on maternal endocrine function. Progesterone is the steroid hormone that dominates pregnancy and is necessary to sustain pregnancy. High levels of progesterone during pregnancy are a function of the fetal placenta either directly (primates) or indirectly (rodents) by production of placental hormones that sustain the ovarian corpus luteum. Progesterone has a broad spectrum of effects by acting on many maternal tissues (Keverne, 2006). Notable among these is the brain, particularly the hypothalamus (Fig. 8.1). In the hypothalamic region of the brain, high levels of progesterone exert a negative feedback on the pulsatile release of gonadotropin-releasing hormone (GnRH) preventing ovulatory cycles and curtailing female sexual behavior. The GnRH neurons are not themselves steroid receptive cells but it is thought that negative feedback inhibition occurs via the action of steroids on...

Theoretical Models

Natural Fertility and the Fertility Transition Louis Henry was led to the study of historical populations by his interest in the proximate determinants of natural fertility, i.e., the fertility of married couples that did not attempt to limit the number of their children by resorting to contraception or abortion. He did not invent the term natural fertility, which was commonly used before him to refer to the reproductive regime of high-fertility populations of the past. In early writings, Henry had called them ''non-Malthusian populations'' and qualified their fertility as biological the terms were clearly inappropriate. He took an important step by providing a way of identifying natural fertility in statistical series, i.e., when the fertility of married couples was not a function of the number of children they already had. By comparing successive marriage cohorts of individuals in family reconstitutions, it was possible to distinguish clearly between the behavior of early cohorts...

Research Exemplars

Knodel was initially drawn to the topic of breast-feeding by his concern for explaining differentials in natural fertility before the onset of the secular fertility transition. Bavaria, with its customary avoidance of nursing, had one of the highest fertility rates in Europe as well as very high mortality. Other factors affecting fecundity prior to the advent of birth control are less easy to identify, although there was a clear, and in some villages considerable, rise in fecundability between the mid-18th and the mid-19th century, perhaps as a result of changes in nutrition during that period (Knodel 1988 285-286). This rise makes it more difficult to identify the time of the beginning of the fertility transition because it operates in the opposite direction of the effect of family limitation to maintain relatively stable levels of aggregate marital fertility (as measured for instance by the index Ig). Knodel uses other indexes to date the beginnings of family limitation the...

Survivorship Issues And Hrql

To understand the magnitude of HRQL issues among cancer survivors, we have classified these concepts into discrete domains, however it is understood that they represent a highly interrelated and dynamic system. Adhering to this model of self-reported health, the late effects of cancer can have wide spread ramifications. For example, many of the late physical effects (e.g., pain, fatigue, urinary incontinence, infertility) can also have significant emotional and social consequences. Since those with increasing age also represent a large segment of cancer survivors, it is sometimes difficult to determine whether physical changes are predominantly age or cancer related (e.g., fatigue, decreased libido, weakness). Apart from the observed physical changes, the psychosocial and existential issues acknowledged by survivors

Laboratory Diagnosis For Thrombotic Disorders

The availability of a wide range of assays to evaluate the hypercoagulable state has enhanced the diagnosis of inherited and acquired thrombotic events. However, the assays are expensive and time consuming. These laboratory tests should be considered for patients in whom the test results will impact the choice, intensity, and duration of anticoagulant therapy, family planning, and prognosis.1

Insertion of the Transgene into the Germ Line

In summary, oocytes may be fertilized in vivo or in vitro. In vivo fertilization may be controlled by artificial insemination of a super-ovulated animal at the stage where the oocyte has matured in the ovary. An alternative pathway is to isolate follicular oocytes from the ovary of the donor animal and proceed to in vitro maturation and fertilization prior to microinjection and implantation in the recipient female. In goats, sheep, and cows the rate of transgenic births is 5-10 .

Male Reproductive Effects

Recent evidence indicates that the human male reproductive capacity has deteriorated considerably during the past five decades. In industrialized countries, a substantial number of couples seek in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) because of poor semen quality.

Follicle Stimulating Hormone Luteinizing Hormone

There are a limited number of human studies regarding how V. agnus-castus directly effects luteinizing hormone (LH) or follicle-stimulating hormone (FSH) (26,27). In a 1994 case report by Cahill et al., a 32-year-old woman undergoing unstimulated in vitro fertilization (IVF) treatment took V. agnus-castus for one cycle without consulting her physician. During this cycle, she had symptoms of mild ovarian hyperstimulation in the luteal phase. Her FSH and LH levels prior to day 13, the predicted day of LH surge in the IVF cycle, were reviewed and found to be much higher than normal. Reviewing five other cycles of this patient and finding normal pituitary gonadotrophin file and normal follicular ovarian responses, the authors suggest that V. agnus-castus was the causative agent (27).

Female Reproductive Effects

Manifestations such as subfertility, infertility, intrau-terine growth retardation, spontaneous abortions, malformations, birth defects, postnatal death, learning and behavior deficits, and premature aging. Because it is difficult to obtain detailed information concerning effects on the reproductive system in humans, evidence is usually limited to animal data or studies on fertility and spontaneous abortions. Pregnancy loss is the endpoint most frequently used to monitor effects on female reproductive function, starting from early losses, which contain a large proportion of chromosomal abnormalities and may represent 35-40 of human pregnancies. The remaining 10-15 later abortions are clinically manifest, and some have been linked to environmental factors (Miller et al, 1980 Runnebaum et al., 1997). Thus, there seems to be a remarkably high background rate of fetal loss in humans. Knowledge about pathogenetic mechanisms of female reproductive damage is limited. Effects may be direct,...

Side Effects Of Hormonal Therapy Similarities And Differences

Hormonal therapy for prostate cancer eventually produces decreases in libido and potency in virtually all patients regardless of the modality used.34,124 Additional side effects include lethargy, depression, anorexia, breast swelling with or without tenderness, hot flashes, anemia, and osteoporosis with potential for pathological fracture.14,125-130 Most side effects, including impotence and infertility, are slowly reversible with cessation of therapy. However, reduced bone mineral density often does not reverse after prolonged hormonal suppression. There is a consensus that irreversible changes occur more often after suppression of longer than 18-24 months.

Effects On Fertility

The issue of fertility in the patient with testicular cancer is a complex topic. Patients with testicular cancer often have testicular dysfunction and infertility prior to the diagnosis of the tumor and before the commencement of any therapy. Some (but not all) patients have persistent dysfunction after the completion of treatment. The variables to be considered when discussing this issue are baseline (pretreat-ment) semen characteristics, exposure to chemotherapy, the type and amount of chemotherapy, and the availability of experienced surgeons to perform a nerve-sparing retroperitoneal lymph node dissection (when feasible), to preserve ejaculation. It must also be realized that oligospermia does not translate into absolute infertility. In one study, 8 of the 30 patients who received chemotherapy were able to father children, and 3 of the 13 patients with oligospermia caused conception there was no difference in sperm motility, count, or concentration between those who fathered a...

Patterns Of Occurrence

Germ Cell Testicular Cancer

In recent decades, remarkable advances in treatment have led to dramatically improved survival of testicular cancer patients in the industrialized world. In the United States, the improvement has been greatest among white persons, and survival is associated with socioeconomic status in many areas.314'20,21 However, it is now evident that survivors are at an elevated risk of several undesirable sequelae, including infertility,22 23 sexual dysfunction,24 other types of cancer,25 26 and second occurrences of testicular cancer.26-35 (See also Chapters 27 and 28.)

Superovulation Of Rhesus Monkeys And Flushing Embryos From The Reproductive Tract

The term superovulation is used liberally in human clinical IVF, but in that context it implies ovarian stimulation with gonadotropins to recruit large numbers of follicles, which are then aspirated prior to ovulation to recover oocytes. In animal studies, superovulation usually means allowing or inducing gonadotropin-stimulated follicles to ovulate into the oviduct, followed by collection from the reproductive tract of oocytes for IVF or of embryos for further study in vitro. The U.S. cattle breeding industry has been transformed by the application of artificial insemination together with ''Multiple Ovulation and Embryo Transfer'' (MOET Gearhart et al., 1989), which results in the collection of perhaps 10-20 high-quality embryos for transfer to recipient females. Collection of flushed embryos from non-stimulated rhesus monkey females is feasible, as shown by years of effort at the Wisconsin National Primate Research Center (Wolfgang et al., 2001). While these embryos are enormously...

Payment for Medicaid Services

States may impose nominal deductibles, coinsurance, or copayments on some Medicaid beneficiaries for certain services. The following Medicaid beneficiaries, however, must be excluded from cost sharing pregnant women, children under age 18, and hospital or nursing home patients who are expected to contribute most of their income to institutional care. In addition, all Medicaid beneficiaries must be exempt from copayments for emergency services and family planning services.

Pregnancy Nutrition

Pregnancy Nutrition

Are You Expecting? Find Out Everything You Need to Know About Pregnancy and Nutrition Without Having to Buy a Dictionary. This book is among the first books to be written with the expertise of a medical expert and from the viewpoint of the average, everyday, ordinary,

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