crimsonpublishersreproductiveblr - Tumblr blog

crimsonpublishersreproductiveblr · 3 years ago

Text

Threshold Value of Anti-Mullerian Hormone for the Diagnosis of Polycystic Ovary Syndrome_Crimson Publishers

Threshold Value of Anti-Mullerian Hormone for the Diagnosis of Polycystic Ovary Syndrome in Hung Vuong Hospital, Vietnam by in Tuyet Hoang TD Perceptions in Reproductive Medicine_Crimson Publishers

Abstractto

Abstract: Polycystic ovary syndrome (PCOs) is one of the most common endocrine disorders in women, accounting for 8-13% of women in reproductive age. Anti-Mullerian hormone (AMH) is secreted only by the granular cells of the ovaries, starting from 25 weeks of pregnancy to menopause. AMH is involved in follicle development and the sensitivity of follicles to FSH. Serum AMH increased in the group with PCOs, but the threshold for diagnosis and prognosis is a matter of great concern.

Objectives: Identify serum AMH cutoff threshold in predicting a PCOs at Hung Vuong hospital and related factors.

Methods: A cross-sectional study of 275 infertility patients with 60 cases of had PCOs and 215 without PCOs in Hung Vuong Hospital's Department of Infertility, which met the sample selection criteria from March 15, 2018 to August 20, 2019.

Results: (1) AMH with cutoff of 6.5ng/ml, sensitivity of 70%, specificity of 77.4% can be used to predict PCOs. (2) There is no relationship between AMH and BMI in both groups of PCOs and without PCOs. Some characteristics of PCOs: The average age of women with PCOs is 28.03 ±74 lower than the group without PCOs (p=0.02). Menstrual disorders and images of polycystic ovaries are the two most common symptoms in PCOs. Androgen intensity only accounts for a few. Most women with PCOs have BMI within normal limits (60%). The rate of LH in the PCOs group was higher than that of the group without PCOs (p <0.001). Conclusion: serum AMH is valuable for diagnosis in PCOS. However more research is needed in the future.

Keywords: PCOs, cross - sectional study, cut threshold, Anti - Mullerian hormone

Polycystic ovary syndrome (PCOs) is one of the most common endocrine disorders in women, accounting for 8-13% of women of reproductive age [1], PCOs can be diagnosed clinically, biochemically and by ultrasound. Following the consensus of the conference in Rotterdam, PCOs were diagnosed when there were two of three criteria: cyclic ovarian disorders, clinical and biochemical androgen increase, polycystic ovarian image on ultrasound [2].

Introduction

Recently, Anti-Mullerian hormone (AMH) has been known as a survey for ovarian reserve. AMH is secreted by the granulocytes of prokaryotic and follicular cysts, which play an important role in early follicular development. Serum AMH also plays an important role in preventing oocyte selection to be the dominant follicle [3]. Many studies have shown the role of serum AMH in diagnosing PCOs [4]. However, due to the diversity in AMH testing, it is difficult to define a serum AMH threshold to diagnose PCOs for all places. Age may affect the relationship of AMH and hormones, with some authors recommending avoiding the diagnosis of PCOs before age 18 [5].

PCOs are characterized by an increase in the number of oocytes at all stages of follicle development [6], in particular an increase in many cavity follicles and small-sized follicles [7]. Therefore, serum AMH-reflecting the source of pre-cysts and small cysts, increases 2-4 times higher in PCOs compared to normal women [8]. Increased serum AMH is thought to be due to an increase in the number of pre-cavity cysts and small-sized cysts. However, AMH secreted by granulocytes increased by 75 times in women with no ovum PCOs and 20 times in women with normal ovulatory PCOs compared to women with normal ovarian activity. The intrinsic regulatory disturbance of granulocytes, increased overexpression of AMH type 2 receptors (AMHRII) also increases serum AMH in PCOs [9].

The cause of serum AMH increase in polycystic ovaries is unknown but there is evidence supporting the role of androgens. There is a positive correlation between androgen and serum AMH, and excessive androgen production may be due to shell cell defects in PCOs [10]. Many studies have been done to evaluate the accuracy of serum AMH in the diagnosis of PCOs and determine the appropriate diagnostic threshold. There is no consensus on the serum AMH threshold used to diagnose PCOs. This serum AMH value ranges from 2.8ng/ml to 8.4ng/ml [11]. A meta-analysis gave a diagnostic threshold of PCOs of 4.7ng/ml with a sensitivity of 79.4% and a specificity of 82.8% and AUC of 0.87 [12]. In Vietnam, research on polycystic ovary syndrome and serum AMH has not been done much, especially research on serum AMH cutoff threshold for diagnosing polycystic ovary syndrome. From the above fact, we have conducted a research with the purpose of finding an appropriate serum AMH cut threshold to diagnose PCOs according to Rotterdam standards at Hung Vuong Hospital, Vietnam.

Our research has the following goals:

A. Determination of serum AMH cut threshold in predicting the PCOs at Hung Vuong Hospital.

B. Determine the correlation between serum AMH and BMI.

Objects and Methods

Go to

Research design: Cross-sectional research

Subjects: Female infertility patients at the Department of Infertility of Hung Vuong Hospital met the sample selection criteria from March 15th, 2018 to August 20th, 2019.

Criteria for admission: The presence of 2 ovaries and the image of the ovaries observed on ultrasound.

Exclusion criteria: Patients diagnosed with congenital adrenal hyperplasia, androgenic tumors, Cushing's syndrome, hyperactactinemia, thyroid dysfunction and other endocrine disorders, autoimmune disease, amenorrhea hypothalamus, premature ovarian failure. Age <18 or> 35. Use oral contraception pill. Ovarian tumors, ovarian cysts, endometriosis.

The sample size is calculated by formula (13):

In which: FP: false positive; TN: it’s negative; p_sp: specificity of the test: 0,8 (12); Z_α: 1.96; W: error of probability of false positive and true negative: 0.05; p: prevalence of the disease: 0.1 (1). The result is N=275. Sampling method: Based on the list of infertility patients stored at Hung Vuong Hospital’s Department of Infertility, we collected samples that met the sampling criteria. Samples are selected according to the convenient selection method until a sufficient number of sample sizes are available. After that, we proceeded to collect the data according to the collected form. The study selected the gold standard based on the diagnostic criteria of PCOs as agreed by the Rotterdam Conference 2003. Endocrine tests: LH, FSH, estradiol, testosterone, AMH tests are performed on day 2-3 of the cycle. periods. The AMH test is an ELISA test: Gen II. We use IBM SPSS software 20 for data entry and data analysis.

Results

Select cut -off serum AMH threshold by drawing ROC curve and a detailed breakdown of cut points, then select the optimal cut point by calculating the maximum value of Youden index (J = Se + Sp -1) and maximum value minor of d = (1− Sn)2 + (1− Sp)2 ) (Figure 1). The area under the curve is 0.758 with 95% CI [0.70-0.82], the suitable serum AMH cut - off point is 6.5 with 70% sensitivity, 77.4% specificity (Table 1 & 2).

Table 1: Group epidemiological characteristics with PCOs and without PCOs (n=275).

Discussion In the world, many studies have been conducted from 2006- 2018 to determine the role of AMH in diagnosing PCOs. These studies all used the consensus of the 2003 Rotterdam Conference to diagnose PCOs. There are 3 studies done in the white race, 3 studies done in Asia. The two studies that used the AMH assay were Gen II varieties in our study, which were from Taiwan and Indonesia. The majority of research designs are controls. Three studies sampled from infertility, three from a general population. In our study, the AMH value in PCOs group was significantly higher (p <0.001) compared to the group without PCOs. AMH is highly sensitive and specific in diagnosing PCOs, the area under the curve is 0.758 with 95% confidence interval [0.7-0.82]. With AMH cutoff point of 6.5ng/ ml, AMH can diagnose PCOs with a sensitivity of 70%, a specificity of 77.4% (OR=5.54, 95% CI [2.993-10.267]). The AMH cut-off threshold for diagnosing PCOs in Taiwan is 7.3ng/ml with 70% sensitivity, 76% specificity is quite similar to the study with our study of 6.5ng/ml, 70%, 77.4% in order. However, this study uses a sample from the general population, so the results are different from our study. Wiweko’s 2011 study [13,14], in Indonesia, has the same characteristics as ours: sampling population, research design, AMH testing and Asian racial similarity, Their AMH cutoff is 4.45ng/ ml with 76% sensitivity, 74.6% specificity. However, the sample size of Wiweko was not very large (142 people). Tremellen’s study in 2015 [15], with a very large sample size, using modern AMH assays (automatic elecsys) for AMH cutoff of 7.6ng/ml with a sensitivity of 76% in order, 87%.

Some characteristics of PCOs: The average age of women PCOs is 28.03 ± 2.74 (yrs) lower than the group without PCOs (p=0.02). Menstrual disorders and polycystic ovarian images are the two most common symptoms in PCOs. Androgen intensity only accounts for a few. Most women with PCOs have BMI within the normal limits (60%). Serum LH was higher in PCOs than non- PCOs (p <0.001). Regarding age, in our study, the average age of women PCOs was 28.03 ± 2.74. This feature is quite similar to the research in the world. The study of Casadei et al. [16] in Italy, the average age of women PCOs is 30.6 ± 3. The study of the authors’ group in Indonesia [14], the average age of women PCOs is 29. 55 ± 3.94. We noted that the average age of PCOs was lower than that of women without PCOs, this difference was statistically significant with p=0.02. The studies of Johnstone [17] and Wiweko [14] also recorded similar. This may be explained by a gradual decrease in the number of cavity-filled ovules and women with symptomatic PCOs who visit earlier, are diagnosed and treated earlier.

In terms of infertility classification, most of our study subjects were primary infertility, accounting for over 70% in both groups with and without PCOs and no difference between the two groups. This is consistent with the pathogenetic characteristics of PCOs - the cause of infertility due to frequent ovulation. Regarding obesity, the median BMI of PCOs in our study was 22.38kg/m2 higher than the non-PCOs group at 21.37kg/m2. The difference was statistically significant (p=0.023) between the two groups of PCOs and without PCOs. Basically, the serum FSH in PCOs group was not different from the without PCOs group. According to Pellat et al., Serum FSH does not affect AMH secretion and AMH gene expression in granulocytes, but in PCOs, AMH decreases by up to 30% after FSH injection [11]. Serum LH in the PCOs group was 10.17 ± 5.77 IU/ml, significantly higher than the without PCOs group (p <0.001). Wiweko’s study [14] also has similar results with ours. According to Wiweko [14], in the group with PCOs, serum LH had an average value of 10.41 ± 8.12 IU/ml, significantly higher than the group without PCOs. Many studies confirm a relationship between serum AMH and serum LH because they find that in patients with PCOs, serum LH is elevated in subjects with high AMH [18].

Regarding ultrasound AFC (Antral follicle count), the average AFC of the group with PCOs was 26.58 ± 3.15, significantly higher (p <0.001) than the group without the PCOs (median AFC was 11). This is also noted in other studies around the world: Casadei [16] and Song [19]. Regarding serum AMH, in the PCOs group, the mean value of serum AMH was 8.33 ± 3.77ng/ml, which is double that of the without PCOs group of 4ng/ml. This difference is statistically significant p <0.001. This result is similar to that of Wiweko [14], the average serum AMH in the PCOs group was 9.5 ± 5.11ng/ml, in the group without PCOs was 3.53 ± 1.95, with the Statistical differences were significant at p <0.001. According to Casadei [16], serum AMH in the group with PCOs is 8.4 ± 4.8ng/ml, in the group without PCOs 2.8 ± 2.2ng/ml. Dewailly et al. [20] suggested that serum AMH is an indicator of follicular growth better than AFC. Therefore, serum AMH testing may be an alternative diagnostic standard in PCOs in clinical practice. Regarding prolactin, the group with PCOs was 14 (10-23) pg/ml, the group without PCOs was 17 (13-22) pg/ml. There was no statistically significant difference between the two groups (p=0.17). Research results of Wiweko [14], prolactin value in PCOs group is 9.85ng/ml, lower than our study. Regarding serum estradiol, the group with PCOs was 34.5 (28.25- 44) pg/ml. Wiweko’s study [14] also recorded the results as we did 38.0 (5.42-191.0)ng/ml. A study of Casadei [16] recorded a higher result of 44.0 ± 17.2ng/ml. Thus, in women with PCOs there was an increase in serum estradiol levels. This is probably due to a decrease in SHGB (Sex Hormone Binding Globulin) concentration, which increases the concentration of estradiol that is not associated with SHGB and increases the bioactive estradiol concentration.

Conclusion

Through the study of 275 infertility patients, including 60 cases of PCOs and 215 cases of no PCOs, draw some conclusions as follows: serum AMH with cutoff of 6.5ng/ml, sensitivity 70%, specificity 77.4% can be used to predict PCOs. There was no relationship between serum AMH and BMI in both PCOs and without PCOs.

Follow On Linkedin: https://linkedin.com/in/chyler-henley-ba9623175

Follow On Medium: https://medium.com/crimson-publishers/crimson-publishers-journals-f29e22da8f5c

#crimson publishers #Crimson Publishers LLC #crimson reproductive medicine #spermatozoa #sexual disorders

0 notes

crimsonpublishersreproductiveblr · 3 years ago

Text

The Health Workers and Delivery Process Related Maternal Satisfaction with Delivery Services at UDUTH Sokoto, Nigeria_Crimson Publishers

The Health Workers and Delivery Process Related Maternal Satisfaction with Delivery Services at UDUTH Sokoto, Nigeria by Lawali Yakubu in Perceptions in Reproductive Medicine

Abstract Every pregnancy and child birth comes with a specific experience and none is guaranteed to be safe. Positive delivery experiences facilitate the further use of the reproductive health services and vice versa. The objective of the present investigation was to determine the maternal satisfaction towards delivery services at Usmanu Danfodiyo University Teaching Hospital Sokoto. A cross-sectional descriptive study was used. The study was conducted on a sample of 158 postnatal women at UDUTH. The study participants were selected using convenient method of sampling and the data was collected using self-administrated questionnaires. Most of the respondents are within the age range of 30-39 71(49.3%) and most of which are Hausas by tribe 57(39.6%). The finding of the study shows that, majority of the women were satisfied with all the process/health workers related factors except for the sex of health care provider who attended to them. Also, majority of the women were satisfied with most of the maternal obstetrics history related factors. However, most of them were not satisfied with assisted delivery services, complicated outcome of delivery as well as loss of child during or after delivery. In conclusion there is a high level of maternal satisfaction with delivery services in UDUTH Sokoto. The study recommended that, condition of toilets and shower rooms in the delivery room and postnatal ward should be addressed to ensure the satisfaction of maternity clients. Government should make infrastructural improvements to overcome shortages of water and electricity, toilet and shower supplies.

Keywords: Maternal; Satisfaction; Delivery services pregnancy

Introduction

With all the global efforts to overcome the pregnancy related deaths, deaths still remain an issue of concern in developing countries. These deaths are almost always preventable through the attendance of pregnancy and deliveries by skilled healthcare professionals in adequately supplied and equipped health facilities [1]. The causes of maternal mortality can be describe as: direct obstetric causes (73%) and indirect causes (27%) with the major causes being haemorrhage (27.1%), hypertensive disorders (14%), sepsis (10.7%), abortion (7.9%), and embolism (3.2%) [2]. Thus, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) envisions a world in which every woman, child, and adolescent in every setting realizes his/her rights to physical and mental health and well-being, has social and economic opportunities, and is able to participate fully in shaping prosperous and sustainable societies [3]. Childbirth is a crucial experience in a women’s life as it has a substantial psychological, emotional, and physical impact. A positive experience in childbirth is important to the woman, infant’s health and well-being, and mother-infant relationship. Furthermore, it is useful for the care providers to guarantee the best preparation, health service, and support to childbearing women [4]. Memories and experiences of childbirth remain with the woman throughout her life. Clearly, the support and care they receive during this period is critical. Patient satisfaction is a major component of the quality of health care in service provision. Patient expectations of care and attitudes greatly contribute to satisfaction [5]. Mostly, maternal satisfaction is determined by the physical environment of the health service, and the availability and accessibility of medicines and supplies.

It is also affected by interpersonal communication with the health care provider, competency of the health care provider and support, and the health status of the mother and newborn [6]. Satisfaction during intrapartum care is the most influential attribute on service return behaviors and utilization [7]. Assessment of satisfaction with maternity services is crucial and helps in the future utilization of service [8]. Understanding and addressing them as part of quality-improvement programme can make delivery care safe, affordable, and respectful. In short, Ubiquinone et al. [9] assert that, continuity of maternal and childcare is related to the levels of satisfaction of mother and family members with health providers and health facilities. Despite that, little is known about the maternal satisfaction with delivery services at UDUTH. Hence the need for the study.

Research Design

A descriptive survey design was used for this study to elicit maternal satisfaction with delivery services at Usmanu Danfodiyo University teaching hospital (UDUTH) Sokoto.

Target population

All mothers who gave birth in Usmanu Danfodiyo University (UDUTH) Sokoto in the labor ward and theatre at the time of data collection that fulfilled the selection criteria.

Inclusion criteria

1. Women who gave birth in UDUTH within the data collection time

2. Postnatal mothers ‘who were mentally or critically well after delivery.

Exclusion criteria

1. Women who gave birth in UDUTH outside the data collection time

2. Postnatal mothers ‘who were mentally or critically ill were not included in the study subjects.

Sampling size determination

The sample size was derived from the average deliveries conducted in the month of August 2019 in the labor ward in UDUTJH Sokoto (Table 1). Therefore, the calculated sample size is 158, and a total of 158 questionnaires will be used.

Table 1: The average delivery conducted in the month of August 2019 in the labor ward in UDUTJH Sokoto.

Using the Slovin’s rule: n = N/(1+ Ne2) Where n = the minimum sample size required, N = study population = 260 e = the margin of error at 95% confidence level The sample size (n) = 260/(1 + 260 x (0.05)2) n = 260/(1+ 260 x 0.0025) n = 260/ 1 + 0.65 n = 260/1.65 n = 157.58 n = 158

Sampling technique

A convenient sampling technique was used in this study. Convenient non-probability sampling technique on the other hand is the type of sampling technique that involves the use of a target population that is available at the time of data collection without any selection criteria.

Instrument for data collection

1. The instrument used for data collection was questionnaires. The questionnaire is divided into four sections: A, B, C and D.

2. Section A comprises of socio-demographic data of respondents.

3. Section B comprises of research questions on structural/health facility related to maternal satisfaction with the delivery services.

4. Section C comprises of research questions on process/health workers related to maternal satisfaction with the delivery services.

5. Section D comprises of research questions on maternal obstetrics history related maternal satisfaction with delivery services.

The questionnaire is close ended type.

Method of Data Analysis

The data collected were organized and presented using descriptive statistics in the form of frequency tables. The result will be analyzed using a statistical package for social sciences (SPSS) version 20. A decision mean of 3.0 will be used to ascertain the satisfaction or non-satisfaction of the respondent to the questionnaire items.

Measurement scale:

Less than 3.0 is unsatisfied.

3.0 and above is satisfied.

Ethical consideration

Permission was obtained from the departmental research committee to carry out the study. The culture and religion of the subjects were considered and respected. Individual verbal consent was obtained from respondents after full explanation of what the project entails by the researcher in the questionnaire. Confidentiality was also maintained, and a serial number rather than names was written on the questionnaires to ensure anonymity. The copy of this research work would only be available in the department library for reference and for further study.

Data analysis

Section A: Socio-demographic data: The Table 2 shows that out of the 144 respondents, 71 were between the age-range of 30-39(49.3%) which formed the majority of the respondents, followed by those within the age range of 20-29(34.0%). 13 are within the age range of 40 and above (9.1%) and those within the age range of 10-19(7.6%) forms a minority of the respondents. Out of the 144 respondents; 57(39.6%) are Hausa by tribe, 28(19.4%) are Yoruba by tribe, 26(18.0%) are Igbo and the remaining 33(28.0%) are of other tribes which includes the Fulani, Gbagi, Igbira, Igala and Nupe. Out of the 144 respondents; 102(70.8%) are Muslims, and the other 42(29.2%) are Christians. 122 of the respondents are married (84.7%), 14(9.7%) single, and others comprised 2% and 1.4% were divorced or widowed, respectively. Of all the participants, 24(16.7%), 48(33.3%) & 39(29.1%) were primary, secondary and higher education certificate holders. While few have Islamic education, 21(14.6%) and 12(8.3%) had no formal education. The Majority of the respondent are unemployed women 41(28.5%), students 36(25%) and government employees 35(24.3%), private employees 18(12.5%) and self-employed women 14(9.7%) (Table 3).

The table shows that the majority of the women were satisfied with the waiting time before been attended to (X=3.49, SD=1.46), respect and courtesy by health workers (X=4.12, SD=1.47), amount of time spent on examination (X=3, SD=1.3), competency and confident of the health worker (X=4.45, SD=1.04), privacy measures provided by the health workers (X=3.84, SD=1.18), as well as the care and support provided to their babies (X=4.52, SD=0.93). However, most of them were dissatisfied with the sex of the health worker(s) who attended to them (X=2.88, SD=1.03) (Table 4). The table shows that the majority of the women were satisfied with the status of their pregnancies whether wanted (X=4.59, SD=0.94) or unwanted (X=4.53, SD=1.03), spontaneous vaginal delivery as a mode of their delivery (X=4.98, SD=1.41), a normal outcome of delivery (X=4.50, SD=1.05), as well as a live fetal birth outcome (X=4.19, SD=1.31). However, most of them were dissatisfied with assisted delivery (vacuum, forceps and CS delivery) (X=2.54, SD=1.03), complicated outcome of delivery (X=2.76, SD=1.26) and still birth & neonatal death outcome of delivery (X=2.98, SD=0.92).

Discussion

A total of 158 post-natal women were approached. 144 completed the questionnaires out of which 102(70.8%) are Muslims, and the other 42 (29.2%) are Christians. Most of the respondents are within the age range of 30-39 years of age-71(49.3%) and most of which were Hausas by tribe 57(39.6%). Most of the 144 respondents are married 122(84.7%) and are secondary education certificate (48-33.3) while few have Islamic education 21(14.6%). The majority of the respondents were unemployed women-41 (28.5%), students-36 (25%) and government employees-35 (24.3%). The respondents were satisfied with the number of health workers (X=3.58, SD=1.4). This is in contrast to a study done in Malawi that showed a shortage of health care workers including health professionals and issues related to their retention were important barriers to their quality of care. Similarly, the majority of the women were satisfied with the waiting time before been attended to (X=3.49, SD=1.46), this is in line with a study conducted in Assela Hospital. For the human dignity, majority of the women were satisfied with the respect and courtesy by health workers (X=4.12, SD=1.47). This is in line with a study conducted in maternity referral hospital in Addis Ababa which found the attitude of the health workers to have a relative higher satisfaction score [10]. As found in this study (X=3, SD=1.3), the above study also established women satisfaction with the amount of time spent on examination.

a. For the competency of the health workers, majority of the women demonstrated significant satisfaction (X=4.45, SD=1.04). This is in line with an Indian study that completeness of procedures, good medicine, and advice were perceived as ‘good care’ [11].

b. Majority of the women are satisfied with the privacy measures provided by the health workers (X=3.84, SD=1.18). This is in line with a study from Debre Markos town indicated good level of maternal satisfaction with assurance of privacy (97.7%) [12].

c. Majority of the women are satisfied with spontaneous vaginal delivery as a mode of their delivery (X=4.98, SD=1.41). This is in conflict with a study in Debre Markos town demonstrated that spontaneous vaginal delivery was significantly associated with reduction of satisfaction on delivery care [13-16].

d. Majority of the women are satisfied with a normal outcome of delivery (X=4.50, SD=1.05) and live fetal birth outcome (X=4.19, SD=1.31). This is in line with a study from west-Arsi Oromiya, Assela showed that mothers with normal delivery and fetal outcome were two times more satisfied than those with complicated delivery and fetal outcome.

e. However, most of them were dissatisfied with assisted delivery (vacuum, forceps and CS delivery) (X=2.54, SD=1.03). This is in contrast with a study from west-Arsi Oromiya, Assela which showed that mothers who had assisted vaginal delivery were less satisfied than mothers who had caesarian section (AOR=0.31, 95% CI: 1.253, 4.5) [17-19]

Implication of the Study

The results of this study will provide scientific evidence regarding mothers’ satisfaction with delivery care at UDUTH as performance measurement and also as consideration of satisfaction by health policy makers might be necessary for improving the quality of mother and newborn care, and reducing maternal mortality rate (MMR) and infant mortality rate (IMR) [19-22].

Conclusion

The above result concludes that there is a high level of maternal satisfaction with health workers and service delivery in UDUTH Sokoto.

Follow On Linkedin: https://linkedin.com/in/chyler-henley-ba9623175

Follow On Medium: https://medium.com/crimson-publishers/crimson-publishers-journals-f29e22da8f5c

#crimson publishers #Crimson Publishers LLC #Crimson reproductive #spermatozoa #sexual disorders

0 notes

crimsonpublishersreproductiveblr · 3 years ago

Text

A Review on Effect of Para-nonylphenol on Male Reproductive System_Crimson Publishers

A Review on Effect of Para-nonylphenol on Male Reproductive System by Malmir M in Perceptions in Reproductive Medicine_Crimson Publishers

Abstract Para-nonylphenol is known as a toxin and an environmental pollutant that has adverse effects on the reproductive system of laboratory animals. In this review, we focus on recent studies on the effect of this pollutant on the reproductive system including testicular tissue, sperm parameters and endocrine system disorders. The reproductive system is one of the most important and extremely sensitive organs of the body that is vulnerable to oxidative stress caused by pollutants. By searching in the scientific databases of PubMed, Google Scholar, Science Direct, Springer and Web of Science related articles were extracted. As a result, all observations have confirmed that Para-nonylphenol can cause multiple damages to the male reproductive system.

Keywords: Para-nonylphenol; Reproductive system; Sperm; Testis

Chemical Structure of Para-nonylphenol

Para-nonylphenol (p-NP) is a term that can be applied to a wide range of isomeric compounds with the general formula C9H12 (OH) C6H4 (Figure-1). p-NP is an organic compound of the alkylphenol group. Alkylphenols are a small group of substances known as Xenostrogen [1]. If the position of the hydrocarbon chain linking to phenol in nonylphenol be para, it is referred to as p-NP or 4-nonyl phenol [1].

Estrogenic Activity of p-NP

p-NP has higher estrogenic activity than other alkylphenols and this effect has been observed in the male reproduction system including mice [1,2]. p-NP has been proposed to act as estrogen mimics by direct action at the estrogen receptor [3]. Estrogen was considered as a female hormone, it is also present in males and is responsible for performing some physiological functions such as maintenance of the skeletal system, normal function of testis and prostate [4]. On the other hand, p-NP can reduce the biosynthesis of testosterone by inhibiting the activity of the 17α-HSD enzymes and the cAMP pathway of Leydig cells [5-15]. Many studies have shown that estrogenic activity disrupts sex hormones such as testosterone [6], estrogen and progesterone [7], which can decrease the chance of fertility (Table-1).

Evaluation of Oxidative Stress and Apoptosis Induced by p-NP

p-NP can induce oxidative stress on germ cells [8] and reduces the level of antioxidant defense system [9] and also increased lipid peroxidation [10] in the testicular tissue [11]. Also, p-NP by increasing Reactive Oxygen Species (ROS) levels that cause increasing active box and the cytochrome exhaust from the mitochondria that leads to activation of the Apaf1/Caspase-9 complex. Activation of this Caspar cascade results in apoptosis [12] of germinal and Sertoli cells [10]. According to the researches presented in Table 1, it can be concluded that this pollutant increases ROS and causes apoptosis in the male reproductive system (Table-2).

Table 1: Evaluation of the adverse effect of p-NP on different species of laboratory animal (male reproductive system).

NIMRI: Naval Medical Research Institute; SD: Sprague-Dawley; NAC: N- acetylcysteine; p-NP: para-nonylphenol; T: testosterone; E: Estrogen; TMDA: Tissue Malondialdehyde; MDA: Malondialdehyde; LH: Luteinizing hormone; FSH: Follicle-stimulating hormone; AEA: Antioxidant; Enzyme Activities; ↑: Increase; ↓: Decrease; +: positive effect on p-NP.

Evaluation of the Adverse Effect of p-NP on Testicular Tissue (Histological and Stereological Studies)

NP can destroy the linkage of Gap junction by reducing the expression of connexin 43 protein, causing a defect and apoptosis in spermatogenic and Sertoli cells that may be a reason for the reduction in epithelial layer [6,13], as well as disruption of the blood-testicle barrier and the production of tissue edema. On the other hand, NP by stopping the B type spermatogonia in the G1 stage of mitosis because of the product of the XPB1 gene, inhibits the expression of cyclin 1 protein, which is one of the necessary factors for mitosis [5]. These studies listed in Table 2 demonstrates the adverse effect of this pollutant on testicular tissue.

Evaluation of the Adverse Effect of p-NP on Spermatogenesis

p-NP can induce apoptosis in germinal and Leydig cells [6] and decrease testosterone levels [5], as well as, leads to a decrease in the count and production of sperm daily [5,7]. The middle part of the sperm contains a large number of mitochondria that is responsible for movement and ROS reduces the progressive sperm motility by degenerating these mitochondria [14]. ROS by lipid peroxidation causes a decrease in membrane fluidity, damage to proteins and DNA, and eventually, abnormalities occur in sperm morphology [10]. Table 3 shows the studies of the adverse effect of p-NP on spermatogenesis.

For more open access journals in Crimson Publishers please click on link: https://crimsonpublishers.com/aboutus.php

For more articles in Journal of Reproductive Health please click on below link https://crimsonpublishers.com/prm/

Follow On Linkedin: https://linkedin.com/in/chyler-henley-ba9623175

Follow On Medium: https://medium.com/crimson-publishers/crimson-publishers-journals-f29e22da8f5c

#crimson publishers #Crimson Publishers LLC #reproductive #spermatozoa #sexual disorders

0 notes

crimsonpublishersreproductiveblr · 4 years ago

Text

Effects of Air Pollution on Reproductive Health_Crimson Publishers

Effects of Air Pollution on Reproductive Health by Yue Zhi Dong in Perceptions in Reproductive Medicine_Crimson Publishers

Plain English Summary

Air pollutant exposure is closely related to many diseases, and its health risks cannot be ignored. Many epidemiological and toxicological studies have confirmed the clear adverse effects of air pollutant exposure on cardiovascular and respiratory system health, while the effects on reproductive health are still inconclusive. This article mainly discusses the effects of air pollution on reproductive health.

Keywords: Air pollution; Reproductive health

Opinion With the development of epidemiology and basic research, it is confirmed that air pollutant exposure is closely related to many diseases, and its health risks cannot be ignored. Many epidemiological and toxicological studies have confirmed the clear adverse effects of air pollutant exposure on cardiovascular and respiratory system health, while the effects on reproductive health are still inconclusive. Air Pollution, reactive oxygen species damage, and genetic or epigenetics abnormalities may be responsible for some cases of male infertility. On the one hand, the occurrence of female infertility is related to the change of life style, the decline of ovarian reserve and egg quality caused by the later reproductive age of women, on the other hand, it is also related to the deterioration of living environment [1].

The main harm of air pollution to male fertility is the impact on semen quality. Long-term exposure to high concentrations of air pollutants can result in a decrease in semen quality [2]. In vitro experiments have shown that exposure to air pollutants can activate multiple intracellular signaling pathways and initiate inflammatory responses [3]. The inflammation may cause the destruction of the integrity of the blood-testis barrier, which results in:

1. Accelerating the apoptosis of spermatogenic cells, resulting in the decrease of the number of spermatogenic cells.

2. Damaging the cell membrane, resulting in the decrease of sperm motility and fertilization ability.

3. Causing DNA damage of sperm, affect the quality of the resulting embryo, resulting in miscarriage or genetic defects in the offspring [4].

In addition, the epigenetics study found that a variety of air pollutants can affect gene expression in somatic cells by interfering with normal DNA methylation, histone acetylation methylation and miRNA regulation [5]. Epigenetics in spermatogenesis is still in its infancy, and abnormalities in Epigenetics are known to affect sperm quality and offspring development, but whether air pollution affects DNA methylation, genomic imprinting, histone methylation and RNA silencing in sperm remains to be explored. Based on the current research data, the mechanism of the damage of air pollution to male fertility should be multi-faceted, but due to the variety of air pollutants, it is impossible to carry out targeted and in-depth research on each pollutant, it is a more effective way to classify the components of air pollutants and find a common way to affect spermatogenic function. The impact of air pollution on female fertility is mainly on ovarian reserve and pregnancy outcome. There is little evidence that air pollution affects ovarian function and worsening air quality causes a decline in ovarian reserve in women or affects the number of eggs collected during the IVF cycle. However, many epidemiological studies have shown that air pollution is closely related to the occurrence of multiple adverse pregnancy outcomes, such as preterm birth, low birth weight infants, embryo cessation, abortion, stillbirth, etc. [6,7].

And the effect was seen in both women who had a natural pregnancy and those who had a subsequent pregnancy treated with assisted reproductive technology [8]. The results of animal experiments showed that air pollution could decrease the number of preantral follicles and affect the fertility rate of mice [9]. Oxidative stress and endocrine disruption may be the main mechanisms by which air pollutants affect ovarian reserve. The possible mechanisms by which air pollutants affect pregnancy outcome and offspring development are unclear. The occurrence of abortion, stillbirth, abortion and birth defects may be mainly related to DNA damage of embryo and fetal cells caused by pollutants. Compared with men, women's individual contribution to human fertility lies not only in egg production, but also in the whole process of fertilization, embryo and fetal development. Therefore, the effects of air pollution on female fertility should be longer and more complex, and due to the instability of gametes and early embryos, the effects should focus on oogenesis, fertilization and early embryonic development, but the mechanism remains to be explored. In summary, in the field of reproductive health, most researchers tend to believe that air pollution can cause a decline in human fertility, but there is still a lack of large sample of prospective experiments and in-depth study of the mechanism.

For more open access journals in Crimson Publishers please click on link: https://crimsonpublishers.com/aboutus.php

For more articles in Journal of Reproductive Health please click on below link https://crimsonpublishers.com/prm/

Follow On Linkedin: https://linkedin.com/in/chyler-henley-ba9623175

Follow On Medium: https://medium.com/crimson-publishers/crimson-publishers-journals-f29e22da8f5c

#crimson publishers #Crimson Publishers LLC #spermatozoa #sexual disorders #reproductive

0 notes

crimsonpublishersreproductiveblr · 4 years ago

Text

How Can We Optimize the Granulose Cell Function of Oocytes from an Endometriosis Patient to Improve the Reproductive Outcomes-A Short Communication?_Crimson Publishers

How Can We Optimize the Granulose Cell Function of Oocytes from an Endometriosis Patient to Improve the Reproductive Outcomes-A Short Communication? by Kulvinder Kochar Kaur in Perceptions in Reproductive Medicine_Crimson Publishers

Abstract Endometriosis, results in infertility in 50% infertile women. Explanations given are poor oocyte quality as well as low grade embryos associated with abnormal folliculogenesis, with reduced chances of fertilization correlated with enhanced oxidative stress, high reactive oxygen species (ROS) levels/local inflammation. Particularly escalated amounts of cytokines are found in follicular fluid of follicles of Endometriosis subjects. Here we further detail on the work going on in finding the role of granulosa cells in Endometriosis subjects with regards to increased inflammation, alteration in cytokines in follicular fluid that associates with follicular fluid in causing the oxidative stress, and how the upstream pathway involving tumour necrosis factor alpha (TNFα) and nuclear factor kappa B( NFκB) that influences both telomere length as well as telomerase activity, with shorter telomeres as well as reduced telomerase activity associated with aging follicles as well as those observed in patients with premature ovarian insufficiency (POI). Thus, this enhanced granulosa cell NFκB corresponds with inflammation found in FF along with effect on telomeres. Ways of targeting it seems to be one answer in improving reproductive potential of Endometriosis patients.

Keywords: Endometriosis; Poor oocyte quality; Oxidative stress; High reactive oxygen species (ROS); NFκB; TNFα; Telomere length; Telomerase activity; POI

Introduction Endometriosis, results in infertility in 50% infertile women [1]. Explanations given are poor oocyte quality as well as low grade embryos associated with abnormal folliculogenesis [2], with reduced chances of fertilization correlated with enhanced oxidative stress, high reactive oxygen species (ROS) levels/local inflammation [3]. Particularly escalated amounts of cytokines are found in follicular fluid (FF) of patients with Endometriosis might result in ovulatory impairment [4]. Further Akila et al. reviewed how in the pathogenesis of ovarian pathologies like Endometriosis and polycystic ovarian syndrome (PCOS) are affected by enhanced ROS, enhanced oxidative stress in the ovary by concentrating on mural granulosa-lutein cells of in vitro Fertilization (IVF) subjects. Synthesis of anti-oxidant enzymes like peroxiredoxin 4, superoxide dismutase and catalase and oxidative stress damage response proteins like aldehyde dehydrogenase 3, member A2 reduces with aging in human granulosa lutein cells, that helps in an unbalance in ROS/anti-oxidants which modulate molecular injury as well as changes in cellular functioning .Increased oxidative stress in the granulosa cells associates with reduced expression of follicular stimulating hormone( FSH) receptor (FSHR) as well as a dysregulated FSHR signalling pathway and thus might have a role in impaired steroidogenic function as well as bad ovarian response to FSH in women who are aging. In case of women having Endometriosis along with those with PCOS have<antioxidants producing ability which may result in abnormal follicle formation as well as infertility. More investigations of the signalling pathways in relation to cellular responses to oxidative stress might throw light into molecular properties of these diseases and allow formation of new treating strategies for increasing reproductive potential in these women. Kunitomi et al. [5] posited that endoplasmic reticulum (ER) Stress is stimulated by great oxidative stress in granulose cells in ovaries from Endometrioma and this modulates oxidative stress-stimulated apoptosis. Human granulosa-lutein cells (GLC’s) from Endometrioma patients expressed great mRNA amounts correlated with unfolded protein response (UPR). Additionally, amounts of phosphorylated ER Stress sensor proteins, inositol-requiring enzyme (IRE1) and double stranded RNA-activated protein kinase-like ER kinase (PERK), were enhanced in granulosa cells from Endometrioma patients. Knowing that ER Stress causes phosphorylation of ER Stress sensor proteins and stimulates UPR, these observations point that these cells were under ER Stress. H2O2, that stimulates oxidative stress, enhanced expression of UPR-related mRNA in cultured human GLC’s with this action getting ameliorated by pre-treatment utilizing tauroursodeoxycholic acid (TUDCA), that is an ER Stress inhibitor utilized clinically. Therapy with H2O2 enhanced apoptosis as well as action of pro- apoptotic factors caspase 8 as well as caspase 3 both of which got ameliorated by TUDCA. This pointed that stimulated ER Stress stimulated by oxidative stress in GCs in ovaries having Endometrioma modulates apoptosis of these cells causing ovarian dysfunction in Endometriosis patients [6].

Reviewing the quality of oocytes in relation to endometriosis, Sanchez et al. [7] tried to concentrate on direct oocytes studied instead of most studies concentrating on cumulus cells or FF content. In summary It has been posited that morphological defects seen that include i)cytoplasmic granularity as well as/or presence of vacuoles might affect fertilization although limited predictive value of these findings in view of restrictions of non-invasive techniques with simple transmitted light microscopy along with subjectivity in morphological analysis as well as morphology might be influenced by other factors like ovarian stimulation or hormonal milieu. Goud et al did functional studies examining immature oocytes obtained from Endometriosis women as compared to control. They observed that oocytes from Endometriosis women showed enhanced cortical granule loss as well as ii) zona pellucid (ZP) hardening, probably interfering with fertilization dissolution of the ZP and the ability of embryo to undergone hatching and implantation (Figure1); [8,9].

Figure 1: Courtesy ref no.-7-Representative morphological changes in oocytes from women affected by endometriosis.

Further capacity of oocytes to undergo in vitro maturation (IVM) to metaphase II stage was checked, observing a significant reduction of number of germinal vesicles (GV) as well as metaphase I (M1) oocytes could reach metaphase II stage in Endometriosis group as compared to controls. iii)Since spindle structure needs to coordinate the alignment as well as normal segregation of homologous chromosomes and sister chromatids in 2 subsequent meiotic division, disruption of meiotic spindle causes abnormal chromosomes alignment and fertilization. Of the 2 methods by which spindle morphology is studied polarized light microscopy overcomes fixing problem of confocal microscopy. Barcelos et al. checked spindle morphology following IVM comparing oocytes obtained from Endometriosis patients (n=35) with oocytes from control group with tubal factor infertility (n=19). Till recently no significant differences were observed. Recently Goud et al. using same IVM, observed a>percentage of abnormal spindles in oocytes obtained from Endometriosis patients as compared to ART secondary to male factor infertility (66.7% vs 16%, p<0.05). Only study that observed spindle in mature oocytes unlike all earlier ones on IVM ,failed to see any significant changes in Endometriosis patients iv)Cytoplasm of mature oocytes have a very high mitochondrial content as compared to other cell types, since it can contain up to 105 mitochondria. The 1st and only study that examined correlation between cytoplasm ultrastructure of oocytes and Endometriosis presence was conducted by Xu et al regarding intra cytoplasmic sperm injection (ICSI). Using transmission electron microscopy (TEM) 50MII oocytes from patients with laparoscopically diagnosed minimal/mild Endometriosis control found a >number of Endometriosis patients contained decentralized chromatin with a voluminous nucleolus as compared to control. Further oocytes from patients with Endometriosis had both a > percentage of abnormal mitochondria (containing small/swollen as well as blurred vacuoles) and in total lower quantity of mitochondrial DNA (mtDNA) copies seen using quantitative PCR. They concluded low mtDNA amount particularly shows reduced oocyte quality with minimal/mild Endometriosis.

Sirtuins are a family of deacetylases which modify structural proteins, metabolic enzymes, and histones for altering cellular protein placement as well as function. In mammals, 7 Sirtuins, that are related to functions like oxidative stress or metabolic homeostasis correlated with increasing age, degeneration/carcinoma. Gonzalez Fernandez et al. [10] explored gene expression of Sirtuins by qRT-PCR in human mural granulosa-lutein cells (hGL)from IVF subjects in various infertility diagnostic groups and in oocyte donors (OD; Control grp). In Study 1 gene expression levels of Sirtuins as well as association with age as well as IVF parameters in women having no ovarian factor was done. They observed that significantly>expression levels of SIRT1, SIRT2 as well as SIRT5 in patients ≥40yrs old as compared to OD and in women among 27-39yrs age with tubal/male factor and no ovarian factor (NOF). Only SIRT2, SIRT5 and SIRT7 expression was associated with age. In Study 2 gene expression of Sirtuins in poor responders (PR), Endometriosis (EM)and PCOS was done. In contrast to NOF Controls, they observed >, SIRT2 gene expression in all diagnostic groups although SIRT3, SIRT5, SIRT6 and SIRT7 expression was > only in PR. Associated with clinical parameters , SIRT1, SIRT6 and SIRT7 correlated in a positive manner with FSH as well as LH doses given to EM patients. The number of mature oocytes obtained in PR correlated in a positive manner with expression amounts of SIRT3, SIRT4, SIRT5. Hence emphasizing on that cellular physiopathology in PR’s follicles might be correlated with cumulative DNA damage that points that future studies are required (Figure2); [8]. Since FF surrounds the granulosa cell- oocyte complex and represents one of the modulating factors in the inter cell conversation among the cells within the follicle the substances present in FF are cytokines and immune cells ,that includes IL-6.IL12, sHLA-G, macrophages, NK cells and lymphocytes. These cells as well as cytokines may impact the granulosa cell-oocyte complex, change in immune component contents might be involved in alteration in folliculogenesis, oocyte maturation, oocyte quality as well as ovulation. Moreover, changes in these balances are probably responsible for immune mediated conditions like Endometriosis. Prins et al., gave a detailed evaluation on FF immune function, as well as FF substance alterations in Endometriosis patients. Escalation of macrophages in FF of Endometriosis patients as well as various cytokines have been documented. The part played by particular immune cells in FF and insight about the biological mode in healthy women as well as Endometriosis patients is unknown. More studies in this field will give us greater understanding in the role of FF immune cells and the influence of change in these balances in patients with Endometriosis [9].

Figure 2: Courtesy ref no.-8-Scheme of alterations in NOF and PR groups and possible Sirtuins’ roles. According to our studies, NOF women between 18 to 38 years old may avoid OS damage by OSR, triggering a normal signaling response and maintaining an equilibrated OS/OSR status (A). It is possible that this equilibrium favors OS during pre-menopausal aging (B). In that case, OSR are not sufficient to protect cells from OS actions and SIRT1, SIRT2 and SIRT5 gene expression increase would be required to recover homeostasis. Failing this response, women poor responders show a different sirtuin pattern (C). In this group, women between 25 to 38 years old have an imbalance between OS and OSR similar to older NOF women. Cellular attempts to reach homeostasis by increasing SIRT1, SIRT2 and SIRT5 gene expression are insufficient and it is necessary activate protein, lipid and DNA repair mechanisms and others sirtuins’ expression. Despite the fact that SIRT6 and SIRT7 gene expression increase, cells cannot response to signaling and homeostasis cannot be recovered, leading to a clinically poor response to follicle stimulation.

In follicular formation there is key role of granulosa cell [10]. In case of endometriotic subjects, abnormalities of granulosa cell might interfere with oocyte maturation and result in poor oocyte quality [11]. Telomerase was found as a biomarker of the potential that germ cells possess [12]. Premature aging and decreased fecundity were seen in mice having Telomerase deficiency [13]. Earlier Li et al. [14] revealed that telomerase activity (TA) in granulosa cell (GTA), had a positive association with IVF treatment results [14]. Healthy follicles showed > amounts of TA, as compared to decreased GTA =>enhancement of atretic follicles [15]. Subjects having subtle and biochemical premature ovarian insufficiency (POI) further demonstrated reduced TA in their granulosa cells [16,17]. Overall these observations point that GTA might work as an ovarian function biomarker. The effect of ovarian endometriosis on granulose cells was recently studied by Li et al. [18], that correlates molecular physiology with results in fertility. An efficient oocyte as well as granulosa cell crosstalk taking place the ovarian follicles sees to it that formation of a mature oocyte occurs for obtaining an embryo having full competency resulting in a pregnancy that is viable. Li et al. [18] described how internally endometriotic lesions present on the ovarian tissue resulted in intrinsic injury by evaluating the inflammatory paths as well as telomerase action within granulosa cell. 80 women got enrolled prospectively having stage II-III Endometriomas as well as 104 controls who were having oocyte recovery utilizing artificial reproductive therapy (ART) therapy. The 2 groups developed pregnancy (clinical)with equal chances, that agrees with most of current literature and helps in giving us assurance with regard to ART overcoming the problems in endometriotic subjects. But emphasis has been paid by them on the impaired results of folliculogenesis which takes place when lesions are existing.

Actually, the antral follicle count (AFC), luteinizing hormone (LH) amounts as well as the number of oocytes recovered, and mature oocytes all were < in their Endometriomas group. Stimulated by these observations they tried to evaluate the molecular reasons behind this effect on follicle formation via a number of repeated in vitro studies where they separated granulosa cell from the follicular fluid ,evaluated them for any basal inflammatory changes as well as culturing them in the exogenous inflammatory stimulants added for getting a response. Their findings were similar to the common factors in such settings like the nuclear factor (NF) κB as well as tumour necrosis factor alpha (TNFα) paths that seem to be controlled separately in granulosa cell in endometriotic subjects as compared to controls. Particularly action of NFκB in addition to its 2 helpers IKκβ as well as IKBα was > in the granulosa cell from the follicular fluid of endometriotic subjects as compared to healthy cells. To find the upstream regulators of NFκB parts of granulosa cell of endometriotic subjects. Their observation was that TNFα found within the follicular fluid (FF) had a positive association with the expression of NFκB in granulosa cell, a finding which was later confirmed by crucial cell culture studies ,where TNFα therapy directly escalated the excess of NFκB as well as IKBα. The biggest importance of these experiments was the innovative understanding of the telomerase enzyme action when endometriosis was existent along with its associated inflammation. Recently trying to assess telomere length as well as telomerase activity in granulosa cell of patients with infertility has been on the rise that has turned to be a good marker of oocyte competence. Telomeres represent conserved areas at the distal part of chromosomes which aid in conferring protection to genomic integrity.

Escalated mitotic action of granulosa cell as well as follicular hormones lead to the shortened length of telomeres that has to be restored by telomerase activity. Minimal but essential proof has aided in the understanding that the activity of telomerase is >in healthy as well as small follicles as compared to atretic larger follicles and this activity of enzymes can be enhanced by estrogens [18]. This telomeres length as well as telomerase enzyme activity as far as theoretical explanation is represent divergence but separate dynamics got detailed in particular situations ,Like granulosa cell of women having a diagnosis of premature ovarian failure(POF) had shorter telomeres as well as < telomerase activity as compared to control ladies, while absence of normal telomerase activity enhances the chances for women to have POF 11 times [19]. Though experiments of cellular modes with regards to telomere structures within oocytes as well as granulosa cell might aid in unfolding the underlying causes related to infertility, mostly little work has been done in this field.

In 2017 Li et al. [18] utilized the niche, detailing the telomeres length as well as telomerase activity in polycystic ovarian syndrome (PCOS). Their observations were shorter telomeres but the granulosa cell telomerase activity (GTA) was same in PCOS subjects as compared to controls [19,20]. In this study, they found that GTA in ovarian endometriotic subjects associated positively with the number of mature oocytes, negatively with granulosa cell NFκB activity and reduced following TNFα therapy. Greater information regarding GTA dynamics was added by studies on (human telomerase reverse transcriptase (hTERT), the catalytic subunit of the telomerase enzyme was reduced with TNFα therapy and enhanced by NFκB inhibitor. An essential observation of this study although negative is that both GTA as well as hTERT were only little lower in endometriotic subjects as compared to controls (p=0.16 and p=0.55 respectively) while NF κB inhibitor did not escalate GTA in granulosa cell culture. It needs to be seen if lowering TNFα activity or use of NFκB inhibitor might be of help in re-establishing the hTERT activity needs to be studied further.

On the basis of in vitro findings, they posited a possible mode where lesion led to escalation of FF TNFα stimulates NFκB cascade activation in granulosa cell that in turn decreases telomerase activity and effects physiologic increase in telomeres that is key for folliculogenesis as well as oocyte quality. Important is follicular TNFα levels was not separate in case as well as controls but the in vivo findings here correlated with limited size sample size or inclusion of earlier operated endometriotic subjects that might have contribute to the complicated nature regarding this. There is requirement for experiments detailing pathophysiology of granulosa cell in endometriotic subjects and time to unveil why subfertility in this disease both for patients as well as professionals [21].

Conclusion

Thus trying to understand why infertility results in Endometriosis patients lot of efforts have been put in originally most studies concentrated on studying follicular fluid for finding the reason of poor quality of oocytes among Endometriosis patients where researchers observed enhanced oxidative stress as well as ER Stress in cases of Endometriosis subjects.

Later deciding to study oocytes directly researchers observed

1. Altered mitochondrial numbers as well as abnormal mitochondria along with reduced mitochondrial DNA in oocytes of Endometriosis patients

2. Spindle abnormalities

3. ZP hardening of oocytes of Endometriosis patients

4. Abnormal spindle patterns and

5. Altered morphology in form of dark central granulation by carrying out study on oocytes during IVM mostly.

Further the role of Sirtuins in effecting the alteration in cytokines in FF associated with Endometriosis patients was emphasized as reflecting which Sirtuins are associated with poor oocyte quality with aging, PR as well as Endometriosis patients and PCOS subjects. Li et al. [18] utilized the niche,detailin g the telomeres length as well as telomerase activity in PCOS subjects where they found shorter telomeres but the granulosa cell telomerase activity (GTA) was same in PCOS subjects found that GTA in ovarian endometriotic subjects associated positively with the number of mature oocytes, negatively with granulosa cell NFκB activity and reduced following TNFα therapy. Greater information regarding GTA dynamics was added by studies on hTERT, the catalytic subunit of the telomerase enzyme was reduced with TNFα therapy and enhanced by NFκB inhibitor .An essential observation of this study although negative ,is that both GTA as well as hTERT were only little lower in endometriotic subjects as compared to controls. On the basis of in vitro findings, they posited a possible mode where lesion led to escalation of FF TNFα stimulates NFκB cascade activation in granulosa cell that in turn decreases telomerase activity and effects physiologic increase in telomeres that is key for folliculogenesis as well as oocyte quality. Important is follicular TNFα levels was not separate in case as well as controls But the in vivo findings here correlated with limited size sample size or inclusion of earlier operated endometriotic subjects Further work is being needed to find why granulosa cells are involved in Endometriosis patients ,studying a larger number of cohort to try to get better possible therapies to reduce oxidative stress and see to it that abnormal cytokines are prevented so that we get optimum oocytes of good quality.

For more open access journals in Crimson Publishers please click on link: https://crimsonpublishers.com/aboutus.php

For more articles in Journal of Reproductive Health please click on below link https://crimsonpublishers.com/prm/

Follow On Linkedin: https://linkedin.com/in/chyler-henley-ba9623175

Follow On Medium: https://medium.com/crimson-publishers/crimson-publishers-journals-f29e22da8f5c

#crimson publishers #Crimson Publishers LLC #reproductive #spermatozoa #sexual disorders

0 notes

crimsonpublishersreproductiveblr · 4 years ago

Text

Thanksgiving Day Wishes

Hope this season is filled with Lots of happiness and joy, wealth and prosperity. May your home be filled with love on this wonderful occasion of Thanksgiving!

0 notes

crimsonpublishersreproductiveblr · 4 years ago

Text

Assessment of Endometrial Receptivity Assay (ERA) Test as a Diagnostic Tool and its Outcome in Patients with Previous IVF Failure_Crimson Publishers

Assessment of Endometrial Receptivity Assay (ERA) Test as a Diagnostic Tool and its Outcome in Patients with Previous IVF Failure by Smitha M in Perceptions in Reproductive Medicine_Crimson Publishers

Abstract

Human implantation is a complex process requiring synchrony between a healthy embryo and a functionally competent or receptive endometrium. Diagnosis of endometrial receptivity (ER) has posed a challenge and so far, the most available tests have been subjective and lack accuracy and a predictive value. Microarray technology has allowed identification of the transcriptomic signature of the receptivity window of implantation (WOI). This technology has led to the development of a molecular diagnostic tool, the ER array (ERA) for diagnosis of ER. Use of this test in patients with recurrent implantation failure (RIF) has shown that the WOI is displaced in a most of these patients and the use of a personalized embryo transfer (pET) on the day designated by ERA improves reproductive performance. In this retrospective study, 74 patients with history of recurrent implantation failures who underwent Endometrial Receptivity Assay in ARC fertility centre, Saveetha medical college over a period of one year were analysed and 44 patients were receptive and 30 non receptive. Out of those 44 receptive patients 37(84.1%) were positive for clinical pregnancy and 7(23.3%) patients were negative for clinical pregnancy after performing pET. Among 30 of the non-receptive patients 7(15.9%) were found positive for clinical pregnancy and 23(76.7%) were found negative for clinical pregnancy. The p value was <0.001 which is statistically significant. Hence this study proves that doing ERA and performing Personal of clinical pregnancy rate and its outcome. Though larger studies are required to validate these results ERA has become a useful tool in our diagnostic armamentarium for ER.

Keywords: Endometrial receptivity; ERA; In-vitro fertilization; Recurrent implantation failure

Abbreviations: ER: Endometrial Receptivity; WOI: Window of Implantation; RIF: Recurrent Implantation Failure; PE: Phenotypes of Proliferative; ESE: Early Secretory; MSE: Mid‑Secretory; LSE: Late‑Secretory

Introduction DNA microarray technology allows measurement of thousands of genes simultaneously, and its use to study the level of gene transcription in tissues has revolutionized medicine. The transcriptome reflects genes that are actively expressed at any given time within a specific cell population or tissue. Transcriptomics allows characterization of gene expression at the mRNA level, giving rise to a “sample‑specific” molecular profile or its “Transcriptomic Signature.” This permits characterization of tissue function or disease phenotype [1]. The transcriptome of the endometrium has been defined in all phases of the menstrual cycle [2,3] clustering of genes into four groups was identified and these were consistent with histological phenotypes of proliferative (PE), early secretory (ESE), mid‑secretory (MSE), and late‑secretory (LSE) phases. Extensive research on endometrial transcriptomics has allowed a provisional definition of the genomic signature of human ER and an understanding of alterations in the endometrium and ER that are associated with gynecological pathology and infertility. At a molecular level, the prereceptive/early secretory phase is characterized by increased metabolic activity in preparation for implantation. This leads to a predominance of products related to cell metabolism (fatty acids, lipids, eicosanoids, and amino alcohols), transport, and germ cell migration [4]. There is an inhibition of mitosis during this phase as suggested by the downregulation of several growth factors [3]. The receptive phase witnesses a “transcriptional awakening” or upregulation of most gene expression. Apart from a high level of metabolic and secretory activity there is also an upregulation of genes involved in the activation of the immune response [3]. During the late‑secretory phase, the WOI closes and in this phase, genes related to the immune response‑both cellular and humoral, blood coagulation, steroid bio‑synthesis, and prostaglandin metabolism are regulated [5].

Search for an adequate marker of ER, led to the development of a molecular diagnostic test the endometrial receptivity array (ERA). ERA consists of a customized microarray based on the transcriptomic signature of human ER, specifically when the human endometrium is receptive to blastocyst adhesion [6]. It has been designed to identify ER by comparing the genetic profile of a test sample with those of a luteinizing hormone (LH)+7 controls in a natural cycle, or on day 5 of P administration (P+5) after E2 priming in an HRT cycle. The test contains 238 genes that are differentially expressed between these profiles. This array is coupled to a computational predictor that can diagnose the personalized endometrial WOI of a given patient regardless of their endometrial histology. The gene signature used by the predictor was obtained by selecting those genes whose expression was consistent among three different models of ER: The natural cycle as the optimal model, the COH cycle as suboptimal, and the refractory endometrium as a negative control [6,7].

The bioinformatic predictor classifies an endometrial sample as “receptive” or “nonreceptive.” The “nonreceptive” ERA is further classified as perceptivity or post receptive giving an exact status of the endometrium at the time of biopsy [8]. Accuracy and consistency are the hallmarks of a good diagnostic test. ERA has a sensitivity and specificity of 0.99758 and 0.8857, respectively [6]. It has also been documented to have a high reproducibility. Gómez et al. [8] in their study demonstrated that the transcriptomic profile of the mid‑secretory phase endometrium did not change significantly between cycles or over relatively long periods (3 years). The study of the transcriptome of ER has brought to light the fact that the WOI is not fixed, as was believed earlier. Embryo‑endometrial synchrony is fundamental to successful implantation. The transcriptomic signature of the WOI can be used to define an individual’s personalized receptive window for use in IVF. It could also help in understanding the effect of different infertility treatments on the endometrial WOI and possibly identify the cause of treatment failure. Identifying ER changes in unexplained infertility, endometriosis, and other causes of infertility would help in providing more efficient treatment.

Aim of the Study

1. To identify the contribution of the endometrial factor in recurrent implantation failure.

2. To see if Pregnancy rates improved after using the personalized Window of implantation.

Type of study

A retrospective analysis of data done for a period from June 2018 to May 2019 investigated at the ARC Fertility centre, Saveetha Medical College and Hospital.

Material and Methods

This retrospective study examined 74 infertile women who underwent ER array (ERA) from June 2018 to May 2019.

Inclusion criteria

1.Age 21-35.

2.Patients with recurrent implantation failures (3 or more than 3 IVF failures).

3.Patients having a normal ovarian reserve (follicle stimulating hormone <8, antral follicle count>10, and anti‑mullerian hormone (1.5 to 4ng/ml) were included.

4.Good quality high grade embryos are preferred for embryo transfer.

Exclusion criteria

1. Age >36.

2. Low Ovarian Reserve.

3. Patients with uncorrected uterine and adnexal pathology, e.g., hydrosalpinx, submucous polyps or myomas & previous difficult ET’s are excluded from the study.

Procedure Endometrial biopsies were collected from the uterine cavity with the use of Pipelle catheters from Gynetics on day Progestrone+5 in an HRT cycle. The day of the EB in HRT cycle is after five full days of Progesterone impregnation, that is in the morning of the 6th day. After the biopsy, the endometrial tissue was transferred to a cryotube containing 1.5mL RNA stabilizing agent (Qiagen), vigorously shaken for a few seconds, and kept at 4 °C in refrigerator for 4h. Care was taken that the tissue was adequate and well‑immersed in the fluid provided. If the tissue is too much, there is RNA degradation, and if too little, sufficient RNA is not available for extraction. The samples were then transported at room temperature to the laboratory. The test results were available in 2 weeks. ERA test diagnosed the endometrium to be receptive (R) or nonreceptive (NR). Nonreceptive endometrium was further classified as pre or post receptive. A second ERA sample was taken for these patients on the suggested day, which means for prereceptive patients, a biopsy is taken one day behind in the subsequent cycle(Progestrone+6) and in post receptive patients in the next HRT cycle one day before ,the sample is taken (Progestrone+4). Patients with a receptive endometrium (Progestrone+5) underwent Frozen Embryo Transfer in a subsequent HRT cycle simulating the ERA cycle. In patients with a changed implantation window, FET was done based on the personalized WOI identified by ERA (pET). Two good quality blastocysts were transferred.

Result and Analysis

A total of 74 patients with history of recurrent implantation failures who underwent Endometrial Receptivity Assay in ARC fertility centre, Saveetha medical college over a period of one year were analysed in this study. The results were analysed used pearson chi square test. Out of 74 patients 13 were in the age group of 25- 30 years in which 7 patients turned positive for clinical pregnancy and the rest were in the age group of 31-35 years in which 37 patients turned positive for clinical pregnancy after performing ERA and personalized embryo transfer. Good quality high grade embryos are only considered for Personalised embryo transfer. The analysis depicts that if embryos grade was higher than the clinical pregnancy was most probably positive, and the embryo was found to be significant p=0.043. Out of 74 patients 44 patients (59.5%) turned to have an ERA report as receptive and the remaining 30(40.5%) of them had non receptive ERA report. In that 44 receptive patients, 37(84.1%) were positive for clinical pregnancy and 7(23.3%) patients were negative for clinical pregnancy after performing pET. Among 30 non receptive patients, 7(15.9%) were found positive for clinical pregnancy and 23(76.7%) were found negative for clinical pregnancy. The p value was <0.001 which is statistically significant. Hence this study proves that doing ERA and performing Personalised embryo transfer in recurrent IVF failure patients has a positive outcome and improves the success of clinical pregnancy rate and its outcome (Tables 1 & 2).

Table 1: Pearson chi-square=27.317** P< 0.001

Table 2:

Discussion The introduction of microarray technology has enabled rapid progress in the understanding of many biological functions and disease processes computing Omics with bioinformatic predictors has improved the diagnosis and subsequent treatment in diseases such as cancer [9]. Success in this area coupled with the identification of the transcriptomics of the receptive endometrium during natural and stimulated cycles [10], led to the development of a molecular diagnostic test to identify the WOI-ERA [6]. In the era of personalized medicine, a “one size fits all” policy is no longer acceptable. In IVF individualized ovarian stimulation, protocols are being promoted to optimize treatment. So far, for lack of an objective and accurate test, ER remains in a gray area. ERA is a step forward in improving IVF results through identification of the WOI and personalizing embryo transfer. The test has been shown to be accurate and reproducible and does not have the limitation of inter cycle variability. The clinical application of the test has been applied only in some clinics, and hence larger studies are required to validate it. In our study, we found that 40.5% women with RIF showed a displaced WOI. The paper by Ruiz-Alonso et al. [11] suggested an increased percentage of NR endometrium in the RIF group, but this did not reach statistical significance similar to our study. The PR, OPR, and IR in the RIF group improved after pET Out of 44 receptive patients, 37(84.1%) were positive for clinical pregnancy and 7(23.3%) patients were negative for clinical pregnancy after performing pET. Among 30 non receptive patients, 7(15.9%) were found positive for clinical pregnancy and 23(76.7%) were found negative for clinical pregnancy.

The p value was <0.001 which is statistically significant. Hence this study proves that doing ERA and performing Personalised embryo transfer in recurrent IVF failure patients has a positive outcome and improves the success of clinical pregnancy rate and its outcome. Though we saw an improvement of results, the numbers in our study are not high enough to draw definite conclusions. ERA is the only test available that can determine ER with accuracy. Since it is reproducible and does not change over a long period of time (1-2 years), it need not be repeated in the event of a delay in treatment. In the clinical setting, ERA definitely has a place in RIF where an endometrial factor could be the contributory cause in a quarter of the patients. In women with even 1 IVF-OD failure with the transfer of 2 good quality embryos, it is advisable to rule out an altered WOI. Defining a receptive window would avoid embryo wastage and emotional, physical, and financial distress. Its use in patients with adenomyosis, endometriosis, and chronic endometritis can prove beneficial, as these conditions are associated with an altered ER. Persistent thin or thick endometrium is also an indication for carrying out ERA. ERA is a valuable addition to our diagnostic armamentarium. The invasive nature of the test, the need for embryo vitrification and cost are some of its limitations. Much of the implantation process still remains to be unraveled. It has to be remembered that the embryo remains a major player in this equation and genetic testing of the embryo with an array of comparative genomic hybridization has shown improved Irs [12]. However, there are no reports suggesting a 100% success even after doing a pET with a euploid embryo. Material actors, especially the immune system involvement needs to be understood.

Conclusion ERA is the most objective and accurate test available today for diagnosing ER. It has been used to define an altered WOI, and thus establish a personalized WOI for each patient. It has been shown to be a benefit in improving reproductive performance in patients with RIF. However, more studies are required to confirm these initial findings. It is limited by its invasive nature and associated costs.

For more open access journals in Crimson Publishers please click on link: https://crimsonpublishers.com/aboutus.php

For more articles in Journal of Reproductive Health please click on below link https://crimsonpublishers.com/prm/

Follow On Linkedin: https://linkedin.com/in/chyler-henley-ba9623175

Follow On Medium: https://medium.com/crimson-publishers/crimson-publishers-journals-f29e22da8f5c

#crimson publishers #Crimson Publishers LLC #reproductive #spermatozoa #sexual disorders

0 notes

crimsonpublishersreproductiveblr · 4 years ago

Text

The Great Debate: Do We Need New Contraceptive Methods to Ensure More Choice?_Crimson Publishers

The Great Debate: Do We Need New Contraceptive Methods to Ensure More Choice? by John Townsend in Perceptions in Reproductive Medicine_Crimson Publishers

Opinion

The call for safer, more effective contraceptive methods is not the same as ensuring informed choice and access to users in countries around the world. But these two diverse perspectives have dominated the debate between health scientists and contraceptive service providers on the best investments in reproductive health and medicine for the last 50 years. Recently, the members of a US-based community of practice (COP) entitled “LARC & Permanent Methods COP met in Washington DC to focus on how best to expand method choice and discuss what it takes to operationalize method choice at the country level. After a series of panels beautifully illustrating the data globally on method use and choice from Demographic and Health Surveys (DHS), procurement data and commodity gaps from the Reproductive Health Supplies Coalition, community-based perspectives on new methods from FHI360, and a review from Performance Monitoring and Accountability 2020 on the underlying dynamics affecting method adoption, continuation and switching among users in developing countries, the COP examined the conditions and environment required to ensure method choice for users as well as the service delivery policies and investments that shape the types of choices available to users, and the requirements for providers and procurement agencies alike.

For more open access journals in Crimson Publishers please click on link: https://crimsonpublishers.com/aboutus.php

For more articles in Journal of Reproductive Health please click on below link https://crimsonpublishers.com/prm/

Follow On Linkedin: https://linkedin.com/in/chyler-henley-ba9623175

Follow On Medium: https://medium.com/crimson-publishers/crimson-publishers-journals-f29e22da8f5c

#crimson publishers #Crimson Publishers LLC #spermatozoa #sexual disorders #crimson reproductive medicine

0 notes

crimsonpublishersreproductiveblr · 4 years ago

Text

Practical Tips to Ensure Patient Safety while Managing Cases of Placenta Praevia_Crimson Publishers

Practical Tips to Ensure Patient Safety while Managing Cases of Placenta Praevia by Lynda M Khouzam in Perceptions in Reproductive Medicine_Crimson Publishers

Background

On many occasions Obstetrician encounter problems or difficulties while managing cases of placenta praevia or while performing caesarean section for placenta praevia. At times, patients loose large amount of blood leading to shock. Excessive and unanticipated blood loss pose the risk of severe maternal morbidity or mortality.

Following are practical tips for managing cases of placenta praevia.

A-Antenatal Woman Diagnosed to Have Placenta Praevia, who is not Bleeding

a. Admit the patient and follow standard protocol of conservative management in antenatal ward.

b. Arrange minimum two units of blood. Ask relatives to donate blood.

c. Do not perform per vaginal and frequent per abdominal examination.

d. Let everyone including nursing staff know about the admitted case, so that anyone can start the zero-hour management, in case patient starts bleeding at any odd hour.

e. Do not change or shift the bed of the patient. Keep the bed close to passage for prompt transfer on stretcher.

f. Allow one female relative with the patient all the time. Write emergency contact number of the patient’s first degree relative on the case sheet front page back side.

g. Take provisional consent for Obstetric hysterectomy, internal iliac ligation, massive blood transfusion and admission to intensive care unit before shifting patient to operation theatre. Additional consents may be obtained during surgery as and when it is needed depending upon intra-operative findings and some unanticipated complication.

h. Plan termination of pregnancy by appropriate method at the completion of 36/37 weeks. There is no advantage of conservative management after completed 37 weeks.

i. Rule out placental invasion by ultra-sonography by senior sonologists. Resident must accompany the patient when patient is shifted for sonography or to operation theatre on stretcher.

j. Reconfirm the blood and component availability before posting the case for surgery k. Confirm the availability of responsible relative of the patient at the time of surgery.

l. Post the placenta praevia caesarean section during routine morning OT, when whole team is available for help. Considering the unanticipated intra operative problems, never post elective placenta praevia caesarean section at night time.

m. Arrange/confirm the availability of two faculty members/obstetrician during surgery.

B-Antenatal Woman Diagnosed to have Placenta Praevia, who is Bleeding

a. Secure two IV line, use No 16/18 vein flow, collect adequate cross matching sample, start Ringers Lactate iv solution.

b. Arrange two units of PCV and four FFP.

c. Arrange/confirm the availability of two faculty members/ Obstetrician during surgery.

d. Mobilize adequate manpower(Residents and Interns). e. Shift patient to operation theatre after taking high risk consent.

f. After opening the abdomen, inspect for evidence of abnormal vascularity of the uterus, especially lower uterine segment. See if there is any evidence of increta and percreta, bladder involvement, prominent vessels in broad ligament.

g. Do not be in hurry to give incision on lower segment without proper inspection of the uterus. Do not blindly believe USG findings regarding invasion. Call for help when needed before opening the uterus.

h. Perform surgery/caesarean as per clinical and ultrasonographic evaluation of the case.

i. If there is evidence of increta or percreta, perform classical caesarean section avoiding extension of vertical incision in lower uterine segment, deliver the baby, do not disturb the placenta, apply temporary haemostatic clamps to both cornua and isthmus. Plan internal iliac artery ligation followed by obstetric hysterectomy.

j. Call surgeon, if bladder invasion is anticipated or seen on inspection before opening the uterus.

k. Inform anesthesiologists about the surgical plan or anticipated blood loss and operation time so that they make necessary arrangement at their end.

l. If there is un-anticipated bleeding from lower uterine segment, then ask second assistant to apply good aortic compression, so as to control placental site bleeding till further preparations/planning for surgery is done. Apply good aortic compression using fist of the hand, so that there is disappearance of femoral pulsation.

m. Do not fiddle with the placenta, if you feel that it is adherent. Attempts of manual separation of adherent placenta can result into profuse torrential bleeding resulting into hypovolemic shock and even cardiac arrest within very short time.

n. If placenta is seen posterior and adherent, inspect the posterior surface of the uterus externally by exteriorization. Judge the extent of invasion and plan further actions accordingly.

It is extremely important to anticipate the complications and thus make necessary arrangements before posting the cases (elective as well as emergency) of placenta praevia for surgery.

Be prepared to deal with adherent placenta or placental site bleeding. Make sure that the operating surgeon/surgeons are well versed with the procedures like internal iliac ligation, aortic compression and obstetric hysterectomy.

For more open access journals in Crimson Publishers please click on link: https://crimsonpublishers.com/aboutus.php

For more articles in Journal of Reproductive Health please click on below link https://crimsonpublishers.com/prm/

Follow On Linkedin: https://linkedin.com/in/chyler-henley-ba9623175

Follow On Medium: https://medium.com/crimson-publishers/crimson-publishers-journals-f29e22da8f5c

#crimson publishers #Crimson Publishers LLC #spermatozoa #reproductive #crimson reproductive medicine

0 notes

crimsonpublishersreproductiveblr · 4 years ago

Text

Is the Fetus an Unborn Baby? The Moral Dilemma of Reproductive Rights: A Commentary_Crimson Publishers

Is the Fetus an Unborn Baby? The Moral Dilemma of Reproductive Rights: A Commentary by Hani Raoul Khouzam in Perceptions in Reproductive Medicine

Commentary The purpose of this commentary is to clarify an alternative point of view in regard to the semantic differentiation that has been promoted as true fact which claims that a fetus is not a real person and as such cannot be called or treated as a baby. Advocates of the reproductive rights insist that a fetus is not a baby unless a passage of rights is earned by leaving the mother womb. As a consequence of this assumption the fetus is not a person and does not possess any right in deciding on whether to live or to be terminated. The fetes is described as a part of the mother’s body and she is the only person that have the right to decide on whether she wishes to keep this part of her body until she delivers a live baby or to exercise her rights to get rid of what she considers as an unwanted pregnancy and aborts the unborn baby. Although abortion is a legal procedure and ending an unborn baby’s life is not consider an act of murder and women who abort their unborn baby are not tried for a murder, it seems contradictory to other legal notions that are widely accepted by most human beings and that is to charge a person with committing a double murder if the action of that person either accidently or intentionally lead to a death of a pregnant woman. How can it be that aborting an unborn baby is not considered a voluntary ending of a human life, while ending a life of pregnant woman is considered a murder of two lives. These facts are described by the United States law of the land which recognizes a child in utero as a legal victim, if injured or killed during the commission of any of over 60 listed federal crimes of violence.

The law defines “child in utero” as “a member of the species Homo sapiens, at any stage of development, who is carried in the womb [1]. To help shed some light on this dilemma; it would be appropriate to illustrate some prevailing notions. “Life” is a property that distinguishes between that which has signaled as a self-sustaining processes and that which does not, by exhibiting such things as cellular organization, homeostasis, metabolism, growth, response to stimuli, etc. Something does not have life occurs when either those biological functions have ceased (death) or when those functions were never possessed in the first place such as in the case of inanimate objects [2]. “Homo sapiens” a member of the human species and the fetus has a human DNA and can’t possibly be classified as any species other than homo sapiens, so it is obvious then that the fetus is a person.

Does the fetus as a person have assigning rights? To claim to a right to live, a person should be able to live independently and since the fetus is only able to live because it is within the mother’s womb; therefore, any claim to a “right” to live is completely dependent on the mother. However, the same must be true for all who have physical and mental disabilities that prevent them from independent life and entail them to receive support and help from the community at large. So why is then the fetus singled out as not deserving life due to the inability to live independent of the mother’s womb. Besides, with the recent scientific research in reproductive services, it would be feasible for a fetus to grow outside of the mother’s body, in what have been called artificial wombs.

Does a pregnant mother have obligations to her Fetus? Being pregnant means having a growing new life within the womb. Whether the fetus is a person or not, and whether the laws of the land take a position on abortion or not, it’s arguable that a pregnant mother have some obligation to her fetus even if that conception was unplanned or unwanted. Although this obligation does not carry a strong standing toward eliminating the option of aborting an unborn baby, it may pose challenges to the ethical and moral choices of pursuing abortion as the only solution of rejecting an unwanted or unplanned pregnancies [3].

The ethics of reproductive rights It is difficult and politically charged to argue that abortion is not within the realm of a mother right to exercise her autonomy and control over her own body. This right to choose would lead to the unavoidable consequence of terminating a pregnancy and resulting into the death of the fetus. Since autonomy exists as an ethical necessity, it also creates the dilemma of how far that autonomy would be allowed to extend and to prohibit any legal authority from forcing the would-be mother of carrying a full-term pregnancy until the birth of a baby? So even if the fetus is a person and abortion is considered unethical, it shouldn’t be prevented through unethical means.

Ethical obligations toward the fathers Should the would-be-mother give the would -be-father the freedom of whether the pregnancy is carried to term? Since fathers have an ethical obligation to support their babies, should they have an ethical claim on whether their babies are allowed to be born or aborted? Ideally, fathers should be consulted, and what would be the outcome if they do not want their unborn babies to be aborted?

Summary The termination of the life of a fetus or unborn baby through elective abortion as a fundamental reproductive right of women to exercise control over their own body does not solve the moral dilemma of denying the personhood of the unborn baby until delivery from the mother’s womb. Elective abortion creates a significant number of important, fundamental ethical questions in regard to the nature of personhood, the nature of perceived human rights, intimate relationships, personal autonomy, the extent of state authority over personal decisions, and more. All of this means that it is very important for the advocates of reproductive rights and providers of reproductive health services to reconsider their views about the personhood of the unborn babies who may be silently pleading for a chance to live beyond the confines of their mothers’ womb because after all is being argued ,these babies are “Fearfully and Wonderfully Created” [4].

#crimson publishers #Crimson Publishers LLC #Crimson reproductive #spermatozoa #sexual disorders

0 notes