[The effects of sulpiride on plasma LH, FSH, and progesterone in women during the reproductive years. Role of hyperprolactinism in ovulation disorders].
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Adolescent↗
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Fluctuation of immunoglobulin levels in cervical mucus during the various phases of female reproductive life and its alteration in uterine disorders.
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Cervix Mucus↗
Hyperprolactinemia presenting with encephalomalacia-associated seizure disorder and infertility: a novel application for bromocriptine therapy in reproductive endocrinology.
OBJECTIVES: To describe successful oral bromocriptine therapy for hyperprolactinemia accompanied by seizure disorder and encephalomalacia identified during infertility evaluation. MATERIALS & METHODS: A 32 year-old male with an unspecified seizure disorder was referred for infertility consultation. The initial seizure was at age 12, and was treated sequentially with phenytoin, phenobarbitol, and carbamazepine monotherapy which was maintained for six years and then discontinued. At age 26, a second seizure was experienced and 150mg lamotrigine b.i.d. was initiated. When the patient married it was discovered that erection was impossible; tadalafil was administered without success. At our center, total testosterone was low at 107ng/dl and semen analysis revealed oligoasthenozoospermia. Serum prolactin was 79.3ng/ml; visual field examination was normal. Brain MR showed no pituitary enlargement. However, encephalomalacia of the right occiptal lobe with porencephalic dilation of the occipital horn of the right lateral ventricle was present. RESULTS: The patient was initially placed on 2.5mg/d bromocriptine but after three months only a nominal reduction of serum prolactin was achieved. Serum prolactin normalized (25.4ng/ml) after bromocriptine was increased to 7.5mg/d. Repeat semen analysis showed overall sperm concentration of 85M/ml, 30% motility and 12% normal forms morphology (Kruger strict criteria). Total testosterone level was 191ng/dl after final bromocriptine dose was attained, which was well tolerated. DISCUSSION: Bromocriptine has an established role in the management of hyperprolactinemia, particularly in women. For males with elevated serum prolactin even when associated with focal encephalomalacia and seizure disorder, bromocriptine therapy can offer safe benefits including improved semen parameters and normal serum testosterone levels.
Adult↗
Polycystic ovary syndrome and its differential diagnosis.
UNLABELLED: Polycystic ovary syndrome (PCOS) is a common disorder of reproductive-aged women. It affects between 3.4-6.8% of this population. Common clinical symptoms of PCOS include menstrual irregularities, hirsutism, and often obesity. Long-term sequelae include anovulatory infertility, endometrial carcinoma, and an increased risk for cardiovascular disease due to type II diabetes mellitus, dyslipidemia, and systolic hypertension. The diagnosis of PCOS is one of exclusion and is defined by the Rotterdam criteria which were established in 2004. However, several other endocrine disorders can closely resemble PCOS. It is important for practitioners to recognize and distinguish PCOS from other disorders in its differential. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize the short-term reproductive and long-term metabolic consequences of polycystic ovary syndrome (PCOS), point out the importance of meeting the current criteria for diagnosis, and recall the recommended treatment related to the clinical presentation of the patient.
Adrenocortical Hyperfunction↗
[Use of estrogens in the treatment of mental disorders].
The relationship between female sex steroids and mental disorders was not thoroughly studied until the last decades. However, in recent years, many studies have appeared that evaluate the influence of estrogens on the onset, outcome and treatment of mental disorders. Although the data are still preliminary, it could be concluded that the estrogens can be useful in the treatment of postpartum depression and menopause related depression, especially if surgically induced. There is still no support for the usefulness of estrogen treatment in non-reproductive related mood disorders. Regarding its utility in schizophrenia, several studies have considered the possibility of adding estrogen treatment in the cases in which patients with schizophrenia experience a worsening of their symptoms clearly related with the fluctuations of the hormonal levels during the menstrual cycle or in patients with resistant forms of the illness. Furthermore, hormone replacement therapy could be useful in some postmenopausal schizophrenic women.
Adult↗
[Polycystic ovary syndrome: from physiopathology to therapy].
Polycystic ovary syndrome (PCOS) is still a complex and heterogeneous disorder that presents a challenge for clinical investigators. It is the most common endocrine and metabolic disorder of reproductive-aged women that presents with varied symptoms such as hyperinsulinemia, anovulatory dysfunction, hirsutism, obesity and elevated incidence of cardiac problems. For these reasons, this syndrome is considered by some physicians as an endocrine and for others as a metabolic syndrome. This article will focus on the disorder of the PCOS. It will be based on an understanding of the physiopathology in order to present therapeutic recommendations.
Female↗
Female hormones affect symptom severity in obsessive-compulsive disorder.
There is circumstantial evidence that reproductive events can influence symptom severity of obsessive-compulsive disorder (OCD). We sent self-report questionnaires to 350 female outpatients with OCD to examine the relationship between the menstrual cycle, pregnancy, menopause, hormonal contraceptives, selective serotonin reuptake inhibitors and symptom severity of OCD. Yale-Brown Obsessive-Compulsive Scale scores were used at three serial time points during the menstrual cycle to assess symptom severity. One hundred and one out of 350 questionnaires (29%) were returned and completed. Forty-nine patients reported an exacerbation of OCD symptoms during the premenstrual period, nine during the menopause and 17 patients during pregnancy, whereas 11 patients mentioned improvement of OCD symptoms during pregnancy. Premenstrual dysphoric disorder could only partly explain a premenstrual exacerbation of OCD symptoms. Exacerbation of OCD could be related to reproductive events in a considerable number of patients, especially the premenstrum. Because reproductive cycle events influence the symptom severity of OCD, the menstrual cycle should be taken into account when assessing the severity of OCD symptoms during pharmacological studies.
Adult↗
[Confabulation in atrophic and vascular disease of old age (clinico-psychopathologic findings)].
The paper is concerned with a study of confabulation seen in 95 patients. A gradual development of the confabulatory syndrome (from mnemonic confabulations to ecmnestic) was seen in senile dementia (5 cases) and in its combination with vascular atherosclerosis (61 cases). An acute development of confabulations (with a prevalence of mnemonic false reminiscence over ecmnestic) was seen in cerebral atherosclerosis (9 cases). Rudimentary ecmnestic confabulations, without mnemonic were seen in Alzheimer's disease (20 cases). The author established a certain correlation between ecmnestic confabulations and disturbances of fixation, between mnemonic confabulations and disorders of selective reproductivity, between their expressiveness and emotional liveliness and the degree of actualization of the past events. In a complacent-euphoric and anxiety affect the confabulations were spontaneous and were accompanied by psuedoactivity. In depressive states they were fragmentary and were detected only in response to questions. Aphatic disorders and the severity of dementia influence the mnestic confabulations making them poorer and incomplete.
Aged↗
Glucocorticoid therapy in hyperandrogenism.
Hyperandrogenism is a common disorder in the reproductive age female. It is associated with cutaneous manifestations and ovulatory dysfunction. The degree of hyperandrogenaemia is directly related to the severity of ovulatory dysfunction. The ovulatory dysfunction frequently leads to infertility. The most common form of hyperandrogenism is idiopathic glucocorticoid-suppressible hyperandrogenism (IGSH). The management of this disorder involves appropriate use of physiological doses of glucocorticoids. This treatment leads not only to normalization of serum androgen levels but also to amelioration of cutaneous symptoms and improvement in ovulatory function. In infertile women with ovulatory dysfunction secondary to IGSH, occurrence of pregnancy after treatment with glucocorticoids is directly related to the degree of the suppression of serum androgen levels. In other words, this treatment does not 'induce ovulation', but its effectiveness in improving ovulatory function is a result of a correction of the hyperandrogenic state. At physiological doses glucocorticoid therapy does not appear to be associated with significant side-effects. With appropriate management, androgen levels can be maintained within the normal range indefinitely. Furthermore, in a majority of patients, androgen levels remain within the normal range for a long time (years) after discontinuation of chronic glucocorticoid therapy.
Androgens↗
The effect of nutritional management of the dairy cow on reproductive efficiency.
The cause of low fertility in dairy cows is multifactorial. Poor nutrition during the dry and early postpartum periods results in reduced glucose, insulin, insulin-like growth factor (IGF-I) and low LH pulse frequency with concomitant increases in beta-hydroxy butyrate, non-esterified fatty acids (NEFA) and triacylglycerol. Cows must mobilize large lipid, but also some protein reserves, with a consequent increased incidence of such metabolic disorders as hypocalcaemia, acidosis, ketosis, fatty liver and displaced abomasums. The occurrence of milk fever and ketosis affects uterine contractions, delays calving and increases the risk of retained foetal membranes (RFM) and endometritis. The nutritional risk factors that cause RFM are hypocalcaemia, high body condition score (BCS) at calving and deficiencies in Vitamin E and selenium. The risk factors for endometritis are hypocalcaemia, RFM, high triacylglycerol and NEFA. Thus, metabolic disorders predispose cows to gynaecological disorders, thereby reducing reproductive efficiency. Cows that are overconditioned at calving or those that lose excess body weight are more likely to have a prolonged interval to first oestrus, thereby prolonging days open. Nutritionally induced postpartum anoestrus is characterized by turnover of dominant follicles incapable of producing sufficient oestradiol to induce ovulation due to reduced LH pulse frequency. High nutrition can also increase metabolic clearance rate of steroid hormones such as progesterone or oestradiol. Lower concentrations of oestradiol on the day of oestrus are highly correlated with the occurrence of suboestrus, thereby making the detection of oestrus in high yielding cows even more difficult. Nutrition also affects conception rate (CR) to AI. Cows that develop hypocalcaemia, ketosis, acidosis or displaced abomasums have lower CRs and take longer to become pregnant. Excessive loss of BCS and excess protein content of the ration can reduce CR while supplemental fats that attenuate the production of F2alpha can improve CR. The increased metabolic clearance rate of progesterone (P4), which decreases blood concentrations during early embryo cleavage up to the blastocyst stage is associated with decreased CRs. In conclusion, poor nutritional management of the dairy cow, particularly before and after calving, is a key driver of infertility.
Animal Nutritional Physiological Phenomena↗
Insulin-like growth factors: clinical experience in ovarian function.
Insulin, insulin-like growth factor, and insulin-like growth factor binding proteins have been shown to play major roles in the modulation of both normal and disturbed ovarian physiology. Identification of many of the actions of these peptides was initially characterized using animal models. However, an increasing body of evidence has emerged to clarify their contributions in human reproductive function. It is clear that at various stages of folliculogenesis, local steroid production acts in concert with intraovarian peptides to promote dominant follicle development. This review will discuss the physiologic role(s) of the insulin-insulin-like growth factor-insulin-like growth factor binding protein family in reproductive function and disorders of androgen excess.
Carrier Proteins↗
A case-control study to identify farm factors affecting fertility of dairy herds: univariate description of factors.
OBJECTIVE: To identify farm factors which were associated with reproductive performance in dairy herds in New South Wales. PROCEDURE: A survey was administered by face to face interview to examine the responses of producers drawn from 757 herds, which used the New South Wales Agriculture Department Dairy Herd Improvement scheme. A case-control approach was used to select a total of 126 herds from the first (top group-cases) and fourth quartiles (low group-controls) for intercalving interval. RESULTS: We found that the estimated interval from calving to first mating was significantly different between group (P = 0.03) and that the groups significantly differed in both their target for interval to first mating (P = 0.02) and their perceived optimum time for first mating (P = 0.04). Other factors associated with a longer intercalving interval included, use of embryo transfer programs (P = 0.08), younger managers (P = 0.02), fewer breedings per day (P = 0.01), a greater number of people detecting heats (P = 0.07), but less hours spent detecting heats while handling the cows (P = 0.11), and a failure to vaccinate bulls for campylobacteriosis (P = 0.14). CONCLUSIONS: Managers of herds with poorer reproductive performance did not intend to mate cattle as soon after calving as managers with better reproductive performance, were not as active in seeking veterinary advice on reproduction, and were attempting to treat reproductive diseases and disorders themselves.
Animal Husbandry↗
Organochlorine concentrations, reproductive physiology, and immune function in unique populations of freshwater Atlantic stingrays (Dasyatis sabina) from Florida's St. Johns River.
Within the past decade, reproductive and health disorders have been reported to occur in unique populations of Atlantic stingrays (Dasyatis sabina) inhabiting certain components of Florida's St. Johns River. Since these irregularities are consistent with the alleged effects of organochlorine (OC) contaminant exposure in other Florida wildlife, the goal of this study was to examine possible associations between OC concentrations and reproduction and/or immune function in stingrays from this river system. Liver concentrations of 30 OC pesticides/pesticide metabolites and total polychlorinated biphenyls (PCBs) were measured and compared in D. sabina collected from four central Florida lakes of the St. Johns River: Lake George, Lake Harney, Lake Jesup, and Lake Monroe. Reproductive biology, serum testosterone and 17beta-estradiol concentrations, and circulating white blood cell counts were examined and compared in stingrays from lakes that were determined to contain low (Lake George), intermediate (Lake Monroe), and high (Lake Jesup) levels of pesticide contamination, based on the results of liver OC assessments. Successful breeding occurred in Lake Jesup stingrays, indicating that the degree of OC accumulation in these animals is not high enough to cause reproductive impairment. However, elevated serum steroid concentrations and white blood cell counts were observed in Lake Jesup stingrays, suggesting that endocrine and immune function may be altered in these animals due to OC exposure and/or other, as yet unknown, ecological factors. Inconsistencies in the reproductive success of Lake Monroe stingrays were observed, confirming earlier reports of reproductive complications in this sub-population. Based on these findings, previous occurrences of reproductive failure in St. Johns River stingrays may be due to environmental factors other than OC exposure.
Animals↗
Chronic pelvic pain.
Chronic pelvic pain is a common and significant disorder of women. It is estimated to have a prevalence of 3.8% in women. Often the etiology of chronic pelvic pain is not clear, as there are many disorders of the reproductive tract, gastrointestinal system, urological organs, musculoskeletal system, and psychoneurological system that may be associated with chronic pelvic pain. The history and physical examination are crucial in evaluating a woman with chronic pelvic pain and must address all of the possible systems potentially involved in chronic pelvic pain, not just the reproductive system. Laboratory and imaging studies should be selectively utilized, as should laparoscopy. Conscious laparoscopic pain mapping has been proposed as a way to improve information derived from laparoscopic evaluations. Treatment of chronic pelvic pain may consist of two approaches. One is to treat chronic pain itself as a diagnosis, and the other is to treat diseases or disorders that might be a cause of or a contributor to chronic pelvic pain. These two approaches are not mutually exclusive, and in many patients effective therapy is best achieved by using both approaches. Treatment of chronic pain as well as treatment of four of the more common disorders associated with chronic pelvic pain (endometriosis, adhesions, irritable bowel syndrome, and interstitial cystitis) are discussed in this review.
Chronic Disease↗
Gender differences in risk factors for mood and anxiety disorders: implications for clinical treatment research.
This article discusses the utility and treatment implications of a focus on gender-related variables in the study of the mood and anxiety disorders. Three clinical areas are considered: (1) Mood and anxiety disorders during female reproductive transitions; (2) gender differences in pathogenesis and pathopsysiology; and (3) gender differences in clinical phenomenology and course. Gender analysis is viewed as useful in specifying variability in treatment response, especially in regard to the menstrual cycle, pregnancy, the postpartum period, and menopause; and in defining clinical covariates modifying treatment course. A psychobiological approach to mood and anxiety disorders is seen as critical in this regard.
Anxiety Disorders↗
Mitral valve prolapse. Echocardiographic changes during pregnancy.
Mitral valve prolapse (MVP) has been reported to be the most common cardiac disorder in reproductive-age women. The purposes of this prospective investigation were to determine the effect of pregnancy on cardiac function in women thought to have MVP and to determine whether any such changes would adversely affect pregnancy outcome. During a recent three-year period, 43 (1.2%) of 3,582 pregnant women followed in our clinic had a prior diagnosis of MVP without any other cardiac disorder. On closer evaluation, only 21 women (0.6%) had a previous echocardiogram suggestive of MVP. Serial echocardiograms in these women revealed that pregnancy caused either no change or an improvement in the valve prolapse. No cardiac complications were present, and perinatal outcomes were favorable. MVP may be less pronounced during pregnancy, and an echocardiogram late in gestation seems worthwhile to confirm the diagnosis before delivery.
Adult↗
Defective reproduction of passive meaningless gestures in right brain damage: a perceptual disorder of one's own body knowledge?
Right Hemisphere Damaged Patients (RHDP) with left hemiparesis are known to experience motor programming difficulties and to have poorer functional outcome when compared with Left Hemisphere Damaged Patients (LHDP). The role played by body-related cognitive disorders remains unclear. In this study we investigate whether reproduction of passive meaningless gestures may contribute to a further development of this question. Ten RHDP with neglect, 10 RHDP without neglect, 10 LHDP, and 10 controls were given a battery of tasks requiring reproduction of passive meaningless gestures. The gestures were passively applied by the examiner on either the ipsilesional or the contralesional upper limb of the subject who was asked to reproduce them with his ipsilesional- non-paretic -limb. LHDP performed virtually as well as controls when the influence of deafferentation was controlled. The performance of RHDP with and without neglect did not differ from each other but both groups were significantly impaired when compared with either controls or LHDP, whether the gestures were applied on the contralesional or ipsilesional limb. RHDP performed defectively whether they had closed or open eyes, which tends to indicate a perceptual multimodal integration disorder rather than a modality-related sensory disorder. The left hemisphere is generally considered dominant for deliberate motor control of both sides of the body, not only for symbolic gestures but also for (visual) imitation of meaningless gestures. The results of this study raise the question of why reproduction of meaningless gestures is more impaired for LHDP than RHDP when stimulus presentation is visual and vice versa when stimulation is passively applied upon the subject's body. One reason may be that in visual imitation, the model is given by another person's body, whereas passive gestures, directly applied upon one's body, place demands on perceptual analysis of one's own body experience. These results might give evidence for a disorder of bilateral, perceptual, multimodal integration of knowledge about one's own body in RHDP.
Adult↗
Neuro-reproductive toxicities of 1-bromopropane and 2-bromopropane.
2-Bromopropane was used as an alternative to chlorofluorocarbons in a Korean electronics factory and caused reproductive and hematopoietic disorders in male and female workers. This causality was revealed by animal studies, and target cells were identified in subsequent studies. After identification of 2-bromopropane toxicity, 1-bromopropane was introduced to the workplace as a new alternative to ozone-depleting solvents. 1-Bromopropane was considered less mutagenic than 2-bromopropane, but, in contrast, animal experiments revealed that 1-bromopropane is a potent neurotoxic compound compared with 2-bromopropane. It was also revealed that 1-bromopropane has reproductive toxicity, but the target cells are different from those of 2-bromopropane. Exposure to 1-bromopropane inhibits spermiation in male rats and disrupts the development of follicles in female rats, in contrast to 2-bromopropane, which targets spermatogonia and oocytes in primordial follicles. After the first animal study describing the neurotoxicity of 1-bromopropane, human cases were reported. Those cases showed decreased sensation of vibration and perception, paresthesia in the lower extremities, decreased sensation in the ventral aspects of the thighs and gluteal regions, stumbling and headache, as well as mucosal irritation, as the initial symptoms. The dose-response of bromopropanes in humans and mechanism(s) underlying the differences in the toxic effects of the two bromopropanes remain to be determined.
Abnormalities, Drug-Induced↗