Help Getting Pregnant

The Pregnancy Miracle by Lisa Olson

The Pregnancy Miracle book details a highly unique program for treating infertility using traditional Chinese medicine and holistic methods. The author, Lisa Olson, offers easy-to-follow techniques and remedies involving diet, herbs and acupressure to improve your overall health and well-being, strengthen the organs and systems vital to reproduction, heal specific conditions that may affect fertility and even support reproductive methods such as IVF and hormone therapy. Lisa has revealed one secret hormonal-balancing supplement that will balance your hormone and sometime dramatically improves your infertility condition. Does your doctor suggested you for conventional Infertility? Wait and read what Lisa has to say about all these Infertility treatments and also tells you how to free yourself from these conventional Infertility treatments and medication treatment. Best of all, the step-by-step, done-for-you system inside Lisa Olson's Pregnancy Miracle guide works without harmful infertility medication, magical creams, IUI or IVF procedures, crazy diets, herbal remedies, or weird vitamin/mineral therapy. Continue reading...

Pregnancy Miracle Overview

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Author: Lisa Olson
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My Pregnancy Miracle Review

Highly Recommended

I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

This book served its purpose to the maximum level. I am glad that I purchased it. If you are interested in this field, this is a must have.

The Genetics and IVF Institute

The Genetics and IVF Institute (GIVF), a private reproductive and genetics services clinic, offered BRCA testing using a different approach than GDL or OncorMed. It built BRCA testing as a commercial service and offered it both as an integrated genetic counseling and laboratory analysis for a single fee under one roof as well as a stand-alone laboratory service that could be purchased through any physician. GIVF's service, however, was not useful to everyone as its method of laboratory analysis searched only for the three BRCA gene mutations common among individuals of Ashke-nazi Jewish descent. As such, its laboratory analysis served as an inadvertent gatekeeping mechanism that restricted access differently than GDL's or OncorMed's had. the first provider of genetics and infertility services to provide both medical care and laboratory testing under one roof it took the individual through her initial appointment and counseling about the procedure to laboratory analysis and follow-up...

Special considerations 1871 Fertility Issues

Current fertility preservation options for women commencing adjuvant chemotherapy are limited. The option of submitting to a cycle of ovarian hyperstimulation and egg harvest raises concerns over the safety of ovarian hyperstimulation in the breast cancer setting. The possibility of ovarian cryopreservation requires further progress in in-vitro maturation of thawed primordial follicles, their fertilization, and subsequent embryo transfer. Attempts to reduce the gonadotoxic effect of chemotherapy have been tried with co-treatment with a gonadotropin-releasing hormone (GnRH) agonist analogue. In 13 breast cancer patients aged between 26 and 39 years given leuprolide during their adjuvant chemotherapy all patients resumed spontaneous menstruation within 1 year of completion of therapy 71 . In addition, in 64 patients who received goserelin, 3.6 mg monthly in combination with their adjuvant chemotherapy with a median follow-up of 55 months, 86 of patients resumed normal menses and one...

Abortion or Miscarriage and Breast Cancer

Some reports have suggested that incomplete pregnancies, terminated either by induced abortion or miscarriage, increases the risk of breast cancer (reviewed in Reference 184). A number of other studies have not shown an increased risk of breast cancer in women who have undergone induced abortions.184 A well-controlled study of the effects of induced abortion and miscarriage on breast cancer incidence, involving age-, parity-, and race-matched cases and controls, showed that neither induced abortion nor miscarriage increased breast cancer risk.184 This claim appears to be more of an issue of politics and religious beliefs than science.

Reproductive Medicine

Reproductive medicine encompasses all aspects of fertility including birth control and the reproductive results of aging of the reproductive organs. The utility of drugs for use as birth control agents and in the treatment of postmenopausal disorders like endometriosis is an underesearched area. Birth control involves the use of practices, devices, and drug treatments to reduce the possibility of becoming pregnant and involves the use of both devices and drugs that act as contraceptives. These can be divided into agents that prevent (1) fertilization and (2) implantation of the embryo after fertilization occurs. The latter agents are also characterized as abortifacients. Birth control, while somewhat less controversial than abortion, is a controversial issue both politically and ethically. Devices that prevent conception as an alternative to abstinence, e.g. male and female condoms, female diaphragms, and sponges, date back to the dawn of history, but were only formally approved by...

Diet Infertility

In women, being overweight or underweight can impair fertility.3 Excessive thinness from vigorous dieting or strenuous exercise is a common cause of infertility in women in the industrialized countries. In underweight women with body fat content lower than 16-18 of their body weight (women normally have about 25 body fat), ovarian production of estrogen is reduced. This can impair ovulation, interrupt the menstrual cycle, and produce infertility. On the other hand, too much body fat can also interfere with ovulation and cause infertility. About one in ten overweight women have irregular menstrual cycles. Weight loss in overweight, infertile women can cause a return of ovulation and fertility. Women who are trying to become pregnant to maintain or attain a normal body weight.2,3

Functional Anatomy of White Adipose Tissue

University discovered the gene of obesity 8 their subjects were mice, which in the 1950s had developed a spontaneous mutation resulting in hyper-phagia, infertility and reduced activity of the sympathetic nervous system, and consequently in early, massive obesity (ob ob mice) 9 .

Psychosocial and Supportive Care

Most patients are in a relationship or hope to be in one. However, the relationship will be tested by the strain of the cancer diagnosis and its therapy. Patients may wonder whether the partner stays in the relationship out of guilt or sympathy. Some significant others may feel ignored by medical staff because they are not formally a family member. After treatment, commitment to the relationship in the face of fear of relapse or infertility can be difficult for both parties. Those contemplating having children often worry about passing on a genetic predisposition to cancer.

Estrogen Receptors ERa and ER

The physiological functions of the ER subtypes have been characterised in mice lacking the ERa, the ER , or both receptors 11 . Disruption of the ERa resulted in infertility of both male and female mice and inhibited the outgrowth of the mammary duct during puberty, whereas disruption of the ERjS had no effect on fertility and mammary gland development 17 . A number of ERa and ER isoforms have also been described, many of which alter estrogen-mediated gene expression 18 .

Historical Look at the Acceptance of Behavioral Genetics

Mendelian genetics, which were rediscovered in 1900 (Galton died in 1911). It remained for Fisher (1918), who later held a chair in eugenics established by Galton at the University of London, to reconcile Mendelian genetics with quantitative (i.e., continuous trait) genetics. He did so by observing that although a single gene would yield only categorical traits (i.e., AA yellow pea, Aa yellow pea, aa green pea), the action of multiple genes in concert would yield a smooth and continuous trait distribution (in which each gene has a relatively small effect on variation). Galton, too, inspired the social application of genetics in a movement called eugenics (meaning well born) that sought to improve humanity through regulating human reproduction, much as artificial breeders improved nonhuman animal and plant species for human use.

Expected Outcome including Late Effects

Impairment of growth rates after busulfan cyclophosphamide or cyclophosphamide total body irradiation (TBI) conditioning regimens is a problem in children treated before or during their growth period. Gonadal toxicity is seen in all age groups, mainly as gonadal dysfunction however, it is relatively low with modern conventional therapy 44 . Gonadal toxicity may cause disorder of pubertal development, infertility, sexual dysfunction, and the need for long-lasting hormone substitution. In adult women, high doses of alkylating agents and TBI increase the risk of ovarian failure and the probability of restoring the ovarian function decreases by a factor of 0.8 per year of age 46 . The addition of busulfan to cyclophosphamide causes permanent ovarian failure in nearly all female patients. In males the effects of both cytotoxic chemotherapy and TBI will damage the germinal epithelium of the testis, and for the majority of males in all age groups, permanent...

Incidence And Sources Of Cytomegalovirus Infection

Blood products and transplanted organs are the most important vehicles of transmission of CMV in the hospital setting the latter are unlikely to be of concern during pregnancy. Transmission of CMV through packed red blood cell, leukocyte, and platelet transfusions poses a risk of severe disease for seronegative small premature infants and immunocompromised patients (41). The risk of transmission of CMV with blood products increases with the number of units transfused, the presence of white blood cells, and the lack of serum antibody in the recipient (42). Prevention of blood product transmission of CMV can be achieved by using seronegative donors or by special filters that remove white blood cells (41,43,44). Another potential source of nosocomial CMV infection of particular concern to those in reproductive medicine is semen donated for artificial insemination (45,46). Although no cases of congenital CMV infection attributed to donor insemination have been reported, the fact that...

General Treatment Consideration

Plete remission after 3-6 cycles of chemotherapy received some sort of consolidation therapy in the form of additional chemotherapy, obviating the benefit of radiation. However, such strategies lead to high cumulative doses of chemotherapy and the risk of male infertility due to the use of alkylating agents, cardiomyopathy from anthracyclines, pulmonary fibrosis from bleomy-cin, and of secondary leukemia and lung cancer after alkylating agents and etoposide.

Epidemiology and consequences of varicellazoster virus infections during pregnancy Seroepidemiology

VZV is spread by respiratory transmission or direct contact with infectious lesions. Seronegative persons are at risk of primary infection manifest as varicella. According to a seroepidemiological study in Germany, the prevalence of VZV-specific IgG class antibodies increases from 7 to 61 after the first to fifth year and reaches 94 among the 8-9 years olds. Among the more than 40 years olds, only isolated individuals are susceptible to VZV (Wutzler et al., 2001). Seroepidemiological studies performed between 1973 and 2002 in different industrial countries revealed that up to 26 of women of reproductive age do not possess VZV-specific IgG class antibodies (Table 1). Women from tropical and subtropical areas are more likely to be seronegative for VZV IgG and are, therefore, more susceptible to the development of chickenpox (Garnett et al., 1993). However, although only 3-4 of women of child-bearing age in Germany were found to be susceptible to primary VZV infection (Wutzler et al.,...

Prenatal Evaluation Of Mother

Women planning to become pregnant should be questioned about whether (and when) they had varicella. Those with a history of disease need no further evaluation, but those with a negative history should be tested for the presence of VZV antibodies. This is most practically done by enzyme-linked immunosorbent assay (ELISA) tests that are commercially available. Although in general these tests lack sensitivity, they are useful for determining natural immunity (7,12). Women who have no history of varicella and who have no detectable VZV antibodies by ELISA should ideally be vaccinated before becoming pregnant. As has been mentioned, women reared in countries with a tropical climate are highly likely to be susceptible if they have no history of varicella. Immunization of adults requires two doses of vaccine administered 4-8 weeks apart. If the woman is already pregnant, she should not be immunized, but the CDC recommends immunization of close susceptible contacts, such as young children...

Balancing the Risk and Benefits of RT in Adolescent and young adult Patients

Spinal RT (CrSp) in this group are considerable, and include secondary hypothyroidism, growth hormone deficiency, and in girls, either precocious puberty or incomplete pubertal development, as well as risking infertility from irradiation of the hypothalamus, pituitary, and ovaries. Irradiation to the vertebrae will result in failure of these bones to grow during the adolescent growth spurt, causing loss of up to 5 cm in height this is unresponsive to growth hormone therapy.

Distinct Clinical Entities

Pregnancy seems to predispose to AA, but this issue remains controversial. In fact, one of the first cases of AA documented in the early writings on this disease was a young pregnant woman.75 The mechanism that triggers AA in pregnancy remains unclear, but AA often resolves with the termination of pregnancy and can recur during subsequent pregnancies. Even if the initial presentation of AA was not associated with pregnancy, women with a recent history of successfully treated AA should be counseled to not get pregnant. Successful pregnancies have been described, and in the majority of case series most of the women had good outcomes.76 The therapy of pregnancy-associated AA depends on the gestational age of the fetus. The pregnancy of a women with severe AA may be terminated if it is close to term. Earlier in pregnancy, supportive measures are most commonly used. ATG has also been administered to women with severely depressed counts, especially low absolute neutrophil count (ANC)....

Alcohol Induced Sexual Dysfunction

Alcohol consumption has been found to have a negative relationship to physiological arousal in women. Although women state that they felt more aroused, the physical responses tend to be depressed when alcohol is consumed. Inhibition of ovulation, decrease in gonadal mass, and infertility may follow chronic heavy alcohol use.

Scientific Foundations

In human reproduction, a sperm from the man fertilizes an egg from the woman. The nuclei (plural of nucleus, the center part of a cell that controls all its functions) from the egg and the sperm merge, forming a zygote (a fertilized egg). The cells begin to divide. After about a week, they form a ball of about 100 cells, called a blastocyst. The inner part of the blastocyst contains the stem cells. These cells are pluripotent, which means that they can develop into any cell or tissue in the body.

Multiple Sclerosis

IVIg or PE is indicated as a second-line therapy for treating severe disabling relapses, when first-line therapies are not effective, tolerated, or appropriate (e.g., women contemplating becoming pregnant). Mitoxantrone is a second-line therapy for patients with worsening MS despite first-line treatment, or for those with inflammatory episodes not responsive to corticosteroids, IVIg, or PE.

Epithelial Ovarian Cancer Surgical and Staging Considerations

Ranted, as this may lead to adhesion formation and decreased fertility. It may be acceptable to preserve a normal-appearing uterus in early-stage disease even if both ovaries are removed, thus preserving the option of donor egg conception. Although these approaches are controversial, fertility-sparing surgery for true early-stage ovarian carcinoma appears to be a viable option if the patient is adequately counseled about fertility preservation and recurrence risk 21 . One exception to this may be for clear-cell histology, which may connote a significantly more aggressive tumor, contra-indicating conservative surgery 50 . In addition, consideration should be given to surgical removal of the contralateral ovary once childbearing is complete 21 .

Counseling Of Pregnant Women

A discussion of risk factors is warranted with all pregnant women, especially those who are around children. Preconceptional counseling of these women should include discussion about the fetal risk of parvovirus B19 infection during pregnancy. Some women may choose to get tested for parvovirus B19 prior to getting pregnant, and serology would be the recommended test in these women. The presence of immunoglobulin (Ig) G antibody to parvovirus indicates that a woman is not at risk for parvovirus B19 infection. Currently, exclusion of pregnant women from the workplace (and other high-risk groups) during an outbreak of parvovirus B19 is not recommended. Women at greatest risk are those who work in the health care industry (especially with children), teachers, day care center workers, and mothers with an infected child in the household (12,32).

Clinical Symptoms and Evaluation

Testicular tumors most commonly present as a firm to hard painless mass. Occasionally, scrotal swelling and acute pain (10 ) may be present. The presence of acute pain increases the likelihood of infection, trauma, torsion, and infarction, but does not rule out tumor or tumor in addition to another diagnosis. A history of trauma is present in 30 of cases. Carcinoma in situ most commonly presents in patients being evaluated for infertility. Germ-cell tumors present more commonly in patients with a history of cryptorchidism and testicular atrophy. Patients with either condition should have both testicles carefully evaluated periodically. Carcinoma in situ occurs in 5 of testes corrected for non-descent and in 5 of the contra-lateral testes in patients with a primary testicular germ-cell tumor. In children, up to 20 of cases are associated with hernia or hydrocele. Tran-sillumination will assist with diagnosis of the hydrocele, but does not rule out the co-existence of tumor.

Marker Assisted Breeding

It was not until Darwin's explanation of evolution was combined with the understanding of genes, which were first described by Gregor Mendel (1822-1824) in the late nineteenth century, that humans were able to selectively breed plants and animals in a scientific way. The first wide application of artificial insemination to selective livestock breeding was in the 1930s. Artificial insemination is when sperm from a male animal is inserted artificially into a female. It is easier to send sperm across the country to a breeding farm than to transport the whole male animal, so artificial insemination became affordable to breed more selectively than before.

Varicella occurring at every time of pregnancy

An effective prophylaxis of chickenpox in pregnant women is only possible by active immunization of seronegative women before pregnancy. A live-attenuated varicella vaccine has been shown to be safe and effective in preventing chickenpox in adults (Gershon and Steinberg, 1990). Varicella vaccine, as all live-attenuated vaccines, is contraindicated in pregnant women. Pregnancy has to be avoided for at least 4 weeks following vaccination. Seronegative women undergoing infertility treatment or those presenting for preconceptual counseling may be offered vaccination in the United States and some European countries (Royal College of Obstetricians and Gynecologists, 2001). The Pregnancy Registry, managed by the Merck Research Laboratories (United States) in collaboration with the Centers for Disease Control and Prevention (United States), records women who exposed to varicella vaccine during pregnancy or within 3 months before conception. Preliminary results show no hints to any birth...

Paternal Age Effect In Progeria

In progeria, it is clearly much less than 25 . Almost all cases are sporadic, and there is no evidence of increased miscarriage rates to suggest selection against the homozygote in utero. A case of identical twins with progeria with 14 normal siblings has been reported (27). Here, three or four affected siblings would be expected if it was a recessive disease. It is recognized that for new dominant mutations, occasionally the mutation can occur in a germ line leading to somatic mutations. Several cases could then occur within one family. Probable cases of familial progeria have been reported in only a few instances among more than 100 families (28-33). We believe that these reports of progeria cases most likely represent misidentified cases of other progeroid syndromes, such as mandibuloacral dysplasia. Among the 50 cases we examined, no family had more than one affected child except for one set of identified twins. There were 80 unaffected siblings. One would expect...

Regulation and use of metals as food contact materials

Can end sealants are based on natural or more usually synthetic rubber latex with additives to give them the particular properties of adhesion, elasticity, temperature resistance and resistance to components of foods and beverages whilst ensuring an enduring hermetic seal. Under USA legislation they are specifically covered under FDA CFR21 175.300(xxxi) listing authorised starting substances. As with coatings, these materials are not yet covered under specific EU harmonised legislation so member state legislation may be used to show compliance. In particular the Dutch legislation has a section specifically covering can end sealants (Verpakkingen- en Gebruiksartikelenbesluit - Hoofdstuk IVf). The German recommendations of the BfR may also be useful for showing compliance. A CoE Resolution on Rubber and Elastomers AP (2004) 4 has been published but is not yet complete. In its finished form, it should be useful as a further reference for demonstrating safety and compliance of can end...

Neonatal Autoimmune Ovarian Disease

Unexpectedly, over 80 of the progenies from the ZP3-positive dams developed severe nAOD at 2 weeks of age, and 40 of those with nAOD developed ovarian atrophy, premature ovarian failure and infertility (Setiady et al. 2003) (Fig. 3). Severe nAOD was induced by serum or purified serum IgG from adult female or male mice immunized with CP2 in CFA, or by transfer of a mouse monoclonal Ab to ZP3 (335-342). Therefore, autoAb to the ZP3 (335-342) B cell epitope is sufficient to trigger severe and frequent nAOD, a process independent of maternal lymphocytes or pregnancy-associated factors.

Chemotherapy Regimens Mopp and MOPP derivatives

Long-term toxicities were of even more serious concern. Most patients experienced infertility after treatment with MOPP. Males had at least an 80 risk of permanent azospermia after MOPP, while 50 of females experienced gonadal failure.4748 The risk appeared lower with patients younger than 25 years of age however, accelerated early menopause seemed to be the case in every female who did recover her menses after treatment.46 At a time when sperm banking and oocyte cryopreservation were in their early stages, many young patients, though cured, experienced significant psychological repercussions due to their infertility.

Germinal Vesicle Nuclear Transfer

In vitro maturation (IVM) medium for denuded mouse oocytes MEM supplemented with 0.24 mM pyruvate (Pyruvic acid sodium salt, P-4562, Sigma) and 5 fetal bovine serum (FBS heat inactivated, F-7678, Sigma), 0.22-pm filter sterile. Pyruvate stock can be made at the concentration of 240 mM (1000X), aliquot, and stored at -20 C.

Relationships with Peers

According to Heiney 43 , studies have found that there is a general lack of knowledge about the anatomy and physiology of reproduction among adolescents generally. This comes at a time when most adolescents display heightened curiosity about sexuality, and some begin to experiment with intimacy and sex. Reviewing the impact of cancer treatment on sexuality, intimacy and relationships, Thaler-DeMers 44 suggests that the issue of sharing one's cancer history with a new partner is particularly salient to a young adult survivor population, and Roberts et al. 45 report that relevant issues arising in a group intervention study among young adult survivors included concerns about fertility and raising children. With regard to family planning, Schover and colleagues 46 identify salient relationship-oriented concerns for young adults, including infertility, reproductive problems, desire for children in the future, sperm banking, concerns about the health of their offspring, and genetic risks,...

Genetic Disease Models

Defects in primary testicular function are also summarized in Table 2. The causes range from congenital and chromosomal to acquired. There are also disorders of testosterone synthesis, metabolism, and action. Androgen-resistant syndromes range from complete androgen resistance to male infertility.

Differences in Body

Differences in body fat arise at puberty when young women begin to store fat in their stomach, buttocks, and legs. This, in addition to skeletal differences, gives women's bodies their curvy shape. Men usually carry their fat in the abdomen. Overall, women have about 10 more body fat then men, which is necessary to maintain fertility. As we discussed in Chapter 2, body fat is required for female fertility because a hormone called leptin, secreted by fat cells, tells the brain if there are enough fat stores to support a pregnancy. When a female does not have enough body fat, the hormones that regulate menstruation are blocked and menstruation ceases. Lack of menstruation can be permanent and results in sterility and bone damage. Excessive exercise or starvation that leads to the cessation of menstruation, called amenorrhea, causes permanent damage when the estrogen that normally increases prior to ovulation is not produced.

The Disappearance of a Distinction

This suggestion fails to coincide with important intuitions expressed in the natural state model. First of all, let us ask the question What is the range of environments relative to which the fittest environment is to be understood Shall we think of the natural state as that which obtains when the environment is the fittest of all possible environments If so, the stud bull, injected with medications, its reproductive capacities boosted to phenomenal rates by an efficient artificial insemination program, has achieved its natural state. And in similar fashion, the kind of environment that biologists use to characterize the intrinsic rate of increase (r) of a population one in which there is no disease, no predation, no limitations of space or food supplies will likewise count as the natural environment. But these optimal environments are not natural, the natural state model tells us. They involve ''artificially boosting'' the fitness of resulting phenotypes by placing the genotypes in...

Male Linked Translocations

Therefore induce inherited sterility in males but have no effect on female fertility. As they are semisterile they will always be eliminated from a population with the exception of the extreme case of fixation, i.e., when all the males in a population carry the translocation. They were proposed as genetic control agents because of their ability to introduce inherited partial sterility into populations. Because these rearrangements are male-linked they are in general easy to maintain as in many Diptera genetic recombination is extremely rare in males. However, in species where sex is determined by a male determining gene that is carried on an autosome the position of the breakpoint relative to the gene is crucial to their stability as in these species recombination occurs in both sexes. alent to those of the wild males. The residual female fertility in F1 females can also present problems for application of this approach if some way is not found to remove them before release. However,...

Etiology of Adhesion Formation

Surgically induced adhesions are a complication of invasive surgical procedures (48). Adhesions induced by either trauma, surgical or otherwise, and pathology (i.e., endometriosis) can lead to a variety of complications including infertility, bowel obstruction, pain, impaired joint mobility, and unintended complications during reoperation (49-53). The etiology of surgically induced adhesions is thought to be a result of incidental trauma caused by tissue manipulation (54), desiccation (54), tissue ischemia, and a foreign body reaction to particulates (55-57). This damage leads to a wound healing response that results in the production of a serous exudate that leads to fibrin clot production (58-60). If the fibrin clot is relatively short lived then it is resorbed with concomitant normal wound repair. If, however, the fibrin clot resides for a longer time period then cells of fibroblastic phenotype are recruited to the site. These cells begin to generate collagen leading to a scar-like...

Neurodegenerative Diseases

An exception to the lack of association of miscarriages and exposure to 50-Hz magnetic fields are three studies 80-82 . They reported that high peak power-frequency exposures were associated with an increased risk of miscarriages in humans. The first population-based prospective cohort study 80 was conducted among pregnant women within a large health maintenance organization. All women with a positive pregnancy test at less than 10 weeks of gestation and residing in the San Francisco area were contacted for participation in the study. All participants were also asked to wear a magnetic field-measuring meter for 24 h and to keep a diary of their activities. Pregnancy outcomes were obtained for all participants by searching the health maintenance organizations' databases, reviewing medical charts, and telephone follow-up. A total of 969 subjects were included in the final analysis. Miscarriage risk increased with an increasing level of maximum magnetic field exposure with a threshold...

Transition of care Key issues for childhood cancer Survivors

In the cancer survivor literature, the most frequently described approach for LTFU is a clinic designed for this purpose at a pediatric cancer center 1, 37 . However, it is likely that multiple models of care are needed to address the heterogeneity in characteristics, location, and resources of this survivor population. There is an ongoing debate within LTFU programs about how to best provide care for childhood cancer survivors who have reached adulthood. Traditionally, many pediatric oncologists and pediat-ric oncology nurses have continued to see these patients as needed to provide education and screening for late effects. This practice has continued despite concerns that some adult healthcare needs may not be ideally dealt with by pediatric providers (e.g., screening and treatment for hypertension, infertility, dyslip-idemias, and type II diabetes). In addition, because there is a need to record and research late-occurring long-term effects, there is reluctance and often an...

Risk Based Healthcare of Survivors

Faced with these risks and challenges, how can the healthcare delivered to survivors be optimized It is important to recognize that there is a window of opportunity to modify the severity of health outcomes by prevention or early intervention. Early diagnosis and intervention or preventive care targeted at reducing risk for late effects can benefit the health and quality of life of survivors 6 . The outcomes of the following late effects can be influenced by early diagnosis and early intervention second malignant neoplasms following radiation therapy (breast, thyroid, and skin), altered bone metabolism and osteoporosis, obesity-related health problems (dyslipidemia, hypertension, diabetes mellitus, cardiovascular disease), liver failure secondary to chronic hepatitis C following blood transfusion, and endocrine dysfunction following chest mantle or cranial radiotherapy. Primary, secondary, and tertiary prevention, including tobacco avoidance cessation, physical activity, low-fat diet,...

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Health information useful to survivors. Under Condition Centers tab, in-depth discussions of diseases, conditions and health topics, including diet and nutrition, fitness and exercise, mental health, infertility, men's and women's health issues, sexuality , and much more.

Impact Of Malignancy On The Reproductive System

In the past, infertility associated with malignant disease was considered a side effect of the drugs and radiation used during the course of treatment. However, this view is changing due to strong evidence that decreased fertility sometimes exists before the treatment starts. In a study conducted on 158 male patients with Hodgkin lymphoma,3 severe damage to fertility was observed in 21 cases before treatment. The decrease in fertility was most prominent in patients with an elevated erythro-cyte sedimentation rate (ESR) and in those with advanced disease. In another study, semen analysis

Effect Of Malignancy Treatment On Fertility

Young patients with a hematological malignancy are often treated with bone marrow transplantation (BMT).22 During BMT, patients may be given alkylating agents and receive total body irradiation for conditioning, both of which result in POF, hormonal disturbances, and eventually, infertility.23 Long-term female survivors treated with total body irradiation and BMT are at risk for ovarian follicular depletion and impaired uterine growth and blood flow, in addition to early pregnancy loss and premature labor if pregnancy is A study that documented the late effects associated with treatment of early Hodgkin's lymphoma revealed that 43 191 men and 16 149 women had sought medical advice for infertility, while 57 191 men and 54 149 women were able to parent children. In addition, sexual activity was disrupted in 25.8 of cases.26

Restoration Of Fertility

Sperm quality may naturally improve after cancer treatment. However, some defects may persist. The incidence of infertility in men who have recovered sperm production following cytotoxic therapy is generally not higher than that of the general population. An interesting case report30 has documented paternity following bone marrow conditioning and transplantation in a patient with acute myeloid leukemia. For the first time, the preservation of fertile sperm was seen despite the use of chemotherapy. Cancer patients with sperm counts below normal (oligozoospermic) are still capable of having children.31 Similarly, infertile women who have menstrual dysfunction following cytotoxic therapy may be treated for menstrual dysfunction and infertility in a manner similar to that of

Assisted Reproductive Techniques

The reproductive capacity of individuals undergoing malignancy treatment can be preserved by cryopre-serving the gametes and using assisted reproductive techniques (ART) when pregnancy is desired.33 When non-cryopreserved spermatozoa are used in combination with intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), clinical pregnancy rates of 30-40 per cycle and delivery rates of 30 can be expected at most reproductive clinics. On the other hand, cryopreserved sperm from cancer patients results in complete pregnancies in only 18 of cycles.34 Similarly, autologous cryopreserved embryos from in vitro-fertilized oocytes can be successfully implanted after cytotoxic therapy if the patient can undergo ovarian hyperstimulation before therapy.35 Men who remain azoospermic long after chemotherapy may benefit from testicular sperm extraction (TESE) combined with intracytoplasmic sperm injection (ICSI). The potential for sperm retrieval is...

Semen Cryopreservation

Only a small percentage of patients (< 10 ) who bank their spermatozoa before chemotherapy or radiotherapy return for assisted reproduction.44-46 This finding may be explained by several reasons recovery or waiting for possible resumption of spermatogenesis, short period from original illness, anxiety regarding potential risks for the children, and uncertainty about long-term health and, therefore, suitability to be par-ents.42 However, trends have started to change, and awareness of sperm banking has increased over the past 4 to 5 years, coinciding with the advent of ICSI. In males with cancer, the extent of sperm DNA damage plays an important role in determining how semen should be cryopreserved before therapy begins. Specimens with high sperm concentration and motil-ity and low levels of DNA damage can be preserved in relatively large aliquots suitable for IUI. If a single specimen of good quality is available, then it should be preserved in multiple small aliquots suitable for...

Testicular Tissue Harvesting

Although spermatogenesis does not occur in prepuber-tal testes, and prepubertal testes do not produce mature spermatozoa, these do contain the diploid stem germ cells from which haploid spermatozoa can be derived. Therefore, testicular tissue can be harvested from a biopsy and stored either as a tissue section or as isolated germ cells, before cancer therapy. Following cure and on entering adulthood, this tissue can be thawed and used to produce offspring in either of the two ways the stored germ cells can be re-implanted into the patient's own testes to restore natural fertility, a procedure known as germ cell transplantation, or the stored stem cells can be matured in vitro until they are able to achieve fertilization via ICSI.47 Although these two measures have been the subject of intensive research in the last decade, further refinements in the protocols may still be needed before they can be used routinely in clinical practice. In vitro maturation In vitro germ cell maturation...

Ethical And Legal Issues

Informed consent should be given voluntarily by a competent person. However, in view of the complexity of the issues surrounding fertility preservation, the anxieties of both patients and their families at the time of diagnosis, and the limited time for discussion due to

Ethical And Emotional Aspects

Some specific points need to be discussed clearly. Many patients are afraid they will transmit the leukemia to their partner or family members. They need to be reassured that CLL is not infectious or transmissible. Younger patients also need to know that birth control should be practiced during chemotherapy because of the potential effects of purine analogs and intensive chemotherapy on the fetus. Information on the substantial risk of transient or permanent infertility after chemotherapy should also be given. Thus, patients aware of the life expectancy related to the diagnosis of CLL who wish to procreate should be informed about procedures to circumvent sterility. Only anecdotial cases concerning pregnancy during CLL have been reported (52). Thus, relatively limited information on the risks for the child and for the affected patient is available.

Phenotype Of Atm Knockout Mice

Several different strains of Atm y mice have been generated since the cloning of the ATM gene (96,99,148). The mice all have a similar AT-like phenotypes in that they express neurological abnormalities, immune defects, genetic instability, radiation sensitivity, infertility, and a high incidence of lymphoma. Despite these phenotypic similarities with AT patients, there are differences, including severe growth retardation, universal sterility, and death from lymphoma by age 6 months in Atm ' mice (96,99,148). The neurological phenotype of the mice is notable.

Risk Of Maternal Infection During Pregnancy

Most adults born in the continental United States are immune to varicella, even if they believe themselves to be susceptible. Individuals born in countries with tropical climates, however, are often susceptible to varicella, particularly if they moved into an area with a temperate climate as an adult (8). Therefore, it is likely that women who were born in the Caribbean, the Philippines, or Southeast Asia are likely to be varicella susceptible if they have no history of the illness. Ideally, such young women should have antibody testing before they become pregnant so that they can be immunized before pregnancy.

Cystic kidney diseases

Autosomal dominant PKD is the prototype, and by far the most prevalent, inherited cystic kidney disease. Diagnosis is based mainly on renal ultrasonographic findings, in at-risk subjects belonging to ADPKD families 4 . Normal renal ultrasonography after 30 years of age excludes the diagnosis, but this is not true for younger subjects. Genetic diagnosis may therefore be required in rare instances (i) when living related kidney donation is considered in at-risk subjects aged less than 30 years (ii) in young at-risk subjects belonging to families with intracranial aneurysms (iii) in young subjects who 'need-to-know' for various reasons, including family planning or professional choice and (iv) in the very rare PKD families in which rapidly progressive ADKD appears in the first years of life and carries a high risk of recurrence in siblings. In these cases, linkage analysis is often the only method available. Indeed, the direct identification of mutations has been performed so far in a...

Quality of Survival

Many adolescent and young adult cancer survivors cite fertility as a primary concern that impacts the quality of their life. Most do not recall an adequate discussion of the risks of infertility or methods to decrease the risks with their physician at the initiation of therapy. The risk of infertility for an individual is difficult to predict. Direct radiation exposure of the gonad had been studied more extensively than other chemotherapy exposures. Permanent ovarian damage occurs between 5 and 20 Gy, with higher doses required in younger females 68 . The male germinal epithelium is much more sensitive to radiation-induced damage, with changes to spermatogonia resulting from as little as 0.2 Gy. Testicular doses of less than 0.2 Gy had no significant effect on follicle-stimulating hormone (FSH) levels or sperm counts, whereas doses between 0.2 and 0.7 Gy caused a transient dose-dependent increase in FSH and a reduction in sperm concentration, with a return to normal values within 12...

Provider issues

Besides choosing a provider for survival advantage, the patient should choose a provider center that is comfortable with and skilled in dealing with the psychosocial and developmental issues of the adolescent. Issues such as compliance, importance of a social calendar, different prioritization, and fertility preservation are issues that do not come up as often for younger or older patients, and some providers may not have the experience or communication skills to address them.

Pregnancy

Consideration must be given to the patient's risk of becoming pregnant. Whenever any risk is identified, the patient should be counseled regarding the availability of hormonal and intrauterine methods of emergency contraception the most suitable method will depend on the patient profile and the time since the assault (198). When patients elect for insertion of an intrauterine contraceptive, they should be given prophylactic antibiotics (see Subheading 13.4.) either in advance of or at the time of the fitting. Follow-up appointments should be made at a convenient venue where pregnancy tests are available. Should the patient become pregnant because of the assault, she must be referred for sympathetic counseling. If the pregnancy is terminated, it may be relevant to seek permission from the patient for the products of conception to be retained for DNA analysis.

Acknowledgements

Too good to be true Is there really a trade-off between number and care of offspring in human reproduction In Human Nature, a Critical Reader, ed. L. Betzig, pp. 83-6. Oxford Oxford University Press. Harpending, H.C. (1994). Infertility and forager demography. American Journal of Physical Anthropology, 93, 385-90. Wood, J.W. (1994). Dynamics of Human Reproduction. New York Aldine de Gruyter.

Late Effects

Early and usually transient side effects of 131I may include nausea, vomiting, sialoadenitis, xerostomia, loss of taste, thyroiditis (if a sizable thyroid remnant remains after surgery), and, rarely, bone marrow suppression (leukopenia and thrombocytopenia) 54 . Some of these early side effects may be minimized by having the patient drink lots of water after therapy and suck on tart candies, such as lemon drops, to promote salivary flow. The long-term consequences of 131I therapy in children remain an area of concern, particularly in individuals who receive high cumulative doses in early childhood. Much remains to be learned about possible late effects, which can include infertility (particularly in men), permanent damage to the salivary glands resulting in chronic xerostomia or salivary duct stones, excessive dental caries, reduced taste, pulmonary fibrosis (in those with diffuse pulmonary metastases), and the possibility of the development of other cancers (stomach, bladder,...

False Confessions

During the last two decades, the United Kingdom has witnessed several well-publicized miscarriages of justice in which the convictions depended heavily on admissions and confessions made to the police that were subsequently shown to be untrue (46-48). In reviewing 70 wrongful imprisonments that occurred between 1950 and 1970, Brandon and Davies (49) found that false confessions were second only to incorrect identification evidence as the most common cause of wrongful conviction. More recently, in 1994, Justice (50) identified 89 cases in which an alleged miscarriage of justice rested on a disputed confession. Thus, it is clear that people can and do make false and misleading admissions against their own interest. We must turn to modern psychology to obtain insights into why this may happen.

Planning a Pregnancy

One of the best ways to achieve a healthy pregnancy outcome is to actively plan for pregnancy and enter pregnancy in good nutritional health. A critical time for nutrition is the periconceptional period the 2 months just before and the 2-3 months after conception. Fetal development occurs rapidly after conception and most organs are formed in the first 8-10 weeks of pregnancy, before many women realize they are pregnant. During this period the tiny embryo is particularly vulnerable to alcohol, environmental toxins, drugs, maternal medications, and nutritional deficiencies. Deficiencies of thiamine, riboflavin, vitamin B12, vitamin A, zinc, and folic acid may increase risk of abnormal fetal development, miscarriage, and birth defects.1

Overweight

Women who are overweight are also at higher risk for a poor pregnancy outcome. In women weighing more than 130 of their ideal body weight serious complications, such as diabetes and hypertension during pregnancy, are more common. Weight loss during pregnancy, even in very obese women, is dangerous for the fetus, thus overweight women should try to lose weight before becoming pregnant. However, crash diets for rapid weight loss should be avoided because they are low in important micronutrients, such as folic acid, zinc, and iron.

Fetal Growth

In the first 2 months after conception - the period of embryogenesis - the fetus develops very rapidly. By 9 to 10 weeks after conception, although the fetus weighs only about 6 g, all of the major organ systems are present, the heart begins to beat, and the fetus begins to move. Optimum, balanced nutrition is very important during this period - the embryo is extremely vulnerable to changes in nutrient supply and adverse effects from environmental toxins. Absence of micronutrients (e.g., fo-late and zinc) during this critical period may impair development and produce a birth defect or cause miscarriage.1 During this stage the pregnant woman should be very careful to avoid environmental hazards (e.g., alcohol and cigarette smoke) and to eat a micronu-trient-dense, high-quality diet.2

Caffeine

Pregnant women should limit their intake of caffeine. Metabolism of caffeine is slowed during pregnancy - caffeine takes two to three times longer to be metabolized and excreted - so levels in the maternal blood are elevated for longer periods. Caffeine readily passes through the placenta to the fetus. Ingestion of more than 300 mg caffeine day (more than three cups of coffee) during pregnancy may be harmful to the fetus - impairing growth and development and increasing risk of miscarriage.10 Even at lower levels of intake (about two cups of coffee), caffeine constricts the blood vessels in the placenta. This can restrict blood flow through the placenta and reduce the supply of oxygen and nutrients to the fetus.10 Pregnant women should limit or eliminate their caffeine intake by avoiding coffee, black tea, chocolate, and colas.

Tobacco

About one-third of pregnant women in the USA and Western Europe are smokers, and mothers who smoke are at increased risk for premature delivery and miscarriage. Children of mothers who smoked during pregnancy may have long-term impairments in physical growth and intellectualperformance. These adverse effects are dose-dependent - the greater the number of cigarettes smoked during pregnancy, the greater the likelihood of harm. Smoking may reduce blood flow through the placenta and restrict oxygen and nutrient flow to the fetus. Smoking can deplete maternal stores of zinc, vitamin C, vitamin B6, folate, and vitamin B12. Levels of vit-

Wound Healing

Repair occurs when the wound involves mesenchymal connective tissue. The predominant matrix component of connective tissue is collagen and the major cell type is the fibroblast. Skin, the largest organ in the body, is composed of both ectodermally and mesodermally derived layers. The dermis is derived from the mesoderm and when the dermis is damaged it will attempt to heal by the process of repair. The outcome of repair is scar tissue. This is obvious in the skin and produces both deformity and disability. Scarring does, however, have widespread effects throughout the body resulting in an extensive range of morbidity. Connective tissues, which produce the scaffolding for specialized organ tissues, can be deformed and distorted by the process of scarring and can result in respiratory dysfunction due to lung parenchymal fibrosis, liver dysfunction due to cirrhosis, renal dysfunction due to post-glomerulonephritic scarring, adhesions in the bowel after surgery,...

Stanford V

This regimen was introduced in 1995 with an objective of improving cure rate and limiting toxicities. Table 73.6 describes the schedule dosing of this regimen. Essentially, it is similar to the MOPP ABV hybrid regimen but adds modest doses of Etoposide. Radiation therapy is an integral component of this regimen with 36 Gy radiation given to sites of bulky disease more than 5 cm in diameter. An initial report, followed recently by more mature data, showed an FFS of 86 with a 95 OS after 6.9 years of follow-up.68'69 These numbers remained consistent in patients with bulky mediastinal disease.70 Secondary malignancies and infertility were reported to be less than 10 . This favorable toxicity profile, coupled with excellent efficacy, prompted interest in this regimen as a substitute for ABVD.71 However, a recent study from Italy showed an FFS inferiority for the Stanford regimen as compared to ABVD.72 This study compared three chemotherapy regimens Stanford V, ABVD, and MOPP-EBV-CAD (MEC)...

Followup Care

In terms of psychological support, follow-up clinics need to offer reassurance as well as advice and education 29 . Traditional health promotion advice is needed regarding the risks associated with smoking or sunbathing, for example. In addition, these young people face additional risks to their health depending on past treatment. Problems that require some psychological intervention include those related to weight-gain following treatment, infertility, or reduced cardiac function. As more is learned about possible late effects, questions need to be asked about how such risk information is best communicated to survivors. They have a right to know about such risks, but care must be taken not to create unnecessary anxiety. Where possible, information about risk needs to be associated with information about what the individuals can realistically do to ensure their own health. Some examples are given in the following section.

Fertility

Infertility is potentially a side effect, especially for those treated with radiotherapy below the diaphragm or chemotherapy with alkylating agents, as covered in Chap. 27 and considered in Chaps. 24, 25, and 30 . It is established in other settings that infertility can cause considerable distress, although individuals differ substantially in their psychological reactions 31 . Information about possible infertility and its impact on psychological function in cancer survivors was investigated by Green et al. 32 . Interviews conducted with 15 male survivors suggested that survivors varied greatly in how prepared they were for such information, with some being well prepared while others regarded it as a bolt from the blue. The most common emotional response was anger. However, emotional responses varied greatly. Three coping styles were identified. A first group wanted no further counseling and chose to get on with their lives as best as possible. A second group included those who were...

Two or More Proteins

Protein components of the complex (bikunin) and heavy chains 1 (HC1) and 2 (HC2). HC1 and HC2 are attached via ester linkages near the nonreducing end of the CS chain. This is more than a merely unusual structure the side proteins are transferred from the CS linker to hyaluronan (Rugg et al., 2005), forming a complex that is essential for ECM formation in some critical tissues such as the cumulus oophorus. Without the presentation of HC1 and HC2 by CS-bikunin this complex cannot form, resulting in infertility. So far, no examples of covalent CS cross-linking outside the ITI family have been described.

Spermatogenesis

Many reports showed remarkable staining patterns of testes with lectins and monoclonal anti-carbohydrate antibodies, suggesting that specific developmental stages of spermatogenic cells are associated with unique cell surface carbohydrate structures (49-55). A mouse gene knockout of UDP-galactose ceramide galacto-syltransferase that is responsible for seminolipid (a sulfated glycolipid) resulted in male infertility because of massive apoptosis of spermatogenic cells (56,57). A mutant mouse lacking a sialyltransferase required for GM2 GD2 glycolipid synthesis resulted in a spermatogenesis defect probably because of impaired secretion of testosterone from Leydig cells (58). These phenotypes indicated that specific carbohydrates play critical roles in spermatogenesis.

Media Activities

Media Activity 12.3 Infertility Research Many people are concerned that human activity is affecting the rate of fertility in the United States. The human reproductive system involves extensive hormone signaling it is important for students to be aware that chemicals in the environment may interfere with this signaling, which sometimes causes problems such as infertility.

Using This Chapter

Comprehensive website addressing the challenge of infertility following cancer treatment, including medical information, parenthood options, resource directory, and financial assistance. Under Physical Topics tab, description of several physical issues that may affect survivors, including both male and female infertility and sexual dysfunction. Healthy behaviors and physical rehabilitation discussed. Information and links about insurance coverage of infertility and adoption services, and financial assistance programs for fertility preservation.

100 Pregnancy Tips

100 Pregnancy Tips

Prior to planning pregnancy, you should learn more about the things involved in getting pregnant. It involves carrying a baby inside you for nine months, caring for a child for a number of years, and many more. Consider these things, so that you can properly assess if you are ready for pregnancy. Get all these very important tips about pregnancy that you need to know.

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