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PubMed1995

Reproductive health and polycystic ovary syndrome.

Women with hyperandrogenic disorders represent a unique group among those with infertility due to anovulation. Although antiestrogens are effective in restoring ovulation in most women, it remains unclear whether these treatments restore fecundability per ovulatory cycle and the ability to maintain pregnancy in these individuals. Moreover, antiestrogens are ineffective in restoring ovulation in some hyperandrogenic anovulatory women, whose condition poses unique and vexing challenges for the infertility therapist. Gonadotropin treatment in antiestrogen-resistant women often leads to ovarian hyperstimulation syndrome, which has been addressed by modification of dosing schedules (e.g., low-dose administration), pretreatment with gonadotropin-releasing hormone (GnRH) analogs, and elimination of luteinizing hormone from the administered gonadotropins. Surgical reduction in ovarian volume has met with some success, although there may be a risk of inducing surgical adhesions of the adnexa. The second major reproductive adversity facing these patients is their elevated risk of endometrial cancer. Unopposed estrogen exposure probably contributes to this risk, but hyperandrogenicity and hyperinsulinism may act independently or in concert with estrogen to amplify the risk in these women. While the risks and strategies for preventive care in these women need to be better defined, reproductive health specialists are urged to continue using presently accepted measures, including education, to maintain these women's reproductive health.

Endometrial Neoplasms↗
PubMed2000

Genetically determined male infertility and assisted reproduction techniques.

This is a review of the common chromosome and genetic disorders associated with male infertility that need to be considered by the clinician and the couple in the context of treatment. Until recently the most relevant disorders have been those inherited from parents, however, with the advent of technologies enabling recovery of sperm from the testicle in men with severely damaged spermatogenesis there is increased interest in those genetic abnormalities that may occur in mitosis and meioses. It is likely that over the next ten years there will be increasing focus on this aspect of male fertility genetic disorders. This article needs to be read in conjunction with the specific in depth reviews in this journal edition.

Aging↗
PubMed2003

Carrier testing for autosomal-recessive disorders.

The aim of carrier testing is to identify carrier couples at risk of having offspring with a serious genetic (autosomal recessive) disorder. Carrier couples are offered genetic consultation where their reproductive options, including prenatal diagnosis, are explained. The Ashkenazi Jewish population is at increased risk for several recessively inherited disorders (Tay-Sachs disease, Cystic fibrosis, Canavan disease, Gaucher disease, Familial Dysautonomia, Niemann-Pick disease, Fanconi anemia, and Bloom syndrome). Unlike Tay-Sachs disease, there is no simple biochemical or enzymatic test to detect carriers for these other disorders. However, with the rapid identification of disease-causing genes in recent years, DNA-based assays are increasingly available for carrier detection. Approximately 5% of the world's population carries a mutation affecting the globin chains of the hemoglobin molecule. Among the most common of these disorders are the thalassemias. The global birth rate of affected infants is at least 2 per 1000 (in unscreened populations), with the greatest incidence in Southeast Asian, Indian, Mediterranean, and Middle Eastern ethnic groups. Carriers are detected by evaluation of red cell indices and morphology, followed by more sophisticated hematological testing and molecular analyses. The following issues need to be considered in the development of a carrier screening program: (1) test selection based on disease severity and test accuracy; (2) funding for testing and genetic counselling; (3) definition of the target population to be screened; (4) development of a public and professional education program; (5) informed consent for screening; and (6) awareness of community needs.

Bloom Syndrome↗
PubMed2005

[Consequences on women's fecundity and on assisted reproductive technology].

Knowledge of the detrimental role of cigarette smoking on human reproduction is constantly improving. In natural fertility, time to pregnancy is longer, frequency of infertility is increased and fertility rate declines 10% to 20% with a dose-effect relationship. Moreover, women exposed in utero also have lower fertility. Cigarette smoking is also a risk factor for menstrual disorders and for early menopause. In assisted reproductive technology, where many parameters are controlled, the deleterious effects of smoking on fertility have been clearly demonstrated: lower estradiol levels, decreased pregnancy and implantation rates, and poorer oocyte morphology. The two published meta-analyses have concluded that the effects are the same in natural and assisted reproduction. These results are in accordance with biological hypotheses on the local and general effect of tobacco and other cigarettes components. In conclusion, women should be informed about the effect of cigarette smoking on their fertility. Education is very important since in many countries, like France, the percentage of smokers is increasing among women, especially among young women.

Adult↗
PubMedDate not supplied

Pregnancy issues in inherited metabolic disorders.

Increasing numbers of individuals with inherited metabolic disorders are surviving into adulthood and considering their reproductive options. This paper discusses a practical approach to supporting such individuals, focusing on issues concerning fertility, the impact of pregnancy on metabolism and the metabolic disorder itself on the pregnancy, as well as highlighting the need to pay special attention during the postpartum period. Apart from pregnancies in women with phenylketonuria, there is a dearth of data in this area and a great need for collection of information within registries to aid our understanding of potential problems and counselling of women and their partners.

Female↗
PubMed1992

Male infertility: the impact of assisted reproductive technologies.

Spermatozoal abnormalities are present in up to 40% of infertile couples. Multiple etiologies may be responsible for these disorders, including pretesticular, testicular, and ductal causes. An adequate andrologic consultation, including history, physical examination, and repeated semen analysis, should be performed routinely in these cases. Evaluation of the basic sperm parameters, including sperm concentration, motion parameters (as evaluated by computer-assisted semen analysis), and sperm morphology (as judged by strict criteria), constitute the first obligatory step for a critical evaluation of male factor patients. Patients in whom fertilization disorders are suspected should be evaluated through bioassays of sperm-oocyte interaction, including the heterologous sperm penetration assay and hemizona assay, a bioassay of sperm-zona binding capacity highly predictive of in vitro fertilization outcome. Male disorders can be subjected to specific therapies (surgical or medical), or to empiric therapeutic modalities. Assisted reproductive technologies have enhanced our understanding of the physiopathology of spermatozoal disorders and also have ostensibly improved pregnancy rates in male factor patients.

Female↗
PubMed2002

Late health effects of childhood nasopharyngeal radium irradiation: nonmelanoma skin cancers, benign tumors, and hormonal disorders.

Nasopharyngeal radium irradiation (NRI) was widely used from 1940 through 1970 to treat otitis serosa in children and barotrauma in airmen and submariners. We assessed whether NRI-exposed individuals were at higher risk for benign tumors, nonmelanoma skin cancer, thyroid disorders, and conditions related to regulatory control of anterior pituitary hormones, such as growth and reproductive characteristics. We conducted a retrospective cohort study in 3,440 NRI-exposed and 3,088 nonexposed subjects, who as children were treated at nine ear, nose and throat clinics in The Netherlands between 1945 and 1981. Based on information from original medical records, we traced vital status through follow-up at municipal population registries. Disease status (including medical confirmation) and indicators of pituitary gland radiation damage were assessed from a self-administered questionnaire in 1997. The average radiation doses were 11, 7, and 1.5 cGy for pituitary, parotid, and thyroid gland, respectively, and 3.2 cGy for the facial skin. Among exposed subjects, 23 benign head and neck tumors were observed, compared with 21 among nonexposed subjects. Elevated risk of basal cell carcinoma of the head and neck area was observed in exposed subjects (odds ratio = 2.6; 95% confidence interval: 1.0-6.7). Exposed and nonexposed groups did not differ substantially with regard to thyroid disorders, height, and reproductive characteristics, although exposed males more frequently reported a history of fertility problems compared with nonexposed males (odds ratio = 1.4; 95% confidence interval: 1.0-2.1). We found no evidence of highly elevated risk of benign head and neck tumors, nonmelanoma skin cancer, thyroid disorders, or indicators of pituitary radiation damage after childhood NRI in The Netherlands.

Adolescent↗
PubMed2006

Metabolic and hormonal control of the desire for food and sex: implications for obesity and eating disorders.

During evolution, the ability to overeat and store the extra energy as glycogen and lipids in specialized tissues must have conferred a reproductive advantage by releasing animals from the need to eat constantly, enabling them to engage in behaviors that improved reproductive success. Mechanisms that inhibited ingestive behavior might have been most adaptive when they caused individuals to stop foraging, hoarding and eating in order to find and court potential mates. Conversely, the ability to abstain from reproductive activities to engage in foraging and eating was probably critical for individual survival during severe energetic challenges because reproductive processes are energetically costly and can be delayed until the energetic conditions improve. The mechanisms that control ingestive behavior most likely evolved under conditions in which both food and mates were available, and thus, our understanding might be limited by our narrow focus on food intake in animals isolated from potential mates, and reproductive behaviors in the absence of food. Our understanding of obesity and eating disorders will be enriched by the study of the choice between ingestive and reproductive behaviors and by a renewed attention to "reproductive" hormones such as gonadal steroids and hypothalamic releasing hormones. Furthermore, leptin and reproductive hormones have both organizational and activational effects on the energy balancing system including those mechanisms that control appetite, body fat content and body fat distribution. Understanding these organizational and activational effects on body fat distribution might lead to a better understanding of sex differences in the propensity to develop obesity, type II diabetes and eating disorders.

Animals↗
PubMed2000

Surgery of the avian reproductive and gastrointestinal systems.

Surgery of the female reproductive system is the most commonly indicated intra-abdominal surgery of avian patients. Surgery of the male reproductive system and avian gastrointestinal tract are less commonly indicated but are occasionally necessary. Indications for surgery of the female reproductive tract include egg-laying-related disorders, dystocia, egg binding, damage or trauma to the oviduct, oviductal torsion and volvulus, abnormal egg production, biopsy or culture of the oviduct, internal laying, egg related coelomitis, oviductal impaction, oviductal or ovarian neoplasia, ovarian cysts, or as a sterilization procedure to stop egg laying. Indications for surgery of the male reproductive tract include castration (most often as a treatment of behavioral problems) and treatment of testicular neoplasia. Indications for gastrointestinal tract surgery include repair of traumatic injury, foreign-body retrieval, obstructive disease, as a treatment for neoplasia, and as a diagnostic tool to retrieve tissue for biopsy. Avian reproductive anatomy and physiology are reviewed. Presurgical and postsurgical patient care ensures successful recovery. Lateral, horizontal, and midline approaches may be preferred based on indication or concurrent disease. Approaches are described in detail. Indications and descriptions of surgery conclude this article.

Animals↗
PubMed2005

[Antidepressants and pregnancy].

Depressive disorders in women are not uncommon during the reproductive period. Identifying women at risk for the development of depression, early detection of depressive symptoms and an adequate treatment are important issues in preventing severe chronic depressive disorders. Do psychotherapeutic interventions not show any sufficient benefits, the use of antidepressants is indicated. In the meantime sufficient data are available concerning the use of anti-depressants during pregnancy to exclude any serious damage to the fetus or newborn. As a basic principle, a monotherapy should be favoured and the drug applicated in the lowest efficient dose. Due to the SSRI's side effect profile the choice of the antidepressant should be done in favour of serotonin reuptake inhibitors rather than tri- and tetracyclic antidepressants. For both substance groups there is no hint for any teratogenic potential. Benzodiazepine should be prescribed with caution. Negative long term effects to the newborn cannot be excluded. Based on few available data, indeed, there exists no reservation against the use of St. John's wort during pregnancy and breastfeeding. A profound ultrasound screening of the organs should be performed in case of lithium exposition, whereas newer studies showed no increase in risk for Ebstein anomaly. A multidisciplinary approach, including psychiatry, obstetrics and neonatology should be always aimed at in case of depressive disorders during pregnancy.

Antidepressive Agents↗
PubMed1999

Chemical communication and mate attraction in echinostomes.

Mate attraction is widespread among animals and appears to facilitate mating and to prevent hybridisation between closely related species. In this study we investigated mate preference between two geographical isolates of Echinostoma caproni (Trematoda, Platyhelminth) and another species of the genus Echinostoma E. sp. Because previous experiments showed a partial reproductive isolation between echinostome isolates, we examined the possibility that such isolation resulted from differential mate attraction. We compared intra-isolate, inter-isolate and interspecific pairings using two in vitro experimental designs. In the first experiment we compared mate attraction of two individuals belonging to or not belonging to the same isolate, while in the second experiment we examined mate choice when individuals were in the presence of individuals from both the same isolate and from a different isolate or a different species. Distances between worms were measured over a period of 90 min. Results from both experiments suggested that mate attraction was similar for intra-isolate, inter-isolate or interspecific combinations. This lack of mate preference in vitro would therefore support an alternative hypothesis of a reproductive isolation through sperm selection.

Animals↗
PubMed2005

[Trauma & the reproductive lifecycle in women].

Women are at significantly higher risk for developing post-traumatic stress disorder (PTSD) than men, resulting in increased psychosocial burden and healthcare related costs. Recent research has shown complex interactions between the impact of traumatic experiences, and the reproductive lifecycle in women. For example, women suffering from premenstrual dysphoric disorder (PMDD) who also report a history of sexual or physical abuse are more likely to present with different neuroendocrine reactivity to stressors, when compared to premenstrual dysphoric disorder subjects without prior history of trauma or abuse or non-premenstrual dysphoric disorder subjects. In addition, women with a history of abuse or trauma may experience re-emergence of symptoms during pregnancy. Lastly, females who experience miscarriage may present with even higher prevalence rates of post-traumatic stress disorder symptoms. In this manuscript we examine the existing data on gender differences in post-traumatic stress disorder, with particular focus on psychological and physiological factors that might be relevant to the development of symptoms after exposure to traumatic events associated with the reproductive life cycle. Current options available for the treatment of such symptoms, including group and counselling therapies and debriefing are critically reviewed.

Abortion, Spontaneous↗