Relative contributions of anovulation and luteal phase defect to the reduced pregnancy rate of breastfeeding women*
|
|
- Dortha Jemimah Bond
- 5 years ago
- Views:
Transcription
1 - FERTILITY AND STERILITY Copyright c() 1992 The American Fertility Society Printed on acid-free paper in U.S.A. Relative contributions of anovulation and luteal phase defect to the reduced pregnancy rate of breastfeeding women* Soledad Diaz, M.D.t:j: Hugo Cardenas, Ph.D.t Astrid Brandeis, B.A.t Patricia Miranda, R.N. II Ana M. Salvatierra, R.N.II Horacio B. Croxatto, M.D.t Ponti/icia Universidad Cat6lica de Chile and Instituto Chileno de Medicina Reproductiva, Santiago, Chile Objective: To evaluate the contribution of anovulation and luteal phase defects to lactational infertility. Design: Prospective longitudinal follow-up. Setting: Outpatient clinic. Subjects: Forty-nine women fully nursing and amenorrheic on day 75 postpartum and 25 cycling, interval non-nursing women. Interventions: Plasma prolactin, luteinizing hormone, estradiol (E 2), and progesterone (P) levels twice a week up to the second postpartum menses. Main Outcome Measures: Ovulation rate and endocrine profile of the menstrual cycles. Results: Ovulation rates were 37% and 97% at 6 and 12 months postpartum; 67% of ovulations occurred in amenorrhea. The luteal phase was shorter, and E2 and P levels were lower in lactating women than in non-nursing women. These parameters were closer to normal in the second cycle than the first, in spite of active nursing. The risk of ovulation and pregnancy in amenorrhea was 27.7% and 0.9% at month 6 postpartum. After the first menses, these risks were 93% and 7%, respectively. Conclusion: The abnormal endocrine profile of the first luteal phase offers effective protection to women who ovulate during lactational amenorrhea within the first 6 months after delivery. Later luteal phases are improved and women are at risk of pregnancy. Fertil Steril 1992;58: Key Words: Breastfeeding, anovulation, luteal phase defect, ovarian function, lactational infertility Lactational amenorrhea is associated with extremely low pregnancy rates (PRs) and the first postpartum cycles of nursing women (1-4) are also Received October 14, 1991; revised and accepted May 5, * Supported by grant from the World Health Organization, Special Programme of Research Development and Research Training in Human Reproduction, Geneva, Switzerland, by grant CB 87.10A/ICCR from the Population Council, and by grant from the Rockefeller Foundation, New York, New York. t Laboratorio de Endocrinologia, Facultad de Ciencias Biologicas. :\: Reprint requests: Soledad Diaz, M.D., Facultad de Ciencias Biologicas, Laboratorio de Endocrinologia, Pontificia Universidad Catolica de Chile, Casilla 114-D, Santiago, Chile. Technician. II Consultorio de Planificacion Familiar, Instituto Chileno de Medicina Reproductiva. associated with decreased fertility. This can be explained by a low incidence of ovulation during the amenorrheic period and the occurrence of anovulatory bleedings or abnormal cycles later on (5-9). Compared with other groups (6,9,10), urban Chilean nursing women experience a relatively high risk of menstruation and ovulation even when they are fully breastfeeding (3). Their risk of pregnancy during amenorrhea is low, but the PR increases rapidly after the recovery of menses (11, 12). This suggests a high incidence of normal ovulatory cycles in spite of nursing. To test this possibility, a longitudinal study was performed to assess the risk of ovulation during the 1st postpartum year before and after the end of amenorrhea, the characteristics of the first postpartum cycles, and their contribution to the pattern of fertility observed during breastfeeding. 498 Diaz et al. Ovarian function and lactational infertility Fertility and Sterility
2 MATERIALS AND METHODS A detailed description of the admission criteria, follow-up procedures, and breastfeeding management has been published (3). The aspects relevant to this report are summarized in the following paragraphs. Characteristics of the Subjects Nursing cases were selected from urban postpartum women who wanted to breastfeed their child for as long as possible. None had a previous history of infertility, irregular menstrual cycles, or endocrine or gynecological pathology before pregnancy. Other criteria for selection were: ages 18 to 38 years, parity 1 to 5, normal pregnancy, vaginal term delivery of a healthy child of normal birth weight, no chronic disease or condition requiring continuous drug therapy, choosing an intrauterine device (IUD) for contraception, * willing to participate in the blood sampiing protocol, and being fully breastfeeding and amenorrheic at day 75 postpartum. Forty-nine of the 96 subjects enrolled during the first postpartum month met these final admission requirements. A contemporary control group was established with 25 non-nursing healthy women of proven fertility, who had not delivered recently, who were within the same age and parity range as the nursing group, and who were using nonhormonal contraceptives (IUDs or sterilization). To compare the risk of ovulation and pregnancy, we used the data obtained in a comparable population of unprotected nursing women who participated in a contemporary study on the contraceptive efficacy of breast feeding (11, 12). These women were selected according to the same biomedical criteria as the study group. They also had a similar socioeconomic status and were followed in the same clinic using comparable follow-up procedures and breastfeeding management. We assumed a similar endocrine profile in the protected and unprotected groups. The data were reanalyzed including only the subsample of women who were also amenorrheic and fully nursing at day 75 postpartum. Follow-up Follow-up took place at the Consultorio de Planificaci6n Familiar, affiliated with the Instituto Chileno de Medicina Reproductiva (ICMER). Women * The Catholic University was not involved in the clinical fol low-up or contraceptive administration done at the Consultorio de Planificacion Familiar (rcmer). were given an appointment at days 7, 20, and 30 postpartum for clinical evaluation, reinforcement of instructions for breastfeeding on demand, and information on the choices available to avoid a new pregnancy. A monthly calendar was provided to record the number of nursing episodes each day and night and all bleeding or spotting days. On days 30 to 35 postpartum, a general physical, pelvic and breast examination, Papanicolaou smear, and hemoglobin (Hb) were performed. Only healthy women with an adequate nutritional status and Hb values > 120 gil were admitted. Thereafter, follow-up visits were scheduled fortnightly up to the end of the 1st year or the occurrence of the second postpartum bleeding, whichever came last. At each visit, the daily breastfeeding chart and the bleeding record were reviewed. Mothers and infant underwent a physical examination. All intercurrent diseases were recorded. Breastfeeding Management The women were instructed to give their infants no liquid or solid food or water and to use the breast as the only source of water and nutrients during the first 6 months postpartum, except for the administration of vitamin drops. These instructions were reinforced at each visit. However, milk supplements were indicated when inadequate milk output was diagnosed. Infant weight gain was considered the most sensitive indicator of the adequacy of milk output. Milk supplements were prescribed when the infant's average weight increase was <20 gld, with the exception of those infants who continued in their weight percentile curve ± 1 SD or those whose absolute weight was higher than expected for their age and length. The Boston percentile weight curve for male infants was used as the reference standard (13). A single nondairy meal was recommended routinely to full nursing infants after the 6th postpartum month, and a second meal was introduced at the 9th month. Blood Sampling Protocol Samples were scheduled at approximately 10 A.M. every 15 or 30 days during the first 3 months postpartum and twice a week thereafter. In a few cases, blood sampling was started later (month 2, n = 6; month 3, n = 7; month 6, n = 1). Additional samples were drawn 10 minutes after the initiation of suckling at 15 to 30-day intervals. Control women were sampled twice a week during one menstrual cycle. Prolactin (PRL) and estradiol (E 2) were measured in all samples available. Luteinizing hormone (LH) Diaz et al. Ovarian function and lactational infertility 499
3 and progesterone (P) were measured once a week up to 30 days before the first menses and in all samples thereafter. Samples for this study were obtained during 1980 and 1981 and were assayed from 1982 through Hormone Assays Determinations of PRL, LH, E2, and P were made using the reagents and methodology of the World Health Organization, Programme for the Provision of Matched Assay Reagents for the Radioimmunoassay (RIA) of Hormones in Reproductive Physiology. Assays of each hormone were done simultaneously for all samples collected from an individual case. Intra-assay and interassay coefficients of variation (CVs) for LH were 5%,10%, and 15% and 14%, 11%, and 29% for high (53.6 ± 6.2 lull), medium (26.5 ± 2.9 lull), and low (5.3 ± 1.5 lull) pools, respectively. Intra-assay and interassay CVs for PRL were 10%, 15%, and 9% and 18%, 17%, and 22% for high (4,559 ± 825 mull), medium (1,445 ± 253 mull), and low (312 ± 69 mull) pools, respectively. Intra-assay and interassay CVs for E2 were 6, 7, and 21 and 13, 15, and 17 for high (1,554 ± 194 pmol/l), medium (922 ± 140 pmol/l), and low (257 ± 23 pmol/l) pools, respectively. Intra-assay and interassay CVs for P were 10, 12, and 18 and 18, 17, and 25 for high (32.1 ± 6.0 nmol/l), medium (16.8 ± 3.0 nmol/l), and low (1.4 ± 0.3 nmol/l) pools, respectively. Pool values are shown as means ± SD. Data Presentation and Analysis First Postpartum Ovulation The occurrence of ovulation was indirectly assessed by P and LH levels. Progesterone values> 10 nmol/l were considered compatible with ovulation. This level is achieved within 3 to 4 days after the LH peak in normal women in whom the occurrence of ovulation has been confirmed by the recovery of an oocyte from the fallopian tube (14). Levels above this threshold have never been observed in the follicular phase of the menstrual cycle in our control population. Luteinizing hormone values > 39 lull were considered as preovulatory surge values. The date of ovulation was determined retrospectively for each subject. The day after the LH surge, if detected, or the intermediate day between the last P level < 6 nmol/l and the first P level> 10 nmol/l were considered to be the day of ovulation. First Postpartum Bleeding The first bleeding consisting of at least 1 day of normal bleeding or 3 consecutive days of spotting was recorded 10 or more days after the end of the puerperal bleeding. Bleeding induced by the insertion of an IUD was not considered in the analysis. First Cycle The events before and after the first ovulation after delivery up to the day before the following menses constituted the first cycle. Nonovulatory intervals between bleedings were not considered cycles. Exclusive Breastfeeding or Full Nursing Women were classified in this category while the breast was the only source of water and nutrients for the infant during the first 6 months and if the child had a normal growth rate according to the Boston reference (13) standard. In this analysis, cases were kept in this category after 6 months if only nondairy food was introduced. Probabilities of first bleeding and first ovulation and pregnancy were calculated by life table analysis. Characteristics of the subjects at the time of first and second ovulation, suckling frequency, and the mean hormonal levels were compared using Student's t-test. The area under the curve (AUC) was calculated for E2 and P, and the values were compared using Student's t-test. Distributions according to nursing categories and highest P level were analyzed by contingency table analysis. The SAS statistics software (SAS Institute Inc., Cary, NC) was used for data analysis. Probability values < 0.05 were considered significant. RESULTS Of the 49 women enrolled in the study group, 43 (88%) ovulated while breastfeeding during the 1st postpartum year. Four of the other 6 women left the study, one completed the year still in amenorrhea, and one had not ovulated when she weaned at month 8. Cumulative probabilities of experiencing the first ovulation and the first bleeding during the 1st postpartum year are shown in Table 1. The risks were nil for the first 2 postpartum months because the study protocol required that all subjects should be amenorrheic and fully nursing at day 75 postpartum. The probability increased with time for both events. Ovulation occurred before the first postpartum bleeding in 12 (67%) of the 18 women who ovulated within months 3 to 6 and in 17 (68%) of the 25 women who ovulated within months 7 to 12. Eleven women ovulated after one bleeding, and three did so after two or more bleedings. In this sample, the 500 Diaz et al. Ovarian function and lactational infertility Fertility and Sterility
4 Table 1 Cumulative Probability of Experiencing the First Bleeding and the First Ovulation During Breastfeeding Table 2 Breastfeeding Status at the Time of the First and Second Postpartum Ovulation First bleeding First ovulation Postpartum length N* CPt N CP rno Breastfeeding (%) Fully Nondairy supplements Milk supplements Suckling frequency (means ± SD) 24 h Night * P = First (n = 43) ± ± 0.2 Ovulation Second (n = 33) ± 0.4* 1.9 ± 0.2 * Number of women entering the month without having experienced the first bleeding or the first ovulation. t Cumulative probability X 100. first menses was a good indicator of the recovery of ovulation. Twenty-eight (57%) women remained fully nursing, and 21 (43%) introduced milk supplements within postpartum months 3 to 6. The first ovulation occurred in this interval in 10 (35.7%) ofthe 28 fully nursing women and in 18 (85.7%) of the women who introduced bottle feeding, showing a significant influence (P < 0.001) of milk supplementation on the risk of ovulation during breastfeeding. In another 15 women, the first ovulation was observed within months 7 to 12 postpartum after the introduction of nondairy food (n = 12) or milk supplements (n = 3). The first and second postpartum ovulatory cycles were studied in 43 and 33 cases, respectively. The breastfeeding status at the time of each ovulation is shown in Table 2. The total suckling frequency per 24 hours decreased significantly from the first to the second cycle but not the suckling frequency at night. Estradiol and P levels observed in the first and second postpartum cycle and in control cycles are shown in Figure 1. Progesterone levels (AVC) were lower in the first (P < ) and second (P = 0.001) cycle during breastfeeding than in control cycles and also in the first postpartum cycle in comparison with the second cycle (P = 0.02). Estradiol levels (AVC) were significantly lower (P < ) in the first and in the second (P = 0.002) postpartum cycle in comparison with the control cycles but did not differ between the first and second cycle. Table 3 shows selected parameters of the first and second cycle during breastfeeding and in control cycles. The length of the first cycle and of the first follicular phase was calculated only for those cases whose first ovulation followed the first menses, excluding one woman who got pregnant in that cycle. The length of the cycle and of the follicular phase were significantly longer in nursing than in nonnursing women. The first luteal phase and its highest P value were significantly shorter and lower than the second or those of the control group. The highest E2 level of the luteal phase was lower in nursing than in non-nursing women. No significant differences were found in PRL basal levels, the length ofthe luteal phase, the highest E2 levels in the follicular and luteal phase, and I II C... '::I! ~ '" w ':J '::I 60 J 40 J4~~ ~~~...,,, iii 0,,,,,,, w z 0 w... '" U> W g '" lo ~lo 0 lo -lo 0 lo III\VS N = 43 N = 33 N = 25 Figure 1 Estradiol and progesterone levels (means ± SE) during the first (I) and second (II) postpartum cycle in nursing women and in interval non-nursing women (C); day 0 = day of ovulation. E2 I < E2 C (P < ); E2 II < E2 C (P = 0.002); P I < P II (P = 0.02); P I < PC (P < ); P II < PC (P = 0.001). Differences calculated for the AVC using Student's t-test. Diaz et ai. Ovarian function and lactational infertility 501
5 == Table 3 Selected Parameters of the First Two Ovulatory Cycles in Lactating Women and Cycles in Nonlactating Women* Parameter Length (d) Cyclet Follicular phaset Luteal phaset:j: Basal PRL OUjL)t Highest E2 (pmol/ L) First cycle (n = 43) 36.1 ± ± ± ± 82 Breastfeeding status Lactating Second cycle (n = 33) 36.6 ± ± ± ± 80 Follicular phase 793 ± ± 53 Luteal phaset 558 ± ± 45 Highest P (nmol/ L) Nonlactating (n = 25) 26.6 ± ± ± ± ± ± 70 Luteal phaset 23.8 ± ± ± 3.1 * Values are means ± SE. t Cycles occurring before first menses (n = 29) excluded from mean length of the first cycle and first follicular phase. Lactating women significantly different (P < 0.05) from nonlactating women. t First cycle significantly different (P < 0.05) from second cycle. the highest P level when comparisons were done between the first ovulatory cycles that occurred before the first bleeding versus those occurring after the first bleeding, those occurring in exclusive breastfeeding versus those occurring in supplemented nursing, and those occurring before or after day 180 postpartum (data not shown). The first postpartum cycle had all P levels < 15 nmoljl in a significantly higher proportion of cases (28%) in comparison with the second (4%) or with the control cycles (0%). The second postpartum cycle and the control cycles were similar in this respect. Luteal phases> 10 days with P levels> 30 nmoljl were found only in 2 of 12 and 3 of 17 cases who ovulated in amenorrhea before and after 6 months postpartum, respectively. The risk of ovulation during lactational amenorrhea described here was compared with the risk of pregnancy during amenorrhea in unprotected nursing women who met the same requirements at admission and had a similar clinical management and breastfeeding behavior. The analysis included only the subjects who were fully nursing and amenorrheic at day 75. Approximately 60% ofthe women of both groups remained fully nursing and in amenorrhea at 6 months. During the period of lactational amenorrhea, the risk of pregnancy was extremely low in comparison with the risk of ovulation, particularly during the first 6 postpartum months (Table 4). In the cycle that followed the first postpartum menses, ovulation was detected in 93 % of the women, which contrasts with the 7% PR observed in the 1st month after the end of amenorrhea in the comparative group of unprotected nursing women. DISCUSSION In this study, the probability of ovulating during breastfeeding was nearly 37% before the 6th month and nearly 100% before the end of the year. In 67% of the women, ovulation occurred before the first menses, and 93 % of the cases had an ovulatory cycle after the first bleeding. The risk of ovulating was high even for fully nursing women, 36% of whom had ovulated in the first 6 months. It should be noted that all women were fully nursing and amenorrheic at day 75 postpartum. Therefore, the risks described here cannot be applied to the general population who experience an even higher probability of bleeding (3) and presumably of ovulating during breastfeeding. The first ovulatory cycle was clearly abnormal in comparison with the control cycles. It showed a prolonged follicular phase, a short luteal phase, and low estrogen and P levels during the luteal phase. This was observed regardless if ovulation occurred before or after the first menses or during exclusive or supplemented breastfeeding. The second cycle also exhibited a prolonged follicular phase, but the luteal phase approached a normal profile with a significantly longer duration and higher E2 and P levels in comparison with the first luteal phase. These differences between the first and second cycle occurred in the presence of similar PRL levels and only minor differences in the nursing frequency during day hours. The second luteal phase showed only minor differences in comparison with the control cycles, Table 4 Comparative Risk of Ovulation and Pregnancy During Lactational Amenorrhea First ovulation Postpartum length N* cpt mo * Number of women in amenorrhea. t Cumulative probability X 100. All women fully nursing at day 75 postpartum. N Pregnancy CP Diaz et a1. Ovarian function and lactational infertility Fertility and Sterility
6 suggesting that the sensitivity of the hypothalamicpituitary-ovarian axis to the suckling stimulus decreases once the hormonal events of the first cycle have occurred. The risk of ovulating in amenorrhea was much higher than the corresponding risk of pregnancy at any given time during the 1st postpartum year (Table 4). The ratio for the risks ofpregnancyjovulation observed in amenorrheic women increased from 1 to 28 at 6 months to 1 to 5 at 12 months. Approximately one fourth of non-nursing control women of similar characteristics become pregnant during the first exposure cycle (12). Therefore, anovulation does not account for all the contraceptive efficacy of lactational amenorrhea. The second luteal phase was normal in a high proportion of cycles, and this probably explains the prompt recovery of fertility in lactating women after the first postpartum bleeding (12). Nevertheless, breastfeeding still retained some effect on the second luteal phase, and this may explain why the PR observed after the first postpartum cycle was lower than that observed in comparable cycles of exposure in control women (12). For a short interval at the end of amenorrhea, breastfeeding prevented pregnancy in ovulatory cycles. Interference with implantation associated with luteal phase defects seems the most plausible explanation, considering the characteristics of the first luteal phase, the small inhibitory influence of breastfeeding on sperm penetration (15), and the coital frequency reported by the women of this study during the postpartum period (11). These results confirm that lactational amenorrhea is associated with a strong inhibition of fertility during the 1st postpartum months (4). Nursing women who ovulate before the end of amenorrhea are protected by the abnormal endocrine profile associated with the first ovulation (7). In contrast, the endocrine pattern of the second cycle does not warrant effective protection against pregnancy. Accordingly, lactating women who want to postpone a new pregnancy should initiate contraceptive measures no later than the first postpartum menses. Acknowledgments. The authors are grateful to the volunteers who participated in the studies, to Mrs. Elizabeth Nunez and Ms. Griselda Bravo for their commitment in doing the RIA and to Mrs. Emma Munoz for secretarial assistance. REFERENCES 1. Van Ginneken JK. The chance of conception during lactation. J Biosoc Sci SuppI1977;4: McCann MF, Liskin LS, Piotrow PT, Rinehart W, Fox G. Breastfeeding, fertility, and family planning. Popul Rep [J) 1984; Diaz S, Rodriguez G, Peralta 0, Miranda P, Casado ME, Salvatierra AM, et al. Lactational amenorrhea and the recovery of ovulation and fertility in fully nursing chilean women. Contraception 1989;38: Kennedy KI, Rivera R, McNeilly AS. Consensus statement on the use of breastfeeding as a family planning method. Contraception 1989;39: Perez A. Lactational amenorrhea and natural family planning. In: Hafez ESE, editor. Human ovulation. New York: Elsevier/ North-Holland Biomedical Press, 1979: Howie PW, McNeilly AS, Houston MJ, Cook A, Boyle H. Fertility after childbirth: post-partum ovulation and menstruation in bottle and breast feeding mothers. Clin Endocrinol (Oxf) 1982;17: McNeilly AS, Howie PW, Houston MJ, Cook A, Boyle H. Fertility after childbirth: adequacy of post-partum luteal phases. Clin Endocrinol (Oxf) 1982;17: Rivera R, Kennedy KI, Ortiz E, Barrera M, Bhiwandiwala PP. Breast-feeding and the return to ovulation in Durango, Mexico. Fertil SteriI1988;49: Shaaban MM, Kennedy KI, Sayed GH, Ghaneimah SA, Abdel-Aleem AM. The recovery of fertility during breast-feeding in Assiut, Egypt. J Biosoc Sci 1990;22: Howie PW, McNeilly AS, Houston MJ, Cook A, Boyle H. Effect of supplementary food on suckling patterns and ovarian activity during lactation. Br Med J 1981;283: Diaz S, Peralta 0, Juez G, Salvatierra AM, Casado ME, Durfm E, et al. Fertility regulation in nursing women. I. The probability of conception in full nursing women living in an urban setting. J Biosoc Sci 1982;14: Diaz S, Aravena R, Cardenas H, Casado ME, Miranda P, Schiappacasse V, et al. Contraceptive efficacy of lactational amenorrhea in urban chilean women. Contraception 1991;43: Nelson WE. Textbook of pediatrics. 8th ed. Philadelphia: Saunders Co., 1964: Croxatto HB, Ortiz ME, Diaz S, Hess R, Balmaceda JP, Croxatto H-D. Studies on the duration of egg transport by the human oviduct. II. Ovum location at various intervals following LH peak. Am J Obstet GynecoI1981;132: Vigil P, Perez A, Neira J, Morales P. Post-partum cervical mucus: biological and rheological properties. Hum Reprod 1991;6: Diaz et al. Ovarian function and lactational infertility 503
Daily blood hormone levels related to the luteinizing hormone surge in anovulatory cycles
FRTILITY AND STRILITY Copyright 1983 The American Fertility Society Printed in U.8A. Daily blood hormone levels related to the luteinizing hormone surge in anovulatory cycles Chung H. Wu, M.D. * F. Susan
More informationMethods Used to Self-Predict Ovulation A Comparative Study
Marquette University e-publications@marquette Nursing Faculty Research and Publications Nursing, College of 5-1-1990 Methods Used to Self-Predict Ovulation A Comparative Study Richard Fehring Marquette
More informationReproductive Testing: Less is More G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives
Reproductive Testing: Less is More G. Wright Bates, Jr., M.D. Professor and Director Reproductive Endocrinology and Infertility Objectives 1. Review definition of infertility and impact of age 2. Stress
More informationme LUTEINIZED UNRUPTURED FOLLICLE SYNDROME AND ENDOMETRIOSIS
FERTILITY AND STERILITY Copyright c 980 The American Fertility Society Vol. 33,, JanuaEY 980 Printed in U.S.A. me LUTEINIZED UNRUPTURED FOLLICLE SYNDROME AND ENDOMETRIOSIS W. PAULDMOWSKI, M.D.,.PH.D.*
More informationTop 5 Fertility Secrets Revealed
Top 5 Fertility Secrets Revealed by Melinda Stevens Brought to you by http://www.pregnancy-online.info All rights reserved, 2007. Copyright 2007, Pregnancy-Online.info 2 Hi, thanks for downloading my free
More informationContraceptives. Kim Dawson October 2010
Contraceptives Kim Dawson October 2010 Objectives: You will learn about: The about the different methods of birth control. How to use each method of birth control. Emergency contraception What are they?
More informationHormonal Changes Following Low-Dosage Irradiation of Pituitary and Ovaries in Anovulatory Women
Hormonal Changes Following Low-Dosage Irradiation of Pituitary and Ovaries in Anovulatory Women Further Studies A. E. Rakoff, M.D. Tms PRESENTATION is a second progress report in a long-term study of the
More informationN. Shirazian, MD. Endocrinologist
N. Shirazian, MD Internist, Endocrinologist Inside the ovary Day 15-28: empty pyfollicle turns into corpus luteum (yellow body) Immature eggs Day 1-13: 13: egg developing inside the growing follicle Day
More informationCASE 41. What is the pathophysiologic cause of her amenorrhea? Which cells in the ovary secrete estrogen?
CASE 41 A 19-year-old woman presents to her gynecologist with complaints of not having had a period for 6 months. She reports having normal periods since menarche at age 12. She denies sexual activity,
More informationStage 4 - Ovarian Cancer Symptoms
WELCOME Stage 4 - Ovarian Cancer Symptoms University of Baghdad College of Nursing Department of Basic Medical Sciences Overview of Anatomy and Physioloy II Second Year Students Asaad Ismail Ahmad,
More informationFamily Planning UNMET NEED. The Nurse Mildred Radio Talk Shows
Family Planning UNMET NEED The Nurse Mildred Radio Talk Shows TOPIC 9: IUD/COIL Guests FP counsellor from MSU, RHU& UHMG Nurse Mildred Nurse Betty Objectives of the programme: To inform listeners about
More informationA contraceptive subdermal implant releasing the progestin S1-1435: ovarian function, bleeding patterns, and side effects*t
FERTILITY AND STERILITY Vol. 58, No.6, December 1992 Copyright CI 1992 The American Fertility Society Printed on ocid-free paper in U.S.A. A contraceptive subdermal implant releasing the progestin S1-1435:
More informationOVERVIEW. FEMM (Fertility Education & Medical Management) is headquartered in New York City, NY. 1
OVERVIEW FEMM (Fertility Education & Medical Management) is headquartered in New York City, NY. 1 FEMM is a three-tiered women s healthcare project. Grounded in revolutionary, peer-reviewed research in
More informationFemale Reproductive System. Lesson 10
Female Reproductive System Lesson 10 Learning Goals 1. What are the five hormones involved in the female reproductive system? 2. Understand the four phases of the menstrual cycle. Human Reproductive System
More information(Received 5th July 1968)
EFFECT OF AN INTRA-UTERINE DEVICE ON CONCEPTION AND OVULATION IN THE RHESUS MONKEY W. A. KELLY, J. H. MARSTON and P. ECKSTEIN Department of Anatomy, Medical School, Birmingham 15 (Received 5th July 1968)
More informationEffects of long-term low-dose mifepristone on reproductive function in women
Human Reproduction vol.13 no.4 pp.793 798, 1998 OUTSTANDING CONTRIBUTION Effects of long-term low-dose mifepristone on reproductive function in women H.B.Croxatto 1,4, L.Kovács 2, R.Massai 1, B.A.Resch
More informationLUTEINIZED UNRUPTURED FOLLICLE SYNDROME: A SUBTLE CAUSE OF INFERTILITY*
FERTILITY AND STERILITY Copyright c 1978 The American Fertility Society Vol. 29, No.3, March 1978 Printed in U.S.A. LUTEINIZED UNRUPTURED FOLLICLE SYNDROME: A SUBTLE CAUSE OF INFERTILITY* JAROSLA V MARIK,
More informationEndocrinology of the Female Reproductive Axis
Endocrinology of the Female Reproductive Axis girlontheriver.com Geralyn Lambert-Messerlian, PhD, FACB Professor Women and Infants Hospital Alpert Medical School at Brown University Women & Infants BROWN
More informationPostpartum LARC. (Long Acting Reversible Contraception) NURSING EDUCATION
Postpartum LARC (Long Acting Reversible Contraception) NURSING EDUCATION What is LARC Long-acting reversible contraception (LARC) methods include the intrauterine device (IUD) and the birth control implant.
More informationA comparison of methods to interpret the basal body temperature graph*
FERTllJTY AND STERILITY Copyright c 1983 The American Fertility Society Vol. 39, No.5, May 1983 Printed in U.SA. A comparison of methods to interpret the basal body temperature graph* John J. McCarthy,
More informationInfertility: A Generalist s Perspective
Infertility: A Generalist s Perspective Learning Objectives Fertility and Lifestyle: Patient education Describe the basic infertility workup Basic treatment strategies unexplained Heather Huddleston, MD
More informationThe Balanced Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High STI/HIV Prevalence Settings.
The Balanced Counseling Strategy Plus: A Toolkit for Family Planning Service Providers Working in High STI/HIV Prevalence Settings Counseling Cards Checklist to be reasonably sure a woman is not pregnant
More informationInformation for Informed Consent for Insertion of a Mirena IUD
Information for Informed Consent for Insertion of a Mirena IUD What is an IUD (intrauterine Device)? An intrauterine device (IUD) is a plastic device that is placed into your uterus to prevent pregnancy.
More informationChapter 7 Infertility, Contraception, and Abortion
Chapter 7 Infertility, Contraception, and Abortion Infertility Incidence Affects about 10% to 15% of reproductive-age population Subfertility: prolonged time to conceive Sterility: inability to conceive
More informationFemale Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF
Female Reproductive Physiology Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF REFERENCE Lew, R, Natural History of ovarian function including assessment of ovarian reserve
More informationMULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure.
Chapter 27 Exam Due NLT Thursday, July 31, 2015 Name MULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure. Figure 27.1 Using Figure 27.1, match the following:
More informationInfertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary
Subfertility Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Infertility affects about 15 % of couples. age of the female. Other factors that
More information1. Ortiz, M. E et al. Mechanisms of action of intrauterine devices. Obstet & Gynl Survey 1996; 51(12), 42S-51S.
1 2 1. Ortiz, M. E et al. Mechanisms of action of intrauterine devices. Obstet & Gynl Survey 1996; 51(12), 42S-51S. The contraceptive action of all IUDs is mainly in the uterine cavity. The major effect
More information100% Highly effective No cost No side effects
effective? Advantages Disadvantages How do I get Cost Abstinence For some it can mean no sexual contact. For others it is no sexual intercourse or vaginal penetration. A permanent surgical procedure available
More informationBirth Control- an Overview. Keith Merritt, MD. Remember, all methods of birth control are safer and have fewer side effects than pregnancy
Birth Control- an Overview Keith Merritt, MD Basics Remember, all methods of birth control are safer and have fewer side effects than pregnancy Even with perfect use, each method of birth control has a
More informationNaProTechnology. An Integrated Approach to Infertility. Tracy Parnell. Geneva 2005
NaProTechnology An Integrated Approach to Infertility Tracy Parnell Geneva 2005 Outline Scientific foundations Illustrative case history Research Discussion and questions NPT Natural Procreative Technology(NPT)
More informationPERIMENOPAUSE. Objectives. Disclosure. The Perimenopause Perimenopause Menopause. Definitions of Menopausal Transition: STRAW.
PERIMENOPAUSE Patricia J. Sulak, MD Founder, Living WELL Aware LLC Author, Should I Fire My Doctor? Author, Living WELL Aware: Eleven Essential Elements to Health and Happiness Endowed Professor Texas
More informationby Falope-rings* or Filshie-clipst*
FERTILITY AND STERILITY Copyright 0 1992 The American Fertility Society Printed on acid-free paper in U.S.A. Hormonal and menstrual changes after laparoscopic sterilization by Falope-rings* or Filshie-clipst*
More informationFDA-Approved Patient Labeling Patient Information Mirena (mur-ā-nah) (levonorgestrel-releasing intrauterine system)
FDA-Approved Patient Labeling Patient Information Mirena (mur-ā-nah) (levonorgestrel-releasing intrauterine system) Mirena does not protect against HIV infection (AIDS) and other sexually transmitted infections
More informationInvestigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle?
Investigation: The Human Menstrual Cycle Research Question: How do hormones control the menstrual cycle? Introduction: The menstrual cycle (changes within the uterus) is an approximately 28-day cycle that
More informationWeb Activity: Simulation Structures of the Female Reproductive System
differentiate. The epididymis is a coiled tube found along the outer edge of the testis where the sperm mature. 3. Testosterone is a male sex hormone produced in the interstitial cells of the testes. It
More informationMonth-Long Hormone Assessment: What goes up must come down. Disclaimer. Aims and Objectives. George Gillson MD PhD
Month-Long Hormone Assessment: What goes up must come down George Gillson MD PhD 1 Disclaimer The information presented in this Webinar is the opinion of Dr. Gillson based on his research and experience.
More informationLOW RESPONDERS. Poor Ovarian Response, Por
LOW RESPONDERS Poor Ovarian Response, Por Patients with a low number of retrieved oocytes despite adequate ovarian stimulation during fertility treatment. Diagnosis Female About Low responders In patients
More informationFertility Treatment: Do not be Distracted
Fertility Treatment: Do not be Distracted Fertility Treatment: do not be distracted by worthless recommendation Fertility Treatment: Do not be Distracted When contemplating options for fertility treatment
More informationCarl Gustaf Nilsson, M.D. t:j: Hannu Allonen, M.D. Juan Diaz, M.D.II Tapani Luukkainen, M.D., Ph.D.t
FERTILITY AND STERILITY Copyright 0 1983 The American Fertility Society Vol. 39, No.2, February 1983 Printed in U.8A. Two years' experience with two levonorgestrel-releasing intrauterine devices and one
More informationReproductive Health and Pituitary Disease
Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives
More informationWelcome to Mirena. The Mirena Handbook: A Personal Guide to Your New Mirena. mirena.com. Mirena is the #1 prescribed IUD * in the U.S.
Mirena is the #1 prescribed IUD * in the U.S. Welcome to Mirena The Mirena Handbook: A Personal Guide to Your New Mirena *Intrauterine Device Supported by 2015-2016 SHS data INDICATIONS FOR MIRENA Mirena
More informationHormonal Control of Human Reproduction
Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with
More informationReproductive Hormones
Reproductive Hormones Male gonads: testes produce male sex cells! sperm Female gonads: ovaries produce female sex cells! ovum The union of male and female sex cells during fertilization produces a zygote
More informationEVALUATING THE INFERTILE PATIENT-COUPLES. Stephen Thorn, MD
EVALUATING THE INFERTILE PATIENT-COUPLES Stephen Thorn, MD Overview The field of reproductive medicine continues to evolve rapidly by offering newer diagnostic testing and therapeutic options to improve
More informationCancer Risks of Ovulation Induction
Cancer Risks of Ovulation Induction 5th World Congress on Ovulation Induction September 13-15, 2007 Louise A. Brinton, Ph.D. National Cancer Institute Rockville, Maryland, USA Ovulation Induction and Cancer
More informationCHAPTER 4 REPRODUCTIVE HEALTH POINTS TO REMEMBER
CHAPTER 4 REPRODUCTIVE HEALTH POINTS TO REMEMBER Amniocentesis : Diagnostic technique to detect genetic disorder in the foetus. Infertility : Inability to produce children in spite of unprotected sexual
More informationWHAT ARE CONTRACEPTIVES?
CONTRACEPTION WHAT ARE CONTRACEPTIVES? Methods used to prevent fertilization *Also referred to as birth control methods With contraceptives, it is important to look at what works for you and your body.
More informationFuzzy Computerized Profile Prediction of Luteinizing Hormone
ISSN No. (Print): 0975-1718 ISSN No. (Online): 2249-3247 Fuzzy Computerized Profile Prediction of Luteinizing Hormone Nutan Verma 1, Vivek Raich 2 and Sharad Gangele 1 1 R.K.D.F University Bhopal (Madhya
More informationFamily Planning and Infertility
Family Planning and Infertility Chapter 20 Objectives Discuss types of reversible contraception Natural methods Mechanical barrier methods Hormonal contraceptives Discuss types of permanent contraception
More informationThe Human Menstrual Cycle
The Human Menstrual Cycle Name: The female human s menstrual cycle is broken into two phases: the Follicular Phase and the Luteal Phase. These two phases are separated by an event called ovulation. (1)
More informationIntrauterine Insemination - FAQs Q. How Does Pregnancy Occur?
Published on: 8 Apr 2013 Intrauterine Insemination - FAQs Q. How Does Pregnancy Occur? A. The female reproductive system involves the uterus, ovaries, fallopian tubes, cervix and vagina. The female hormones,
More informationMULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) Which of the following hormones controls the release of anterior pituitary gonadotropins? A) LH
More informationFERTILITY & TCM. On line course provided by. Taught by Clara Cohen
FERTILITY & TCM On line course provided by Taught by Clara Cohen FERTILITY & TCM FERTILITY AND TCM THE PRACTITIONER S ROLE CAUSES OF INFERTILITY RISK FACTORS OBJECTIVES UNDERSTANDING TESTS Conception in
More informationthe IUD the IUD the IUD the IUD the IUD the IUD the IUD the IUD the IUD the IUD the IUD the IUD the IUD your guide to
your guide to Helping you choose the method of contraception that s best for you IUD IUD the e IUD IU IUD the IUD 2 3 The intrauterine device (IUD) An IUD is a small plastic and copper device that s put
More informationWhat s New in Adolescent Contraception?
What s New in Adolescent Contraception? Abby Furukawa, MD Legacy Medical Group Portland Obstetrics and Gynecology April 29, 2017 Objectives Provide an update on contraception options for the adolescent
More informationCauses of Infertility and Treatment Options
Causes of Infertility and Treatment Options Dr Mrs.Kiran D. Sekhar Former vice President-FOGSI Former Chairperson- Genetics and Foetal medicine-fogsi Founder and Medical Director-Kiran Infertility centre
More informationBiology of fertility control. Higher Human Biology
Biology of fertility control Higher Human Biology Learning Intention Compare fertile periods in females and males What is infertility? Infertility is the inability of a sexually active, non-contracepting
More informationOvulation After Equine Gonadotropin Therapy
Ovulation After Equine Gonadotropin Therapy A Report of Four Cases Irving I. Kurland, M.D. IN 1930 COLE AND HART discovered a gonad-stimulating hormone in pregnant mare serum. It proved effective in producing
More informationContraception: Common Problems Faced in Office Practice. Jane S. Sillman, MD Brigham and Women s Hospital
Contraception: Common Problems Faced in Office Practice Jane S. Sillman, MD Brigham and Women s Hospital Disclosures I have no conflicts of interest Contraception: Common Problems How to discuss contraception
More informationFacts on Contraception and Abortion
Facts on Contraception and Abortion 1. Almost all modern contraceptives are in the World Health Organization's (WHO) Model List of Essential Medicines. The latest list of the WHO (2007, p. 109) include
More informationInfertility in Women over 35. Alison Jacoby, MD Dept. of Ob/Gyn UCSF
Infertility in Women over 35 Alison Jacoby, MD Dept. of Ob/Gyn UCSF Learning Objectives Review the effect of age on fertility Fertility counseling for the patient >35 - timing - lifestyle - workup Fertility
More informationControlled trial of high spermatic vein ligation for varicocele infertile men* Avraham Karasik, M.D.:j: Benad Goldwasser, M.D.t
Urology-andrology FERTILITY AND STERILITY Copyright 1995 American Society for Reproductive Medicine Vol. 63, No. I, January 1995 Printed on acid-free paper in U. S. A. Controlled trial of high spermatic
More informationReproduction and Development. Female Reproductive System
Reproduction and Development Female Reproductive System Outcomes 5. Identify the structures in the human female reproductive system and describe their functions. Ovaries, Fallopian tubes, Uterus, Endometrium,
More informationUnderstanding Infertility, Evaluations, and Treatment Options
Understanding Infertility, Evaluations, and Treatment Options Arlene J. Morales, M.D., F.A.C.O.G. Fertility Specialists Medical Group, Inc. What We Will Cover Introduction What is infertility? Briefly
More informationNotes to Teacher continued Contraceptive Considerations
Abstinence a conscious decision to refrain from sexual intercourse 100% pregnancy will not occur if close contact between the penis and vagina does not take place. The risk of a number of STDs, including
More informationSample Provincial exam Q s: Reproduction
Sample Provincial exam Q s: Reproduction 11. Functions Testosterone Makes the male sex organs function normally, and also inhibits hypothalamus s release of GnRH and thus LH & FSH and thus testosterone
More informationRecent Developments in Infertility Treatment
Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other
More informationInformation Booklet. Exploring the causes of infertility and treatment options.
Information Booklet Exploring the causes of infertility and treatment options www.ptafertility.co.za info@ptafertility.co.za +27 12 998 8854 Faith is taking the first step even if you don t see the whole
More informationFertility Diagnostics
Fertility Diagnostics Fertility hormones measured on PATHFAST For internal use only Diagnostics PATHFAST Chemiluminescence-immuno-analyzer 1 Content: page 1. Fertility hormones - general aspects 1.1 Reproductive
More informationBASAL BODY TEMPERATURE: UNRELIABLE METHOD OF OVULATION DETECTION
FERTILITY AND STERILITY Copyright c 1981 The American Fertility Society Vol. 36, No. 6, December 1981 Printed in U.SA. BASAL BODY TEMPERATURE: UNRELIABLE METHOD OF OVULATION DETECTION JOAN E. BAUMAN, PH.D.
More information9.4 Regulating the Reproductive System
9.4 Regulating the Reproductive System The Reproductive System to unite a single reproductive cell from a female with a single reproductive cell from a male Both male and female reproductive systems include
More informationPrediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene citrate*
FERTILITY AND STERILITY Copyright 1987 The American Fertility Society Printed in U.8A. Prediction of ovulation with the use of oral and vaginal electrical measurements during treatment with clomiphene
More informationOptimizing Fertility and Wellness After Cancer. Kat Lin, MD, MSCE
Optimizing Fertility and Wellness After Cancer Kat Lin, MD, MSCE University Reproductive Care University of Washington Nov. 6, 2010 Optimism in Numbers 5-year survival rate 78% for all childhood cancers
More information* Reprint requests: Dr. T. C. Li, Jessop Hospital for Women,
FERTILITY AND STERILITY Copyright 1987 The American Fertility Society Vol 48, No6, Decemher 1987 Printed in USA A comparison between two methods of chronological dating of human endometrial biopsies during
More informationTiming is everything. Ovulation Tracking. 3 Cycles bulk-billed
Timing is everything Ovulation Tracking 3 Cycles bulk-billed Contents Getting pregnant naturally 3 Getting pregnant the basics 3 What is ovulation? 3 Menstrual cycle 4 When does ovulation take place? 4
More informationACT TRYING TO HAVE A BABY? YOUR STEP-BY-STEP GUIDE TO ASSISTED CONCEPTION THE ACT PATHWAY
ACT TRYING TO HAVE A BABY? YOUR STEP-BY-STEP GUIDE TO CONCEPTION THE ACT PATHWAY ACT HOW TO USE THE ACT PATHWAY BOOKLET Firstly: You are not alone. Up to 1 in 6 couples around the world will experience
More informationInterpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used
Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used Ellenbogen A., M.D., Shalom-Paz E., M.D, Asalih N., M.D, Samara
More informationContraception. Objectives. Unintended Pregnancy. Unintended Pregnancy in the US. What s the Impact? 10/7/2014
Contraception Tami Allen, RNC OB, MHA Robin Petersen, RN, MSN Perinatal Clinical Nurse Specialist Objectives Discuss the impact of unintended pregnancy in the United States Discuss the risks and benefits
More information10.7 The Reproductive Hormones
10.7 The Reproductive Hormones December 10, 2013. Website survey?? QUESTION: Who is more complicated: men or women? The Female Reproductive System ovaries: produce gametes (eggs) produce estrogen (steroid
More informationOne Thousand Cases of Infertility
One Thousand Cases of Infertility Clinical Review of a Five-Year Series Robert B. Wilson, M.D. THE RECORDS of 1032 women who complained of infertility have been reviewed. These patients were seen by various
More informationUnintended Pregnancy is Common LEARNING OBJECTIVES. Distribution Of Contraception Use By Women In The Us. Unintended Pregnancy And Contraceptive Use
3:45 4:30 pm Beyond the Pill: Long Acting Contraceptives and IUDs Presenter Disclosure Information The following relationships exist related to this presentation: Christine L. Curry, MD, PhD: No financial
More informationAnimal Reproduction. Reproductive Cyclicity. # lectures for cumulative test # 02 book 12. Reproductive cyclicity: terminology and basic concepts
Animal Reproduction JP Advis DVM, Ph.D. Bartlett Hall, Animal Sciences, Cook, (732) 932-9240, advis@aesop.rutgers.edu 15 Course website: rci.rutgers.edu/~advis Material to be covered: About lecture Meetings
More informationCynthia Morris DO, FACOOG, FACOS Medical Director, Women s Wellness Center Fayette County Memorial Hospital
Cynthia Morris DO, FACOOG, FACOS Medical Director, Women s Wellness Center Fayette County Memorial Hospital Touchdown to CME Eighth District Academy of Osteopathic Medicine & Surgery October 8. 2017 Goals
More informationLEARNING OBJECTIVES. Beyond the Pill: Long Acting Contraception. Distribution Of Contraception Use By Women In The Us. Unintended Pregnancy is Common
4:15 5 pm Beyond the Pill: Long Acting Contraceptives and IUDs Presenter Disclosure Information The following relationships exist related to this presentation: Christine L. Curry, MD, PhD: No financial
More informationFertility Apps Do not Help You Get pregnant
Fertility Apps Do not Help You Get pregnant Fertility Apps Do not Help You Get pregnant Beyond Regular Intercourse Many women use fertility apps to track their menstrual cycle and time intercourse. Tracking
More informationEndocrine System Hormones & Homeostasis. Regents Biology
Endocrine System Hormones & Homeostasis 2009-2010 Homeostasis Homeostasis maintaining internal balance in the body organism must keep internal conditions stable even if environment changes also called
More informationThe importance of human chorionic gonadotropin support of the corpus luteum during human gonadotropin therapy in women with anovulatory infertility
FERTILITY AND STERILITY Copyright 0 1988 The American Fertility Society Printed in U.S.A. The importance of human chorionic gonadotropin support of the corpus luteum during human gonadotropin therapy in
More information5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle
Infertility FINANCIAL DISCLOSURE I HAVE NO FINANCIAL INTEREST IN ANY OF THE PRODUCTS MENTIONED IN MY PRESENTATION Bryan K. Rone, M.D. University of Kentucky Obstetrics and Gynecology I AM RECEIVING COMPENSATION
More informationSuperovulation with human menopausal gonadotropins is associated with endometrial gland-stroma dyssynchrony*
aes FERTILITY AND STERILITY Vol. 61, No.4, April 1994 Copyright ee) 1994 The American Fertility Society Printed on acid-free paper in U. S. A. r I Superovulation with human menopausal gonadotropins is
More informationHormonal profile, endometrial histology and ovarian ultrasound assessment during 1 year of nomegestrol acetate implant (Uniplant )
Human Reproduction vol.12 no.4 pp.708 713, 1997 Hormonal profile, endometrial histology and ovarian ultrasound assessment during 1 year of nomegestrol acetate implant (Uniplant ) Luigi Devoto 1,5, Paulina
More informationCHINA STUDY. Friendly Collaboration And Fruitful Achievement. Introduction
CHINA STUDY Friendly Collaboration And Fruitful Achievement Some Experiences and Understandings of the Research Work on the Billings Ovulation Method used in Shanghai, China by: Dr. Zhang De-wei, Advisor-
More informationElena H. Yanushpolsky, M.D., a Shelley Hurwitz, Ph.D., b Eugene Tikh, B.S., c and Catherine Racowsky, Ph.D. a
FERTILITY AND STERILITY VOL. 80, NO. 1, JULY 2003 Copyright 2003 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Predictive usefulness of cycle
More informationFemale reproductive cycle: A Comprehensive Review Rachel Ledden Paper for Bachelors in Science January 20, 2018
Running head: 1 Female reproductive cycle: A Comprehensive Review Rachel Ledden Paper for Bachelors in Science January 20, 2018 Female reproductive cycle: A Comprehensive Review 2 The reproductive cycle
More informationPrevalence of Anovulation in Subfertile Women in Kerbala 2012, A descriptive Cross-Sectional Study
Prevalence of Anovulation in Subfertile Women in Kerbala 2012, A descriptive Cross-Sectional Study Mousa Mohsen Ali* Wasan Ghazi* HayderAamerAbboud^ *Kerbala University, College of Medicine, Gynecology
More informationPDF hosted at the Radboud Repository of the Radboud University Nijmegen
PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/24875
More informationReproductive FSH. Analyte Information
Reproductive FSH Analyte Information 1 Follicle-stimulating hormone Introduction Follicle-stimulating hormone (FSH, also known as follitropin) is a glycoprotein hormone secreted by the anterior pituitary
More informationInternational Journal of Research in Pharmaceutical and Nano Sciences Journal homepage:
Review Article ISSN: 2319 9563 International Journal of Research in Pharmaceutical and Nano Sciences Journal homepage: www.ijrpns.com A REVIEW ON INTRAUTERINE DEVICES Boddu Venkata Komali* 1, M. Kalyani
More informationMedStar Health, Inc. POLICY AND PROCEDURE MANUAL Policy Number: PA.018.MH Last Review Date: 08/04/2016 Effective Date: 01/01/2017
MedStar Health, Inc. POLICY AND PROCEDURE MANUAL PA.018.MH Infertility- Treatment This policy applies to the following lines of business: MedStar Employee (Select) MedStar MA DSNP CSNP (Not Covered) MedStar
More informationPregnancy and Epilepsy
Pregnancy and Epilepsy Nowhere is the problem more evident or more complicated than in pregnancy. In the United States, epilepsy affects nearly one million women of childbearing potential. Alarm bells
More information