Environment, human reproduction, menopause, and andropause.

As the hypothalamic gonadotropin-releasing hormone (GnRH) pulse generator is an integrator of hormonal, metabolic, and neural signals, it is not surprising that the function of the hypothalamogonadal axis is subject to the influence of a large array of environmental factors. Before puberty, the central nervous system (CNS) restrains the GnRH pulse generator. Undernutrition, low socioeconomic status, stress, and emotional deprivation, all delay puberty. During reproductive life, among peripheral factors that effect the reproductive system, stress plays an important role. Stress, via the release of corticotropin-releasing factor (CRF), eventually triggered by interleukin 1, inhibits GnRH release, resulting in hypogonadism. Effects of CRF are probably mediated by the opioid system. Food restriction and underweight (anorexia nervosa), obesity, smoking, and alcohol all have negative effects on the GnRH pulse generator and gonadal function. Age and diet are important determinants of fertility in both men and women. The age-associated decrease in fertility in women has as a major determinant chromosomal abnormalities of the oocyte, with uterine factors playing a subsidiary role. Age at menopause, determined by ovarian oocyte depletion, is influenced by occupation, age at menarche, parity, age at last pregnancy, altitude, smoking, and use of oral contraceptives. Smoking, however, appears to be the major determinant. Premature menopause is most frequently attributable to mosaicism for Turner Syndrome, mumps ovaritis, and, above all, total hysterectomy, which has a prevalence of about 12-15% in women 50 years old. Premature ovarian failure with presence of immature follicles is most frequently caused by autoimmune diseases or is the consequence of irradiation or chemotherapy with alkylating cytostatics. Plasma estrogens have a physiological role in the prevention of osteoporosis. Obese women have osteoporosis less frequently than women who are not overweight. Early menopause, suppression of adrenal function (corticoids), and thyroid hormone treatment all increase the frequency of osteoporosis. Aging in men is accompanied by decreased Leydig cell and Sertoli cell function, which has a predominantly primary testicular origin, although changes also occur at the hypothalamopituitary level. Plasma testosterone levels, sperm production, and sperm quality decrease, but fertility, although declining, is preserved until senescence. Stress and disease states accelerate the decline on Leydig cell function. Many occupational noxious agents have a negative effect on fertility.(ABSTRACT TRUNCATED AT 400 WORDS

Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

Abnahme der Spermaqualität bei gesunden Männern aus ungewollt kinderlosen Partnerschaften

In einer retrospektiven Studie wurden Untersuchungs- und Spermiogrammbefunde von 3821 Männern erhoben. Die Daten stammen aus dem Einzugsbereich der Andrologischen Abteilung der Universitätsklinik Leipzig. Es sollte untersucht werden, ob bei Patienten ohne anamnestische oder klinische Befunde eine Verschlechterung der Spermaqualität innerhalb der Untersuchungsjahre 1985 bis 1996 eingetreten ist. Weiterhin sollten Aussagen über eine mögliche Abhängigkeit der Spermiogrammbefunde vom Geburtsjahr gewonnen werden. Innerhalb der Gruppe der 25–34jährigen (n=1650) haben sich von 1985 bis 1996 die absolute Spermienzahl von 195 Mio auf 138 Mio, die Spermienkonzentration von 79,7 auf 52,6 Mio/ml und der Anteil morphologisch normaler Spermien von 64,6% auf 59,6% signifikant (pIn a retrospective study examination- and spermiogram-data were collected from 3821 men. The data came from the vicinity of the andrological department of the Leipzig university-clinic. It should be examined, whether first-examined patients without anamnestic or abnormal clinical findings did show a deterioration of the sperm-quality within the examination-years 1985 to 1996. Furtheron information should be collected concerning a possible dependence of the spermiogram data from the year of birth. Within the group of the 25 to 34 year old men (n=1650) in the time frame from 1985 until 1996 the absolute sperm count of 195 millions changed to 138 millions, the sperm concentration of 79,7 was reduced to 52,6 Mio/ml and the fraction of morphological normal sperm was diminished from 64,6% to 59,6% (all results with