Different Ways Getting Pregnant

Pregnancy Miracle Ebook

In Pregnancy Miracle Lisa Olson reveals her powerful system for getting rid of infertility without resorting to drugs or surgery and according to her claims in the Pregnancy Miracle book you will find a complete holistic system that you can use to reverse infertility and get pregnant quickly even if you are on your late 30s or 40s. The Pregnancy Miracle book begins with approximately 100 pages of informative content on fertility, your biological reproductive system, general methods to increase your chances of conceiving, and analysis of popular fertility treatments in West, and an introduction to less known ancient Chinese fertility techniques. 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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Abortion or Miscarriage and Breast Cancer

Some reports have suggested that incomplete pregnancies, terminated either by induced abortion or miscarriage, increases the risk of breast cancer (reviewed in Reference 184). A number of other studies have not shown an increased risk of breast cancer in women who have undergone induced abortions.184 A well-controlled study of the effects of induced abortion and miscarriage on breast cancer incidence, involving age-, parity-, and race-matched cases and controls, showed that neither induced abortion nor miscarriage increased breast cancer risk.184 This claim appears to be more of an issue of politics and religious beliefs than science.

Centrosome Inheritance during Human Fertilization and Therapeutic Cloning Reproductive and Developmental Diseases and

Cloning Reproductive

A century after Boveri's theory, human in vitro fertilization (IVF) was achieved 6 . Now more than 1 million IVF babies have been born. The discarded specimens from IVF clinics have provided a precious and unique research resource for centrosome biologists, and a new breed of centrosome physician-scientist is emerging. Reproductive mistakes including polyspermy (fertilization by more than one sperm) and parthenogenesis (development beginning in an activated egg without any sperm) subtly challenge aspects ofthe unipaternal centrosome inheritance theory. Here, we focus on the centrosome during fertilization, with special attention to human reproduction and development. We also consider the centrosome during nuclear transfer which represents research frontiers for the next generation of cen-trosome biologists. For obvious ethical reasons, experimental results are obtained and or corroborated by studying non-human primate development. This is essential, ironically, because fertilization...

Tubal Factor Infertility

Tubal infertility is due to damage or obstruction of the fallopian tubes. The changes or obstruction are associated with previous pelvic inflammatory disease (PID), previous pelvic or tubal surgery, and peritoneal factors. Tubal and peritoneal factor infertility often occur concurrently, and their treatments are often similar. Tubal and peritoneal factors account for 30 to 40 of female infertility cases. Salpingitis is the most important etiologic factor in tubal infertility. The risk of infertility is high after a single bout of PID. In addition. PID increases the incidence of ectopic pregnancy, which also can contribute to infertility. The incidence of infertility doubles with successive bouts of salpingitis, reported to be 12 , 23 , and 54 after one. two, and three episodes of PID, respectively. The outcome of surgical management of tubal factor infertility is dependent on the following factors I) severity of the disease process that affected the pelvis, 2) extent of the tubal...

The Genetics and IVF Institute

The Genetics and IVF Institute (GIVF), a private reproductive and genetics services clinic, offered BRCA testing using a different approach than GDL or OncorMed. It built BRCA testing as a commercial service and offered it both as an integrated genetic counseling and laboratory analysis for a single fee under one roof as well as a stand-alone laboratory service that could be purchased through any physician. GIVF's service, however, was not useful to everyone as its method of laboratory analysis searched only for the three BRCA gene mutations common among individuals of Ashke-nazi Jewish descent. As such, its laboratory analysis served as an inadvertent gatekeeping mechanism that restricted access differently than GDL's or OncorMed's had. GIVF was founded in 1984 by Joseph Schulman, a pediatrician and obstetrician who was the only student of Robert Edwards and Patrick Steptoe, the British inventors of in vitro fertilization. It originally focused on providing prenatal genetic testing,...

Female Infertility

Infertility can result from ovulatory or uterine problems mechanical problems, including obstruction of the fallopian tubes male fertility factors or multiple factors in either sex or combined female and male factors. Ovulatory problems are the most common cause of female infertility. Polycystic ovarian syndrome (PCOS) affects up to 5 of reproductive-age women. It is the most common cause of ovulatory infertility. PCOS is a condition characterized by multiple ovarian cysts, often found in a row, resembling a string of pearls. Ovarian cysts are fluid-filled sacs arising from follicles swollen with fluid that are prevented from producing mature oocytes. Patients with PCOS also have hormonal imbalances, including decreased levels of LH, FSH, and progesterone and increased androgen production, including excess testosterone and DHEAS causing hirsutism or male facial patterns of hair growth. Insulin resistance is a common associated condition. PCOS is generally diagnosed when two of the...

Diet Infertility

In women, being overweight or underweight can impair fertility.3 Excessive thinness from vigorous dieting or strenuous exercise is a common cause of infertility in women in the industrialized countries. In underweight women with body fat content lower than 16-18 of their body weight (women normally have about 25 body fat), ovarian production of estrogen is reduced. This can impair ovulation, interrupt the menstrual cycle, and produce infertility. On the other hand, too much body fat can also interfere with ovulation and cause infertility. About one in ten overweight women have irregular menstrual cycles. Weight loss in overweight, infertile women can cause a return of ovulation and fertility. Women who are trying to become pregnant to maintain or attain a normal body weight.2,3

Preface to the series

Today, plant selection is not only for the yield of active principle, but for the plant's ability to overcome disease, climatic stress and the hazards caused by mankind. Such methods as in vitro fertilization, meristem cultures and somatic embryogenesis are used. The transfer of sections of DNA is giving rise to controversy in the case of some end-uses of the plant material.

What Is the Best Therapy

A related question is What would have best prevented this condition For instance, if the scenario presented is a 23-year-old woman with tubal factor infertility, then the most likely etiology is C. trachomatis cervicitis that ascended to the tubes, causing damage. The best preventive measure would be a barrier contraception such as condom use.

Depression and Single Parents

This snapshot of the current state of family structure reveals remarkable changes over the past 30 or 40 years, the main features of which are (1) the proliferation of single-parent and blended households (2) an extraordinary variety of families made possible by technology, such as IVF, that was unavailable not so long ago (3) multiple routes to single motherhood, and the recent phenomenon of older unmarried professional women choosing to have babies and (4) same-sex couples. In relation to single-parent families, the social disadvantages for a vast majority of single mothers are often at the root of many of their ills. The family intervention literature with single-parent families has proliferated over the last few years, and in the following section we shall review that body of literature.

Histone Variants And Complexes Involved In Their Exchange

Abstract In contrast to canonical histones, which are assembled into nucleosomes during DNA replication, histone variants can be incorporated into specific regions of the genome throughout the cell cycle. Recent findings suggest that histone variants associate with factors mediating their deposition into specialized chromatin domains. The mechanisms of their targeted deposition, their turnover, and their posttranslational modification are not yet fully understood. Emerging evidence indicates that histone variants and associated factors are essential for the epigenetic control of gene expression and other cellular responses. Thus, histone variants and complexes involved in their exchange are likely to play major roles in controlling chromosomal architecture, and their deregulation is expected to be linked to cancers, infertility, mental disorders, ageing, and degenerative diseases

Pregnancy the fetus and lactation

Pregnancy is unlikely to occur in severely alcoholic women (who have amenorrhoea secondary to liver injury). The spontaneous miscarriage rate in the second trimester is doubled by consumption of 1-2 units day. There is no level of maternal consumption that can be guaranteed safe for the fetus. But it is plainly unrealistic to leave the matter there, and it has been suggested that if the ideal of total abstinence is unachievable then women who are pregnant or are thinking of becoming pregnant should not drink more than 1-2 units of alcohol per week and should avoid periods of intoxication.34

The gendering of bodies and technologies

Despite Rayna Rapp's impressive study of the 'uneven benefits and burdens' that genetic knowledge and technology has for a diverse range of women (1999), there has been something of a 'gender blindness' in terms of the way that social scientists have analysed developments in the new genetics (Stacey 1999). Although the issue of gendering in relation to genetic technologies has begun to be addressed (Hallowell 2000 D'Agincourt-Canning 2001 Ettorre 2005), it is examined here as a complex configuration of social practices, with diverse and ramifying consequences. Focusing on an interface between gendered health activism and genetic knowledge in relation to predictive rather than reproductive medicine, this study explores what is at stake in situating women as specific kinds of citizens and how this is related to particular articulations of morality and ethics. At the same time fresh light is cast on the relationship between agency, identities and the materiality of science and the body...

Ethics Of Dna Testing For Inherited Disease

Analysis of fetal DNA can inform parents if their child is affected by an inherited disorder. It is now possible, using the PCR, to examine the genotype of a single cell from an eight-cell embryo. If the DNA test is negative, the embryo can be inserted into the mother, and the parents know they have not passed on a defective gene to their child. This combination of DNA testing and in vitro fertilization has given rise to the unfortunate phrase designer babies .

Suggested Readings And Resources

Wilkinson, S., & Kitzinger, C. (Eds.). (1996). Representing the other A feminism and psychology reader. London Sage. This book explores when and how we should represent members of groups to which we ourselves do not belong. Discussions include when and how to represent diverse groups such as children, prostitutes, gay men with HIV AIDS, and infertile women.

Distinct Clinical Entities

Pregnancy seems to predispose to AA, but this issue remains controversial. In fact, one of the first cases of AA documented in the early writings on this disease was a young pregnant woman.75 The mechanism that triggers AA in pregnancy remains unclear, but AA often resolves with the termination of pregnancy and can recur during subsequent pregnancies. Even if the initial presentation of AA was not associated with pregnancy, women with a recent history of successfully treated AA should be counseled to not get pregnant. Successful pregnancies have been described, and in the majority of case series most of the women had good outcomes.76 The therapy of pregnancy-associated AA depends on the gestational age of the fetus. The pregnancy of a women with severe AA may be terminated if it is close to term. Earlier in pregnancy, supportive measures are most commonly used. ATG has also been administered to women with severely depressed counts, especially low absolute neutrophil count (ANC)....

Safety and Tolerance of Combination Therapy

Clearly, from the side effect profile of ribavirin, that combination therapy is not indicated for every patient. It should be used with great caution, or not at all, in patients with pre-existing anemia or hemolytic disorders, coronary artery disease, or hypoxia. Careful consideration should be given to the potential effects of an acute anemia in each patient in whom combination treatment is considered. Because of the potential for teratogenic and embryotoxic effects in animals, it should not be used in patients of child-bearing potential, unless adequate contraception is assured. Trial and postmarketing surveillance data suggests that most patients or spouses of patients who become pregnant during or within 6 mo after treatment will spontaneously abort, if the pregnancy is not otherwise terminated, but one fetal anomaly has been observed (Davis, unpublished data).

Defining the Roles of System Participants

Thus, by the end of 1996 there was no consensus in the United States on how best to build a BRCA-testing system. Patient advocates, professional organizations, and prospective test providers disagreed about each component of the system's architecture, from the overall strategy to the methods of laboratory analysis used. They also offered different visions of testing system participants. For some, the client resembled a traditional patient, while for others, she was an empowered individual consumer of medicine. The way these groups envisioned these testing systems and their participants, however, were clearly linked to the history of genetic research, technology, and medicine in the United States and, more broadly, the structure and politics of American health care. First, the four systems represented the diversity of the genetic-testing services that were being provided in the United States GDL's test combined research with the goals of a diagnostic laboratory, Oncormed's service wove...

Scientific Foundations

Almost all living things pass on their DNA (deoxyribonucleic acid, their genetic information) to the next generation when they reproduce. DNA is present in almost every cell in humans. Throughout their lives, cells use their DNA copy as a recipe book to make large, complex molecules called proteins. Most cells in the human body contain or two copies of the human genome divided up into forty-eight microscopic packages called chromosomes. The egg cells produced by females and the sperm cells produced by males each contain only twenty-three chromosomes. When they come together, they produce a cell containing a new mixture of chromosomes with the correct number, forty-six. The fertilized cell divides into two, those two cells divide into four, and so on, beginning a growth process that can produce an adult person. In-vitro fertilization simply allows the beginning of this process to happen outside the female body instead of inside.

Neonatal Autoimmune Ovarian Disease

Unexpectedly, over 80 of the progenies from the ZP3-positive dams developed severe nAOD at 2 weeks of age, and 40 of those with nAOD developed ovarian atrophy, premature ovarian failure and infertility (Setiady et al. 2003) (Fig. 3). Severe nAOD was induced by serum or purified serum IgG from adult female or male mice immunized with CP2 in CFA, or by transfer of a mouse monoclonal Ab to ZP3 (335-342). Therefore, autoAb to the ZP3 (335-342) B cell epitope is sufficient to trigger severe and frequent nAOD, a process independent of maternal lymphocytes or pregnancy-associated factors.

Regulation and use of metals as food contact materials

Can end sealants are based on natural or more usually synthetic rubber latex with additives to give them the particular properties of adhesion, elasticity, temperature resistance and resistance to components of foods and beverages whilst ensuring an enduring hermetic seal. Under USA legislation they are specifically covered under FDA CFR21 175.300(xxxi) listing authorised starting substances. As with coatings, these materials are not yet covered under specific EU harmonised legislation so member state legislation may be used to show compliance. In particular the Dutch legislation has a section specifically covering can end sealants (Verpakkingen- en Gebruiksartikelenbesluit - Hoofdstuk IVf). The German recommendations of the BfR may also be useful for showing compliance. A CoE Resolution on Rubber and Elastomers AP (2004) 4 has been published but is not yet complete. In its finished form, it should be useful as a further reference for demonstrating safety and compliance of can end...

Geneticisation and the social impact of the new genetics

Questions of 'impact' have been central to the ways in which social science has begun to address developments in genetic knowledge and technology. However, this work has been somewhat narrowly defined (Kaufert 2000). On the one hand, there has been a tendency to examine the psychological or social consequences of technologies, such as genetic testing, for the relatively small numbers of persons undergoing these procedures.3 At the same time attempts to broaden the field of analysis have tended to separate the consequences of genetic knowledge and technology for patients from changes in health policy or the social context of medical practice itself (see, for instance, Marteau and Richards 1996). One of the repercussions of this demarcation has been not only a tendency to sustain the novelty of these developments, often referred to as the 'new genetics', but also a theoretical emphasis given to the notion of 'geneticisation'. Responding mostly to genetic developments in reproductive...

General Treatment Consideration

Plete remission after 3-6 cycles of chemotherapy received some sort of consolidation therapy in the form of additional chemotherapy, obviating the benefit of radiation. However, such strategies lead to high cumulative doses of chemotherapy and the risk of male infertility due to the use of alkylating agents, cardiomyopathy from anthracyclines, pulmonary fibrosis from bleomy-cin, and of secondary leukemia and lung cancer after alkylating agents and etoposide.

See Case 28 Definitions

Salpingitis isthmic nodosa (tubal diverticuli) Condition in which the tubal epithelium penetrates into the muscularis or even the serosa, commonly associated with tubal infection. Tubal factor infertility Tube damage or disease leading to inability to conceive, usually divided into proximal blockage and distal blockage. Tubal reconstructive surgery Operative techniques for repairing tube damage in an attempt to enhance conception rates, which may or may not include microsurgery. Microsurgery uses magnification and fine suture material.

Cystic Fibrosis ABCC7CFTR

Nherf Dimer

Cystic fibrosis, caused by mutations in ABCC7 (CFTR) (Tab. 3.2) is one of the most frequent inherited diseases in Caucasian populations with a prevalence of 1 900 to 1 2500, whereas African and Asian individuals are affected to a much lesser extent. Interestingly, a three base pair deletion (AF508) accounts for 70-80 of the mutated alleles in northern European populations. The total number now comprises more than 1000 CFTR mutations The spectrum of the disease severity is dependent on the residual function of ABCC7 164, 165 . Patients with two affected alleles develop a severe disease with a disturbed exocrine function ofthe pancreas leading to nutritional deficiencies, bacterial lung infections, and a blockade of the vas deferens causing male infertility. In

Paternal Age Effect In Progeria

In progeria, it is clearly much less than 25 . Almost all cases are sporadic, and there is no evidence of increased miscarriage rates to suggest selection against the homozygote in utero. A case of identical twins with progeria with 14 normal siblings has been reported (27). Here, three or four affected siblings would be expected if it was a recessive disease. It is recognized that for new dominant mutations, occasionally the mutation can occur in a germ line leading to somatic mutations. Several cases could then occur within one family. Probable cases of familial progeria have been reported in only a few instances among more than 100 families (28-33). We believe that these reports of progeria cases most likely represent misidentified cases of other progeroid syndromes, such as mandibuloacral dysplasia. Among the 50 cases we examined, no family had more than one affected child except for one set of identified twins. There were 80 unaffected siblings. One would expect...

Hormonal Changes In Menopause

Menopause is defined as cessation of menstruation and fewer remaining follicles causing infertility, generally at around 50 years of age. Perimenopause, the period of time leading into the menopause in women, is often characterized by irregularity in length of the menstrual cycle. Perimenopause is marked by dramatic changes in the hypothalamic-pituitary-ovarian axis. An early finding is a rise in circulating FSH levels unaccompanied by a rise in LH. It has been suggested that there is a decreased secretion of ovarian inhibin along with the decreasing follicular pool, which may be the primary cause of the rise in FSH. The resultant ovarian changes include short follicular phases with early ovulation, and ovarian insufficiency characterized by lower levels of estrogen and progesterone secreted for shorter periods of time compared with the luteal phase of younger women. The major significant endocrine event in women in the early perimenopausal phase is a fall in the circulating levels of...

Phenotype Of Atm Knockout Mice

Mice Phenotypes

Several different strains of Atm ' mice have been generated since the cloning of the ATM gene (96,99,148). The mice all have a similar AT-like phenotypes in that they express neurological abnormalities, immune defects, genetic instability, radiation sensitivity, infertility, and a high incidence of lymphoma. Despite these phenotypic similarities with AT patients, there are differences, including severe growth retardation, universal sterility, and death from lymphoma by age 6 months in Atm ' mice (96,99,148). The neurological phenotype of the mice is notable.

Wendy Arneson and Jean Brickell

Markers of Pregnancy Problems in Early Pregnancy Trophoblastic Neoplasm Multiple Fetuses and Pregnancy Hormones PREGNANCY TESTS AND EARLY MARKERS OF PROBLEMS Case Scenario 12-2. Infertility and Polycystic Ovarian Disease String of Pearls in a Bearded Lady SEX STEROIDS The Role of Inhibins THE FEMALE REPRODUCTIVE CYCLE NORMAL MALE REPRODUCTIVE PHYSIOLOGY HORMONAL CHANGES IN MENOPAUSE FEMALE INFERTILITY Treatment for Infertility Infertility of Multiple Causes The laboratory provides vital information regarding reproductive endocrinology, pregnancy, and fetal testing for physicians and other health-care providers. This chapter will focus on fertility, pregnancy, and fetal well-being assessment. Laboratory tests for reproduction, pregnancy, and fetal assessment and procedures of analysis will be discussed in the context of six scenarios. These will illustrate the importance of providing quality laboratory results and correlating laboratory values with disorders such as complications of...

Etiology of Adhesion Formation

Surgically induced adhesions are a complication of invasive surgical procedures (48). Adhesions induced by either trauma, surgical or otherwise, and pathology (i.e., endometriosis) can lead to a variety of complications including infertility, bowel obstruction, pain, impaired joint mobility, and unintended complications during reoperation (49-53). The etiology of surgically induced adhesions is thought to be a result of incidental trauma caused by tissue manipulation (54), desiccation (54), tissue ischemia, and a foreign body reaction to particulates (55-57). This damage leads to a wound healing response that results in the production of a serous exudate that leads to fibrin clot production (58-60). If the fibrin clot is relatively short lived then it is resorbed with concomitant normal wound repair. If, however, the fibrin clot resides for a longer time period then cells of fibroblastic phenotype are recruited to the site. These cells begin to generate collagen leading to a scar-like...

Adrenal Steroids And Pregnancy

Adrenal steroids are teratogenic in animals. Although a relationship between steroid pharmacotherapy and cleft palate and other fetal abnormalities has been suspected in man, there is no doubt that many women taking a steroid throughout have both conceived and borne normal babies. Adrenal insufficiency due to hypothalamic pituitary suppression in the newborn occurs only with high doses to the mother. Dosage during pregnancy should be kept as low as practicable and fluorinated steroids are best avoided as they are more teratogenic in animals (dexa- and betamethasone, triamcinolone and various topical steroids, e.g. fluocinolone). Hypoadrenal women who become pregnant may require an increase in hydrocortisone replacement therapy by about 10 mg per day to compensate for the increased binding by plasma proteins that occurs in pregnancy. Labour should be managed as described for major surgery (below).

Acute Fatty Liver of Pregnancy

The pathogenesis of AFLP remains unclear. Recent reports revealed that some women with AFLP are heterozygous for a defect in one of the enzymes (long-chain 3-hydroxyl-acyl CoA dehydrogenase LCHAD ), involved in p oxidation of fatty acids in the mitochondria. These women remain asymptomatic until they become pregnant with a LCHAD homozygous fetus, and develop AFLP. Infants with LCHAD deficiency may develop a Reye's-like syndrome and possible death caused by nonke-totic hypoglycemia. A DNA test is available to identify the gene defect involved in LCHAD deficiency. This test allows for identification of heterozygous mothers who should receive counseling regarding subsequent pregnancies (34).

Summary Of Adverse Effects

Reports of gynaecomastia and decreased human sperm count are small in number and so a link to cannabis cannot be regarded as proven. Decreased sperm count has not been associated with infertility. 13. The effects of cannabis upon human female fertility are not clear.

Marker Assisted Breeding

It was not until Darwin's explanation of evolution was combined with the understanding of genes, which were first described by Gregor Mendel (1822-1824) in the late nineteenth century, that humans were able to selectively breed plants and animals in a scientific way. The first wide application of artificial insemination to selective livestock breeding was in the 1930s. Artificial insemination is when sperm from a male animal is inserted artificially into a female. It is easier to send sperm across the country to a breeding farm than to transport the whole male animal, so artificial insemination became affordable to breed more selectively than before.

Variants Of The Histone H2a

Histone H2a Structure

In addition, H2A.X seems to be important in functions associated with telomere maintenance and meiotic recombination (Fernandez-Capetillo et al. 2003b). In male mice, H2AX functions in the silencing of the sex chromosomes as well as in meiosis and its loss results in infertility (Fernandez-Capetillo et al. 2003c). Intriguingly, H2A.X is also necessary for the incorporation of the H2A variant macroH2A1.2 (see below) into the inactivated sex chromosomes. The underlying mechanism and the link between these H2A variants are not yet understood. H2A.X also mediates apoptosis and somatic recombination events (Petersen et al. 2001).

Immunity and Prophylaxis

Pregnant women have a unique susceptibility to malaria, such that maternal malaria, a distinct clinical entity, causes serious pregnancy-related complications in endemic areas. Increases in miscarriage, premature delivery, retardation of fetal growth, anemia, low birth weight, and mother and infant mortality rates are observed when the mother contracts malaria during pregnancy. Adult women acquire the same degree of immunity to the common strains of parasites as do adult men however, after becoming pregnant, this acquired immunity diminishes markedly. With successive pregnancies, the loss of immunity is less pronounced. To explain the apparent loss of acquired immunity in pregnancy, researchers studied the binding of infected red blood cells to placental tissue (80). A subpopulation of P. falciparum parasites preferentially binds to placental tissue and multiplies there. The binding site in placenta normally binds chondroitin sulfate A (CSA). The severity of the infection must be...

Comprehension Questions

59.3 A 22-year-old nulliparous woman with irregular menses of 7 years' duration complains of primary infertility. She has a family history of diabetes. She has mild hirsutism on examination. Which of the following is the most appropriate therapy E. Intrauterine insemination

Retrieval Of Scientific Data

National l ibrary of Medic ine has a free service to medical and dental literature via Medline. This gives users the ability to search l author, topic, and journal and to download abstracts of selected articles (www.ncbi. niin.nih.gov PubMed). Essentially till ol the important periodontal, dental, and medical journals are viewable at the National l ibrary of Medicine site More than II million citations are stored in their servers' database, which also gives online access to participating online journals. Another web site al the National Library of Medicine is called Grateful Med (http igin.nlm.nih.gov). which includes Medline as well as main other databases. Some examples .ire ( hem ID, with a file of 44,000 chemical compounds of interest to health scientists DIKIINL, with 16,000 records of health and biomedical information on courses associated with health care organizations (All.INI . a database of 78b,000 monographs and manuscripts going back to the I S,h century...

Impact Of Malignancy On The Reproductive System

In the past, infertility associated with malignant disease was considered a side effect of the drugs and radiation used during the course of treatment. However, this view is changing due to strong evidence that decreased fertility sometimes exists before the treatment starts. In a study conducted on 158 male patients with Hodgkin lymphoma,3 severe damage to fertility was observed in 21 cases before treatment. The decrease in fertility was most prominent in patients with an elevated erythro-cyte sedimentation rate (ESR) and in those with advanced disease. In another study, semen analysis

Restoration Of Fertility

Sperm quality may naturally improve after cancer treatment. However, some defects may persist. The incidence of infertility in men who have recovered sperm production following cytotoxic therapy is generally not higher than that of the general population. An interesting case report30 has documented paternity following bone marrow conditioning and transplantation in a patient with acute myeloid leukemia. For the first time, the preservation of fertile sperm was seen despite the use of chemotherapy. Cancer patients with sperm counts below normal (oligozoospermic) are still capable of having children.31 Similarly, infertile women who have menstrual dysfunction following cytotoxic therapy may be treated for menstrual dysfunction and infertility in a manner similar to that of

Assisted Reproductive Techniques

The reproductive capacity of individuals undergoing malignancy treatment can be preserved by cryopre-serving the gametes and using assisted reproductive techniques (ART) when pregnancy is desired.33 When non-cryopreserved spermatozoa are used in combination with intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), clinical pregnancy rates of 30-40 per cycle and delivery rates of 30 can be expected at most reproductive clinics. On the other hand, cryopreserved sperm from cancer patients results in complete pregnancies in only 18 of cycles.34 Similarly, autologous cryopreserved embryos from in vitro-fertilized oocytes can be successfully implanted after cytotoxic therapy if the patient can undergo ovarian hyperstimulation before therapy.35 Men who remain azoospermic long after chemotherapy may benefit from testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection (ICSI). The potential for sperm retrieval is...

Semen Cryopreservation

Only a small percentage of patients ( 10 ) who bank their spermatozoa before chemotherapy or radiotherapy return for assisted reproduction.44-46 This finding may be explained by several reasons recovery or waiting for possible resumption of spermatogenesis, short period from original illness, anxiety regarding potential risks for the children, and uncertainty about long-term health and, therefore, suitability to be par-ents.42 However, trends have started to change, and awareness of sperm banking has increased over the past 4 to 5 years, coinciding with the advent of ICSI. In males with cancer, the extent of sperm DNA damage plays an important role in determining how semen should be cryopreserved before therapy begins. Specimens with high sperm concentration and motil-ity and low levels of DNA damage can be preserved in relatively large aliquots suitable for IUI. If a single specimen of good quality is available, then it should be preserved in multiple small aliquots suitable for IVF...

The beginnings of GIFT

In the mid-1980s, ICLARM developed an aquaculture programme based on the recognition that more productive and profitable aquaculture in developing countries would depend on development of better breeds of farmed aquatic organisms and better farm environments. Tilapias were chosen as test species because of their importance in warm water aquaculture and their usefulness in investigating the application of genetics in aquaculture. The proposed programme, which employed both in situ and ex situ conservation of genetic resources, would proceed in three phases documentation of genetic resources (wild and farmed) evaluation of their culture performance and the use of germplasm in breeding programmes. This programme became the foundation for the GIFT project, which was started in 1988 with the objective of developing more productive stocks of tilapia by selection for high growth rate and other economically important traits (eg disease resistance and maturation rate), and providing the...

Developments twin arrows

The superb protection from the elements afforded by the mammalian womb has a major effect on the balance of internal and external selective forces that act on the embryo. In this sort of situation, internal selection reigns supreme. As we know, many mammalian embryos die before they are born human miscarriages, for example, are all too common, and doubtless the same is true of our various mammalian cousins. But this mortality is not caused by intrauterine predators. Nor can it be caused by harsh winters, except indirectly when the death of the embryo is caused by the death of the mother. What kills mammalian embryos, therefore, must be problems within the developing embryo itself, though problems with the umbilical connection to the mother are sometimes also a factor. Integration, in this sort of situation, comes in two forms. At any precise moment, the embryo must be sufficiently well integrated to function to stay alive to avoid the fate of miscarriage. But, when viewed over an...

Genetic Susceptibility to Chlamydia trachomatis Determines the Outcome of the Disease Data from a Mouse Model

In BALB c mice, which had a transient salpingitis without infertility, the immune response started very fast, especially against the MOMP. On the other hand in C3H mice, which become chronically ill and infertile, the response was quite slow, with, at the end, a different pattern of immunostained antigens, such as OMP2, GroEL-like protein and EF-Tu.

Germinal Vesicle Nuclear Transfer

In vitro maturation (IVM) medium for denuded mouse oocytes MEM supplemented with 0.24 mM pyruvate (Pyruvic acid sodium salt, P-4562, Sigma) and 5 fetal bovine serum (FBS heat inactivated, F-7678, Sigma), 0.22-pm filter sterile. Pyruvate stock can be made at the concentration of 240 mM (1000X), aliquot, and stored at -20 C.

Commerce and Regulation

Managing reproduction has always been a lucrative business. If the experience of infertility services, such in vitro fertilization (IVF) clinics, is any indication, immortalization will take off' once it is an available option for human beings. Infertility services have been transformed from a small medical specialty to a 2-billion-a-year industry. Couples seeking IVF are spending 44,000 to 200,000 to achieve a single pregnancy. Infertility specialists are now the highest-paid doctors, with experienced ones making an average of 625,000 per year.3 Presumably, governments will take a hand in regulating immortality under pressure from one or another class, but regulation need not be arbitrary. If only because so much of the biotechnology of immortalization will have been developed commercially, and bottom-line economics rules, regulations governing immortality and the choice of having immortal children will probably follow the same rules adopted for IVF and surrogacy, namely, regulating...

Technology and Human Dignity

Controversy over artificial means of controlling human life generally settles on two problems (which may be one and the same) objections to human experimentation and to treating human beings as means to ends (objectification).14 I can offer no solution to the problem posed by human experimentation without indulging in self-contradiction, since achieving immortality will inevitably require human experimentation. I would imagine that, contrary to the experience with other forms of cyborgian birthing, such as in vitro fertilization and embryo transfer, experiments with other animals will precede human experimentation.15 Current law would seem to preclude the possibility of using human beings in experimentation on immortality until research on other animals has demonstrated the efficacy and safety of the procedure.

Contemplating Immortal Life

Chances are, the immortals' problems will not be that different from ours. For example, pressure on traditional families and kinship structures will certainly continue following immortalization. Technology, however, will be as much the parent of immortals as mortal parents. But we too have been replacing the family with some more nebulous institution ever since in vitro fertilization and surrogacy were invented. As Lori Andrews, the dean of lawyers specializing in the birth industry, points out, In the Clone Age, it would be possible for a child to have five parents a sperm donor, egg donor, surrogate mother, and the couple who intended to raise the child. 16

On The Applied Side Design Of Culture

Wiest and Squire's analysis separates those who are strongly motivated to avoid pregnancy from people who want to have several children. The researchers suggest that little reinforcement is required to contact family planning agencies if pregnancy is not wanted. In these cases, how to use contraceptives may be the problem and teaching techniques of instruction and modeling could be employed.

Class I The Lanthionine Containing Lantibiotic Bacteriocins

Flucloxacillin Bioavailability

In addition to its widespread use as a food preservative, nisin and other members of the lantibiotic class have been investigated for their potential applications in medicine. The MICs of mutacin B-Ny266 and nisin A were shown to be comparable to those of vancomycin and oxacillin against various bacterial pathogens (Mota-Meira et al. 2000). Both lantibiotics were active against vancomycin- and oxacillin-resistant strains of Helicobacter pylori and Neisseria spp., making them potential candidates for treatment of infections caused by these bacteria (Hancock 1997 Mota-Meira et al. 2000). A novel potential application of nisin is as a spermicidal contraceptive. Studies with rabbits indicated that vaginal administration of 1 mg of nisin stopped sperm motility completely, none of the treated animals having become pregnant (Reddy et al. 2004). Complete histopathologic evaluation of the vagina indicated no adverse effects resulting from the intravaginal application of nisin,

Test Methodology 121 Qualitative Human Chorionic Gonadotropin By Immunoassay

Quantitative hCG tests are more sensitive than qualitative tests, detecting hCG levels at 5 to 10 IU L, and are necessary when ruling out pregnancy before the first menstrual period. This information regarding very early pregnancy is helpful prior to surgery or other potentially harmful medical interventions. Quantitative hCG tests require an automated instrument to read results, often by some labeled immunoassay method, and standard solutions of hCG for instrument calibration and calculation of results. Serial hCG levels are helpful to rule out abnormalities in the pregnancy however, for accurate interpretation of test results, such testing is best performed by the same laboratory using the same methodology.5 In a healthy pregnancy, hCG will double about every 2 days during weeks 2 to 5, while in abnormal pregnancies such as ectopic pregnancies or in impending miscarriage, the hCG levels do not double as quickly or may even decline. Measurement of hCG at 16 to 20 weeks' gestation is...

Intrauterine Adhesions Ashermans Syndrome

IUA should be suspected if a woman presents with secondary amenorrhea, a negative pregnancy test, and does not have progestin-induced withdrawal bleeding. There is no consistent correlation between the menstrual bleeding patterns and the extent of IUA. The diagnosis of IUA should be suspected in every patient with infertility, recurrent abortions, uterine trauma, and menstrual abnormalities. The most common method for diagnosing IUA is the hysterosalpingogram. In cases of severe IUA, the cavity cannot be sounded, making the procedure very difficult to perform. Vaginal ultrasound can be used for the diagnosis of IUA however, it lacks specificity. Sonohysterography is an excellent complement to the vaginal ultrasound and can allow for evaluation of the uterine cavity. Magnetic resonance imaging (MRI) is expensive and does not offer a greater advantage over the other diagnostic modalities. Hysteroscopy allows for direct visualization of the uterine cavity and is considered the gold...

Historical Context

While Galton's pioneering scientific study of twins helped advance knowledge of inborn and learned characteristics, in 1953 James Watson and Francis Crick gave deeper access to life's secrets. They fueled contemporary genetic engineering by deciphering the structure of DNA and by identifying the basic inherited molecular characteristics of life. This event and the plant and animal biotechnical advances since that time are fully described in Bernice Schacter's Issues and Dilemmas of Biotechnology (1999). Since Brave New Worlds 1932 publication, cautionary lessons have been evoked by moralists who fear each significant leap in understanding the biotechnology of creating life. For instance, although the general population took little notice in 1952 when Robert Briggs and Thomas King cloned tadpoles from cells, much later in 1978 there was considerable concern as the first testtube human baby was born through in vitro fertilization, or combining eggs with sperm in a dish, then implanting...

Compliance with New Federal Regulations

The revised guideline, adopted in 1993, withdrew the restriction on the participation of women of child-bearing potential in early clinical trials. It stated instead that, in accordance with good medical practice, women should be counseled against becoming pregnant during the trial and should be advised to take appropriate precautions to avoid pregnancies.

The Histone H3 Variant Nucleosomes

Histone Variants and Infertility Since, H2AX deficient males, but not female mice, are infertile, H2AX could be involved in male infertility (Celeste et al, 2002). The size of the testes of male H2AX- - mice was twofold reduced, the diameter of the seminuferous tubules was smaller and at early pachytene stage the H2AX- - cells showed apoptotic features, pointing that the H2AX spermatocytes were arrested in the pachytene stage of meiosis I (Celeste et al, 2002). An accumulation of -y-H2AX in the sex body (a condensed structure observed in the nuclei of the mammalian spermatocytes at meotic prophase I, which contains the highly condensed X-Y chromosome pair) was also observed (Fernandez-Capetillo et al, 2003). This accumulation did not depend on the meiotic recombination-associated DSB (Fernandez-Capetillo et al, 2003). Importantly, the loss of H2AX resulted in the absence of sex-body and no initiation of meiotic sex chromosome inactivation was detected (Fernandez-Capetillo et al,...

You Will Be Careful as to the Second Article

Smith, who had recently suffered a miscarriage, felt unwell with weakness and the local pharmacist, Mr. Jones, sent in a prescription of nine grains of salicine (willow bark), a useful analgesic, mixed with orange-peel. This arrived at about six o'clock in the evening. The hypothesis that Mrs. Smith was not really ill is supported by the fact that she did not take any of it until seven o'clock the next morning, when Hickson saw her drink half a wineglassful. She said that it seemed to taste unlike previous prescriptions of the same medicine that she had been given by other druggists, but she thought that this may have been because she had also been taking laudanum to treat a pain in her face. The laudanum had given her bad dreams during the night, and she had been terrified by a vision of a madwoman. A few years earlier, M. Duclos was treating another bogus but anxiety-causing nineteenth-century condition, spermatorrhoea.25 Nineteenth-century doctors found...

Ghb With Synthetic Glycogen For Cancerous Cells

376-378, 377f Female infertility causes of, 442-444 endocrine glands involved in, 438 menopause and, 442, 443 physiology of, 438-441, 439f, 441f sex steroids involved in, 436-437, 437f treatment of, 443 FEn (fractional excretion of sodium), 214 Ferritin, 181-182 deficiency of, 193f, 194t lead inhibition of, 187, 188f Fertility, problems with. See Infertility Fertilization definition of, 270 Inference studies, 67 Infertility In utero fetal testing, 449 In vitro fertilization, 443 In vitro stability, of specimens, 48 Instrumentation, 102. See also specific instruments

Conclusion Chlamydia pneumoniae Chronic Nonspecific Lung Disease Cnsld And The Dutch Hypothesis

It is now well established that acute Cpn infection can cause acute bronchitis and pneumonia(149,150) and additional evidence presented herein suggests that lower respiratory tract illnesses caused by acute Cpn infection can develop into asthma and chronic bronchitis.(8,151) Chronic Cpn infection has also been associated with a wide variety of chronic upper-airway illnesses(152,l53) as well as with the spectrum of acute and chronic lower-airway conditions including acute bronchitis,(154) asthma and COPD.(81) Taken together, these data suggest a role for Cpn in the entire spectrum of respiratory illnesses embracing the natural history of CNSLD.(19,20,155) Just as early identification and treatment of genital chlamydial infection of women is required to prevent the occurrence of pelvic inflammatory disease and tubal infertility, and timely treatment of eye infection in children is required to prevent blinding trachoma, early identification and treatment of Cpn infection in chronic...

Functional Anatomy of White Adipose Tissue

University discovered the gene of obesity 8 their subjects were mice, which in the 1950s had developed a spontaneous mutation resulting in hyper-phagia, infertility and reduced activity of the sympathetic nervous system, and consequently in early, massive obesity (ob ob mice) 9 .

Pregnancy Tests And Early Markers Of Problems

What early markers are there for problem pregnancies such as ectopic, trophoblastic, or multiple pregnancies or threatened miscarriages Quantitative hCG tests are used in conjunction with history, physical examination, and ultrasound for detecting abnormal pregnancy, such as ectopic pregnancy, or miscarriage. There is an exponential increase in hCG early in a normal pregnancy. In ectopic or misplaced pregnancy, the hCG value may continue to increase but not to a level as high as that for a normal pregnancy, while fetal demise and impending miscarriage are indicated by leveling off or falling of hCG levels. Trophoblastic diseases such as hydatiform mole result from the demise of the fetus but with an abnormal growth of remaining trophoblastic cells causing higher than normal levels of hCG. Ultrasound and other imaging techniques will indicate grapelike clusters of watery sacs instead of a fetus. Multiple fetuses, including twins, will result in hCG levels higher than those expected for...

The Use Of alloBmt For The Treatment Of Cancer

Our preliminary experience seems promising and suggests that allogeneic nonmyeloablative stem-cell transplantation may result in complete elimination of malignant or genetically abnormal host cells with no or minimal procedure-related toxicity and mortality 84 . For young patients, in contrast to myeloab-lative allogeneic BMT, allogeneic nonmyeloablative stem-cell transplantation may reduce the incidence of growth retardation and infertility which stems from the unique sensitivity to chemoradiotherapy of the growth centers in the bones, the gonads and testicles. For elderly individuals with a matched donor available, who were denied alloBMT until recently, nonmyeloablative stem-cell transplantation may offer an option for cure with no upper age limit. It remains to be seen whether a similar therapeutic approach can be developed for patients with matched unrelated donors and for patients with no matched donors, as well as for malignancies other than those originating in hematopoietic...

Testicular Tissue Harvesting

Although spermatogenesis does not occur in prepuber-tal testes, and prepubertal testes do not produce mature spermatozoa, these do contain the diploid stem germ cells from which haploid spermatozoa can be derived. Therefore, testicular tissue can be harvested from a biopsy and stored either as a tissue section or as isolated germ cells, before cancer therapy. Following cure and on entering adulthood, this tissue can be thawed and used to produce offspring in either of the two ways the stored germ cells can be re-implanted into the patient's own testes to restore natural fertility, a procedure known as germ cell transplantation, or the stored stem cells can be matured in vitro until they are able to achieve fertilization via ICSI.47 Although these two measures have been the subject of intensive research in the last decade, further refinements in the protocols may still be needed before they can be used routinely in clinical practice. In vitro maturation In vitro germ cell maturation...

Effect Of Malignancy Treatment On Fertility

Young patients with a hematological malignancy are often treated with bone marrow transplantation (BMT).22 During BMT, patients may be given alkylating agents and receive total body irradiation for conditioning, both of which result in POF, hormonal disturbances, and eventually, infertility.23 Long-term female survivors treated with total body irradiation and BMT are at risk for ovarian follicular depletion and impaired uterine growth and blood flow, in addition to early pregnancy loss and premature labor if pregnancy is A study that documented the late effects associated with treatment of early Hodgkin's lymphoma revealed that 43 191 men and 16 149 women had sought medical advice for infertility, while 57 191 men and 54 149 women were able to parent children. In addition, sexual activity was disrupted in 25.8 of cases.26

Clinical Approach

Long-term complications of salpingitis include chronic pelvic pain, involuntary infertility, and ectopic pregnancy. The risk of infertility due to tubal damage is directly related to the number of PID episodes. The intrauterine contraceptive device (IUD) places the patient at greater risk for PID. whereas oral contraceptive agents (progestin thickens the cervical mucus) decrease the risk of PID.

Differences in Body

Differences in body fat arise at puberty when young women begin to store fat in their stomach, buttocks, and legs. This, in addition to skeletal differences, gives women's bodies their curvy shape. Men usually carry their fat in the abdomen. Overall, women have about 10 more body fat then men, which is necessary to maintain fertility. As we discussed in Chapter 2, body fat is required for female fertility because a hormone called leptin, secreted by fat cells, tells the brain if there are enough fat stores to support a pregnancy. When a female does not have enough body fat, the hormones that regulate menstruation are blocked and menstruation ceases. Lack of menstruation can be permanent and results in sterility and bone damage. Excessive exercise or starvation that leads to the cessation of menstruation, called amenorrhea, causes permanent damage when the estrogen that normally increases prior to ovulation is not produced.

Chemotherapy Regimens Mopp and MOPP derivatives

Long-term toxicities were of even more serious concern. Most patients experienced infertility after treatment with MOPP. Males had at least an 80 risk of permanent azospermia after MOPP, while 50 of females experienced gonadal failure.4748 The risk appeared lower with patients younger than 25 years of age however, accelerated early menopause seemed to be the case in every female who did recover her menses after treatment.46 At a time when sperm banking and oocyte cryopreservation were in their early stages, many young patients, though cured, experienced significant psychological repercussions due to their infertility.

Clinical Symptoms and Evaluation

Testicular tumors most commonly present as a firm to hard painless mass. Occasionally, scrotal swelling and acute pain (10 ) may be present. The presence of acute pain increases the likelihood of infection, trauma, torsion, and infarction, but does not rule out tumor or tumor in addition to another diagnosis. A history of trauma is present in 30 of cases. Carcinoma in situ most commonly presents in patients being evaluated for infertility. Germ-cell tumors present more commonly in patients with a history of cryptorchidism and testicular atrophy. Patients with either condition should have both testicles carefully evaluated periodically. Carcinoma in situ occurs in 5 of testes corrected for non-descent and in 5 of the contra-lateral testes in patients with a primary testicular germ-cell tumor. In children, up to 20 of cases are associated with hernia or hydrocele. Tran-sillumination will assist with diagnosis of the hydrocele, but does not rule out the co-existence of tumor.

Gonadal Toxicity Following Malignancy Treatment

Histological sections of ovaries exposed to cytotoxic drugs show a spectrum of changes, ranging from reduced number of follicles to no follicles and fibrosis.15 The exact incidence of premature ovarian failure (POF) after chemotherapy is difficult to establish because there are many contributing factors. Depending on the type of chemotherapy regimen used, the incidence of amenorrhea ranges from 0 to 100 .16 Cytotoxic drugs may impair follicular maturation and or deplete primordial follicles.1517 Temporary amenorrhea occurs when cytotoxic drugs destroy maturing follicles,

Epithelial Ovarian Cancer Surgical and Staging Considerations

Ranted, as this may lead to adhesion formation and decreased fertility. It may be acceptable to preserve a normal-appearing uterus in early-stage disease even if both ovaries are removed, thus preserving the option of donor egg conception. Although these approaches are controversial, fertility-sparing surgery for true early-stage ovarian carcinoma appears to be a viable option if the patient is adequately counseled about fertility preservation and recurrence risk 21 . One exception to this may be for clear-cell histology, which may connote a significantly more aggressive tumor, contra-indicating conservative surgery 50 . In addition, consideration should be given to surgical removal of the contralateral ovary once childbearing is complete 21 .

Ethical And Legal Issues

Informed consent should be given voluntarily by a competent person. However, in view of the complexity of the issues surrounding fertility preservation, the anxieties of both patients and their families at the time of diagnosis, and the limited time for discussion due to

Psychosocial and Supportive Care

Most patients are in a relationship or hope to be in one. However, the relationship will be tested by the strain of the cancer diagnosis and its therapy. Patients may wonder whether the partner stays in the relationship out of guilt or sympathy. Some significant others may feel ignored by medical staff because they are not formally a family member. After treatment, commitment to the relationship in the face of fear of relapse or infertility can be difficult for both parties. Those contemplating having children often worry about passing on a genetic predisposition to cancer.

Balancing the risk and Benefits of RT in adolescent and young adult Patients

Spinal RT (CrSp) in this group are considerable, and include secondary hypothyroidism, growth hormone deficiency, and in girls, either precocious puberty or incomplete pubertal development, as well as risking infertility from irradiation of the hypothalamus, pituitary, and ovaries. Irradiation to the vertebrae will result in failure of these bones to grow during the adolescent growth spurt, causing loss of up to 5 cm in height this is unresponsive to growth hormone therapy.

Expected Outcome including Late Effects

Impairment of growth rates after busulfan cyclophosphamide or cyclophosphamide total body irradiation (TBI) conditioning regimens is a problem in children treated before or during their growth period. Gonadal toxicity is seen in all age groups, mainly as gonadal dysfunction however, it is relatively low with modern conventional therapy 44 . Gonadal toxicity may cause disorder of pubertal development, infertility, sexual dysfunction, and the need for long-lasting hormone substitution. In adult women, high doses of alkylating agents and TBI increase the risk of ovarian failure and the probability of restoring the ovarian function decreases by a factor of 0.8 per year of age 46 . The addition of busulfan to cyclophosphamide causes permanent ovarian failure in nearly all female patients. In males the effects of both cytotoxic chemotherapy and TBI will damage the germinal epithelium of the testis, and for the majority of males in all age groups, permanent...

Ethical And Emotional Aspects

Some specific points need to be discussed clearly. Many patients are afraid they will transmit the leukemia to their partner or family members. They need to be reassured that CLL is not infectious or transmissible. Younger patients also need to know that birth control should be practiced during chemotherapy because of the potential effects of purine analogs and intensive chemotherapy on the fetus. Information on the substantial risk of transient or permanent infertility after chemotherapy should also be given. Thus, patients aware of the life expectancy related to the diagnosis of CLL who wish to procreate should be informed about procedures to circumvent sterility. Only anecdotial cases concerning pregnancy during CLL have been reported (52). Thus, relatively limited information on the risks for the child and for the affected patient is available.

The Team Approach

Fetus, such as chromosomal abnormalities incompatible with life.9 Miscarriage can also result from hormonal fluctuations, including inadequate levels of progesterone or estrogens that are necessary for maintenance of the uterine lining. A sudden drop in progesterone levels will cause the endometrium to slough, evacuating the embryo and causing menstruation to begin. This may happen early before pregnancy is suspected and, if it occurs repeatedly, may be the cause of infertility.1,10


Age must be recorded because some conditions are more common at certain ages for instance, pregnant women younger than 17 years or older than 35 years are at greater risk for preterm labor, preeclampsia, and miscarriage. b. Gravidity Number of pregnancies including current pregnancy (includes miscarriages, ectopic pregnancies, and stillbirths).

Clinical Pearl

Chief complaint What is it that brought the patient into the hospital or office Is it a scheduled appointment or an unexpected symptom, such as abdominal pain or vaginal bleeding in pregnancy The duration and character of the complaint, associated symptoms, and exacerbating and relieving factors should be recorded. The chief complaint engenders a differential diagnosis, and the possible etiologies should be explored by further inquiry. For example, if the chief complaint is postmenopausal bleeding, the concern is endometrial cancer. Thus, some of the questions should be related to the risk factors for endometrial cancer, such as hypertension, diabetes, anovulation, early age of menarche, late age of menopause, obesity, infertility, nulliparity, and so forth.

Risk Factors

A blended family (the marriage of two previously married individuals who often bring their children from their previous marriages in this new union, and then may have children in this marriage), a rather uncommon phenomenon in the earlier decades of the 20th century, became a relatively common type by the end. In 1967, only 12 of families were blended, which rose to 25 by 1997. This is a direct consequence of the meteoric rise in the rate of divorce and remarriage over the past 40 years. Apart from these larger trends in family composition, no discussion on this topic can be complete without addressing some family types that were either socially taboo or medically impossible not so long ago. These include children born to couples with fertility problems, gay couples with children, an increasing mix of interethnic and interreligious marriages, and so on. Families with adopted children fall into a category of their own. Infertility affects 15 to 20 of all married couples in the United...

Other Products

Follicle stimulating hormone is used for the treatment of infertility. Follistim (Organon) and Gonal (Serano) obtained approval in 1997 and 1998, respectively, for stimulation of ovulation during assisted reproduction. CHO cells are used for the production of both products.


Who could have predicted that in a short period of 25 or 30 years the nuclear family would have fallen from its pivotal position, that nearly 30 of the adult population would live in one-person households, that the stigma associated with children born out of wedlock would disappear, that divorce and remarriage would become commonplace, that single-parent families would become dominant, that living in common-law marriages would have legal sanction, that same-sex couples would gain some recognition and acceptance, and that dazzling technological advances would begin to reverse infertility and give rise to new types of families These and other less prominent phenomena, such as single women choosing to have babies in their late thirties or even early forties, are current realities. A case can be made that the family therapy literature, at least in part, has not entirely kept pace with the rapid and dramatic changes in family structure in recent times. This chapter has identified this...

Cell Based Therapy

Sperm are incubated with a fluorescent dye that generically binds to DNA, the fluorescence intensity is considerably higher from X chromosome-bearing sperm than that from those sperm containing a Y chromosome (Fig. 5). As such, X-bearing sperm can be separated in bulk and used for in vitro fertilization to greatly enhance the chances for female offspring. In humans, the difference in DNA content between X- and Y-bearing sperm accounts for an approximately 2 difference in overall DNA content, and hence fluorescence signal detected by flow cytometry. Indeed this method has been employed for the use of gender-selection in the case of families with known X-linked diseases, and to assist with family balancing , sparking ongoing ethical debate.

Stem cells

Most of the fundamental research on stem cells was done on embryonic or embryonal stem (ES) cells obtained from mouse preembryos or blastocysts and raised in tissue culture. These cells could differentiate into virtually any adult mouse cell upon reintroduction into developing mouse blastocysts. But, in the November 6, 1998 issue of the weekly science magazine, Science, the team led by James Thomson at the University of Wisconsin with funding from Geron Corporation of Menlo Park, California, announced that it had isolated and cultured human ES cells from 20 of 36 human blastocysts left over from in vitro fertilization.65 Thus, a virtually endless supply of human stem cells became available for research. Commons approved 366 to 174 new rules allowing scientists to derive and use stem cells from human embryos and perform experiments with nuclear transfer.68 In the United States, the National Bioethics Advisory Commission recommended easing the strictures on research utilizing human...


Consideration must be given to the patient's risk of becoming pregnant. Whenever any risk is identified, the patient should be counseled regarding the availability of hormonal and intrauterine methods of emergency contraception the most suitable method will depend on the patient profile and the time since the assault (198). When patients elect for insertion of an intrauterine contraceptive, they should be given prophylactic antibiotics (see Subheading 13.4.) either in advance of or at the time of the fitting. Follow-up appointments should be made at a convenient venue where pregnancy tests are available. Should the patient become pregnant because of the assault, she must be referred for sympathetic counseling. If the pregnancy is terminated, it may be relevant to seek permission from the patient for the products of conception to be retained for DNA analysis.

Box 372

X Studies in animals or human beings have demonstrated fetal abnormalities, or there is evidence of fetal risk based on human experience, or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug contraindicated in women who are or may become pregnant.

False Confessions

During the last two decades, the United Kingdom has witnessed several well-publicized miscarriages of justice in which the convictions depended heavily on admissions and confessions made to the police that were subsequently shown to be untrue (46-48). In reviewing 70 wrongful imprisonments that occurred between 1950 and 1970, Brandon and Davies (49) found that false confessions were second only to incorrect identification evidence as the most common cause of wrongful conviction. More recently, in 1994, Justice (50) identified 89 cases in which an alleged miscarriage of justice rested on a disputed confession. Thus, it is clear that people can and do make false and misleading admissions against their own interest. We must turn to modern psychology to obtain insights into why this may happen.

Planning a Pregnancy

One of the best ways to achieve a healthy pregnancy outcome is to actively plan for pregnancy and enter pregnancy in good nutritional health. A critical time for nutrition is the periconceptional period the 2 months just before and the 2-3 months after conception. Fetal development occurs rapidly after conception and most organs are formed in the first 8-10 weeks of pregnancy, before many women realize they are pregnant. During this period the tiny embryo is particularly vulnerable to alcohol, environmental toxins, drugs, maternal medications, and nutritional deficiencies. Deficiencies of thiamine, riboflavin, vitamin B12, vitamin A, zinc, and folic acid may increase risk of abnormal fetal development, miscarriage, and birth defects.1


Women who are overweight are also at higher risk for a poor pregnancy outcome. In women weighing more than 130 of their ideal body weight serious complications, such as diabetes and hypertension during pregnancy, are more common. Weight loss during pregnancy, even in very obese women, is dangerous for the fetus, thus overweight women should try to lose weight before becoming pregnant. However, crash diets for rapid weight loss should be avoided because they are low in important micronutrients, such as folic acid, zinc, and iron.

Fetal Growth

In the first 2 months after conception - the period of embryogenesis - the fetus develops very rapidly. By 9 to 10 weeks after conception, although the fetus weighs only about 6 g, all of the major organ systems are present, the heart begins to beat, and the fetus begins to move. Optimum, balanced nutrition is very important during this period - the embryo is extremely vulnerable to changes in nutrient supply and adverse effects from environmental toxins. Absence of micronutrients (e.g., fo-late and zinc) during this critical period may impair development and produce a birth defect or cause miscarriage.1 During this stage the pregnant woman should be very careful to avoid environmental hazards (e.g., alcohol and cigarette smoke) and to eat a micronu-trient-dense, high-quality diet.2


Pregnant women should limit their intake of caffeine. Metabolism of caffeine is slowed during pregnancy - caffeine takes two to three times longer to be metabolized and excreted - so levels in the maternal blood are elevated for longer periods. Caffeine readily passes through the placenta to the fetus. Ingestion of more than 300 mg caffeine day (more than three cups of coffee) during pregnancy may be harmful to the fetus - impairing growth and development and increasing risk of miscarriage.10 Even at lower levels of intake (about two cups of coffee), caffeine constricts the blood vessels in the placenta. This can restrict blood flow through the placenta and reduce the supply of oxygen and nutrients to the fetus.10 Pregnant women should limit or eliminate their caffeine intake by avoiding coffee, black tea, chocolate, and colas.


About one-third of pregnant women in the USA and Western Europe are smokers, and mothers who smoke are at increased risk for premature delivery and miscarriage. Children of mothers who smoked during pregnancy may have long-term impairments in physical growth and intellectualperformance. These adverse effects are dose-dependent - the greater the number of cigarettes smoked during pregnancy, the greater the likelihood of harm. Smoking may reduce blood flow through the placenta and restrict oxygen and nutrient flow to the fetus. Smoking can deplete maternal stores of zinc, vitamin C, vitamin B6, folate, and vitamin B12. Levels of vit-

Toxicity Evaluation

(iii) prenatal and postnatal studies. The study is needed to determine the effect of a given drug on gonadal function, estrus cycles, mating behaviour, conception rates and early stages of gestation. The observations recorded are number and distribution of embryos in each uterine horn, presence of empty implantation sites, embryo undergoing resorptions, abnormal condition in the uterus, gestation period, litter size, stillborn, litter weight, gross anomalies.

Wound Healing

Repair occurs when the wound involves mesenchymal connective tissue. The predominant matrix component of connective tissue is collagen and the major cell type is the fibroblast. Skin, the largest organ in the body, is composed of both ectodermally and mesodermally derived layers. The dermis is derived from the mesoderm and when the dermis is damaged it will attempt to heal by the process of repair. The outcome of repair is scar tissue. This is obvious in the skin and produces both deformity and disability. Scarring does, however, have widespread effects throughout the body resulting in an extensive range of morbidity. Connective tissues, which produce the scaffolding for specialized organ tissues, can be deformed and distorted by the process of scarring and can result in respiratory dysfunction due to lung parenchymal fibrosis, liver dysfunction due to cirrhosis, renal dysfunction due to post-glomerulonephritic scarring, adhesions in the bowel after surgery,...

Sexual function

Today, we can offer drugs and different stimulations in order to improve erectile function and to produce an anterograde ejaculation. Vibration and electro-stimulation need careful monitoring of blood pressure since these methods readily evoke autonomic dysreflexia. By the means of vibration and electro-stimulation in combination with insemination or in vitro fertilization, men after spinal cord injury can become fathers. At our Spinal Cord Injury Unit, with 35-50 newly injured patients admitted every year, we have about 75 children who have cord-injured fathers (Agneta Siosteen, personal communication).

Case Scenario 122

Infertility and Polycystic Ovarian Disease String of Pearls in a Bearded Lady The special chemistry section received laboratory requests for the following hormones total testosterone, free testosterone, FSH, midfollicular LH, mid-follicular prolactin, androstenedione, DHEAS, dihydrotestosterone, andro-standiol glucuronide, and sex hormone-binding globulin. Many of these laboratory tests were to be sent to a reference laboratory. The referral database was consulted so that the correct type of specimen was collected and proper storage and handling conditions were met prior to performing the tests at the reference laboratory. The patient was a 23-year-old African-American female with a preliminary diagnosis of hirsutism and infertility. Previous laboratory results showed a slightly elevated 8 00 a.m. plasma cortisol level but a low-dose dexamethasone test showed normal cortisol suppression. The following laboratory results were obtained initially from the special chemistry section

Rehabilitation Goals

Diagnostic or therapeutic procedures, and the necessity of hospital attendance for regular follow-up. Furthermore, support in terms of planning a future life independent from the parents,job training, choice of employment, sexuality, and family planning can be of great importance. Especially in adolescence, promoting acceptance of the disease can constitute an essential rehabilitation goal, as restricted acceptance may result in inefficient disease management.

Quality Assessment

As described earlier in this chapter, FSH, LH, and estradiol levels fluctuate dramatically during the ovulatory cycle of a normal adult female. In an average 28-day cycle, FSH levels begin to rise by day three, stimulating the ovary to release estradiol and the pituitary to release LH. These hormones stimulate ovulation at mid-cycle and development of the corpus luteum for potential fertilization. Usually at midcycle, there is a peak of circulating FSH, LH, and estradiol concentrations as well as increased clinical signs of ovulation, such as a slight increase in basal body temperature and cervical mucus production. It is generally a complex interaction of hormones and physical changes that allow for ovulation and then fertilization of an oocyte by sperm. Fertility testing involves assessing many of these aspects. Test Methodologies 12-4 and 12-5 describe methods of analysis for LH and FSH, respectively.

Alkylating Agents

Systemic adverse effects of alkylating agents include nausea and vomiting, and bone marrow depression (delayed with carmustine and lomustine), cystitis6 (cyclophosphamide, ifosfamide) and pulmonary fibrosis (especially busulfan). Male infertility and premature menopause may occur. Myelodysplasia and secondary neoplasia are particularly associated with alkylator therapy (due to sublethal damage to normal cells) especially when accompanied by radiotherapy. These agents are used widely in the treatment of both haemato-logical and nonhaematological cancers, with varying degrees of success.


Cloning Dolly

Inevitably, individuals are no more likely to see their clones as themselves as they are likely to see their offspring, as currently conceived, as themselves. The break between nuclear donor and clone is just as large as the break between parents and ordinary offspring, especially since the clone would develop in utero much the same way as any normally fertilized egg or an egg following in vitro fertilization and embryo transfer to a prenatal foster mother or surrogate. Furthermore, no matter how much one's clone looks and behaves like oneself as an infant, one's own ego is likely to balk and leave one unable to identify one's clone with oneself as an adult. In the final analysis or moment, one is unlikely to go quietly into that gentle sleep believing that one's clone is oneself.

Two or More Proteins

Protein components of the complex (bikunin) and heavy chains 1 (HC1) and 2 (HC2). HC1 and HC2 are attached via ester linkages near the nonreducing end of the CS chain. This is more than a merely unusual structure the side proteins are transferred from the CS linker to hyaluronan (Rugg et al., 2005), forming a complex that is essential for ECM formation in some critical tissues such as the cumulus oophorus. Without the presentation of HC1 and HC2 by CS-bikunin this complex cannot form, resulting in infertility. So far, no examples of covalent CS cross-linking outside the ITI family have been described.

A HHS Regulations

Subparts B, C, and D set out additional protections that apply, respectively, to research, development, and related activities involving fetuses, pregnant women, and in-vitro human fertilization, biomedical and behavioral research involving prisoners as subjects, and those applying to children as subjects in research.

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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