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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Normal placentation is important to avoid complications in pregnancy and diseases later in life. Infertility, spontaneous abortions, intrauterine growth retardation and preeclampsia may be a spectrum of disorders all caused by poor placentation. The aetiology may in all instances be due to decreased interaction between the trophoblasts and the endometrium/decidua, although in different degrees. Implantation is to a large extent controlled by a complex interplay between surface molecules on trophoblasts and cells in the uterus. Different cytokines, enzymes, receptors and adhesion molecules play an essential role. Defect placentation may lead to "programming", whereby an insult suffered at a critical period of development results in a permanent effect on the structure or function of the organ or tissue. Poor growth in utero is associated with diseases like hypertension and diabetes later in life. Over-invasion of trophoblasts may result in placenta accreta/pancreata and uterine rupture. Under-invasion may lead to preecklampsia, growth retardation and spontaneous abortion. Therefore, the balance between trophoblast invasion and maternal defence must be maintained in order to obtain successful pregnancy outcomes. Unravelling how this is done remains a major challenge in reproductive biology.
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PMID:[Normal implantation is important in order to avoid pregnancy complications and diseases later in life]. 1059 50

Five allelic mutants of the diabetes (db) gene have been previously described in mice and rats causing obesity, infertility, and varying degrees of diabetes. We have identified a new, spontaneous mutation resulting in obesity and diabetes in a colony of CD-1 outbred mice, Mus musculus domesticus. Genetic complementation studies indicated that the new mutation was an allele of the diabetes locus. Sequence analysis of cDNA fragments showed a deletion of one G residue located in exon 12 of the leptin receptor gene. The mutation, Lepr(db-NCSU), results in a frameshift and reduces Lepr transcript levels 10-fold. Mutant mice drank up to four times more water and were up to two times heavier than wild-type mice. Blood glucose and plasma insulin and leptin concentrations were sexually dimorphic among affected mice, suggesting an effect of sex steroids. Mortality of affected males was 100% by 5 mo, whereas affected females survived up to 10 mo of age.
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PMID:Spontaneous mutation in the db gene results in obesity and diabetes in CD-1 outbred mice. 1066 31

In recent years the complexities and heterogeneity of polycystic ovarian syndrome (PCOS) have been recognised. Most PCOS sufferers with amenorrhoea, menstrual dysfunction, hirsutism, acne and infertility can be evaluated and safely managed in primary care. It is prudent to remember that all women with PCOS are at risk of insulin resistance and the associated abnormalities of the insulin resistance syndrome--dyslipidaemia, hypertension, coronary artery disease and diabetes mellitus.
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PMID:Polycystic ovarian syndrome: is community care appropriate? 1069

Polycystic ovary syndrome (PCOS) describes a convergence of chronic multisystem endocrine derangements, including irregular menses, hirsutism, obesity, hyperlipidemia, androgenization, large and cystic-appearing ovaries, insulin resistance and subfertility. Few PCOS patients exhibit all of these features, and often only one sign or symptom is evident. The sequelae of PCOS reach beyond reproductive health, as women affected with PCOS have increased relative risks for myocardial infarction, hypertension, ischemic heart disease, thromboembolic disease and diabetes. Although the adverse health consequences associated with PCOS are substantial, unfortunately most women are not aware of these risks. Indeed, in infertility practice such concerns are secondary as most patients are referred for treatment specifically to achieve a pregnancy. Impairments in insulin metabolism appear central to the physiologic cascade of PCOS, yet clomiphene therapy fails to remedy this defect. Several investigators have described satisfactory reproductive outcomes for PCOS patients treated with oral insulin-lowering agents. In this report, we outline a diagnostic and therapeutic approach for women with PCOS refractory to clomiphene with attention to the underlying insulin imbalance associated with impaired fertility.
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PMID:Correction of hyperinsulinemia in oligoovulatory women with clomiphene-resistant polycystic ovary syndrome: a review of therapeutic rationale and reproductive outcomes. 1086 85

Thyroid gland ultrasonography is recommended in patients with nonspecific clinical symptoms such as fatigue, weight gain, dry skin, amnesic symptoms, depression, bradycardia, abnormal myocardial contractility, increased diastolic pressure, hypercholesterolemia, menstrual abnormalities, infertility, fibrocystic breast disease, anxiety, insomnia, tachycardia, paroxysmal atrial fibrillation and osteoporosis. Subclinical hypothyroidism or hyperthyroidism can cause any of the above mentioned symptoms. Diffusely decreased, decreased and inhomogenous thyroid gland echogenicity requires laboratory examination. Thyroid gland ultrasonography is recommended also in patients with type I. diabetes mellitus and vitiligo because of increased incidence of thyroid disorders in these patients. Clinical observation of patients treated with Lithium, Amiodaron or Interferon is also recommended. (Tab. 2, Fig. 6, Ref. 18.)
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PMID:Contribution of thyroid gland ultrasound for screening of patients with suspected subclinical thyroid gland disorders. 1091 42

Severe obesity is a grave disease in the U.S. as well as other industrialized nations. This disease has many ramifications on both an individual and social levels. It affects 12.5 million people in the U.S., according to national survey data. The health risks of severe obesity include hypertension, hyperlipidaemia, cardiomyopathy, diabetes, hypoventilation disorders, increased risk of malignancy, cholelithiasis, degenerative arthritis, infertility, and psychosocial impairments. Medical weight reduction programmes have rarely achieved long-term success. Most authorities now agree that bariatric surgery is the treatment of choice for well-informed and motivated obese patients with acceptable operative risks, who strongly desire substantial weight loss or who have severe impairments because of their weight. Surgery is indicated for patients with a BMI greater than 40 kg/m2, or for those with serious medical co-morbidities and a BMI greater than 35 kg/m2. Three procedures, the adjustable silicone gastric banding (ASGB), vertical gastric banding (VBG), and gastric bypass (GB), have produced the best results to date. Each of these procedures is much more effective than dietary therapies. Each has advantages and disadvantages, with GB producing greater sustained weight loss in the long-term, with a slightly higher risk of metabolic complications. All can be done with surprisingly low operative mortality. The pronounced weight loss induced with these operations can relieve and bring co-morbid diseases, such as diabetes and hypertension, once thought to be only barely controllable, into full long-term remission.
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PMID:Surgical intervention for the severely obese. 1093 82

Recent diagnostic and pharmacologic developments have focused renewed attention on polycystic ovary syndrome. Clinical features of the syndrome include anovulation, hyperandrogenism and menstrual dysfunction, but several other abnormalities, including hyperinsulinemia, luteinizing hormone hypersecretion, elevated testosterone levels and acyclic estrogen production, have been documented. Accompanying obesity and lipid abnormalities compound the risk of developing diabetes mellitus or cardiovascular disease, and chronic anovulation increases the risk for endometrial cancer. A careful history and physical examination should guide diagnostic testing. Slowly progressive hyperandrogenic symptoms with anovulation of peripubertal onset often represent polycystic ovary syndrome. Treatment goals include symptom management and the identification and prevention of potential cardiovascular risks. Treatment should take into account the patient's desire for fertility. Advances in transvaginal ultrasonography and infertility treatments, including newer medications, have facilitated assisted reproduction in patients with polycystic ovary syndrome. Ongoing pharmacologic research focusing on the treatment of insulin resistance appears promising in reversing the longterm complications of the syndrome.
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PMID:Polycystic ovary syndrome: it's not just infertility. 1099 32

Despite advances in lactation skills and knowledge, insufficient milk production still continues to mystify mothers and lactation consultants alike. Based on 3 cases with similar threads, a connection is proposed between polycystic ovary syndrome (PCOS) and insufficient milk supply. Described are the etiology and possible symptoms of PCOS such as amenorrhea/oligomenorrhea, hirsutism, obesity, infertility, persistent acne, ovarian cysts, elevated triglycerides, and adult-onset diabetes, along with possible pathological interference with mammogenesis, lactogenesis, and galactopoiesis. Clinical suggestions include guidelines for screening mothers and careful monitoring of babies at risk. Further research is necessary to confirm the proposed association and to develop therapies with the potential to improve lactation success.
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PMID:Polycystic ovary syndrome: a connection to insufficient milk supply? 1115 45

As primary care becomes a larger part of the obstetrician/gynecologist's practice, we are beginning to be relied upon to address and manage fundamental primary care issues such as nutrition, obesity, hypertension, and the risk assessment for heart disease, cancer, and diabetes. Evidence is now showing that insulin in chronically excessive amounts plays a significant role in the pathophysiology of these illnesses as well as in polycystic ovarian syndrome and infertility. The recent trend in low-carbohydrate, high-protein dieting may prove to play a significant role in the management of these illnesses. This review will discuss the pathophysiology of hyperinsulinemia as is supported heavily in the literature. It will explain the effects of a low-carbohydrate diet in relation to hyperinsulinemia and how it compares with the more widely accepted high-carbohydrate/low-fat diet regimen. It will also address many of the commonly held concerns regarding low-carbohydrate/high-protein diets and provide a brief overview of the typical low-carbohydrate/high-protein diet regimen.
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PMID:The low-carbohydrate diet in primary care OB/GYN. 1116 46

Primary care physicians can manage two thirds of cases of suspected infertility. Assisted reproductive technology can help in many cases of pelvic adhesive disease, although the effectiveness of these procedures declines significantly with patient age. Testing for ovarian reserve is an important first step for many patients who are considering infertility treatment. Some causes of infertility are associated with significant medical problems such as diabetes and abnormal lipids; these should be assessed and a long-term management plan implemented.
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PMID:What the internist needs to know about infertility. 1120 67


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