Fertility Treatment For Women

The Pregnancy Miracle Ebook

The Pregnancy Miracle, Infertility cure book by Lisa Olson is an extensive 279 pages pregnancy book that consists of a simple and effective 5 step holistic & ancient Chinese system. This easy to follow, step-by-step pregnancy book has illustrations and diagrams to ensure everything is easy to follow and understand. This e-book is designed to offer a natural approach for conception. It is based on the expertise of a nutritionist, coupled with her personal experiences and research for many years. The book then spends an additional 200 pages providing an in-depth personal plan, with natural system involving several lifestyle changes, mind setting, whole body treatment, and natural techniques. Lisa Olson spent years developing the Pregnancy Miracle book so that people like her who are experiencing difficulties conceiving can have a chance to have their dreams of a new family member. Her program has helped thousands of women solve their fertility problems, but the program is designed to help men as well. Read more here...

Pregnancy Miracle Overview


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Author: Lisa Olson
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My Pregnancy Miracle Review

Highly Recommended

All of the information that the author discovered has been compiled into a downloadable book so that purchasers of Pregnancy Miracle can begin putting the methods it teaches to use as soon as possible.

When compared to other ebooks and paper publications I have read, I consider this to be the bible for this topic. Get this and you will never regret the decision.

Regulation and licensing of IVF

Regulation and licensing are systems that are imposed on an organization, such as a clinical laboratory or an IVF Center. These systems, which are not optional, are usually created and enforced via legislation and consequently vary widely between countries, and even between states in countries such as Australia and the USA. Licensing bodies (e.g. the Human Fertilisation and Embryology Authority, the HFEA, in the UK) typically issue a licence after an inspection process to confirm that an organization is, indeed, operating in accordance with the law. While this process does create some sort of minimum standards to which the facility or organization will operate, there is often no consideration of performance standards or quality within the terms of the licensing process. Regulations that concern the handling and use of hazardous materials such as flammable solvents, strong acids and alkalis, liquid nitrogen, radioactive materials, etc. All materials used in the IVF lab must be stored,...

Importance of Oxidative Stress and ROS in Male Infertility

Sperm dysfunction is one of the leading causes of infertility. Despite much research, there is limited knowledge about the causes of sperm dysfunction. However, oxidative stress (OS) has been identified as one of the causes of abnormal sperm function. OS refers to the state in which free radicals overwhelm the body's antioxidant capacity 21 an excess of ROS can have harmful effects on the tissues and organs 9, 10 . ROS has been shown to negatively affect sperm quality and function 22, 23 . For normal male fertility, a fine balance between the generation of ROS and its removal is very important. Excess of ROS also has a negative impact on the pregnancy outcome as well as the assisted reproductive techniques 24, 25 . Moreover, excess ROS can damage DNA in spermatozoa, induce cell apoptosis, and cause lipid peroxidation, which leads to morphological abnormalities, decrease in fertility, and increased sperm membrane permeability 26-28 . It is important to effectively detect the amount of...

Ineffective use of testosterone in male infertility

Since testosterone has been used so effectively in the treatment of endocrine insufficiency of the testes, its use has also been attempted in the treatment of idiopathic male infertility. Testosterone rebound was one of the earliest modalities in this regard. The published success rate in terms of pregnancies varied considerably from centre to centre, but remained low overall (Charny and Gordon 1978 Getzoff 1955 Lamensdorf etal. 1975 Rowley and Heller 1972). All studies were uncontrolled trials without placebo and double-blinding and therefore inconclusive. Testosterone rebound therapy cannot be recommended for treatment of infertility and is no longer practiced. More recently, testosterone undecanoate has been tested for the treatment of idiopathic male infertility. However, a significant increase in pregnancy rates could not be demonstrated (Comhaire etal. 1995 Kloer etal. 1980 Pusch 1989). When testosterone undecanoate was given combined with tamoxifen and or hMG, an improvement of...

Unexplained Infertility

Unexplained infertility is diagnosed whenever routine testing methods including semen analysis fail to identify a reason for delay in achieving pregnancy. Other testing methods such as assessment of ROS and DNA fragmentation may reveal the actual cause of infertility in these cases 82 . Higher seminal ROS levels and lower antioxidant levels were shown in men diagnosed with unexplained infertility compared to healthy controls 83 . Moreover, abnormal levels of ROS were seen in 25-40 of men diagnosed with unexplained infertility 84 . Assessment of the sperm DNA fragmentation analysis can also provide the exact etiology in cases with unexplained infertility especially in the presence of normal semen parameters 85 . Since OS is one of the causes of increased sperm DNA damage, both conditions may play a conjoint potentiating role resulting in male infertility. Also, apoptosis markers such as cytochrome c, mitochondrial membrane potential, and caspases 3, 9 have been shown in association...

Generation ofROS During Assisted Reproduction Techniques

Literature has documented role of OS in the pathophysiology of infertility and assisted fertility 135, 161, 194 . ROS may originate directly from gametes and embryos (endogenous sources) as well as their surroundings (exogenous sources). Several exogenous factors identified in culture media enhance embryo production of ROS oxygen concentration, the presence of metallic cations, and visible light exposure. Spermatozoa may also aid in the production of ROS during assisted reproduction techniques. Elevated ROS levels generated exogenously or endogenously influence the gametes, gamete interaction, fertilization, and pregnancy rates with IVF ICSI. Oxidative insult to embryos can lead to two-cell block, embryonic arrest, or even embryonic demise 213,214 . Higher levels ofROS in the follicular fluid and semen are associated with poor fertility outcomes with assisted reproduction 171, 174 . In a metaanalysis from our group, ROS in semen have been reported to significantly effect the...

Idiopathic Infertility

Infertile men are diagnosed with idiopathic infertility when normal sperm parameters and no other clinical condition that may result in infertility are seen. Oxidative damage may be a contributing factor to infertility in these normozoospermic males. While the exact cause of infertility may be unknown, idiopathic infertility has been correlated with higher levels of ROS and lower antioxidant levels than in fertile men 58 . A study found that men with idiopathic infertility had the second highest level of OS among the clinical diagnoses studied 44 . Therefore, it would be expected that infertile men diagnosed with idiopathic infertility would benefit from antioxi-dant treatments. Idiopathic infertility has also been associated with increased sperm DNA damage. A study by Wang et al. found a relationship between increased sperm damage by ROS and higher levels of cytochrome c and caspases 9 and 3 3 . This may also indicate elevated apoptosis in males with idiopathic infertility. Studies...

Infections of the Male Genital Tract and Infertility 2521 Initial Nosological Gaps

The state of the art in the field of prostatitis and infertility suffers some gaps originating from classification and definitions given by two parallel research groups ending up with two independent consensus conferences. The first, originating mainly from the urologic area (NIH Chronic Prostatitis Collaborative Research Network), was inspired by the clinical aspects of prostatitis (difficult to diagnose and to effectively treat) and includes only two categories (II and IV) associated with male infertility 6, 7 . According to the NIH classification, seminal bacterial infection, corresponding to chronic bacterial prostatitis (category II), has a marginal epidemiologic role, since bacterial prostatitis (acute or chronic) accounts for a low number of patients with prostate symptoms (5-10 ) 8, 9 . The NIH prostatitis classification recognizes a main role to one gland (prostate) and to two factors presence of microbial agents and evidence of inflammation (leukocytes) in the semen,...

Early Loss of a Child Miscarriage and Perinatal Deaths

Parental loss of a child, as discussed in Chapter 4, is one of the most difficult and intense losses to cope with. The age of the child will bring unique issues along with it however, one of the most unrecognized losses within the broader category of parental loss is miscarriage, stillborns, and other early deaths following childbirth. These losses have been called 'lonely' because often the mother has been left to grieve the death of her child alone. Often parents must say goodbye to their child before they even say hello. If the father has not bonded with the child during pregnancy, it is often difficult for him to grieve, or to understand what his wife is experiencing. For all, the grief process is more difficult because what is being grieved often is a dream. How one grieves and the specific issues to be addressed will relate strongly to how the parents had fantasized the child. A wished-for child may have represented various hopes and expectations. Many pregnancies are...

Diagnosis of infertility

Infertility is defined as the inability to conceive after 1 year of unprotected intercourse, with 75 of patients able to conceive after 6 months and 90 of patients able to conceive after 1 year 3 . This inability to conceive can be caused by male or female factors. Twenty percent of cases result from solely male factors, whereas 40 of cases are caused by male and female factors combined therefore, male-factor infertility affects 60 of infertile couples 4 . The evaluation of male infertility begins with a thorough history that includes a sexual history, past medical history, and family history. Pertinent information garnered from the sexual history includes frequency and timing of coitus and potency. A patient's past medical history is equally important and provides information regarding congenital abnormalities, cryptorchidism, inguinal or retroperitoneal surgery, radiation, infections, medications, toxic exposures, and past pregnancies. A family history may reveal cystic fibrosis,...

Role of Caspase PARP and Oxidative Stress in Male Infertility

Abstract The etiology and pathogenesis of male infertility remain not well defined. Oxidative stress has been identified as one of the major causes of male infertility. Integrity of the sperm DNA, which could be caused by oxidative stress, also plays an important role in vivo and in vitro male fertility. Poly (ADP-ribose) polymerase (PARP) is a DNA repair enzyme that has been demonstrated in mature spermatozoa and fertile men. PARP becomes activated in an attempt to repair oxidative DNA strand breaks. Higher levels of cleaved PARP (cPARP) have been reported in infertile men. Caspases play an important role in mediating and upregulating apoptosis. The cleavage of PARP by caspase 3 inactivates PARP in two segments and inhibits the function of PARP as a DNA repair enzyme. Therefore, high levels of cPARP may be considered as a new marker of apoptosis in sperm of infertile men. In this chapter, we define the relationship between caspases, PARP, and oxidative stress and their role in male...

The Role of Obesity in ROS Generation and Male Infertility

Aim To discuss the relationship between obesity and male infertility, specifically exploring the role of reactive oxygen species (ROS) production in obesity and the subsequent generation of oxidative stress, as well as abnormal hypothalamus-pituitary-gonadal regulation associated with obese males. Conclusion The continuing rise and prevalence of both obesity and declining male sperm count all over the world call for additional research and a greater awareness to obesity as a potential etiology of male infertility. Keywords Male infertility Obesity Reactive oxygen species Oxidative stress Hormones Center for Reproductive Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA Center for Reproductive Medicine, Cleveland Clinic, Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA e-mail agarwaa ccf.org

Protecting IVF laboratory staff from unfair litigation

As risk management moves from the manufacturing industry to healthcare there is a far greater - or at least more immediately obvious -impact of risk on customers' wellbeing. Although the underlying issue and driving force for risk management is patient safety, the increasing focus on financial risk, not just medical risk, has substantial implications for healthcare workers - and hence IVF Centers. Protection of employees from personal liability is essential if any modern-thinking IVF Center is to function without its staff living in permanent dread of litigation - a concern of everyone, not just clinical embryologists. To this end Centers must have fully-detailed standard operating procedures (SOPs) documented and in place, complemented by comprehensive quality management and risk management programs. Then, so long as staff work within this framework, the Center should have a legal (not just moral) obligation to indemnify its employees against personal responsibility for any adverse...

Cytokines as Potential Diagnostic Markers of Male Infertility

The clinical role of evaluation of cytokines participating in urogenital infections inflammations has been recently found to be the important area of interest. The present routine diagnostics of inflammation in the male reproductive tract is mainly based on the determination of leukocyte concentration and microbiological evaluation of the semen. Because the harmful effect of cytokines on spermatozoa is closely connected with the accompanying leukocytospermia, the evaluation of the leukocyte count in the semen still remains an important but insufficient factor to the diagnosis and treatment monitoring of male genital tract infection inflammation and its particular stages or kinetics. Consideration of additional biomarkers of inflammation, especially in cases of inflammatory conditions which occur without clinical symptoms, seems to be helpful in establishing the proper algorithm 163 . Determination of the levels of proinflammatory cytokines in the seminal plasma using a quantitative...

Identifying high risk IVF laboratories

IVF is an area of rapidly advancing technology, meaning that continual training and proficiency testing are imperative. But these tactics in isolation will not prevent the type of problems that keep appearing in the mass media, and we must recognize that the overall environment in which people work can either support or obstruct both technical training and improvements in operational systems. Is it possible for a hospital or Fertility Center to identify whether their IVF laboratory is at particular risk for adverse events, especially of the high profile kind From experience, the following are the most likely areas where such risk factors might be identified (but it must be stressed that this is by no means an exhaustive risk analysis of an IVF Lab).

Relationship between infertility and testicular cancer

Theoretically, any cause that adversely affects testicular function can result in infertility and testicular tumorigenesis. Many studies evaluating testicular cancer have documented an increased risk for abnormal semen analysis parameters in patients who have testicular tumors. Of 15 patients presenting with germ cell tumors, 10 (66 ) had evidence of abnormal spermatogenesis, including poor motility, low sperm concentration, or low semen volume 5 . Conversely, studies have been published documenting an increased risk for testicular cancer in patients presenting with infertility. This connection is clearly documented in a large population-based study in Denmark including 32,442 men who underwent semen analysis from 1963 to 1995. Men who had abnormal semen analyses had a 1.6-fold increased risk for developing testicular cancer compared with the general Danish population. In evaluation of specific semen analysis parameters, a low sperm concentration, decreased motility, and increased...

Oxidative Stress DNA Damage and Apoptosis in Male Infertility

Abstract Oxidative stress, sperm DNA damage, and apoptosis are associated with male infertility as a cause and as a manifestation. Several clinical conditions and laboratory findings may be indicative of the presence of oxidative stress, sperm DNA damage, and apoptosis. The use of standardized assays for the diagnosis of oxidative stress, sperm DNA damage, and apoptosis should be limited to cases where these conditions are suspected. The identifications of the causative factor for infertility will lead to a specific and subsequently more successful treatment option. In this chapter, we provide a description of the clinical conditions associated with oxidative stress, sperm DNA damage, and apoptosis that lead to male infertility. The different signs and results of laboratory investigations will be provided to highlight manifestations of these conditions. We also describe the impact of oxida-tive stress, sperm DNA damage, and apoptosis on male fertility and the different approaches that...

Clinical Consequences of Oxidative Stress in Male Infertility

Abstract Male infertility affects 40 of infertile couples in the USA and may be attributed to conditions such as varicocele, leukocytospermia, infection, and idiopathic infertility. Such conditions may be associated with elevated levels of reactive oxygen species (ROS), decreased antioxidants, and oxidative stress (OS). OS can lead to male infertility in both an in vitro and in vivo setting. The negative effects of ROS on male fertility present as sperm DNA damage, decreasing motility, apopto-sis, and lipid peroxidation. ROS and antioxidant levels can be measured and quantified in order to detect OS in semen samples. Both oral antioxidant therapy and culture media supplementation have proven to be effective in reducing OS. Future research is still needed in order to better understand the mechanisms involved in oxidative damage in the context of male infertility and to improve the treatments available for patients with OS-mediated male factor infertility. Keywords Male infertility...

Uterine Aspiration for Biopsy or Miscarriage Management

Manual vacuum aspiration (MVA) can be used in the office setting for easy sampling of the uterine endometrium with a 4-mm or 5-mm cannula when a small endometrial biopsy catheter is insufficient (Fig. 28-19). The MVA can also be used in the office for removal of retained products of conception after an incomplete or missed miscarriage up to 12 weeks without the added cost of an emergency room visit, surgical suite, and general anesthesia. The MVA device is a handheld plastic aspirator syringe attached to a plastic cannula of varying sizes. The cannula can be flexible or rigid to allow for provider preference. Vacuum aspiration is safe, quick to perform and less painful than sharp curettage and should be recommended for use in the management of incomplete abortion (Forna and Gulmezoglu, 2001). Figure 28-19 The Ipas manual vacuum aspirator (MVA) is displayed with 4-mm and 5-mm cannulas used for miscarriage management in outpatient setting. Note thumb buttons that close the barrel...

Potential Therapeutic Role of PARP in Male Infertility

The role of PARP in male infertility could be advocated. In a study by Wang et al., men with idiopathic infertility showed a significant positive correlation between ROS levels and caspase-9 and caspase-3, which suggests possible DNA damage and subsequently PARP in these cases 90 . In men with azoospermia, the expression of PARP-1 (enzyme) and poly(ADP-ribose) (PAR) (an indicator for PARP activity) as two markers has been localized in round and elongating sperma-tid. Also, PAR activity has been shown in all of the spermatocytes in maturation arrest patients at the spermatocyte level 91 .

Obesity and Male Infertility

Infertility Obesity Mechanism

BMI has been found to be associated with altered sperm parameters in numerous reports. In a recent study investigating factors related to semen quality, the prevalence of infertility in obese men was found to be three times greater than in male partners of couples with idiopathic or female-factor infertility 12 . Moreover, sperm density and total count was shown to have a statistically significant negative correlation to increasing BMI 12 . Another study looked at normozoospermic partners in an infertile population and reported a reduction in sperm concentration among men with BMI greater than 30 kg m2 when compared to leaner members of the study group 23 . Kort et al. further examined the relationship between sperm parameters and BMI in a generally overweight selection of subjects 24 . After 520 semen samples were subjected to analysis, semen quality and the number of normal sperm per ejaculate exhibited declines with increasing BMI 24 . On the other hand, when obesity was expressed...

Studies on EMR and Male Infertility

Within the last decade, there have been several well-designed and executed studies on the effects of mobile phone radiation on spermatozoa, covering three main areas, clinical epidemiological, human (in vitro) and in vivo animal models. The association between RF-EMR and male infertility was initially suggested by an epidemio-logical study in 2001 where it was speculated that differences in fertility parameters from Chinese males in various professions may be due to EMR exposures 52 . More pertinent epidemiological data from a study in 2005 found negative correlations between mobile phone usage and various attributes of semen quality, particularly motility 53 . Studies on male reproduction in mouse or rat models showing that mobile phone radiation affected testicular histology, including decreased seminiferous tubule diameter, appeared in 1999 54 . but wasn't investigated further until 2003 55 and 2004 56 with the effects of low frequency EMR on murine models. There were some...

Gynaecology And Infertility

Is not targeted at individual patients, but at groups of patients. This can happen where the intervention is an information package for the management of menorrhagia in primary care9 or a clinical guideline for the management of infertility.10 In these studies, randomising patients to receive management using the information package or clinical guidelines would have introduced contamination, since GPs would have been expected to manage both study (information leaflet, clinical guidelines) and control patients. Potentially this could underestimate the true effectiveness of the intervention. Therefore, clusters of patients (e.g. general practices) were randomly allocated to receive intervention (e.g. information leaflets, clinical guidelines) or control. Cluster randomisation should only be carried out when there is a strong justification for doing so. Clustering of outcomes can also occur in infertility trials where alternative treatments are being compared. For example, in randomised...

Creating a quality IVF lab

Creating a quality IVF lab is neither a simple nor short task. Certainly it is easier to create such a lab when one is starting afresh with a new facility, but most IVF labs don't have that opportunity, they have to rebuild and reorganize what they have - usually while having to maintain services with already limited human resources. Nonetheless, it is a daunting task that many Lab Directors will have to face anywhere that accreditation is pursued, but especially within the European Union as the Tissues and Cells Directive is implemented (http europa.eu.int eur-lex en ). There is no single right way of doing this, no cookbook recipe that can be followed to achieve this goal. Each IVF lab will have to develop its own strategic plan in response to its unique combination of circumstances. However, the general principles described in the earlier Chapters of this book will provide the background and framework for doing this, and the techniques and approaches we have described will provide...

OS and In Vitro Infertility

Reactive oxygen and nitrogen species that lead to OS have a negative impact not only on male fertility in natural conception but also on assisted reproductive technologies (ART) in an in vitro setting. In any ART procedure, there is a risk of oxidative damage from sources such as exposure to ambient air 70 . Other sources Studies have shown that the ROS levels in the seminal fluid correlate with fertilizing potential and the IVF rate in procedures such as intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) 71, 72 . Also, high ROS levels in day 1 embryo culture media have been related to decreased blastocyst and cleavage rate, low fertilization rate, and increased embryo fragmentation in ICSI cycles. Consistently, high day 1 ROS levels in culture media have been correlated with decreased pregnancy rates in ICSI and IVF 73 . ROS production and sperm DNA damage are associated with apoptosis 3 , which has been shown to be associated...

Impact of Infertility on the Patient

The problem of infertility is not new. From ancient times, cultures have practiced fertility rites to ensure the continuation of their people. Many societies considered a woman's worth in terms of her ability to have children. The ''barren woman'' was frequently banished. The average time it takes for a woman to conceive is 4 to 5 months. The American Fertility Society defines infertility as the inability to conceive ''after one year of regular coitus without contraception.'' During this time, more than 80 of women conceive. After 3 years of regular sexual intercourse, 98 of women become pregnant. It has been estimated that approximately one of every six couples in the United States has some problem with fertility. Infertility should be considered a problem of both men and women. It was previously thought that infertility was functional (no demonstrable organ disorder) in 30 to 50 of all cases, but it is now recognized that more than 90 of infertile couples have a pathologic cause....

The Influence ofROS and Total Antioxidant Capacity in IVF and ICSI Cycles

Women who have undergone IVF have a tendency toward higher levels of ROS in their follicular fluid than those who conceive naturally 170 . Bedaiwy et al. 173 assessed day 1 culture media ROS effects on fertilization rates, cleavage rates, fragmentation, and blastocyst formation after prolonged culture. The authors compared conventional IVF with ICSI in order to determine which technique produced higher ROS levels. The results showed that slow development, high fragmentation, and reduced formation of morphologically normal blastocysts were associated with increased levels of day 1 ROS. This study did not show any significant difference in fertilization rates and blas-tocyst development rates in IVF cycles, but significant reduction in these outcomes was reported in ICSI cycles with higher day-1 ROS levels 173 , In more recent study, Aurrekoetxea et al. describe, for the first time, serum oxi-dizability and antioxidant status in women undergoing an IVF cycle. The author found that the...

Strategies to Overcome OS in Assisted Reproduction

ROS may originate from the male or female gamete or the embryo or indirectly from the surroundings, which includes the cumulus cells, leucocytes, and culture media. In human IVF ICSI procedures, the clinical pregnancy rates have remained unchanged at 30-40 218 . It has been noted that blastocyst development in vitro always lags behind blasto-cyst development in vivo as there is a variation in the ability of IVF media and its components to scavenge ROS and prevent DNA damage and apoptosis 219 . During ART procedures, it is important to emulate in vivo conditions by avoiding 3. Enzymatic and nonenzymatic antioxidant culture media supplementation Higher implantation and clinical pregnancy rates are reported when antioxidant-supple-mented media is used rather than standard media without antioxidants. Various nonenzymatic antioxidants including beta-mercaptoethano 220 , protein 219 , vitamin E 149 , vitamin C 221 , cysteamine 222 , cysteine 223 , taurine and hypotaurine 224 , and thiols...

Oxidative Stress and Female Fertility

Many events related to infertility may occur due to OS in the female reproductive tract, such as endometriosis, hydrosalpinx, polycystic ovarian disease, unexplained infertility, and recurrent pregnancy loss 129 . In addition, apoptosis may cause embryo fragmentation, implantation failure, abortion, or congenital abnormalities in offspring.

Female Infertility The Obstruction to Reproduction

For most couples, getting pregnant isn't a problem, but one in five couples experience fertility issues in America today. The risk for infertility among women 35-44 years of age is double that of women 30-34 years of age, and the risk is one-and-a-half times higher for black women than for white women. Doctors usually define infertility as the inability to conceive after a year or more of regular sexual activity without contraception during the time of ovulation. It also encompasses an inability to carry a pregnancy to full term. Needless to say, infertility is an emotionally painful, financially draining, and physically exhausting condition. Getting pregnant isn't as easy as it looks. Indeed, there are a host of intricate processes that must be completed during ovulation, fertilization, and implantation of eggs into the uterus. Most of the couples I see have already been through a battery of tests to determine the possible causes of infertility. These conditions range from failure to...


Infertility is the inability to conceive or to cause pregnancy. Infertility is a common problem found in as many as 10 of all marriages. A couple is said to be infertile when after 1 year of normal intercourse without the use of contraceptives, pregnancy does not occur. It has been estimated that almost 30 of all infertility is attributable to a male factor. Any patient with a history of infertility should be questioned regarding a history of mumps, testicular injury, venereal disease, history of diabetes, history of a varicocele (see Fig. 18-27), exposure to radiation, or any urologic surgical procedure. Diabetic men may be infertile because of retrograde ejaculation, or ejaculation into the urinary bladder. Determine the frequency of sexual intercourse and any difficulty in achieving or maintaining an erection. Document a careful history of general work habits, medications taken, alcohol consumption, and sleeping habits.

Male Infertility

Infertility is defined as failure to achieve pregnancy after 1 year of unprotected intercourse. A specific cause can be identified in approximately 80 of couples, one third of which are female factors alone, one third male factors alone, and one third a combination of both. Unexplained infertility, in which no specific cause can be identified, occurs in approximately 20 of infertile couples. The initial step in evaluation of the male is a thorough medical history, focusing on general health, erectile function, STD history, medications, surgical history, previous successful pregnancy, contraception use, drug or alcohol use, and family history of genetic disease. The first and often only test needed in evaluating male factors is semen analysis. If two consecutive analyses indicate oligospermia or azoospermia, ordering blood tests for testosterone, LH, FSH, and prolactin levels is warranted. Varicocele is the most common cause of male infertility (Griffin and Wilson, 2003)(Table 35-5)....

Intrinsic Causes of Mitochondrial ROS Generation

There is evidence for the role of mitochondrial ROS in the etiology of male infertility in human spermatozoa. Although the factors responsible for stimulating increased free radical release from the mitochondria of spermatozoa are still unresolved, recent research suggests the involvement for a number of intrinsic factors including FAs and apoptosis. Koppers et al. 87 were the first to reveal that highly significant correlations exist between spontaneous mitochondrial ROS production by human spermatozoa and their free (unesterified) unsaturated FA content for both omega-6 (R2 0.605) and omega-3 (R2 0.615) PUFAs. The findings are also consistent with previous analysis of the FA content of human spermatozoa, which observed an increase in the cellular content of both saturated and unsaturated FAs in spermatozoa from men seeking infertility treatment compared to a cohort of normozoospermic controls

Environmental and External Factors Related to Mitochondrial ROS

The carcinogenic and toxic effects of cigarette smoking on the health of an individual are well documented. Smoking has also been shown to result in an increased likelihood of male infertility, with significantly higher levels of seminal ROS generation 123 and DNA damage 124 found in these men. Previous research has shown a significant elevation in the activity of MnSOD (mitochondrial isozyme) in cigarette smokers 125 , indicating that cigarette smoking may cause increased mitochondrial ROS generation, rather than via a cytosolic or membrane oxidase system. In smokers, the overall mitochondrial ETC function is significantly decreased which also correlates with increased peroxidative damage to lymphocyte membranes 126 . An extremely large Danish study of 2,542 healthy men, without bias towards reproductive history, discovered that compared with nonsmokers, smokers exhibited significantly decreased sperm concentration, semen volume, motility, and total sperm count 127 . Although the...

The European Tissues and Cells Directive

On 31 March 2004 the European Union passed Directive 2004 23 EC On setting standards of quality and safety for the donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells - the Tissues and Cells Directive-which specifically includes reproductive cells and stem cells for human transplantation (European Union, 2004). The extent of the Directive's application is defined in Article 6, which requires that all Tissue Establishments where any of the aforementioned activities are undertaken will be accredited, designated, authorized or licensed by a competent authority of the Member States for the purpose of those activities, with legal compliance required not later than 7 April 2006. Therefore, it seems that not only sperm banks and IVF labs, but also any lab that processes sperm for artificial insemination (e.g. intra-uterineinsemination IUI ) willbeconsidered as Tissues Establishments and will be subject to regulation under this...

ROS in Cell Physiology and Sperm Activation First Data and Clinical Relevance

Clinical data also support a role for ROS in sperm activation. First, we observed over the years that about 16 of men presenting at the infertility clinic and having normal sperm parameters according to the World Health Organization 47 have recurrent spontaneous sperm hyperactivation in whole semen this appears linked to a lower SOD-like activity (O2'- scavenging capacity) in seminal plasma (by 37 ) and spermatozoa (by 45 ) as compared to what is found in samples from nor-mospermic men 48, 49 . On the other side, we have seen two cases in which an excessively high (2-2.5-fold) O2'- scavenging capacity in seminal plasma was associated with complete failure at capacitation, hyperactivation, and in vitro fertilization (unpublished data). Therefore, imbalance in the scavenging of O2'- seems to lead to fertility problems. Furthermore, the concentration of ROS in the medium after sperm washing correlates positively with success in in vitro fertilization and there is then even a positive...

Targeting the Zona Pellucida

Given the potential permanence of vasectomy, it is not a viable choice for many. Ignoring the facts that some degree of sexism may be attendant to the history of birth control research and that many men and women simply feel that birth control is primarily a woman's responsibility, there are three major physiological reasons for the inequitable emphasis on female rather than male directed approaches. First, since fertilization and conceptus development occur within women, there are a greater number of reproductive events to manipulate to prevent pregnancy. Second, since women have to centers of ''brain control'' of the endocrine events controlling the activities of their ovaries and men have only a single brain center of testic-ular control, it is easier to hormonally interrupt the events controlling female fertility without causing adverse effects on the production of the hormones needed for other body functions. Third, and perhaps most important, it is...

Burden of Disease

In women, infection with N. gonorrhoeae is a major cause of cervicitis and PID. PID may cause ectopic pregnancy, infertility, and chronic pelvic pain. In men, gonorrhea can result in urethritis, epididymitis, and prostatitis. Gonorrheal infection is frequently asymptomatic in women. Infection in men can be asymptomatic as well, but less often than in women (Glass et al., 2005b).

Organizational Requirements

People have many technological options available to them for family planning. The legal requirements for such technologies begin with the duty to exercise good judgment when applying new technology or procedures.81 Organizations offering preimplantation genetic diagnosis (PGD) have been sued for failure to perform proper testing.82 Efforts to plan technologically assisted reproduction involve the law of contracts, which has threatened to supplant family law in determinations of parentage. When couples divorce, property, contract and family law have all been brought into the conflict over what to do with stored frozen embryos.83

Pathogenicity of CAG repeat amplification in the androgen receptor

In a recent study, Cram etal. (2000) have investigated CAG repeat numbers in the AR of 92 infertile men and their inheritance in 99 female offspring conceived after intracytoplasmic sperm injection (ICSI). It turned out that a stable inheritance in the female offspring could be detected in more than 95 of the cases investigated. A CAG expansion or contraction of the paternal AR allele was observed only in 4 father-daughter pairs. All alterations were within the normal range of CAG repeat number and no phenotypic consequences were observed. The study indicates a frequency of changes to occur in the order of 5 . The range of repeat numbers for the AR to be stably transmitted is presumably between 15 and 28 CAG. CAG repeats beyond 28 might bear the risk of instability, possibly up to a disease-causing length (Zhang et al. 1994). Single sperm analysis was performed in a patient with spinobulbar muscular atrophy (SBMA) with a CAG repeat number of 47 in the AR (Zhang etal. 1995). The number...

The need to use your own processes

When developing a Quality Management System, it is vital that you develop and use your own processes rather than try to follow somebody else's rules. Every IVF Lab or IVF Center is different. There will be local permutations or variations in practice that will preclude you blindly following a system or process that you have borrowed from another clinic. Certainly you can base your methods and systems on those from another IVF lab, but unless you intend to copy that entire Center in the most minute detail, you will always have to adapt them. This subject is discussed in more detail in Chapters 5 and 6.

Reproductive functions

When only fertile men covering the whole range of normal sperm concentrations were involved in respective evaluations, a shorter CAG repeat tract was associated with higher sperm numbers (von Eckardstein etal. 2001 Rajpert-De Meyts et al. 2002). Nevertheless, a marked variation of sperm density in relation to the AR polymorphism was observed. Hence, spermatogenesis is likely to be influenced by the number of CAG repeats within the normal range, but whether this reaches relevance for individuals remains doubtful. The range of sperm concentrations leading to infertility is most likely reached at CAG repeat numbers that are associated with X-SBMA. Furthermore, it can be assumed that the proportion of men with longer CAG repeats among infertile patients may, in case of strict selection criteria excluding all known causes of infertility, appear higher than in a control population. Genetic counselling concerning inheritabilityofthis modulator of spermatogenesis is of very restricted value,...

The Negative Impact of Unsaturated Fatty Acids and Lipid Peroxidation

The association between male infertility and the peroxidation of polyunsaturated fatty acids (PUFA) has been appreciated since the landmark studies of Thaddeus Mann and colleagues at the University of Cambridge. Mann et al. drew attention to the vulnerability of human spermatozoa to lipoperoxidative damage because of their particularly high PUFA content 23 . They also demonstrated that when washed human spermatozoa were treated with as little as 30 nmol of lipid peroxide mL, they become irreversibly immotile within a few minutes. In addition, this seminal paper 23 highlighted the significance of seminal plasma antioxidants in protecting spermatozoa from oxidative damage.

Gender in Demography Increasing Attention

Attention to gender has also come from reproductive rights activists. Although such perspectives have been present for some time (Freedman and Isaacs 1993 Cook 1993 Dixon-Mueller 1993 Kabeer 1994), their voices were especially heard during and after the 1994 International Conference on Population and Development in Cairo. This conference, and the discussions surrounding it, put scholars and activists interested in gender, especially those from the Third World, onto the radar screen of demographers. Even in the disagreement of some mainstream demographers and in their concern of what was removed from the population agenda to make room for issues of women and gender (McIntosh and Finkle 1995), we see a new way of dealing with the issues surrounding gender. One of the most important contributions of the reproductive health activists has been the attention given to feminist projects. Feminist research is necessarily political, and the activist work relating to the Cairo conference made...

Total quality management

While there are many definitions of TQM, they all share the common perspective of it being a philosophy rather than a simple management procedure. It must be seen as a process of improvement beyond the status quo that then extends into an all-encompassing program of developing, and fostering, the desire for change and improvement throughout the entire organization. TQM is an all-encompassing quality system, it includes QC, QA and QI within a perpetual reiterative process, but it is still based upon the foundations of inspection and audit (see Figure 3.2). TQM must be seen as a long-term goal, there are no short cuts or quick fixes in implementing TQM. There is no tool or technique that can be seen as a panacea for all the problems and woes of an organization, no turn-key systems that can be plugged into an organization's pre-existing management structure. Achieving a system of continuous improvement can take years, depending on the nature and size of the organization time frames of 8...

Identifying Resistance

We see another kind of resistance in Kenya. There, among the Luo, women's use of contraceptives may be undermining men's control over their families. In that setting, men's dominance has rested on their ability to control important material and symbolic wealth and the connections those various components of wealth and prestige could bring ''Cattle were used primarily as bridewealth, which legitimated control over the women who would produce the children that would perpetuate the husband's lineage'' (Watkins, Rutenberg, and Wilkinson 1997 216). While men continue their economic control and domination today, they have not been able to control women's reproduction in the same way. Watkins and her colleagues attribute this change to the new family planning programs, introduced by outsiders to the culture, which have made contraception easy to obtain. Consequently, Luo women have been able to make decisions about contraception and reproduction that their husbands may disagree with. While...

The Meaning of Motherhood

Inhorn's insights (1994, 1996) about childless women in urban Egypt is an example of research that is not part of mainstream demography but can inform demographic research. In this society, particularly among poor migrants who have moved from rural to urban centers, women's status and power are so powerfully tied to the bearing and raising of children that to be childless is a disaster. When these women moved to the city, they lost other sources of power, income, and even identity, and those losses made children even more important. Inhorn lived and talked with women who were searching for cures to their infertility and came to understand the cultural necessity of bearing children for women in this part of the world. She notes that ''indeed, it is from the study of infertility that issues of pronatalism, or child desire, are perhaps best understood. Namely, those who are missing children and who therefore have had much cause to reflect on their object of desire are often in the best...

Education and training

Everyone in the organization - the directors, managers and all employees - must be provided with the education to ensure that their general awareness and understanding of quality, its concepts and the necessary attitudes and skills, is sufficient for them to understand the philosophy of continuous quality improvement and to allow them to participate actively in the process. What might seem like a load of jargon at the outset must become a language of quality that is understood by the entire organization. This requires that it be made relevant to running an IVF Center, with explanation given in terms that illustrate its relevance and value.

Involvement and commitment

As a result of this involvement, there is increased recognition that an organization's employees are its greatest asset - one that will appreciate over time. Concern for, and support of, professional development, as well as providing a career structure, are too often ignored in many industries, including IVF labs. We all know that it takes a long time to properly train a new IVF scientist, yet how many of us have ever tried to put a value on this investment Helping people realize their potential is rewarding on many levels. Staff development and retention are integral to accreditation schemes and merely reflect one of the most basic business principles don't allow your competitor to acquire your assets (see Chapter 12 for further discussion of these topics).

Nerve Sparing Retroperitoneal Lymphadenectomy

Historically, the major long-term morbidity of RPL was ejaculatory dysfunction and potential infertility resulting from damage to the sympathetic nerves during dissection. Specifically, injuring the lumbar sympathetic trunks, postganglionic sympathetic fibers, and or nerves of the hypogastric plexus risked loss of seminal emission and consequently dry ejaculation. The traditional bilateral lymphadenectomy results demonstrated a 70 to 100 risk of this complication 2 . The movement to include suprahilar dissection was short lived and this approach was abandoned when no added benefit was realized 3 . The original procedures have since been further modified such that the minimal dissection is performed to spare relevant sympathetic nerves without risking an incomplete cancer resection. The initial strategy for minimizing postoperative ejaculatory dysfunction attributable to sympathetic nerve injury was the downscaling

Embryology And In Vitro Fertilization

In vitro fertilization (IVF) is a technique originally developed as a treatment for infertility. In IVF a number of ova are removed from a woman's ovaries and fertilized outside of her body. When they have developed to the eight-cell stage they are transferred back into her uterus, or the uterus of another woman. A number of variations of the IVF technique have been developed, each with its own acronym. These include GIFT (gamete intrafallopian transfer), ZIFT (zygote intrafallopian transfer), ICSI (intracytoplasmatic sperm injection), The development of IVF opened new possibilities for embryological research, and new possibilities for intervention at the embryonic stage of human life. Some of these possibilities are briefly outlined here. Ova can be donated from one woman to another, or one woman (a so-called surrogate mother) can bear a child for another couple. Ova from aborted female fetuses can be matured and used in IVF procedures. The normal reproductive span of women can be...

Is Viability or Birth Important

Embryos can be used in research for a number of purposes ranging from basic embryological research to improvements of IVF techniques. It is often claimed that embryo research is necessary for the further development of IVF techniques, and that the information produced about the earliest development of the human being may prove useful in the understanding of aging and of cancer. The embryos used in embryo research can either be so-called spare embryos that are surplus to requirements in the context of IVF treatments (e.g., because the treatment is a success and there are stored embryos which the parents do not need anymore), or they can be created specifically for research. There has been some debate about whether it is ethically acceptable to create embryos specifically for research. was created as an end in itself it is transformed into a mere means as soon as it is donated to research. The Kantian argument may, however, be more applicable in the context of custody or inheritance...

Relationship of Cytokines with Redox Status of Semen

Oxidative stress in semen has been suggested to be an important factor in the etiology of poor sperm function, especially through peroxidative damage to the sperm plasma membrane and DNA integrity in the sperm nucleus 98 . In many studies, the role of cytokines and oxidative stress in infertile patients was examined, especially together with an infection inflammation in the genital tract 57, 85, 99, 100 . The frequent presence of leukocytes in the semen, including their major subpopulation of neutrophils, is inseparably connected with reactive oxygen intermediate (ROI) production 101, 102 . A condition in which the number of leukocytes exceeds 1 x 106 mL of semen, defined as leukocytospermia, is considered to be the threshold value above which sperm dysfunction may occur. However, rather than the leukocyte number in the semen, their activity may decide on the final effects of oxidative stress on spermatozoa 76, 103 . Many authors have observed correlations between the levels of...

Radiation Therapy

Bone marrow suppression, soreness in the back of the throat with resultant dysphagia, transient loss of taste, transient xerostomia, and occasionally wound dehiscence (usually when there is not an adequate 10- to 14-day interval between surgery and initiation of radiation therapy). Late effects are generally less prominent in adults than in children and include potential pituitary dysfunction, possible infertility, effects on cognition, and possible induction of second malignancies. Although the neu-rocognitive effects in treated adults have not been studied as extensively as in children, there are data to suggest that cranial doses of 30 to 36 Gy may have an impact on cognitive function in survivors, especially on memory, reasoning, visual-spatial ability, and arithmetic calculation skills.40

Political Approaches To Ethics

Although global feminists praise the ways in which multiculturalist feminists have amplified socialist feminist thought, they nonetheless regard even this enriched discussion of women's oppression as incomplete. All too often, feminists focus in a nearly exclusive manner on the gender politics of their own nation. Thus, while U.S. feminists struggle to formulate laws to prevent sexual harrassment and date rape, thousands of women in Central America, for example, are sexually tortured on account of their own, their fathers', their husbands', or their sons' political beliefs. Similarly, while U.S. feminists debate the extent to which contraceptives ought to be funded by the government or distributed in public schools, women in many Asian and African countries have no access to contraception or family planning services from any source.

Complement Regulators And Reproduction

It is not surprising or novel to discover that CReg expressed on the surface of sperm and on the trophoblast function to protect these cells from C attack. However, a surprising alternative role for MCP in fertilisation and reproduction has come to light. It has been known for some time that MCP is found at high levels in the reproductive system in fact, even before its characterisation as a regulator of the C system, MCP was identified by several different groups as an antigen found on the acrosomal region of sperm (172-174). MCP was localised to the inner acrosomal membrane and was only exposed to extracellular fluid following the acrosome reaction, an essential prelude to fertilisation. The cryptic site of expression suggested a role other than C regulation, possibly in the fertilisation process itself. This notion was supported by observations of abnormal MCP on the sperm of infertile men and by studies demonstrating that antibodies to the first SCR in MCP inhibited sperm egg...

What Psychosocial Interventions Are Appropriate For Patients Whose Epilepsy Has Not Been Confirmed

Although a single seizure is usually not diagnosed as epilepsy, a person who has had a seizure will have many of the same initial feelings and concerns as one whose epilepsy has been diagnosed. In particular, fears about seizures and of physical harm have been noted in parents and children with first seizures.1316 Thus, regardless of whether the person has a single seizure or many seizures, attention should be paid to the person's and the family's initial reactions, feelings, and concerns. For example, experiencing a first seizure can be particularly difficult for women who are planning to have children. Some may wish to put their plans to become pregnant on hold until the medical picture is clearer. Other patients may cope better by not embracing the idea of having epilepsy until it is clearly diagnosed. Some patients may have more difficulty coping or obtaining access to care if the terms seizure and epilepsy are not defined appropriately. Education and support tailored to the...

Misoprostol In Practice

Unfortunately, rapid population growth, economic collapse and the spread of HIV AIDS in some African countries and the endless recruitment of skilled health professions from developing to developed countries will make the road to providing comprehensive obstetric care long and slow. During this interval, widespread access to misoprostol and the education to use it safely during home births have the potential to make a significant contribution - perhaps even the single most important contribution - to reducing the global burden of deaths from postpartum hemorrhage. The only other practical intervention with the potential to reduce postpartum hemorrhage in low-resource settings is realistic access to family planning, as all women who wish to limit childbearing are at risk of postpartum hemorrhage, and the older, higher-parity women, who have the greatest unmet need for family planning, are at even higher risk.

Caspase and Capacitation

12.2.4 Caspases and Male Infertility Semen Parameters and Caspase A significant association has been reported between caspase-3 activity and sperm morphology and motility 35 . It has been shown that nonapoptotic sperm that are negative for caspase-3 present with higher quality in terms of normal morphology 36 . Furthermore, spermatozoa of infertile patient have shown an increase in caspase activity 37 . Similarly, a significant negative correlation between sperm motility and viability and caspase-3 activation has been reported 38-43 . In a study that evaluates caspase enzymatic activity, semen fractions of infertile patients had higher caspase enzymatic activity compared to fractions in fertile controls 44 . Although there are significant correlation between caspase activation and the sperm quality regarding motility and vitality values, other contradictory results show no significant correlation between sperm morphology and caspase-3 activation 41 . There are different...

Theoretical Issues

Specifically, substantive behavioral explanations for fertility transition focus on at least one of three elements the nature of fertility decisions, the information and knowledge available to decision makers, and the institutional context for decision making. We first consider high fertility in pre industrial settings. Widespread evidence indicates that the high fertility of many populations coincided with a ''natural fertility'' regime, one in which potential decision makers did not limit their number of births via changed behavior at higher parities (Henry 1961). There are three possible reasons (1) decision makers were motivated to have as many children as possible, (2) decision makers did not know how to limit fertility, or (3) fertility control was not licit. Important behavioral theories focus on each alternative. The fertility transition's second stage views family size declines as resulting from conscious actions by decision makers, specifically decisions to curtail...

Empirical Findings

As noted earlier, natural fertility results if there are no attempts to control family size. In practice, however, natural fertility is frequently operationalized as involving no contraception or abortion (Henry 1961). Fertility is high in natural fertility populations but how high Females can have children as early as the midteens and can continue until the late 40s. Theoretically, women could have nearly one birth per year. Thus the theoretical maximum fertility, in the absence of all behavioral constraints, could be as high as 35 births On the other end of the natural fertility spectrum lie the Dobe Kung hunter-gathers, residents of the Kalahari Desert in Africa prior to 1975 (Howell 1979, 2000). The reported TFR for this natural fertility population was about 4.5 births per woman. Thus, the question, How can natural fertility populations be so different from each other, and why are even the highest observed rates much lower than the theoretical maximum '' In short, the...

Controversy over Source of Fetal Tissue

An even more troublesome source of fetal material might arise if a human fetus is conceived specifically for the purpose of aborting it for research or therapy. Although there is no documented evidence that this has happened, in at least two cases women have asked if they could become pregnant to produce tissues or organs for another person. In one case, the daughter of an Alzheimer's patient asked to be inseminated with the sperm of her father and, at the appropriate stage, to abort the fetus to provide her father with fetal neural tissue for transplantation. Although there is no evidence at present that this is technically possible, and the women's request was denied, this case demonstrates a possible demand for such applications. Similarly, another woman requested that her midterm fetus be aborted and the kidneys be transplanted to her husband who was dying of end-stage renal disease. There is also concern that increased pressures for fetal tissue could lead to a marketplace for...

Medical Risk Assessment

Hypertension may have many effects on the pregnancy depending on the degree of abnormality. Fetal effects range from none to increased miscarriage, IUGR, abruptio placentae, and fetal death. Underlying blood pressure disorders should be treated appropriately before pregnancy. Some hypertensive, reproductive-age women are treated with angio-tensin-converting enzyme (ACE) inhibitors. This class of therapeutics can cause significant risk to the developing fetus. These medications should be stopped and alternate medications started if needed. Women with preexisting hypertension should be referred for concurrent care with a physician experienced in managing hypertension in pregnancy.

Health Promotion Activities and Information for

Routine fetal heart auscultation, urinalysis, and assessment of maternal weight, blood pressure, and fundal height generally are recommended, although the supportive evidence varies (Kirkham et al., 2005). Women should be offered ABO and Rh blood typing and screening for anemia during the first prenatal visit. Genetic counseling and testing should be offered to couples with a family history of genetic disorders, a previously affected fetus or child, or a history of recurrent miscarriage. All women should be offered prenatal serum marker screening for neural tube defects and aneu-ploidy. Women at increased risk for aneuploidy should be offered amniocentesis or chorionic villus sampling (CVS). Counseling about the limitations and risks of these tests, as well as their psychologic implications, is necessary. Folic acid supplementation beginning in the preconception period and early pregnancy reduces the incidence of neural tube defects. Laboratory testing during the first prenatal visit...

Germ Line Gene Therapy

Very closely linked to germ-line gene therapy, in fact one might almost call it passive germ-line therapy, is the technique of selective implantation in in vitro fertilization (IVF). This technique does not directly act on the genome like germ-line gene therapy, but produces the same results. By using genetic screening, it is possible for couples undergoing IVF to select embryos to implant which are free from disease genes (for example, if their families have a history of muscular dystrophy). This would produce a child without the gene for that disease, just as germ-line gene therapy would. This technique is already available and being used by some hospitals, yet although there has been ethical discussion of it, it has not really been of the same tenor as that around germline therapy. The point is that if both selective implantation and germ-line therapy produce the same results, are they ethically different, and if they are different, then there must be something ethically...

Rare Coagulation Disorders Fibrinogen deficiency

The hypo- and dysfibrinogenemias comprise a collection of disorders that are usually dominantly inherited and associated with both bleeding and venous thrombotic manifestations. Women are at risk of recurrent miscarriage, and both antenatal and postnatal hemorrhage. In hypofibrinogenemia, both antigenic and functional fibrinogen levels are reduced. The diagnosis of dysfibrinogenemia is made by demonstrating a prolonged TT with a normal antigenic fibrinogen level.

Right to an Unaltered Genome

Conception, before any possible person exists), and perhaps, if we do not count a fertilized ovum as a person, germ-line therapy as a whole. Can a person describe themselves as having an altered genome, when in fact what happened was that their parents chose the characteristics that they would have Does this make an ethical difference It certainly makes germ-line gene therapy closer to selective implantation and IVF in ethical terms.

Antiphospholipid Antibodyinduced Pregnancy Loss

Over the last two decades, APS has emerged as a leading cause of pregnancy loss and pregnancy-related morbidity. It is now recognized that recurrent miscarriage occurs in 1 of couples (39-39), that up to 20 of women with recurrent miscarriage have aPL antibodies, and that in approximately 15 of otherwise apparently normal women aPL is the sole explanation for recurrent fetal loss (31, 40). The primary treatment for these patients, anticoagulation throughout pregnancy, is inconvenient, sometimes painful, expensive, and fraught with potential complications, including hemorrhage and osteoporosis. Moreover, it is often ineffective. Thus, the identification of a novel mechanism for pregnancy loss in women with aPL antibodies holds the promise of new, safer and better treatments.

Indications For Treatment

Varix ligation is indicated in patients with a palpable varix and at least one of the following (i) pain that is not attributable to other intrascrotal pathology (17) (ii) adolescent ipsilateral testis volume loss of 2 ml or greater than 20 of volume (18-21) or (iii) infertility attributable to the male partner based upon abnormal semen analysis or abnormal results of sperm function tests associated with a female partner who is fertile or suffers a treatable cause of subfertility (16). Treatment of varicocele is not indicated for infertility if the male partner has normal semen quality or a subclinical varicocele (16). Men with palpable varicoceles and abnormal semen quality who are not currently attempting conception but are interested in preservation of fertility may wish to undergo varix ligation when informed of the progressive deterioration of semen quality associated with varicocele (5,7,9). Varix ligation is cost-effective in comparison to alternate treatments, which might...

Impact of Hysterectomy

Rebecca also had fibroids and had tried for years to become pregnant but never conceived. Emotionally, she found the hysterectomy decision to be gut-wrenching. Once her surgery was scheduled, she couldn't bear to see a woman with a baby. The finality of what she was going to do was nearly overwhelming.

Pharmacologic Therapy

Most women with hyperprolactinemia require dopamine agonist therapy to achieve regular ovulatory cycles and pregnancy. Since restoration of the ovulatory cycle may occur within 1 week of initiating therapy, it is necessary to caution patients regarding their potential to become pregnant.50 Overall, there is reassuring worldwide experience that bromocriptine use during pregnancy does not increase fetal malformations, spontaneous miscarriage, ectopic pregnancy, or multiple births.39,41 Furthermore, no teratogenic effects have been reported in women who received cabergoline during the first and second trimesters of pregnancy.4145 Despite these data, women who become pregnant while on a dopamine agonist should discontinue treatment immediately to minimize fetal exposure. Because cabergoline has a prolonged half-life, women who plan to become pregnant should discontinue the drug at least 1 month before planned conception.

Mothers Health Babys Risks

A father's health can bring risks to a baby, too. Studies of men in a variety of occupations reveal that prolonged exposure to radiation, anesthetic gases, and other toxic chemicals can alter a father's chromosomes, increasing the risk of miscarriage or genetic defects. And even if the mother doesn't drink alcohol or use drugs, a father who is a heavy drinker or drug user is linked to lower weight newborns. Apparently substances such as cocaine can bind directly to live sperm and cause mutations in them.

Effects of ROS on Membranes

With regard to the impact of oxidative stress on membrane lipids Khosrowbeygi and Zarghami 55 showed that spermatozoa from patients with asthenozoospermia, asthenoteratozoospermia or oligoasthenoteratozoospermia had significantly higher PUFA levels in their plasma membranes than normozoospermic men and were therefore more susceptible to oxidative stress and LPO. Additionally, significantly higher malondialdehyde (MDA) concentrations, which correlated negatively with the sperm count, were detected in samples from infertile patients 61 . Another study revealed that the amount of MDA present in spermatozoa correlated negatively with fertilization rates in an IVF programme 62 . Among other factors, the different physico-chemical behaviour of different ROS (H2O2 vs. 'OH or ' O2-) is the reason for a differentiated action of membrane permeable and non-membrane permeable ROS on different sperm functions such as motility or DNA integrity. Also, the location of the production, extrinsic by...

Cryptic Female Choices

The last chapter focused on the effects of sexual selection, via sperm competition, upon the evolution of the male genitalia in mammals, with special reference to the question of human reproduction and evolution. However, in human beings as in other mammals, it is the female's reproductive tract which constitutes the arena for sperm competition. Spermatozoa must traverse anatomical and physiological sieves and barriers in the vagina, cervix, uterus, uterotubal junction, and oviduct before encountering an ovum, enclosed in its vestments (Figure 4.1). Once it is acknowledged that the female's anatomy and physiology may influence the fate of spermatozoa, it is logical to ask whether such factors might act differently upon the ejaculates of rival males. If, for example, one male possesses a more advantageous penile morphology, or copulatory pattern, or a biochemically more effective mixture of accessory glandular secretions, then the female's reproductive system might preferentially...

Impact of Varicoceles

A varicocele is a tortuous distension of intra-scrotal veins of the pampiniform plexus, and is regarded as one of the leading causes of male infertility with a prevalence of about 15-20 among the general adult men population and up to 40 in infertile males 117 . The aetiology of a varicocele is likely to be multifactorial 118 , Pathophysiological , clinical varicoceles are characterized by hyperthermia of the scrotum and the affected testicle leading to spermatogenic damage 119 possibly induced by oxidative stress mediated apoptosis 120 with an increased expression of apoptosis-related proteins in spermatozoa 121 . Moreover, endocrine and paracrine imbalances compromising Sertoli cell function have been described 118 , positively correlate with those in the blood. In turn, if there is a positive correlation between genital oxidative stress with that found in the blood, this raises the question if this could possibly also be the case if there is a systemic infection or generally too...

Enzymatic Antioxidant Protection

Recent studies revealed that seminal MDA, nitric oxide and SOD levels were significantly altered in infertile patients as compared to fertile controls 140, 141 , confirming earlier observations by Kobayashi et al. 134 and Calamera et al. 142 . Since no difference in the seminal concentration of catalase between fertile and infertile patients could be found, it appears that seminal SOD activity plays a bigger role for the maintenance of sperm motility and the sperm cells' protection against ROS than catalase 143 . However, the usefulness of the determination of SOD levels to diagnose male infertility is also questioned by Hsieh et al. 144 who could not find any significant correlation with motility of sperm concentration, neither for the intracellular, nor for the seminal SOD levels. The relationship of seminal SOD levels on various sperm functions such as acrosome reaction, however, did not appear so clear 140, 141, 145 .

Marriages and Children

She had had an abortion after becoming pregnant by one of the saxophonists in the Benny Goodman band when she sang with them. After this, she never had a child. She never discussed this. Her first marriage in 1941 to Bernard Kornegay, an admirer of the Chick Webb band, was short-lived and ended in mid-1942 in annulment, after Ella's managers discovered Kor-negay's criminal past and conveyed to her that they thought he was using her. Ella met her second husband, Ray Brown, a bass player, on the first tour with Dizzy Gillespie. They were married in December, 1947. They divorced in 1953, but continued to work together over the years. They adopted one son, Ray Brown, Jr., the son of her half-sister, Frances, who died young, and to whom Fitzgerald was very close. During the years she also had several affairs, but after she and Brown divorced, she never remarried.

Determination of Oxidative Stress in Seminal Plasma

Correlated with the male germ cells' acrosin activity 66 as well as with fertilization rates in an IVF programme 62 . These data indicate that the determination of seminal TBARS levels can be indicative of male infertility. However, proper cut-off values have not been calculated yet.

Prevention and Treatment

The factors contributing to the problem of acute diarrhea are well known. However, their modification will not be easy because of cost and required changes in behavior. The important variables that will require attention include the following availability of plentiful potable water adequate systems of sewage removal improved personal and food hygiene improved nutrition through food supplementation programs discontinuance of the practice of using night soil as fertilizer promotion of breast feeding effective measles vaccine programs availability of adequate health care to administer oral rehydration therapy and selected antimicrobial therapy family planning insect control vaccine development and implementation for certain enteric infections such as cholera, enterotoxigenic E. coli diarrhea, rotavirus gastroenteritis, shigellosis, and typhoid fever. Because achieving all of these activities will initially be too costly in developing areas, research in developed countries will be...

Identification of Sperm Oxidative Stress

Importance of oxidative stress as a cause of male infertility, a perceived lack of cost-effective assays for sperm oxidative stress and the absence of a universally accepted treatment regime. Chapters 13 and 14 have already outlined the various assays for sperm oxidative stress. The Luminol assay is probably the most commonly used direct measure of oxidative stress, but more than 30 other assays currently exist 6 . The Luminol assay is the only assay of sperm oxidative stress described in the current WHO semen analysis manual, but unfortunately has the disadvantage of requiring expensive specialised equipment (Luminometer) not commonly present in clinical andrology laboratories and can be quite technically demanding from a quality control perspective 8 . In my own fertility clinic, we measure sperm oxidative stress with the Nitro Blue Tetrazolium (NBT) assay, since this is easy to perform with limited specialised equipment and is relatively inexpensive, making it an ideal assay for a...

Possible Role Of Egvegf In Pathological Conditions

EG-VEGF may have considerable pathophysiological and therapeutic significance for several endocrine disorders characterized by excessive angiogenesis and for certain endocrine gland tumors. We have recently evaluated the expression of EG-VEGF in a panel of human ovary specimens isolated from patients diagnosed with poly-cystic ovary syndrome (PCOS) (N. Ferrara et al., in prep.). This condition is a major cause of infertility, affecting 5-10 of women of reproductive age (Goldziher and Green 1962 Dunaif and Thomas 2001). It is known that the increase in ovary mass in PCOS is accompanied by extensive angiogenesis in the stroma and theca (Yen 1999). Our previous studies have demonstrated that ade-novirus-mediated delivery of EG-VEGF in the ovary elicits an angiogenic response and cyst formation, similar to that induced by VEGF (LeCouter et al. 2001). Although both EG-VEGF and VEGF are expressed in the PCOS ovaries, their expression patterns are very distinct, essentially nonoverlapping....

Oxidative Stress and Testicular Torsion

Abstract Testicular torsion is a medical urologic syndrome that constitutes a surgical emergency affecting newborns, children, and adolescent boys. The main pathophysiological event in testicular torsion is ischemia (torsion) followed by reperfusion (detorsion) of the testis, and multifactorial mechanisms seem to mediate this condition. Testicular damage after ischemia reperfusion (I R) is related to the duration of ischemia and to the severity of the torsion. I R injury is associated with activation of neutrophils, inflammatory cytokines, and adhesion molecules with increased thrombogenicity, release of massive intracellular calcium, and overgeneration of reactive oxygen species and reactive nitrogen species. Although the results are not conclusive and the molecular mechanism by which antioxidants control male fertility have not yet been clearly identified, several antioxidant enzymes and antioxidant drugs have been studied to prevent such I R injury in testis. Antioxidant therapy...

External quality assurance

Although we have mentioned external quality assurance (EQA) several times in this book, there are limited options for IVF labs in terms of EQA programmes (EQAPs) at this time. However, one resource that does exist is a web-based commercial service called FertAid run by Jim Stanger of Newcastle, Australia (www.fertaid.com) that offers not only EQA but also operates as a training tool and an ongoing educational scheme. FertAid covers both embryology and andrology, and results can be viewed not only in comparison with a peer group, but also within a particular enrolled Center, effectively giving it an internal QC dimension as well. The major drawback that we have seen with this service is that, for now, unless you're a very patient individual, a broadband Internet connection is the least that should be available

Contraceptive Devices Diaphragms

Depth of the vagina, and any trapped air is vented through a one-way valve, creating a tight fit between the vaginal wall and the device. The Shield is removed using the incorporated removal loop with a finger more than 8 hours after intercourse. Women had an 8.7 chance of becoming pregnant within 6 months when using the Lea's Shield (Yama, 2010). The shield is cleaned with warm soapy water and dried for reuse.

Varicocele and Oxidative Stress

Abstract A varicocele is an abnormal dilatation of the pampiniform plexus within the spermatic cord. It is the most common male infertility factor, with multiple potential etiologies involved in its development. However, despite ongoing extensive research on varicoceles, the exact mechanism(s) by which varicocele influences male fertility is not known. Recent studies have shown that infertile men with varicocele have higher levels of seminal oxidative stress (OS) markers, and or lower seminal antioxidant levels, than do fertile men and infertile men without varicocele. The abnormally high levels of seminal OS biomarkers (e.g., reactive oxygen species, malonaldehyde) in infertile men with varicocele is clinically relevant as these markers have been associated with poor sperm function and reduced fertility potential. In addition, infertile patients with varicocele possess high levels of sperm DNA damage and the mechanism of varicocele-induced sperm DNA damage is believed to be at least...

Clinical Manifestations and Pathology

Midwives and empirics discovered that spasmodic ergotism caused abortion or miscarriage in pregnant women, the drying up of milk in lactating mothers, and amenhorrea in young girls. This abortifacient or oxytocic effect was later noted by orthodox medicine and led to the widespread use of ergot to accelerate uterine action. Before long, doctors began distinguishing ergot with such sobriquets as poudre obstetrical, forcing powders, or more commonly, forcing drops. Not surprisingly, it also played a major role among quacks, charlatans, and private specialists who promised a quick and painless cure for women desiring to regulate their menstrual cycles. The term regulation was euphemistically used to mean the termination of a pregnancy. For some, ergot substituted for the more common borax, cinnamon, and turpentine as an abortifacient.

Failure Modes and Effects Analysis

In engineering, Pareto methodology is commonly used to identify the 20 of significant risk issues that cause 80 of the process variability (Hutchison, 1994), i.e. the most important Failure Modes to address. However, in biology this sort of relationship is not always apparent or easy to determine, and decisions are often based on experience this is a significant part of the reason why an IVF lab needs to have a senior, experienced scientist acting as its Director.

Mechanisms of Disease

Despite ongoing extensive research on varicoceles, the exact mechanism(s) by which varicocele induces male infertility is not known. The most plausible mechanism is that varicocele induces scrotal hyperthermia and this results in defective spermato-genesis 4-6 . Studies have shown that elevations in scrotal temperature can impair spermatogenesis in patients with or without varicocele 7 . In support of this theory, external cooling of the scrotum has been associated with improved sperm parameters 8 . An additional mechanism by which varicocele may induce male infertility is the reflux of adrenal and renal metabolites into the spermatic veins. These metabolites have been shown to have a detrimental toxic effect on the testes and high levels of catecholamines 9 , prostaglandins E and F 10 , and adrenomedullin 11 have been reported in the internal spermatic vein of infertile patients with varicocele. Finally, venous stasis and hypoxia has also been implicated as a potential mechanism....

Recreational Drugs and ROS Production in Mammalian Spermatozoa

Abstract Oxidative stress is caused by an imbalance between the production of reactive oxygen species (ROS) and antioxidant capacity of the cell. Oxidative stress appears to be the major cause of DNA damage in the male germ line. Furthermore, many studies have indicated a significant correlation between DNA damage and high levels of ROS in infertile patients. Male reproductive health is already under threat from a range of environmental factors including endocrine disruptors, toxic pollutants, ionizing and lifestyle factors such as sexually transmitted infections, alcoholism, smoking, and anabolic steroid use. Further hazards such as fast food, recreational drugs, and stress levels may also impair male fertility. Recreational drugs such as alcohol, barbiturates, amphetamines, THC, PCP, cocaine, and heroin, but also includes caffeine in coffee and cola beverages, and environmental factors may increase ROS production, leading to DNA damage and further male infertility.

Birth Control Information

The issue of school involvement in the provision of family planning information is highly controversial and involves deep-rooted family and community values. School policies run the gamut from those that forbid discussion of birth control with individual students, to experimental programs that allow easy student access to family planning information and contraceptives (e.g., health clinics on or adjacent to school grounds).

Using Root Cause Analysis

To illustrate the use of Root Cause Analysis, let us consider an example of troubleshooting where an IVF Lab Director is concerned about the poor quality of the sperm preparations that are being produced by the laboratory (see Table 7.5). The pertinent technical background on sperm preparation methods has been extensively reviewed previously (Mortimer, 2000 Mortimer and Mortimer, 1992) and will not be repeated here. Issue Even with normal semen samples our sperm preparation method provides a low relative yield (about 15 of the motile spermatozoa initially applied to the gradient) with only 65-70 progressively motile spermatozoa and frequent contamination of the post-gradient sperm population with other cells and debris. A swim-up is needed to improve the motility, but that takes more time and further reduces the yield. Method The SOP for sperm preparation in our imaginary IVF lab can be summarized as follows. Apply 1 ml of liquefied semen to a gradient comprised of 0.5 ml layers of 80...

Whats gone wrong Troubleshooting

There are several different conceptual ways of looking at problems (see Table 8.1). While much of this book is about being proactive, no system will be perfect and sometimes you will need to deal with a problem that has occurred or an issue that is affecting the lab, and you will have to be reactive. This Chapter is about what to do when things have gone wrong, including dealing with problems and troubleshooting them. Learning how to deal with these subjects is of interest to IVF lab people. alpha, the international society of scientists in reproductive medicine (www.alphascientists.com), held an internet conference on this subject in 1998 (Elder and Elliott, 1998), and the alpha workshop at the 11th World IVF Congress held in Sydney in May 1999, structured as a foundation workshop in reproductive biology, concluded with a session by Jacques Cohen on the practical application of this knowledge in the ART laboratory, with particular reference to troubleshooting.

Acu Points to Clear the

Your acu-pro will instruct you as to the exact points to press according to your individual diagnosis. Here are some of the most common acu-points that will fit into any acupressure session for infertility issues. Additional acu-points used to treat infertility are discussed in Chapter 9, Pain Below the Belt, and Chapter 17, The Disappointment Down Under.

Apoptosis and Oxidative Stress

Infertile males were reported to have relatively high rates of apoptosis in their testicular biopsies 31 . In addition, the percentage of apoptotic sperm is higher in ejaculated semen samples from infertile men compared with healthy men 32 . Moreover, sperm caspases become more activated in patients with infertility than in healthy donors during cryopreservation 33 . Nevertheless, it has not been confirmed if the apoptotic markers detected in spermatozoa are due to an abortive apop-totic process started before ejaculation or whether they result from apoptosis started in the postejaculation 34, 35 . Wang et al. 49 reported a positive correlation between the presence of apopto-sis markers, due to OS-induced apoptosis, and sperm DNA damage. It has been shown that infertile patients with higher ROS levels in their seminal plasma had a higher percentage of sperm apoptosis than normal healthy donors 50 . Oxidative stress-induced apoptosis in ejaculated spermatozoa has been recently reviewed...

Clinical Presentations 2021 Varicocele

Infertile patients with varicocele present with higher levels of ROS and lower levels of seminal antioxidants leading to increased OS 78 . Published data have shown that the grade of varicocele has an impact on the levels of seminal ROS, which were proven to decline following the surgical correction of varicocele 78 . The relationship between varicocele and OS is not fully understood however, some mechanisms have been proposed. Significant amount of nitric oxide (NO) production are released from the dilated pampiniform plexus of veins leading to OS 79 . Additionally, NO may also interact with superoxide anion resulting in the production peroxynitrate, which result in further sperm damage 80 . Patients diagnosed with infertility and varicocele had significantly higher levels of OS and sperm DNA damage compared to healthy controls 64 . This could indicate a potential pathway for sperm DNA damage resulting from OS in these patients with varicocele 64 . OS and its resulting sperm...

Outcomes of Assisted Reproductive Techniques

Seminal ROS levels correlate with success rates of intrauterine insemination (IUI), in vitro fertilization (IVF), and ICSI 97 . Since spermatozoa used in assisted reproductive techniques originate from an environment conducive to OS, they could be the source of introduction of high levels of ROS 98 . In support, embryo culture media showing higher levels of ROS have been correlated with low fertilization rate, decreased blastocyst and cleavage rate, and decreased embryo quality and pregnancy rates following assisted reproductive techniques 99 .

Why bother with that Its never happened here

How often have you identified a potential problem, only to be told Oh that's never been a problem here, or We've never had a problem with that, or Why waste our time, that's just so unlikely Of course, the truth is that this head-in-the-sand mentality is exactly why some of the worst problems in IVF labs have arisen. We have personally experienced situations where an identified risk was pooh-poohed by the Medical Director, General Manager or equivalent, onlyto havejustthatproblem occur a few weeks later - although professional confidentiality clearly precludes quoting specific examples The dreaded It's never happened here should probably be considered a warning bell that a proper risk assessment should be undertaken forthwith. After all, Captain Edward John Smith hadn't hit any icebergs before the maiden voyage of the Titanic, either

Risk reduction or risk minimization

These terms are essentially synonymous and are used in risk management to describe the application of appropriate techniques to reduce the likelihood of an adverse event, its consequences, or both. A real world example of this type of action is shown in Figure 9.2. In the IVF lab, the management of the cryobank is a good area to see risk minimization strategies not only should the cryotanks' usage of liquid nitrogen be monitored on a regular basis (e.g. their level at weekly top-up for tanks not fitted with an autofill system) but they must also be connected to low-level alarms in case of tank failure, especially outside normal working hours. Further dimensions of risk minimization in

Origin of ROS in Male Reproductive System 21321 ROS Production by Spermatozoa

Leukocytes are found in the male reproductive tract and human ejaculates 85 they play an immunological role against pathogens as well as phagocytic clearance of abnormal sperm 86 . The leucocytes produce ROS as a result of their activity 59 . Male subfertility and infertility have been correlated with reproductive tract inflammation and the presence of leukocytes in ejaculate 13, 87 . Patients exhibiting leukocytospermia secondary to infection or as consequence of a paraplegia showed high level of oxidative stress in their ejaculates 39 Plante et al. 88 reported that activated leukocytes can produce 100-fold higher amounts of ROS than nonactivated leukocytes. Inflammation and infections activate leukocytes 89 . High levels of ROS produced by leukocytes 90 or during separating spermatozoa from seminal plasma for assisted reproduction will increase the incidence of spermatozoa damage 13 , This spermatozoal damages may include chromatin alterations 91 , poor motility 92 , and inhibition...

Oxidative Stress and Spermatozoa Functions 2141 Association Between Oxidative Stress and Subfertility

Increased levels of ROS were correlated with female infertility as well as male subfertility 96 , Low levels of natural antioxidants production or excessive ROS The effect of ROS on male fertility is dependent on their concentration in seminal plasma regardless of their sources of production. Significant opposite correlation has been established between defective sperm chromatin structure and fertility in IVF cycles 103 . However, this condition can be overcome by applying intracy-toplasmic sperm injection (ICSI), in which normal fertilization and pregnancy rates can be achieved with cells that have not completed spermatogenesis, such as epididymal and testicular spermatozoa 104 . Hammadeh et al. 105 found in patients undergoing IVF or ICSI therapy that the concentration of ROS and total antioxidants (TAS) in seminal plasma did not significantly differ however, they showed a negative correlation between ROS concentration in seminal plasma and sperm vitality, membrane integrity, sperm...

Polycystic Ovary Syndrome

A common endocrine disorder in adolescent girls and women with concomitant hyperandrogenism and insulin insensitivity is polycystic ovary syndrome (PCOS). Features of PCOS include obesity, hirsutism, acne, and amenorrhea (Himelein and Thatcher 2006). Additionally, infertility frequently results from PCOS and is thought to be a stressor that contributes to reduced quality of life and increased depressive symptoms for women and girls (Trent et al. 2003 Weiner et al. 2004). However, compared with women with infertility due to other causes, those with PCOS report greater depression and dissatisfaction with their body image (Himelein and Thatcher 2006). Furthermore, depressive symptoms and quality of life do not differ between women with PCOS who desire pregnancy and those who do not (Tan et al. 2008). Clearly, depressive symptoms and poor body image result from aspects other than infertility in girls and women with PCOS.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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