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PubMedDate not supplied

[Basic questions on andrological appraisals in a court of law. Procreative ability in the past].

In a court of law the andrological appraisal towards the assessment of the procreative ability of a man is concerned with the degree of procreative ability during the legal time of conception (181st to 302nd day prior to the date of birth including both of these days BGB Section 1592). The andrological expert is a servant of the court, not a judge. Each finding deviating from the norm must be controlled at least twice. Preliminary diagnoses must be fully considered. In the case of oligozoospermia manifested at the present point in time, whereby anamnestic data regarding any past sicknesses are lacking, it must be assumed that during the legal time of conception a condition similar to that now detected also existed. This means that the present finding was already in a state of effect in the past.

Fertility↗

PubMed1977

[Etiopathogenetic and clinical notes on the syndrome of the micropolycystic hyperandrogenic ovary and matrimonial sterility].

The nosological, clinical, aetiopathogenetic and therapeutic aspects of hyperandrogenic micropolycystic ovary are examined with particular reference to matrimonial sterility. There is not doubt about the existence of a syndrome substantially characterized, clinically, by menstrual trouble, inability to procreate, more or less evident signs of hyperandrogenism and a tendency to obesity and, morphologically, by ovarian micropolycystic alterations of typical pathognomonic aspect: the marked production of androgens on the part of the female gonad possibly accompanied by peripheral alterations interfering with their metabolism. The syndrome is not too frequent and, in personal experience, occurs in less than 1% of the series. The main therapeutic approach remains cuneiform resection of the ovary. Still in personal experience, 21.2% of cases treated led to pregnancy but not more than eight-ten months after operation. The effect would therefore appear to be transitory and the operation is decisively rejected where unmarried women are involved.

Androgens↗

PubMedDate not supplied

[1997 results of medical assisted procreation with third party donations and autopreservation. CECOS French Federation].

During the year 1997, the French Federation of CECOS recorded the results of the 23 CECOS centers and IFRAERES in Toulouse. 1620 first demands of procreation with sperm donors were registed (versus 1,690 in 1996) but only 3,235 patients received at least one donation in the year, 22% less than 1996. From 10,935 cycles (AID or IVFD), 1,333 pregnancies were obtained, scoring the identical amount in terms of pregnancies as in 1996 but with less 30% in terms of cycles. The analysis of the 1,298 deliveries of the 1996 pregnancies show a malformation rate of 1.9%. 419 male volunteers came forward as sperm donors (5% more than 1996). In gamete autocryopreservation, the number of semen preservation is globally increasing (11.2% more than 1996), mainly because the capacity of a better reutilization with ICSI.

Cryopreservation↗

PubMed1985

[Clinical approach to male infertility].

The clinical approach to male infertility involves uncertainties, and various circumstances must be considered: 1. If no pregnancy occurs in the case of a couple whose sexual relations are "normal" and regular, and who have used no form of contraceptive for one year, the evaluation must systematically include both the woman and the man. 2. In the case of a man wishes to know his capacity for procreating, what are the possibilities for improvement? 3. Are there ways of predicting male infertility? If there are, the socioprofessional and iatrogenic risks should be more fully investigated. 4. What are the current possibilities for male contraception? In practical terms, the case of the infertile couple offers the widest field for clinical and paraclinical investigations. An exploratory strategy must guide this evaluation, assuring efficacy and taking account of current therapeutic possibilities, which are still unfortunately limited. The change in attitudes is clearly expressed by the number of couples who resort to adoption or artificial insemination rather than continue examinations and treatments when there is little chance of achieving pregnancy.

Cervix Mucus↗

PubMed1994

[Cryopreservation of the ovary and ovarian tissue].

Cryopreservation followed by grafting of ovarian tissue should enable prevention of the irrevocable loss of ovarian function sometimes associated with radio and/or chemotherapy in young women with malignant neoplasms. Cryopreservation of the oocyte should improve the general results of medically assisted procreation by enabling the creation of an oocyte bank. Three research areas have been developed in terms of preservation of the ovary or of the ovarian tissue by refrigeration. Freezing of the whole organ, or of fragments, was the first technique to be studied and did not lead to any practical applications. Freezing of the oocyte is being widely studied at present. Despite some successes, it is still far from possible to create an oocyte bank. Freezing of primary follicles is the latest ovarian cryopreservation technique described. Preliminary results are interesting and this method may offer the solution to the total restoration of ovarian function.

Cryopreservation↗

PubMed1995

The importance of dreams and action in the adolescent process.

The author argues that after puberty dreams and action are indicators of the capacity of the psychic apparatus to perform the work of binding drive energy. He notes that the development of adult sexuality always involves risk and that effective dream activity affords a definitive solution to the problem of incestuous and parricidal temptations, which attain an unprecedented pitch of intensity with the onset of sexual and procreative potency in adolescence. The author illustrates his thesis by the case of an adolescent patient with particular sexual pathology who broke down at the age of 17 and who, once he became able to dream in the course of analysis, had less need to act out. A 'work of the negative' is presented as a paradoxical but important element in psychic development. Dreaming and action are stated to be inseparable and to constitute an essential safety valve that facilitates the developmental process. A discussion of the connections between dreams and initiation leads to some ethnological considerations on sexuality and society, and the paper ends with a plea not to overlook the death drive.

Adolescent↗

PubMed1984

A second career in academic medicine.

Career changes in all vocations are relatively common in the forties age group due to a variety of factors which include a crisis period caused by polarities of Generativity versus Stagnation as conceptualized by Erik H. Erikson. Generativity is served not only by procreativity but also by guiding the next generation through teaching. The result can be the strength of Care. Stagnation can result in unhappiness, irrational and destructive behavior, or withdrawal. Concepts of young, old and mortality also come into focus. A successful career change from private practice to academic medicine depends upon a combination of power, opportunity, and character. To be successful, the change should be made for positive reasons and be based upon youthful concepts in the cold reality of the financial and intellectual challenges of a new and competitive career. If properly done, both the personal rewards and the contribution to future medical care can be quite positive.

Adult↗

PubMed2002

Spinal cord injury medicine. 4. Optimal participation in life after spinal cord injury: physical, psychosocial, and economic reintegration into the environment.

UNLABELLED: This learner-directed module on spinal cord injury (SCI) presents a variety of perspectives of the process of personal and environmental adaptation for reintegration. Adaptation is unique to each person and does not predictably follow stages. Models used for understanding the process include biopsychosocial, ICIDH-2 (International Classification of Functioning, Disability and Health), and sector divisions of the environment. Home modification requires home (intermediate environment) evaluation and sociospatial behavioral mapping for planning and appropriation of remodeling in proportion to functional need and use. Options for access to the natural environment include specialized wheelchairs, climbing rigging, kayaks, and sail boats. Sports participation with adaptations is expanding and includes a larger variety of organizations and leagues. Economic needs are effectively anticipated with development of a life care plan. Procreative options to overcome infertility after SCI include vibratory stimulation for ejaculation, intravaginal insemination, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. Approaches to requests for withdrawal of life-sustaining care include depression screening, pain evaluation, and assistance in accomplishment of person centered goals. Overall, community reintegration after SCI is continually improving because of better acceptance, accessibility, and technology for building adaptations. OVERALL ARTICLE OBJECTIVES: (a) To review models and theories of medical intervention and disablement and (b) to demonstrate their application in rehabilitation practice by designing unique treatment plans that meet patient person-centered goals.

Adaptation, Physiological↗

PubMed1989

Artificial procreation with frozen donor semen: experience of the French Federation CECOS.

The French Federation CECOS (Centre d'Etude et de Conservation du Sperme Humain) sperm banks collate the results of its 20 centres and provides annual reports on their activity. Since its creation in 1973, approximately 17,000 pregnancies have been obtained using frozen donor semen either for artificial insemination by donor (AID) or for in-vitro fertilization. The recruitment of the donors was very strict, only 62% of the 6810 donor candidates were accepted. The overall mean success rate per cycle for all women who began AID was approximately 8%, and the theoretical cumulative success rate was 48% at six cycles and 66% at 12 cycles. The population of recipient patients was very heterogeneous, including fertile, sub-fertile and infertile women. Some of these female factors have been analysed.

Cryopreservation↗

PubMed1978

[Legal capacity to act and the sexual life of the mentally handicapped in Sweden (author's transl)].

In Sweden efforts are being made to integrate the mentally handicapped as much as possible into society. If these efforts are to be successful society must concede to them the same rights it does to its non-disabled citizens. On the basis of the terms "legal status" and "legal capacity act" the article examines the consequences which might arise for the mentally handicapped from their being granted these legal rights. As the Swedish society principally allows the mentally handicapped the right to sexual intercourse difficulties arise, in particular, if there is the possibility of procreation and, even more, if children are desired. The pros and cons of pregnancy and its consequences for mentally handicapped people are discussed. Old and modern countermeasures (marriage obstacles, sterilisation, abortion) and the alternatives (systematic sexual instruction, counselling as regards preventive measures and control of their use) are compared and examined in view of their applicability in accordance with the Swedish normalisation efforts. The study showed that mentally handicapped persons can live--also in the sexual area--according to the same principles that guide us all, if we help and advise them adequately and at the right time. Under these circumstances restrictions are no longer the rule, but the exception.

Abortion, Induced↗

PubMed1991

Retinoma. Case studies.

The new concept of retinoma, or retinocytoma, brings up the rare 'spontaneous regressions' long-reported in the literature. Systematic investigation of all relatives of children suffering from retinoblastoma is showing up more and more retinoma cases undetected until now. From 1975 to 1990 the authors have identified 11 retinoma cases amongst 103 retinoblastoma patients and their families. The average age of the retinoma patients is 23 years with a mean follow-up of four years. There are four bilateral cases, one of which with phthisis bulbi, three unilateral retinomas associated with retinoblastoma of the fellow-enucleated eye, and four unilateral cases. Of the 11 retinomas, seven patients have a family history of retinoblastoma. Of the seven patients of procreating age, 16 offspring, three abortions and two miscarriages are noted. Of the 16 offspring, 12 developed retinoblastoma, 11 of which bilaterally. One 21-year-old patient presented in the process of malignant transformation. A child, enucleated for retinoblastoma of one eye and showing lesions conforming to retinoma in the fellow eye at two years of age, suffered an osteosarcoma when nine years old. The authors' data show that retinoblastoma and retinoma follow the same genetic changes and consequently require the same investigation and follow-up. This study indicates a frequency of retinoma of 10% amongst retinoblastoma patients and their families which is higher than that usually quoted.

Adult↗

PubMed1995

Sperm banking and patients with cancer. Issues concerning patients and healthcare professionals.

In 1994, approximately 52,000 new cancers will have occurred in patients < or = 34 years of age. Reported survival rates for tumors common to males in this age group are promising and are expected to improve. Chemotherapy treatment may produce infertility, and without appropriate intervention, the aspiration of producing offspring may never be realized. Semen cryopreservation (sperm banking) may be offered to male patients with cancer as an intervention to circumvent loss of procreation ability resulting from chemotherapy-induced infertility. Oncology nurses can discuss infertility and sperm banking with patients at the most opportune time, before initiation of chemotherapy. Considerable debate exists among health-care professionals regarding the practicality and usage of sperm banking for young adult male patients with cancer being treated with chemotherapy. In addition, health-care professionals may be uncomfortable discussing issues of a sexual nature with patients. Staff nurses administering chemotherapy to young adult males need to work toward improving their knowledge about the effects of cancer and cancer treatment on reproduction. Improved knowledge will reinforce the importance of offering sperm banking to circumvent treatment-induced infertility.

Adult↗

PubMed2001

[The general practitioner and screening reproductive age women].

All women in age of procreation might benefit of well established screening tests. The latter being conduct to identify, in this apparently healthy population, diseased or carrier women of an affection. This screening program might be realised by a general practitioner and must be encouraged. Actually, in Belgium, there is no national screening program for this population. Recommendations might be proposed for all screening tests that can be realised in preconceptual period. These concern screening of diseases which affect all women like cervical cancer, which might influence the pregnancy or infant outcome, like an infection or an hereditary disease, or which could be adversely affected by the pregnancy, like diabetes.

Adult↗

PubMed1996

The ticking of the social clock: adults' beliefs about the timing of transition events.

In two studies, beliefs about descriptive and prescriptive age norms for adult developmental transitions were examined in a sample of 214 Australian university students aged seventeen to fifty years. The results of Study 1 revealed a belief by the vast majority that descriptive age norms still exist for both family transitions (marriage, parenthood, grandparenthood) and career transitions (leaving school, retirement). While these results were in keeping with those of Neugarten et al.'s original study of age norms in the United States, the actual "best" normative ages recommended by this sample of contemporary Australian adults differed in every case from the U.S. age norms of three decades ago. Matching contemporary demographic trends, the present Australian young-adult sample advocated later ages for marriage and grandparenthood, a younger norm for leaving school, and a broader normative age range for retiring from work. Study 2 tested Neugarten's hypothesis that age norms today lack some of the prescriptive overtones implicit in original "social clock" concept. The results supported this suggestion. In fact, only a minority of contemporary Australian adults believed that there were prescriptive upper age boundaries for first marriage or university study. Furthermore, their prescriptive lower age limits for every transition except retirement fell at or below the onset of adulthood itself (18 years), in keeping with biological constraints on procreation and maturational constraints on social and cognitive development. The mean ranges of acceptability prescribed by this Australian sample for each key adult transition were likewise very wide, stretching from an average of twenty-four years (for motherhood) to forty-nine years (for a man's first marriage). This result also contrasts sharply with the ranges of no more than five years prescribed for the same transitions by the vast majority of Neugarten et al.'s sample three decade ago. The probable consequences for self-esteem, mental health and life planning of this heightened variability and reduced prescriptiveness in the timing of life events for contemporary men and women were discussed.

Adolescent↗

PubMed2003

Normal onset of puberty have definitions of onset changed?

Puberty is the sequence of events that culminates in the ability to procreate. It is widely accepted that the onset of puberty in girls occurs on average at 8 years of age and that onset prior to 8 years of age is precocious puberty. As a result of the cross-sectional study by the American Association of Pediatrics, a movement exists to change the age limit of the onset of puberty to 6 years of age in black girls and 7 years of age in white girls. We should be cautious in adhering to strict age limits when diagnosing precocious puberty. Also the rapidity and progression of puberty should be evaluated, and if appropriate, therapy to suppress pubertal development considered.

Adolescent↗

PubMed1995

[Folic acid and pregnancy. Société française de pdiatrie--Comité de nutrition].

Epidemiological studies have shown a relationship between maternal folic acid status and the incidence of neural tube defects, prematurity, abortions. Based on the actual data, the Committee of Nutrition recommends that all women at age of procreation should be encouraged to regularly eat fresh fruits and vegetables in order to increase their reserve of folic acid, and that pregnant and lactating women should be supplemented with a daily dose of 200 micrograms of folic acid. In addition, the Committee is in favour of a folacin enrichment of some food which would allow to cover the needs of pregnant and lactating women. Those women who gave birth to a child with neural tube defects must be informed of the high risk of recurrence and be encouraged to take a treatment of 4 mg/day of folic acid, ideally starting one month before the beginning of pregnancy and to be maintained during the first 3 months.

Female↗

PubMed2005

[Smoking (active or passive) in relation to fertility, medically assisted procreation and pregnancy].

Maternal and paternal smoking are associated with numerous problems of reproduction and pregnancy. Among men, active smoking reduces the quality and mobility of the spermatozoa which could result in loss of fertility. It also increases the risk of impotence. Moreover, active smoking of the father is responsible for passive smoking for the mother and her baby. Among women, active smoking has a negative impact on fertility and in case of treatments against infertility, the chances of success are reduced. It leads to delayed conception and increases the risk of ectopic pregnancies and placental complications. It reduces the risk of pre-eclampsia but it also worsens its consequences. Passive smoking has not been associated with certainty with any clear impact on fertility among men and women. By contrast, active and passive smoking can lead to intra-uterine growth retardation and a lower birth weight.

Female↗

PubMed1992

Is there an indication for embryo reduction?

The selective reduction of embryos in multiple pregnancies poses numerous medical, technical, ethical and psycho-social problems. In a retrospective study, we analysed nine hundred and twenty-two pregnancies obtained using medically assisted procreation between May 1982 and May 1990. Among 922 successful pregnancies, 372 were singleton, 102 were twin and 13 were triplet. Data from this analysis and from a French multicentre study of 262 embryo reduction procedures demonstrated the value of an embryo quality score for minimizing the risk of multiple pregnancy and the existence of extremely infrequent, ethically acceptable indications for embryo reduction. These indications included ultrasound-proven malformations of one fetus, multiple pregnancies in patients with extensive uterine scarring, and multiple pregnancy despite the appropriate use of preventative measures which can be expected to make this technique unnecessary in the future.

Abortion, Therapeutic↗