Treatments For Fertility

Pregnancy Miracle by Lisa Olson

The author of the Pregnancy Miracle book Lisa Olson, has spent an inordinate amount of time involved in Chinese medicine research and is a successful health consultant, alternative health and nutrition specialist, as well as former infertility sufferer herself. This is the exact 5-step process Lisa used to get pregnant twice at age 43 and 45 after battling infertility for more than a decade and being told by her doctors she would never have kids of her own. Best of all, the step-by-step, done-for-you system inside Lisa Olson's Pregnancy Miracle guide works without harmful infertility medication, magical creams, IUI or IVF procedures, crazy diets, herbal remedies, or weird vitamin/mineral therapy. Read more...

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Infertility secondary to cancer and cytotoxic treatments

Childhood cancer is rare - the risk for an individual child developing cancer in the United Kingdom before the age of 15 years is 1 in 500. Seventy-three per cent of patients are still alive five years after diagnosis (Toms 2004). Both radiotherapy and chemotherapy may directly damage the ovary or testis, while tumours and radiation to the brain may affect the hypothalamo-pituitary axis (see above). The extent of resulting infertility is unclear as

Icsi And Male Fertility

Each technological conception of semen enables new strategies to further measure, define, control, and use sperm. Similar to the evolution of systems that define and classify normal sperm, semen manipulations have proliferated from the low-tech donor insemination, intracervi-cal, or intrauterine, to the high-tech intracytoplasmic sperm injection, where a single sperm cell is injected into an oocyte, commonly called an egg. These innovations related to human sperm are not isolated events but, rather, part of sweeping technical advances into human reproduction, with profound implications for men and masculinity. Available since 1992, one of the most recent innovative procedures is intracytoplasmic sperm injection (ICSI).27 This procedure is performed by a physician for selecting a sperm cell from the testes or epi-didymides for direct injection into the egg. Now subfertile men (defined as those men who produce some sperm with the correct morphology and may eventually achieve pregnancy...

Integrins And Infertility

Infertility affects approximately 2 to 4 million couples annually and, despite a widening in the number of infertility diagnosis, many of the molecular defects associated with female infertility are still not understood. Recurrent spontaneous abortion and failure of implantation due to defects in uterine receptivity may contribute to 20 of these cases.43 One of the methods used earlier to monitor the defects in implantation is based on dating of the endometrial biopsy. The classic work of Noyes et al.45 on endometrial morphology that has served clinicians so well for 50 years is losing its power in the evaluation of human endometrium in normal and abnormal circumstances, due to conflicting views on the timing and interpretation of endometrial biopsies.46 Recent studies indicated that lack or delayed expression of a4p1 and avp3 integrins on endometrial cells of infertile women may provide a new diagnostic modality for the evaluation of endometrial defects.20 These integrins appear to...

Learning about infertility

That almost all parents (90 ) find it difficult to cope with their daughter's infertility (Slijper etal. 1998). Published family stories and anecdotes show that parents are devastated by the information that normal ovaries are not present and that their daughter is unlikely to have her own child (Karamesinis 2003 Turner Syndrome Support Society, UK 2002). At the age of puberty or when HRT is introduced, the doctor explains or re-explains to the girl that the ovaries will be unable to produce egg follicles, and that having babies 'in the usual way' is not possible. At the same time the doctor offers the girl and her parents encouraging information about alternative routes to forming a family, for example through in vitro fertilization (IVF) using egg donation or through adoption. One of my medical colleagues emphasizes to her adolescent patients the similarities they have with other young women - namely the ability to carry a pregnancy, give birth and breast feed. She may talk over the...

The Risk of Miscarriage

Studies indicate a 32 percent risk of miscarriage in women with antithyroid antibodies, or subclinical Hashimoto's disease or Graves' disease, compared to a 16 percent risk in women without them. The risk of miscarriage also rises because of age. In the general population of healthy pregnant women under thirty-five, one in six pregnancies ends in miscarriage with risk at its highest point during the first trimester. Given these statistics, it's important to be alert to signs of miscarriage.

Symptoms of Miscarriage

Heavy bleeding and cramping anywhere between the end of the second month to the end of the third month are classic signs that you're in the process of miscarrying. The bleeding can be heavy enough to saturate several pads within an hour or may be manageable and more like a heavy period. Cramps without bleeding are also a danger sign that you're miscarrying. You may also experience unbearable cramping that renders you incapacitated. Sometimes, you can pass clots, which are dark red clumps, or you may even pass gray or pink tissue. A miscarriage can also be occurring if you have persistent, light bleeding and milder cramping at this stage.

Experiencing infertility

There are few studies in the extensive professional literature on TS that ask women with TS about their thoughts on the infertility, or their experiences of adoption or IVF. Sylven etal. (1993) found in semi-structured interviews with 22 women that half (11) said infertility was the most difficult part of having TS. In their study of 63 women, Wide Boman etal. (2000) reported that out of 55 (87 ) who remembered their reaction to the diagnosis ofTS, 49 (78 ) reported negative consequences of having TS, with infertility as one of the consequences most often mentioned. Tang (1989), in a study of 86 Chinese women, found that for 51 per cent (44) the stigma of infertility appeared a cultural barrier to marriage or relationships. Kagan-Kreiger (1999), in her qualitative study of eight women with TS aged 23-44 years, found that most of them needed to rethink or revisit their feelings about their infertility, sometimes with the help of therapy, in order to ameliorate its impact on their...

The impact of infertility

So what can social work interventions and research tell us about the impact of infertility The following section examines data collected and analysed from my clinical social work practice and research to begin to explore the place of fertility and its impact on teens and young women with TS. In the discussion and conversations about themselves, infertility was rarely brought up verbally, but some girls expressed it visually. The following illustrated designs and accompanying descriptive words are from the second group programme. Infertility an unspoken presence In the creative floor design 'About me' two out of six girls referred to their fertility status. In session one Katherine (13) carefully selected scarves and objects to make her design. Then, in response to my questions, she verbally described her work referring in the main to her infertility and its impact. In the first group programme a young married woman of 21 with TS came and spoke to the participants about her own...

Why is Family Planning Important

In the United States, only half of pregnancies are planned at the time of conception. For some of these unplanned pregnancies, the women would prefer to get pregnant later for others, the women desired no more children. About one half of unplanned pregnancies end in an induced abortion. Among active duty enlisted female Sailors who became pregnant in 2003, approximately 55 of pregnancies were unplanned. About half of these women were not using any form of birth control. Unplanned pregnancies are also associated with more problems for the mother and infant than planned pregnancies. Women with unplanned pregnancies cannot take advantage of preconception care, a special healthcare visit that helps the women achieve the healthiest possible pregnancy outcome. Planning to become pregnant at a time when a woman is healthy and ready to become a parent can maximize the health and opportunities for women, children and families and reduce the likelihood of abortions.

What family planning services are available through the Navy

BUMED Instruction 6300.9 directs Naval medical facilities, including facilities on board naval vessels, to provide (or authorizes them to provide referral to) family planning services. Also, MANMED Article 15-76 provides annual health maintenance examination requirements for all active duty women which includes family planning, contraceptive counseling, and STD prevention counseling. Counseling should include information on availability and effectiveness of birth control methods (including emergency contraception).

Future developments in fertility preservation in males

Although the cryopreservation of ejaculated (or surgically recovered) mature spermatozoa remains the mainstay of fertility preservation in males, there are a number of areas of current research which, if successful, could revolutionize fertility preservation. The prospects for spermatogenesis in vitro have recently been reviewed by Parks etal. (2003) who outline the technical complexity of cell culture systems that would be required to maintain the development of spermatozoa in vitro. Although some progress in animal models has been made (in as much as presumptive spermatids i.e. early sperm cells expressing appropriate genetic markers have been identified and have been injected into eggs to produce viable embryos), it is far from the stage of being clinically useful for human applications. However, an area with perhaps more technical promise is in the development of techniques to transplant pieces of testicular material (termed explants) into 'host' animals that then act to support...

Infertility

Too much thyroid hormone can interfere with a woman's ovulation cycle resulting in temporary infertility. Once thyroid hormone levels are restored to normal, in the absence of other barriers (such as endometriosis or blocked ovarian tubes), fertility is restored. Thyrotoxicosis in early pregnancy can lead to miscarriage repeated miscarriage is often considered a form of infertility. If this is a problem for you, it's important to insist that your TSH levels are checked to rule out an underlying thyroid problem. For more information about thyroid disorders and pregnancy, see Chapter 13.

Male infertility

As a result of this transport defect, men with CF were previously unable to have children. Recent developments in reproductive technology now enable infertile men with CF to achieve biological paternity through aspiration of sperm from the epididymis (microsurgical epididymal sperm aspiration or MESA) or from the testis itself (testicular sperm aspiration or TESA) in association with intracytoplasmic sperm injection (ICSI) (see Chapter 6). The use ofthese techniques in couples where the male has CF has resulted in pregnancy rates of 30-35 per cent per cycle, with 62.5 per cent of couples achieving pregnancy following the treatment programme (McCallum etal. 2000 Rosenlund et al. 1997). These are expensive technologies that are only available in specialized assisted reproduction centres (and at variable expense to the affected couple). In a recent survey of males with CF in Australia, nearly 20 per cent of adult men had children (Sawyer etal. 2005). Six had fathered children using...

Female Fertility

The ovum remains viable and capable of being fertilized after it is expelled from the ovary probably no longer than 24 hours.There-fore, sperm must be available soon after ovulation if fertilization is to take place. A few sperm can remain fertile in the female reproductive tract for up to 5 days. Therefore, for fertilization to take place, intercourse must occur sometime between 4 and 5 days before ovulation up to a few hours after ovulation. Thus, the period of female fertility during each month is short, about 4 to 5 days. Abnormal Conditions That Cause Female Sterility. About 5 to 10 per cent of women are infertile. Occasionally, no abnormality can be discovered in the female genital organs, in which case it must be assumed that the infertility is due to either abnormal physiological function of the genital system or abnormal genetic development of the ova themselves. Another common cause of female infertility is salp-ingitis, that is,...

The structure of the book

While there is an increasing literature that acknowledges sexuality in adults with physical impairments or health conditions, there is a marked lack of writing about childhood or adolescent sexuality and fertility issues. Contrast this to the burgeoning industry that surrounds teenage sexual health but which uses a narrow definition of sexual risk-taking and limited underpinning understanding of teenage sexuality and results in a concentration on pregnancy avoidance and reduction in sexually transmitted diseases. A glance at this and at school sex education curricula might lead one to conclude that there is no such thing as a teenager facing fertility difficulties Little work has been done to enable us better to comprehend what those in middle childhood and teenage years understand about fertility and aspire to most as they become adults. health is written about and understood. She raises challenging issues regarding the idea of children as sexual beings and how adults' reactions can...

Meaning of parenthood

Undertaken with adults, largely in relation to infertility and new reproductive technologies In one study, Zabin, Astone and Emerson (1993) examined 'wantedness' (attitudes towards having a baby) amongst 313 inner city Black women under 17 years who presented for pregnancy tests at a US clinic. The questionnaire survey found that 8.5 per cent of them wanted to be pregnant. However, since participants already suspected they were pregnant, their attitudes may have been influenced by impending pregnancy test results. In other American studies, Stevens-Simon et al. (1996) found that 17.5 per cent of 200 pregnant 13-18-year-olds had wanted to become pregnant and Forrest and Singh's (1990) study revealed that 20 per cent of the pregnant 15-19-year-olds surveyed had intended to become pregnant. Rodriquez and Gore (1995) surveyed 341 teenage mothers and found that 31 per cent had intentionally become pregnant. A study examining prevention of teenage pregnancy in the US (Stevens-Simon, Beach...

Hypothalamopituitary dysfunction

Secondary hypogonadism results from deficiency of luteinizing hormone (LH) and follicular stimulating hormone (FSH). The primary deficiency arises from the pituitary or hypothalamus. Hypopituitarism may be idio-pathic or secondary to tumours of, or adjacent to, the hypothalamic-pituitary axis. In childhood and adolescence, these include craniopharyngiomas, germ cell tumours and adenomas. Radiotherapy to the central nervous system for the treatment of brain tumours or leukaemia may result in acquired failure of the hypothalamic-pituitary axis with secondary infertility.

Prediction of ovarian damage

Embryos after IVF young ovary can be lost as a consequence of treatments without unduly compromising the future fertility of the individual. In support of this concept, there are numerous reports ofyoung women who suffer a transient loss of reproductive cyclicity following cancer treatment before their hormonal and reproductive cycles are re-established and their natural fertility is restored (Meirow 2000). The ability to assess accurately the ovarian reserve in these individuals, both before and after their cancer treatment, would provide these patients with reassurance that their cancer treatment has not induced a premature menopause.

Protecting the ovaries

Are routinely used in reproductive medicine to reversibly shut down ovarian function and induce a hypogonadotrophic2 state. In the context of shielding the ovary of a young patient, the GnRH analogue would be administered before the start of chemo- or radiotherapy to suppress the release of the follicle stimulating hormone (FSH) and luteinizing hormone (LH) from the brain (Bath etal. 2001). FSH and LH normally drive cell division and promote growth in ovarian follicles. If the cells in the follicle are actively dividing, they are more vulnerable to the cytotoxic damage by chemo- or radiotherapy treatments. Administration of drugs such as GnRH agonists during treatment would therefore be expected to protect the ovaries by inhibiting the later stages of follicle growth. In support of this idea, Ataya etal. (1995) demonstrated in primates that GnRH-agonist co-treatment protected the Rhesus monkey from cyclophosphamide (an alkylating agent) induced ovarian damage. These findings are...

Restoration of fertility

To date, the most viable clinical option for fertility restoration in girls and young women after ovarian tissue cryopreservation is centred around orthotopic or heterotopic autografting of cryopreserved tissue (Figure 5.1). Indeed there have now been a number of reported cases of a transient restoration of follicle growth in young women after ovarian autografting (for example, Oktay and Yih 2002 Oktay etal. 2004 Radford etal. 2001). The most recent reported case resulted in the birth of a healthy baby girl to a 26-year-old Belgium woman who had tissue from one of her ovaries cryopreserved prior to chemotherapy for Hodgkin's lymphoma (Donnez et al. 2004). The successful development of this technology in humans follows the restoration of natural fertility and the birth of live young in a number of species including sheep (Gosden etal. 1994 Salle etal. 2003) and rabbits (Almodin etal. 2004) after autografting of cryopreserved ovarian tissue. In all of the species studied to date,...

Conception following medical treatments

For males who are already producing sperm at the time of diagnosis and treatment (i.e. they have passed through puberty) there is a growing body of evidence to suggest that, for some treatments at least, there can be a good chance of natural fertility returning in the months or years following the cessation of treatment. For example, in an examination of 1115 post-treatment semen analyses in 314 patients who had received gonadotoxic therapy over a 26-year period, Bahadur etal. (2005) found that the type of cancer (or disease) and the initial pre-treatment sperm concentration were the most significant factors governing post-treatment semen quality and the recovery of spermatogenesis. For example, patients with lymphoma and leukaemia had the highest incidence of post-treatment azoospermia and oligozo-ospermia.2 However, while men with testicular cancer had the lowest pre-treatment sperm concentrations, they also had the lowest incidence of azoospermia after treatment. This confirms an...

Methods of assisted conception

Should methods of natural family planning fail then there are currently a number of methods of assisted conception that can be used. These are summarized in Table 6.2 and range from a relatively simple and inexpensive procedure such as intra-uterine insemination (IUI) to more sophisticated procedures such as in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI). The choice of which technique to use (for any couple) is dependent on a range of factors and includes the With regard to the latter point, it is a sad reflection that in circumstances where public money is unavailable to fund treatment and the couple needs to fund their own, then the choice of treatment may be sometimes dictated by the cost rather than its clinical effectiveness. However, little has been published on this topic and so it remains anecdotal as to whether the availability of funding is a major factor in influencing the outcome of fertility treatment in this group of patients. Thawed sperm are...

The complexities of decisionmaking

In addition, there is the potential in fertility preservation services for the blurring of the boundaries between research and treatment. Are young people and parents being asked to opt for an established treatment Are they being invited to participate in a formal research project

Identity diversity and difference young peoples experience of fertility difficulties

Policy and practice, however, still associate 'ethnicity' with the 'other' and, by failing to engage with the relationship between ethnicity, socio-economic status, age and gender, can obscure fundamental similarities as well as differences among populations (see, for example, Chamba et al. 1999 Nazroo 1997 Smaje and Field 1997). We now explore this in greater detail and draw out the specific implications of these debates for making sense of young people's experience of fertility problems. As a start, we need to be aware of how fertility difficulties relate to young people's broader conception of who they are. This requires understanding them as 'young people' rather than 'young people with fertility problems'. Exploring identity is fundamental to this. How can we make sense of identity, which often evokes abstract and esoteric debates, in a way relevant to our discussion In the first instance, when making sense of a young person's fertility problems, we need to conceptualize a young...

Background to the study

Given the lack of existing research and the sensitive nature of the subject, it was agreed that a pilot study should be undertaken initially, funded by the UK National Health Service. As part of that study, 22 interviews were held with a range of professionals from paediatric oncology and reproductive medicine, nursing, reproductive science and social work, primarily from two regional paediatric oncology centres and three assisted conception units that had sperm banks in the North of England. These interviews established the professionals' understanding of the processes in their local fertility preservation service and identified any concerns about its delivery. This, together with findings from the literature, served the purpose oforienting the researchers to local and national services and issues, and identifying areas on which professionals would welcome feedback (a crucial factor in effecting service change) (Crawshaw et al. 2003, 2004).

So what can be learnt from this

In reproductive medicine, information about the immediate and longer-term experience of participating in medical advances often lags behind the technology. This study aimed to begin to address the gap in research knowledge about the experiences of young men under the age of majority and their parents when offered fertility preservation following cancer diagnosis.

What is Turner Syndrome

Those with TS this includes a combination of characteristic physical features and a complete or partial absence of the second sex (X) chromosome in some or all cells (Saenger et al. 2001). Described and named by Henry Turner (1938), nearly all those with the syndrome have short stature and insufficiently or non-functioning ovaries and thus face future infertility.

Involving the social worker

For girls with TS, infertility recedes into the background but even so is still remembered. Natalie, now 18 and looking back, told me Girls diagnosed in their early to mid-teen years, on the other hand, have to take in the doctors' information about growth, puberty development and infertility at the same time. Through the teen group counselling programme, several of the girls were able to tell me more about their reactions to finding out about TS at this time of life. Nola learned about her diagnosis at 15 years and told me that it made her scared. Linette learned at 13 when she came to hospital for another investigation she said it made her feel so mixed up she did not know how to feel. Geraldine learned at 14 years she said she was shocked but relieved when the doctor explained it all. Marie knew at 11 and was also relieved to find out why she was short, but said it really annoyed her. Yet they often find it hard to expand further on how they feel. They sometimes find it easier to...

Who says what when and to whom

The above discussion has focused on aspects of fertility and reproductive health, although as briefly discussed in the introduction, a wide range of sexual health issues are relevant to adolescents with CF. Given the risks of pregnancy, it is especially of concern that sexually active young women with CF are less likely to use contraception than otherwise healthy young women, and have erroneous beliefs about infertility and pregnancy risk (Sawyer, Phelan and Bowes 1995). It is equally of concern that approximately one in three young men with CF report confusing not needing to use In contrast to acquired medical conditions where an 'event' such as the diagnosis of cancer or the commencement of chemotherapy may act as a catalyst for a discussion of reproductive complications such as infertility, CF is a congenital condition that is generally diagnosed in infancy In contrast to infertility as a complication of chemotherapy where actions can sometimes be taken to improve later...

HIVpositive children and the experience of pregnancy

There is research that suggests that those who lack emotional support and stability look to early sex and motherhood to provide closeness (Horwitz et al. 1991 Musick 1993). It has also been suggested that those with limited life options and choices are more likely to become pregnant (Coley and Chase-Lansdale 1998). In one situation there was a teenager who was quite aware that she was gravely ill. She wanted to do everything in a short time frame. For her, getting pregnant was a way of strengthening the connection to her boyfriend. She had a child about a year and a half before she died. The baby was not infected. In another situation a young adult, in college and doing well, was someone no one thought would get pregnant but did. She saw herself as 'sick' and not like everyone else. For her, the idea of having a baby who was not sick made her feel more normal and less at the mercy of HIV

Selfconcept body image sexual identity

When they said I couldn't get pregnant I was very upset. I felt guilty, like it was something I wouldn't be able to do and everybody else could do it. All these teenagers were having children and not wanting them, and I wouldn't even have a choice. I wasn't exactly the cautious teenager. I just didn't think I could have children. We didn't use a lot of protection, because I thought I couldn't. You just think that every woman should be able to have kids and that's the one thing you were made to do, is to have children. And when you're told that you may not, you don't even have the option of doing that, it's taken away from you, then you feel horrible, because you definitely want one when they say you can't have one. I thought I was just weird. I remember praying when I was 19 and saying, 'God, why can't I just be like all the other girls Why can't I just have kids Why can't I have that option, why can't you give me that option ' And no sooner did I say that, I had my son. I got...

My path to parenthood

As adolescent and young adult cancer survivors age and mature, they appear to lack critical information necessary to make informed choices about family planning including regarding their cancer and its treatment types and dosages of treatment in some cases, even the type of cancer they had and knowledge about potential long-term physical effects (Kadan-Lottick etal. 2002). Given that there is a general lack of knowledge about the anatomy and physiology of reproduction among adolescents in general and that this lack of knowledge is often accompanied by heightened curiosity about sexuality and experimentation with intimacy and sex (Heiney 1989), adolescent and young adult cancer survivors must cope with the impact of diagnosis and treatment as it may affect their sexual identity and sexual behaviour in ways unique and specific to cancer survivors (Zebrack et al. 2004). Seven years after my own treatment I was finally ready to make a 'withdrawal' from the sperm bank. Only then did I...

Years old a week before starting chemotherapy

Despite widespread acceptance of the sadness caused by infertility, research shows that communication in this area is neglected. A study by Schover etal. in 1999 showed that 57 per cent of young survivors receiving cancer treatment cannot recall ever discussing the possibility of infertility with their specialists even though half of the original study sample viewed themselves as having impaired fertility (Schover etal. 1999). Only 26 per cent of childless male survivors banked sperm before treatment, a low figure given that the technique of in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) is now a well-established successful technique (Schover 1999). Many difficulties exist surrounding discussion of potential infertility at the time of initial diagnosis and treatment. A young patient must assimilate many painful truths. The oncologist must breach sensitive topics the loss of being able to have children, the need to explain masturbation to provide sperm samples...

Years old a month before getting engaged

For those who discover that they have impaired fertility, a variety of assisted reproduction options exist, such as sperm banking and IVF-ICSI. Other techniques such as ovarian cryopreservation are in their experimental infancy. Options such as donor insemination, egg donation, surrogacy and adoption may be available to infertile couples. We do not yet know the emotional hurdles these procedures may present for the cancer survivor. Does the need for further medical intervention produce more distress and anxiety for a person who has undergone repeated hospitalizations in the past, or are survivors made more resilient by previous unpleasant treatment Do adoption agencies, donors and surrogates view cancer survivors as potential parents or do they take a negative view of a past history of malignancy We simply do not know, as few survivors have faced such situations. However, with improved survival, the number of young adults seeking answers to these questions will increase. And what of...

Years old ten weeks pregnant

On the other hand, there is little evidence to suggest that survivors worry about more relevant issues such as increased risk of miscarriage, premature birth and having low birthweight babies (Critchley etal. 1992). Evidence shows that all these fears are justified after some chemotherapy regimes and particularly after pelvic irradiation. Again, survivors do not appear to be getting a clear picture and we must ask why. There may be scope for oncologists to liaise with obstetric colleagues in developing education and research initiatives. Informing survivors and professionals from overlapping disciplines could help to raise awareness as well as anticipating and preventing perinatal problems.

Years old ten weeks into my fourth pregnancy

I am ten weeks pregnant and I can't cope with another miscarriage and losing another embryonic life. The first miscarriage wasn't too bad - I lost the baby early on, about six weeks. It would have been difficult to cope with a toddler and a newborn. But it did cross my mind that maybe the chemotherapy might have been responsible. I didn't even go to the doctor at the time - just got on with recovering and forgetting how it felt to flush all those early baby hopes down the toilet. But the second time was horrendous 16 weeks pregnant and I knew my baby. I'd seen her tiny form and felt her move inside me. I loved her and wanted her. I had so many dreams and then one day she was gone, with nothing to hold on to apart from my scan pictures. And I felt so bereft. I could not go through that again. I blame the chemotherapy now. Nobody told me it would do this but it cannot just be down to coincidence. If it hadn't been for those drugs my baby - even my babies - would still be alive. So this...

Years old one year after my second childs birth

I've relapsed - a secondary in my lung. I need major surgery and I am very sick. I might die. Bethany was one year old last month. And now my biggest fear She may not even remember me. Nobody told me this could happen. My cancer was 17 years ago and I thought I was cured. But now it all makes sense and I can see what has happened. The doctor showed me a chest x-ray taken five years ago, when Adam was two years old. There it was - an embryonic secondary, just a tiny grain of salt but I could see it nonetheless. That's when my chest began to get bad -1 just thought it was asthma. Then I had the two miscarriages and afterwards my breathing got so much worse. Then I became pregnant with Bethany and since then it's been one chest infection after another and now I know why. The secondary was there all the time growing alongside my babies, developing into a fully fledged killer and now the enemy has been unleashed and I have to fight it again, not just for me but for my...

Question four what about my children

Survivors worry greatly about their offspring's risk of inheriting cancer. Studies have shown that this is the greatest source of concern amongst survivors (American Society for Reproductive Medicine 1995 Stephen and Chandra 1998). This occurs even in situations where cancer type is not part of an inherited syndrome, despite reassuring evidence to the contrary (Green et al. 2003). At present, no increased risk of cancer in survivors' offspring has been demonstrated and yet amongst cancer survivors, a significantly higher rate of medically induced abortion has been shown to exist, which may reflect the degree of parental anxiety concerning a child developing cancer (Green et al. 2002, 2003). Other attitudinal surveys have shown that 42 per cent of survivors worry that their offspring have a higher risk of contracting cancer (Schover etal. 1999). The research conducted to date does not bear out these fears and, once again, it would seem that many young survivors are misinformed.

Preservation of oocytes

The current options available to preserve the fertility of young patients, irrespective of their diagnoses, are limited. The methods used include assisted reproductive techniques such as in vitro fertilization (IVF), which enable collection and freeze storage of embryos before myeloablative4 cancer treatment (Atkinson et al. 1994). However, assisted reproduction is costly and stressful, carries no guarantee of success, may create 'orphan embryos' if the woman dies and requires that the patient has a male partner. A further disadvantage of assisted conception is that sick patients must undergo an extended protocol of four to nine weeks of ovarian monitoring, down regulation (whereby drugs are used to block the natural mechanism that releases eggs) and drug stimulation to produce sufficient mature oocytes for IVF, embryo production and freezing. Consequently, very few recently diagnosed cancer patients, for example, have sufficient time to go through an IVF cycle before they start their...

Young people citizenship and disadvantage understanding fertility and ethnicity

We start by exploring how received ideas of legitimacy and interpretation inform engagement with minority ethnic people who have fertility problems. 'Institutional racism' has recently become a popular explanation for the inability of services to respond to the needs of an ethnically diverse society. In the UK context this can be attributed directly to the Macpherson Enquiry (1999) into the death of Steven Lawrence.1 Macpherson provided the term with moral authority, which found legal expression with the introduction, in April 2001, of amendments to the 1976 Race Relations Act. These made statutory agencies - including health and social care agencies -responsible for promoting equal opportunities and identifying and tackling institutional racism within their organizations (see Commission for Racial Equality 2003). 2004). A more detailed empirical example, with potential lessons for those developing work around fertility and ethnicity, will illustrate this further and concerns how...

Mllerianuterine anomalies

Uterine anomalies occur in between 3 and 10 per cent of the fertile female population and are often discovered by chance during coincidental investigations for infertility They have usefully been classified by the American Society for Reproductive Medicine into five groups. Women with uterine anomalies are usually asymptomatic, unless there is obstruction to menstrual flow, when cyclical pain may be experienced. While infertility per se is rarely caused by uterine anomalies, they may be associated with endo-metriosis if there is retrograde menstruation secondary to obstruction. Furthermore, recurrent miscarriage may be experienced by some women with uterine malformations.

Sexual health

STIs are on the increase, with many showing steep rises in recent years. Sexual intercourse without using a condom (outside of a life-long faithful partnership) brings the risk of an STI. Some STIs can be extremely serious, with complications leading to chronic disease, infertility and, in some cases, death. The global rise of HIV AIDS is now widely recognized and the number of young people in the UK becoming infected with HIV through sexual intercourse is rising dramatically, amongst girls in particular (PHLS Aids Centre and the Scottish Centre for Infection and Environmental Health 2002). Other infections are, however, less commonly discussed. The prevalence of chlamydia, which can have severe effects on both male and female fertility, is now above one in ten in some parts of the world the highest rates in the UK are amongst 16 to 19-year-old females and 20 to 24-year-old males (Health Protection Agency 2004a). Another very prevalent infection, human papillomavirus (HPV), can result...

The Study

Our study focused on responses from a population of children and young people in mainstream education rather than specifically from those receiving medical treatment for illness, living with a health condition or disability or receiving special education. This sample was chosen in order to provide some benchmark information since discussions about infertility and possible fertility preservation options sometimes have to be entered into at a time of diagnosis that is, before any psychological, physical, emotional and cognitive changes that treatment and its effects may bring about (Eiser 1993). The fieldwork was located in seven schools in the north of England and involved 98 pupils from School Years 6-11 (10-16 years of age). how they think a child or young person being offered fertility preservation might feel

Methodology

The interviewer probed the participants' views on reasons why adults do and do not have children and their knowledge of infertility and fertility preservation. Research interventions are not neutral processes we wanted to ensure that we did not introduce any new knowledge (for example, making a previously unaware child or young person aware of the notion of infertility) and were mindful of the comments from concerned school parent-governors who had given permission for our pilot study For these reasons the interview schedule had a potential pre-determined cut-off point. Those who demonstrated no prior knowledge of infertility finished the interview here and moved on to the vocabulary section (see below). Those who demonstrated a prior knowledge of infertility were presented with two vignettes. The first concerned an infertile couple and participants were asked questions to ascertain their knowledge of treatment and treatment prospects. They were also asked to comment on the possible...

Undescended testis

The undescended testis (cryptorchidism) is associated with infertility as well as tumours and torsion (abnormal twisting of the testis). Cryptorchidism is bilateral in 30 per cent of cases and infertility occurs in these individuals. Interestingly, where there is a contralateral testis (the descended testis), this may have impaired spermatogenesis, suggesting that some people with maldescended testes have a congenital defect of the germ cell population (Giwercman et al. 1989). Cryptorchidism is found in 0.7 per cent of males after one year of age. The incidence increases with prematurity and is found in 100 per cent of 28-week gestation neonates. After the first year of life, spontaneous descent does not occur. To minimize the risk of malignancy, torsion and infertility, treatment before two years of age is indicated.

Background

There are a number of incidences where young patients may wish to protect and or preserve their future fertility. Fertility preservation may, for example, be advocated in girls and adolescents undergoing surgical interventions where the ovaries must be removed as a consequence of abdominal trauma. For adolescents and young women who have a familial history of premature ovarian failure, it may be foolhardy to delay child-bearing (Conway 2001 Davis etal. 2000). These patients may elect to preserve their oocytes or ovarian tissue to prolong their reproductive lifespan. Girls with Turner Syndrome have a very high risk of premature menopause or, in the most severe cases, they may be permanently sterile. The former group of individuals may elect to cryopreserve their ovarian tissue during their pre-pubertal or early teenage years before their ovarian reserve is completely lost and menopause ensues (Hreinsson etal. 2002 Saenger etal. 2001). The overwhelming application of fertility...

Future prospects

Loss of ovarian function and reduction of fertile potential in young patients can be combated by the development of strategies to quantify the risk of ovarian damage, to protect the gonads from the destructive effects of medical treatments and, in extreme cases, to cryopreserve fertility. Advances in fertility preservation methods for young patients will inevitably be dependent on the development of an improved understanding of the effects on the ovary of contemporary treatments, as exposure to cytotoxic agents is frequently unavoidable prior to a window of safety being available for oocyte and ovarian tissue harvesting. Furthermore, the development of a safe clinical strategy to preserve the fertility of all young patients, irrespective of diagnosis, has to be based around high-quality basic research into the biology and technology of oocyte and ovarian tissue cryopreservation and its safe and efficient use to restore fertility. Future research topics are therefore likely to include...

Concluding remarks

Fertility preservation in males has a long history and sperm banks were in existence well before the development ofthe sophisticated assisted conception technologies (e.g. IVF and ICSI) that are now used to provide the opportunity for men rendered infertile through medical treatments to father their own genetic child. However, it should be recognized that the process of sperm banking is much more than just the provision of infertility treatment to males who have stored sperm prior to medical treatments. It involves an ongoing interaction with the patient in the years post-banking to review his fertility after treatment has ceased and provide practical and ongoing advice about contraception, family planning, access to counselling and assisted conception treatments, if that is required. Sadly, this is sometimes forgotten by staff in many IVF units who provide sperm banking services alongside their repertoire of infertility treatments yet provide little by the way of a focused service...

Legal framework

When the Act was passed, some fertility preservation services were already storing the mature gametes of some patients, including minors, about to enter treatments that might render them infertile (the Act only covers mature gametes regulation of storage of immature gametes is covered below). However, numbers were low and the Act did not make any special provision for the younger age group. People facing potentially sterilizing treatments are treated in UK law in the same way as others using fertility preservation services - including couples storing their embryos for future treatment and gamete donors. They are required to have the medical, scientific, legal and psycho-social implications of their decision explained to them, to be offered counselling and to have sufficient time to consider their decision prior to signing an HFEA consent form (HFEA 2003 Part 6). However, there are two notable differences for this group. First, their gametes can be stored up to them reaching age 55...

Riskbenefit analysis

The prize that beckons at the end of the trail that starts with diagnosis is not hard to describe. The medical treatment programme on which the young person is due to embark may ensure their survival at the cost of several significant side-effects. One price that the individual may have to pay is that their reproductive capacity may be permanently impaired. Cryopreservation offers the promise of being able to bank tissue or gametes pre-operatively so that the individual's reproductive capability can be safeguarded. Infertility does not threaten the survival of the individual in the way that, for example, treatment-related cardiac complications might. Infertility does not immediately impair the person's social or intellectual functioning in the manner that damage to the central nervous system might. But infertility can have great personal psychological significance (Dunkel-Schetter and Lobel 1991). Not everyone will want to become a parent but most would like that role tobe one of the...

The family context

As well as bearing in mind widely shared cultural assumptions, it is important also to respect the central way in which different cultural beliefs will influence a family's choices about the prospect of cryopreservation of sexual material. For example, Jewish rabbinical teaching is very reluctant to allow masturbation to obtain sperm for testing or insemination (Grazi and Wolowelsky 1995). In Hindu society infertility is highly stigmatizing and any clinical interventions to induce conception may be viewed as an intrusion into the intimacies of the marital relationship (Bharadwaj 2003). Moslem law forbids the use of cryopreserved sperm being used to impregnate a wife after her husband's death (Ahmad 2003). More generally we should anticipate that all religious faiths will have something important to say about the origins of life, and so we should expect that there will be an added spiritual component to the way many families and individuals make sense of their predicament. A...

Comment

Infertility is an unspoken shadow that is always present for girls and adolescents with TS from the time of diagnosis at whatever age. The impact of infertility can be masked by the teens' preoccupation with their physical differences from their peers, and also for some by the need to focus on the chronic illness features of their condition. The difficulty for the young person with TS is finding a language to name and express feelings about infertility. By a woman's mid-thirties, when wisdom from life-experience permits more verbal exploration, it may be too late for her to think about assisted reproduction. Even when fertility is possible through reproductive technology, thoughts may still be hard to form. One young mother with TS (28) described her IVF experience as A further dilemma is the need for young women to move on from the helpful and optimistic information, received in the paediatric setting about alternative ways to become a mother, in order to face the pain and...

Female reproduction

In contrast to men with CF, adolescent and adult women have anatomically normal reproductive tracts. While fertility may be reduced due to thickened cervical mucous and the potential anovulatory effects of severe respiratory disease and malnutrition, fertility should be assumed to be normal until proven otherwise (Sawyer 2000). Exact fertility rates are unknown, as many women with CF choose not to become pregnant, citing concerns about the impact of pregnancy, the time and energy required to care for a young child on their health and concern that the child may have CF (Odegaard et al. 2002 Sawyer, Phelan and Bowes 1995). Early reports of fertility rates as little as 20 per cent normal (Kopito, Kosasky and Shwachman 1973) are most unlikely, as recent studies have shown that up to three-quarters of women who tried to become pregnant were successful (Odegaard et al. 2002 Sawyer, Phelan and Bowes 1995). Reports of unplanned pregnancy (Hull and Kass 2000 Kotloff, FitzSimmons and Fiel 1992...

The way ahead

Although many women with CAH remain single and have few sexual relationships, increasing numbers do have loving, caring, lifelong partners (May etal. 1996). Advances in endocrine control since the 1990s (though still not universally available), together with advances in modern fertility treatments, mean that even those with severe salt-wasting CAH have been successful in having children. As CAH is an autosomal recessive condition, the child will only have CAH if both parents have CAH. If one has CAH and the other is a carrier then the risk of transmission is 1 in 2 with the other being a carrier if both parents are carriers then the risk reduces to 1 in 4. Between 1 in 50 and 1 in 80 of the population carry the faulty gene and increasing numbers of those with CAH are being recommended to have genetic screening as part oftheir family planning.

Intersex disorders

Females with CAH invariably have polycystic ovaries and a tendency to express a PCOS-like condition. One of the best indicators of good therapeutic control of CAH, and hence avoidance of infertility, is a regular menstrual cycle. Males appear normal at birth and develop premature physical sexual development over the first five years of life.

Discussion

This study aimed to explore the current level of awareness and knowledge about infertility amongst children and young people. The responses raise a range of issues for consideration. At some regional paediatric oncology centres, fertility preservation is currently being offered to young patients (Crawshaw et al. 2003 Glaser, Wilkey and Greenberg 2000 Wallace 2000). The need to understand what children do and do not understand about infertility and medical terminology is central to this practice, as is an understanding of the emotional consequences such treatment may bring for them (Broome and Allegretti 2001). Open discussion is often potentially therapeutic for the vulnerable family facing treatment. Discussion of fertility issues at the time of diagnosis provides the family with the reassurance that.the team believe in a future when these issues will become important. (p.493)

Sarah Clough

So the process of coming to terms with infertility had begun. OK, so I was infertile but did it change me I had Turner Syndrome but was I really that different Yes, deep down I was, my chromosomes were different. But what did that mean Aren't we all individuals Don't we all have our own 'foibles' that make us different from one another I gradually came to accept I may not like Turner's or being infertile but it was one of those things that made me me. It was part of me, part of my personality. Six years after meeting the man my Mum and Dad described, I gave birth to our son. No miracles, just a long slog at IVF and egg donation.

Jane Davies

There are many, many different reasons for infertility and here is my family's experience. It will resonate with some of you and not with others. So hold that in your mind as I tell you my story We found out by chance that our son was almost certainly infertile when he was just 16. We were told by the experts not to tell him because, they said, 16 isn't a good time to tell a young man that he's probably infertile. Now I absolutely agree with them that it isn't a good time, but is 17 any better As an 18th birthday present When he's first engaged Yes it's a bad time, but no other time was better as far as my husband and I were concerned. So we decided to tell him. It was partly because of that and partly because our family way of coping with things is to be up-front and honest with each other. When you want to tell somebody something, it does depend a little bit on how your family operates. If you tend to be secret and introverted then it's difficult to make an exception. But for us it...

Fertility

Suggesting that sperm-banking is the answer to infertility is like saying that chemotherapy is the answer to cancer. There is an element of truth, but the reality is far more complex there are no guarantees. Furthermore, this 'answer' pertains only to men. The options for women are far more complex and invasive and just as uncertain (see Chapters 5 and 6). Most research on fertility and pregnancy outcomes after treatment has reported primarily on the risks for infertility in cancer survivors. Current knowledge regarding reproductive effects in young adult survivors of adult-onset and childhood cancer focuses primarily on treatment-related risk factors for infertility and other reproductive organ gonadal effects, including early menopause (Byrne 1999a Kwon and Case 2002). Fertility preservation and pregnancy outcomes, including effects of treatment on progeny of childhood survivors and risks for congenital defects and cancer, also have been evaluated (Aslam et al. 2000 Blatt 1999 Byrne...

Normalizing Spermand

The first diagnostic tool to be used in the detection of male infertility was the spermatozoa count, or sperm count, developed in 1929 by scientists D. Macomber and M. Sanders.22 Sperm count was used for decades as the primary tool in measuring male infertility. However, clinical endocrinologist Richard Spark contends that this no longer is sufficient, for recent advances in endocrinology, genetics, immunology and embryology have established a broader base for the differential diagnosis of male infertility.23 Imaging technologies, such as electron microscopes and other devices, create new opportunities to produce scientific knowledge about sperm. For example, biochemists can measure the components of human seminal plasma one textbook listed 35 different elements of semen and their referent anatomical production mechanisms.24

Radioactive Iodine RAI Therapy for Graves Disease

In more than fifty-five years of active use, radioactive iodine has not yet proved harmful as a therapy for Graves' disease. Over the years, many studies have been conducted however, there is no evidence that RAI (as given for Graves' disease) increases the risk for cancer, or that it causes infertility or birth defects. Taken in either capsule form or in water, radioactive iodine can effectively destroy the thyroid gland. This effect takes from several weeks to months. There is usually a waiting period of at least six months after the radioactive iodine treatment is administered to determine if the full effect of the RAI has been seen.

In Vivo Function of the Oestrogen Receptors

The development of mice lacking the ERa (aERKO) or ERft (ftERKO) gene have proved to be valuable tools in evaluating the in vivo function of these receptors. The aERKO mice were generated in 1993, and the disruption of ERa expression not only caused infertility in both sexes, but also had profound effects on behaviour (Couse and Korach, 1999). Specifically, pre- and neonatal development of female reproductive organs such as uterus, ovary and mammary gland was almost normal, but maturation of these organs during and after puberty was severely impaired. The aERKO females also failed to display sexual receptivity when treated with the hormonal regime of oestrogen and progesterone that normally induces receptivity in wild-type mice. Surprisingly, adult aERKO males have significantly fewer epididymal sperm than heterozygous or wild-type males, caused by the disruption of spermatogenesis and degeneration of the seminiferous tubules, which becomes apparent 10 weeks after birth. Furthermore,...

If You Had Radioactive Iodine Therapy

If you were treated for hyperthyroidism or thyroid cancer with radioactive iodine, a reasonable recommendation is that you shouldn't plan to get pregnant for about six months. If you're pregnant after you had RAI, but did not wait this six-month period, you shouldn't be worried since there isn't any definite evidence that there's any harm to your child. Pregnancies should proceed normally so long as you're taking sufficient doses of your thyroid hormone replacement and the TSH is monitored monthly.

Thyrotoxicosis Because of Molar Pregnancy

Symptoms of molar pregnancies can begin in the first trimester, but the molar pregnancy is often not diagnosed until the second trimester. The first sign is continuous staining. The molar pregnancy can even damage the placenta to the point of miscarriage, and you might experience what you think is a normal first or second trimester miscarriage until you're examined via ultrasound which will always confirm a molar pregnancy. In this case, bleeding will usually become heavy and a dilation and curet-tage (D & C) will be performed to prevent any molar tissue from being left behind.

Prevention of Testicular Damage

The cytotoxic effect of chemotherapy on germinal epithelia function launched a search for possible fertility preservation strategies in men undergoing therapy. Cryopreservation of sperm has become standard practice, and it should be offered to all newly diagnosed, postpubertal males at risk for potential infertility. Many improvements have been made in the techniques used to store sperm. There have also been advancements in assisted reproductive technology using intracytoplasmic sperm injection (ICSI). As a result,there is an increased chance of successful pregnancy using banked sperm 53,58,62 . toxicity of chemotherapy have to be interpreted in light of the fact that assisted reproductive technology makes it possible to use testis sperm to conceive. The level of sperm necessary for sperm to exist in the testis is far less than the level required for sperm in the ejaculate 14 . As a result, testis sperm extraction (TESE), followed by ICSI, now makes it possible for patients who have...

Variable Stimulation Of The Immune System Of Primates Under Different Conditions

The long-term survival of the pathogen in a vertebrate host depends on proper balance (or evasion) of the pathogen with the host's immune system. A possibly critical factor of difference among modern humans, the Stone Age man, and the modern non-human primate needs to be recognized here. Some of the possible differences would make the response greater or weaker, and could consequently support or conflict with the hypothesis proposed here. This balance could depend on the variety and extent of immune stimulation in general and is in addition to the responses of these host species to their particular retroviruses. The stimulation of the immune system, variety of stimulations, and the age dependency of individuals exposed to other antigens before they are challenged by viral antigen do vary greatly (see for example, Miedema and Klein, 1996). There must be marked differences in the antigenic stimulation of the members of primate societies in the wild, the humans in developing countries,...

Concerning Human Implications

Embryo splitting in the human is the event that gives rise to monozygotic (one-egg) twins and higher multiples. It has been discussed in the context of assisted reproduction, as a means of increasing the success rate of IVF, but there is no evidence that it has ever been used for this purpose, nor that it would be effective if it were so used, because of the pattern of early development of the human embryo.

Role of Wolbachia in Filarial Biology

A number of antibiotic-based studies have been conducted, which emphasize the dependency of the filarial nematode on its bacterial symbiont. Antibiotic treatments of Wolbachia-containing nematodes have demonstrated a range of deleterious effects. These include the inhibition of larval development, the inhibition of embryogenesis, infertility, and the stunting of adult worm growth. It is notable that larval and embryonic development are especially prone to disruption through the action of bacteriostatic drugs, as in these stages of development the Wolbachia divide most rapidly (41). This may also explain the prolonged effects on other stages of the parasite, such as the adult, in which the bacteria are more slowly dividing. It has been demonstrated that the macrofilaricidal activity of an antibiotic may only become evident after one year following treatment (43).

Background And Commentary Onora ONeil Ruth Deech

The Human Fertilization and Embryology Authority (HFEA) was created by the Human Fertilisation and Embryology Act 1990 and has been operating since 1991. Its major function is to license all clinics offering treatments involving the use of embryos created outside the body (in vitro fertilization) or donated eggs or sperm (e.g., donor insemination). The HFEA also licenses the storage of eggs, sperm, and embryos and all permitted research on human embryos. The HFEA has a statutory duty to keep the whole field of fertility treatment and research under review and make recommendations to the government, if asked to do so. It maintains a confidential database recording all treatments.

The Legislative And Administrative Context Background

The history of the Human Fertilisation and Embryology Act 1990 is usually traced back to 1978 with the birth of Louise Brown, the world's first IVF baby. Although the 1990 act also covers treatments such as donor insemination, the development of IVF treatment and human embryo research was the main impetus for the development of the current legislation and the HFEA. An important milestone was the publication in 1984 of the Warnock Report.11 It was the Warnock Report that first suggested the setting up of a statutory body to oversee the practice of certain fertility treatments and human embryo research. Editor's note See chapter 21 for Baroness Warnock's views on the regulation of new technology specifically in the context of cloning.

Human Reproductive Cloning

The consultation document set out a number of scenarios where cloning technology could be applied to make a copy of another human being, envisaging single or multiple copies of a living or a dead fetus, baby, child, or adult. These included parents who might wish to replace an aborted fetus, dead baby, or child killed in an accident produce a sibling to be a compatible tissue or organ donor for a child dying from, say, leukemia or kidney failure or an individual attempting to cheat death by using cloning technology. Mention was also made of the possibility of selecting characteristics in offspring or to assist human reproduction in the case of infertile couples or lesbian couples. Views were sought on the acceptability of cloning in all, or any, of these circumstances. 4.3. The response to the consultation was conclusive. There was very little support for reproductive cloning, though there were a few who saw benefit in certain circumstances, mainly in connection with infertility...

Role of Mammalian Telomeres in Disease 31 The Telomerase Deficient Mouse Model

The telomerase-deficient mouse model has been instrumental in demonstrating the impact of short telomeres in the context of the whole organism. Telomerase-deficient mice were first generated by elimination of the gene encoding the murine Terc gene (Blasco et al. 1995, Blasco et al. 1997). The long-term viability of the Tercmouse strain is severely compromised, and only a limited number of generations can be derived, due to infertility and the progressive anticipation of pathologies associated with loss of telomeric repeats (Blasco et al. 1997, Lee et al. 1998, Blasco 2005, Herrera et al. 1999, Herrera et al. 2000 Franco et al. 2002 Ferron et al. 2004 Leri et al. 2003 Samper et al. 2002). These pathologies include loss of fertility, heart failure, immunosenescence, various tissue atrophies, and decreased tissue regeneration (of the digestive system, skin, hematopoietic system), among others (See

Canine Monocytic Ehrlichioses

In naturally infected dogs, in which the stage of infection is unknown, depression (67 ), weight loss (59 ), anorexia (56 ), hemorrhagic tendencies, in particular, epistaxis (46 ), pyrexia (40 ), and lymphadenomegaly (30 ) are the most commonly reported clinical signs in the United States (28). Rarely, there might be polymyositis, paresis, meningoencephalitis, cranial nerve deficits, seizures, abortions and infertility, corneal opacity, anterior uveitis, hyphema, focal chorioretinal lesions, retinal detachment, coughing, and exercise intolerance.

Introduction Richard Harries

In the end however it was not the ethical arguments in themselves which were conclusive, but the fact that Parliament, after widespread debate, had already passed acts not only allowing research on embryos in 1990 but allowing IVF (in vitro fertilization) and abortion under certain circumstances. The committee therefore concluded

The Status of the Early Embryo

Most research on early embryos uses surplus embryos left over from IVF treatment. But the 1990 Act allows embryos to be created for research. The number created has been much smaller than the number of surplus embryos donated for research. In the Committee's view embryos should not be created specifically for research purposes unless there is a demonstrable and exceptional need that cannot be met by the use of surplus embryos.

Cell Nuclear Replacement and Cloning

Cell nuclear replacement (CNR) involves the replacement of the nucleus of an egg with the nucleus of a cell from another individual (to produce an embryo that is the clone of the donor). The implantation of such an embryo in a woman (commonly called reproductive cloning) was made a specific criminal offense by the Human Reproductive Cloning Act 2001. There have been calls to prohibit the use of CNR for research purposes as well. The majority scientific view seems to be that CNR is more likely to be used as a research tool, which would assist the understanding of the behavior of adult stem cells and how they might be manipulated, than as the basis for general therapies in its own right. In the committee's view that is a sufficiently serious and important objective, particularly if the potential of adult stem cells is to be realized, to justify the use of CNR, if licensed by the HFEA, provided that (as with embryos created by IVF for research) embryos are not created by CNR unless there...

Conclusions and Recommendations

(xi) Although there is a clear distinction between an IVF embryo and an embryo produced by CNR (or other methods) in their method of production, the committee does not see any ethical difference in their use for research purposes up to the 14 day limit. (xii) Even if CNR is not itself used directly for many stem cell-based therapies, there is still a powerful case for its use, subject to strict regulation by the HFEA, as a research tool to enable other cell-based therapies to be developed. However, as with embryos created by IVF for research, CNR embryos should not be created for research purposes unless there is a demonstrable and exceptional need which cannot be met by the use of surplus embryos. (xvii) The HFEA has an excellent record in ensuring that IVF clinics comply with the law, and we are satisfied that its regulatory powers, now reinforced by a specific statutory prohibition, provide sufficient protection against the (xxiv) The separation of clinical and research roles...

Where can I get more information

This information was adapted by the Sexual Health and Responsibility Program (SHARP), Directorate Population Health, Navy Environmental Health Center from Protecting Against Unintended Pregnancy A Guide to Contraceptive Choices, U.S. Food and Drug Administration (June 2000) BUMEDINST 6300.9 Family Planning Services (20 Sep 2001) MANMED Article 15-76, Annual Health Maintenance Examination Recommendations for Active Duty Members (change 118 20 Aug 2002) unpublished data from 2003 Pregnancy and Parenthood Survey, Navy Personnel Research, Studies, and Technology, Institute for Organizational Assessment, Millington TN (April 2004) Fact Sheet - Women's Health Policy facts - Emergency Contraception, The Henry J. Kaiser Family Foundation, Menlo Park CA (Feb 2004), and material developed by the Planned Parenthood Federation of America, Inc.

Risk Based Healthcare Definition and Rationale

Radiation therapy (breast, thyroid and skin), altered bone metabolism and osteoporosis, obesity-related health problems (dyslipidemia, hypertension, diabetes mellitus, cardiovascular disease), liver failure secondary to chronic hepatitis C following blood transfusion and endocrine dysfunction following chest mantle or cranial radiotherapy. Primary, secondary and tertiary prevention, including tobacco avoidance cessation, physical activity, low-fat diet and adequate calcium intake, can modify risk. Longitudinal care addressing other late effects, such as infertility, musculoskeletal problems, cognitive dysfunction and psychosocial issues, may also improve survivors' health outcomes and quality of life.

Why should my sexual partner be told that I have a sexually transmitted disease

If you have a sexually transmitted disease, any or all of the people you had sex with (vaginal, oral, or anal sex) may also be infected with the disease. But they may not even know they are infected. By notifying them, you can help ensure they receive the medical treatment they need. Telling your partner shows you respect and care about them. Your honesty may build trust and may encourage your partner to share sexual health information with you. Telling your partner may also prevent future misunderstandings or legal action. Many people who are infected with an STD do not notice any symptoms, until they become very ill. For example, while most (though not all) men who are infected with Chlamydia or gonorrhea get symptoms within 30 days of becoming infected, most women do not. Instead, many women may not notice their infection at all, until it causes very serious problems, like pelvic inflammatory disease (PID) or infertility. It is very important that everyone who may have been exposed...

Risk Of The Other Guys Sperm

Semen Retention Drug

While there may be skepticism about the validity of human sperm competition theories, experimental research takes these theories quite seriously. Presuming that human sperm competition exists, studies have been designed to explore the role of human sperm competition in the context of male anatomy, male psychology and behavior, and human reproduction. One such study hypothesized that the human penis may have evolved as a semen displacement device.54 A research team created artificial anatomical models of male genitalia complete with simulated semen to test the hypothesis that the human penis is designed to displace semen deposited by other men in the reproductive tract of a woman (figure 2.3).

The Impact of Sexually Transmitted Diseases and Unplanned Pregnancy

The total cost of the most common STDs and their complications is conservatively estimated at 17 billion annually (USDHHS, 2000). Women generally suffer more serious STD complications than men, including pelvic inflammatory disease, ectopic pregnancy, infertility, chronic pelvic pain, and cervical cancer from the human papilloma virus (USDHHS, 2000). Another factor which complicates control is the lag time between infection and complications. Often, a long interval sometimes years occurs between acquiring a sexually transmitted infection and recognizing a clinically significant health problem. Examples are cervical cancer caused by human papillomavirus (HPV), liver cancer caused by hepatitis B virus infection, and infertility and ectopic pregnancy resulting from unrecognized or undiagnosed chlamydia or gonorrhea. The original infection often is asymptomatic, and, as a result, people frequently do not perceive a connection between the original sexually acquired infection and the...

Assessment of Testicular Function

Following pubertal staging and hormone analysis, semen analysis is necessary to confirm spermatogen-esis. The sample should be fresh and properly collected. This usually involves abstaining from sexual intercourse for 3-5 days and collecting the specimen by masturbation. Sperm count and quality can provide useful information about the likelihood of natural fertilization and, hence, whether assisted reproduction may be required. The sperm count should be at least 20 x 106 per ml. Since recovery from damage to germinal epithelium may occur 5-10 years (or even later) after therapy, these counts should be repeated from time to time, as such evaluation is indicated.

SHARP Fact Fact Sheets

- talking to teens about sexual responsibility, and family planning. The following pages in this chapter are SHARP FACTS which are 1 page (double sided) fact sheets on STDs, HIV, condoms, and family planning. They provide basic, evidence based information on these subjects. They're available to download and print for distribution as part of your disease prevention and health promotion efforts. 5HARP FACT5 are 1 page (double sided) fact sheets which provide evidence based information about STDs, HIV, condoms, and family planning. Download and print these free factsheets for your health promotion and disease prevention efforts. SHARP FACTS are provided in ,pdf or hypertext (htm) format.

In Vitro Fertilization Outcome And Immune Responses To

Women who are infertile owing to blockage of the fallopian tubes are prime candidates for IVF. The possible effect on IVF outcome of being sensitized to (16). Endocervical samples were obtained from 216 women at the time of oocyte retrieval and tested by ELISA for immunoglobulin A (IgA) antibodies reactive with the recombinant C. trachomatis 57-kDa hsp. Among the 68 women whose IVF cycle resulted in a term birth, only 5 (7.3 ) were hsp antibody positive. In marked contrast, this antibody was detected in 41 (27.7 ) of the women whose IVF cycle did not result in a live birth. In the majority of the positive women, there was no evidence of pregnancy after embryo transfer, indicating that immune sensitization to hsp in the genital tract may result in interference with embryo implantation in the uterus and or other early pregnancy events. The means by which sensitization to hsp leads to very early stage pregnancy failure remains to be elucidated. Initial studies in my laboratory have...

Correlation Between Endometrial Cell And Peripheral Lymphocyte Integrins

Expression of integrins on endometrial cells has been compared with that on PBLs with an aim of identifying a marker for assessing implantation failure in infertile women. We have shown that changes in expression of a4p1 and avp3 integrins on PBLs mirror the changes in endometrial cells during implantation and that this may be helpful in assessing endometrial functional defects.32 Immunocy-tochemical and immunofluorescence studies revealed that the expression of both a4p1 and avp3 integrins was significantly decreased in infertile women compared with those who were fertile (Figure 8.2 through Figure 8.5). Considering the relationship of PBLs with endometrial cells, we believe that failure of the immune system to support pregnancy through production of various integrins might be responsible for the demise of embryo. PBLs were once considered as mere target cells for various hormones, and not involved in cell-cell signal transduction mechanisms. However, the evidence now indicates that...

Honorable Death Kamikaze Sperm

Britain.38 Indeed, their ideas are taken seriously by popular writers and physical anthropologists. Baker and Bellis's stated aims are to offer a purely scientific understanding of the reproductive behavior of humans and other animals and to possibly revolutionize the medical approach to infertility.39 However, their interpretation of biomedical evidence is rife with sociobiological claims about how human behavior emerges from the seemingly conscious motivation of individual sperm cells. From the start, this book relies on evolutionary and genetic language, claiming that men and women are programmed to behave in predetermined ways in sexual matters. For example, human mate-guarding, whereby the male species shields the female in order to reduce the probability of sperm competition, is proposed in this book by extrapolating from squirrel data. One claim from these data and a methodologically questionable survey40 is that some form of mate-guarding behavior is a nearly universal feature...

Sexual Health and Responsibility Program SHARP

SHARP's Sexual Health Primer includes the impact of STDs and unplanned pregnancy, Risk Assessment and Risk Reduction Counseling -Guidance and Training for Health Care Providers, SHARP Facts Fact Sheets on STDs unplanned pregnancy HIV testing options for risk reduction male and female condoms talking to teens about sexual responsibility and family planning. This course is available on the SHARP website. SHARP issues a certificate of training to each person who completes the 40-question exam. Continuing education credit is awarded. SECNAV INSTRUCTION 1000.10 provides Department of Navy policy for all military personnel on pregnancy and issues related to pregnant servicewomen including, but not limited to, thorough family planning information to be made available to servicemen and servicewomen through the training establishment and at the unit level. BUMED Manual for Medicine provides requirements for the Annual Health Maintenance Examination for all female beneficiaries including...

Clinical picture of hypogonadism

Androgen production is minimal and hypogonadism will not manifest itself. Hypogonadism at the normal time of puberty will result in a typical syndrome of eunuchoidism. Epiphyseal cartilage does not stop growing, so the long bones continue to grow, resulting in a ratio of upper to lower body < 1, and arms extending beyond the torso by over 5 cm. Voice does not deepen, and hair development remains of the feminine type horizontal pubic hair line, no facial hair, no body hair. Fat distribution is also of the female type, with pronounced hips. The penis and testes remain child-like, the scrotum is only slightly wrinkled and not very pigmented, and the prostate is small. Libido and potency do not develop. Spermato-genesis is not initiated, resulting in aspermia and infertility. After puberty, the clinical picture may vary considerably according to the time elapsed since puberty and the degree of the androgen deficiency. Body proportions, size of penis, and pitch of voice do not change....

What services are available through the Navy

BUMED Instruction 6300.9 directs Naval medical facilities, including facilities on board naval vessels, to provide (or authorizes them to provide referral to) family planning services. Also, MANMED Article 15-76 provides annual health maintenance examination requirements for all active duty women which includes family planning, contraceptive counseling, and STD prevention counseling. Counseling should include information on availability and effectiveness of birth control methods (including emergency contraception). Emergency Contraceptives This information was adapted by the Sexual Health and Responsibility Program (SHARP), Directorate Population Health, Navy Environmental Health Center from BUMEDINST 6300.9 Family Planning Services (20 Sep 2001) MANMED Article 15-76, Annual Health Maintenance Examination Recommendations for Active Duty Members (change 118 20 Aug 2002) unpublished data from 2003 Pregnancy and Parenthood Survey, Navy Personnel Research, Studies, and Technology,...

Polyspermous Semen Is Everywhere

A quick survey of various media from the summer of 2005 illustrates other seminal overload. Summer books were full of sperm. Brooke Shields's postpartum depression memoir, Down Came the Rain, fueled by a feud with Tom Cruise, climbed the bestseller lists. In the book, Shields, struggling with infertility, laments the fate of her husband's body fluid in her vagina the little spermies couldn't swim upstream because the poor guys have been jumping into a pool with no water.3 (Ironically, Shields and Cruise's partner, Katie Holmes, would both give birth on the same day in the same hospital a year later in the summer of 2006, proving that the spermies did eventually swim to their target.) Sperm stories also regularly pop up in newspaper headlines. Stealing a glance at the New York Post on the subway on July 25, 2005, I was drawn to a headline Pop Shock EXCLUSIVE Dad must pay for 'secret sperm tot.' I inched closer to the paper through the throngs of people and read, A Brooklyn man says his...

Evaluation of Overt Sequelae

For young girls who have had pelvic tumors, gynecologic examinations may be necessary at a young age. The vagina, cervix and uterus are best examined under direct visualization using a speculum. General anesthesia may be required to produce adequate relaxation and to decrease motion. The uterus may be examined by ultrasound, CT and MRI injection of contrast-enhancing dye is not generally necessary. Young women who have difficulty becoming pregnant need to be evaluated for hormonal dysregula-tion versus late structural (uterine) injury.

Clinical assessment of psychologic and interpersonal factors

The patient's psychologic state must be assessed in every case, with special attention to symptoms of anxiety or depression, past and present partner relationships, history of sexual trauma abuse, occupational and social stressors, health issues in either partner, infertility, child-rearing difficulties, economic status, and educational level.

Diagnosing Thyrotoxicosis andor Hyperthyroidism

The challenge for diagnosing either hyperthyroidism and or thyrotoxicosis is similar for hypothyroidism the symptoms can overlap with stress, anxiety, panic disorder, low blood sugar, and cardiovascular diseases. For women, PMS and perimenopause can mask, or be mistaken for, thyrotoxicosis miscarriage or infertility can also result from thyrotoxicosis.

Unusual Aspects Of Breastfeeding

Infant in her arms and thus gave a reason to uncover the breast as proof of her feminine nature. A very decent solution of a very delicate problem It seems quite obvious that a 52-year-old woman who probably suffered from an androgen-producing tumour ofthe adrenal glands or ovaries would not be able to get pregnant and breastfeed her own infant. In fact, the baby is not sucking. So, de Ribera does not really deceive his spectators, except perhaps those who do not read his Latin explanations. On the other hand, based on observations of relactating grandmothers or even nursing men, she might have been able to breastfeed without having been pregnant

The Testosterone Theory

Indirect support for the GBG hypothesis comes from research with people whose mothers during pregnancy received a drug known as diethylstilbestrol (DES) to prevent miscarriage. Geschwind and Galaburda suggested that this drug resembles testosterone in its actions on the central nervous system. Subsequently Schacter (1994) reported that in 77 daughters of women who had been given DES, the distribution of handedness was shifted away from strong toward moderate right-handedness. Similar findings were reported by Scheirs and Vingerhoets (1995).

Precocious Development

Meas, T., Chevenne, D., Thibaud, E., Leger, J., Cabrol, S., Czerni-chow, P., & Levy-Marchal, C. (2002). Endocrine consequences of premature pubarche in post-pubertal Caucasian girls. Clinical Endocrinology, 57(1), 101-106. Partsch, C. J., & Wippell, W. G. (2001). Pathogenesis and epidemiology of precocious puberty. Effects of exogenous oestrogens. Human Reproduction Update, 7(3), 292-302. Partsch, C. J., & Wippell, W. G. (2002). Treatment of central precocious development. Clinical Endocrinology and Metabolism, 16(1), 165-189.

Prevention Strategies

Progress in reproductive endocrinology has resulted in the availability of several potential options for preserving or permitting fertility in females about to receive potentially toxic chemotherapy or radiotherapy. In pre- and post-pubertal females, cryopreservation of ovarian cortical tissue and enzy-matically-extracted follicles, with the in vitro maturation of prenatal follicles, is of potential clinical use. To date, most of the studies involving this technology have been performed in laboratory animals 50-52 . Another option available to the post-pubertal female is the stimulation of ovaries with exogenous go-nadotropins and the retrieval of mature oocytes for cryopreservation. Only a few oocytes, however, can be harvested after stimulation of the ovaries 51 . In vitro fertilization and subsequent embryo cryop-reservation have also been successful. These interventions, however, may not be readily available to the pediatric and adolescent patient, and the necessary delay in...

Role of Telomere Length and Telomerase in Human Disease

Strikingly, DC patients show increased chromosomal instability with age, consistent with a faster rate of telomere loss, suggesting that DC may be a chromosomal instability syndrome produced by a defect in telomerase activity and the proper maintenance of telomeres (see Du et al., this volume). DC patients develop many of the pathologies shown for the telomerase-deficient mouse model, such as short stature, hypogonadism and infertility, defects of the skin and the hematopoietic system, bone marrow failure, and premature death. Similarly to telomerase-deficient mice, human DC is characterized by showing disease anticipation in affected progeny, demonstrating that short telomeres directly contribute to disease presentation (Vulliamy et al. 2004). In addition, a number of patients diagnosed with aplastic anemia also show mutations in the telomerase Terc and Tert genes, resulting in accelerated telomere shortening and premature death (Yamaguchi et al. 2005, Marrone et al. 2004). However,...

Egg Cell Nuclear Transfer

Tilized egg and fused to a donor cell from which the nucleus has been removed and discarded. This cut-and-pasted egg would then be fertilized through in vitro fertilization (IVF), and the resulting embryo transferred to the woman for pregnancy. This technique would bypass MELAS by discarding the woman's disease-linked mtDNA and using a donor's presumably healthy mtDNA in its place. The woman's child would therefore be related to her genetically but he or she would not suffer from the disease that afflicted the woman's family. Researchers have also proposed using egg cell nuclear transfer to improve fertilization rates in assisted conception.29 If low fertilization rates for older women are due to programming errors in the cytoplasm of the older women's eggs, then a proposed solution is to fuse the patient's nucleus with enucleated eggs donated by younger women.30 In addition, egg cell nuclear transfer might be used for egg freezing in infertility treatment. Success in freezing eggs...

100 Pregnancy Tips

100 Pregnancy Tips

Prior to planning pregnancy, you should learn more about the things involved in getting pregnant. It involves carrying a baby inside you for nine months, caring for a child for a number of years, and many more. Consider these things, so that you can properly assess if you are ready for pregnancy. Get all these very important tips about pregnancy that you need to know.

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