Postpartum amenorrhea in selected developing countries: estimates from contraceptive prevalence surveys.
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Amenorrhea↗
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The effect of improved nutrition on plasma prolactin concentrations and postpartum infertility in lactating Gambian women.
A substantial increase in food consumption of lactating Gambian women has been shown to be associated with a reduction in their plasma prolactin concentration. Women receiving food supplements during pregnancy as well as in lactation exhibited an even greater lowering of the postpartum plasma levels of this hormone. Consequently prolactin values of supplemented women returned more quickly to levels which allowed the resumption of menstrual and ovulatory activity. Concurrent measurements of the plasma concentrations of estradiol and progesterone in addition to prolactin allowed the calculation of prolactin values at which half the lactating women could be expected to have resumed menstruation and ovulation. These values were 1007 and 759 microU/ml, respectively. Dietary improvement during lactation alone resulted in these critical prolactin concentrations being reached 21 wk earlier than in nonsupplemented counterparts, while those receiving the extra food in both pregnancy and lactation showed a 35-wk shortening of postpartum amenorrhea and infertility.
Amenorrhea↗
DNA of adeno-associated virus (AAV) in testicular tissue and in abnormal semen samples.
BACKGROUND: Human genital tissues, including spermatozoa, have been found to be frequently infected with the helper-virus dependent parvovirus, adeno-associated virus (AAV). METHODS: To assess the role of AAV infection in disorders of the male reproductive system, semen samples from 95 men (including 73 men attending a fertility programme) and testicular samples from patients with azoospermia (n = 38) or prostate cancer (n = 8) were analysed using polymerase chain reaction for the presence of AAV DNA. Semen quality was assessed according to World Health Organization guidelines and the grade of atrophy of testicular biopsies was determined histomorphologically. RESULTS: AAV DNA was detected in 38% (28/73) of ejaculates from men with abnormal semen analyses (oligoasthenozoospermia or asthenozoospermia) and in 4.6% of normal semen samples (1/22, P = 0.003). DNA from AAV helper-viruses (human papillomaviruses, cytomegalovirus) was detected at similar frequencies in normal and abnormal semen samples. In testes, AAV DNA was detected in 10 out of 38 biopsies from infertile men (26%), and in 2 out of 8 orchidectomy samples. CONCLUSION: The data show an increased incidence of AAV infection with abnormal semen analysis. Detection of AAV DNA in the testes might point to a role for AAV infection in male infertility, possibly by interfering with spermatozoa development.
Adolescent↗
Three-dimensional assessment of ultrasound features in women with clomiphene citrate-resistant polycystic ovarian syndrome (PCOS): ovarian stromal volume does not correlate with biochemical indices.
BACKGROUND: Polycystic ovarian syndrome (PCOS) is a heterogeneous endocrine disorder affecting women of reproductive age. The syndrome is characterized by a combination of polycystic ovarian morphology, clinical features and biochemical indices. The objective of this prospective observational study was to investigate the relationship between the total ovarian volume and the ovarian stromal volume, measured using a three-dimensional (3D) ultrasound scan, with biochemical indices of PCOS. METHODS: Twenty-three infertile women (mean age +/- SD: 31 +/- 3.1 years; range: 26-37) with clomiphene citrate-resistant PCOS were examined. Early follicular phase (days 2-4) serum FSH, LH and testosterone concentrations were measured following a withdrawal bleed. Total ovarian volume, stromal volume, pre-antral follicle (<10 mm) number and total follicular volume were measured by 3D transvaginal ultrasound. RESULTS: Total ovarian volume, follicular volume and follicle number correlated positively with serum FSH and LH, but not testosterone, concentrations. Ovarian stromal volume correlated strongly with total ovarian volume only, but not with serum FSH, LH or testosterone concentrations. CONCLUSIONS: These findings demonstrate an association of the total ovarian volume, pre-antral follicle number and total follicular volume with some of the biochemical indices of PCOS, but no association was observed between ovarian stromal volume and these indices.
Adult↗
A study of finger lengths, semen quality and sex hormones in 360 young men from the general Danish population.
BACKGROUND: It has been suggested that finger length may correlate with function or disorders of the male reproductive system. This is based on the HOXA and HOXD genes' common embryological control of finger development and differentiation of the genital bud. The objective of this study was to explore the association between the ratio of 2nd to 4th finger length (2D:4D ratio) and testis function in a sample of young Danish men from the general population. METHODS: Semen samples and finger measurements were obtained from a total of 360 young Danish men in addition to blood samples for sex hormone analysis to describe the possible association between 2D:4D and semen and sex-hormone parameters. RESULTS: A statistically significant inverse association with the 2D:4D was found only in relation to hormone levels of FSH in the group of young men with a 2D:4D >1 (P = 0.036) and a direct association with the total sperm count in the group of young men with a 2D:4D < or = 1 (P = 0.045). CONCLUSION: The statistically significant results may be 'false positives' (type I error) rather than representing true associations. This relatively large study of young, normal Danish men shows no reliable association between 2D:4D finger ratio and testicular function. Measurements of finger lengths do not have the power to predict the testicular function of adult men.
Adolescent↗
Specific haplotypes of the CALPAIN-5 gene are associated with polycystic ovary syndrome.
BACKGROUND: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. The aim of the present study was to investigate the role of CALPAIN-5 (CAPN5) gene in PCOS susceptibility. METHODS: We analysed four intronic polymorphisms of the CAPN5 gene in 148 well-characterized women with PCOS and 606 unrelated controls. We performed a case-control study and an intracohort analysis of clinical characteristics associated with PCOS. RESULTS: Analysis of haplotypes distribution between PCOS population compared to controls showed a strong deviation (P = 0.00029). The haplotypes GGCA and GGTG were overrepresented in PCOS patients (P = 0.009 and P = 0.001, respectively). In addition, we identified several CAPN5 haplotypes associated with phenotypic differences observed between PCOS patients, such as the presence of obesity (P = 0.02), cardiovascular complications (P = 0.02), familial antecedents of obesity (P = 0.003) and of hypertension (P = 0.007) and type 2 diabetes mellitus aggregation (P = 0.04). CONCLUSIONS: These results suggest a role of CAPN5 gene in PCOS susceptibility in humans. Moreover, novel candidate risk alleles have been identified, within CAPN5 gene, which could be associated with important phenotypic and prognosis differences observed in PCOS patients.
Alleles↗
Aberrant DNA methylation of imprinted loci in superovulated oocytes.
BACKGROUND: There is an increased incidence of rare imprinting disorders associated with assisted reproduction technologies (ARTs). The sex-specific epigenetic modifications that are imposed during gametogenesis act as a primary imprint to distinguish maternal and paternal alleles. The most likely candidate for the gametic mark is DNA methylation. However, the timing of DNA methylation acquisition in adult oocytogenesis and the effects of superovulation are unknown. METHODS: We examined the maternal methylation of PEG1(MEST), LIT1(KCNQ1OT1) and ZAC(PLAGL1) and the paternal methylation of H19 in adult growing oocytes of humans and mice and compared them with the methylation status of mouse neonatal growing oocytes by using bisulphite sequencing. Furthermore, we examined the effects of superovulation in the human and mouse. RESULTS: Maternal methylation of these genes has already been initiated to some extent in adult human and mouse non-growing oocytes but not in mouse neonates. In addition, the methylation dynamics during adult human and mouse oocyte development changed more gradually than those during neonatal oocyte development. Furthermore, we found the demethylation of PEG1 in growing oocytes from some ART-treated infertile women and a gain in the methylation of H19. We also detected methylation changes in superovulated mice. CONCLUSION: Our studies in the human and mouse suggest that superovulation can lead to the production of oocytes without their correct primary imprint and highlight the need for more research into ARTs.
Adult↗
Saviour siblings: trauma and tort law.
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Donor Selection↗
Ectopic endometrial cells express high concentrations of interleukin (IL)-8 in vivo regardless of the menstrual cycle phase and respond to oestradiol by up-regulating IL-1-induced IL-8 expression in vitro.
Endometriosis, an oestrogen-dependent disorder affecting women of reproductive age, is associated with active angiogenesis and an increased recruitment of leukocyte into the peritoneal cavity where the implants often develop. The role of oestrogens in the development of endometriosis has been clearly established, but the biochemical mechanisms of their action are still not clearly elucidated. The present study shows that interleukin-1 (IL-1) induces interleukin-8 (IL-8) secretion by endometriotic cells and that oestradiol enhances endometriotic cell responsiveness to IL-1. In contrast, no significant cell responsiveness to progesterone either alone in the culture medium or in combination with oestradiol was noted. Positive immunostaining for IL-8 was observed throughout endometriotic tissue, and no perceptible difference in the intensity of staining regarding the menstrual cycle phase was observed. Together with the in-vitro data, this suggests that IL-8 expression in endometriotic tissue is not subject to cyclic variation. Furthermore, this study provides evidence that oestradiol indirectly up-regulates the expression by ectopic endometrial cells of IL-8, a cytokine endowed with neutrophil chemotactic and angiogenic properties. This may contribute to peritoneal leukocyte recruitment and to the growth of endometriotic implants, and may be a new mechanism for oestradiol action in endometriosis.
Adolescent↗
Annual update: drugs, diagnostics and devices.
As NPs continue to play an important role in health care as administers of prescriptions, the value of reviewing the latest Food and Drug Administration (FDA) approvals for new drugs and devices is immeasurable. In 2002, the FDA approved several new drugs and devices, as well as monitored previously approved drugs for adverse reactions and untoward events. This article provides a brief review of relevant primary care topics.
Anti-Inflammatory Agents↗
Pseudotumor cerebri in pregnancy. Case reports and review of literature.
Pseudotumor cerebri is a rare disorder occurring in the reproductive age range of females, thus occurring infrequently in pregnancy. We are reporting three cases and reviewing the reports in English since 1960. Presentation, diagnosis, etiology, treatment, and pregnancy outcome are discussed in this review of the literature. Overall, pregnancy outcome does not appear to be adversely affected and the risk of recurrence in subsequent pregnancies does not appear to be increased. Medical management and observation are usually effective. Pregnancy termination is rarely, if ever required.
Adolescent↗
Hyperinsulinism and its interaction with hyperandrogenism in polycystic ovary syndrome.
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. It has become increasingly evident that insulin resistance plays a significant role both as a cause and result of the syndrome. The purpose of this review is to summarize the possible mechanisms leading to insulin resistance and resultant hyperinsulinism (HI) and their interaction with hyperandrogenism (HA) in PCOS. We conducted a computerized search of MEDLINE for relevant studies in the English literature published between January 1966 and January 2000. We reviewed all studies that investigated the roles of insulin, insulin receptor, and insulin gene in insulin resistance and its interaction with hyperandrogenism in PCOS. Insulin resistance in PCOS seems to involve a postbinding defect in the insulin receptor and/or in the receptor signal transduction. Current research has focused on identifying a genetic predisposition for insulin resistance in this syndrome. The answer to the question whether HI or HA is the initiating event is still unclear inasmuch as there are clinical and molecular evidences to support both of these approaches. Our view is that whichever is the triggering insult, a vicious cycle is established where HI acts to aggravate HA and vice versa. In this model, obesity and genetic predisposition seem to be the independent factors that can give rise or contribute to HI, HA, or both simultaneously. It seems that "hyperinsulinemic hyperandrogenism" represents a significant subgroup of PCOS, which probably needs to be renamed and reclassified in the light of this new approach.
Animals↗
A framework for genetic service provision for haemophilia and other inherited bleeding disorders.
This framework document offers guidance to patients, doctors, nurses, laboratory scientists, funders and hospitals on the provision of clinical and laboratory genetic services for haemophilia. With recent advances in molecular laboratory techniques it is now possible to give the vast majority of individual patients and family members very reliable genetic information. To enable these genetic data to be used for both the optimal treatment of patients with inherited bleeding disorders and for appropriate reproductive decisions in carriers, there needs to be a clear and robust framework for systematically acquiring the necessary clinical, personal, family and laboratory information upon which decisions can be made. This document provides guidance on the range and standards of clinical and laboratory genetic services which should be offered to patients and their families. Included are arrangements for genetic counselling and testing (including consent and confidentially issues), management of early pregnancy, standards for laboratory genetic services, as well as advice on data storage, security and retrieval.
Adult↗
The practical value of the progestogen challenge test, serum oestradiol estimation or clinical examination in assessment of the oestrogen state and response to clomiphene in amenorrhoea.
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Adolescent↗
Comparison between antifibrinolytic and antiprostaglandin treatment in the reduction of increased menstrual blood loss in women with intrauterine contraceptive devices.
The effects of a fibrinolysis inhibitor (tranexamic acid, TA) and prostaglandin synthesis inhibitor (diclofenac sodium, DS) were compared in the reduction of excessive menstrual blood loss in 19 women with an intrauterine contraceptive device (IUCD). These women (mean blood loss before treatment to 135.1 +/- 18.9 SE ml, range 70-294 ml) were treated in random order with TA (1.5 g three times daily for 5 days starting on the first day of menstruation for two periods), and with DS (50 mg three times on the first day followed by 25 mg three times daily for 4 days, for two periods), or with placebo (one period) in a double-blind trial. The placebo treatment did not change menstrual blood loss (128.3 +/- 15.6 ml). The TA treatment decreased blood loss to 59.4 +/- 7.7 ml (P less than 0.001) and the DS treatment to 102.1 +/- 13.6 ml (P less than 0.01). Neither treatment abolished pelvic discomfort during menstruation or shortened its duration. Various side-effects were noted by 12 women during 19 TA treatments and by five women during six DS treatments. Thus, while TA is generally far more effective, DS gave pronounced decreases in menstrual bleeding in some women and had less frequent side-effects.
Adult↗
Alcohol use, negative mood states, and menstrual cycle phases.
This study investigated the hypothesis that alcohol consumption patterns among normally menstrually cycling women would be influenced by increased negative mood states and phase of the menstrual cycle. A time-series, within-groups design was used to allow for comparisons among normally cycling women, women maintained on oral contraceptives, and men. Thirty-two adults recorded daily estimates of ongoing behaviors in the areas mentioned for two menstrual cycles or equivalent periods. Radioimmunoassay and temperature data were used to confirm ovulation and to define ovulatory, premenstrual, and menstrual phases. Estimates of anxiety, depression, and hostility were highly intercorrelated, but negative moods were not significantly related to frequency/amount of alcohol consumption. However, normally cycling women reported significantly more negative moods, were frequent drinking to relieve tension/depression, and more frequent solitary drinking at menstruation. These relationships were not observed among oral contraceptive women or men. Collected among psychologically robust, working subjects of high intelligence, these data provide estimates of baseline functioning for future studies exploring the progression of pathological alcohol use patterns among women.
Adult↗
Re-expression of disease-characteristic features of non-bullous congenital ichthyosiform erythroderma (CIE) after grafting of the pathological keratinocyte cultures to athymic mice.
Epidermal keratinocytes separated from skin lesions of non-bullous congenital ichthyosiform erythroderma were investigated in an attempt at experimental reproduction of this keratinization disorder. In vitro studies on growth and differentiation of pathological keratinocytes isolated from the influence of the host's dermal and humoral components were performed using the immersed epidermal cell culture technique. Ten to 25-day-old confluent and stratified cultures were examined by means of photonic and electron microscopy, and stained with various differentiation markers for indirect immunofluorescence studies. The cultured epidermis showed low-grade differentiation and no clear-cut evenly distributed signs of the original disease. Grafting on congenitally athymic nude mice allowed further differentiation of the epidermal sheets and re-expression of the histologic and ultrastructural features of non-bullous congenital ichthyosiform erythroderma. Thus, the purely epidermal origin of this particular form of autosomal recessive ichthyosis could be confirmed. Large amounts of pathological keratinocytes generated from small skin biopsies may be used for experimental purposes after grafting on several athymic animals.
Animals↗
Côte d'Ivoire 1998-99: results from the Demographic and Health Survey.
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Adult↗