Journal of reproductive health and medicine最新文献

Aims

Although we have progressed a long way in performing in vitro fertilization, one hurdle that still remains is the assessment of embryos. The aim of the current paper was to evaluate an embryo selection protocol based on the presence of high implantation potential (HIP) embryos on Day 3 embryo transfer outcomes.

Methods

The analysis of cycles from 6573 IVF cycles in a private fertility clinic was done. Patients included IVF couples having day 3 embryos transferred. Rates of clinical pregnancy, twinning, and high order multiples (HOM) were investigated.

Results

When one or more HIP embryos were present in the cohort, there were no significant differences in clinical pregnancy rates when the decision was made to reduce the scheduled number of embryos to transfer by 1, that is, when comparing 2 embryos transferred with 2 reduced to 1, 3 with 3 reduced to 2, or 4 with 4 reduced to 3. Twinning rates were the same when at least 2 embryos were transferred and high order multiple rates were not different when at least 3 embryos were transferred. The presence of HIP embryos increases the chance of pregnancy when 1–2 embryos are transferred. With 3–4 embryos, the presence or absence of a HIP embryo becomes less of a factor in establishing pregnancy.

Conclusions

Selecting HIP embryos can reduce the number of embryos transferred without adversely affecting pregnancy rates. Their presence is a strong predictor of pregnancy in patients ≤37 years old.

Background

Inequalities in risk of maternal deaths between high and low-income countries and within countries are the widest of any known health indicator. Understanding and addressing the factors underlying these inequalities are crucial for preventing avoidable maternal deaths.

Objective

To examine social and health system factors associated with maternal deaths in Wayanad, a less developed district of Kerala.

Methods

This was a qualitative study using a social autopsy tool covering all maternal deaths that occurred in Wayanad district from January 2010 to June 2011, and in-depth interviews with service providers at different levels.

Results and conclusions

Fourteen (14) of 15 maternal deaths reported during this period were included in the study. Women from the Scheduled Tribes accounted for a majority (64%) of maternal deaths, while constituting only 17% of the district's population. Thirteen of the 14 deaths took place after reaching a health facility.

Interactions between multiple social vulnerabilities (geographic remoteness, poverty, fear of health system and gender norms) and health system factors acted in synergy to compound the negative effects of each other. Geographic distribution of different levels of emergency obstetric care resulted in loss of precious time in receiving emergency care. Failure of Emergency Obstetric Care facilities to perform most of the signal functions of emergency obstetric care, including not stabilizing women before referral was a major factor. The reasons for this failure were as much related to risk-averse attitudes of health providers as to limited availability of personnel, equipments, and supplies.

Investigators from around the world, working for more than 25 years, have contributed to the progress on the paradigm shift on the actions of human chorionic gonadotropin (hCG) and luteinizing hormone (LH). Although many knowledge gaps remain, the paradigm shift has already provided a better understanding of many normal phenomena, several human diseases, and offered many potential new therapies. As all the previous paradigm shifts, this too faced uphill battles. Nevertheless, it is now here to stay and there is no turning back.

Objectives

To evaluate the effectiveness and safety of 2.5, 5 and 10 mg doses of mifepristone against a placebo in women with laparoscopic diagnostic of endometriosis.

Methods

Double-blind, placebo-controlled study of 360 subjects randomly assigned to receive orally one daily tablet of 2.5, 5 or 10 mg mifepristone for 6 month, or 1 daily tablet of mifepristone placebo for 3 months, (90 in each treatment group), carried out at “Eusebio Hernández” Hospital, Havana, Cuba. Efficacy was assessed by measuring changes in prevalence of dysmenorrhea and changes in scores according to AFS. Safety was evaluated by the incidence of hot flushes, nausea, dizzy spells, vomiting, fatigue/tiredness, raised hepatic transaminases, histological alterations of the endometrium.

Results

In the mifepristone groups, the prevalence of symptoms was significantly inferior to those at the beginning of treatment with no significant differences between the groups of 5 and 10 mg, unlike in 2.5 mg of mifepristone and the placebo group. The scores of the AFS were significantly different at the end of the treatment in the mifepristone groups. In the mifepristone groups, there were 9/264 (3.4%) subjects with raised hepatic transaminases up to 99 IU.

Conclusions

Mifepristone 5 mg was safer and more effective than the other mifepristone doses and placebo.

ClinicalTrials.gov Identifier: NCT02271958.

For an over-burdened economy, such as India, reproductive health challenges are enormous to meet population demands. Successive governments through promotion of best policies and practices have reinforced this national priority, but failed to overcome pragmatic impediments even after sixty-eight years post-independence. The link between population dynamics and sustainable development has been jeopardized by a number of structural and social issues. Despite meeting several millennium development goal's target, major reproductive health concerns, such as need for contraception, unsafe abortion services, gender inequality, violence against women, and vulnerability to sexual transmitted diseases including HIV and cancers of the reproductive tract, remain to be vastly improved. Post-2015, a sustainable development agenda presents to India valuable opportunities to not only provide universal reproductive health care but also prioritize efforts to evolve a holistic approach with a strong commitment to discuss, deliberate, and disseminate knowledge and information in reproductive health sciences and medicine.

Very small embryonic-like stem cells (VSELs) were first reported in bone marrow and cord blood. We detected them by immunolocalization studies using polyclonal OCT-4 antibody on human testicular and ovarian cell smears. Cells with nuclear OCT-4A were the VSELs and cytoplasmic OCT-4 was expressed in the immediate descendants, i.e. spermatogonial stem cells and ovary germ stem cells. VSELs are postulated to be primordial germ cells, and during their migration to the gonadal ridge during embryonic development, they also migrate to various somatic organs, serve as a backup pool for tissue-specific adult stem cells to maintain life-long tissue homeostasis, and are also postulated to be the ‘embryonic remnants’ whose uncontrolled proliferation possibly results in cancer. VSELs express receptors for gonadotropin and sex hormones and express OCT-4, CD133, and hCG and thus their presence, differentiation, and uncontrolled proliferation during cancer could explain ubiquitous expression of OCT-4, CD133, hCG and receptors for sex and gonadotropin hormones in various normal and cancerous somatic and gonadal tissues.

This paper is an attempt to analyze the proposed amendment to The Medical Termination of Pregnancy Act, 1971 in the current scenario of reproductive rights and abortion law in India. This is a comparative analysis of abortion laws in India with that of United States, United Kingdom, and South Africa. The paper finds the proposed amendments as radical and gender-sensitive in comparison with its legislative counter parts.

Reproductive disorders and sexual ill-health are a serious global health issue. To address this, substantial research into reproductive systems and processes is currently being conducted. Whilst significant elements of this research are undertaken using human volunteers or in-vitro, studies involving laboratory animals are unavoidable. However, there is a global shortage of researchers with the knowledge and skills to undertake these integrative whole-animal studies, and therefore many countries have invested significant sums in the education and training of the next generation of in-vivo researchers. However, this training is limited, restricted to early career researchers, and does not provide the broader education they require or for their continued professional development. To address this, ETRIS, a free open access repository of e-learning resources was developed. Collectively, the resources within ETRIS can be used to provide education, training, and the continued development of in-vivo researchers at all stages of their career and for the training of Ethical Review Committees.

A brief overview is given of a vaccine that is competent to prevent pregnancy without any disturbance of normal ovulation, normal making of sex steroids, and menstrual regularity. It requires periodic intake and offers full privacy of use to the women. In order to render it reproducible on large scale, it has been made as a recombinant vaccine. To our knowledge, this is the first and only potential Birth Control vaccine at present in the world. This vaccine received the precious support from the International Committee on Contraception Research of the Population Council New York with clinical trials conducted in Finland, Sweden, Chile, and Brazil under eminent clinicians showing its safety and reversibility. Phase II trials in 3 major Institutions showed that it prevents unwanted pregnancy in sexually active women at antibody titers of 50 ng/ml and above. Fertility is regained with decline of antibody titers, and progeny born to previously immunized women is normal developmental land marks and cognitive ability with respect to their siblings.