Future Fertility (future + fertility)

Distribution by Scientific Domains

Selected Abstracts

Bilateral Tubal Ectopic Pregnancy: A Tale of Caution

Mary T. Ryan MD
Abstract. Diagnosis of ectopic pregnancy continues to be an important challenge facing emergency physicians. The authors present a case of bilateral tubal ectopic pregnency and discuss its clinical features and diagnositc difficulties. A review of the English-language literature on the subject is discussed. Suggestions are made on ways to increase diagnostic accuracy, reduce complications, and preserve future fertility in this group of patients. [source]

The hypothalamus-pituitary-testis axis in boys during the first six months of life: a comparison of cryptorchidism and hypospadias cases with controls

Frank H. Pierik
Summary It is inconclusive whether the feedback mechanisms of the hypothalamus-pituitary-testis (HTP) axis are already established in the first 6 months of life, partly due to the dramatic changes in HPT-axis hormone levels over this period. Moreover, it is unclear whether these hormone levels are aberrant in boys with cryptorchidism or hypospadias, and therefore predictive for future fertility. We studied the regulation mechanisms of the HTP axis, and the effect of age, in boys 1,6 months of age. Secondly, we studied testicular function - as reflected by HPT hormones - in newborns with cryptorchidism or hypospadias. Sera from a population sample of infants with cryptorchidism (n = 43), hypospadias (n = 41) and controls (n = 113) were analyzed for inhibin B, anti-Müllerian hormone (AMH), testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and sex hormone binding globulin (SHBG). LH, testosterone, non-shbg-bound testosterone (NSBT), and AHM levels showed significant age-related trends. After age-correction, a negative correlation between FSH and inhibin B was observed (r = ,0.43). The only significant group-differences were lower testosterone and NSBT levels in cryptorchidism cases, with a mean testosterone of 1.8 and 2.6 nmol/L and a mean NSBT of 0.48 and 0.70 nmol/L for cryptorchidism cases and controls, respectively. The higher levels of LH, testosterone, and NSBT in boys born pre-term or with a low birthweight indicate that abnormal prenatal development may determine postnatal testis function. Our results support the hypothesis that the inhibin B , FSH feedback loop is already functional before puberty. The lower testosterone and NSBT levels indicate that disturbed Leydig cell function can already be detected early after birth in cryptorchid boys. [source]

The role of males in the dynamics of ungulate populations

Atle Mysterud
Summary 1In this review, we focus on how males can affect the population dynamics of ungulates (i) by being a component of population density (and thereby affecting interpretation of log-linear models), and (ii) by considering the mechanisms by which males can actively affect the demographic rates of females. 2We argue that the choice of measure of density is important, and that the inclusion or exclusion of males into models can influence results. For example, we demonstrate that if the dynamics of a population can be described with a first-order auto-regressive process in a log-linear framework, the asymmetry between the effects of females on the male dynamics and vice versa can introduce a second order process, much in the same way that the interaction between disease and host or predator and prey can. It would be useful for researchers with sufficient data to explore the affects of using different density measures. 3In general, even in harvested populations with highly skewed sex ratios, males are usually able to fertilize all females, though detailed studies document a lower proportion of younger females breeding when sex ratios are heavily female biased. It is well documented that the presence of males can induce oestrus in females, and that male age may also be a factor. In populations with both a skewed sex ratio and a young male age structure, calving is delayed and less synchronous. We identify several mechanisms that may be responsible for this. 4Delayed calving may lower summer survival and autumn masses, which may lead to higher winter mortality. If females are born light, they may require another year of growth before they start reproducing. Delayed calving can reduce future fertility of the mother. As the proportion of calves predated during the first few weeks of life is often very high, calving synchrony may also be an important strategy to lower predation rates. 5We argue that the effects of males on population dynamics of ungulates are likely to be non-trivial, and that their potential effects should not be ignored. The mechanisms we discuss may be important , though much more research is required before we can demonstrate they are. [source]

Three-dimensional ultrasonographic diagnosis and hysteroscopic management of a viable cesarean scar ectopic pregnancy

Sebiha Özkan
Abstract Implantation of conception material within a cesarean section scar is an extremely rare form of ectopic pregnancy with devastating complications, such as uterine rupture and intractable bleeding. Both 2-D and 3-D transvaginal ultrasonographic devices are used adequately for precise diagnosis, but there is still a lack of consensus concerning management strategies. No therapeutic modality is suggested to be entirely efficacious and safe for preserving uterine integrity. We present here a 29-year-old woman with vaginal bleeding and a gestational sac with a viable embryo of 6 weeks of age that was implanted in a cesarean section scar. Serum ,-hCG levels were 16 792 mIU/mL. Following an unsuccessful treatment course of systemic methotrexate, the patient underwent operative hysteroscopy. Minimally invasive hysteroscopic resection of the ectopic gestational mass without major complication appears to be an alternative therapeutic approach with minimal morbidity and preservation of future fertility. [source]

Retained intrauterine fetal bone as a rare cause of secondary infertility

Retention of intrauterine fetal bone is a rare cause of secondary infertility that should be considered when ultrasound demonstrates strongly shadowing echodensities in the endometrial space. It seems that the bone acts as an intrauterine contraceptive device as long as it is present in the cavity. Hysteroscopy is both diagnostic and therapeutic, with a generally good prognosis for future fertility in the absence of coexisting factors. [source]

Relationship between adult dark spermatogonia and secretory capacity of Leydig cells in cryptorchidism

Dragana Zivkovic
In a paper from Switzerland, the authors describe the relationship between adult dark spermatogonia and the secretory capacity of Leydig cells in cryptorchidism. OBJECTIVE To examine whether hormonal therapy before orchidopexy affects the histology of the testis and to assess the responsiveness of the Leydig cells, as it has been shown that although basal plasma testosterone levels are within the ,normal' range in cryptorchid boys there is an insufficient increase of testosterone after a human chorionic gonadotrophin (hCG) stimulation in ,,30% of cryptorchid boys. PATIENTS AND METHODS In all, 55 boys (aged 1,7 years) with a unilateral undescended testis were included in the study and divided into two groups. Group I (32 boys) received hormonal therapy before orchidopexy; 17 boys received a long-acting LHRH analogue (buserelin) administered as a nasal spray in doses of 20 µg/day for 28 days, followed by 1500 IU hCG intramuscularly (i.m.) once a week for 3 weeks, and the remaining 15 received 1500 IU hCG i.m. once a week for 3 weeks. Group II (33 boys) had orchidopexy alone. During orchidopexy biopsies were taken from the undescended and contralateral descended testes of the boys in both groups for histological analyses. Variations in the number of adult dark (Ad) spermatogonia per tubule (Ad/T) were assessed and testosterone levels were measured during the course of the hormonal therapy (before treatment, 14 days after initiation of buserelin administration, 24 h after each hCG injection, and 3 months after cessation of therapy). RESULTS In group I, 17 boys (53%) had a ,normal' Ad/T after hormonal treatment vs only six (18%) in group II after orchidopexy alone (P = 0.019). In the hormonally treated boys (group I) we compared the testosterone values 24 h after the second injection of hCG (when the response was most pronounced). Those with a normal Ad/T had a mean (sd) testosterone level of 199.5 (97.6) ng/dL vs 99.6 (85) ng/dL in those with an inadequate Ad/T response to hormonal therapy (P < 0.003). CONCLUSION We have confirmed that there are two subgroups of cryptorchid boys. Patients with a sufficient Leydig cell secretory capacity will have normal testicular histology and Ad spermatogonia count after hormonal treatment. While those with a suboptimal Leydig cell capacity will have a low Ad spermatogonia count and consequently poor prognosis for future fertility, despite successful surgery. As to whether different types and durations of the hormonal therapy in patients with impaired Leydig cell response could lead to improved testicular histology and consequently improved prognosis for future fertility, remains to be answered. [source]