Reproductive Potential Of Women Research Articles

PROGESTERONE INSUFFICIENCY AS A PREDICTOR OF FUTURE REPRODUCTIVE LOSSES

The article presents new data on the significance of vitamin D deficiency in the formation of endometrial structure disorders in women with luteal phase defect and unrupted follicle syndrome. Disorders of the menstrual cycle caused by a progesterone deficiency from the position of influence on the onset and progression of pregnancy are considered. Fertility of women, especially with endocrine imbalances, deserves special attention, since the frequency of early pregnancy loss in them is about 67 %. Aim: study of the effects of vitamin D deficiency and progesterone deficiency in the luteinized unruptured follicle syndrome (Geis-Genes) and the luteal phase defect on the reproductive potential of women. Materials and methods: a hormonal study, determination of vitamin D levels, a sonographic study conducted on days 5–7 and 21–24 of the menstrual cycle in the periconceptional supplementation program of 45 women with luteal phase deficiency (LPD) and luteinized unruptured follicle syndrome (LUF). Results: The relationship between the content of vitamin D and the hormonal levels of the reproductive system of women with LPD and LUF is traced. The role of reducing vitamin D levels in the formation of hormonal imbalances in women of reproductive age has been established. Conclusions: – progesterone deficiency entails changes in various regulatory substances of the reproductive system, and therefore the periconceptional supplementation must be individual. – The introduction of the definition of vitamin D in the periconceptional supplementation plan and its correction are justified and necessary to improve the structure of the endometrium and its secretory transformation in women with progesterone imbalance.

Recent advances in fertility preservation

Most cancer treatments like chemotherapy, radiotherapy or a combination of both are highly toxic to the gonads, putting girls and young women at risk of premature ovarian insufficiency and subsequent infertility. Non-oncological conditions may also require therapies that put women's reproductive potential at risk. Fertility preservation counseling should therefore be offered to all patients requiring gonadotoxic treatments, and to those who wish to postpone motherhood for social/personal reasons. Among the most effective fertility preservation options available today, oocyte and embryo cryopreservation, and ovarian tissue cryopreservation have emerged as the front-runners. This review focuses on the currently available and most widely accepted fertility preservation and restoration strategies, with a special focus on recent advances in ovarian tissue cryopreservation and transplantation. To manage cancer patients satisfactorily and offer proper counsel on the most appropriate option available to them, different parameters need to be taken into account, including pubertal status, partner status and urgency of treatment for the underlying pathology. When fertility preservation is carried out for non-oncological indications or personal reasons, oocyte cryopreservation by vitrification is clearly the highest-yield clinical strategy. Ovarian tissue cryopreservation followed by transplantation is rapidly gaining ground as a fertility preservation and restoration strategy, and will hopefully soon have its 'experimental' label removed to allow practitioners to move on to open clinical application. Techniques to improve grafted ovarian tissue life span and quality as well as to avoid transmission of malignant cells have been developed, showing promise as a way to expand this procedure.

Dietary Pesticide Exposure May Hinder Women's Reproductive Potential

In the U.S., detectable concentrations of pesticides or their metabolites are present in most individuals, primarily through eating conventionally

Особливості оваріального резерву у жінок з безплідністю після органозберігальних операцій на органах малого таза

Ovarian reserve (OR) – an important part of the reproductive potential of women, is the ability of the ovaries to provide growth of full-blown follicles containing healthy, fertile eggs. The objective: to evaluate the characteristics of the OR in women with infertility after organ-saving operations on the pelvic organs Patients and methods. 128 women with infertility and hyperplastic diseases of the uterus and appendages (HDUA) were examined. Of these, 54.5% had a chronic inflammatory process of the internal genitalia (CIPIG). 42 patients with HDUA with CIPIG were treated conservatively, 28 patients with HDUA under the condition of CIPIG performing organ-preserving treatment, 27 women with GDUA without CIPIG performed conservative treatment, 31 patients with HDUA without CIPIG carrying out organ-preserving treatment. The volume of ovaries and the number of antral follicles (AF), the amount of anti-Muller hormone (AMG) were studied. Results. In the surveyed women, after surgical treatment, a decrease in the volume of the ovaries and the amount of аntral follicles (AF) was revealed, mainly due to ovarian resection. There was also a decrease in AMG. Moreover, the volume of operated ovaries in the group of patients who underwent cystectomy was significantly lower than in patients after resection or bipolar electrodeletion of the cyst capsule. Such changes in the ovarian reserve in the postoperative period can be explained by the volume of surgical intervention not only on the uterus, but also on the ovaries. Conclusion. The condition of the ovarian reserve in women with infertility against the background of uterine fibroids largely depends on the concomitant volume of surgical intervention. Cystectomy or ovarian resection, even in a sparing volume, is accompanied by a risk of a decrease in primordial and antral follicles. Key words: ovarian reserve, infertility, AMH, operations on pelvic organs, ultrasound.

Chapter 8 Human Oocytes Slow-Rate Freezing: Methodology.

Cryopreservation of human oocytes is an important technique for the treatment of human infertility, as it deals successfully with legal, ethical, and moral issues related to embryo cryopreservation (Coticchio et al., Human Fertil (Camb) 4:152-157, 2001; Tucker et al., Eur J Obstet Gynecol Reprod Biol 113: 524-527, 2004) and maintains reproductive potential in women with diseases or conditions that may compromise reproductive capacity. Here, we describe an oocyte cryopreservation technique involving slow freezing-rapid thawing with differential sucrose concentration (0.2M in the freezing stage-0.3M in thawing stage) (Bianchi et al., Reprod Biomed Online. 14:64-71, 2007), describing the technique in detail, from the preparation of the solutions through to the performance of the technique and, finally, to a number of helpful hints for optimum results.

Fertility Control: Reproductive Desires, Kin Work, and Women's Status in Contemporary India.

This article reappraises the link between fertility and women's status by examining changing means and meanings of reproduction in India. It is based on data gathered during and after 16 months of ethnographic fieldwork conducted between 2005 and 2007 in Lucknow, Uttar Pradesh, India, on social and cultural contexts of infertility. Lucknow is the capital city of Uttar Pradesh, India's most populous state. Historical views of population and fertility control in India and perspectives on the contemporary use of assisted reproductive technologies (ARTs) for practices such as surrogacy situate the ethnographic perspectives. Analysis of ARTs in practice complicates ideas of autonomy and choice in reproduction. Results show that these technologies allow women to challenge power relations within their marital families and pursue stigmatized forms of reproduction. However, they also offer new ways for families to continue and extend an old pattern of exerting control over women's reproductive potential.

Relevance of endoglin, IL-1α, IL-1β and anti-ovarian antibodies in females with multiple sclerosis

Few studies support the concept of reduced fertility in females with multiple sclerosis (MS). Recently we reported on reduced serum levels of Anti-Müllerian Hormone (AMH) in reproductive-age females with MS, suggestive of reduced ovarian reserve. The cause for this observation is not evident and remains speculative. The aim of the study is to examine possible immunological mechanisms interfering with fertility, as well as ovarian reserve that might affect the reproductive potential in women with MS.ELISA experiments were done to detect anti-ovarian antibodies (AOA), endoglin and interleukin (IL)-1α/-1β in sera of 85 MS females, including 15 women with known low AMH level as a marker of ovarian reserve, compared to 63 healthy controls.Groups did not differ with respect to age, smoking habits, BMI, and use of oral contraceptives. MS females showed significantly increased endoglin values compared to healthy controls. Remarkable, the highest endoglin values were found in subjects with low AMH. AOA were neither detectable in MS patients nor control subjects. IL-1α and IL-1β levels did not differ between groups.Our data established no relevance of IL-1α/-1β or AOA in ovarian insufficiency/dysfunction but suggests the involvement of endoglin in RRMS.

Prospective evaluation of the impact of intermenstrual bleeding on natural fertility

To evaluate the impact of an episode of intermenstrual bleeding on the probability of conception in a menstrual cycle (fecundability). Prospective, time-to-pregnancy cohort study. Community-based cohort. Women trying to conceive, ages 30 to 44years, without known infertility. Not applicable. Current cycle and subsequent cycle fecundability. A total of 549 women provided 1,552 complete cycles for analysis. Intermenstrual and luteal bleeding were reported in 36% and 34% of cycles, respectively. Ninety-three percent of all intermenstrual bleeding was luteal. Cycles in which women had intermenstrual bleeding or luteal bleeding were statistically significantly less likely to result in conception (fecundability ratio [FR] 0.23; 95% confidence interval [CI], 0.16-0.34; and FR 0.22; 95% CI, 0.14-0.33). Women with an episode of intermenstrual and luteal bleeding had a statistically significant increase in the probability of pregnancy in the subsequent cycle (FR 1.61; 95% CI, 1.15-2.25; and FR 2.01; 95% CI, 1.52-2.87, respectively). Intermenstrual bleeding statistically significantly decreases the odds of conceiving in that cycle but does not appear to negatively impact a woman's immediate future reproductive potential. NCT01028365.

Pituitary-ovary axis and ovarian reserve in fertile women with multiple sclerosis: A pilot study

Since a decline in the ovary function might impact the reproductive potential in women with multiple sclerosis (MS), we investigated the pituitary-ovary axis and ovarian reserve, including anti-Müllerian hormone (AMH) levels and ultrasound imaging of the ovaries, of 25 relapsing–remitting MS patients and 25 age-matched healthy controls. Mean levels of pituitary-gonadal hormones and age-adjusted parameters of ovarian reserve markers were not significantly different between both groups. Patients with higher disease activity (annualized relapse rate >0.5; n=9) had significantly lower AMH levels, total antral follicle count and ovarian volume, than those with lower disease activity. The finding of poorer ovarian reserve associated with higher disease activity should be taken into consideration since it may negatively impact the reproductive prognosis.

Contemporary state of diagnostic and therapeutic approaches to hydatidiform mole - clinical aspects

The relative rarity of gestational trophoblastic disease often leads to diagnostic and treatment errors and the risk of malignancy, trace violations women's reproductive health and reproductive largest social potential, give the issue a significant medical and social relevance. The aim of the study was to evaluate the differential diagnostic and therapeutic approaches to molar pregnancy and early pregnancy loss. Complex examination of patients included clinical, hardware, immunological, pathological methods. Thus, according to a retrospective and prospective study, the ratio of partial and complete hydatidiform mole ratio is 1:1.92; the signs of proliferative activity are 5 times more often in full molar pregnancy. The special features of the current hydatidiform mole at the present stage should include little symptomatic, no imbalance between the gestational ages of the uterus in 32.2% of cases, the development of most of the primiparas women aged 23 to 33 years, the preferential occurrence of partial hydatidiform mole after repeated pregnancy. The course of pregnancy in women with molar pregnancy in 88,1% of cases complicated with early gestation, while dominated the early gestosis, anaemia pregnant, threatened miscarriage. An ultrasound may be identified four options for ultrasound picture of molar pregnancy.

Причины и результаты преждевременных родов

Premature delivery is the leading cause of perinatal morbidity and mortality of newborns. The article presents the analysis of preterm birth in the perinatal center of Tula region. Depending on the causes of premature birth the author formed three groups. The 1-st group (n=32) included spontaneous preterm births, the 2nd group (n=115) -premature birth as a result of prenatal rupture of membranes, the 3st group (n=180) included preterm births for medical reasons. In all three groups, the demographic data, age, and parity were analyzed. The problem is the development of complex diagnostic techniques for the purpose of prognosis and preventive measures for pregnant women, because at present the obtained results do not allow us to accurately predict a preterm birth and to identify clearly the criteria for their possible development. Reduction of morbidity and mortality in newborns can be achieved through the timely identification of pregnant women at high risk, methods of prevention of preterm birth, quality of treatment and nursing of low-birth-weight infants [1]. This is of paramount importance not only in the formation of a healthy generation from a very early period of their lives and health, but also for the reproductive potential of women in the future [8].

Metabolic syndrome and hyperproliferative endometrial processes

The article discusses mechanisms of action of metabolic syndrome and related dysfunction of adipose tissue in the development hyperproliferative processes of endometrМОдm. The results of testiнг the program of lifestyle modification we have developed, shows the reduction of the mass of adipose tissue in the abdominal region, the enhancement of the quality of life and the contribution to preservation of reproductive potential in women with metabolic syndrome.

Lifestyle factors and oxidative stress in female infertility: is there an evidence base to support the linkage?

At present, between 10 to 15% of couples are infertile, and half of all infertility cases are credited to a female factor. Determination of the source of the problem may hold the key to improving fertility for women. Emerging research demonstrates that reactive oxygen species and oxidative stress (OS) have strong connections with female reproductive function; increases in OS which is associated with certain lifestyle factors can negatively impact female fertility. Lifestyle factors including being obese or underweight, exercising, cigarette smoking, alcohol and caffeine consumption, drug use, psychological stress and environmental and occupational exposures can all have adverse effects on fertility due to their complex interactions and impact exerted via OS on female reproductive processes. Our review highlights these linkages to explain their impact on female fertility, as well as provide suggestions to reduce OS and improve reproductive potential in women.

Fertility Preservation Options after Gonadotoxic Chemotherapy

Chemotherapy has the potential to deplete and destroy a woman’s reproductive potential. Although many oncologists are referring women for fertility preservation before chemotherapy, in many cases there is limited time for fertility preservation. This review provides an overview of the impact of cancer and chemotherapy on the ovarian reserve, a summary of methods of fertility preservation prior to chemotherapy, and current knowledge of fertility preservation techniques after gonadotoxic chemotherapy.

Polymorphisms in MMP-2 and MMP-9 promoter regions are associated with endometriosis

In this case-control study, we investigated the potential associations of MMP-2 and MMP-9 gene promoter region polymorphisms as well as MMP-2 promoter haplotypes with susceptibility to endometriosis in women of caucasian origin. The results demonstrated that polymorphisms in MMP-2 (-735 C/T) and MMP-9 (-1562 C/T) were associated with elevated risk of endometriosis and that certain MMP-2 promoter haplotypes were more common in control group.

Rethinking the biological clock: Eleventh-hour moms, miracle moms and meanings of age-related infertility

Over the past generation, aging and female reproduction have been lodged within the gendered and gendering debates regarding women's involvement in the workforce and demographic shifts toward delayed parenting that culminate in discourses on the “biological clock”. Technological solutions to the biological clock, specifically in vitro fertilization, have led to clinical attempts to assess “ovarian reserve”, or qualitative and quantitative changes in the ovary that correlate with aging and with successful infertility treatment. Rupturing the longstanding historical connections between menstruation and female reproductive capacity by specifically focusing on the aging of a woman's eggs, the clinical designation of “diminished ovarian reserve” has come to imply that a woman has “old eggs”. This is associated in practitioners’ and patients’ minds with the eclipse of a woman's reproductive potential and with hidden harbingers of menopause. In an ethnographic interview study of 79 couples in the US who conceived after using donor oocytes, we found that women voiced two different narratives that described their experience and attitudes when confronted with an apparent age-related decline in their fertility. The “eleventh-hour mom” narrative was voiced by women who initially tried to become pregnant with their own eggs and turned to donated oocytes as a second-choice option, whereas the “miracle mom” narrative was expressed by women who were generally older, some of whom had entered infertility treatment hoping to conceive with their own eggs, but some who knew from the outset that it was not going to be possible. Through their narratives women not only embodied and made meaningful “diminished ovarian reserve” in varying ways that connect with cultural, social, structural/organizational, symbolic and physical aspects of aging, they reproduced the socio-biological project of the biological clock, but rooted this social project in the metaphor of “old eggs” rather than menopause.

Defining the menopausal transition

Menopause signifies the permanent cessation of ovarian function and the end of a woman's reproductive potential. A universal experience in women's aging, it is the culmination of some 50 years of reproductive aging--a process that unfolds as a continuum from birth through ovarian senescence to the menopausal transition and the postmenopause. The menopausal transition is known to play a major role in the etiology of many symptoms common in middle age and may contribute to chronic conditions and disorders of aging such as osteoporosis and cardiovascular diseases. However, the mechanisms underlying ovarian senescence and the occurrence of various short- and long-term biological and psychological sequelae are poorly understood. Progress in researching reproductive aging and the menopause has been impeded by the lack of a staging system based on meaningful, reliable, and objective criteria for staging reproductive aging and specifying menopause-related status. Current nomenclature is described and its limitations are discussed. Specifically, contemporary terminology lacks the sensitivity and specificity needed to operationally define a woman's reproductive status in the continuum of reproductive aging. A number of proposed staging systems are currently being evaluated for their suitability in identifying appropriate demarcations across the span of reproductive aging. Further research and a better understanding of the menopausal transition are necessary to establish the validity, practicality, and acceptability of these proposed staging systems.

Issues Regarding Use of Hormonal Contraceptives in Clinical Trials of Antiretroviral Therapy

Objective Over 30% of HIV-infected adults and adolescents in the United States are female, yet women make up less than 20% of participants in most antiretroviral clinical trials. We sought to understand how policies regarding fertility regulation might have influenced women's participation in Adult AIDS Clinical Trials Group (AACTG) antiretroviral trials. Methods We reviewed AACTG and the National Institute of Allergy and Infectious Diseases Division of AIDS (DAIDS) policies relating to the eligibility of women of reproductive potential to participate in antiretroviral clinical trials from 1996 to the present. We focused specifically on policies related to the documentation of women's reproductive potential, contraceptive requirements stratified by the FDA Use-in-Pregnancy categories, the management of incident pregnancies for female study subjects, and the impact of previous limited antiretroviral use in pregnancy and eligibility for antiretroviral-naive clinical trials. Results Before 1998, most AACTG protocols specified that ‘adequate birth control’ should be used during clinical trials and for 3 months afterwards, but there was no standard definition of adequate birth control. Most protocols implied that it was the woman's responsibility to prevent pregnancy. In 1998, a focus group on pregnancy issues and antiretroviral agents recommended that adequate birth control should be practised by both heterosexually active women and men on study. Adequate birth control was defined as either abstinence, hormonal plus barrier methods, or two barrier methods. In 2000, women of reproductive potential were explicitly defined as all adult and adolescent women except those who have undergone surgical sterilization, hysterectomy, bilateral oophorectomy or menopause, or whose male partners have documented azoospermia from a vasectomy or other condition. Source documentation of sterilization, menopause or azoospermia was required to confirm a lack of reproductive potential for study subjects. Women of reproductive potential were required to use at least one non-hormonal contraceptive method for trials involving FDA category A, B and most category C drugs, and were required to use two non-hormonal contraceptive methods for some category C drugs (efavirenz) and all category D and X drugs. Hormonal contraceptive methods were thought to be possibly ineffective when prescribed with some antiretroviral agents, and so could not fulfill the contraceptive requirement. IUD were discouraged because of the potential increased risk of pelvic inflammatory disease. In 2002, the source documentation requirement for women not of reproductive potential was relaxed for trials of category A, B and C drugs with the exception of efavirenz; however, the contraceptive requirements were not changed. Most antiretroviral trials require that female study subjects who become pregnant discontinue study medications unless there are adequate safety data in pregnancy. Most clinical trials for antiretroviral-naive study subjects exclude women with limited previous exposure to zidovudine or nevirapine during a pregnancy. Conclusion The vast majority of HIV-infected women in the United States are of child-bearing age, and so fertility regulation policies may have a substantial impact on women's eligibility for and participation in antiretroviral clinical trials. The burden of pregnancy prevention disproportionately affects women, including those who are not heterosexually active but are still thought to be ‘of reproductive potential’. We need better and more complete data regarding the safety, pharmacokinetics and efficacy of newer antiretroviral agents in pregnancy and in conjunction with hormonal contraceptives. In addition, antiretroviral-naive clinical trials should consider whether the exclusion of women with previous limited antiretroviral exposure in pregnancy is truly justified.

Ovarian tissue harvested from lymphoma patients to preserve fertility may be safe for autotransplantation.

Ovarian failure is a common sequel to chemo/radiotherapy in patients successfully treated for cancer. Harvesting, cryopreserving and subsequently re-implanting ovarian cortical grafts can be used to re-establish reproductive potential in women with cancer. The safety issue, however, is of great concern because residual disease in autografted ovarian tissues might cause recrudescence of disease. A total of 30 non-obese diabetic severe combined immunodeficient (NOD/LtSz-SCID) mice were individually xenografted s.c. with frozen-thawed ovarian tissue from 18 patients with lymphoma [13 Hodgkin's lymphoma (HL) and 5 non-Hodgkin's lymphoma (NHL)]. The animals were autopsied at 16 weeks, or earlier if cachectic. The xenograft, liver, spleen, sternum, para-aortic lymph nodes and thymus were prepared for histology, immunohistochemistry and human DNA microsatellite analysis. None of the animals grafted with ovarian tissue from lymphoma patients developed disease. However, all 3 animals grafted with lymph node tissue from an NHL patient developed B-cell lymphomas that were confirmed as human in origin by DNA microsatellite analysis. Ovarian tissue harvested before high-dose chemotherapy for HL or NHL may not carry a risk of disease transmission by autotransplantation, although the possibility is difficult to exclude completely.

Reproductive potential in women after tubal pregnancy operation

The ectopic pregnancy frequency is studied by the data of one of the great puerperal houses in Kazan for 19931997. It is established that following the ectopic pregnancy, the pregnancy comes in each fifth woman; among women wishing to give birth, the pregnancy comes in each second one. Hence, in ectopic pregnancy complications of tuboperitoneal sterility in calculations it is necessary to take into account the womans wish to retain reproductive function.