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PubMed2004

Subfertility and gastrointestinal disease: 'unexplained' is often undiagnosed.

Subfertility can be more reliably explained and effectively treated with an improved understanding of the contribution of chronic medical disease to reproductive dysfunction. This review addresses several common gastrointestinal disorders which are increasingly implicated in infertility and early pregnancy loss: celiac disease, inflammatory bowel disease (ulcerative colitis and Crohn's disease), and hemochromatosis. Appreciating the reproductive impact of these comorbidities and their treatments enables clinicians to accurately counsel patients and to modify medical and fertility treatments based on etiology. Because unexplained infertility can represent the initial presentation of undiagnosed medical disease, considering these often-subclinical gastrointestinal disorders in the differential diagnosis of subfertility provides an opportunity not only to increase the probability of conception and uncomplicated pregnancy, but also to improve overall maternal health.

Celiac Disease↗
PubMedDate not supplied

When agreeing with the patient is not enough: a schizophrenic woman requests pregnancy termination.

In this article, we discuss the ethical dilemma health care providers faced when Rebecca, a pregnant schizophrenic patient who lacked decision-making capacity, inconsistently requested elective pregnancy termination. When a patient's decision-making capacity is severely impaired, how does the physician balance obligations to protect the patient from harm (beneficence) while also respecting her reproductive preferences and decisions (respect for autonomy)? Rebecca suffers from polysubstance abuse and paranoid schizophrenia characterized by disorganized thought and speech, auditory hallucinations, and delusional ideas. She arrived 14+ weeks pregnant and unaccompanied at an obstetric clinic requesting an abortion. This is her second and final request. On all prior and subsequent occasions, she was either ambivalent or said she wanted to continue the pregnancy. After the consulting psychiatrist determined that she lacked decision-making capacity, steps were taken to address ethical and clinical issues. The steps included treating her schizophrenia to see if she could regain decision-making capacity; identifying a surrogate and using a shared decision-making model; and devising strategies to protect Rebecca and her fetus without resorting to excessive paternalism. Rebecca continued her pregnancy. Due to poor adherence to medical regimen and inadequate social support, Rebecca's schizophrenia was poorly controlled and she continued to use drugs during the pregnancy. She delivered a term baby who was soon removed from her custody. Despite some people's desire to protect Rebecca by complying with her request for abortion, we conclude that to do so would be ethically unjustified. To treat a decisionally impaired patient's requests for abortion as autonomous is disrespectful of the vulnerable patient because such paternalism fails to respect the patient's liberty and the surrogate's authority.

Abortion Applicants↗
PubMed2005

Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders.

OBJECTIVE: This study ascertained the incidence of complications during pregnancy, labor, and delivery and the neonatal characteristics of infants born to women with schizophrenia, bipolar disorder, or major depression in a population-based cohort. METHOD: Based on records linkage across a psychiatric case register and prospectively recorded obstetric data, the study comprised women with schizophrenia or major affective disorders who had given birth to 3,174 children during 1980-1992 in Western Australia. A comparison sample of 3,129 births to women without a psychiatric diagnosis was randomly selected from women giving birth during 1980-1992. Complications were scored with the McNeil-Sjöström Scale. Odds ratios were calculated for specific reproductive events. RESULTS: Both schizophrenic and affective disorder patients had increased risks of pregnancy, birth, and neonatal complications, including placental abnormalities, antepartum hemorrhages, and fetal distress. Women with schizophrenia were significantly more likely to have placental abruption, to give birth to infants in the lowest weight/growth population decile, and to have children with cardiovascular congenital anomalies. Neonatal complications were significantly more likely to occur in winter; low birth weight peaked in spring. Complications other than low birth weight and congenital anomalies were higher in pregnancies after psychiatric illness than in pregnancies preceding the diagnosis. CONCLUSIONS: While genetic liability and gene-environment interactions may account for some outcomes, maternal risk factors and biological and behavioral concomitants of severe mental illness appear to be major determinants of increases in reproductive pathology in this cohort. Risk reduction in these vulnerable groups may be achievable through antenatal and postnatal interventions.

Bipolar Disorder↗
PubMed2005

Screening women with menorrhagia for underlying bleeding disorders: the utility of the platelet function analyser and bleeding time.

Menorrhagia is a very common clinical problem among women of reproductive age and recent studies have suggested that underlying bleeding disorders, particularly von Willebrand's deficiency and platelet function defects, are prevalent in women presenting with menorrhagia. The objective of this study was to determine the utility of the platelet function analyser (PFA-100) and bleeding time (BT) as initial screening tests for underlying bleeding disorders in women with menorrhagia. In this study, 81 women with a physician diagnosis of menorrhagia underwent PFA-100 testing, BT and comprehensive haemostatic testing. The effectiveness of the PFA-100 and BT as screening tools in women with menorrhagia was assessed using results of haemostatic testing for von Willebrand's disease (VWD) and platelet dysfunction. In women presenting with menorrhagia, the PFA-100 had a sensitivity 80%, specificity 89%, positive predictive value (PPV) 33%, negative predictive value (NPV) 98% and efficiency 88% for VWD. For platelet aggregation defects, the PFA-100 closure time had a sensitivity 23%, specificity 92%, PPV of 75%, NPV of 52% and efficiency 55%. The data suggest that the PFA-100 may be useful in stratifying women with menorrhagia for further von Willebrand testing; however, neither the PFA-100 nor the BT tests are effective for purposes of classifying women for standard platelet aggregometry testing in women presenting with menorrhagia.

Adolescent↗
PubMed2001

The developmental program of the hypothalamus and its disorders.

The hypothalamus integrates physiological processes essential for survival and reproduction. Recent studies have shown that developmental events can affect these processes. Pathways required for the induction of the ventral midline of the hypothalamus or for the differentiation of specific hypothalamic lineages have the potential of causing endocrine and metabolic disorders, including obesity. Also, some genes with paternal monoallelic expression are involved in the development of hypothalamic centers that are critical physiological regulators. Developmental defects affecting the hypothalamus might represent a more frequent cause of clinical disorders than previously suspected.

Animals↗
PubMed1988

Control of feeding and sexual behaviors by neuropeptide Y: physiological implications.

Recent evidence suggests that a variety of hypothalamic neuropeptides may mediate interneuronal communication to coordinate diverse neuroendocrine and behavioral functions. In this work, we describe the effects of neuropeptide Y (NPY) on feeding and sexual behaviors. We observed that central administration of bolus NPY stimulated a robust, dose-related feeding response in satiated male and female rats. Continuous NPY receptor activation also evoked dose-related, intermittent feeding in a manner normally observed during nocturnal feeding. It appears that the paraventricular nucleus in the hypothalamus may be the primary site of NPY action because the anticipated reciprocal changes in NPY concentrations, in response to food deprivation followed by ad libitum food intake, occurred only in this site. Additional findings revealed that NPY-induced feeding may follow either substantial reduction or complete restraint of an inhibitory influence on feeding mediated by alpha 2-adrenoreceptor systems in satiated rats. Further, NPY was found to suppress male and female sexual behaviors. The suppressive effects on sexual behavior were apparent prior to or at the time of the onset of feeding after NPY administration. These observations may provide a neurochemical basis for clinical and animal studies on disorders of feeding associated with diminished reproductive functions.

Animals↗
PubMed1993

The significance of olfaction and social cues in milt availability, sexual hormone status, and spawning behavior of male rainbow trout (Oncorhynchus mykiss).

Male rainbow trout orientate to a "releaser" pheromone emitted by an ovulated female. This chemical signal is not necessary for the completion of spawning behavior: anosmic males spawned as readily as intact males when paired with ovulated females. The amount of "strippable" milt and plasma concentrations of testosterone (T) and 17 alpha,20 beta-dihydroxy-4-pregnen-3-one (17,20 beta-P) were greater in males paired for 3 hr with ovulated females than in isolated males, or males placed with nonvitellogenic adult females or in all male groups. Milt and plasma T, 17,20 beta-P, and 11-ketotestosterone (11-KT) were reduced in anosmic males paired with ovulated females, indicating the existence of a priming pheromone. Milt, T, 11-KT, and 17,20 beta-P increased in intact males within 4 hr after injection of salmon gonadotrophin-releasing hormone analogue, lyophilized salmon pituitary extract, or homogenized fresh rainbow trout pituitary material. The results indicate that the priming pheromone acts through the hypothalamus-pituitary-gonad axis.

Animals↗
PubMed1988

A micro-computer software for the analysis of menstrual diaries: the menstrual diary system.

A microcomputer software was developed to analyse menstrual diaries following the reference period method as described in the article "The analysis of vaginal bleeding patterns induced by fertility regulating methods" published in this journal (Contraception, 34:253-260, 1986). The programme allows the analysis of groups of diaries selected according to subjects' characteristics recorded at commencement of the diary. It also offers flexibility in selecting options of analysis within the reference period method. The output can be presented graphically as Box-whisker plots. A tutorial is included in the package.

Contraception↗
PubMed1979

Prostaglandin biosynthesis inhibitors and endometriosis.

Prostaglandins (PGs) may be involved in the development of the symptoms of endometriosis. Therefore 18 patients with pelvic endometriosis were treated in placebo controlled double-blind trial with different prostaglandin biosynthesis inhibitors. These drugs were: acetylsalicylic acid (0.5 g x 3) exerting a weak PG-synthetase inhibition, indomethacin (25 mg x 3) inhibiting PG-synthetase, and as a representative of fenamates, tolfenamic acid (200 mg x 3), which both inhibits PG-synthetase and antagonizes PGs at the target level. The therapeutic effect was evaluated using a specific endometriosis score separately during menstruation and in premenstrum. Prostaglandin biosynthesis inhibitors did not alleviate premenstrual complaints better than placebo. During menstruation tolfenamic acid relieved endometriotic symptoms more effectively than placebo while indomethacin and acetylsalicylic acid did not differ from placebo. A drug which inhibit both the synthesis and action of PGs can thus be used in the alleviation of secondary dysmenorrhea due to endometriosis.

Aspirin↗
PubMed1986

Carnitine: an overview of its role in preventive medicine.

Carnitine (beta-hydroxy-gamma-N-trimethylaminobutyric acid) is required for transport of long-chain fatty acids into the inner mitochondrial compartment for beta-oxidation. Widely distributed in foods from animal, but not plant, sources, carnitine is also synthesized endogenously from two essential amino acids, lysine and methionine. Human skeletal and cardiac muscles contain relatively high carnitine concentrations which they receive from the plasma, since they are incapable of carnitine biosynthesis themselves. Since the discovery of a primary genetic carnitine deficiency syndrome in 1973, carnitine has become the subject of extensive research. It is now recognized that carnitine deficiency may also occur secondary to genetic disorders of intermediary metabolism as well as to a variety of clinical disorders, including renal disease treated by hemodialysis, the renal Fanconi syndrome, cirrhosis, untreated diabetes mellitus, malnutrition, Reye's syndrome, and certain disorders of the endocrine, neuromuscular, and reproductive systems. Administration of the anticonvulsant valproic acid and total parenteral nutrition may also induce hypocarnitinemia. In many instances, the physiological implications of secondary carnitine deficiency have not been resolved. However, evidence for a specific carnitine requirement for the newborn, especially if preterm, is accumulating. Moreover, carnitine administration may have a favorable effect on some forms of hyperlipoproteinemia. Carnitine, now recognized as a conditionally essential nutrient, is a significant factor in preventive medicine.

Animals↗
PubMed2004

Seizure disorders in pregnancy.

This article discusses seizure disorders in pregnancy. Seizure disorder affects 1.1 million women of reproductive age in the United States. In 1995, the annual cost of treatment of patients who had epilepsy was estimated to be 12.5 billion dollars. Seizures are disorganized firing of neural cells. Epilepsy is the presence of two or more seizures in the absence of an identifiable cause for the seizures (ie, no intracranial or metabolic abnormality). Epilepsy has an impact on many aspects of women's health, particularly with respect to reproduction. The management of women who have epilepsy during pregnancy is the focus of this article.

Anticonvulsants↗
PubMed1996

The maternal and neonatal outcome of triplet gestations.

OBJECTIVE: Our purpose was to determine the contemporary maternal and neonatal outcome of triplet gestations. STUDY DESIGN: A retrospective review of 57 triplet deliveries between April 1, 1989, and July 31, 1994, was performed. RESULTS: The mean gestational age at delivery was 33.0 +/- 2.7 weeks, and the mean birth weight was 1820 +/- 513 gm. The most common maternal complications were preterm labor (86.0%), anemia (58.1%), preeclampsia (33.3%), preterm premature rupture of the membranes (17.5%), postpartum hemorrhage (12.3%), and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (10.5%). Neonatal complications included hyaline membrane disease (29.6%), transient tachypnea of the newborn (20.1%), intraventricular hemorrhage (7.7%), and major congenital anomalies (7.1%). The perinatal mortality was 41 per 1000. Birth order had no significant effect on the incidence of neonatal complications. CONCLUSION: Perinatal mortality rates have improved in recent years but remain higher than for singleton gestations. Despite increasing experience with triplets, the rate of maternal complications is high.

Female↗
PubMed1984

Poor reproductive outcome in insulin-dependent diabetic women associated with later development of other endocrine disorders in the mothers.

In a prospective study of insulin-dependent diabetic women who in the 1950s were involved in a drug trial, 13 (14%) of those who were still alive 27 years later were reported to have acquired thyroid disease or pernicious anaemia during the follow-up period. This suggests that their diabetes mellitus was a manifestation of a more generalised polyendocrine disorder. The pregnancy history of these 13 women differed strikingly from that of the other 82 insulin-dependent diabetic women: in the diabetic women who subsequently acquired other endocrine disease 69% of pregnancies resulted in a fetal or infant death, compared with 44% in other insulin-dependent diabetic women (p less than 0.01). This risk increased with pregnancy order, the odds ratio of an unfavourable outcome in women who later acquired thyroid disease or pernicious anaemia, compared with the other diabetic women, being 1.2 for the first pregnancy, 3.1 for the second pregnancy, 7.3 for the third pregnancy, and 14.0 for the fourth pregnancy. The mean birthweight of offspring of the women with other endocrine disease was substantially lower than the mean birthweight of offspring of other diabetic mothers (2977 g and 3430 g, respectively). These differences in birthweight and mortality could not be explained by the severity of the mothers' diabetes at the time of their pregnancies, and were evident even before the diabetes was diagnosed.

Abortion, Spontaneous↗
PubMed1993

Biology and medicine of turtles and tortoises.

Turtles and tortoises are unique reptiles that are gaining popularity as pets. Their anatomy and defense posture hinder, but do not preclude, clinical assessment and performance of routine diagnostic and therapeutic procedures by the clinician. A basic working knowledge of chelonian taxonomy, anatomy, physiology, husbandry, common diseases, and therapeutics will enable the veterinarian to provide health care to this order of reptiles.

Anesthesia↗
PubMed2006

Oocyte and embryo donation 2006: reviewing two decades of innovation and controversy.

For over 21 years, oocyte and embryo donation have been used to treat infertility caused by a variety of conditions affecting the ovary. Many disorders, including premature ovarian failure, advanced reproductive age, unexplained recurrent implantation failure and inherited conditions, are amenable to gamete donation, with high pregnancy rates and good obstetrical outcomes observed in recipients. Protocols for the medical screening of recipients and donors, as well as infectious disease and genetic testing, have become relatively uniform and well accepted. Established guidelines allow synchronization of the menstrual cycles of both women to ensure that embryos are transferred to a receptive endometrium. The high demand for donor services has led to escalating costs and long waiting lists. American programmes bid against each other to secure the participation of young women often motivated as much by financial reward as altruism. In the United States, where the majority of oocyte donation is practised, more than 100,000 treatment cycles have occurred. However, to date no meaningful longitudinal studies detailing the long term effects of treatment on donors, recipients, children born, or families created have been published. Throughout its history, oocyte and embryo donation has proven to be both efficacious and clinically innovative, yet remains highly controversial.

Embryo Transfer↗