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PubMed2006

Absence of conception after caesarean section: voluntary or involuntary?

BACKGROUND: Women who deliver by caesarean section have been shown to be less likely to have a subsequent pregnancy. It is not clear whether this is due to a direct effect of the procedure on future fertility or due to deliberate avoidance of a future pregnancy. OBJECTIVE: To investigate whether absence of conception following caesarean section is voluntary or involuntary. DESIGN: Follow up of a population-based retrospective cohort. SETTING: Grampian region, Scotland. POPULATION: Women who had no further viable pregnancies within 5 years of an initial delivery. METHODS: Cases included women who delivered their first child by caesarean section between 1980 and 1995 but had no further viable pregnancies by December 2000. Controls included women who delivered their first child during the same period, by means of either spontaneous vaginal delivery (SVD) or instrumental vaginal delivery (IVD), and who had no further viable pregnancies by December 2000. Eligible women were identified from the Aberdeen Maternity and Neonatal Databank (AMND) and sent postal questionnaires to determine the extent to which not conceiving after first delivery was voluntary and the reasons for avoiding further pregnancies. Characteristics of the different mode of delivery groups were compared using univariate techniques. MAIN OUTCOME MEASURES: Extent to which absence of conception following an initial delivery by caesarean section is voluntary. RESULTS: Questionnaires were returned by 3204 (60%) of 5300 women identified from the AMND. Of these, 1675 women had not conceived at all during the follow-up period (median duration = 13 years). Absence of conception was voluntary in 488 (69%; 95% CI 66-73%) women following caesarean section, 340 (71%; 95% CI 67-76%) following SVD and 354 (72%; 95% CI 68-76%) following IVD. Few women considered seeking fertility treatment (caesarean section = 72 [10%], SVD = 50 [11%], IVD = 39 [8%]). Of the women who decided to delay or avoid a further pregnancy, fewer women who delivered by SVD reported that the birth experience influenced their decision (caesarean section = 163 [32%], SVD = 67 [18%], IVD = 136 [35%]; P < 0.001). CONCLUSIONS: Irrespective of mode of delivery, not conceiving following the birth of the first child is mainly voluntary. The experience of the previous birth is one of several factors affecting women's decisions to avoid a subsequent pregnancy.

Adult↗
PubMed2003

Reproductive challenges facing the cattle industry at the beginning of the 21st century.

The aim of this review is to pinpoint the areas that require further research for greatest impact to improve the efficiency of dairy and beef production. Increased knowledge about the principal causes of reduced fertility is essential. Increases in milk yield have been at the expense of reduced fertility in dairy cows and although diet has a major impact, the precise interaction between nutrition and reproduction still needs to be characterized in both beef and dairy cows. Furthermore, during periods of inadequate nutrition or stress, the intensity of oestrus is reduced by inadequate exposure to oestradiol. However, it is still unclear which pheromones are involved at oestrus, how synthesis is controlled and how pheromones are detected in herd-mates. GnRH may be involved in behaviour but the brain centres that translate hormonal messages are unknown. Attempts to overcome poor oestrous detection include measurements of milk progesterone, telemetric pressure detectors and devices that record the extra activity at oestrus. Substitution of heat detection by 'hormone treatment remedies' has met strong consumer resistance in Europe. The creation of larger cattle units and increased movements world-wide render herds more susceptible to infectious agents, such as Neospora, Leptospira, Trypanosoma and Bovine Viral Diarrhoea virus (BVDv), but it is unclear how other clinical conditions, such as lameness or endometritis, also interfere with ovarian function. The future of dominant follicles selected within 14 days after parturition is crucial--normal ovulation, prolonged persistence or atresia. Calving carries the greatest risk in the reproductive life of a cow and yet little work has focused on reducing the frequency of this event. For dairy cows, a greater understanding about induced or extended lactation is required. For beef animals, precise induction of twinning and nutritional adjustments could produce two offspring per pregnancy. At the start of pregnancy, the trophoblast produces interferon to prevent luteolysis, but the immunological implications are unknown and it is not clear how the rest of pregnancy is maintained. Profiles of pregnancy specific protein B (PSPB) have increased understanding of embryonic death. However, 25% of cows in abattoirs are pregnant, even though 30% of involuntary cullings are 'for failing to conceive'. Clearly, this is an area of wastage that requires urgent resolution. It is unknown why undernutrition at the time of insemination or in early pregnancy leads to delayed births, low fetal weights and later adverse health. At the end of pregnancy, the fetus controls the onset of parturition, but very little is known about the biochemical control of cervical dilation and placental separation. On the male side, bulls are selected for optimal freezability of semen; however, there is as yet no reliable predictor for semen fertility. Methods for accurately pre-determining the sex of both semen and embryos will revolutionize the dairy and beef industries.

Animal Nutritional Physiological Phenomena↗
PubMed1994

Association between familial autoimmune diseases and recurrent spontaneous abortions.

PROBLEM: To examine the aggregation of autoimmune disease in the families of women experiencing recurrent spontaneous abortions. METHOD: The 95 participants in this case-control study were recruited from Magee Womens Hospital, Pittsburgh, Pennsylvania from June 1988 to May 1991. The women having recurrent spontaneous abortions (N = 45) reported at least three early fetal losses, and the controls (N = 50) reported a minimum of three pregnancies with at least two live births and no more than one induced or involuntary pregnancy loss. Data from the participants and from their first-degree and second-degree relatives were obtained by questionnaire and verified by a repeated interview, if necessary. RESULTS: The prevalence of arthritis, thyroid disease, and diabetes mellitus was increased among the relatives of women having recurrent spontaneous abortions compared to normally fertile couples. Several autoimmune diseases occurred concurrently in family members of patients, but not in the family members of normally fertile couples. CONCLUSIONS: Autoimmune diseases occur more frequently in the families of women who have experienced recurrent spontaneous abortions. Both types of diseases involve genes in the class II region of the major histocompatibility complex.

Abortion, Habitual↗
PubMed1995

Does occupational nuclear power plant radiation affect conception and pregnancy?

OBJECTIVES: To determine the effect of occupational exposure in a nuclear power plant in Griefswald, Germany on male and female fecundity. METHODS: The frequency of men and women exposed to ionizing radiation through work in a nuclear power plant among 270 infertile couples was retrospectively compared to a control fertile population using a pair-matched analysis. The total cumulative equivalent radiation dose was determined. In addition, the spermiograms of the male partners in both groups were compared and correlated to the degree of exposure. RESULTS: No differences were noted in the frequency of nuclear power plant exposure between sterile and fertile groups. There was a higher rate of anomalous spermiograms in nuclear power plant workers. However, abnormalities were temporary. No correlation was found between the cumulative equivalent radiation dose and abnormal spermiograms. CONCLUSION: The data suggest that occupational exposure due to ionizing radiation should be investigated as a possible cause for involuntary temporary sterility and as a risk factor for early pregnancy disorders.

Female↗
PubMed1982

Acute salpingitis in the adolescent female.

Acute salpingitis is an important complication of sexually transmitted disease in young women and should be considered in the differential diagnosis of abdominal pain in all young women. Many organisms, in addition to N. gonorrhoeae, have been associated with this tubal infection giving support to polymicrobial etiology. However, the exact pathophysiologic role of these organisms needs to be clearly defined. The microbiology of acute salpingitis, through direct culture from the site of infection, the fallopian tubes, needs to be clearly elucidated. Early recognition and treatment of acute salpingitis is essential in preventing the major long-term problem, involuntary infertility. Curran has estimated the reproductive outcome for a cohort of adolescent women reaching reproductive age in 1970. By the year 2000, there will have been one episode of salpingitis for every two women; 15% will be hospitalized for salpingitis with over half of these women requiring major gynecologic surgery; 10% will be rendered nonsurgically sterile; and 3% will have experienced an ectopic pregnancy. Adolescent females may be more susceptible to upper genital tract infection than older women due to possible unique biologic characteristics and sexual behaviors. Prospective microbiologically controlled studies of women with salpingitis using laparoscopy need to be developed to evaluate treatment regimens. Until such studies are undertaken, diagnosis, treatment, and fertility in women with acute salpingitis will remain unsatisfactory.

Acute Disease↗
PubMed1995

Infertility, involuntary infecundity, and the seeking of medical advice in industrialized countries 1970-1992: a review of concepts, measurements and results.

Several new methods of infertility treatment have been developed. There is therefore an increasing interest among physicians in gaining knowledge about the occurrence of infertility in order to estimate the need for treatment. This article examines epidemiological studies in industrialized countries 1970-1992 on the prevalences of infertility, involuntary infecundity, and the seeking of medical advice for infertility. The studies are compared on the basis of study design, definitions, methods of measurement and results. Comparison of the studies is difficult, as researchers use different concepts and there is a large variation in the delineation of the populations involved. The current prevalence of infertility among women in the fertile age group varies from 3.6 to 14.3%, the life-time prevalence varies from 12.5 to 32.6%, the prevalence of involuntary infecundity from 2.6 to 5.9%, and medical contact for infertility from 3.6 to 17%. It is probable that these large differences in prevalences are mainly due to differences in definitions and methods of measurement. We recommend that future studies be carried out in representative population groups, and that only couples who have tried to have children should be included in the estimated prevalences.

Developed Countries↗
PubMed1996

[Unfulfilled desire for children in the man: coping and pain. Results of a psychosomatic-andrologic cooperative study].

115 andrological patients were studied with psychological self-assessment tests to assess both their motivation concerning parenthood, and their own explanations for the causes. Additionally self-esteem was evaluated in 51 patients. The main results were: Motivation concerning parenthood is of greater importance in coping with involuntary childlessness than objective andrological data. Patients assess their situation quite realistically; no tendency to misinterpret the medical data in order to defend negative feelings and to protect self-esteem could be found. Most patients with reduced fertility consider this situation a challenge and are willing to mobilize resources and the help of others in order to cope. Self-esteem was only threatened in those patients with longlasting unvoluntary childlessness and little acceptance of medical infertility treatment and parenting substitutes, e.g. adopting a child.

Adaptation, Psychological↗
PubMed1983

Conversion disorder following termination of pregnancy.

A variety of psychologic disorders may present as physical complaints without organic basis. As characterized by Sydenham over 300 years ago, such disorders "mimic all the physical disease to which man is heir." The case here presents the evolution of a conversion disorder (urinary retention) in response to a decision to terminate pregnancy. The predominant disturbance in a conversion disorder is an involuntary loss or alteration in somatic function that is temporally related with an environmental stressor. Conversion, as a defense mechanism, provides primary gain by keeping the conflict from the patient's awareness and secondary gains by generating environmental support and avoidance of undesired activities. Awareness of a patient's current life events, past responses to stress, and support systems is essential in order to recognize and manage this array of physical complaints of functional origin.

Abortion, Induced↗
PubMed1985

Enhanced reproduction and its economic implications.

Reproductive performance affects profit of dairy herds because it directly affects milk produced per cow per day, number of replacements produced, and rates of voluntary and involuntary culling. High producing cows will reproduce at a satisfactory rate if they are managed properly. There appears to be direct relationship between herd management and reproductive performance. Thus, reproductive performance and profit respond positively to improvements of rates of detection of estrus, improvements of rates of conception, and improvements of management of the periparturient cow. Pharmacological procedures are now available for controlling time of estrus and insemination in groups of cattle. It is feasible to limit the breeding period in a herd to 1 wk of each 3-wk interval. Primary benefits of controlled breeding are convenience and efficient use of labor for detection of estrus and insemination. Biotechnical procedures such as embryo transfer and insertion of specific genes may enhance rates of genetic improvement for important economic traits.

Animals↗
PubMed1999

The intrauterine device and its dynamics.

In the past decade, attention has shifted from family planning (often made available through population programs) to reproductive health--a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters related to the reproductive system and its function and processes. Reproductive health has three components: the ability to procreate, regulate fertility and enjoy sex; the successful outcome of pregnancy through infant and child survival and growth; and the safety of the reproductive process. According to Mitchell et al., the following are key elements in a reproductive health program: (a) Family planning services that offer complete and accurate information about all contraceptive methods and that make contraceptive services, supplies and counseling accessible. (b) Antenatal care, which research suggests lowers rates of maternal mortality. (c) Safe delivery services, so that all women deliver under some type of supervised care and so that referral systems are established to provide emergency treatment of life-threatening complications of delivery. (d) Postnatal care that contributes to a woman's ability to have a speedy and complete recovery from the stress of pregnancy and childbirth, to enjoy sexual relations without pain and to have safe pregnancies and deliveries in the future. (e) Management of the complications of abortion where safe abortions are not available. (f) Infertility services that enable women to achieve their reproductive goals; and effective screening for or control of reproductive tract infections (RTIs), because RTIs are the most common preventable cause of involuntary infertility and ectopic pregnancy, as well as of chronic pelvic pain and recurrent infection. (g) Management and treatment of systemic sexually transmitted diseases (STDs), such as HIV and hepatitis B. (h) Symptomatic treatment of urinary tract infections. (i) Detection and treatment of breast and reproductive tract cancers, such as cervical cancer. (j) Attention to and treatment of dysmenorhea, which in some cases is the first sign of other problems, such as pelvic inflammatory disease, endometriosis, fibroids, endometrial cancer and ectopic pregnancy. (k) Nutritional supplementation to meet the special needs of adolescents, pregnant or lactating women, and women older than 50 years. (1) Services for menopause and other health problems that women encounter as they grow older. (m) Services for adolescents, including family planning and STD prevention and treatment. It shall be clear that many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. In this context, we would therefore like to discuss the dynamics of IUDs.

Contraindications↗
PubMed2005

In vitro production of Holstein embryos using sex-sorted sperm and oocytes from selected cull cows.

The objective of this study was to explore potential synergies between sex-sorted sperm and in vitro embryo production for generating replacement heifers on commercial dairy farms. Selected involuntary cull cows (i.e., genetically suitable cows that were culled due to injury, illness, or infertility) from 7 Wisconsin farms were used as donors, and ovaries were collected via colpotomy or at the time of slaughter. Oocytes were aspirated, fertilized in vitro with sex-sorted sperm 22 +/- 0.2 h later, cultured, matured for 7 to 8 d, and transferred into recipient cows and heifers on the farms from which the cull cows originated. From August 2002 to June 2003, ovaries were recovered from 104 Holstein donors. Sex-sorted sperm from 3 Holstein sires (obtained via fluorescence-activated cell sorting) were used. A total of 365 transferable embryos were produced, an average of 3.6 +/- 0.3 per donor. However, due to limited availability of recipient animals, only 272 (fresh) embryos were transferred, an average of 2.6 +/- 0.3 per donor. A random subset of recipients received an injection (i.m.) of GnRH (100 microg) at the time of embryo transfer. When lactating cows were used as recipients, mean conception rates were 16.3% for recipients identified based on standing estrus and 20.0% for recipients synchronized using a timed breeding program (Ovsynch). Conception rates for in vitro-produced embryos were lower than corresponding conception rates for control cows inseminated using unsorted semen. When virgin heifers were used as embryo recipients (all standing estrus), the mean conception rate was 34.2%. The following effects significantly impacted conception rate: farm, season, recipient group (cow vs. heifer), sire of embryo, and GnRH injection. Of 40 full-term calves generated using sex-sorted semen, 37 were female. These results suggest that "low-cost" in vitro embryo production using cull cows as donors, in conjunction with sex-sorted sperm, could be an effective tool in dairy cattle breeding programs, but only if conception rates can be improved.

Animals↗
PubMed1984

Comparative evaluation of contraceptive efficacy of norethisterone oenanthate (200 mg) injectable contraceptive given every two or three monthly. Indian Council of Medical Research Task Force on Hormonal Contraception.

A total of 2388 subjects, 1181 for 60 +/- 5-day and 1207 for 90 +/- 5-day treatment regimen with norethisterone oenanthate (NET OEN) 200 mg injection, were observed for 24 months, constituting 28,513 woman-months. This clinical trial represents the largest clinical trial undertaken on NET OEN. The observations indicated that NET OEN given at 60 +/- 5-day intervals provides adequate contraceptive protection. However, as compared to the published studies elsewhere, higher method failures were seen during the first six months of NET OEN usage, when all women were receiving the drug at 60 +/- 5-day intervals. The reasons for this discrepant observation in the present study cannot be explained. The higher method failures reported with 90 +/- 5-day regimen were mainly during the third month following the injection, suggesting reduced contraceptive efficacy of the drug during this period. Thin build women (body weight less than or equal to 40 kg) were at higher risk of involuntary pregnancy. Disrupted menstrual pattern was the major reason for discontinuation ranging between 42-43 per 100 users at the end of 24 months. Amongst these, amenorrhoea was the commonest reason for discontinuation. No change in blood pressure was observed during contraceptive usage. The majority of NET OEN users did not show any change in body weight. The overall continuation rates with NET OEN were lower than those observed in similar conditions with Cu-T 200 mm2 IUCD.

Adult↗
PubMed1979

Frustrated fertility: a population paradox.

This Bulletin examines the causes of subfecundity -- the diminished ability to reproduce -- and its effect today and in the past on the fertility, or actual reproductive performance, of individuals and, hence, populations. By definition, all real populations are subfecund since all experience some degree of involuntary biological factors affecting coitus, conception, or the ability to carry a conceptus to live birth which reduces their fecundity below the estimated biological population maximum of 15 children per woman. Affecting both men and women, these factors fall into 5 categories: genetic factors such as blood group incompatibilities and inherited sickle cell anemia or diabetes; psychopathology, including psychic stress and behavioral disorders (e.g., drug and alcohol abuse); infectious diseases such as gonorrhea, malaria, tuberculosis, and postabortion infection; malnutrrition, including the chronic undernutrition of the 3rd World and the overnutrition of developed societies; and hazards posed by increasing amounts of radiation and toxic chemicals in the environment. Reducing subfecundity requires improved living conditions, avoidance of or protection from known hazards, and adoption of medical advances which now can help 40 to 60% of subfecund couples. But even in the U.S. fertility would certainly rise among the 15% of couples now estimated to be involuntarily childless and the 10% who have fewer children than they want, and among disadvantaged groups, and teenagers.

Abortion, Induced↗