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PubMed2005

[GnRH antagonists: present and future].

Antagonists act by competitive inhibition of pituitary GnRH receptors for which they have a high affinity with a dose-dependent activity. The inhibition concerns LH but also FSH by inhibiting their secretion for 24 hours. At this time, only three molecules are available. Cetrorelix is mainly used for in vitro fertilization protocols, but research is currently being carried out in benign prostatic hypertrophy. Ganirelix is only used in medically assisted procreation. Abarelix is used in the United States as a monthly "depot" injection for the treatment of prostate cancer resistant to other therapies. Other molecules including orally active antagonists are in the course of clinical evaluation or in preclinical phases. The development of this therapeutic class is hampered by conflicting industrial interests and also by problems of tolerability in particular because of the side effects due to induced histamine release. The current indications in France are therefore limited to Assisted Reproductive Technology, and, recently, prostate cancer pending comparative studies versus agonists. The indications under development are endometriosis, myoma and precocious puberty, fields in which agonists have already been found to be effective. Male contraception seems to have a future however this therapeutic regimen remains very expensive. Finally, in benign prostatic hypertrophy, the antagonists administrated intermittently may be used to rapidly improve urinary flow.

Dose-Response Relationship, Drug↗
PubMed1999

[Successful PMA. Review of the activities of the Center for Medically Assisted Procreation of University of Liege, 1985-1997].

Assisted reproductive treatments (ART) hold an increasing place in the field of female infertility but also of male infertility with the development of new micromanipulative technologies. From January 1985 to December 1997, more than 3,000 ovarian punctures were achieved at the CPMA of the University of Liege and more than 40,000 oocytes were recovered. Global results show a take home baby rate of 23% per ovum pick-up and 27% per embryo transfer. Embryo cryopreservation offers an efficient solution to the problem of supernumerary embryos and opens the way for IVF-derived procedures such as oocyte or embryo donation, surrogate mother. The transfer of frozen-thawed embryos increases the total ongoing pregnancy rate per cycle of 31%. One of the aims of our Centre in the near future is the development of new technologies such as control of chromosomal abnormalities or genetic defect in preimplantation embryos and clinical applications of oocyte or ovarian tissue freezing.

Belgium↗
PubMed2004

Feminist discourse on sex screening and selective abortion of female foetuses.

Although a preference for sons is reportedly a universal phenomenon, in some Asian societies daughters are considered financial and cultural liabilities. Increasing availability of ultrasonography and amniocentesis has led to widespread gender screening and selective abortion of normal female foetuses in many countries, including India. Feminists have taken widely divergent positions on the morality of this practice. Feminists from India have strongly opposed it, considering it as a further disenfranchisement of females in their patriarchal society, and have agitated successfully for legislative prohibitions. Libertarian feminists on the other hand, primarily from the United States, have argued that any prohibition of the use of this technology is a curtailment of a woman's reproductive choices and a violation of her right to make autonomous decisions regarding procreation. Using India as an illustrative case, this paper argues that in the context of what prevails in some societies, an ethical argument that hinges on the principle of autonomy as understood in the West can be problematic. Furthermore, a liberal theoretical assumption that it is always better to have more rather than fewer choices may not hold up well against the realities of life for such women. Although feminists have little disagreement concerning substantive matters, it is in the area of strategy that differences of opinion have arisen, their moral reasoning and responses shaped by the culture, ethnicity, class and race to which they belong. A view that a single 'orthodox' feminism of any variety can embody the aspiration of all women reverts to the problematic issues in the evolution of the rationalistic, individualistic, 'male' ethics against which women have consistently raised objections.

Abortion, Induced↗
PubMed2005

[Global HIV care in general/family practice].

Dealing with HIV/AIDS in primary care encompasses preventive, curative, social and psychological aspects within a framework of a person-centred approach. Antiretroviral treatments enable the control of HIV infection, prevent opportunistic infections and allow patients to "live their life" with an increased life expectancy, active sexuality and need to procreate. The holistic care of patients should always be the primary concern. An increased involvement of GP's in HIV care can raise the quality of care, reduce the stigma and prejudice surrounding HIV Medical care providers can substantially affect HIV transmission by positively reinforcing changes to safe behavior, by referring patients for specialized services and working in direct collaboration with them, by facilitating partner counseling and testing. However, providers must interweave the "half-baked "science about drug therapies, side effects and drug interactions with the psychosocial and lifestyle factors of the patient. Sometimes it's not easy to find adequate and relevant information about HIV in primary care. This document will provide primary care givers the keys for improvement, increase their basic HIV-related skills (and strengthen their role in HIV/AIDS prevention and follow-up) and make them more confident in their assessments.

Acquired Immunodeficiency Syndrome↗
PubMed1995

A surrogate carries a fertilised ovum: multiple crossings in ego boundaries.

Recent advances in reproductive technologies have created situations in which early psychoanalytic thinking with regard to the procreative wish, infertility, and the significance of pregnancy in mothering, calls for reconsideration. The paper addresses briefly issues related to psychological infertility; it focuses specifically on possible psychological implications during full surrogacy, as this procedure is now practised in many fertility clinics in North America. The analysis of a young woman whose infertility was related to her exposure, during intra-uterinary life, to her mother's hormonal treatment (DES), presented us with the opportunity to observe the many psychological issues developing during in vitro fertilisation (IVF) and other similar procedures and, ultimately, to address the far more complex interpersonal states evolving between the biological (genetic) mother and the surrogate during full surrogacy. Analytic material provides the opportunity to discuss, specifically, questions of boundaries and boundary confusion in the relationship between the surrogate (who carried the couple's fertilised ovum to the birth of a healthy child) and the genetic mother.

Adult↗
PubMed1995

[Maternal risks of medical assistance with procreation].

It is now well demonstrated that assisted reproductive technologies, namely intra-uterine insemination, in vitro fertilization and embryo transfer, and gamete intra fallopian transfer (GIFT) are the source of maternal complications, sometimes life-threatened. All documented hazards concern the short term. Few are related to the techniques: local, regional or general infections, severe hemorrhages. Most are the consequence of controlled ovarian hyperstimulation: ovarian hyperstimulation syndrome (OHSS), thrombosis, multiple pregnancies. High range multiple pregnancies could be prevented by a reduction in the number of embryo transfered, which is now currently limited to two or three in most centers. Similarly, good results can be obtained with intrauterine insemination, while maintaining the multiple pregnancy rate at the physiologic level, about 1%, by avoiding poly-ovulation. In comparison with spontaneous pregnancies, ART pregnancies are more complicated (toxemia, intra-uterine growth retardation, prematurity). The caesarean section rate is over 25% in singleton deliveries, 40% for twins and 89% for triplets. With a long term follow-up of 15 years, no hazard has been demonstrated. Concerns about ovarian epithelial cancer, breast cancer, and premature menopause remain hypothetic. Further studies are in development in this field.

Breast Neoplasms↗
PubMed1989

Alcohol abuse and familial alcoholism: psychosocial correlates in men and women.

Multivariate and univariate analyses were conducted to investigate specific hypotheses concerning the effects of alcohol abuse, family history of alcoholism and gender on items in five categories: (1) family of origin; (2) childhood attention deficit, conduct and learning disorders; (3) intraindividual (psychological) variables; (4) peers and family of procreation; and (5) sociocultural and community variables. The sample consisted of 76 male and 72 female detoxified alcoholics and 50 male and 51 female community controls. By selection procedures, groups had an approximately 50% incidence of familial alcoholism; all were given detailed structured interviews covering the above areas. Significant differences between alcoholics and controls were found for all five categories, and four of the five categories showed significant family history effects. Gender differences were present on only one category. There were no significant Alcoholism X FH interactions. We conclude that (1) alcoholism and family history of alcoholism are distinct, separate factors that have additive and not interactional effects; and (2) these separate effects seem to operate in similar fashion in both male and female populations. The findings have relevance for methodological considerations and the identification of problem areas of functioning in the adult alcoholic and nonalcoholic offspring of alcoholics.

Adult↗
PubMed2001

A comparison of intrauterine versus intracervical insemination in fertile single women.

OBJECTIVE: To compare the efficacy of intrauterine insemination (IUI) and intracervical insemination (ICI) when used by fertile single women in a donor insemination program. DESIGN: Prospective randomized crossover study. SETTING: Donor insemination program (not an infertility clinic). PATIENT(S): Single fertile women choosing to inseminate with frozen donor semen. INTERVENTION(S): Clients received procreative counseling and screening and were then randomly assigned to begin office insemination with ICI or IUI. If additional insemination cycles were required, the clients used the method opposite their previous method of insemination until pregnancy was achieved. MAIN OUTCOME MEASURE(S): Monthly fecundity rate was compared between the two methods of insemination. RESULT(S): Sixty-two women contributed a total of 189 cycles, 94 by IUI and 95 by ICI. The monthly fecundity rate for IUI was 15%, as compared with 9% for ICI, (P=0.14). When the analysis was confined to cycles in which only one insemination was performed (64 IUI and 65 ICI cycles), the monthly fecundity rates were 14% for IUI and 5% for ICI (P=0.04). CONCLUSION(S): Intrauterine insemination with frozen donor sperm is more effective than intracervical insemination for single women without known fertility problems.

Adult↗
PubMed2000

Non-reproductive heritable disorders in infertile couples and their first degree relatives.

The genetic safety of intracytoplasmic sperm injection (ICSI) remains a matter of continuing debate. One source of concern is the limited knowledge about the general genetic constitution and background of patients who need sophisticated reproductive technology to procreate. It has been postulated that such individuals could be carriers of genetic lesions that might result in an increased prevalence of heritable disorders among their offspring. To investigate this issue, we determined the frequency of potentially heritable non-reproductive diseases in 621 infertile couples and their first degree relatives. A total of 1302 fertile couples who underwent genetic counselling prior to prenatal diagnosis served as controls. The infertile patients had a slightly higher prevalence of potentially heritable non-reproductive disorders ('significant genetic risk factors') than the controls (1. 9 versus 0.9%; P = 0.015). In contrast, such diseases were less prevalent in their families than in the fertile couples' families. Our data do not support the hypothesis that their familial genetic background predisposes children born after ICSI to malformations or other non-reproductive genetic diseases.

Adult↗
PubMed1996

Connections between primary vaginismus and procreation: some observations from clinical practice.

So far, the literature on vaginismus has mainly been contemplative. Quantitative data are scarce, while fertility and obstetrical aspects are almost never considered. In this article, these two aspects are addressed. A cohort of patients received a questionnaire, developed to obtain information about possible connections between the vaginistic reaction, the patient's treatment goals and, if relevant, obstetrical characteristics. Our data reveal that the desire to have a child is not a negative predictor for treatment outcome in terms of consummation. In some instances, however, self-insemination, as a bedroom procedure, is an effective treatment option to enable the couple to reach their fertility goal. Some women will conceive without intercourse experience; according to our data, delivery in this group is hardly more problematic than in a group of women who, after treatment for vaginismus, conceived by sexual intercourse. Having delivered a child may have a slightly positive effect on the capability to have intercourse, but only in a minority. Obstetricians should be aware that not infrequently, women give birth who suffer from severe penetration phobias.

Adult↗
PubMed1990

Gonadal status and reproductive function following treatment for Hodgkin's disease in childhood: the Stanford experience.

To ascertain the impact of therapy on gonadal function and reproductive outcome among children treated for Hodgkin's disease, we reviewed the experience at Stanford University Medical Center during the years 1965-1986. There were 240 children 15 years of age or younger, 92 girls and 148 boys; with median follow-up of 9 years, maximum follow-up was 26 years. Of this cohort, data on gonadal function were available on 20 boys, 5 of whom were considered prepubescent; they had no clinical evidence of sexual maturation and were less than 13 years of age. Evaluation of the boys included testicular biopsy, semen analyses and the ability to procreate. Serum gonadotropin hormone levels (FSH, LH) were studied in 11 boys who also had semen analyses. Sexual maturation was attained in all boys without the need for androgen replacement. Among the eight boys treated with radiation alone, four were able to father a child (3 following 40-45 Gy pelvic radiation dose, 1 without pelvic radiation) from 3-19 years following treatment. Three others who received 30-44 Gy pelvic radiation were oligospermic when tested at 10 to 15 years post-treatment. Semen analyses in 10 of 12 (83%) boys who had been treated with six cycles of MOPP with or without pelvic radiation revealed absolute azoospermia with no evidence of recovery as along as 11 years of follow-up. Following prolonged azoospermia, 2 of the 12 boys (17%) had recovery of fertility, with normalization of sperm count and/or ability to procreate at 12 and 15 years following treatment. There was no correlation with serum gonadotropin levels and sterility. Data on menstrual history, pregnancy and offspring were available in 86 (92%) of the girls. Seventy-five of the 86 girls (87%) have normal menstrual function. However, none of the females who underwent pelvic radiation without prior oophoropexy has maintained ovarian function. Both the prepubescent and postpubescent boys were affected by 6 cycles of MOPP whether or not pelvic radiation was administered. On the other hand, in girls similarly treated, ovarian injury was directly related to both the number of cycles of chemotherapy and the ovarian radiation dose. The chances of maintaining gonadal function following combined modality treatment are significantly greater among girls than boys. The progeny of patients treated for Hodgkin's disease appear normal and no excess fetal wastage has been noted.

Adolescent↗
PubMed1995

Transrectal electroejaculation in combination with in-vitro fertilization: an effective treatment of anejaculatory infertility after testicular cancer.

Treatment of non-seminomatous testicular cancer often leads to infertility due to anejaculation/retrograde ejaculation and poor sperm quality. In these men spermatozoa may be obtained by transrectal electroejaculation (TE), but the optimal strategy for assisted procreation in these couples is not known. Our aim was to examine whether TE and conventional in-vitro fertilization (IVF) would be successful. A total of 10 couples, with long-standing infertility due to anejaculation or retrograde ejaculation after treatment for testicular cancer 5-14 years earlier, were referred to our unit. All men underwent diagnostic TE under general anaesthesia. Spermatozoa were recovered in nine cases. The antegrade fraction was prepared and used for IVF. Sperm quality was variable and conventional IVF was considered impossible in three cases. Altogether six IVF treatment cycles in six couples resulted in five pregnancies, of which four resulted in a delivery and one resulted in a spontaneous abortion. One additional pregnancy is ongoing after transfer of cryopreserved embryos. The fertilization rate was 54% (33/61) and the cleavage rate was 97% (32/33). No complications relating to the procedure have been encountered.

Adult↗
PubMed2003

A low rate of trisomy 21 in twin-pregnancies: a cytogenetics retrospective study of 278 cases.

From January 1st 1990 until December 31st 2001, we collected 19686 prenatal diagnosis (on amniocentesis and chorius villus sampling). Five hundred twelve samples (2.6%) concerned 278 twin pregnancies. The most frequent indications were maternal age > or = 35 years (108/278 = 38.8%), medically assisted procreation (34/278 = 12.3%), positive ultrasound (20/278 = 7.2%). Chromosome abnormalities were found in eight twin-pregnancies (2.9%): five with only one fetus affected [47,XX,+ 18; 45,XX,t( 13;14); 47,XYY; 47,XXX; 45,XX, t(13;14)], two with both fetuses showing the same chromosomal abnormality [inv(11)(q21q25); 47,XX,+ 18] and one with only one fetus tested [47,XX,+ 18]. In total, we found eight autosomal abnormalities, four inherited balanced rearrangements (two robertsonian translocations and two paracentric inversions of chromosome 11) and four trisomies 18. We also observed two sex chromosome abnormalities interesting only one of the two fetuses. Surprisingly, we did no detect any Down Syndrome among this population. The frequency of Down Syndrome was significantly (p < 0.05) lower in our population of twin pregnancies (0.0%) as compared to the observed incidence in singleton pregnancies during the same period (163/19162 = 0.9%).

Adult↗
PubMed2001

[Pregnancy outcome and the status of the newborn infant after ICSI at La Conception Hospital in Marseille].

OBJECTIVE: To evaluate obstetric outcome of pregnancies and pediatric follow-up of children born after ICSI procedure. MATERIAL AND METHOD: Prospective study from october 1994 to September 1998 in medical assisted procreations center in La Conception hospital in Marseilles. Three hundred forty-two couples undergoing ICSI procedures. INTERVENTIONS: analysis of pregnancy rates, prematurity rates, obstetric outcome and frequency of congenital malformations. RESULTS: One hundred seventy-eight pregnancies have been obtained with 111 children. Multiple pregnancy rate arise 29.7%. The average term at birth in the singleton pregnancies (38.7 weeks) is higher than in the twins (35.7 weeks). The prematurity rate of delivery before 35 weeks of gestation is about 9.6%. Seven of 111 neonates was born with a congenital malformation, no cardiovascular one. One of boys presents a bilateral cryptorchidism with severe bilateral hypotrophy. CONCLUSIONS: Our results are similar with those of others teams. Congenital malformation rates is near rates reported in others studies. However, no bilateral cryptorchidism with bilateral severe hypotrophy has been yet reported in literature.

Congenital Abnormalities↗
PubMed2002

[Which psychological support for couples seeking medical assistance for procreation?].

OBJECTIVES: The objective of our qualitative study was to define modalities of psychological support to be offered to couples seeking medically assisted procreation. MATERIAL AND METHODS: Forty couples participated in a semi-structured videotaped interview, which touched on themes such as personal and family histories, the couple's relationship, etc. We focused on the "narrative mobility", that is the way in which the couples transmit their personal and family history during the interview and the interviewer's impression that he may or may not share this with the couples. RESULTS: Observed differences in narrative mobility led us to distinguish three groups of couples and to propose various types of psychological support. DISCUSSION AND CONCLUSION: This exploratory study, with its interest for the narrative mobility, concerns the couples' capacity to stand back from their own story as responsible interlocutors. We made the hypothesis that this capacity is linked to their capacity to handle their emotional stress, to act as partners to the medical team and to prepare themselves for their future parenthood.

Emotions↗
PubMedDate not supplied

[A control program for an outbreak of the scorpion Tityus serrulatus, Lutz and Mello 1922 in the town of Aparecida, São Paulo state (Scorpiones, Buthidae)].

A scorpion control program was proposed for the town of Aparecida (SP), an endemic region of Tityus serrulatus. Clusters of scorpions in urban and rural areas, environmental degradation of the town's outskirts and new scorpion procreation and dispersal habitats were studied. In addition, infrastructure problems such as the disposal and collection of residential and municipal refuse, sanitation (sewage and storm sewer), condition of vacant lots and constructions in the urban area were evaluated. After an epidemiological study, educational measures such as the distribution of pamphlets, cleaning group work, visits to residences and cooperation from High School teachers and students were also suggested. Chemical control was indicated in high-risk sites, especially those of near-school buildings. Furthermore, the use of natural predators was also mentioned within the present sanitation regulations for urban areas. The authors assert that these procedures must be integrated and continued uninterruptedly for several years. They also suggest a collaborative work with those responsible for the dengue eradication program, as well as the institution of the "scorpion study week", which would greatly contribute to the education of the population, to preventive programs and to scorpion control.

Animals↗
PubMed2006

Retarded ejaculation.

Retarded ejaculation (RE) has a relatively low prevalence (<3%), yet this condition results in considerable distress, anxiety, and lack of sexual confidence for those suffering from it. Furthermore, men with partners often experience impairment of both the sexual and nonsexual aspects of their relationships, with such negative effects compounded when procreation is a consideration. The definition of RE is ambiguous, due to the variability and paucity of data regarding normal coital ejaculatory latency. RE is influenced by both biogenic and psychogenic components, which may vary over time both between and within individuals. While specific pathophysiology can often be identified, further elucidation of the biogenic components of this dysfunction will require greater understanding of the physiological mechanisms underlying ejaculation. Yet, the most useful strategies for understanding RE will integrate rather than isolate the various biogenic and psychogenic aspects of this dysfunction. Evidence based evaluation and treatment protocols for this disorder are lower than for other sexual dysfunctions, but reports suggest better treatment efficacy when the etiology is predominantly psychogenic. As with erectile dysfunction (ED) and premature ejaculation (PE), if safe and efficacious oral pharmaceuticals are eventually developed for this condition, the treatment algorithm is likely to undergo significant alteration. Even then, however, the most effective treatments are likely to result from a combination treatment that integrates sex coaching with pharmacotherapy.

Ejaculation↗
PubMed2006

Utrastructural analysis of asthenozoospermic ejaculates in the era of assisted procreation.

OBJECTIVE: To define by transmission electron microscopy (TEM) analysis, the prevalence of sperm tail defects of genetic origin among men suffering for a reduced or absent sperm motility. DESIGN: A retrospective study. SETTING: Andrology Clinic, University of L'Aquila, Italy. PATIENT(S): The 120 ejaculates of infertile men with a forward motility (FM) < or =20% were compared to 200 ejaculates with a FM >20%. All ejaculates had a sperm vitality >50%. INTERVENTION(S): Some 25-50 tails were analyzed by TEM in each ejaculate. MAIN OUTCOME MEASURE(S): Receiver operating characteristics (ROC) analysis was applied by plotting the FM of cases with or without genetic tail defects detected by TEM. RESULT(S): The area under the ROC curve was 0.96 (95% confidence interval 0.92-0.98). The positive predictive accuracy for genetic tail defects in ejaculates with 0% FM was 46%. Three of 17 cases with genetic tail defects were classified as false negative when TEM analysis was restricted to ejaculates with 0% FM. A FM < or =7%, allowed the identification of all cases with genetic tail defects. CONCLUSION(S): The TEM analysis identifies sperm tail defects of genetic origin and should be restricted to ejaculates with severe asthenozoospermia (< or =7% motile sperm) and sperm vitality >50%.

Ejaculation↗