[Reproduction of a syndrome of acrichine "psychosis" in animals].
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Mental Disorders↗
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The pharmacology of bipolar disorder during pregnancy and breastfeeding.
Treating bipolar disorder in women during reproduction presents a significant challenge to the physician. The pharmaceutical agents most commonly used for treating bipolar disorder have been associated with adverse effects when used during pregnancy and breastfeeding. Of particular concern has been the association of lithium with cardiac malformations, and the association of carbamazepine and valproate with neural tube defects including spina bifida. Toxicity in neonates has also been reported for the most commonly used mood-stabilising agents. Treatment options for mood stabilisation are either associated with risks of adverse events, have been used less frequently and their associated risks are unknown, or may not provide effective prophylaxis against recurrences of bipolar episodes. However, strategies are available that minimise the risk to the fetus and infant whilst still providing effective prophylaxis against bipolar disorder in the mother. Ideally, a treatment regimen tailored to suit the individual should consider both mother and baby and should be planned prior to conception.
Abnormalities, Drug-Induced↗
Management of migraine throughout the reproductive cycle--an overview of treatment issues.
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Adult↗
Inherited thrombophilia: impact on human reproduction.
The development of thrombotic disorders is a major threat for young women during pregnancy. It is one of the main causes of pregnancy-related disorders, which may also result in harm for the conceptus. Successful pregnancies require an even balance of coagulation and fibrinolysis, in order to secure stabilization of the basal plate as well as adequate placental perfusion. Thrombophilia is a laboratory definition for pre-disposing factors of thrombosis, which can be inherited or acquired. Many individuals, who carry a thrombotic defect remain asymptomatic, at least until additional boosting factors arise. The documentation of thrombophilic causes of recurrent miscarriage or pregnancy-related disorders is important, because of availability of effective early treatment. There is a rapidly growing awareness on the relationship of genetic factors influencing hemostasis and pregnancy-related disorders. The aim of our review is to summarize this knowledge, focusing on common genetic variations.
Blood Coagulation↗
Adolescent menstrual disorders.
The adolescent years present a vulnerable period of time during which menstrual abnormalities may arise. These abnormalities may be related to the maturational processes of the neuroendocrine, gonadal, and anatomic components of the reproductive system. Adolescent menstrual disorders may be totally unrelated to these maturational changes or may occur after puberty is completed. Manifestation of pubertal and nonpubertal conditions is variable. Most patients with aberrations of puberty present with amenorrhea, and most adolescents with disorders unrelated to puberty present with abnormal bleeding. However, amenorrhea and bleeding problems may occur in both groups of patients. All adolescents with menstrual disorders must be treated aggressively because of the known association with these conditions and poor outcome. Morbidity, mortality, and reduced reproductive potential have been demonstrated for all such adolescents.
Adolescent↗
Pregnancy complicated by obsessive-compulsive disorder.
Obsessive-compulsive disorder (OCD) is a well-recognized psychiatric disorder often beginning in reproductive age. A case of OCD in pregnancy is presented and its management discussed. A 28-year-old G3P2 woman presented at 8 weeks' gestation for prenatal care. She had been diagnosed with OCD following her prior pregnancy. Her symptoms primarily involved obsessions about infectious disease and compulsive cleaning and organization of household items, both of which greatly distressed her and interfered with caring for her children. She had been managed with clomipramine between pregnancies and was beginning a clinical trial of fluvoxamine when pregnancy was diagnosed. She discontinued medication when she realized she was pregnant. Her symptoms were managed during the pregnancy with frequent appointments with her obstetrician and her psychiatrist. She used a behavioral technique, "thought-stopping", as well. Her symptoms worsened in the last month of pregnancy and immediately after delivery; she delivered a normal infant. The clomipramine was restarted postpartum. She has done well since then, with minimal psychiatric symptoms. OCD is a disabling psychiatric disorder that occurs in women of reproductive age. With careful management, pregnancy without disabling psychiatric symptoms can occur.
Adult↗
Thyroid disease and pregnancy.
Thyroid disease is common in younger women and may be a factor in reproductive dysfunction. This probably only applies to severe cases of hyper- or hypothyroidism. Once adequately treated, neither of these disorders significantly impacts on fertility. The key is to recognize and to treat thyroid disorders in the reproductive-age woman before conception. Thyroxine therapy and even antithyroid drug therapy should be continued during pregnancy as necessary. Pregnancy is a euthyroid state that is normally maintained by complex changes in thyroid physiology. The fetal and neonatal hypothalamic-pituitary-thyroid system develops independently, but it may be influenced by thyroid disease in the mother. Early pregnancy is characterized by an increase in maternal T4 secretion stimulated by hCG and an increase in TBG, resulting in the elevated total serum T4 in pregnancy. The debate continues as to whether maternal T4 is important in early or late fetal brain development. If so, the physiologic changes in thyroid hormone secretion and transport in early pregnancy would help to ensure that a sufficient amount of thyroid hormone was available. There is new evidence in human subjects that substantial maternal T4 can cross the placenta during pregnancy, and this may be particularly important when fetal thyroid function is compromised as a result of congenital hypothyroidism. Maternal and fetal/neonatal outcomes in pregnancy are adversely affected if severe hypothyroidism is undiagnosed or inadequately treated. Thyroid function tests should be obtained during gestation in women taking T4 and appropriate dose adjustments should be made for TSH levels outside a normal range. The TSH-receptor blocking antibodies from the mother are a recognized cause of congenital hypothyroidism in the fetus and neonate that can be permanent or transient. If neonatal hypothyroidism is detected through neonatal screening programs, and prompt and adequate T4 replacement therapy is instituted as soon as possible following delivery, subsequent growth and development are usually normal. Paradoxically, pregnancy often has a favorable effect on the course of maternal Hashimoto's disease, although there is the risk of relapse postpartum. Pathophysiologic conditions of hCG secretion such as gestational trophoblastic disease and hyperemesis gravidarum may present as thyrotoxicosis in pregnancy, but the main cause of this syndrome is Graves' disease. The mainstay of treatment is antithyroid drugs and either propylthiouracil or methimazole may be used safely. Subtotal thyroidectomy, after medical control, is the alternative treatment, but radioiodine ablation is contraindicated.(ABSTRACT TRUNCATED AT 400 WORDS)
Female↗
Epidemiology of male reproductive function: a field searching for tools.
BACKGROUND: An increase in the frequency of disorders of the male human reproductive organs has been described over recent decades. Neither its causes nor its consequences on fecundity, the ability of the couples to produce a live child, are clearly known. This lack of knowledge may partly be due to methodological difficulties specific to reproductive epidemiology. METHODS: We discuss the relevance and limits of some markers of the male aspects of human reproduction, focusing on semen parameters and fecundability, a measure of the probability of pregnancy. RESULTS: Semen parameters are associated with fecundability, although they have a relatively low sensitivity to detect couples with low fecundability. The study of semen parameters proved central to describe the influence of environmental factors on the male side of reproductive function. The main limitation of semen studies is low participation rates and the possible selection biases ensuing. Fecundability can be estimated by collecting waiting time to pregnancy. Its assessment in retrospective studies often excludes the least fecund, those couples remaining childless, which entails a bias and a decrease in statistical power. The prospective approach and an approach relying on the enrollment of a cross-sectional sample of the couples currently trying to obtain a pregnancy (current duration approach) do not have these limitations. Although it has never been used, the assessment of fecundability using the current duration approach is promising both for aetiologic research and monitoring. CONCLUSION: Most of the potential markers of male reproductive function are not assessed in the general population of France, with the exception of the incidence rate of testis cancer, which is currently increasing. We present some alternatives for a monitoring system of reproductive function.
Adult↗
The frequency of insulin resistance calculated upon the basis of a fasting glucose to insulin ratio and characteristics of insulin resistant women with polycystic ovary syndrome.
BACKGROUND: The Polycystic Ovary Syndrome (PCOS) is a common endocrine and metabolic disorder of women of reproductive age, characterized by hyperandrogenism and chronic anovulation. Peripheral insulin resistance (IR) has a crucial role in the pathogenesis of this disorder. A fasting glucose to insulin (G/I) ratio is a simple, reliable, sensitive and specific measurement of insulin sensitivity and is a useful test for the identification of IR in women with PCOS, who have to be treated with insulin sensitizers. OBJECTIVE: To calculate the frequency of IR among patients with PCOS, using the fasting G/I ratio, and to compare the clinical and biochemical parameters between insulin-resistant and insulin-sensitive groups. PATIENTS AND METHODS: The study comprised 62 patients of reproductive age (18-40) with PCOS. The diagnosis PCOS was determined according to the diagnostic criteria from Rotterdam 2003, i.e. the presence of two of the following three criteria: oligo-ovulation and/or anovulation; clinical and/or biochemical hyperandrogenism; and polycystic ovaries. All other states associated with hyperandrogenism had been previously excluded. An inclusion criterion for the study was the body mass index (BMI) >or=25 (kg/m2). After calculating the fasting glucose(mg/dl) / insulin(microU/ml) ratio, the patients were separated in two groups, i.e. an insulin-resistant group with a fasting G/I ratio of < 4.5(mg/10(-4) U) and an insulin-sensitive group with a fasting G/I ratio of >/=4.5(mg/10(-4) U). RESULTS: In our study, 58.06% of women with PCOS and BMI >or=25 (kg/m2) were insulin-resistant. There was no significant difference between the two groups in age or BMI. Sex hormone binding globulin (SHBG) levels were significantly lower in the insulin-resistant group (17.83 +/- 8.38 vs. 42.66 +/- 27.65 (nmol/l); p=0.0036) and they had a higher free testosterone index (19.38 +/- 8.91 vs. 9.55 +/-3.51(%); p=0.001) in comparison with the insulin-sensitive group. Progesterone levels were significantly lower in the IR group (2.41 +/- 2.50 vs. 7.05 +/- 8.04 (ng/ml); p=0.034). CONCLUSION: A fasting glucose to insulin ratio is a simple and useful test for identifying insulin-resistant obese women with PCOS. SHBG and progesterone (oligo-ovulation/anovulation) can be useful markers for long-term health risks in women with PCOS (diabetes mellitus type 2 and cardiovascular diseases). In this way we could identify the group of PCOS subjects and its subgroups, which would benefit from therapy with insulin sensitizers, with respect to the reduction of risks of chronic complications.
Adolescent↗
Genetics of polycystic ovary syndrome: searching for the way out of the labyrinth.
Polycystic ovary syndrome (PCOS) is a complex and heterogeneous disorder presenting a challenge for clinical investigators. It is the most common endocrine disorder of women in reproductive age, a multifaceted reproductive, cosmetic and metabolic problem, with an enigmatic pathophysiological and molecular basis. Although the familial segregation has been noticed very early in the description of the syndrome and family studies in first-degree relatives of women diagnosed with PCOS reveal clustering of the disease, the genetic studies have not as yet determine the pattern of heredity. Part of the problem in genetic studies has been the lack of uniform criteria for diagnosis, heterogeneity of phenotypic features and the fact that the disorder is only expressed clinically in women during their reproductive years. Even within affected families and between sisters with polycystic ovaries, there is heterogeneity in presentation. However, regardless of diagnostic criteria used to identify profanes and to determine affected status in the kindred, the foundation of genetic studies suggests a strong familial component. Currently, PCOS is considered a polygenic trait that might result from the interaction of susceptible and protective genomic variants under the influence of environmental factors, whose role is under intensive investigation. Candidate genes cover a broad spectrum of an endless list of molecules which participate on every step of reproductive and metabolic pathways of this syndrome. Focused research in identification of these genes may provide valuable information and shed some light on the way out of the genomic labyrinth, elucidating the underlying pathophysiology and aiming at a more efficient therapeutic approach of this complicated endocrine disorder.
Animals↗
Partial and generalized seizures affect reproductive physiology differentially in the male rat.
PURPOSE: Reproductive dysfunction and endocrine disorders occur frequently among men with epilepsy. This study tested the hypothesis that focal limbic seizures and generalized seizures may both contribute to reproductive dysfunction. METHODS: The rat kindling model was used to mimic focal limbic seizures. Kindling electrodes were placed in the basolateral amygdala. Male rats were either intact, gonadectomized (GDX) or GDX + testosterone (T) replaced and then kindled. Controls were left intact and sham-kindled. Maximal electroconvulsive shock (MES) treatment was used to model generalized seizures, by using eight stimulations, one every other day, for 2.5 weeks. Animals were killed either 3 h or 6 weeks after MES treatment to determine short- and long-term effects. RESULTS: Kindled seizures resulted in an increase in serum testosterone, estradiol, and prolactin in intact males, accompanied by a significant increase in testis, epididymis, and pituitary weight, as well as a significant decrease in prostate weight. MES treatment caused a short-term reduction in serum testosterone and testis, epididymis, and prostate weight. All parameters were restored to control values within 6 weeks of the last MES seizure, with the exception of pituitary weight and serum prolactin, which remained significantly elevated 6 weeks after MES treatment. CONCLUSIONS: Our results indicate that both focal limbic (amygdaloid) seizures and generalized MES seizures disturb normal reproductive physiology in the male rat. Amygdaloid-kindled seizures have mixed effects on different parameters of reproductive function, whereas MES seizures induce a transient hypogonadal state. These results suggest that reproductive dysfunction in men with epilepsy may result from seizure-related interference with the normal functions of the hypothalamic-pituitary-testicular axis.
Amygdala↗
Basic psychopharmacology of antidepressants, part 2: Estrogen as an adjunct to antidepressant treatment.
Estrogen exerts profound effects upon behavior by interacting with neuronal estrogen receptors. Changes in estrogen levels over a woman's life cycle are linked not only to behavioral fluctuations, but potentially to the onset or recurrence of mood disorders. The modern psychiatric evaluation of women requires obtaining a complete reproductive history, including details of hormone treatments, while identifying reproductive events as triggers of affective disorder episodes. While guidelines for the use of reproductive hormones in psychiatry are just evolving, administration of estrogen as an adjunct to antidepressants is an exciting possibility for expanding the frontiers of psychiatry into the field of women's health.
Antidepressive Agents↗
The health status of young adults in the United States.
The health issues of young adulthood have received relatively little attention compared with those of adolescence, although the critical issues in young adulthood parallel those of adolescence. Young adults often fare worse than adolescents on health indicators, with many measures of negative outcomes--including rates of injury, homicide, and substance use--peaking during the young adult years. The contextual factors shaping health status and access to care in young adulthood differ significantly from the context of adolescence. This article synthesizes national data to present a health profile of young adults, reviewing social indicators that describe the context of young adulthood and presenting measures of health status. We examine mortality, morbidity, risky behaviors, and health care access and utilization, identifying the most significant gender and racial/ethnic disparities. The article also identifies limitations of existing data and offers suggestions for future research and health monitoring in this area. We conclude with a discussion of current efforts to address the health and well-being of young adults and argue for creating a national health agenda for young adults that includes research, programs and policies to address health issues during this period of the lifespan.
Accidents↗
Increased depressive-like traits in an animal model of premenstrual irritability.
Women are at higher risk of anxiety and mood disorders, especially at transitions across the reproductive life cycle (premenstruum, postpartum, menopause). Premenstrual dysphoric disorder (PMDD) is one of female mood disorders associated with changing ovarian hormone levels. Because anxiety and depression frequently occur in women with PMDD, premenstrual dysphoria might be a manifestation of certain vulnerability traits increasing the risk of those disorders. The present study was conducted to elucidate a potential association between estrous cycle-dependent aggression, the rodent model of "premenstrual irritability" (resident-intruder test), and anxiety (elevated plus maze), depressive-like traits (forced swim test) as well as carbohydrate craving in female Wistar rats. Some aggressive and nonaggressive females were restraint-stressed before testing to determine their sensitivity to stress at different hormonal stages. The results revealed that females expressing the estrous cycle-dependent aggression but not those not expressing cycle-dependent aggression spent longer time immobile and shorter time swimming in the forced swim test at metestrus compared to proestrus phase of the estrous cycle. There was no difference between aggressive and nonaggressive females in anxiety, locomotor activity and sensitivity to restraint stress and sucrose consumption. The present study suggests a common neurobiological background for the estrous cycle-dependent aggression and depressive-like traits in rodents. This phenomenon could potentially aid the elucidation of premenstrual emotional dysfunctions and might be used as an ethological model to study a biochemical and genetic proneness to depression.
Aggression↗
Coping with problems related to cancer and cancer treatment.
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Digestive System Diseases↗
Inhibitory effect of cadmium and tobacco alkaloids on expansion of porcine oocyte-cumulus complexes.
Studies aimed at the influence of smoking on reproductive functions have found out fertility disorders in smokers occurring at any stage of reproductive processes. In our experiments the role of cadmium, nicotine and anabasine was investigated in the expansion of oocyte-cumulus complexes (OCC) isolated from large antral porcine follicles. Suppression of FSH-induced cumulus expansion and significant inhibition of synthesis and accumulation of hyaluronic acid in the cell/matrix compartment of the OCC was observed in the presence of different concentrations of tested compounds. The suppressive effect of cadmium and tobacco alkaloids on the cumulus expansion was accompanied by decreased progesterone production by cumulus cells during 42 h incubation of the OCC with FSH.
Alkaloids↗
Bilateral epididymal sarcoidosis presenting without radiographic evidence of intrathoracic lesion: Review of sarcoidosis involving the male reproductive tract.
Sarcoidosis is a multisystem disorder that rarely involves the genitourinary tract. To date, only 59 cases of histologically proven sarcoidosis involving the male reproductive tract have been reported in the literature. We present here a case of bilateral epididymal sarcoidosis without radiographic evidence of intrathoracic lesion. A 46-year-old man presented with a one-week history of painless bilateral scrotal swellings. Physical examination detected multiple elastic firm nodules on both sides of the scrotum which showed no tenderness. The nodules seemed to involve the entire bilateral epididymides. Some irregularly shaped hypoechoic masses in the bilateral epididymides were identified on gray scale ultrasonography. On magnetic resonance images, the bilateral epididymides were seen to be enlarged, heterogeneous and nodular without any signs of testicular involvement. The lesion showed a slightly high signal intensity on the T2-weighted image. Pathological evaluation following bilateral epididymectomy found non-caseating epithelioid cell granulomas with giant cells in epididymal tissue, thus confirming a diagnosis of sarcoidosis. Gallium-67 scanning showed additional small hot spots in the anterior chest wall and extremities. Open biopsy of a superficial papular lesion in the dermis of the right upper arm was performed and pathological findings indicated sarcoid granulomas. This report also includes a review of the literature pertaining to sarcoidosis of the male reproductive tract.
Epididymis↗
[The limits of hormone substitution in pollutant exposure and fertility disorders].
Heavy metals and chloro-organic compounds can influence female fertility at every phase of reproduction. They may induce hormonal disorders, preventing ovulations and pregnancies. They can also result in abortions and fetal malformations. For this reason, the urinary excretion of heavy metals was measured after oral load with the chelating agent dimercaptopropanesulfonate (Dimaval) in women with hormonal irregularities. In addition, blood was examined for various polychlorinated compounds (polychlorinated biphenyls - PCB -, hexachlorocyclohexane - HCH -, pentachlorophenole - PCP -, hexachlorobenzol - HCB -, dichlordiphenyltrichloroethane - DDT -, dichlorodiphenylethane - DDE -, tetrachlorodiphenylethane - DDD -). Mercury contaminations were seen most commonly and correlated significantly with the number of amalgam fillings and with the release of mercury while chewing. The latter was demonstrated with the so-called chewing-gum test. Women with hormonal disorders or alopecia had, on the average, the highest mercury excretion during the wash-out test. Cadmium excretion was pronounced for the following groups of women: those with technical professions, those suffering from thyroid dysfunctions, and those with habitual abortions and uterine fibroids. With increasing age, pesticide concentrations of the blood rose significantly. Women with endometriosis and with antihyroidal antibodies had significantly higher PCB values. Despite therapeutic intervention, fewer women with elevated DDT/DDE/DDD values conceived when compared to those with lower values. alpha-HCH concentrations were often elevated in women with uterine fibroids. With increasing PCP levels pregnancies often ended in abortion. Results of this investigation indicate that women with hormonal irregularities or specific fertility disorders should be examined for heavy metal and pesticide contamination prior to hormone treatment.
Adult↗