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PubMedDate not supplied

The behavior of Italian family physicians regarding the health problems of women and, in particular, family planning (both contraception and NFP).

The hospital-centered trend that has dominated medical culture and the management of health care during this entire century has, in the last few years, undergone a reversal in Italy. Conditions in other countries suggest that similar changes have or will become increasingly common. The family physician today manages many of the functions previously handled by hospitals and specialists. In the field of reproductive health, family physicians are responsible not only for diagnosis and treatment, but also for prevention and education. The present study considers this new context with the objective of investigating the knowledge and behavior of Italian family physicians in the field of women's health, with particular regard to family planning (including natural family planning), through (1) a qualitative study (focus groups) of a small group of family physicians and (2) a questionnaire sent to 500 family physicians throughout Italy. The results of the focus group are summarized in the form of obstacles that the family physician finds in providing family planning services and proposals for change. The results indicate that because of their holistic approach, the family physician is an appropriate provider of family planning services although continued use of specialists' services, changes in logistics of the family physicians' practice, increased gender sensitivity, and additional training and information are necessary. The results of the questionnaire (121 responses, 24.2%) indicate that the Italian family physician currently lacks certain important information about family planning and would require logistical support to provide these services but is interested in acquiring information and is an appropriate family planning provider. An additional challenge for encouraging family practitioners to provide natural methods is that they favor a "medical" approach rather than a "behavioral" one in their treatment preferences for several other conditions.

Contraception↗
PubMedDate not supplied

Gender, sexuality and communication issues that constitute barriers to the use of natural family planning and other fertility awareness-based methods.

Fertility awareness-based methods of family planning are rarely offered through reproductive health services in Latin America, despite evidence that many women use them. Providers state that clients do not want these methods, but provider-bias is evident. Providers overestimate the difficulty of learning and using fertility awareness-based methods, and they underestimate their efficacy. Both providers and clients have difficulty dealing with sexuality (which is central to fertility awareness-based methods). Many providers lack gender sensitivity, 'worsening' the unequal relationship between providers and clients. Experience has shown that when fertility awareness-based methods are well provided, they can have a positive effect on sexuality, self-understanding, and equality in the couple's relationship.

Awareness↗
PubMed1999

Research and quality control in natural family planning with relational database systems.

Research and quality control in natural family planning (NFP) is based on continuous data collection in prospective studies. The quality of the data is determined by the reliability of collection, input, management, and retrieval. During a period of ten years, different relational databases were programmed to manage the large number of very different data in NFP studies. Recently, all experience with different database systems has been summarized by writing and testing a completely new data management system based on MS Access 97: NFPDAT 1.0. This new software is used for data collection, evaluation and administration in NFP Study Groups. Over 200 internal formulae guarantee maximum data consistency while 30,000 cycles from 1477 patients were stored. Easy data evaluation for research and administration is possible with the help of a new report generator even without prior knowledge of SQL (System Query Language) or Visual Basic for MS Access 97. Using this method, interim results for research and quality control can be obtained at any time. NFPDAT can be used by all Natural Family Planning Study Groups using the symptothermal method for research and administration. With the help of NFPDAT, various prospective studies of Natural Family Planning were conducted.

Austria↗
PubMed2005

[Contraception and bleeding disorders--diagnostic contributions by ultrasound].

Practically all widely used and safe and reversible methods of contraception exert a direct (or at least an indirect) impact on the endometrium. Not surprisingly, abnormal uterine bleeding is a frequent adverse reaction associated with contraception. In this situation sonography--in particular transvaginal sonography--offers the physician a practically non-invasive imaging technique for determining the etiology of abnormal uterine, cervical or vaginal bleeding. Ultrasonographic imaging provides the physician with a detailed picture of the internal reproductive organs. It can also be used to monitor the efficacy of the particular contraceptive method. e.g. to check the position of IUDs, confirm the suppression of ovarian follicle activity in women taking ovulation inhibitors, detect ovarian cysts as a focus of undesirable hormonal activity, etc. In some cases, the failure of contraception, namely pregnancy, can be diagnosed by ultrasound. By using high-frequency linear ultrasonographic probes, the physician can verify the position of subcutaneous contraceptive implants on the medial upper arm. Therapeutic consequences can be derived, in particular, from the ultrasonographic measurement of the total thickness of the endometrial layer.

Adult↗
PubMed2002

Sonography: dizygotic twin survival in early pregnancy.

It has been suggested that losses of twin conceptuses in very early pregnancy are high, and that for every liveborn twin pair there are a further 10-12 twin pregnancies that end up as a singleton birth. Here we show that in a group of women who had double-ovulated and conceived, the probability of the second egg also becoming fertilized and developing is 20-30% - which is comparable to the probability of conception and survival of a single conceptus. We conclude that the presence of one embryo does not affect the development of its twin.

Embryo Loss↗
PubMed1993

Preoperative ultrasonic assessment of women undergoing gamete intrafallopian transfer: a prospective study of 350 cases.

A total of 350 women due to undergo gamete intrafallopian transfer were scanned vaginally on the operation day and the findings were compared with those recorded 2 days previously when human chorionic gonadotropin was administered. The aim was to assess the clinical value of ultrasound assessment on the operation day, especially from a prognostic point of view. Seven women (2%) were found to have already ovulated and evidence of imminent ovulation was detected in another 27 cases (7.7%). There were more frequent and more marked increases in the number of follicles with a diameter of > 14 mm, in the diameter of the leading follicle and in the endometrial thickness in the women who subsequently conceived. The endometrial reflectivity was brighter than the myometrium (grade A) in 77.3% of the women who conceived, compared with only 37.5% of those who did not conceive. These differences were statistically significant. It was concluded that follicular and endometrial changes recorded on the day of gamete intrafallopian transfer may have a prognostic value, as the pregnancy rate was higher in women who had the favorable ultrasonographic features outlined in the study.

Journal Article↗
PubMed1987

Pulsatile LH secretion during the preovulatory surge in the ewe: experimental observations and theoretical considerations.

The secretion of LH during the preovulatory surge has been shown to be pulsatile in several species. We confirmed this phenomenon in intact ewes in two experiments in which we studied the LH surge in detail. In the first experiment, the levels of LH were measured in discrete blood samples taken every 5 min around the onset of oestrus in 5 intact Merino ewes. For 2-5 h immediately prior to the onset of the surge, the median pulse interval was 17.5 min (range 10-55) and the median pulse amplitude was 0.70 ng/ml (range 0.28-1.33 ng/ml). During the ascending phase of the surge, the pulse interval did not change significantly (median 18.3 min) but the median pulse amplitude increased 20 fold to 18.0 ng/ml. During the descending phase, the median pulse interval was 22.5 min and the median amplitude decreased to 8.1 ng/ml (P less than 0.005). During the surge, intervals of 10 min and amplitudes over 30 ng/ml were common. In the second experiment with 2 oestrous Romanov x Préalpes-du-Sud ewes, blood was withdrawn continuously and samples were pooled over 4 min periods for 19-27 h. In the resulting profiles, individual pulses were better defined but the pulse frequencies (median interval 15.2 min during ascending phase) and amplitudes (median 35.0 ng/ml) varied in similar fashion to the Merinos. Using a simple mathematical description of pulsatile secretion, and assuming that LH is only released in pulses, we also found that the high concentrations normally achieved during the surge can only be explained by pulse frequencies and amplitudes well above those normally observed in other physiological situations, including the follicular phase or following ovariectomy. These findings strongly support the experimental data and the combined results of the two studies suggest that the initiation and execution of the LH surge is probably accomplished by changes in the amplitude of pulses. A high frequency is also essential and our data suggest that it may be established some time before the onset of the surge proper, but this requires confirmation. Respectively, the changes in amplitude and frequency reflect the pituitary and hypothalamic components of the positive feedback mechanism. The theoretical study suggested that a change in clearance rate could also contribute to the surge and this awaits further investigation.

Animals↗
PubMedDate not supplied

Relationship between embryo recovery rate and uterine lavage fluid composition in postpartum mares.

The aim of the study was to determine whether neutrophil numbers (PMN), trypsin-inhibitor capacity (TIC), lysozyme, N-acetyl-beta-D-glucosaminidase (NAGase), beta-glucuronidase (B-Gase), total protein, and plasmin in uterine lavage fluid of postpartum (p.p.) mares, either at the time of foal heat insemination or around the time of arrival of the embryo in the uterus, could be used in predicting conception. Fifteen mares were inseminated within 13 h after the first p.p. ovulation. Uterine lavage fluids were successfully collected from 9 out of 12 mares before insemination and from all 15 mares before embryo recovery 7 to 8 days after insemination. The embryo recovery rate was 53% (8/15). Prior to insemination, PMN, TIC and lysozyme levels were elevated in 3/4 mares not producing embryos. However, only 1/5, 1/5 and 0/5 mares producing embryos had elevated levels of PMN, TIC, and lysozyme, respectively. None of the parameters was significantly different in mares with or without embryos, but lysozyme was the closest to significance (p = 0.07). In both groups of mares, activities of NAGase (p < 0.01) and B-Gase (p < 0.05) were significantly higher in dioestrus than immediately after ovulation. At embryo recovery, NAGase was higher in mares not producing embryos (p < 0.05). The results suggest that a long-lasting inflammation is the best explanation for low pregnancy rates during the first p.p. oestrus. Further research is needed to establish whether lysozyme, or possibly TIC, could be used in predicting conception at foal heat.

Acetylglucosaminidase↗
PubMedDate not supplied

Relationship between peri-oestrus progesterone levels and time of ovulation by echography in pigs and influence of the interval between ovulation and artificial insemination (AI) on litter size.

Two methods for the determination of ovulation were compared to one ultrasonography performed 5 times a day. Time of ovulation by echography was 40 +/- 5.8 h (mean +/- SD) after the onset of oestrus. Preovulatory LH rise (two blood samples per day) began near the onset of oestrus but, in our conditions, this parameter could not be used to predict ovulation. The basal level of progesterone (two blood samples per day) was determined with a non-linear model, the timing when progesterone rose more than one SD (0.3 ng x mL(-1)) coincided with the timing of ovulation determined by echography (R2 = 0.98). This method was efficient and was used in a field trial to measure the consequences of the variability of the interval between Al and ovulation on litter size. The interval between Al and ovulation had an effect on litter size; litter size decreased by one piglet when this interval increased by 10h.

Animals↗
PubMed1979

Ovulation recovery after hormonal contraception.

In an attempt to study the ovulation recovery after hormonal contraception, 20 patients who were on B. C. P. (birth control pills) during 12--36 months, were switched to I. U. D. contraception, and the ovarian changes occurred were assessed by laparoscopy and laparoscopic ovarian biopsy. Fresh corpus leuteum was found in 12 cases (60%), some follicular activity in 4 cases (20%) and no signs of activity in 4 cases (20%). Our results suggest that neither the length of hormonal contraception nor the patient's age have any particular influence upon the return of ovulation.

Adult↗
PubMed2006

Environmental influences on female fecundity and fertility.

An increasing body of evidence suggests that environmental exposures are adversely influencing female fecundity and fertility. Endocrine-disrupting compounds (EDCs) are of particular concern, due to their ability to interfere with the body's hormonal milieu. An overview of the literature regarding the effect of EDCs on female fecundity and fertility end points such as puberty, menstruation, endometriosis, time to pregnancy, pregnancy loss, reproductive senescence, and secondary sex ratio is presented. Methodologic challenges in studying the effects EDCs on sensitive reproductive end points are discussed and include exposure to mixtures, the choice of biologic media in which to measure compounds, laboratory methods, and varying modeling techniques. Also reviewed are novel technologies for home-based biospecimen collection and testing that offer promise for field-based research aimed at addressing questions about environmental influences on female fecundity and fertility.

Endocrine Disruptors↗
PubMed1989

[Vaginosonography in gynecology].

Vaginosonography is a new method for gynaecological diagnosis. Its special advantage is to reach the uterus and the ovaries at close range. A structural refinement of the surrounding tissue allows to better coordinate individual structures to the different organs. A further advantage is, that a filled bladder is not required. At the first time diagnostic ultrasound can be used in corpulent patients as well. Vaginosonography is of special importance in the diagnosis of the endometrium according to the event of cycle identifying different types of amenorrhea, and also informative during the climacteric period. Besides the demonstration of the endometrium the time of ovulation can be determined by folliculometry, and an exceeding follicular growth can be stopped at the right time. Transvaginal puncture of follicles is a quicker and easier technique than the usual laparoscopic approach. Early diagnosis of pregnancy is of great importance as well. Using vaginosonography, a missed abortion and an extrauterine pregnancy can be varified in a simple way. A cervical insufficiency can be evaluated in a better way by the determination of the opening of the internal orificium of the cervix. There is further use of the method in other fields of gynaecology.

Abortion, Missed↗
PubMed1989

[Possibilities for using the LH color test in determining ovulation time].

The LH color test was used to monitor 40 cycles of 32 patients. The urine test, which becomes positive at a LH-concentration of at least 50 I. U./ml, indicated the LH-peak in 34 out of 35 cycles with ascertained ovulation. In 24 cycles, the urine LH-peak preceded the serum LH-peak by one day. The urine LH-peak was found on cycle day 13.6 on average. The serum LH-peak on day 14.2 on average. The sensitivity of the LH color test was 97.2%, its specificity 100%.

Adult↗
PubMed1987

[Significance of 17-hydroxyprogesterone for the diagnosis of ovulation].

In 30 sterility patients with normal course of the cycle, 17 OHP already rises significantly one day before the LH-peak. It influences not only progesterone and E2 but also hypothalamic opiate activity and LHRH and LH secretion. 17 OHP is on the one hand discussed as a further trigger for the LH peak and is on the other hand regarded as an initiator for incipient luteinization.

17-alpha-Hydroxyprogesterone↗
PubMed1985

[Comparison between the radioimmunologic measurement of plasma E2 and estrogen determination in urine using a hemagglutination inhibition test].

To prove the diagnostic value of a new haemagglutination inhibition test (HI-Estrotec), urinary and plasma oestrogens were simultaneously measured in 42 stimulated cycles of 40 women of the Erlangen IVF programme. Comparing the results of all paired samples, there was a correlation coefficient r = 0.6968. Correlating the total oestrogens in the early morning urine with the plasma-E2, the coefficient was r = 0.641. In 26 cases of the 42 stimulated cycles egg retrieval could be performed. Averaging the daily values of these women the graphs of E2 and urinary oestrogens show nearly parallel curves with maximal values on the same day, i.e. the first day after HCG application. Comparing the two curves of the individual patient, in 14 of 26 cases there are differences of more than 24 hours between the maximal values of urinary and plasma oestrogens. The advantages of the HI-Estrotec-Assay are: Simple handling without special demands on the laboratory equipment. The results can be obtained after two hours already. The possibility to measure several times a day without great effort. The disadvantage is: The delayed appearance of the hormones in the urine. To induce ovulation with HCG, however, actual parameters are indispensable. If the ovulation is triggered by the endogenous LH surge the diagnostic value of the new assay is sufficient when it is combined with an LH monitoring.

Adult↗