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PubMedDate not supplied

Suppression of androgen action and the induction of gross abnormalities of the reproductive tract in male rats treated neonatally with diethylstilbestrol.

This study evaluated whether androgen action is altered in rats treated neonatally with diethylstilbestrol (DES) at a dose that induced reproductive tract abnormalities. Rats were treated on alternate days 2-12 with 10 microg DES and studied on Day 18. DES-induced abnormalities included a 70% reduction in testis weight, distension and overgrowth of the rete, distension and reduction in epithelial height of the efferent ducts, underdevelopment of the epididymal duct epithelium, reduction in epithelial height in the vas deferens, and convolution of the extra-epididymal vas. In DES-treated rats, androgen receptor (AR) immunoexpression was virtually absent from all affected tissues and the testis, whereas AR expression in controls was intense in epithelial and stromal cells. The DES-induced change in AR immunoexpression was confirmed by Western analysis for the testis. In rats treated neonatally with 1 microg DES, reproductive abnormalities were absent or minor, except for a 38% reduction in testis weight; loss of AR immunoexpression also did not occur in these rats. Treatment-induced changes in AR expression were paralleled by changes in Leydig cell volume per testis (91% reduction in the 10-microg DES group; no change in the 1-microg DES group). To test whether suppression of androgen production or action alone could induce comparable reproductive abnormalities to 10 microg DES, rats were treated neonatally with either a potent gonadotropin-releasing hormone antagonist (GnRHa) or with flutamide (50 mg/kg/day). These treatments reduced testis weight (68% for GnRHa, 40% for flutamide), and generally retarded development of the reproductive tract but failed to induce the abnormalities induced by 10 microg DES. GnRHa and flutamide caused no detectable change in AR immunoexpression in target tissues, with the exception of minor changes in the testes of flutamide-treated males. GnRHa treatment caused a reduction (83%) in Leydig cell volume comparable to that caused by 10 microg DES. Immunoexpression of estrogen receptor alpha (ER alpha) in the efferent ducts and of ER beta in all tissues studied were unaffected by any of the above treatments. Neonatal coadministration of testosterone esters (TE; 200 microg) with 10 microg DES prevented most of the morphological abnormalities induced by 10 microg DES treatment alone, though testis weight was still subnormal (46% reduction in DES + TE vs 72% in DES alone and 49% with TE alone) and some lumenal distension was still evident in the efferent ducts. Coadministration of TE with DES prevented DES-induced loss of AR immunoexpression (confirmed for testis by Western blot analysis). It is concluded that 1) reproductive tract abnormalities induced in the neonatal male rat by a high (10 microg) dose of DES are associated with reduced AR expression and Leydig cell volume; 2) these changes are largely absent with a lower dose of DES (1 microg); 3) treatments that interfere with androgen production (GnRHa) or action (flutamide) alone failed to induce reproductive tract abnormalities or alter AR expression as did 10 microg DES; 4) a grossly altered androgen:estrogen balance (low androgen + high estrogen) may underlie the reproductive tract abnormalities, other than reduced testis weight, induced by high doses of DES.

Androgen Antagonists↗

PubMed2004

Reproduction rates for 1990-2002 and intrinsic rates for 2000-2001: United States.

OBJECTIVE: This report presents revised rates of reproduction for 1990-93, reproduction rates for 1994-2002, and intrinsic rates for 2000-2001. The revised rates for 1991-93 are based on populations consistent with the April 1, 2000, census, as are the rates for 1994-2002. METHODS: Tabular and graphic data on the reproduction and intrinsic rates by race and Hispanic origin of mother are presented and described. RESULTS: Rates of reproduction (total fertility, gross reproduction, and net reproduction rates), the intrinsic rate of natural increase, and the intrinsic birth rate were lower in 2001 (and 2002) than 1990. Among the race and Hispanic subgroups, the reproduction rates were lower for all groups except Cubans and whites (total). The overall intrinsic death rate increased between 1990 and 2001 with the rate declining for whites (total) but increasing for blacks (total).

Birth Rate↗

PubMedDate not supplied

Adolescent self reported reproductive morbidity and health care seeking behaviour.

BACKGROUND: Addressing reproductive health issues of women is now on the global social agenda in the new millennium. Maternal mortality has long been the only indicator of women's health even though reproductive morbidity occurs far more frequently and seriously affects women's lives. In this paper, an attempt was made to assess the magnitude of self reported gynaecological morbidity unrelated to childbearing among the adolescents irrespective of their marital status. The paper also explored the determinants of health care seeking behaviour of the adolescents for their reproductive ailments. METHODS: Both quantitative and qualitative data were collected for this study. Cross sectional study was conducted both in rural and urban areas using a multistage cluster sampling technique. A nationally representative data on 2883 adolescents irrespective of their marital status were analysed. RESULTS: Analysis revealed that a large proportion of the adolescents (64.5%) reportedly has been suffering from gynaecological morbidity. The most frequent form of morbidity was menstrual disorders (63.9%) followed by lower abdominal pain (58.6%), burning sensation during urination (46.1%), genital itching (15.5%), vaginal discharge (3.4%) etc. Multivariate logistic regression analysis revealed that older adolescents aged 15-19 years, family income, type of family, type of residence and hygienic practice during menstruation appeared to be influencing factors for adolescents reproductive morbidity. The results also revealed that about one fifth (18.0%) sought health care for their gynaecological ailments indicating that adolescents were unaware about their reproductive morbidity (p<0.05). For assessing the factors influencing their health care seeking for reproductive morbidity, multivariate logistic regression analysis found significant positive association with adolescents aged 15-19 years, having autonomy in treatment, working status, adolescents of joint or extended family (p<0.05). DISCUSSION: Adolescent reproductive health in Bangladesh indicates high incidence of maternal morbidity. The incidence of these health problems varied by socio-economic and demographic characteristics of the adolescents. Recommendations to address these problems include encouragement of female education, introduction of family life education in school curricula, creating community awareness for seeking health care and empowerment of women in household decision making process.

Adolescent↗

PubMed2003

NTP-CERHR Monograph on the Potential Human Reproductive and Developmental Effects of Methanol.

The National Toxicology Program (NTP) Center for the Evaluation of Risks to Human Reproduction (CERHR) conducted an evaluation of the potential for methanol to cause adverse effects on reproduction and development in humans. Methanol was selected for evaluation because it is a high production volume chemical with high potential for occupational, consumer, and environmental exposure. Methanol is used in chemical syntheses and as an industrial solvent. It is found in a variety of consumer products such as paints, antifreeze, cleaning solutions, and adhesives and is a by-product of sewage treatment, fermentation, and paper production. Methanol is used in racecar fuels, and there is the potential for the expanded use of methanol as a vehicle fuel or fuel additive. Methanol occurs naturally in a variety of fresh fruits and vegetables, alcoholic beverages, and cigarette smoke. The results of this evaluation on methanol are published in an NTP-CERHR monograph which includes: 1) the NTP Brief, 2) the Expert Panel Report on the Reproductive and Developmental Toxicity of Methanol, and 3) public comments received on the Expert Panel Report. As stated in the NTP Brief, the NTP reached the following conclusions regarding the possible effects of exposure to methanol on human development and reproduction. First, there is concern for adverse developmental effects in fetuses if pregnant women are exposed to levels of methanol that result in high blood concentrations, such as with acute methanol poisoning. Although there is insufficient evidence to determine if a human fetus is more or less sensitive than rodents to the adverse effect of methanol, humans suffering acute methanol poisoning may have blood levels similar to those resulting in developmental toxicity in rodents. Second, for exposures that result in low blood methanol concentrations (below approx. 10 mg/L blood), there is minimal concern for adverse developmental effects , and negligible concern for adverse male reproductive effects. There is insufficient evidence to assess the effects of methanol on female reproduction. Data available to the expert panel were not sufficient to rule out the possibility of male reproductive effects at toxic exposure levels. The panel judged that blood levels >/=10 mg/L are not expected to result from normal dietary or occupational exposures. NTP-CERHR monographs are transmitted to federal and state agencies, interested parties, and the public and are available in electronic PDF format on the CERHR web site (http://cerhr.niehs.nih.gov) and in printed text or CD-ROM from the CERHR (National Institute of Environmental Health Sciences, P.O. Box 12233, MD EC-32, Research Triangle Park, NC; fax: 919-316-4511).

Journal Article↗

PubMed2004

NTP-CERHR Monograph on the Potential Human Reproductive and Developmental Effects of Fluoxetine.

The National Toxicology Program (NTP) Center for the Evaluation of Risks to Human Reproduction (CERHR) conducted an evaluation of the potential for fluoxetine to cause adverse effects on reproduction and development in humans. Fluoxetine (Prozac(R); Serafemtrade mark) was selected for evaluation because of 1) sufficient reproductive and developmental studies, 2) human exposure information, 3) changing prescription patterns, and 4) public concern about potential reproductive and/or developmental hazards associated with exposure. Fluoxetine, an antidepressant, is also prescribed to treat premenstrual dysphoric disorder and has recently been approved for use in 7-17 year-olds. The results of this evaluation on fluoxetine are published in an NTP-CERHR monograph which includes: 1) the NTP Brief, 2) the Expert Panel Report on the Reproductive and Developmental Toxicity of Fluoxetine, and 3) public comments received on the Expert Panel Report. As stated in the NTP Brief, the NTP reached the following conclusions regarding the possible effects of exposure to fluoxetine on human development and reproduction. First, there is some concern for developmental effects, specifically shortened gestation and poor neonatal adaptation at therapeutic doses (20-80 mg/day). This conclusion is based on evidence from human studies that fluoxetine produces an increased rate of poor neonatal adaptation and that fluoxetine exposure during pregnancy can result in a shortened gestation and reduced birth weight at term. Second, there is minimal concern for adverse reproductive effects in fluoxetine-exposed adults. Evidence from human studies show that therapeutic doses of fluoxetine may, in both men and women, result in reversible, impaired sexual function, specifically a delay in or an inability to achieve orgasm. Finally, there are insufficient data to draw conclusions on 1) an association between fluoxetine therapy in pregnant women and pregnancy loss; and 2) on how breast milk or therapeutic exposures to fluoxetine might affect development. In a study in mice, early fluoxetine exposure affected adult behavior. However, additional data are needed to confirm and extend these findings and determine if such effects might possibly occur in humans. NTP-CERHR monographs are transmitted to federal and state agencies, interested parties, and the public and are available in electronic PDF format on the CERHR web site (http://cerhr.niehs.nih.gov) and in printed text or CD-ROM from the CERHR (National Institute of Environmental Health Sciences, P.O. Box 12233, MD EC-32, Research Triangle Park, NC; fax: 919-316-4511).

Journal Article↗

PubMed2003

NTP-CERHR Monograph on the Potential Human Reproductive and Developmental Effects of 2-Bromopropane (2-BP).

The National Toxicology Program (NTP) Center for the Evaluation of Risks to Human Reproduction (CERHR) conducted an evaluation of the potential for 2-bromopropane to cause adverse effects on reproduction and development in humans. 2-Bromopropane was selected for evaluation due to documented evidence of worker exposures and published evidence of reproductive toxicity in both rodents and humans. 2-Bromopropane may be used as an intermediate in the synthesis of pharmaceuticals, dyes, and other organic chemicals. In Asia, 2-bromopropane was also used as a replacement for chlorofluorocarbons and 1,1,1-trichloroethane, and is used as a solvent/cleaner for microelectronics. The results of this evaluation on 2-brompropane are published in a NTP-CERHR monograph which includes: 1) the NTP Brief, 2) the Expert Panel Report on the Reproductive and Developmental Toxicity of 2-Bromopropane, and 3) public comments received on the Expert Panel Report. As stated in the NTP Brief, the NTP reached the following conclusions regarding the possible effects of exposure to 2-bromopropane on human development and reproduction. No data were available on environmental exposure of the general public to 2-bromopropane. However, occupational exposure data indicate workplace exposures to 2-bromopropane range from </=0.004- 1.35 ppm. Conclusions were based on the available occupational exposure data and on studies in humans and laboratory animals. First, there is some concern for adverse reproductive effects when people are exposed to concentrations of 2-bromopropane at the high end of the occupational exposure range, and minimal concern at the low end of the exposure range. These conclusions are supported by toxicity in rats at 100 ppm exposures and adverse reproductive effects in occupationally exposed humans. Second, there is insufficient evidence to assess the developmental effects of 2-bromopropane exposure. These conclusions are based on occupational exposure data which do not account for dermal contact with 2-bromopropane. NTP-CERHR monographs are transmitted to federal and state agencies, interested parties, and the public and are available in electronic PDF format on the CERHR web site (http://cerhr.niehs.nih.gov) and in printed text or CD-ROM from the CERHR (National Institute of Environmental Health Sciences, P.O. Box 12233, MD EC-32, Research Triangle Park, NC; fax: 919-316-4511).

Journal Article↗

PubMed2004

NTP-CERHR Monograph on the Potential Human Reproductive and Developmental Effects of Ethylene Glycol.

The National Toxicology Program (NTP) Center for the Evaluation of Risks to Human Reproduction (CERHR) conducted an evaluation of the potential for ethylene glycol (EG) to cause adverse effects on reproduction and development in humans. EG was selected for evaluation due to recent toxicity and occupational exposure information and widespread exposure in the general public. EG is a small, hydroxy-substituted hydrocarbon used as a chemical intermediate in the production of polyester compounds. It is also found in automotive anti-freeze, industrial coolants, hydraulic fluids, and windshield deicer fluids. The results of this evaluation on EG are published in a NTP-CERHR monograph which includes: 1) the Expert Panel Report on the Reproductive and Developmental Toxicity of Ethylene Glycol, 2) the NTP Brief, and 3) public comments received on the Expert Panel Report. As stated in the NTP Brief, the NTP reached the following conclusions regarding the possible effects of exposure to EG on human development and reproduction based on the conclusions of the NTP-CERHR Expert Panel Report and the public comments received on that report. These conclusions concurred with those of the expert panel. First, although EG could possibly affect human development if exposures are sufficiently high, there is negligible concern for developmental effects in humans at current proposed/estimated exposure levels. There is no direct evidence that exposure of people to EG adversely affects reproduction or development, but studies reviewed by the expert panel show that oral exposure to high doses of EG can adversely affect development in mice and rats. These studies indicate doses that exceed saturation of the glycolic acid metabolism are needed to produce developmental toxicity. Proposed exposure scenarios constructed by the expert panel and current proposed/estimated exposure levels suggest that human exposures are at least 100- to 1000-fold lower than the dose expected to result in metabolic saturation in humans (estimated at 125 mg/kg body weight). Second, there is negligible concern for reproductive effects in humans. Studies evaluated by the expert panel showed that, at high exposure levels, there is no evidence of adverse reproductive effects in mice or rats. NTP-CERHR monographs are transmitted to federal and state agencies, interested parties, and the public and are available electronically in PDF format on the CERHR web site (http://cerhr.niehs.nih.gov) and in printed text or CD-ROM from the CERHR (National Institute of Environmental Health Sciences, P.O. Box 12233, MD EC-32, Research Triangle Park, NC; fax: 919-316-4511).

Journal Article↗

PubMed1991

The female reproductive cycle: new variations on an old theme.

Understanding the female reproductive cycle is the essence of the practice of reproductive medicine. This article reviews important publications that shine new light on the female reproductive cycle. Menstrual dysfunction can begin at adolescence and persist throughout the reproductive years. Adolescent women with menstrual dysfunction should be evaluated and treated. Approximately 30% of pregnancies terminate in abortion during the first trimester. New epidemiologic data on the etiology of spontaneous abortion are reviewed. Advancing age is associated with a decline in fecundity. Delay in childbearing and advances in assisted reproductive technologies have enabled reproductive endocrinologists to better understand the effects of advancing age on reproductive function. The most important paper that we received supports the timing of breast cancer to the luteal phase of the menstrual cycle. There was a statistically significant increase in 10-year survival in women who had surgery during the luteal phase compared with the follicular phase.

Abortion, Spontaneous↗

PubMed1989

Hormonal evaluation of female infertility and reproductive disorders.

Performance of the male and female reproductive systems reflects the orderly operation of the hypothalamic-pituitary-gonadal axis. Aberrant operation of this axis can result in many different reproductive disorders, including various forms of infertility. Proper evaluation of these disorders involves a multifaceted diagnostic approach, which includes a critical contribution from the clinical laboratory. This adjunctive testing, involving the measurements of peptide and sex-steroid hormone concentrations, allows the clinician to biochemically "dissect" the hypothalamic-pituitary-gonadal axis and ascertain the presence as well as location of the specific defect. In practice, the specific tests utilized during the evaluation of a patient depend upon the underlying disorder. Typically, in evaluating the reproductive disorders discussed in this review, a primary battery of tests is obtained that reflects the initial clinical presentation and physical examination. The results of these initial studies then dictate any secondary testing required to complete the evaluation. Such an approach, in use at our institution, is provided in Table 5. Although this discussion has concentrated on the laboratory assessment of the female reproductive system, it is important to remember the special case of infertility, where couples, in general, are evaluated together by the clinician. The cause of infertility can reside with the female, the male, or, in the cases of immunological "incompatibilities," a combination of the male and the female. As such, rigorous schemes for evaluating male reproductive disorders (1, 3, 89-94) and immunological incompatibilities (95-98) have been developed, and the information derived from such testing represents a critical contribution to establishing the etiology of a couple's infertility. Although the laboratory assessment of peptide and sex-steroid hormone concentrations clearly plays a pivotal role in the evaluation of reproductive disorders, these diagnostic tools probably will continue to change and improve in the years to come. Such changes will probably occur as the finer details of the operation of the hypothalamic-pituitary-gonadal axis become known. With this improved knowledge, we should have the capacity to design assays that will allow more clinically refined and biochemically precise means of diagnosing and treating specific reproductive disorders.

Adult↗

PubMed1988

[Developmental trends in reproduction medicine].

In the last few years reproductive medicine has developed into a medical research field of its own. It deals with the theoretical and practical problems of human reproduction and is characterized by close cooperation between medical and scientific specialists both clinically and in research. Far-reaching social effects arise from the application of hitherto unknown research and treatment methods. The results of research in reproductive medicine led, due to the development of effective contraceptives, to a reduced connection between sexual intercourse and reproduction, and have made possible reproduction even without sexual intercourse, by means of artificial insemination and in-vitro fertilization. These latest and most exciting developments in reproductive medicine are based on and justified by the right of every couple to a child of their own. In-vitro fertilization and related treatments, eg. gamete intrafallopian transfer, are expected to dominate the treatment of the sterile couple in future. The social effects of the new techniques in reproductive medicine nessecitate the development of ethical standpoints, in which human welfare must predominate. In the GDR, in accordance with the recommendations of the "Ethics in medicine" working group, in-vitro fertilization using gametes of the same couple is ethically accepted, as is also oocyte and embryo donation, provided they aim to fulfil a couple's wish for a child. Surrogate mothers are rejected, however. The combination of in-vitro fertilization and genetic engineering could potentially be used in the treatment of certain types of hereditary disease, but there is also the possibility of misuse.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed1986

[Is the postmenopausal-age-at-death variable a fitness-maximizing reproductive strategy?].

On the basis of the complete 18th century vital statistics available for 811 women from Ostfriesland (Germany), an attempt is made to examine the relationship between the postmenopausal age at death and the reproductive behaviour (reproductive effort and reproductive management). Although reproductive activities appeared to have a basically life-shortening effect in the population under study, this was independent of the amount of reproductive effort. The positive correlation reported in the literature to exist between the number of (surviving) children and the age at death was confirmed in our analysis; and it can partly be explained by the interference of another relationship, i.e. between the age at the last parturition and longevity. This correlation is interpreted as an expression of fitness-maximizing reproductive management. To this belongs the idea that the existence of unmarried children, i.e. the sub-optimal social position of one's descendants, had a life-lengthening effect on the women investigated. Whereas the effects found are largely statistically significant, they are on the whole very minor, so that we may surmise that only a small part of the total variance of the postmenopausal age at death can be interpreted as an expression of an adaptive reproductive strategy.

Female↗

PubMed1986

[Perspectives of reproductive medicine].

The physiology and pathology of human reproduction constitute the main focus of "reproductive" medicine, the major tasks of which lie in the treatment of infertile couples and in birth control. The current relevance of research into human reproduction is illustrated by the population explosion in developing countries, the high rate of abortion in industrialized nations and the technical and ethical implications of in vitro fertilization. Since the complex phenomenon of reproduction can only be elucidated through the cooperation of many disciplines, reproductive medicine is a truly interdisciplinary field. Dermatology also plays a role in reproductive medicine via andrology, a subspecialty of dermatology. However, in contrast to the worldwide trend, in Germany andrology is showing signs of stagnation. Only if andrology gains in strength and does not isolate itself, will it be in a position to contribute to solving the urgent problems involved in reproductive medicine.

Birth Rate↗

PubMed1983

Ethanol-induced male reproductive tract pathology as a function of ethanol dose and duration of exposure.

Chronic ethanol ingestion by the male results in several manifestations of reproductive dysfunction. However, little is known concerning 1) the level of ethanol or duration of ethanol exposure necessary to produce pathological changes in the male reproductive tract; or 2) mechanism(s) by which ethanol exerts its toxic effects. The purpose of the present study was to develop an animal model which describes ethanol-induced male reproductive failure and to define conditions of ethanol exposure which alter male reproductive tract function. Proven breeder male C57Bl/6J mice were maintained on either a 5% (v/v) ethanol liquid diet for periods of 5, 10 or 20 weeks or a 6% (v/v) ethanol diet for 5 weeks. Daily blood ethanol levels peaked at 125 to 200 and 268 mg/100 ml in animals consuming the 5 and 6% ethanol diets, respectively. Plasma testosterone levels were depressed throughout all treatments, an effect which appeared reversible. Plasma testosterone was poorly correlated (r = 0.28) with blood ethanol levels during treatment. After treatment, reproductive tract pathology included reduced testicular and accessory sex organ weights, decreased spermatogenesis, increased desquamation of immature germ cells into the seminiferous tubule lumina and increased frequency of inactive seminiferous tubules. Whereas minimal changes were noted after 5 weeks treatment with the 5% ethanol diet, deficiencies became increasingly evident after either longer exposure periods or treatment with 6% ethanol for the same period. None of the treatment regimens resulted in altered plasma levels of hepatic enzyme markers or in altered histological appearance. The data indicate that male reproductive function is sensitive to both ethanol dose and duration of exposure. The animal model described in the present study should have utility in the evaluation of putative mechanisms of ethanol-induced male reproductive dysfunction.

Alcoholism↗

PubMed2002

From asexual to eusocial reproduction by multilevel selection by density-dependent competitive interactions.

A game theoretical model is developed to illustrate that multilevel selection by density-dependent competitive interactions in mobile organisms might have played a major role in the evolutionary transitions from asexual over sexual to eusocial reproduction. The model has four equilibria with selection occurring among interacting units of respectively one, two, three, and up to infinitely many individuals. The different equilibria are characterised by different levels of competitive interactions among interacting units, and these levels select for different levels of sexual and co-operative reproduction among the individuals of the units. The model predicts: (i) that low-energy organisms with negligible body masses have asexual reproduction; (ii) that high-energy organisms with non-negligible body masses in evolutionary equilibria have sexual reproduction between a female and a male; (iii) that high-energy organisms with non-negligible body masses that increase exponentially at an evolutionary steady state have co-operative reproduction between a sexual pair and a single sexually produced offspring; and (iv) that high-energy organisms with upward constrained body masses have eusocial reproduction between a sexual pair and up to an infinite number of sexually produced offspring workers.

Animals↗

PubMed2005

Reproductive biology in the era of genomics biology.

Current and emerging technologies in reproductive biology, including assisted reproductive technologies and animal cloning, are discussed in the context of the impact of genomics era biology. The discussion focuses on the endocrinology associated with establishment and maintenance of pregnancy, fetal-placental development, lactation, and neonatal survival. Various aspects of uterine biology, including development during the neonatal period and function in adult females, are discussed with respect to reproductive efficiency. It is clear that combining strategies for use of conventional animal models for studying the reproductive system with new genomics technologies will provide exceptional opportunities in discovery research involving data integration and application of functional genomics to benefit animal agriculture and the biomedical community. New and emerging biotechnologies and comparative genomics approaches will greatly advance our understanding of genes that are critical to development of the reproductive system and to key events at each stage of the reproductive cycle of females and males.

Agriculture↗

PubMed1994

Complications of assisted reproductive techniques.

OBJECTIVE: To review and appreciate the relevant data on assisted reproduction techniques and their potential complications. DATA RESOURCES: Major publications on assisted reproduction that include the information concerning complications associated with this practice. RESULTS: Assisted reproduction is a common practice in modern reproductive medicine. Complications are associated with ovulation induction and the extracorporeal methods that are used for IVF-ET, GIFT, and zygote intrafallopian transfer (ZIFT). These complications are associated with laparoscopy, anesthesia, oocyte retrieval, and laboratory facilities. Pregnancies resulting from assisted reproduction are more complicated than spontaneous pregnancies. There are higher rates of ectopic, heterotopic, and multifetal pregnancies; abortions; and premature deliveries. Increased rates of perinatal mortality and morbidity result from prematurity, and higher rates of maternal diseases in pregnancy (preeclampsia, diabetes mellitus, bleeding, anemia) contribute to fetal intra-uterine growth restriction and maternal morbidity. CONCLUSIONS: Assisted reproduction practice should be well controlled in view of the potential for complications before and during pregnancies.

Embryo Transfer↗

PubMed2004

Epidemiology of male reproductive function: a field searching for tools.

BACKGROUND: An increase in the frequency of disorders of the male human reproductive organs has been described over recent decades. Neither its causes nor its consequences on fecundity, the ability of the couples to produce a live child, are clearly known. This lack of knowledge may partly be due to methodological difficulties specific to reproductive epidemiology. METHODS: We discuss the relevance and limits of some markers of the male aspects of human reproduction, focusing on semen parameters and fecundability, a measure of the probability of pregnancy. RESULTS: Semen parameters are associated with fecundability, although they have a relatively low sensitivity to detect couples with low fecundability. The study of semen parameters proved central to describe the influence of environmental factors on the male side of reproductive function. The main limitation of semen studies is low participation rates and the possible selection biases ensuing. Fecundability can be estimated by collecting waiting time to pregnancy. Its assessment in retrospective studies often excludes the least fecund, those couples remaining childless, which entails a bias and a decrease in statistical power. The prospective approach and an approach relying on the enrollment of a cross-sectional sample of the couples currently trying to obtain a pregnancy (current duration approach) do not have these limitations. Although it has never been used, the assessment of fecundability using the current duration approach is promising both for aetiologic research and monitoring. CONCLUSION: Most of the potential markers of male reproductive function are not assessed in the general population of France, with the exception of the incidence rate of testis cancer, which is currently increasing. We present some alternatives for a monitoring system of reproductive function.

Adult↗

PubMed2004

Ten years of democracy in South Africa: documenting transformation in reproductive health policy and status.

The advent of democracy in South Africa in 1994 created a unique opportunity for new lows and policies to be passed. Today, a decade later, South African reproductive health policies and the laws that underwrite them are among the most progressive and comprehensive in the world in terms of the recognition that they give to human rights, including sexual and reproductive rights. This paper documents the changes in health policy and services that have occurred, focusing particularly on key areas of sexual and reproductive health: contraception, maternal health, termination of pregnancy, cervical and breast cancer, gender-based and sexual violence, HIV/AIDS and sexually transmitted infections and infertility. Despite important advances, significant changes in women's reproductive health status are difficult to discern, given the relatively short period of time and the multitude of complex factors that influence health, especially inequalities in socio-economic and gender status. Gaps remain in the implementation of reproductive health policies and in service delivery that need to be addressed in order for meaningful improvements in women's reproductive health status to be achieved. Civil society has played a major role in securing these legislative and policy changes, and health activist groups continue to pressure the government to introduce further changes in policy and service delivery, especially in the area of HIV/AIDS.

Democracy↗