Natural Infertility Treatments

The Pregnancy Miracle Ebook

Lisa Olson is the author and creator of The Pregnancy Miracle, a book containing holistic methods that is designed to help infertile couples get pregnant naturally and become parents. Lisa is a licensed nutritionist, health consultant and medical researcher, who herself, was a former infertility sufferer. In this system you will discover how you can reverse each and every cause of infertility and get pregnant safely and naturally without using any drugs, without risking your health with typical infertility treatment, without any risky surgery and without any side-effects. The Pregnancy Miracle Book is amazing opportunity for you and your partner to educate yourself with everything you need to know to conceive the baby of your dreams. It is a wonderful fertility product for an affordable price and all the thousands of happy couples and families out there are proof that it works. Read more here...

Pregnancy Miracle Summary

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Author: Lisa Olson
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Highly Recommended

The author has done a thorough research even about the obscure and minor details related to the subject area. And also facts weren’t just dumped, but presented in an interesting manner.

When compared to other e-books and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

Assisted reproduction

Artificial insemination (using the husband's semen) has been available from the late eighteenth century, and donor insemination since 1884. Its psychological effects on the marriage seem minimal husbands rarely react with jealousy to the birth of the baby, any more than to an adopted child. The proof that the experience is acceptable is that it is often repeated. One of the principles of treatment is privacy, ensuring that donor and couple never meet and remain ignorant of each other's identity. It is felt that violating anonymity might compromise the marriage, since donor and mother are too deeply involved in procreation to regard their relationship with detachment but times may be changing nowadays couples often confide their involvement in donor insemination. The interests of the children also have to be considered donor insemination obscures the genetic lineage, and they will never know their genetic history or be able to benefit from modern advances in genetics. In vitro...

In Vitro Fertilization of Ciona intestinalis Ascidia

Many species of ascidian have been studied by developmental biologists here we cover only C. intestinalis. This species is cosmopolitan and common in the United Kingdom it is abundant in the vicinity of several major marine biology laboratories, including Plymouth, Southampton, and Millport. As with many other ascidian species, if adults are kept in constant illumination, they can be induced to spawn by moving them to the dark (2) animals can also be kept in the dark, and spawned by moving to the light. An alternative procedure to obtain embryos involves in vitro fertilization using gametes obtained by dissecting gonoducts. This method is convenient, since embryos can be obtained immediately after collection of animals. They can be spawned throughout the year or throughout summer in northern Europe.

Fertilization by ICSI and Embryo Culture

ICSI is a robust efficient fertilization procedure in the monkey resulting in high pronuclear formation rates (80-90 ). 3. Adjust sperm concentration to 1 x 106 motile spermatozoa per milliliter in TH3 medium and store for approx 3 h at room temperature before ICSI. 4. The ICSI procedure is conducted on an inverted microscope equipped with Hoffman optics, heating stage (set at 37 C), and micromanipulators. 7. Fill the ICSI micropipet completely with light paraffin oil and then attach it to a Milli-Q water filled Narishige pipet holder and Teflon tubing that extends to a 200- L volume Hamilton microsyringe controlled by a microinjector (Narishige). The line, microsyringe, and ICSI micropipet must be completely free of air bubbles. 11. Lower the ICSI pipet into the sperm drop and select a motile sperm, which is immobilized by striking the midpiece with the tip of the pipet, and slowly aspirated into the pipet tail first. 15. Bring the ICSI pipet into sharp focus at the 3-o'clock...

Infertility

Motherhood is among the strongest and most universal of motivations. For many infertile women, childlessness is the most upsetting experience of their lives, and the yearning for children dominates everything. Infertile couples often suffer from self-reproach over sexual indiscretions, abortions, contraception, or venereal disease. It is especially difficult to deal with the envy of fertile couples contacts with other people's children, family celebrations, and pregnancies in relatives and friends become crises. The security of the marriage may be threatened by the fear that the spouse will desert to a fertile partner nevertheless, the marriages themselves are often happy. Infertility differs from other stresses in its duration. The psychological reaction unfolds over years. When treatment begins, there is a cycle of optimism and hope, with a build-up of tension towards the end of the cycle, followed by disappointment and despair. Sexual functioning comes under strain during the...

Stem Cells Cloning and Related Techniques Offer Exciting Possibilities but Raise Some Concerns

The ability to make and manipulate mammalian embryos in the laboratory has led to new medical opportunities as well as various social and ethical concerns. In vitro fertilization, for instance, has allowed many otherwise infertile couples to have children. A new technique involves extraction of nuclei from defective sperm incapable of normally fertilizing an egg, injection of the nuclei into eggs, and implantation of the resulting fertilized eggs into the mother.

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.

Significance Of Impurities In Water For Use In Cell Culture

The potential adverse effects of endotoxins on cell culture have been widely reported (see Case Gould 1984). Dawson (1998) produced an interesting review, highlighting the wide range of effects and great variation in sensitivity of even parent and daughter cell lines. A series of papers describing the interactions of endotoxins with cells are included in Levin et al. (1993). Nagano et al. (1999) reported the beneficial results obtained by eliminating endotoxins from water for preparing protein-free media for the culture of bovine embryos. Endotoxins are well known to have deleterious effects on in-vitro fertilization, see for example Fukuda et al. (1986) and Dumoulin et al. (1991). Cotton (1994) and Weber (1995) both reported that the presence of

Systemic Radiation Therapy

Treatments are usually well tolerated without causing long-term effects, such as cancer or infertility. Several ongoing and new initiatives to explore the use of targeted therapy to be used as conditioning regimens for bone marrow transplant instead of nonspecific total-body irradiation show strong potential for reducing the side effects associated with the transplant process.51

Determinants or causes of death

New technologies are not necessarily beneficial, as sex-selection procedures and inappropriate assisted reproduction show. The way they contribute to adverse pregnancy outcomes is not captured in current methods of collecting, analysing or presenting perinatal data. It has long been known that multiple pregnancy is associated with greater risk for both the mother and the fetus, when compared with singleton pregnancy. Up to one half of twins and almost all triplets are born preterm and die at higher rates than term infants (10). Data from Demographic and Health Surveys (DHS) for 1990-2000 (11) show that, in less developed countries, the risk of neonatal death in multiple births, when compared with single births, was about six times higher in the neonatal period (range 3-15), and gradually decreased to 2.2 in the postneonatal period, and to 1.4, in the age group 1-4 years. The incidence of multiple births varies according to the region, the country and the availability of technology. In...

Nuclear Transfer Protocols

Nuclear Transfer Protocols Cell Reprogramming and Transgenesis is a comprehensive review of nuclear transfer technology in vertebrates, aimed at reprogramming differentiated nuclei and effecting targeted gene transfer. The authors provide readily reproducible techniques for the generation of cloned embryos and animals in a number of key research and commercially important vertebrates. Additional chapters provide alternative cutting-edge methods for nuclear transfer, such as zona-free nuclear transfer. Of immense benefit are descriptions of procedures associated with cloning, such as in vitro maturation of oocytes, activation and culture of cloned embryos, maintenance of pregnancy, and neonatal care of clones.

CASE 3 Euthanasia as an Ethical Question in Pharmacy Practice

How do we interpret the principles to respect autonomy, respect democracy, and avoid harm in this controversial subject And is this really a new question Does anyone remember the discussion about sexual morality and oral contraceptives in the 1960s Or look at the debate about xenotransplantation today, about IVF, the cloning of animals, and experiments with embryos. Many people have the illusion that moral philosophy could be of some use in finding guidelines for practical behaviour. But if we accept that no one philosopher can define a particular truth other than from the cultural perspective, then it is a mistake to look to the moral philosopher for guidance.

Combinations of risk factors

Major depression in women suggest that genetic influences may alter the sensitivity of individuals to the depression-inducing effect of adverse life events (Kendler et al., 1995). In other cases, it seems as if people act in ways that increase their likelihood of adversity, a pattern which in turn increases their risk of depression. One of the best-known examples of this phenomenon comes from the research of Brown et al. (1986) with inner-city young women. They found that women who had experienced lack of care during childhood (such as abuse) were more likely to become pregnant while young. In turn, early pregnancy increased the risk of other forms of adversity, such as marrying an abusive partner. These later forms of adversity were strongly associated with depression.

Clinical Utility of Testing

Prenatal diagnosis for galactosemia can provide the opportunity for immediate dietary restriction of the newborn. Although galactosemia is considered treatable, symptoms such as mental and growth delays, speech dys-praxia, abnormal motor function, and premature ovarian failure in women may still occur even with early intervention and lifetime dietary restrictions. These long-term phe-notypes are often associated with specific mutations for example, Q188R can cause premature ovarian failure and speech dyspraxia. Genetic counseling is very important for parents of affected fetuses before a choice regarding pregnancy outcome is made.

Nuclear Transfer in Nonhuman Primates

The nonhuman primate is a highly relevant model for the study of human diseases, and currently there is a significant need for populations of animals with specific genotypes that can not be satisfied by the capture of animals from the wild or by conventional breeding. There is an even greater need for genetically identical animals in vaccine development or tissue transplantation research, where immune system function is under study. Efficient somatic cell nuclear transfer (SCNT) procedures could provide a source for genetically identical nonhuman primates for biomedical research. SCNT offers the possibility of cloning animals using cultured cells and potentially provides an alternative approach for the genetic modification of primates. The opportunity to introduce precise genetic modifications into cultured cells by gene targeting procedures, and then use these cells as nuclear donors in SCNT, has potential application in the production of loss-of-function monkey models of human...

Laparoscopic Oocyte Recovery

Oocytes are collected by laporascopic follicular aspiration 27-33 h after hCG injection (9) via transabdominal needle aspiration of gravid ovarian follicles. Laparoscopy plays a prominent role in the IVF laboratory, with most surgical procedures accomplished by this methodology.

Radioiodine Complications

Neck edema, nausea, and gastritis (95). The salivary glands concentrate iodine and sialoadenitis may occur in about 30 of patients treated with radioiodine (96). It is characterized by pain, tenderness, and swelling of the salivary glands. Some patients suffer from reduced salivary gland function for more than one year after therapy with I-131. The use of lemon juice or lemon candies and abundant water ingestion reduces the incidence and severity of sia-loadenitis and reduces absorbed radiation dose to the salivary glands. Recently, a study indicated that an early start of sucking lemon candy may provoke an increase in salivary gland damage suggesting that lemon candy should not be given until 24 hours after therapy with I-131 (97). The use of amifostine may reduce significantly the damage to salivary glands, mainly when high doses are administered (98). Radiation thyroiditis and neck edema (99), when symptomatic, are usually treated with nonsteroidal anti-inflammatory drugs, or with...

The impairment of hypothalamicpituitarygonadal function

These abnormalities signify that the patient is infertile and remains so until endocrine function recovers. Pregnancy occasionally occurs as the patient is still underweight and improving but before the appearance of the first menstrual period. (81 The pregnancy carries a risk of poor fetal growth during the first trimester, albeit with some 'catch-up' growth during the neonatal period.(82) Occasionally an underweight anorexic patient may seek treatment at an infertility clinic. Treatment with gonadotrophin-releasing hormone may restore fertility, but this practice has been severely criticized. (83)

Clinical Studies in Special Risk Groups

A similar dilemma exists concerning use of medicines in pregnancy. Some medical conditions spontaneously improve in pregnancy, but many do not and require ongoing treatment. Alternatively a patient may be established on medication and be likely to become pregnant should they take contraceptive precautions or is the safety acceptable However, the human foetus is known to be sensitive to exogenous compounds, and safety of both mother and baby is paramount. Clinical studies in pregnancy, and the collection of data from pregnant women, have to be on a case-by-case basis, subject to a very careful assessment of benefits and risk. As always, adequate informed consent is essential. The potential risk to the individuals is hard to balance against the potential longer-term benefits to society or the wider patient population.

Extraction Of Subcellular Compartments From Single Cells

In contrast to optical trapping where damage to the sample is minimized, laser surgery, or laser ablation, relies on the capability of lasers to physically alter or damage the sample and is commonly employed in well-known biomedical procedures (Niemz, 2004 Berns et al., 1991 Srinivasan, 1986 Vogel and Venugopalan, 2003). More applicable to this chapter is the use of laser surgery in microscale applications, such as laser capture microdissection, in vitro fertilization, and procedures on single cells (optoporation, injection, or lysis). Laser ablation can occur under more than one mechanism (Srinivasan, 1986 Vogel and Venugopalan, 2003). Photoablation involves the absorption of light by molecules in the

Establishing the estimation dataset of available data

E Macro International Inc., an Opinion Research Corporation company, (ORC Macro) is headquartered in the Washington, DC area. The MEASURE DHS project is funded by USAID and implemented by ORC Macro in partnership with Johns Hopkins University Bloomberg School of Public Health Center for Communication Programs (Hopkins CCP), PATH, Casals & Associates and Jorge Scientific Corporation (JSC). As a key participant in the MEASURE program, the Demographic and Health Surveys (DHS) project is specifically charged with the task of collecting and analysing reliable demographic and health data for regional and national family planning and health programmes.

Gabor Vajta Ian M Lewis and R Tayfur Tecirlioglu

Apart from the biological and ethical problems, technical difficulties also hamper the improvement and widespread application of somatic cell nuclear transfer (NT). Recently introduced zona-free procedures may offer a solution for the latter problem. The most radical approach of these techniques is the so-called handmade cloning (HMC). It does not require micromanipulators because the manipulations required for both enucleation and nucleus transfer are performed by hand. The HMC technique includes manual bisection of zona-free oocytes, selection of cytoplasts by staining, and the simultaneous fusion of the somatic cell with two cytoplasts to produce a cloned embryo. HMC is a rapid and efficient technique that suits large-scale NT programs. It requires less expertise and time than traditional NT methods and the cost of equipment is significantly less. Production efficiency is high and embryo quality, in terms of pregnancy rates and live births, is not compromised. Although HMC has been...

Efficiency of Transgenesis Procedure

After transplantation with swelled sperm nuclei, 20-40 of the eggs cleave and develop normally. One person can transplant about 500 sperm nuclei h to produce several hundred to one thousand embryos in a typical experiment. As with embryos produced by in vitro fertilization, the frequency of normal, advanced development varies somewhat, depending on the overall quality of the eggs typically, 5-40 of the cleaving eggs develop normally beyond feeding tadpole stages. We commonly obtain 1-2 mo old tadpoles and are currently raising transplantation-derived metamorphosed froglets to sexual maturity.

Overview of a New Technique for Fertilizing In Vitro Matured Oocytes

In addition to describing a procedure for making transgenic frog embryos, we are also including a new protocol for using sperm nuclear transplantation to fertilize oocytes that have been matured in vitro. A number of investigators have successfully depleted maternal RNAs from Xenopus embryos by injecting oocytes with antisense deoxyoligonucleotides for a message of interest, and then maturing and fertilizing these injected oocytes to produce embryos (12-15). However, the approaches currently available for obtaining embryonic development from oocytes matured in vitro are quite labor-intensive and technically demanding (16). The difficulty arises in large part because the surface of matured oocytes must be altered by proteolytic enzymes, and covered with a jelly coat in the oviduct of the female frog in order to become competent for fertilization. When oocytes are matured in vitro, these processes must either be simulated, or the matured oocytes must be reimplanted into the body cavity...

Historical Pessary Applications

Suggested that cervical incompetence was attributable to a lack of central uterine support. Uterine retroversion has also been associated with infertility and pelvic pain. Placing a lever pessary would displace the cervix posteriorly, thus lifting the weight of the uterus off of the incompetent cervix. Women diagnosed with an incompetent cervix were treated during pregnancy with a Hodge pessary from 14 to 38 weeks' gestation, with an 83 success rate.3 Currently, cervical cerclage is the treatment of choice for women with cervical incompetence. There is great controversy regarding the possible causative role of uterine retroversion in many gynecologic conditions including pelvic pain, infertility, and sexual dysfunction.

Autonomic and Endocrine Effects

All antipsychotics except clozapine and perhaps olanzapine produce hyperprolactinemia by removing the inhibitory actions of dopamine on prolactin secretion. This results in amenorrhea, galactorrhea, and infertility in women and in loss of libido and impotence in men. Inhibition of the release of follicle-stimulating and luteinizing hormones may also play a role. In addition, weight gain is common, and food intake must be monitored.

Contraindications and Drug Interactions

Leflunomide is teratogenic in animal models it is absolutely contraindicated in pregnancy, in women who may become pregnant, and in breast-feeding women. Because of its long half-life, the M1 metabolite of leflunomide may remain in the body for up to 2 years therefore, a drug elimination procedure using choles-tyramine should be used before any attempt at pregnancy. This drug is not recommended for use in children. Caution should be used when administering this drug to individuals with renal or hepatic disease, heavy alcohol use, or immunosuppression.

Heat Shock Factors Working Together

The generation of double knockout mice has provided valuable information for a functional relationship also between HSF1 and HSF2. While spermatogenesis is normal in hsfl'1' mice and only modesdy impaired in hsftf mice, the simultaneous disruption of both hsfl and hsft leads to male infertility.7'8'85 A gene expression analysis of the hsfl I hsft double knockout testis revealed that many genes involved in spermatogenesis were downregulated, suggesting that HSF1 and HSF2 could have complementary or interdependent functions in the regulation of male fertility.85 The notion that HSF1 and HSF2 could share a subset of target genes was initially proposed when HSF2 was found to bind to the hsl> 70promoter upon hemin-induced erythroid differentiation of K562 erythroleukemia cells. More recently, an extensive promoter analysis in K562 cells by Trinklein and coworkers demonstrated that both HSF 1 and HSF2 are recruited to several hsp promoters in response to hemin treatment, implying that...

Complications of celiac disease

Malignancy is the most feared complication of celiac disease, but more concerning than the risk of malignancy are other, more common complications of celiac disease that can develop when celiac disease is not recognized and or treated. These include osteopenic bone disease, growth retardation in children, iron deficiency and other nutritional deficiencies. There are also issues related to fertility including increased rates of infertility, spontaneous abortions and intrauterine growth retardation that are associated with untreated celiac disease 21-24 . There is some suggestion that untreated celiac disease may be complicated by developing other autoimmune diseases at a higher rate than expected, but this may only be true in children, and even then, not all studies support this observation. Complications of the malabsorption associated with celiac disease include metabolic bone

Hsf1 and the Quality Control of Spermatogenesis

Infertility resulted from the arrest of spermatogenesis at the pachytene stage of spermatocytes, concomitant with a massive death of cells at this differentiation stage. The authors related these effects to the well-known inhibition in humans of spermatogenesis by acute febrile diseases or crypto-orchidism, as well as by sauna or wearing close-fitting underwear. All these conditions result in an increase in the temperature of the testes, which in normal conditions are maintained at a temperature lower than the core body temperature. Activation of HSF1 in these conditions would be responsible for the observed effects.

Prevention and Treatment

Prevention of German measles depends on subcutaneous injection of an attenuated rubella virus administered to babies at 12 to 16 months of age with a second dose at age 4 to 6 years. The vaccine produces long-lasting immunity in about 95 of recipients. The vaccine is not given to pregnant women for fear that it might result in congenital defects. As an added precaution, women are advised not to become pregnant for 28 days after receiving the vaccine.

Pregnancy Complications

In an attempt to reduce their frequency, various pregnancy complications or poor outcomes and their potential causes (particularly increased proinflammatory cytokine levels) have been evaluated by researchers. Increased levels of proinflammatory cytokines, such as IL-2, IL-6, TNFa, and IFN-y, have been observed in spontaneous abortions (Clark et al. 1996), recurrent miscarriages (MacLean, Wilson, Jenkins, Miller, and Walker 2002 Raghupathy 2001), and preeclampsia (Afshari et al. 2005 Dekker and Sibai 1999), while anti-inflammatory cytokines, including IL-3, -4, and -10, have been noted to assist in the promotion, establishment, and completion of successful fetal growth (Clark et al. 1996 Dekker et al. 1999 Gaunt and Ramin 2001 Gennaro and Fehder 1996 Hanson 2000 Piccinni et al. 2000 Raghupathy 2001 Sacks, Studena, Sargent, and Redman 1998 Saito, Sakai, Sasaki, Tanebe, Tsuda, and Michimata 1999). It has been suggested that a predominance of proinflammatory cytokines at various points...

Parental Factors Reproductive History

Several studies have explored associations between prior maternal fetal loss (miscarriage, stillbirth) and risk of childhood leukemia.13,21,22 Although there is some suggestion that a history of fetal loss may be associated with an increased risk, the data are not entirely consistent.21-26 An association with prior fetal loss could indicate either a chronic environmental exposure and or some type of genetic susceptibility that results in a spectrum of effects - from nonviability to damage to a single cell lineage.

Hsf2 Is Involved in Fertility and Brain Development

In contrast, female fertility is decreased in hsf2 - animals. The size of litters is reduced, independently of the genotype of the partner. Ovarian function is affected with the presence of hemorrhagic large follicles and a 60-fold increase in luteinizing hormone receptor. Ovulation is perturbed, but can be returned to a normal level by treatments used to obtain superovulation. Nevertheless, even in these conditions, the eggs have an abnormal shape and the rate of embryonic death is abnormally high. The nature of the target genes of HSF2, the underexpression of which might b e responsible for the observed alterations, remains unknown. The level of expression of the major Hsp genes was checked by RT-PCR in different tissues of the hsf2 - embryos and adults and found not to be different from the level measured in wild-type animals. The level of HSP70-2, a member of the Hsp70 gene family specifically expressed during the formation of the male germ cells (Sarge et al. 1994), was halved....

Medical and veterinary applications of gonadotropins

Because of their central role in maintaining reproductive function, the therapeutic potential of gonadotrophins in treating subfertility some forms of infertility was obvious. Gonadotrophins are also used to induce a superovulatory response in various animal species, as outlined later. The market for these hormones, though modest by pharmaceutical standards, is, none the less, substantial. By the late 1990s the annual human market stood at about US 250 million, of which the USA accounts for US 110 million, Europe US 90 million and Japan US 50 million.

Management of glandular cell abnormalities

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

Identification of male lineages

Useful for forensic stain analyses since they might cause interpretation difficulties in mixed stains with more than one male involved (Butler et al., 2005). Some of these multicopy markers are located in Y-chromosomal regions where the number of copies is assumed to be associated with male fertility problems (such as AZF). Consequently, a Y-STR profile including these loci can potentially be informative for the fertility status of a man (Bosch and Jobling, 2003). Such loci should be omitted from forensic tests because of the additional information they potentially reveal.

Veterinary uses of gonadotropins

The theory and practice of superovulation is quite similar to the use of gonadotrophins to assist in vitro fertilization procedures in humans. Exogenous FSH is administered to the animal such that multiple follicles develop simultaneously. After administration of LH to help promote ovulation, the animal is mated, thus fertilizing the released egg cells. Depending upon the specific animal and the superovulatory regime employed, anything between 0 and 50 viable embryos may be produced, although, more typically, the number is between 4 and 10. The embryos are then Some forms of infertility Some forms of infertility

Product case study Ovitrelle

Ovitrelle (tradename in EU, sold as Ovidrel in the USA and also known as choriogonadotropin alfa) is a recombinant hCG approved for general medical use in the EU and USA in 2001. It is indicated for the treatment of female infertility due to anovulation and for patients undergoing assisted reproductive technology. It is used to trigger final follicle maturation and luteinization after follicle stimulation. Pivotal pre-approval safety and efficacy was assessed in a randomized, open label, multicentre study of infertile females undergoing in vitro fertilization and embryo transfer. The primary efficacy parameter was the mean number of oocytes retrieved, which (at 13.6) was similar to the number retrieved when urinary-derived hCG was used. Serious potential side effects can include ovarian over hyper-stimulation, sometimes with pulmonary or vascular complications. The product is marketed by Serono Inc.

Melatonin Duringaging

The pineal gland, through its hormone melatonin is involved in animal and human reproduction. It has been suggested that melatonin may be involved in the aging process (8). Melatonin is produced and secreted into the blood in a circadian rhythm with maximal production always during the dark phase of the day. The 24h rhythm of melatonin production is very robust in young animals, but this circa-dian rhythm deteriorates with age. Thus, in old animals the amounts of melatonin secreted are lower than that of young individuals and the supplemental administration of melatonin may be beneficial in delaying age-related degenerative conditions (7). Long-term melatonin treatment in rats can postpone the age related decrease in survival rates, circulating sex steroids and 125I-melatonin binding sites in the brain (5).

Counselling in general hospital settings

Counselling is a valuable part of care within many medical arenas. (62> Much of the psychological distress caused by medical problems can be conceptualized as forms of adjustment, described above. Examples include counselling for cancer, disfiguring surgery, HIV and AIDs, fertility problems, facial disfigurement, or cardiology. Many hospitals employ bereavement officers to help relatives cope with the aftermath of a recent bereavement and also to offer longer-term support and counselling for the bereaved.(63>

Thiazolidinediones in Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is characterized by menstrual irregularities, infertility, hyperandro-genism, obesity, and insulin resistance. In a study of rosiglitazone (4 mg twice daily for 2 months) with or without clomiphene in 25 women with PCOS who had not responded to clomiphene alone, ovulatory rates were higher in the combined versus monotherapy groups (77 and 33 , respectively) 53 .

Production of Cloned Mice

F1 hybrid donor animals can be prepared not only by natural mating, but also by in vitro fertilization-embryo transfer. Conventional in vitro fertilization procedures for mice can be applied to JF1 spermatozoa and oocytes. Embryos are transferred into the oviducts or uteri of pseudopregnant ICR female mice, which is similar to the protocol used in embryo transfer experiments.

Groundbreaking Announcement

Thomson expected that, just as in mice and monkeys, embryonic stem cells in human embryos would grow from the inner wall of the blastocyst. The fertility clinic embryos, however, presented a problem that had not arisen in the animal experiments. Fertility clinics froze embryos the day after fertilization, and as far as Thomson knew, thawed embryos had been made to develop in a laboratory for only about two more days before dying. Human embryos do not form blastocysts until about five days after fertilization. Unable to produce human blastocysts, Thomson was stymied until May 1996, when he learned that David Gardner, an Australian scientist, had invented a way to keep human embryos growing in laboratory dishes long enough to reach this stage of development. After much struggle, Jeff Jones, an embryologist in the university's in vitro fertilization laboratory, succeeded in adapting Gardner's technique to Thomson's needs. Thomson's laboratory grew their first human blastocysts with this...

The Use Of Antiretroviral Drugs In Pregnancy

The teratogenic risk associated with administration of antiretroviral drugs during the first trimester of pregnancy is not clear. Women who have not begun therapy prior to becoming pregnant may consider waiting until after 10 to 12 weeks' gestation to begin antiviral treatment. If a woman decides to discontinue antiretroviral therapy during pregnancy, all drugs should be stopped and reintro-duced simultaneously to avoid the development of resistance. Pregnant women may be particularly susceptible to hyperglycemia caused by protease inhibitors.

Special Issues For The Transplant Patient

Among patient groups, those receiving liver and cardiac transplants often tend to be older individuals. As such, fertility issues are typically not frequent health concerns. However, those patients with end stage renal disease (ESRD) are often young when afflicted, and their primary disease process itself has been shown to directly impair fertility. For this reason, many of the items discussed below apply specifically to the ESRD uremic population. Other items, duly noted, apply to the larger transplantation population as a whole. The hypothalamic-pituitary-gonadal (HPG) axis is markedly disturbed by chronic renal failure, and this is manifest in diminished testosterone levels and impaired spermatogenesis. These patients often present with complaints of diminished libido, erectile dysfunction (ED), and infertility. Upon evaluation, they have low serum testosterone levels and elevated follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels.1 Interestingly, these patients...

Treatment Of The Infertile Male Transplant Patient

The presence of male factor infertility in a transplant patient can present a difficult clinical problem for the patient and treating physician. Some of the medications which are essential for maintaining allograft viability posttransplant are directly injurious to spermatogenesis. Furthermore, especially in patients with a longstanding history of renal failure and uremia, there may already be significant, permanent underlying damage to the testes. For these reasons, the appropriate treatment for the infertile couple depends on the patient's clinical problems, the age of the patient and his partner, and the desires of the couple. The specific appropriate treatments for the various causes of male infertility in the transplant patient have been outlined above. It is important to realize that although therapy targeted for these various disorders is quite often well tolerated and effective, some of these treatments do require several months time before the full clinical impact of...

Prevalence Of Overweight And Obesity

Obesity is now known to be a major contributor to the global burden of disease.3 Obesity is associated not only with some nonfatal but debilitating health problems, such as respiratory difficulties, chronic musculoskeletal problems, skin problems, infertility, sleep apnea, and poor mental health, but also more life-threatening problems, including hypertension, type 2 diabetes, heart disease, stroke, some types of cancer.315 Obese people have higher mortality from all causes 16-19 more than 280,000 deaths annually have been attributed to obesity among U.S. adults.20 In Europe, this number is at least 279,000 deaths, of which 175,000 are attributable to obesity and 104,000 to overweight.21 Furthermore, a large decrease in life expectancy is observed among obese individuals, especially among younger adults.22,23 Severely obese children and adolescents have lower health-related quality of life24 and early-onset obesity has been suggested as a risk factor for morbidity and mortality later...

Case Presentation

Newer tests for HIV antibody and nucleic acid give positive results within 1 month of infection in most but not all cases. Screening tests used for infection have also markedly reduced the risk of HIV transmission from artificial insemination and organ transplantation.

Ethical problems of prevention

Usually there are no ethical problems. There are hardly any issues surrounding the prevention of causative diseases or injury, the attempt to reduce the prevalence of inheritable diseases by family planning or genetic counselling, the screening that leads to the treatment of the fetus or the newborn, preparation for the birth of a new infant, improving the care and rehabilitation, and planning a safer society.

Genetic Effects to Offspring

There is no evidence that exposure to radioiodine affects the long-term outcomes of subsequent pregnancies and offspring (59). A 370-MBq (10 mCi) dose of iodine-131 is estimated to deliver a dose of approximately 0.01-0.03 Gy to the ovaries, mostly from excreted RAI in the bladder. Radiation dose can be minimized with hydration and frequent voiding following treatment. Women of child-bearing age should be counseled to refrain from becoming pregnant for at least six months following therapy. This is primarily to confirm treatment response, given that there are significant perinatal risks related to thyrotoxicosis.

Adverse reactions Contraindications and Interactions

Ginkgo may reduce the effectiveness of thiazide diuretics for blood pressure control and at least theoretically should be avoided with MAOIs. There is also a suggestion that ginkgo may decrease male and female fertility, and it should be avoided in those trying to conceive.

Direct Vs Indirect Molecular Diagnostic Tests

Carrier screening Testing for a gene mutation in an autosomal recessive disorder in asymptomatic individuals for the purpose of family planning and genetic counseling to determine probability of disease in children. Requires extensive pretest and posttest counseling. Carrier screening might be recommended in various situations including (1) if one or both partners have a family history of the disease, (2) if one or both partners are members of a population or ethnic group with a higher incidence of the disease, (3) if partners are seeking preconception or prenatal testing, and (4) general population screening.

Indications For Chromosomal Evaluation

Human Metaphases

Primary amenorrhea and premature ovarian failure are indications for chromosomal evaluation. Primary amenorrhea might be caused by Turner syndrome (45,X), a Turner variant or other abnormalities involving the X chromosome. Premature ovarian failure might also be associated with abnormalities involving the X chromosome. Couples with a history of unexplained multiple pregnancy loss or infertility might harbor a balanced chromosomal aberration that they are passing on to offspring in an unbalanced form and are, therefore, candidates for chromosomal study. Infertility

Hyperthyroidism in pregnancy

Thyroid function should be assessed in women with hyperemesis gravidarum. Women known to have Graves' disease may decide on definitive treatment of their condition prior to becoming pregnant. If Graves' disease is diagnosed during pregnancy, it is important to use the smallest dose of antithyroid drugs by reviewing regularly to maintain maternal concentrations of free thyroid hormone and thyroid-stimulating hormone within their respective normal ranges. This is to avoid fetal hypothyroidism and goiter. Most recommend that carbimazole should be discontinued 4 weeks before the expected date of delivery to avoid any possibility of fetal hypothyroidism at the time of maximum brain development. If subtotal thyroidectomy is necessary because of poor drug compliance or hypersensitivity, it is most safely performed in the middle trimester. Radio-iodine is contraindicated because it invariably induces fetal hypothyroidism. If antithyroid agents are given postdelivery, breast feeding is not...

The Endometrial Vasculature and Uterine Pathologies

Infertility As discussed previously, changes in vascular permeability play a critical role in the preparation of the uterus for implantation and in the implantation process itself. Inadequate permeability, due to inadequacy of hormonal stimulation, the inability of the endometrium to react with appropriate VEGF expression, or failure of vessels to respond to VEGF, could give rise to a nonreceptive endometrium and failure of implantation. Infertility could also result from placental insufficiency. Hypoxia, one of the strongest inducers of VEGF expression, is believed to play an essential role in the growth of the placenta through maintenance of trophoblast cell proliferation 18 . Furthermore, knockout of HIF-1, a key regulator of VEGF expression (below), blocks placentation. Endometriosis Endometriosis is the abnormal growth of endometrial tissue at ectopic sites in the peritoneal cavity. It is a major cause of infertility in women of reproductive age, as well as of severe pelvic pain....

Hypointense Seminal Vesicle

Mullerian duct cysts arise from the Mullerian duct remnants, which should regress in utero. These are a common cause of obstruction of the ejaculatory duct. They are spherical in shape and, if large in size, can lie superior to the prostate. They are connected to the verumontanum but do not communicate with the urethra. Mullerian duct cysts can contain hemorrhage and calculi and are associated with an increased risk of prostate carcinoma. Surgical correction of the cysts can relieve genital duct obstruction in men with infertility (69-71). Seminal vesicle or Wolffian duct cysts result from congenital atresia of the ejaculatory duct and are often associated with ipsilateral renal agenesis. The cysts are unilateral, located laterally in the seminal vesicle, commonly protrude into the bladder, and may present with symptoms of hematospermia, hematuria, and epid-idymitis. Wall irregularity or a mass associated with the cyst is suggestive of underlying adenocarcinoma. If large enough,...

Essential Fatty Acid Requirements

In studies on EFA, C18 2n-6 and C20 4n-6 have been emphasized because mammals have an absolute requirement for the n-6 family of FA. EFA are required for stimulation of growth, maintenance of skin and hair growth, regulation of CH metabolism, lipotropic activity, and maintenance of reproductive performance, among other physiologic effects. On a molecular level, EFA are components of specific lipids and maintain the integrity and optimal levels of unsaturation of tissue membranes. Because EFA are necessary for normal function of all tissues, the list of symptoms of EFAD is long (111). Detailed studies on the symptoms of EFAD have been done in young rats, in which EFAD was found to be avoided by providing 1 to 2 of calories as C18 2n-6 (112). In these rat studies, classic signs of EFAD included reduced growth rates, scaly dermatitis with increased loss of water by a change of skin permeability, male and female infertility, and depressed inflammatory responses. Also observed during EFAD...

Preparation of Cytoplasts and Somatic Cell Suspension

Nuclear Transfer Zona Free Process

Remove 150-200 oocytes from the maturation dish 21 h after the start of in vitro maturation (hpm) and transfer to an Eppendorf tube containing 500 L of hyaluronidase solution. 27. Thouas, G. A., Jones. G. M., and Trounson, A. O. (2001) A novel method for micro-culture of mouse zygotes to the blastocyst stage the GO system. In Proceedings of the 17th Annual Conference of the European Society of Human Reproduction and Embryology (ESHRE), Lausanne, Switzerland, p. 168.

Hormone Replacement Therapy

Infertility Patients with normal or elevated estrogen levels and normal pituitary and hypothalamic function respond most frequently to treatment with clomiphene citrate. In this group, the ovulation rate following clomiphene citrate may be 80 . Clomiphene citrate is administered on a cyclic schedule. First, menstrual bleeding is induced next drug is given orally for 5 days at 50 mg day. Ovulation is expected 5 to 11 days after the dose of clomiphene citrate. Pregnancy rates approach 50 to 80 after six such treatment cycles, with most pregnancies occurring during the first three treatment cycles. Clomiphene is also used in conjunction with gonadotropins to induce ovulation for in vitro fertilization.

Mistletoe as a Remedy

The intentions of mistletoe uses were manifold and conflicting in several cases. According to the Greek physician and author Dioskorides (15-85 AC), Hippocrates (460-377 BC) used the mistletoe to treat diseases of the spleen and complaints associated with menstruation. Plinius (23-79 AC) reported mistletoe from oak trees, when applied as a chewed pulp, to be beneficial for epilepsy, infertility, and ulcers (Historia naturalis, liber XXIV, 12). Around 150 AC, the Platonist Celsus reported the use of mistletoe in the treatment of swellings or tumours (De Medicina, liber V, 18 and 23). Although the conditions have never been accurately defined, the use of mistletoe in medicine was referred also by the Alexandrian physician and surgeon Paulus Aegineta (625-690 AC), and the Persian philosopher and physician Avicenna (Ibn-Sina, 980-1037 AC) (Foy, 1904). However, as suggested by Marzell (1923), oak mistletoes described and used by most ancient scientists might not be identical with the...

The psychiatry of pregnancy Pregnancy adjustment

The fetus is cushioned from external violence by the amniotic fluid, but it can still be damaged, for example by vehicle accidents, with placental separation or rupture of the uterus. The miscarriage rate is increased, and congenital abnormalities have been claimed. Falls are unlikely to affect the uterus, unless the pelvis is fractured. Infants can be damaged by penetrating wounds, and there are over 100 instances of gunshot wounds to the gravid uterus the result of murderous assaults, attempts to induce a late abortion, or suicide attempts.

Paul J Verma Alan O Trounson

The stage of the donor cell cycle is a major factor in the success of cloning. Quiescent cells arrested in the Gq Gj phases of the cell cycle by either serum starvation or growth arrest when cultured cells reach confluence have been used as donors to produce cloned animals. Recently, we have developed a novel and effective method using roscovitine to synchronize adult bovine granulosa cells in the Gq Gj cell cycle stage. The resulting fetal and calf survival after transfer of cloned embryos was enhanced in the roscovitine-treated group compared with serum-starved controls. The methods described in this chapter outline (1) the preparation of donor cells, (2) the preparation of recipient oocytes, and (3) the production of cloned embryos. The first section involves methods for the preparation of donor cell stocks from isolated granulosa cells and the roscovitine treatment of the cells before nuclear transfer. The second section explains procedures of in vitro maturation of recipient...

Therapeutic Use of Androgens in Women

Endometriosis is abnormal growth of endometrial tissue in the peritoneal cavity. Women with this disorder have dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility. Danazol (Danocrine) is a 2,3-isoxazol derivative of 17a-ethynyl testosterone (ethisterone) that has weak virilizing and protein anabolic properties. It is effective in endometriosis through its negative feedback

Reproductive and Developmental Toxicology Carole A Kimmel PhD Judy Buelke Sam

Gametogenesis Males And Females

Development can be divided into the prenatal and postnatal periods. Prenatal development includes the preimplantation andpostimplantation periods, and the latter encompasses the embryonic and fetal periods. Preimplantation is characterized by transport of the zygote from the upper ends of the oviduct into the uterine cavity during a period of 7-8 days in humans, or 5-6 days in rats or mice (Figure 3.3). Rapid cell division of the single-cell zygote (fertilized ovum) proceeds through the morula stage, a solid ball of approximately 16 cells, and further division results in a multicellular blastocyst that contains a cavity. The blastocyst implants in the uterine wall and develops into the definitive embryo. The embryo itself develops from a small group of cells in the blastocyst, the inner cell mass. The rest of the cells, the extraembryonic cells, form the placenta and surrounding membranes. Implantation occurs around gestational day (gd) 7 in humans, gd 5-6 in mice and rats, and gd 7...

Sources and medical uses of folliclestimulating hormone luteinizing hormone and human chorionic gonadotrophin

In females, menotrophins and hCG are used for the treatment of anovulatory infertility. This condition is due to insufficient endogenous gonadotrophin production. Menotrophin is administered to stimulate follicular maturation, with subsequent administration of hCG to promote ovulation and corpus luteum formation. Mating at this point should lead to fertilization. Gonadotropins are also used in assisted reproduction procedures. Here the aim is to administer therapeutic doses of FSH that exceed individual follicular FSH threshold requirements, thus stimulating multiple follicular growth. This, in turn, facilitates harvest of multiple eggs, which are then available for in vitro fertilization. This technique is often employed when a woman has a blocked fallopian tube or some other impediment to normal fertilization of the egg by a sperm cell. After treatment, the resultant eggs are collected, incubated in vitro with her partner's sperm, incubated in culture media until the embryonic...

Identifying placebo effects in patients receiving drugs contribution of pattern analyses to treating relapse and the

Patients who, following a beneficial acute response, are assigned to antidepressant continuation therapy of approximately 6 months have a more favourable prognosis than those switched to placebo (or stop treatment). (212 2 and 24 However, some patients desire to stop drug therapy for a variety of reasons, including increased side-effect susceptibility, a desire to become pregnant, or a coexisting medical condition potentially complicating antidepressant use. (25,26 and 2Z> Can we identify patients where the indication for maintenance medication may be less compelling No predictors of survival in maintenance treatment have been clearly demonstrated. However, for patients receiving antidepressants it may be possible to identify improvement with a greater likelihood of resulting from a placebo rather than a true drug effect. The difference between placebo and true drug effects, becomes apparent if we consider that if 60 per cent of a drug-treated sample are rated much improved, then,...

The Genetic Family History

Symbols used to document pedigree information have varied, often depending on personal, professional, or national preferences. The key to functionality for pedigrees, however, is the degree to which they are able to communicate information uniformly to all users. In 1993, a task force of the National Society of Genetic Counselors surveyed genetic counselors regarding interpretation of pedigree symbols and conformity of usage.2 As many as 17 different symbols were used to depict pregnancy, with 16 different symbols being used to denote miscarriage in both cases, symbols sometimes had several meanings to different users. It became evident that standardization of symbol usage was needed. The group established a recommended nomenclature for pedigrees, which was published in the American Journal of Human Genetics in 1995.3 The currently recommended methods for documenting pedigree information including symbols, spatial relationships, and clinical investigative status are detailed in...

Estrogen and Lupus Human and Animal Studies

Tion of these immune complexes triggers inflammation, culminating in widespread tissue damage (Abdou et al., 1981). Gender is a strong risk factor for SLE since this disease primarily affects women in the reproductive years and the female-to-male susceptibility ratio can be as high as 13 1 (Rider and Abdou, 2001). SLE has been associated with situations where levels of gonadal hormones are changing such as during pregnancy, postpartum period, menopause, and during estrogen administration. The first onset of the disease is unlikely to occur before puberty or after menopause. Pregnancy has been associated with flares of lupus (Wilder, 1998). SLE disease activity fluctuates with the menstrual cycle (Bruce and Laskin, 1997) and lessens after menopause (Mok et al., 1999). The flares of lupus have been reported to increase during in vitro fertilization when levels of female hormones, particularly estrogen, are clinically manipulated (Guballa et al., 2000). Further, although not unequivocal,...

Gonadotropin Releasing Hormone

For treating infertility is that normal levels of LH and FSH should be maintained because of feedback from the gonads. This should reduce the risk of ovarian hyperstimulation and multiple births, since the procedure should not result in inappropriately high levels of gonadotropins (Table 59.2). In women, GnRH agonists are sometimes given along with FSH when stimulating follicles in fertility treatments this addition prevents premature ovulation caused by the release of pituitary LH. Uterine leiomy-omas and endometriosis regress when gonadotropin secretion is decreased. GnRH analogues relieve these conditions, but the relief usually lasts only as long as the analogue is administered, and the condition generally returns within a few months after therapy ceases. The main side effects are a result of estradiol deprivation

Clinical Manifestations of Hypothyroidism

In adults, the signs and symptoms of hypothyroidism include somnolence, slow mentation, dryness and loss of hair, increased fluid in body cavities (e.g., the pericardial sac), low metabolic rate, tendency to gain weight, hy-perlipidemia, subnormal temperature, cold intolerance, bradycardia, reduced systolic and increased diastolic pulse pressure, hoarseness, muscle weakness, slow return of muscle to the neutral position after a tendon jerk, constipation, menstrual abnormalities, infertility, and sometimes myxedema (hard edema of subcutaneous tissue with increased content of proteoglycans in the fluid). A goiter (i.e., enlargement of the thyroid gland) may be present.

Patterns of Inheritance

In X-linked dominant inheritance, an affected individual has one non-functional or mutant allele at a locus on an X-chromosome. X-linked dominant conditions can occur in either males or females. Risk for offspring of an affected female is 50 , regardless of the gender of the offspring. Risk to offspring of affected males is gender dependent, with all daughters but no sons inheriting the gene. Many of these conditions, however, are lethal in males, so pedigrees may show overrepresentation of females or increased frequency of miscarriages, presumably of affected male fetuses (see Table 4-2 and Figure 4-6). overrepresentation of females in the pedigree Increased occurrence of miscarriage Association with increased infertility rates in families In rare cases, one of a limited number of genes on the Y chromosome can be mutated. This can result in disparity between chromosomal and phenotypic gender if the SRY region is involved, or can be associated with genetic hereditary forms of...

Are Humans Photoperiodic

The best correlative evidence for an influence of photoperiod on human physiology was a survey by Roenneberg and Aschoff (1990) (10).The authors analysed hundreds of thousands of births spanning the globe over part of the last century up to the time of publication. They found very strong correlations, especially in the older data, of conception rate (A conception A time) with deviation of photoperiod from 12L12D. Much of the correlation was lost, or the rhythm changed shape, in the middle of this century, suggesting that the advent of widespread artificial lighting, central heating and air conditioning may have eliminated to some extent this relationship. Their data lead to the conclusion that in the absence of an artificial environment, the maximum human birthrate is found in the spring with sometimes a second peak in autumn. Thus we are, from this correlative evidence, long day breeders. If this is true, then long duration mela-tonin should be inhibitory to human reproductive...

Use of Toxicological Data in Evaluating Chemical Safety Gloria Rachamin PhD

Four types of tests, usually in rodents, are used to study potential effects on development and reproduction. General fertility and reproductive performance are tested by administering the chemical to male and female rats before mating and throughout gestation. Typical end points measured are the percentage of females that become pregnant, the number of stillborn and live offspring and the weight, growth, survival and general condition of offspring in the first three weeks of life. Teratogenic effects are tested by administering the chemical to pregnant females during organogenesis (day 6-15 of gestation in rats). The fetuses are removed by Cesarean section a day before the estimated time of delivery. The numbers of live, dead, and resorbed fetuses are recorded. Live fetuses are weighed, half of each litter is examined for skeletal abnormalities, and the other half for soft tissue anomalies.

Somatic Cell Cloning Efforts in the Monkey

Embryo Chimpanzee

Piercing the plasma membrane during the ICSI procedure is critical and often difficult to assess because the needle can grossly invaginate the membrane without breaking through. For that reason, the injection pipet should be inserted through the zona pellucida and into the oocyte across approx one-third of the egg's diameter. Cytoplasm is slowly aspirated into the ICSI pipet (as far back as the needle junction with the zona pellucida) until the plasma membrane brakes. A pop or sudden movement of cytoplasm into the pipet indicates the release of membrane tension. Once the membrane is penetrated, the sperm is expelled into the cytoplasm, visualized as a dive of the sperm. Frozen-thawed sperm can also be used for ICSI. We have previously reported that fertilization rates by ICSI with cryopre-served sperm injected shortly after thaw are significantly lower than with fresh sperm (13). However, preincubation times of more than 3 h after thaw were associated with ICSI fertilizing capacity...

New Approaches To Intracellular Analysis

PEBBLES may be introduced into cells by one of four routes They may be introduced by liposome fusion or direct injection, propelled ballistically into the cell like a bullet using a device called a gene gun, or taken up by endocytosis. The methods differ in their degree of efficacy with a given cell line and where within the cell the PEBBLE ends up. PEBBLES can be directly injected into the cell using a micropipette. While this procedure is used routinely for in vitro fertilization, there is reason to suspect that such injections may indeed disrupt the cell. PEBBLES may be phagocytosed like bacteria or other small particles this approach is especially valuable to study the phagosomes or lysosomes, but by itself it may not be very useful for studying other organelles such as the mitochondria or nucleus. PEBBLES can be introduced into the cell by fusion of liposomes that contain them with the cell membrane. This technique is very benign but has little target specificity. Most ingenious...

Why knowledge of causation is important

For the family knowledge of causes helps to dispel wrong beliefs, self-blame, and anxieties. The parents and siblings may change their preconceived ideas about the disability. It helps the parents to adopt appropriate standards for bringing up their child, and for life as an adult. It helps them to become aware of the child's special needs.(l6) Aetiologic diagnosis is the necessary basis of the reliable genetic counselling and helps the parents and siblings in family planning. (49

Effects of Cytoreductive Therapy on Fertility and the Fetus

Gonadal suppression resulting in amenorrhea or azoospermia may occur in patients taking cytoreductive agents. High doses of HU, busulfan, and interferon-alpha have been shown to be harmful to spermatogenesis in experimental animals and busulfan has resulted in ovarian failure in older patients.125 However, fertility has been retained in patients treated with HU and inter-feron-alpha126,127 Anagrelide has no effect on fertility in male rats but in female rats, at high dosage, it disrupted implantation and retarded or blocked parturition. Five women have, however, become pregnant on anagrelide therapy. Treatment was stopped as soon as the pregnancy was detected and all five patients delivered normal babies.125

Emotion and Cognition in Real World Moral Judgment

Many normative explanations come to mind, but none is terribly compelling. Are we allowed to ignore the plight of faraway children because they are citizens of foreign nations If yes, then would it be acceptable to let the child drown, provided that the child was encountered while traveling abroad, or in international waters Is it because of diffused responsibility - because many are in a position to help a starving child abroad, but only you are in a position to help this hypothetical drowning child What if there were many people standing around the pond doing nothing Would that make it okay for you to do nothing as well Is it because international aid is ultimately ineffective, only serving to enrich corrupt politicians, or create more poor people In that case, our obligation would simply shift to more sophisticated relief efforts incorporating political reform, economic development, family planning education, and so on. Are all relief efforts doomed to ineffectiveness That's a bold...

Mechanisms of Selenium as an Evolutionary Pressure on Gametogenesis

Selenium is critically important in spermatogenesis, and it is incorporated in the sperm mitochondria capsule and may thus affect the behavior and function of the spermatozoon. In humans, information is contradictory both low and high sperm selenium concentrations are reported to have a negative influence on the number and motility of spermatozoa (33). Selenium sits in the catalytic cleft of glutathione peroxidase in the form of selenocysteine, where it neutralizes free radicals. It is well recognized that selenium protects developing sperm from susceptibility to peroxidative damage as a consequence of spermatozoa's high polyunsaturated fatty acid level, inability to repair membrane damage, and high potential to generate DNA-damaging superoxide and hydrogen peroxide (34). Selenium deficiency in females may also be important, and it has been reported to result in infertility, abortions, and retention of the placenta (35).

Anxiety obsessional and stressrelated neuroses

After excessively painful labours, some women suffer insomnia, nightmares, and repetitive daytime intrusion of images and memories, similar to those that occur after the harrowing experiences of war and natural disaster. (53> If they become pregnant, the symptoms may return, especially in the last trimester. They may develop a secondary tocophobia. Even without the specific components of puerperal panic and fear of sudden infant death, the care of an infant involves ceaseless vigilance. In women prone to anxiety and excessive worrying, motherhood can lead to persistent overarousal, with excessive solicitude about banal tasks that put the baby at risk (e.g. bathing) and sensitivity to the slightest indication of illness. These symptoms are prominent in mothers who have suffered years of infertility or recurrent miscarriage.

Surgery for Prolapse

Little epidemiologic information regarding surgical procedures for prolapse. In a 1997 survey, approximately 226000 women underwent surgery for pelvic organ prolapse in the United States, making prolapse one of the most common indications for gynecologic surgery.1 The average age of women undergoing prolapse surgery was 55 years. The overall rate of pelvic organ prolapse surgery was 22.7 per 10000 women in the United States. This increased with age to a peak rate of 42.1 per 10000 women aged 60 to 69 years. Vaginal hysterectomy with rectocele and cystocele repair was the most common surgery performed. There was a higher percentage of women aged 70 to 79 years compared with the other age groups that underwent vault fixation or suspension. Women in the southern part of the United States were more likely to undergo surgery for prolapse than women in the midwest or northern states (29.3 per 10000 vs. 21.7 per 10000 vs. 19.1 per 10000, respectively). In addition, women aged 30 to 39 and 70...

Clinical Information

The genotype may not reflect the phenotype when the patient has undergone one of certain medical procedures. Transplantation with homologous stem cells and recent massive or chronic transfusion can result in apparent disagreement. In the prenatal setting, a history of artificial insemination, in vitro fertilization, questionable paternity, or surrogate motherhood can complicate the interpretations. It is helpful to obtain the ethnic background of the patient. Gene frequencies and the presence of rare variant alleles differ among ethnic groups, which impacts on the analysis.

Obstetric Factors

Obstetric injury is thought to be a principal factor contributing to the development of pelvic floor dysfunction (prolapse, urinary and fecal incontinence). This is attributed to direct muscular and connective tissue injury or to denervation injury to the pudendal nerve. There is question as to whether the mode of obstetric delivery, or just the event of being pregnant, has a role in developing prolapse. In a case-control study, patients who delivered their first child before the age of 25 years had an almost fourfold increase of developing prolapse.7 Up to 50 of all parous women have some degree of prolapse, with 10 to 20 being symptomatic.13 Elective cesarean delivery in a non-labored patient has been speculated to protect the pelvic floor from damage leading to prolapse however, to date there are no prospective randomized studies to support this theory. It has been well established that vaginal parity, notably the first, is an independent risk factor for the future development of...

Technology Society

That are unused for fertility treatment. When embryonic stem cells are harvested, the embryo is destroyed. Many people believe it is unethical to destroy embryos that have the potential to develop into babies. The harvesting of adult stem cells causes no lasting harm to the donor, but the potential for the cells may be limited.

Chinese Medicine

In China, methods for conducting clinical studies differ from the West in that they consider giving a placebo to a sick person unethical. If they do use a placebo, they first offer the patient a choice. When double-blind studies are conducted, there is an application of two substances in which both are presumed to be effective. They believe the West relies too much on laboratory tests and not enough on how patients feel and their quality of life. Chinese medicine therapy is individualized and so there is not a standard treatment for any one condition. Studies in both the East and West have proven Chinese medicine to be effective in the treatment or prevention of nearly all common health conditions including infertility, digestive problems, respiratory ailments, cancer, brain dysfunctions, cardiovascular irregularities, and AIDS.

Enucleation

The micromanipulation tool set up is similar to that described for the ICSI procedure except that a larger, beveled, enucleation pipet (25- to 27- m outer diameter) is used. Completely fill the enucleation pipet with high-viscosity silicon oil to improve control over aspiration and injection.

HSF Knockouts

Absence of stress response Lack of thermotolerance Partial embryonic lethality Placenta defect Reduced size Female infertility Absence of stress response Lack of thermotolerance Normal viability Female infertility Partial male and female infertility Reduced female fertility Brain abnormalities

Haploid Based Screen

The ease with which haploids may be produced depends entirely on the ability of mutagenized F1 females to yield their stored eggs, a trait that seems highly strain-dependent. Typically, in a strain considered accessible to this manipulation, sexually mature gravid females will yield eggs in at least 20-30 of squeeze attempts. Each wild-type strain should be assessed for its ability to undergo this procedure. Ideally, fish of the AB strain should be used, since they have been selected over several generations for the ability to allow in vitro fertilization in this manner. Tricks that seem to lead to a more consistent yield from females are

Toxoplasmosis

Development of toxoplasmosis when their CD4 count falls below 100 (35). Pregnant women, women who plan to become pregnant, and immunocompromised individuals who test negative for Toxoplasma infection should take precautions against becoming infected. Precautions consist in measures such as consuming only properly frozen or cooked meats, avoiding cleaning cats' litter pans and avoiding contact with cats of unknown feeding history.

Transmission

Elimination of human sperm mtDNA in the egg is supported by the lack of paternal mtDNA in extra-embryonic tissues and offspring after intracytoplasmic sperm injection (101,102). The nature of the molecular surveillance mechanism that selectively destroys sperm-derived mtDNA from the fertilized egg became clear in 1999, when it was discovered that sperm mitochondria inside fertilized cow and rhesus monkey eggs are tagged with the universal proteolytic marker ubiquitin (103). Ubiquitination selectively earmarks sperm mitochondria for degradation by the embryo's proteosomes and lysosomes (104,105). The ubiquitination and destruction were not observed in hybrid embryos of domestic cow eggs and wild bull sperm, substantiating the preceding inferred suggestion of a species-specific recognition apparatus. The evolutionary basis for the destruction may be that paternal mtDNA is compromised by the action of reactive oxygen species encountered by the sperm during spermatogenesis and...

Molecular pathology

A difficult practical problem is that of genetic counseling for couples who have had the misfortune of having a child with PMPS. The risk of recurrence depends on whether the deletion is present in most, or only in some, of the mother's gonadal cells. At the moment there is no established method for determining this. At an experimental level, it could be achieved by inducing multiple ovulation and using the polymerase chain reaction (PCR) to test individual oocytes for the deletion previously detected in an affected sib. The same could be done in very early embryos after in vitro fertilization (pre-implantation prenatal diagnosis). Because of the high copy number of mtDNA, testing for mtDNA mutations is much easier than testing for mutations in nuclear genes.

Ifosfamide

Ifosfamide is less myelosuppressive than cyclophos-phamide but is more toxic to the bladder. It also may produce alopecia, nausea, vomiting, infertility, and second tumors, particularly acute leukemias. Neurological symptoms including confusion, somnolence, and hallucinations have also been reported. It is recommended

Figure 123

Of adipocyte pARs in essentially every model of obesity that we have examined, including obesity induced by high-fat feeding in non-mutant mice.60 In considering the molecular basis for this dramatic impairment of PAR expression, an important connection may exist between the abnormal endocrine profiles that are observed in these models of obesity and the expression and function of individual PAR subtypes. For example, both the C57BL 6J Lepob and C57BL 6J LepRdb mice exhibit many endocrine abnormalities, including hyperinsulinemia, hypercorticoidism, infertility, and some evidence for perinatal hypothyroidism.10,61-65 While glucocorticoids appear essential for the development of obesity in C57BL 6J Lepob and C57BL 6J Lep-Rdb mice,66-68 adrenalectomy does not completely restore body composition and circulating insulin levels to those of lean controls. Most of these endocrine patterns, including the corticosteroid axis, are normalized when ob ob mice are administered recombinant leptin...

Rorrzr

Of the other two members of this orphan receptor group, RZR ROR gamma is highly expressed in skeletal muscle72 while RZR ROR beta is specific to the brain. RZR ROR beta is present in a number of regions generally known to be involved in receiving and processing sensory input, such as the dorsal horn of the spinal cord, layers IV and V of the sensory cortex, and the thalamus.190 RZR ROR beta is also expressed in several regions involved in the regulation of circadian rhythms, including the retina, suprachiasmatic nuclei, and the pineal gland. It had been suggested that melatonin was a ligand for RZR ROR beta 15 however, this now seems to be in doubt.14 Nevertheless, the light dark cyclic changes in RZR ROR beta in the pineal gland and the retina suggest that this gene plays some role in circadian timing.3 That RZR ROR beta has an essential role in development is demonstrated by the phentoype of the null mutants which exhibit ataxia, retinal degeneration, and male infertility.3

Stem cells

Embryonic stem cells are derived from pre-implant-stage human embryos, usually at the blastocyst stage (the blastocyst is a thin-walled hollow structure containing a cluster of cells, known as the inner cell mass, from which the embryo arises). These embryos are invariably ones initially generated as part of in vitro fertilization procedures but which are destined to be discarded, either due to poor quality or because they are in excess to requirement. There are an estimated 400 000 in vitro fertilization-produced embryos in frozen storage in the USA alone, of which some 2.8 per cent are likely to be discarded. Figure 14.17 Overview of the generation and culture of human embryonic stem cells. IVF in vitro fertilization. Refer to text for further details

Gonadotropins

Injections of these hormones are used to treat infertility in women and men. Traditional sources of gonadotropins are from human urine. Human menopausal gonadotropins (menotropins, Humegon, Pergonal) are isolated from urine of postmenopausal women and contain both FSH and LH. Purified preparations of FSH from the same source are also available (urofollitropin, Fertinex, Fertinorm HP). During early pregnancy, trophoblasts of the placenta produce hCG in large amounts. LH and hCG bind to the same go-nadal receptors, but hCG is more stable and can be isolated from urine of pregnant women, so hGH preparations (Pregnyl, Profasi) are used to mimic the burst of LH secretion before ovulation. Recombinant preparations of FSH are also available (follitropin, Gonal F, Follistim). Gonadotropins are used to treat infertility in women with potentially functional ovaries who have not responded to other treatments. The therapy is designed to simulate the normal menstrual cycle as far as is practical....

About The Editors

Etienne-Emile Baulieu is Professor of Biochemistry and Professor of Human Reproduction at the Coll ge de France in Paris. He is also Research Director of the Unit on Steroid Hormones and Hormonal Communications at the National Institute of Health and Medical Research (INSERM). He is a cofounder of the World Health Organization (WHO) Program on Human Reproduction and a member of the French Acad mie des Sciences, National Academy of Sciences of the USA, and the Academia Europea. He is also a Commander of the Legion d'Honneur.

Medicaid Databases

Although Medicaid recipient services vary by state, the federal government requires that minimum services include physician and nurse-midwife services, home health care, care in skilled nursing facilities, inpatient and outpatient hospital care, rural health clinics, independent laboratory and radiology services, early and periodic screening of children, family planning services, and transportation to and from medical services. Virtually all states provide for reimbursement of prescribed drugs the list of drugs eligible for reimbursement also varies by state.

Preperinatal Setting

All women are at risk to have a child with a chromosome abnormality or birth defect with every pregnancy however, the chromosomal abnormality risk increases with age. At about the age of 35, a woman's risk to have a child with a chromosomal abnormality is roughly equivalent to the risk of a miscarriage from an amniocentesis (1 in 200 to 300). An amniocentesis is a standard procedure performed between 14 to 20 weeks of pregnancy to obtain a sample of amniotic fluid, which contains fetal cells that can be used for cytogenetic and molecular analysis. Another procedure called chorionic villus sampling (CVS), can be done earlier in pregnancy (10 to 12 weeks) to obtain fetal cells for testing.3 The miscarriage risk associated with CVS is slightly greater than that of amniocentesis at most centers. CVS is offered to women who know that they are at risk to have a child with a genetic condition so that diagnostic information can be obtained earlier in the pregnancy. Other pregnancy-related...

From Sheep to People

Concern about possible use of cloning to create human children reached fever pitch in the years following Dolly's birth, particularly after several groups, ranging from the Italian fertility specialist Severino Antinori to a flying saucer cult called the Raelians, announced (without supporting evidence) that they were about to produce or had produced a cloned child. The Council of Europe banned this kind of cloning, called reproductive cloning, on January 12, 1998, and at least two dozen individual nations have also banned or placed a moratorium on the activity. The United States has not yet passed a law banning reproductive cloning, but several states have done so, and most Americans seem to feel that it should be forbidden. British law allows this kind of human cloning, which is called research cloning or therapeutic cloning. Any researcher who plans to carry out therapeutic cloning, however, must obtain a permit from a government agency called the Human Fertilization and Embryology...

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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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