Treatments For Fertility

Pregnancy Miracle System

The Pregnancy Miracle book details a highly unique program for treating infertility using traditional Chinese medicine and holistic methods. The author, Lisa Olson, offers easy-to-follow techniques and remedies involving diet, herbs and acupressure to improve your overall health and well-being, strengthen the organs and systems vital to reproduction, heal specific conditions that may affect fertility and even support reproductive methods such as IVF and hormone therapy. Pregnancy Miracle comes in 279-pages guide which cover how to permanently remove your infertility as well as your partners infertility by using holistic and ancient Chinese treatment. It is the most powerful anti-infertility system ever developed and it is one of the best-selling guides ever exist on the internet. The Pregnancy Miracle book is by far one of the most comprehensive, friendly, accurate and easiest-to-follow guides I've ever seen. The customer support from Lisa Olson and the Pregnancy Miracle team is very good and all my support tickets were responded in about 6-8 hours. Continue reading...

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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. 3. Ovulation on a specified dosage of CC should be confirmed with a midluteal phase serum progesterone assay, BBT rise, pelvic ultrasonography, or urinary ovulation-predictor kits. In the event ovulation does not occur with a specified dose of CC, the dose can be increased by 50 mg day in a subsequent cycle. The maximum dose of CC should not exceed 250 mg day. The addition of dexamethasone is advocated for women with elevated dehydroepiandrosterone sulfate levels who remain anovulatory despite high doses of CC. The incidence of multiple gestations with CC is 5 to 10 . Approximately 33 of patients will become pregnant within five cycles of...

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.

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.

Reproductive Medicine

Reproductive medicine encompasses all aspects of fertility including birth control and the reproductive results of aging of the reproductive organs. The utility of drugs for use as birth control agents and in the treatment of postmenopausal disorders like endometriosis is an underesearched area. Birth control involves the use of practices, devices, and drug treatments to reduce the possibility of becoming pregnant and involves the use of both devices and drugs that act as contraceptives. These can be divided into agents that prevent (1) fertilization and (2) implantation of the embryo after fertilization occurs. The latter agents are also characterized as abortifacients. Birth control, while somewhat less controversial than abortion, is a controversial issue both politically and ethically. Devices that prevent conception as an alternative to abstinence, e.g. male and female condoms, female diaphragms, and sponges, date back to the dawn of history, but were only formally approved by...

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 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. E. Male factor infertility includes conditions that affect sperm production, sperm maturation, and sperm delivery. Intrauterine insemination is frequently used to treat men with impaired semen parameters.

Infertility

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.

Discharge And Home Healthcare Guidelines

Spontaneous abortion (SAB) is defined as the termination of pregnancy from natural causes before the fetus is viable. Viability is defined as 20 to 24 weeks' gestation or a fetal weight of more than 500 g. SABs are a common occurrence in human reproduction, occurring in approximately 15 to 22 of all pregnancies. If the abortion occurs very early in the gestational period, the ovum detaches and stimulates uterine contractions that result in its expulsion. Hemorrhage into the decidua basalis, followed by necrosis of tissue adjacent to the bleeding, usually accompanies the abortion. If the abortion occurs later in the gestation, maceration of the fetus occurs the skull bones collapse, the abdomen distends with blood-stained fluid, and the internal organs degenerate. In addition, if the amniotic fluid is absorbed, the fetus becomes compressed and desiccated.

How To Use Delmars Dental Drug Reference

Finally, when taking the dental history, emphasis should be placed on the client's ability to read and to follow directions. Clients with language barriers should be identified, and appropriate written translations should be provided. In addition, client life-style, cultural factors, and income as well as the availability of health insurance and transportation are important factors that may affect adherence with therapy and followup care. The potential for a client being becoming pregnant, and whether a mother is breast feeding her infant should be included in assessments. The age and orientation level, whether learned from personal observation or from discussion with close friends or family members, can be critical in determining potential relationships between drug therapy and or drug interactions. Including these factors in the dental health assessment will assist all on the dental care team to determine the type of therapy and drug delivery system best suited to a particular...

Derivation and Cultivation of Human ES Cells

Human ES cell lines have generally been derived from 6- or 7-day-old, preimplan-tation human blastocysts by isolation of the inner cell mass and culturing on a feeder layer of fibroblasts Thomson et al., 1998 Reubinoff et al., 2000 Park et al., 2003 Amit et al., 2003 Mitalipova et al., 2003 Cowan et al., 2004 Fang et al., 2005 Genbacev et al., 2005 , although there is at least one report of successful hES derivation using embryos cultured for up to 8 days Stojkovic et al., 2004 . In most cases, embryos have been obtained by donation from couples undergoing routine in vitro fertilization, although human ES cell lines have also been derived from embryos specifically created for this purpose Lanzendorf et al., 2001 . In addition, pluripotent ES cell lines have been generated from human primordial germ cells obtained from first-trimester elective terminations Shamblott et al., 1998 Turnpenny et al., 2003 , but in most cases these cells have been shown to lose pluripotency gradually within...

Management of Graves Hyperthyroidism

There is a good case for a preconception clinic for patients with Graves' hyperthyroidism who wish to become pregnant. Firstly, education about the effects of the disease on maternal health and fetal well-being can be given to allay fears which are commonly present in these women. The patient's thyroid status should be checked frequently to minimise risk of miscarriage should she be hyperthyroid at the time of conception. If treatment had been commenced with methimazole or carbimazole a change to propylthiouracil (PTU) is recommended to reduce the admittedly rare occurrence of aplasia cutis 35 and the equally rare methimazole embryopathy 36 reported following the administration of the former drugs. The patient may have been rendered euthyroid by partial thyroidectomy or radioiodine therapy. However, if these procedures are performed the patient may require thyroxine therapy (with a requirement for an increase in dose and monitoring during gestation) in addition, there is still a small...

Community Development

The attempt to organize and stimulate local initiative and leadership in a community to encourage change. The emphasis in community development is on local, self-determined efforts. Community development is process-oriented and emphasizes the development of skills and abilities conducive to social and health improvement. Community development ideas have been used by health educators in many countries in the world to improve health, family planning, childhood nutrition, and agriculture. See Community Organization.

Blepharophimosis Syndrome

Blepharophimosis Ptosis Epicanthus

INTRODUCTION This is a group of related congenital eyelid deformities with a strong autosomal dominant hereditary etiology although sporadic cases also occur. Blepharophimosis refers to a horizontal narrowing of the palpebral fissure, and the syndrome (known as BPES) is characterized by blepharophimosis, ptosis, and epicanthus inversus. Depending upon the presence (type I) or absence (type II) of premature ovarian failure, two clinical forms have been described. Both forms have been mapped to chromosome 3q23 and are due to mutations of a forkhead

Animals and Production of Embryos

Eggs of Ambystoma mexicanum (axolotl) are inseminated as they pass through the cloaca of the female. (After a ritual courtship, she picks up sperm packets spermato-phores fastened to the substrate e.g., rocks by a male.) Fertilized eggs are usually obtained by natural spawnings in the laboratory. Artificial insemination is also possible (6), but rather difficult when compared with the Xenopus artificial insemination procedure. To obtain natural axolotl spawnings, a male is placed together with a female in the mating container (e.g., plastic dishpan lined with pebbles) and left in the dark. Enhanced spawning frequencies can be obtained by injecting a female intramuscularly with 250 IU of human chorionic gonadotropin (6). The male is removed the next day after spermatophores have been deposited on the pebbles. The container with the female is then returned to the dark. The female usually starts to shed fertilized eggs about 24 h after she has picked up spermatophores. Staging series...

Equipment and Instruments

Obtaining eggs. (A) Obtaining Cynops fertilized eggs Cynops females, which have already received spermatophore from males, are induced for oviposition by the injection of human chorionic gonadotropin (HCG) into the body cavity. After two or three injections of 100 IU of HCG at 1-d intervals, females continue laying fertilized eggs for a week. 1) Female, 2) fertilized egg adhering to a polyethylene tape (10 x 200 mm), and 3) polypropylene case (100 x 70 x 40 mm). (B) Obtaining Xenopus fertilized eggs Fertilized eggs are obtained by the injection of HCG into the dorsal lymph sacs of male and female (600 IU each). 1) Male, 2) female, 3) fertilized egg adhering to the bottom of container, and 4) polypropylene container (530 x 350 x 120 mm). (C) HCG-induced ovulation of Xenopus female Eggs for artificial insemination can be obtained by the injection of 600 IU of HCG into the dorsal lymph sac. After 12 h (depending on the temperature), the female will lay eggs with her cloaca tinged...

Tracking and Programming Early Hematopoietic Cells in Xenopus Embryos

The Xenopus embryo is an ideal system for experiments designed to follow early precursor cell populations during developmental time. The embryos are large (1 mm in diameter) and thus are easily visualized and manipulated at low magnification. They are laid externally in large numbers and are therefore accessible from the earliest times of development. In vitro fertilization allows for the synchronous development of embryos at experimentally suitable times. The speed of development is dependent on temperature and thus can be manipulated to suit experimental needs or design. The first six cleavage divisions are easy to follow under the microscope because they occur

Normal serum prolactin and FSH concentrations with history of uterine instrumentation preceding amenorrhea

Oral conjugated estrogens (0.625 to 2.5 mg daily for 35 days) with medroxyprogesterone added (10 mg daily for days 26 to 35) failure to bleed upon cessation of this therapy strongly suggests endometrial scarring. In this situation, a hysterosalpingogram or hysteroscopy can confirm the diagnosis of Asherman syndrome.

Risk Of Maternal Infection During Pregnancy

Most adults born in the continental United States are immune to varicella, even if they believe themselves to be susceptible. Individuals born in countries with tropical climates, however, are often susceptible to varicella, particularly if they moved into an area with a temperate climate as an adult (8). Therefore, it is likely that women who were born in the Caribbean, the Philippines, or Southeast Asia are likely to be varicella susceptible if they have no history of the illness. Ideally, such young women should have antibody testing before they become pregnant so that they can be immunized before pregnancy.

Premenopausal women

Endometrial hyperplasia with atypia on endometrial biopsy is further evaluated by hysteroscopy with dilatation and curet-tage. If the diagnosis remains unchanged (eg, no coexistent adenocarcinoma), treatment with continuous oral megestrol 40 mg two to four times per day is initiated. Hysterectomy is an alternative for women who are not planning future pregnancy.

Labeling Cytoplasmic Constituents

Fluorescently labeled actin Approximately 20 nL of fluorescent (rhodamine) nonmuscle actin was injected into the center of manually defolliculated, meiotically immature oocytes. To do this, the tip of the microinjection needle was inserted in the animal hemisphere, typically midway between the animal pole and the equator, and brought to rest just beneath the nucleus (see Note 3). After 8-10 h, oocytes were matured by adding 1 L progesterone solution to the oocytes in Barth's medium and overnight incubation at 16-17 C. The next morning, oocytes were examined for the appearance of the white spot at the apex of the animal pole, signifying germinal vesicle breakdown. Several hours after the appearance of the white spot, the oocytes were placed in viewing dishes (described in Subheading 3.3.), then pricked in the animal hemisphere with a finely drawn glass needle (gravity-drawn and hand-tapered Drummond microcapillary tubes, Drummond Scientific, Broomall, PA) held in a micromanipulator....

Gender Ethnicracial And Life Span Considerations

Elicit a complete history of the woman's menstrual, obstetric, sexual, and contraceptive practices. Endometriosis is difficult to diagnose because some of its symptoms are also manifestations of other pelvic conditions, such as pelvic inflammation, ovarian cysts, and ovarian cancers. A thorough description of the patient's symptoms becomes important, therefore, in the early diagnosis of the condition. Symptoms of endometriosis vary with the location of the ectopic tissue. Some women may even be asymptomatic during the entire course of the disease. The classic triad of symptoms of endometriosis are dysmenorrhea, dyspareunia, and infertility. The symptoms may also change over time. The major symptom is dysmenorrhea (pain associated with menses) that is different from the normal uterine cramping during the woman's menstrual cycle. This cramping has been referred to as a deep-seated aching, pressing, or grinding in the lower abdomen, vagina, posterior pelvis, and or back. It...

Multiple Sclerosis

IVIg or PE is indicated as a second-line therapy for treating severe disabling relapses, when first-line therapies are not effective, tolerated, or appropriate (e.g., women contemplating becoming pregnant). Mitoxantrone is a second-line therapy for patients with worsening MS despite first-line treatment, or for those with inflammatory episodes not responsive to corticosteroids, IVIg, or PE.

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.

Wanting Them To Be Safe And Healthy

One of these parents, Ann, grew up in Hawaii. She became pregnant at fifteen but was able to stay in school because the teen pregnancy rate at my high school was high enough that they had a program to support teen parents and their children. Not long after giving birth to her son, Bane, Ann's own mother left the islands and Ann decided to move in with Bane's father and his family. This Filipino family was large and extended, and few of the members spoke English. Feeling isolated, Ann wrote to her mother pleading for a plane ticket to the mainland. Although Ann imagined she would someday return to Hawaii and marry Bane's father, things didn't work out that way.

Primary Nursing Diagnosis

Teaching Safe sex Medication management Fertility preservation Treatment of gonorrhea is primarily pharmacologic, with antibiotic regimens. The Centers for Disease Control and Prevention (CDC) recommends that treatment for gonorrhea include concomitant therapy for chlamydia, because it is found in 20 to 40 of all patients with gonorrhea. Both partners should be treated at the same time and instructed to avoid sexual activity until negative cultures are obtained. If the male partner is symptomatic, the female should be treated even before culture results are obtained to prevent infertility. If a woman has an intrauter-ine device (IUD) in place, it may be removed.

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.

Counseling Of Pregnant Women

A discussion of risk factors is warranted with all pregnant women, especially those who are around children. Preconceptional counseling of these women should include discussion about the fetal risk of parvovirus B19 infection during pregnancy. Some women may choose to get tested for parvovirus B19 prior to getting pregnant, and serology would be the recommended test in these women. The presence of immunoglobulin (Ig) G antibody to parvovirus indicates that a woman is not at risk for parvovirus B19 infection. Currently, exclusion of pregnant women from the workplace (and other high-risk groups) during an outbreak of parvovirus B19 is not recommended. Women at greatest risk are those who work in the health care industry (especially with children), teachers, day care center workers, and mothers with an infected child in the household (12,32).

Sperm Chromatin Structure Assay for Fertility Assessment

Animal and human fertility clinics typically assess semen quality by measuring sperm density, total count, motility, and morphology. Clinics rarely measure sperm DNA integrity, perhaps because they are unaware of the availability of, or lack the instrumentation for, a rapid, reliable, and practical test. The sperm chromatin structure assay (SCSA see Basic Protocol) is one such test whose importance is becoming increasingly recognized. Whereas light microscope measurements are commonly made on 100 to 200 sperm per sample, the SCSA can utilize a fresh (or frozen-thawed) semen sample and collect data on 5000 or more cells in just a few minutes. Figure 7.13.1 shows two examples of a SCSA clinical report that can be generated and sent to a clinician by FAX or e-mail within 15 to 30 min of measurement.

Background Information

In recent years the sperm chromatin structure assay (SCSA) has been presented by various symposium speakers at fertility and toxicology congresses as a promising assay for use in animal and human reproductive clinics. The recent advent of the intracytoplasmic sperm injection (ICSI) procedure for human fertilization has focused increased attention on the quality of the paternal genome (Evenson, 1997, 1999a). ICSI bypasses virtually all Mother Nature's checks for insuring that a high-quality sperm reaches the oocyte in vivo. With ICSI, an individual sperm with the best looking morphology and motility, as seen and judged by a technician using light microscopy, is picked up with a micromanipulator and injected into an oocyte. If fertilization occurs, the ICSI procedure is considered successful. However, the only real consideration for success by the paternal contribution should be whether or not the integrity of the paternal genome is sufficient for proper embryo development, resulting in...

Effects of Estrogen on Endothelial Function

The onset of menopause provides a natural model of estrogen deprivation in which the effects of the endogenous hormone on vascular function can be evaluated. In studies of changes in branchial artery diameter after reactive hyperemia, responses were greater in premenopausal than in postmenopausal women (31). Importantly, blood-flow responses to the NO donor glyceryl trinitrate (GTN) were similar in the two groups, indicating comparable vascular smooth muscle responses to NO. The responses in postmenopausal women were comparable to those observed in men (31). In agreement with these findings, sex hormone deprivation after ovariectomy or premature ovarian failure, is associated with a decline in endothelial-dependent vasodilation, whereas the response to GTN is unaltered (32,33). Another natural model of changes in estrogen levels is the menstrual cycle. In young women, endothelium-dependent vasodilation in the branchial artery paralleled serum estradiol levels, and furthermore, there...

Current And Future Developmental Toxicity Protocols Fertility Studies

Rhesus and cynomolgus macaques have served as test animals in studies of female and male reproductive toxicity of biologics and pharmaceuticals (Henck et al. 1996). The focus here will be on female fertility. As noted above, both macaque species closely resemble the human female in menstrual cycle length and other aspects of reproductive biology and endocrinology. Monitoring hormonal profiles is particularly important in evaluating reproductive toxicity. The hormones commonly monitored include serum progesterone, 17-beta-estradiol, and their urinary metabolites. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) may also be monitored in specific studies. Although all of these hormones may be informative in detecting potential toxicity, progesterone provides the most critical information regarding alterations in the cycle and in the ovulatory process. For example, progesterone values below 2 ng ml in the luteal phase are indicative of anovulation, and an abbreviated...

Infancy And Childhood

During early infancy and childhood human hepatic mHMG-CoA synthase expression appears to remain at levels similar to those at term, suggesting that the potential capacity for its use is maintained despite a relatively slower maturation rate over a period when there might be more flexible nutritional conditions than in the rat. Ketogenesis in human infants is extremely important particularly during the initial neonatal period and for meeting energy shortfalls during periods of metabolic stress later during infancy and childhood.

Iiifigo staging systems

Based upon FIGO guidelines, the following examinations are appropriate to establish the stage of disease palpation and inspection of the primary tumor, palpation of groin and supraclavicular lymph nodes, colposcopy, endocervical curettage, conization, hysteroscopy, cystoscopy, proctoscopy, intravenous pyelogram (IVP), and radiographic examination of the lungs and skeleton.

Stat5a 5b Crystallization

Gcsf Bcl2 Caspase

-> - Infertility High levels of VEGFare also involved in pathologic angiogenesis and are responsible for several gynecological disorders, such as endometriosis, dysfunctional uterine bleeding, endometrial hyperplasia, and polycystic syndrome, which is known to be a leading cause of infertility.121-123 Antiangiogenic compounds are under investigation in order to provide novel therapeutic approaches for such diseases.124'125 expression in males Female infertility Both STAT5a and STAT5b are known to become activated by a large number of cytokines. Among these, numerous interleukins (IL2, IL3, IL4, IL5, IL7, IL9, IL15, and IL21) implicate STAT5 signaling. Additionally, erythropoietin, GH, prolactin, and growth factor signaling (EGF, PDGF, granulocyte-macrophage colony-stimulating factor (GM-CSF)) display an action on STAT5 activation. First studies with STAT5 knockout mice showed that the deletion of STAT5a leads to deficient prolactin-dependent mammary gland development and...

Effects of Hyperthyroidism on Mother and Child

Several reviews of this subject are available 27-29 . Maternal complications of hyperthyroidism include miscarriage, placenta abruptio and preterm delivery. Congestive heart failure and thyroid storm may also occur and the risk of pre-eclampsia is significantly higher in women with poorly controlled hyperthyroidism and low birth weight may be up to nine times as common. Neonatal hyperthyroidism, prematurity and intra-uterine growth retardation may be observed. A retrospective review documented a 5.6 incidence of fetal death or stillbirth in 249 pregnancies from hyperthyroid mothers and a further 5 fetal and neonatal abnormalities. Women with thyroid hormone resistance who, despite being euthyroid, had high levels of circulating T4 had a significantly increased miscarriage rate compared to euthyroid unaffected couples 30 . However, a recent study of women with subclinical hyperthyroidism, comprising 1.7 of women, showed no significant adverse pregnancy outcomes suggesting that...

Directions for the Future

The discovery of the genetic cause of Pendred syndrome opened up new opportunities in the study of thyroid, ear and kidney physiology. The next challenge is to translate these findings into clinically relevant interventions. Genetic testing can identify carriers in high-risk populations, and this information can then be used for genetic counseling and family planning. The thyroid disease per se does not cause overwhelming disability however, early, complete thyroid

Relationship to Insulin Resistance and Diabetes

Although the exact mechanisms that lead to the development of PCOS are not clear it has been shown that insulin resistance and compensatory hyperinsulinemia possess the central role in the pathophysiology of the syndrome. Women with PCOS have both basal and glucose-stimulated hyperinsulinemia compared with weight-matched women and the high levels of insulin are thought to mediate the development of hyperandrogenemia, anovulation, and infertility. At the same time, insulin resistance and compensatory hyperinsulinemia are responsible for the cardiovascular risk factors. The hyperinsulin-ism correlates with the hyperandrogenism and occurs independent of obesity (180,181).

The Uterus Benign Conditions Leiomyoma

Leiomyomas may be located intramurally (most common), submucosally or subserosally. They tend to be well-demarcated and may undergo some degree of degeneration (e.g., hyaline, cystic, fatty or carneous). Calcification is common in leiomyomas of older women. Rare complications include infection, torsion and sarco-matous degeneration (< 1 ). Symptoms associated with leiomyomas include menorrhagia, dysmenorrhea, infertility (especially submucosal leiomyomas that may impede the implantation of fertilized ova) and bulk-related symptoms (mass effect on the bladder or bowel). The incidence of congenital uterine anomalies among women of reproductive age ranges from 0.1-0.5 . The clinical significance of such anomalies is an increased likelihood of infertility, pregnancy wastage (e.g., recurrent miscarriage, premature labor, intrauterine growth retardation) and menstrual disorders.

Subjective Physical Health and Health Related Behavior

A number of studies report on changes in reproductive behavior. Rachmatulin et al. 21 reported a 240 increase in induced abortions in factory workers in an area partly contaminated by fall-out from Chornobyl. Bertollini et al. 22 reported a reduction of births in Italy 9-12 months after the Chornobyl disaster, followed by a catch-up increase in the ensuing months. In some Italian regions, there was an increase of induced abortions in the first 3 months following the disaster. Lower pregnancy rates and a rise in the number of induced abortions in the year following the disaster were observed in the Scandinavian countries 23-25 . Although a direct link between these changes in reproduction behaviors and the accident remains speculative, Knudsen 23 concluded, on the basis of these data, that the fear of radiation from this disaster probably caused more fetal deaths than the released radioactivity itself.

Autoimmune Ovarian Disease Induced by Immunization with Zona Pellucida ZP3 Peptide

Autoimmune ovarian disease is a known cause of human premature ovarian failure. In 1991, an experimental murine model was developed by immunization with a peptide of ZP3, an ovary-specific glycoprotein (Rhim et al., 1992). ZP3, the primary sperm receptor of the zona pellucida (ZP) that surrounds all growing ovarian and ovulated oocytes, is also present in the ovarian atretic follicles (Dean, 1992). Mice injected with the ZP3 peptide ZP3(330-342) , in complete Freund's adjuvant (CFA) or incomplete Freund's adjuvant (IFA), develop histological evidence of ovarian inflammation (oophoritis), as well as antibody to the zona pellucida and T cell responses to the peptide. The ovarian pathology is transferable to normal syngeneic recipients by ZP3-specific CD4+ T cells that produce IL-2 and interferon y but not IL-4 or IL-5.

Genetic Disease Models

Defects in primary testicular function are also summarized in Table 2. The causes range from congenital and chromosomal to acquired. There are also disorders of testosterone synthesis, metabolism, and action. Androgen-resistant syndromes range from complete androgen resistance to male infertility.

Fetal Thyroid Development and Function

Fertility is impaired in hypothyroid women with autoimmune thyroid disease and if such patients do achieve pregnancy the hypothyroid state is associated with a higher incidence of miscarriage early in pregnancy reviewed in 14 . Thyroid autoimmunity, as evidenced by the presence of anti-thyroid antibodies, present during early pregnancy even in the euthyroid situation, is associated with an increased risk of subsequent miscarriage 25 . Thyroid autoantibody positive women miscarry at a rate of between 13 and 22 compared to 3.3-8.4 in control euthyroid antibody negative women 14 . While the association between thyroid antibodies and miscarriage is strong that between these antibodies and recurrent abortion is less so. In the euthyroid woman with thyroid antibodies no specific treatment can be offered to reduce the antibody titres one uncontrolled study in euthyroid thyroid antibody positive women with recurrent abortion reported a significant success rate with thyroxine administration 26...

Incisional Tubal Interruption

PID can be a life-threatening and life-altering condition. Complications of PID include pelvic (or generalized) peritonitis and abscess formations, with possible obstruction of the fallopian tubes. Obstructed fallopian tubes can cause infertility or an ectopic pregnancy. Other complications of PID are bacteremia with septic shock, thrombophlebitis with the possibility of an embolus, chronic abdominal pain, and pelvic adhesions.

Timing And Routes Of Transmission

There are two major ways that TB infection in the mother can lead to infection of the fetus in utero. If dissemination of organisms through the blood and lymphatic channels occurs during pregnancy, the placenta may be infected directly. This can occur as part of an asymptomatic dissemination that accompanies the mother's initial infection or can be a complication of pulmonary or disseminated TB disease in the mother. Infection with M. tuberculosis that occurs during pregnancy, as opposed to dormant infection that occurred prior to pregnancy, poses a greater risk to the fetus. The second mechanism by which a fetus can be infected with M. tuberculosis is directly from established genitourinary TB in the mother. Genital TB is most likely to start around menarche and can have a long and relatively asymptomatic course. The fallopian tubes are most often affected, followed by the uterus, ovaries, and cervix (2). Sterility is a common complaint with genitourinary TB, explaining one reason...

Congenital Anomalies of the Uterus

Uterus Unicornu

Congenital malformations of the uterus, also termed Mullerian duct anomalies (MDA), are a relatively uncommon, but often treatable, cause of infertility. The incidence of congenital MDA among women of reproductive age is estimated to be up to 0.5 . However, since normal pregnancies can occur in women with MDA and the anomalies are discovered in most cases in patients presenting with infertility, the reported prevalence of MDA in the general population is probably underestimated. Uterine malformations can be associated with subfertility, pregnancy wastage, and menstrual disorders. Congenital malformations of other organ systems may be present - most frequently renal malformations like renal agenesis or ectopia - whereas bony malformations, such as fusion of the vertebral column, are less commonly seen. Whereas transvaginal ultrasound and hysterosalpingography are the primary imaging modalities, MRI is currently used as a problem-solving modality in inconclusive cases, e.g., in the...

Diethylstilbestrol And Steroid Hormones

The use of diethylstilbestrol (DES) from the 1940s to the 1970s to prevent threatened miscarriage in pregnant women was found to cause development of genital tract anomalies and neoplasia in a number of adult women exposed in utero (Ways et al. 1987). Several lines of evidence also indicate a link between DES exposure and alterations in the development of the immune system. Perinatal DES exposure in mice results in a long-term impairment of both cell-mediated and humoral-mediated immunity (Ways et al. 1987). Postnatal immunosuppression following pre- and or perinatal DES exposure includes altered T- and B-lymphocyte mitogen responsiveness, graft-vs.-host reaction, delayed hypersensitivity, NK cell activity, and antibody production (Ways et al. 1987 Luster et al. 1979 Kalland and Forsberg 1981 Ways et al. 1980). The consequences of immunosuppression in rodents resulting from DES exposure during development include increased susceptibility to virally induced mammary tumors and to...

The Disappearance of a Distinction

This suggestion fails to coincide with important intuitions expressed in the natural state model. First of all, let us ask the question What is the range of environments relative to which the fittest environment is to be understood Shall we think of the natural state as that which obtains when the environment is the fittest of all possible environments If so, the stud bull, injected with medications, its reproductive capacities boosted to phenomenal rates by an efficient artificial insemination program, has achieved its natural state. And in similar fashion, the kind of environment that biologists use to characterize the intrinsic rate of increase (r) of a population one in which there is no disease, no predation, no limitations of space or food supplies will likewise count as the natural environment. But these optimal environments are not natural, the natural state model tells us. They involve ''artificially boosting'' the fitness of resulting phenotypes by placing the genotypes in...

International Planned Parenthood Federation IPPF

IPPF is a nongovernmental, independent association that works to initiate and support family planning services, develop resources, and stimulate research. IPPF currently links national autonomous Family Planning Associations in over 180 countries globally and is committed to promoting the right and freedom of women to decide on the number and spacing of their children. The federation provides several publications, including a bimonthly medical bulletin.

The TH2Bias of the Neonatal Immune System

Before the fetus has even a rudimentary immune system, the maternal immune response has had to adapt to permit development of a child whose paternal antigens are cause for immune rejection. Evidence exists in both murine and human studies that during pregnancy, TH2 immune responses dominate in the mother, reducing TH1 type reactions that would presumably mediate rejection of the fetus (reviewed in Donovan and Finn 1999 Warner and Warner 2000). In support of this idea, Sills and coworkers demonstrated a relationship between the TH1-associated cytokine TNF and infertility. In that report, chronic therapy for infertility using biologic agents to block TNF was associated with successful induction of ovulation, conception, and normal delivery (Sills et al. 2001). Pregnant women have been shown to have compromised cell-mediated immunity (Weinberg 1984), impaired lymphocyte proliferation (Matthiesen et al. 1996), and a loss of peripheral blood mononuclear cell proliferative responses to...

Genetics Epigenetics and Asthma

Lastly, if the forces influencing susceptibility to asthma are visualized as components of a Venn diagram, factors such as environment and molecular dys-regulation should not be solely supplemented by genetics per se. In light of information from recent reports, balancing an equation that fully integrates factors determining disease risk should include epigenetic factors (Figure 14.11). Defined as changes having no effect on the sequence of molecules that make up a genome, the study of epigenetics refers to the pattern of gene silencing and activation. Although every cell contains two copies of almost every gene, many genes in sperm and ova are biochemically altered to be silenced, or imprinted, throughout life. The potential relevance of epigenetics to the influence of perinatal toxicant exposure on asthma sensitization becomes clear when one considers recent data from experiments conducted in mice. In a report by researchers at Duke University (Waterland and Jirtle 2003), mice with...

Therapeutic Hyaluronidases

Bovine testicular hyaluronidase has been used in the cosmetic, pharmaceutical, and medical fields. However, the advent of bovine spongiform encephalitis halted commercial production of bovine hyaluronidase. Wydase from Wyeth was one of the most popular bovine preparations, but production of this product has now ceased. However, a new formulation called Vitrase, by ISTA Pharmaceuticals Inc., has recently gained FDA approval. This enzyme is derived from sheep testicular tissue and is formulated as a sterile lyophilized 6200 USP unit preparation with 5 mg of lactose, 1.92 mg of potassium phosphate dibasic, and 1.22 mg of potassium phosphate monobasic as excipients. The product can be reconstituted with sodium chloride injection, USP 150 . Attempts have been made to clone bovine testicular hyaluronidase in an effective expression system that will yield a correctly glycosylated and functional enzyme 151 . Newer preparations include recombinant human testicular enzyme (rHuPH 20), which has...

Prenatal Evaluation Of Mother

Women planning to become pregnant should be questioned about whether (and when) they had varicella. Those with a history of disease need no further evaluation, but those with a negative history should be tested for the presence of VZV antibodies. This is most practically done by enzyme-linked immunosorbent assay (ELISA) tests that are commercially available. Although in general these tests lack sensitivity, they are useful for determining natural immunity (7,12). Women who have no history of varicella and who have no detectable VZV antibodies by ELISA should ideally be vaccinated before becoming pregnant. As has been mentioned, women reared in countries with a tropical climate are highly likely to be susceptible if they have no history of varicella. Immunization of adults requires two doses of vaccine administered 4-8 weeks apart. If the woman is already pregnant, she should not be immunized, but the CDC recommends immunization of close susceptible contacts, such as young children...

Effect of Insulin Resistance Treatment on Polycystic Ovary Syndrome Weight Loss

Women with PCOS very often require medications to induce ovulation. Metformin is very beneficial in ovulation induction when administered in combination with medications such as clomiphene citrate and this improves pregnancy rates (216). Also, metformin, improved fertilization and pregnancy rates when administered to clomi-phene-citrate-resistant women with PCOS who were undergoing in vitro fertilization (217). Additionally, metformin administration during pregnancy reduced first-trimester pregnancy loss (218). Metformin's beneficial reproductive effects are clearly attributed to amelirioration of hyperinsulinemic insulin resistance.

Additional Nursing Diagnoses Anxiety

Defining Characteristics (Specify increased apprehension and expressed concern about future infertility and effect on body image, presence of empty scrotum and smaller size, expressed concern about impending surgery or need for future surgery and procedure performed to correct abnormality.) usually performed after the age of 1 but may be done during the preschool years by the age of 5 if testes have not spontaneously descended on their own. infertility.

Incidence And Sources Of Cytomegalovirus Infection

Blood products and transplanted organs are the most important vehicles of transmission of CMV in the hospital setting the latter are unlikely to be of concern during pregnancy. Transmission of CMV through packed red blood cell, leukocyte, and platelet transfusions poses a risk of severe disease for seronegative small premature infants and immunocompromised patients (41). The risk of transmission of CMV with blood products increases with the number of units transfused, the presence of white blood cells, and the lack of serum antibody in the recipient (42). Prevention of blood product transmission of CMV can be achieved by using seronegative donors or by special filters that remove white blood cells (41,43,44). Another potential source of nosocomial CMV infection of particular concern to those in reproductive medicine is semen donated for artificial insemination (45,46). Although no cases of congenital CMV infection attributed to donor insemination have been reported, the fact that...

Polycyclic Aromatic Hydrocarbons

PAH exposure during gestation can cause developmental abnormalities in animals, including stillbirths, reabsorbed fetuses, decreased birth weight, birth defects, and infertility or sterility of the offspring (U.S. DHHS 1995). PAHs are also toxic to the developing fetal immune system. Exposure of experimental animals to B(a)P during immune system ontogenesis appears to result in persistent alterations in immune function. Mouse progeny of dams exposed to B(a)P during mid-pregnancy had abnormalities in their cell mediated and humoral immune response. For example, offspring of pregnant mice receiving 150 mg kg B(a)P from days 11 to 17 of gestation showed suppression in plaque-forming cells, graft-vs.-host, and mixed lymphocyte responses. Suppression of immune responses was detected during gestation, one week after birth, and still demonstrable at 18 months of age (Urso and Gengozian 1984). These animals further exhibited an 8 to 10 fold higher tumor incidence than vehicle-exposed...

Alcohol Induced Sexual Dysfunction

Alcohol consumption has been found to have a negative relationship to physiological arousal in women. Although women state that they felt more aroused, the physical responses tend to be depressed when alcohol is consumed. Inhibition of ovulation, decrease in gonadal mass, and infertility may follow chronic heavy alcohol use.

Cohoba Yopo Yupa Vilca Anadenanthera spp Fabaceae

A number of species of trees in the Anadenanthera genus (A. peregrina, A. colubrina among them) have hallucinogenic properties and have been widely used to make powerful psychoactive snuff in a number of indigenous South-American Indian cultures. The snuff is prepared by making a paste from the beans, then mixing in an alkaline additive made from either snail shells or a plant source. It plays a central role in shamanistic practices such as divination, trance, communication with spirits, and the diagnosis of illness. Its use is usually limited to adult males. Although it is a powerful hallucinogen in larger doses, smaller amounts are sometimes taken as a stimulant. The seeds are also used to treat urinary disorders and infertility, and as emetics, purgatives, and laxatives.

Embryos

To date, only a handful of laboratories worldwide have been able to derive human stem cell lines. This may be due in part to the quality of the embryos available for research and stem cell derivation. During assisted reproduction treatment, good-quality embryos are used in fertility treatment of the patients requiring treatment. Often the second-grade embryos are frozen for later patient use, and only then will the poorest-quality embryos that would not have been used for patient fertilization be donated for research Pickering et al., 2003 . An alternative approach to obtaining high-quality embryos is the use of embryos screened for known genetic disorders with preimplantation genetic diagnosis (PGD). PGD can be used to diagnose, with a high degree of certainty, embryos containing monoallelic genetic disorders and often relies on the use of polymerase chain reaction (PCR) to amplify DNA from a single cell obtained from in vitro fertilized (IVF) eggs when they are at the 8-cell stage...

Thyroid Drugs

Ism during the recovery phase of subacute thyroiditis. To treat or prevent euthyroid goiters. With antithyroid drugs for thyrotoxicosis (to prevent goiter or hypothyroidism). Diag-nostically to differentiate suspected hyperthyroidism from euthyroidism. The treatment of choice for hypo-thyroidism is usually T4 because of its consistent potency and its prolonged duration of action although it does have a slow onset and its effects are cumulative over several weeks. Contraindications Uncorrected adrenal insufficiency, acute MI, hyper-thyroidism, and thyrotoxicosis. When hypothyroidism and adrenal insufficiency coexist unless treatment with adrenocortical steroids is initiated first. To treat obesity or infertility.

Treatment

Functional hypothalamic amenorrhea can usually be reversed by weight gain, reduction in the intensity of exercise, or resolution of illness or emotional stress. For women who want to continue to exercise, estrogen-progestin replacement therapy should be given to those not seeking fertility to prevent osteoporosis. Women who want to become pregnant can be treated with gonado-tropins or pulsatile GnRH. F. Hypothalamic or pituitary dysfunction that is not reversible (eg, congenital GnRH deficiency) is treated with either exogenous gonadotropins or pulsatile GnRH if the woman wants to become pregnant.

Endometrial biopsy

Additional endometrial assessment should be performed if abnormal uterine bleeding persists after a benign endometrial biopsy. Transvaginal sonography with or without hysteroscopy and directed biopsy should be considered to rule out an occult malignancy. C. Hysteroscopy and curettage. If endometrial hyperplasia with atypia is diagnosed by blind biopsy, further evaluation is needed to exclude a coexistent endometrial adenocarcinoma, which is present in 25 percent. Hysteroscopy with curet-tage is recommended.

Gatekeeper

Examples Working with a schoolteacher or principal to gain entrance into the school before implementing a program for schoolchildren in cultures where husbands are considered gatekeepers, working with husbands prior to implementing family planning education for wives in a community.

Chlamydia

Chlamydia is the most common bacterial STD in the United States. The microorganism Chlamydia trachomatis infects more than 3 million men and women each year. Chlamydia also is one of the most devastating STDs, because it often causes no symptoms and can lead to pelvic inflammatory disease (PID) in women. PID is responsible for up to 15 percent of cases of female infertility.

Birth Control

Birth control has several different meanings. When used as a synonym for family planning, it refers to control over the number or spacing of children using various methods to either prevent or control the frequency of pregnancy. When used as a synonym for contraception, birth control refers strictly to the prevention of pregnancy. Contraceptives are the means by which pregnancies are prevented.

Acknowledgements

Too good to be true Is there really a trade-off between number and care of offspring in human reproduction In Human Nature, a Critical Reader, ed. L. Betzig, pp. 83-6. Oxford Oxford University Press. Harpending, H.C. (1994). Infertility and forager demography. American Journal of Physical Anthropology, 93, 385-90. Wood, J.W. (1994). Dynamics of Human Reproduction. New York Aldine de Gruyter.

Conjoint Analysis

A range of techniques that is used to reveal people's values of entities like health states or health services. Within this range are such methods as card sorts, choice modelling, discrete choice analysis, hierarchical choice, pairwise comparisons, stated preference analysis and trade-off matrices. A variety of hypothetical questions or vignettes is formulated, each varying in its mix of attributes (which have to be considered 'conjointly' by the subject) and subjects are asked to give discrete answer (yes no or 'I prefer option A' and so on). Regression analysis is used to estimate the relative strength of preferences for attributes. In a study of fertility service quality, for example, the attributes to do with quality might include attitudes of staff to the patient (uncaring unsympathetic caring sympathetic), continuity of contact with staff (see same staff see many different staff), time on waiting list for first IVF attempts (1, 3, 6, 18, 36 months), cost to patient per attempt (...

Primary Health Care

Primary health care includes health education, environmental sanitation (particularly food and water), promotion of nutrition, maternal and child health programs, immunization, family planning, and appropriate treatment of common diseases and injuries. Primary health care, mostly seen in developing countries and poorer nations, is usually an integral part of the country's health care system. In setting up a primary health care program, goals are developed, budgets identified and assigned, strategies are formulated, and pilot projects are undertaken.

Antimalarials

The more long-lived erythrocytes (anemia). Infertility is caused by suppression of spermatogenesis or follicle maturation. Most cytostatics disrupt DNA metabolism. This entails the risk of a potential genomic alteration in healthy cells (mutagenic effect). Conceivably, the latter accounts for the occurrence of leukemias several years after cytostatic therapy (carcinogenic effect). Furthermore, congenital malformations are to be expected when cytostatics must be used during pregnancy (teratogenic effect).

Findings

Endometriosis is the most likely ,cause of infertility in a menstruating woman over age of 30 (in the absence of a PID history). Leiomyoma (fibroids) benign tumors most common indication for hysterectomy (when they grow too large or cause symptoms). Malignant transformation is rare (< 1 ). Look for rapid growth during pregnancy or use of oral contraceptives with regression after menopause (estrogen-dependent). Fibroids may cause infertility myomectomy may restore fertility. Other symptoms include pain and menorrhagia metrorrhagia. Anemia due to leiomyoma is an indi cation for hysterectomy. D& C rules out endometrial cancer and malignant transformation in women > 40. Patients may present with polyp protruding through cervix. Polycystic ovarian syndrome (PCOS) look for heavy woman who has hirsutism, amenorrhea, and or infertility. PCOS is the. most Likely cause of infertility in a woman, under 30 with abnormal menstruation. Multiple ovarian cysts often are seen, on ultrasound.The...

Duodenal Obstruction

Duodenal obstruction results from duodenal atresia, web, stenosis, annular pancreas, or malrotation. It usually presents in newborns as feeding intolerance and stomach distension. Bilious emesis is seen if the obstruction is distal to the ampulla of Vater, which is the case in the vast majority of cases. One-third of patients will also have Down's syndrome. Diagnosis is confirmed with air contrast upper GI with findings of a Double-Bubble. Initial treatment is NG tube decompression and IVF hydration. Operative treatment is dependent upon the cause of the obstruction but should be pursued rapidly if malrotation is the suspected cause. The most commonly employed surgical therapy is duodenoduodenostomy. However, duodenal webs may be treated with duodenotomy and excision. An annular pancreas should never be divided.

Efficiency

Ethics committees are agencies (some statutory) that are designed to protect people who are directly or indirectly the subjects of, or might be affected by, research. Their approval is normally required for research involving patients, relatives or carers of patients access to data, organs or other bodily material of past and present patients foetal material and IVF involving patients the recently dead in hospitals the use of, or potential access to, health care premises or facilities health care staff, recruited as research participants by virtue of their professional role.

Mark R Curry Summary

Mammalian spermatozoa were among the very first cells to be successfully cryopreserved and over the last five decades the use of frozen-thawed semen for artificial insemination has come to play an important role in domestic livestock production. More recently, semen freezing has increasingly been utilized in the establishment of genetic resource banks for endangered species. Semen is collected, most commonly either by use of an artificial vagina or by electroejaculation of an anaesthetized animal, and basic sperm parameters assessed. Semen is extended using a TEST-egg yolk-glycerol diluent, packaged in 0.25-mL plastic straws and slowly cooled to 5 C over a period of 1-2 h. Cooled straws are frozen by suspending within liquid nitrogen vapor above the liquid nitrogen surface before plunging into the liquid phase. Straws are thawed briefly in air before immersing in a 35 C water bath for 15 s, and often are used directly for insemination without any further processing.

Child Development

Compared to non-pregnant women with the same disease 58 . Whether women already treated for thyroid malignancy should become pregnant is of concern but current evidence suggests that differentiated thyroid cancer should not inhibit an intended pregnancy. Previous 131I therapy does not result in demonstrable adverse events in subsequent pregnancies although miscarriage appears to be more frequent during the year preceding conception 59 .

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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