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Use of assisted reproductive techniques for treatment of ejaculatory disorders.

Ejaculatory disorders can interfere with the fertility of young adults who suffer from spinal cord injury, have type I diabetes mellitus or have undergone retroperitoneal or intrapelvic operations. Following an overview of causes and treatment of ejaculatory disorders, the data of our centre are presented. From a group of 37 patients with genuine loss of seminal emission, 15 men and their wives were offered a combined treatment of rectal probe electro-ejaculation and artificial reproductive techniques. No serious complications occurred. During 40 cycles with intracorporeal insemination and 11 cycles with extracorporeal fertilization techniques, seven pregnancies were achieved, representing a pregnancy rate of 46% per couple and 14% per cycle for all cycles. Five healthy children were born, all following extracorporeal insemination. The 'take-home baby rate' for this population and for this technique is 45%. In vitro fertilization (IVF) led to one birth, intracytoplasmic sperm injection (ICSI) achieved four live births out of three pregnancies, one being a twin gestation. Since our successes are due to the use of extracorporeal insemination techniques, these are now incorporated in a new, more rational treatment protocol.

Ejaculation↗

Physical activity and its effects on reproduction.

The reproductive system is tightly coupled with energy balance, and thereby changes in the status of energy balance through changes in physical activity can impact on the reproductive system. In light of the new physical activity for health recommendations, it is therefore important to understand the inherent effects, both positive and negative, of physical activity on the reproductive system. At both extremes of the energy spectrum, disorders of chronic energy excess and energy deficiency are characterized by a wide range of reproductive disorders, including menstrual irregularity, anovulation, polycystic ovarian syndrome, and infertility in women, and erectile dysfunction and altered spermatogenesis in men. Although laboratory research indicates that individuals may be able to prevent or reverse reproductive disruptions, either by increasing energy expenditure in cases of energy excess or by dietary reform in cases of energy deficits, there is an acute need for applied research to confirm this idea and to identify mechanisms by which the availability of energy per se regulates reproductive function in humans.

Energy Metabolism↗

The genomic era and perceptions of psychotic disorders: genetic risk estimation, associations with reproductive decisions and views about predictive testing.

As a result of publicity surrounding genetic advances, increasing public awareness of a genetic role in major mental illness may be contributing to a "geneticization" of these illnesses. Geneticization could lead to oversimplified ideas about genetic risk, producing significant social consequences. We sought to investigate perceptions of genetic risk, associated effects on reproductive decisions and attitudes towards genetic testing amongst unaffected relatives of individuals with psychosis. A web-based survey design was used, which all visitors to a psychosis support/information website had the option to complete. Responders were representative of website visitors, and the study design facilitated collection of a large dataset, although the response rate was low. Over-estimating risk was associated with reproductive decisions favoring fewer children, and more positive attitudes towards genetic testing. Facilitating accurate risk perception through genetic counseling could significantly impact reproductive decisions, and the appropriate use of genetic tests in the future.

Adult↗

The self-perceived survival ability and reproductive fitness (SPFit) theory of substance use disorders.

A new theory of substance use disorders is proposed-the SPFit theory-that is based on evolutionary biology and adaptive systems. Self-perceived survival ability and reproductive fitness (SPFit) is proposed as a human psychobiological construct that prioritizes and organizes (i.e. motivates) behavior, but is highly vulnerable to temporary, artificial activation by drugs of abuse. Autoshaping/sign-tracking/feature positive phenomena are proposed to underlie the development of craving and expectations about drugs as the individual learns that abused drugs will easily and reliably inflate SPFit. The cortico-mesolimbic dopamine system and its modulating interconnections are viewed as the biological substrate of SPFit; it is proposed to be a survival and reproductive motivation system rather than a reward center or reward pathway. Finally, the concept of modularity of mind is applied to the SPFit construct. Although considerable empirical data are consistent with the theory, new research is needed to test specific hypotheses derived from SPFit theory.

Biological Evolution↗

Genetics of the female reproductive ducts.

Familial aggregates of the most common disorders of müllerian differentiation in females-Müllerian aplasia, incomplete Müllerian fusion-are best explained on the basis of polygenic/multifactorial inheritance. No information exists on the number and chromosomal location of responsible genes. Single mutant genes (Mendelian) are responsible for the McKusick-Kaufman syndrome (MKS) and the hand-foot-genital syndrome. The molecular basis for the latter condition involves HOXA13, but the molecular basis of MKS and other disorders of the female reproductive ducts is unknown. Vaginal atresia, Müllerian aplasia, and incomplete Müllerian fusion are not infrequently observed in malformation syndromes.

Cervix Uteri↗

Melatonin and sex hormone interrelationships--a review.

Melatonin, the main hormone secreted by the pineal gland at night, plays a major role in regulating reproductive physiology in seasonal breeders and influences the age of sexual maturation in laboratory rodents. In humans these relationships are less clear. Evidence supporting a melatonin-reproductive hormone relationship relies on findings of abnormal melatonin secretion in disorders of the reproductive system and on pathologies of the pineal gland which are associated with clinical abnormalities of the reproductive hormones. Normal melatonin rhythms are closely related to those of the reproductive hormones during infancy and reciprocally correlated during puberty. The demonstration of melatonin receptors in the brain and in reproductive organs, together with the localization of sex hormone receptors in the pineal gland, further strengthen these relationships. However, it is not yet clear that these correlations are functionally related, as data on the antigonadal effects of exogenous melatonin on the reproductive hormones are not conclusively established.

Animals↗

The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders.

Various mood and anxiety disorders are more prevalent in reproductive-aged women, and appear to be linked to hormonal and reproductive events. Premenstrual affective disorders consist of premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual exacerbation of mood or anxiety disorders. Postpartum affective disorders can range from postpartum "blues" to postpartum depression with or without psychosis, and also include anxiety disorders, such as panic disorder, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. In perimenopausal women, the vulnerability to mood and anxiety disorders is increased. All of these disorders share risk factors, and have etiologic features in common, such as exposure to the rise and fall of ovarian sex steroids. The following is a review of these syndromes and their etiology, diagnosis, and treatment.

Adult↗

Seasonality and seasonal affective disorder (SAD): an evolutionary viewpoint tied to energy conservation and reproductive cycles.

The characteristic symptoms of SAD, including hypersomnia and weight gain, might reflect a genetically programmed attempt to conserve energy during historically predictable periods of dwindling food supply. While this basic hypothesis has obvious conceptual appeal, few authors have considered the specific positive selection pressures that might have contributed to such a process. The goal of the current paper is to further develop an evolutionary model of SAD with a focus on energy conservation in the context of seasonal reproductive cycles. To accomplish this, seasonal data on birth rates are considered from an evolutionary viewpoint. There is considerable indirect evidence that in temperate climates, the symptoms of SAD reflect a predisposition for conception to occur in late spring/early summer to ensure a peak of births in the late winter/early spring. The adaptive value of such a pattern, and its putative role in natural selection in humans, is also discussed.

Adaptation, Physiological↗

Social transmission of reproductive behavior increases frequency of inherited disorders in a young-expanding population.

The observation of high frequencies of certain inherited disorders in the population of Saguenay-Lac Saint Jean can be explained in terms of the variance and the correlation of effective family size (EFS) from one generation to the next. We have shown this effect by using the branching process approach with real demographic data. When variance of EFS is included in the model, despite its profound effect on mutant allele frequency, any mutant introduced in the population never reaches the known carrier frequencies (between 0.035 and 0.05). It is only when the EFS correlation between generations is introduced into the model that we can explain the rise of the mutant alleles. This correlation is described by a c parameter that reflects the dependency of children's EFS on their parents' EFS. The c parameter can be considered to reflect social transmission of demographic behavior. We show that such social transmission dramatically reduces the effective population size. This could explain particular distributions in allele frequencies and unusually high frequency of certain inherited disorders in some human populations.

Female↗

Hazards of assisted conception in women with severe medical disease.

The issues relating to assisted reproduction in women with severe medical disease can be divided into the likely effect of pregnancy upon the medical condition, and how the medical condition may adversely affect pregnancy outcome. In addition, consideration of the hazards relating to the process of assisted conception, in particular the risk of ovarian hyperstimulation syndrome and multiple pregnancy, must be remembered. In some women, successful assisted reproduction may result in a life-threatening pregnancy. Clinicians advising women about assisted conception should be aware of the medical conditions that are absolute contra-indications to pregnancy. Some women with severe medical disease may have a significantly reduced life expectancy, in which case ethical issues regarding the future welfare of the child must be considered. Examples include sickle cell disease, cystic fibrosis and HIV. One of the biggest advantages of assisted reproduction for women with severe medical disorders is that the pregnancy is planned. Thus, there is an opportunity for the patient to be informed fully about any risks, both to herself and her fetus. This article reviews the general management of women with severe medical disorders who seek assisted reproduction and gives specific guidelines for the more common conditions.

Child↗

Reproductive decisions by women with bipolar disorder after prepregnancy psychiatric consultation.

OBJECTIVE: This study ascertained family planning decisions by women with bipolar disorder after psychiatric consultation. METHOD: The authors surveyed 116 women with DSM-IV bipolar disorder after specialized consultation about treatment options and risks regarding pregnancy. RESULTS: Of 70 respondents, 45% had been advised to avoid pregnancy by a health care professional before consultation. After consultation, 63% decided to pursue pregnancy. CONCLUSIONS: Women with bipolar disorder often encounter obstacles from health care professionals regarding pregnancy. Individualized comprehensive review of risks and benefits of treatment options during specialized preconception consultation can support thoughtful clinical planning.

Adult↗

[Surgical advancements in reproductive medicine with emphasis on tubal disorders].

Achieving patency of the Fallopian tubes by selective transcervical hysterosalpingography, transcervical tuboplasty using PTCA-balloon catheters and microsurgical techniques has a success rate in excess of 90%, however, the pregnancy rates following these procedures is still less than 50%. Thus, the surgical approach for the treatment of tubal infertility which may improve post therapeutic pregnancy rates remain as yet unsolved problems. Modalities proposed include tubal transplants and prosthetic functional tubes. The purpose of surgical approaches to treat tubal infertility is to regain the physiologic ability to become pregnant without further clinical intervention. This has the advantage of reducing both economic and psychologic stress in the previously infertile couple, thus is clinically highly desirable, when achievable. However as there are limits for the indications of these procedures, for instance in occluded tubes, where disease has caused irreversible damage to the tubal endothelium, physical restoration of patency may not restore fertility. Thus, this discussion covers the limitations of surgical procedures and alternate procedures when surgical procedures are inadequate. We further investigated the tubal influences on the establishment and development of the zygote, and the tubal influences such as pressure and exudate dynamics on their transport within the tube. Thus, the advances in enhanced fertility studies, including in vitro fertilization have led more definitive understanding of fertilization, development of the zygote and its nidation, necessitating more intensive investigation of tubal physiology. In conclusion, where possible, surgical procedures which may allow physiologic pregnancies without additional clinical intervention are an attractive approach which should be utilized maximally when acceptable pregnancy rates can be expected.

Fallopian Tube Diseases↗

Use of semen as biopsy material for assessment of health status of the stallion reproductive tract.

Conventional light microscopic evaluation does not fully utilize potential indicators in seminal ejaculates for diagnosis of disorders of the reproductive tract. The technique of evaluation of all cellular components of semen, as described in this article, utilizing both light and transmission electron microscopy is a valuable diagnostic tool. Compare with other common biopsy procedures, use of semen as biopsy material is noninvasive, more representative than excisional biopsy, less expensive, and helps in the longitudinal evaluation after a therapeutic regimen.

Animals↗

Pregnancy and post partum: changes in cognition and mood.

Steroidal hormones are increasingly recognized as highly relevant in multiple aspects of brain functioning. While basic science has actively worked to advance understanding of fundamental steroid mechanisms within the brain, investigation of the neurobehavioral outcomes of reproductive hormone actions on the human brain has received less attention. We argue that the dramatic steroidal hormone changes seen in human reproduction must be systematically studied and may provide novel explanations of cognitive and mood disorders associated with reproductive events. This chapter provides a review of current literature establishing a role for a variety of steroids on neuroactivity, and evidence from a variety of observational and experimental paradigms linking hormones and clinical aspects of cognition and mood in humans. The specific hormonal changes of pregnancy are described and discussed in relation to concomitant alterations in cognition and mood across the peri-natal period. A review of studies that have systematically observed cognitive and affective changes both during pregnancy and the post-partum period is presented, as well as new data that follow a small cohort of women for an extended period of time after delivery. We conclude that women may show specific areas of cognitive changes during and after pregnancy, notably deficits in verbal learning and memory. Mood appears to be impacted as well. While steroidal hormones show a pattern of associations with mood during and after pregnancy, no such pattern is evident for cognition. The embryonic state of our knowledge regarding reproductive hormones and neurobehavioral functioning is evident, as are the scientific and public health reasons to redress this lacuna.

Affect↗

The obese patient with infertility: a practical approach to diagnosis and treatment.

Overweight and obesity are serious and prevalent conditions in Western countries and carry many health consequences, including reproductive dysfunction. In particular, excess fat in the abdominal area is strongly related to disorders of the reproductive system. Moderate weight loss and reduction of abdominal fat improves menstrual regularity, ovulation, and infertility in women. This may be etiologically related to insulin resistance, particularly in a subset of infertile women with polycystic ovary syndrome. As such, weight loss should be promoted as an initial treatment option for obese women with infertility. However, the most effective method for achieving and maintaining weight loss is unclear. Gradual weight loss is best achieved through a sensible eating plan that can be maintained over long periods of time. The likelihood of maintaining weight loss is increased when diet is combined with regular exercise, cognitive behavior therapy, and a supportive group environment. Adoption of these principles in a primary healthcare setting can therefore aid in treatment of infertility related to obesity.

Adult↗

Drug prescribing for chronic medical disorders during pregnancy: an overview.

Women of reproductive age with chronic medical disorders are often concerned about hazards from drug exposure during pregnancy. The avoidance of any medication after conception may be ideal but is often unwise for maternal well-being. Adverse fetal effects are often not clinically apparent. Current standards for prescribing these medications during pregnancy are discussed from a review of the recent literature.

Asthma↗

Role of leptin in women with eating disorders.

OBJECTIVE: This study investigated the role of leptin on eating behavior and reproductive function in eating disorders. METHOD: The subjects included 80 eating-disordered women, having different fat mass, eating behavior, and endocrine abnormalities, and 26 control women. Plasma leptin, insulin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), cortisol, insulin growth factor-1 (IGF-1), free T4 levels, percent body fat, eating behavior score, and menstrual status score were evaluated for each subject. RESULTS: In eating-disordered patients, log of leptin levels were significantly correlated with body fat mass, eating behavior score, menstrual status score, and insulin, LH, and FSH levels. Stepwise regression analysis showed that fat mass and eating behavior score were significant determinants of leptin levels. Furthermore, in patients undergoing recovery, leptin levels were determined by fat mass and/or eating behavior. DISCUSSION: These results suggest that leptin may play some role in counteracting the abnormal eating behavior, reproductive function, and fat mass in these disorders.

Adipose Tissue↗