International journal of fertility and menopausal studies最新文献

{"title":"Contraception for women with health problems.","authors":"S L Corson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Investigational data collected during FDA-monitored clinical trial stem from populations that are sharply defined so as to exclude commonly encountered clinical pathology. This is certainly the case with testing of new contraceptive agents in which patients with obesity, hypertension, altered glucose metabolism, and various endocrine disorders are screened out. What happens in the real world of clinical practice when these patients seek contraceptive counseling? This article examines some of these everyday occurrences.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"77-84"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19797357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary women's health centers--a viable option?","authors":"S P Levison","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The recognition that women's health encompasses more than reproductive health has led to changes in research and education, and a reexamination of health care delivery to women. Examination of care offered by traditional obstetrical/gynecological practices, besides those of internists and general medicine practitioners, reveals that the care of women is often fragmented. The health care needs of women can be met by an interdisciplinary team approach. The members of the interdisciplinary team include non-physician health care practitioners. Examples of successful models are discussed.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"132-5"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19796934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The connective tissue diseases and the overall influence of gender.","authors":"R G Lahita","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The autoimmune diseases are more common in women than men. The actual prevalence ranges from the high of 10 to 15 females for each male for systemic lupus erythematosus to four females for every male with rheumatoid arthritis. Though these diseases are found in the very young and the aged, the high prevalence is observed after puberty in most patients. These diseases vary with regard to severity, and most investigators suspect that the signs and symptoms of these diseases vary with menstrual cycle and change severity during pregnancy. The collagen diseases are devastating to the health of young women. Rheumatoid arthritis occurring at a mean age of 40 years results in debilitating erosive changes in bone with morning stiffness and eventual crippling. Systemic lupus erythematosus, Sjögren's syndrome and others, common to women of the childbearing years, act in several ways to destroy organ systems of the body. Virtually any organ system of the female anatomy can be affected by these illnesses. In the case of lupus, the disease has protean manifestations, such as procoagulation, renal destruction, skin disease, unrelenting arthropathy and arthritis, and encephalopathy (to name only a few). The underlying mechanisms are not known; however, the immune system acts to destroy tissue via immune complex deposition and through the action of cytotoxic lymphocyte activity. There is an association of both clinical signs and autoantibody subpopulations with markers of the HLA-D or MHC II locus on chromosome 6. No constitutive gene for any of the collagen vascular diseases has been identified in the human. Evidence exists to support an altered metabolism of estrogens and androgens in patients with these diseases. Recent data also indicate that increased estrogen levels might initiate autoimmune diseases in many women and men. Estrogen hydroxylation is increased in both men and women with autoimmune diseases like lupus. The mechanisms are unknown, although estrogenic metabolites have been shown to increase B cell differentiation and activate T cells. Moreover, isolated cases of hyperprolactinemia have been observed in association with these hyperestrogenic states, and treatment of hyperprolactinemia has been shown to ameliorate diseases like lupus. Androgen oxidation is also increased in patients with autoimmune disease, but this abnormality has been observed only in patients with lupus, and only women at that. The result is that women with autoimmune diseases like lupus and rheumatoid arthritis have lower plasma androgens than control cases. These data have supported the use of weak androgens, e.g., DHEA, for the treatment of lupus.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 2","pages":"156-65"},"PeriodicalIF":0.0,"publicationDate":"1996-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19797420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of different HRT regimens on compliance.","authors":"M Dören,&nbsp;H P Schneider","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Epidemiological data strongly suggest a substantial improvement of quality of life for post-menopausal women using hormonal replacement therapy (HRT). Nevertheless, reluctance of women to choose HRT is high. Various attempts to develop regimens with substantially better acceptance are being investigated. Sequential and continuous combined regimens, oral and transdermal routes of administration are available; however, no regimen nor any mode of administration has proven superior with regard to patients' compliance. Research on the specific problems of compliance in HRT has not yet offered solutions to the medical community about optimal conditions concerning long-term hormonal therapy. Unless metabolic profiles of the various modes of treatment are defined in long-term trials, general recommendations are difficult to justify. As long as the occurrence of uterine bleeding is associated with any concept of HRT in non-hysterectomized women, adherence has been reported to be very low. Persisting endometrial atrophy has not been achieved by any type of HRT. New regimens not stimulating endometrial growth are essential, since women in most cultures do not accept uterine bleeding after cessation of ovarian function. Educational programs should be developed to inform women about the physiology of menopause in general and the rationale of HRT. The occurrence of uterine bleeding due to the present types of HRT needs to be specifically addressed. Risk-benefit assessments are to be explained to patients to reach an informed decision on HRT, and fears of women about actual or alleged negative metabolic impacts of HRT need to be discussed.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 1","pages":"29-39"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19648400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of computer-assisted semen analysis and sperm function testing in an IVF program.","authors":"N Joshi,&nbsp;G Kodwany,&nbsp;D Balaiah,&nbsp;M Parikh,&nbsp;F Parikh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To study the relationship of sperm motion characteristics, sperm morphology, and hypo-osmotic swelling test with fertilization rates in vitro.</p><p><strong>Design: </strong>Computer-assisted measures of fresh seminal and processed sperm preparations, sperm morphology, and hypo-osmotic swelling test results were assessed for predicting fertilization by step-wise regression analysis.</p><p><strong>Settings: </strong>In vitro fertilization laboratory, department of infertility management, university affiliated-hospital.</p><p><strong>Interventions: </strong>None.</p><p><strong>Patients: </strong>One hundred and two couples who underwent IVF were studied.</p><p><strong>Main outcome measures: </strong>Computer-assisted sperm motion variables in semen and following semen processing in capacitating media; hypo-osmotic swelling of sperm tails before and after semen processing; morphology of sperm before and after processing; fertilization of oocytes as evidenced by presence of two pronuclei as the end point.</p><p><strong>Results: </strong>Various sperm motion parameters, hypo-osmotic swelling test results, and normal morphology of sperm were directly correlated to fertilization as judged by the Karl-Pearsons test. However, in step-wise regression analysis, normal morphology of sperm from seminal fraction exhibited 61% correlation with fertilization rates (P < .001). In step 2, normal morphology along with percent motility exhibited a 64% correlation with fertilization rates (P < .001). In step 3, normal morphology, percent motility, and linearity showed a 67% correlation with fertilization rates (P < .001). The hypo-osmotic swelling test did not predict fertilization rates (regression coefficient = 0.066, P = 0.474). In the processed sample preparations, normal sperm morphology showed a 72% correlation with fertilization rate (P < .001). In step 2, normal morphology along with curvilinear velocity exhibited a 77% correlation with fertilization rates (P < .001). In step 3, normal morphology, curvilinear velocity, and average path velocity showed a 79% correlation with fertilization rates (P < .001). The hypo-osmotic swelling test did not predict fertilization rates (regression coefficient = 0.076, P = 0.512).</p><p><strong>Conclusions: </strong>Morphology of sperm and computer-assisted sperm motion variables, such as motility, linearity, curvilinear velocity, and average path velocity, may serve as prognostic indicators for fertilization potential of sperm. The hypo-osmotic swelling test may describe only physiological intactness, rather than the fertilization potential of sperm. The results suggest that objective analysis of sperm motion characteristics and precise sperm morphology may form a first, and obligatory, step for critical evaluation of patients before they start IVF treatment.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 1","pages":"46-52"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19648403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormone replacement therapy: aspects of bleeding problems and compliance.","authors":"G Samsioe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Mitigation of vasomotor symptoms and urogenital problems, along with reductions in osteoporosis and cardiovascular disease, provides the rationale for using hormone replacement therapy (HRT), and the duration of use. However, user surveys have indicated poor compliance with HRT, and that means user time may be less than 12 months, a period unlikely to influence metabolic disorders. The main reasons for discontinuing HRT are unacceptable bleeding pattern and fear of cancer. There is solid evidence that HRT does not increase gynecological, gastrointestinal, or other adenocarcinomas. In fact, the only remaining controversy relates to breast cancer. Since the media often underscore and strengthen \"old wives' tales\" about the menopause and HRT, access to correct, unbiased information is the key to combating the misconceptions about HRT. Information also helps women understand the nature of menstrual-like bleeding, and thus contributes to compliance. Unfortunately, existing formulations do not control the bleeding pattern in every women. Our understanding of spotting and breakthrough bleeding is still poor. Older data, which suggested routine endometrial histology to find the cause and select treatment of vaginal bleeds, have been contradicted, rendering endometrial biopsy less useful in decision making; endometrial ultrasonography seems to be of more value for endometrial surveillance in HRT. Recent advances in understanding the nature and function of growth factors in uterine tissues help to unravel an array of events of importance for explaining the bleeding sometimes encountered during continuous combined therapy. The pharmaceutical industry should be challenged to work closely with scientists and regulating agencies. Doing so will help to advance our knowledge and therapeutic modalities, which will help us to combat the chief cause of poor compliance to, and discontinuation of, a very important potential contributor to maintaining quality of life of elderly women.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 1","pages":"11-5"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19648399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopy in surgical treatment of vaginal aplasia: laparoscopy-assisted colpopoiesis and perineal hysterectomy with colpopoiesis.","authors":"L V Adamian,&nbsp;Z R Zurabiani,&nbsp;S I Kiselev,&nbsp;A Z Khashukoeva","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To optimize methods of surgery in patients with malformations of the genitalia.</p><p><strong>Methods: </strong>Comparative evaluation of effectiveness of reconstructive plastic operations for malformations of uterus and vagina, performed by conventional methods or via laparoscopy.</p><p><strong>Results: </strong>Laparoscopy permits identification of the pelvic peritoneum plus opening it and using the most mobile portion to create the vaginal fornix. In patients with vaginal and cervical aplasia and non-communicating functional rudimentary uterus, laparoscopy assists hysterectomy performed by the vaginal approach, as well as the last step of colpopoiesis.</p><p><strong>Conclusions: </strong>Laparoscopy significantly facilitates the procedure, reduces operating time and risks, and makes the operation available to the wide range of surgeons skilled in laparoscopy.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 1","pages":"40-5"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19648402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemothorax after Lupron therapy of a patient with pleural endometriosis--a case report and literature review.","authors":"M T Margolis,&nbsp;L D Thoen,&nbsp;L J Mercer,&nbsp;L G Keith","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary endometrial implants, although uncommon, have been well described in the literature. Symptoms occur with menses and may include recurrent pleuritic chest pain, pneumothorax, hemoptysis, or hemothorax. Exacerbation of pulmonary symptoms by Lupron therapy has not been previously described.</p><p><strong>Case report: </strong>A 38-year-old African-American female with known endometriosis but no history of pulmonary disease was evaluated for a 2-year history of severe dysmenorrhea. A trial of hormonal suppression was unsuccessful, and she was offered Lupron therapy. Three weeks after its initiation, and shortly after the onset of menses, she came to the emergency room with pleuritic chest pain and shortness of breath and was found to have a right-sided hemopneumothorax. Thoracentesis treatment was successful in eliminating this symptom.</p><p><strong>Conclusion: </strong>Although pulmonary endometriosis is rare, physicians should be aware that Lupron therapy can exacerbate pulmonary symptoms during the initial phase of therapy.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 1","pages":"53-5"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19648353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New birth control options.","authors":"A. Judge","doi":"10.1056/WH200608310000002","DOIUrl":"https://doi.org/10.1056/WH200608310000002","url":null,"abstract":"A US Food and Drug Administration (FDA) Advisory Committee has recommended approving medical abortions using the two-step process involving administration of RU-486 followed by administration of misoprostol and has endorsed the use of oral contraceptives for emergency postcoital contraception. The FDA has recently approved the female condom, which is the first barrier method to protect against sexually transmitted diseases that is controlled by women. Contraceptive options may be further increased as a result of European studies on a 3-month oral contraceptive cycle that allows only 3 or 4 menses per year. This is consistent with what used to occur naturally when women were more often pregnant or nursing.","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 5 1","pages":"445"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58210757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometrial morphology and bleeding patterns as a function of progestogen supplementation.","authors":"D W Sturdee","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Progestogens are added to estrogen replacement therapy for postmenopausal women to prevent endometrial hyperplasia and adenocarcinoma, and in sequential therapy to promote a regular and predictable bleed. This protective effect of progestogens is well recognized, but it is not due to endometrial shedding at a withdrawal bleed and cannot be predicted from the pattern or timing of the bleed. While irregular bleeding may be a reflection of endometrial abnormality and possibly insufficient progestogen, a regular controlled bleed may also occur in the presence of endometrial abnormality. A large multicenter study of postmenopausal women who were taking standard 28-day sequential regimens of estrogen and progestogen found a 2.7% prevalence of complex hyperplasia, and most of these women had a normal and regular bleeding pattern. Regular bleeding may also occur from an atrophic endometrium. Therapy employing a longer cycle with a course of progestogen given every 4 or 4 months may improve patient continuance for long-term therapy. During the estrogen-only phase, the endometrium becomes increasingly proliferative, and simple or cystic hyperplasia may develop only after about 12 weeks, and then can be corrected by progestogen. Women seem to prefer a less frequent withdrawal bleed despite the higher incidence of breakthrough bleeding compared to a monthly loss. Continuous combined therapy with estrogen and progestogen taken every day causes no withdrawal bleed, though some will have light breakthrough bleeding for the initial 2 or 3 months. The continuous progestogen keeps the endometrium atrophic and also converts preexisting complex endometrial hyperplasia occurring during sequential therapy to a normal state. As yet, there are no clinical guidelines that can give reassurance about the state of the endometrium in postmenopausal women who are taking hormone replacement therapy.</p>","PeriodicalId":79342,"journal":{"name":"International journal of fertility and menopausal studies","volume":"41 1","pages":"22-8"},"PeriodicalIF":0.0,"publicationDate":"1996-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19648398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}