Prevention of multiple pregnancy

Abstract Monozygotic twins are two individuals derived from one sperm and one egg; dizygotic twins are individuals born together but originating from different eggs fertilized by different sperms. Dizygotic twinning rates vary in different populations but have risen in the last 30 years on account of ovarian stimulation and the increasing tendency to postpone childbearing. Iatrogenic ovarian stimulation induces the simultaneous growth of multiple follicles leading to the ovulation of more than one egg and hence multiple fertilization. Milder forms of ovarian stimulation in intrauterine insemination (IUI) cycles and the choice of single embryo transfer (SET) for in vitro fertilization (IVF) cycles help prevent iatrogenic twinning. The risk of dizygotic twinning linked to postpone childbearing and the higher follicle-stimulating hormone (FSH) concentration poorly controlled by an older ovary is harder to change in the short term. As increasing number of women delay reproduction, for understandable social reasons, the ovarian/pituitary system in women older than 25 generates 5–8 additional twins per 1000 births every additional year of age. A new social strategy to encourage reproduction in young couples would be needed to influence the current widespread tendency

Postmenopausal bone loss : prevention and replacement

Osteoporosis is a skeletal disorder predominantly affecting postmenopausal women. Combination therapy of Carbocalcitonin (Elcatonin) and oral conjugated oestrogens (Premarin) not only prevents postmenopausal bone loss but leads to an increase in bone mass in normal early postmenopausal women. The aims of the study was to investigate the effect of combination therapy. A combination of Elcatonin (Carbo calcitonin) and Premarin was compared to Premarin alone, and to Elcatonin (Carbocalcitonin) alone and all groups were then compared to a control group.peer-reviewe

Progestogens for endometriosis : forward to the past

We performed a MEDLINE and EMBASE search to identify all studies published in the last decade in the English language literature on the use of progestogens for the treatment of endometriosis. Our aim was to clarify the biological rationale for treatment and define the drugs that can be used with their doses, routes of administration, efficacy and tolerability. Progestogens may prevent implantation and growth of regurgitated endometrium inhibiting expression of matrix metalloproteinases and angiogenesis, and they have several anti-inflammatory in-vitro and in-vivo effects that may reduce the inflammatory state generated by the metabolic activity of the ectopic endometrium, and the consequent immune response. Oral contraceptives increase the abnormally low apoptotic activity of the endometrium of women with endometriosis. Moreover, anovulation, decidualization, amenorrhoea and the establishment of a steady estrogen-progestogen milieu contribute to disease quiescence. Progestogens are effective in the control of pain symptoms in approximately three out of four women with endometriosis. Their effect does not seem to be inferior to that of other drugs used for the disease. Different compounds can be administered by the oral, intramuscular, subcutaneous, intravaginal or intrauterine route, each with specific advantages or disadvantages. Medical treatment plays a role in the therapeutic strategy when administered over a prolonged period of time. Given their good tolerability, minor metabolic effects and low cost, progestogens must therefore be considered drugs of choice and are currently the only safe and economic alternative to surgery. However, their contraceptive effectiveness limits their use to women who do not wish to have children in the short term

Variational Approach to the Modulational Instability

We study the modulational stability of the nonlinear Schr\"odinger equation (NLS) using a time-dependent variational approach. Within this framework, we derive ordinary differential equations (ODEs) for the time evolution of the amplitude and phase of modulational perturbations. Analyzing the ensuing ODEs, we re-derive the classical modulational instability criterion. The case (relevant to applications in optics and Bose-Einstein condensation) where the coefficients of the equation are time-dependent, is also examined

Effect of the ethinylestradiol/norelgestromin contraceptive patch on body composition. Results of bioelectrical impedance analysis in a population of Italian women

<p>Abstract</p> <p>Background</p> <p>As weight gain is one of the most frequently cited reasons for not using and for discontinuing hormonal contraceptives, in an open-label, single-arm, multicentre clinical study we evaluated the effect of the ethinylestradiol/norelgestromin contraceptive patch (EVRA, Janssen-Cilag International, Belgium) on body composition using bioelectrical impedance analysis (BIA).</p> <p>Methods</p> <p>Body weight and impedance vector components (resistance (R) and reactance (Xc), at 50 kHz frequency, Akern-RJL Systems analyzer) were recorded before entry, after 1, 3 and 6 months in 182 Italian healthy women aged 29 yr (18 to 45), and with BMI 21.8 kg/m²(16 to 31). Total body water (TBW) was estimated with a BIA regression equation. Vector BIA was performed with the RXc mean graph method and the Hotelling's T²test for paired and unpaired data.</p> <p>Results</p> <p>After 6 months body weight increased by 0.64 kg (1.1%) and TBW increased by 0.51 L (1.7%). The pattern of impedance vector displacement indicated a small increase in soft tissue hydration (interstitial gel fluid). Body composition changes did not significantly differ among groups of previous contraceptive methods. Arterial blood pressure did not significantly change over time.</p> <p>Conclusion</p> <p>After 6 months of treatment with the ethinylestradiol/norelgestromin contraceptive patch we found a minimal, clinically not relevant, increase in body weight less than 1 kg that could be attributed to an adaptive interstitial gel hydration. This fluctuation is physiological as confirmed by the lack of any effect on blood pressure. This could be useful in increasing women's choice, acceptability and compliance of the ethinylestradiol/norelgestromin contraceptive patch.</p

Management of hyperprolactinemic infertility

Pathological hyperprolactinemia may cause defective ovulation and reduced fecundability. Abnormal prolactin (PRL) secretion is usually related to an idiopathic hypothalamic dysfunction or to the presence of a pituitary adenoma. The use of medication is the most common cause of functional hyperprolactinemia. Pituitary prolactin secreting adenoma is classified according to size: micro (the vast majority) being smaller than 10 mm in diameter or macroprolactinoma (very few) of larger size. An excessive PRL secretion decreases the pulsatile release of GnRH impairing the pituitary production of FSH and LH. Furthermore it may directly impair the endocrine activity of ovarian follicles. As a consequence: defective luteal phase, inconstant ovulation and chronic anovulation are conditions frequently observed in young hyperprolactinemic patients. In addition 5% of unselected, asymptomatic infertile women show hyperprolactinemia. In such patients fertility may be promoted with long-term use of dopaminergic drugs. The normalized PRL level induced by the treatment allows the occurrence of spontaneous ovulatory cycles or the normalization of the defective luteal phase. Treatment should be continued for at least one year since half of the pregnancies occurring during dopaminergic therapy start after the first 6 months of drug assumption. An ovarian stimulation with gonadotropin and the pulsatile administration of GnRH may also induce ovulatory cycles and fertility in the infertile hyperprolactinemic patients. Hyperprolactinemia either, due to hypothalamic dysfunction, as well as the presence of PRL secreting adenoma usually improves after delivery

Good oocytes for successful IVF cycles

Human fertility is mainly related to the egg quality both in spontaneous and IVF induced cycles