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Current
Women's Health Reviews
ISSN: 1573-4048
Upcoming Articles
Single Embryo Transfer: Double Remedy for Complications
After Assisted Reproduction
Delbaere Ilse, De Sutter Petra, Gerris Jan and
Temmerman Marleen
[Abstract]
Disorders of Sex Development: A Review
Dushyant Maharaj
[Abstract]
Advances in the Knowledge and Clinical Applications
of Lactic Acid Bacteria as Probiotics in the Urogenital Tract
María Elena Fátima Nader-Macías,
Clara Silva de Ruiz, Virginia S. Ocaña and María
Silvina Juárez Tomás
[Abstract]
Fertility Preservation for Young Women with Cancer:
Hope for the Future
M. S. Neal, L. DiPaolo, K. Willoughby, M. Faghih,
M. Karnis, E. G. Hughes and Portwine C
[Abstract]
Polo-Like Kinases (Plks) are Prognostic Markers for
Gynecologic Malignancies
Noriyuki Takai and Hisashi Narahara
[Abstract]
The Effects of Placental Corticotrophin Releasing
Hormone on the Physiology and Psychology of the Pregnant Woman
Murray Thomson
[Abstract]
Placental Cytokines in the Pathogenesis of Preeclampsia
and Hellp Syndrome
Andrea Luigi Tranquilli, Alessandra Corradetti,
Stefano Raffaele Giannubilo, Beatrice Landi, Francesca Orici
and Monica Emanuelli
[Abstract]
Abstracts
[Back to top]
Single Embryo Transfer: Double Remedy for Complications
After Assisted Reproduction
Delbaere Ilse, De Sutter Petra, Gerris Jan and
Temmerman Marleen
Thanks to assisted reproductive technologies (ART), the majority
of subfertile couples are no longer set aside from one of
the deepest desires mankind has in life. However, since the
early days of ART - application, two major disadvantages derived.
First, the transfer of multiple embryos in order to obtain
acceptable pregnancy rates brought about an epidemic of multiple
pregnancies. Second, in studies comparing pregnancy outcomes
between naturally conceived children and children after ART,
higher incidences of preterm birth and low birth weight were
assessed in the ART- group. Single embryo transfer (SET) in
IVF/ICSI proved the only answer to the epidemic of multiple
pregnancies. Moreover, studies assessing outcomes of singletons
after SET are promising and indicate that a wider application
of SET may positively affect pregnancy outcome after ART as
well.
[Back to top]
Disorders of Sex Development: A Review
Dushyant Maharaj
Disorders of sex development comprises a spectrum of embryological
anomalies resulting in ambiguous genitalia at birth or develops
at puberty ie., the appearance of the external genitalia being
at variance with normal development for either sex. Sex outcome
at birth is the result of a coordinated and sequential series
of developmental events controlled by temporally expressed
genes and hormones. The birth of an infant with ambiguous
genitalia is one of the most difficult challenges faced by
physicians. Management is compounded by psychological, social,
ethical, and sexual concerns. Genetic issues dominate the
pathophysiology of disorders of sex development, and in the
long term management would include the skills of counselors
trained in psychosexual issues affecting children and adolescents.
The management of disorders of sex development is quite complex,
and a multidisciplinary team network of appropriate professionals
is essential. The decision of sex of rearing and the timing
of surgery need careful consideration within a multidisciplinary
environment with full informed consent of the family. This
review gives an overview of disorders of sex development with
emphasis on the more frequently encountered anomalies, the
pathophysiology, presentation, and management.
[Back to top]
Advances in the Knowledge and Clinical Applications
of Lactic Acid Bacteria as Probiotics in the Urogenital Tract
María Elena Fátima Nader-Macías,
Clara Silva de Ruiz, Virginia S. Ocaña and María
Silvina Juárez Tomás
Probiotics, defined as live microorganisms administered in
high numbers to produce beneficial and physiological effects
on the host, are increasingly applied to the prevention and
treatment of many clinical situations in both human beings
and animals. The female urogenital tract is one of the targets
of probiotics, mainly by the frequency of infectious diseases
that affects patients of all ages, including pregnant women
and, potentially, newborns. Urogenital infections are associated
with high morbidity and mortality rates as well as with high
health care costs. The development of a probiotic formula
to control these situations is of great interest. In this
review, the mechanisms that support the probiotic action of
lactic acid bacteria in the urogenital tract are summarized.
Animal models used to test their effect on certain pathologies
as well as clinical trials performed in humans are described.
Some products currently available on the market are also mentioned.
[Back to top]
Fertility Preservation for Young Women with Cancer:
Hope for the Future
M. S. Neal, L. DiPaolo, K. Willoughby, M. Faghih,
M. Karnis, E. G. Hughes and Portwine C
Advances in the diagnosis and successful treatment of childhood,
adolescent, and adult cancers have allowed many young women
to lead healthy lives after overcoming their disease. However,
life-saving cancer treatment often impairs fertility. Chemotherapy
and/or radiation may irreversibly damage the reproductive
system. The maturing field of assisted conception, and specifically
cryopreservation, has created a unique partnership between
oncologists and fertility specialists. Improving assisted
conception success and fertility sparing strategies provide
options for young women who would like to have children of
their own after cancer treatment. This review article focuses
on the current practices and developing opportunities for
women who wish to preserve their fertility when faced with
gonadotoxic cancer treatment.
[Back to top]
Polo-Like Kinases (Plks) are Prognostic Markers for
Gynecologic Malignancies
Noriyuki Takai and Hisashi Narahara
Deregulated centrosome duplication or maturation often results
in increased centrosome size and/or centrosome number, both
of which show a positive and significant correlation with
aneuploidy and chromosomal instability, thus contributing
to cancer formation. Given the role of Polo-like kinases (Plks)
in the centrosome cycle, it is not unexpected that deregulated
expression of Plks is detected in many types of cancer and
is associated with oncogenesis. Plk1 has been closely linked
to cellular proliferation, cancer development and cancer progression.
There is no Plk1 expression in most differentiated cells in
contrast to tissues with proliferative potential such as placenta
and cancers. Many studies have shown that Plk1 expression
is strongly correlated with aggressiveness and prognosis in
gynecologic cancers. Plk1 gene and protein expression has
been proposed as a new prognostic marker for gynecologic malignancies,
and Plk1 is a potential target for cancer therapy. To date,
several techniques and compounds to inhibit Plk1 have been
identified and appear to be promising. In the future, methods
for inhibition of Plk1 could be improved and applied in treatment
of cancer patients.
[Back to top]
The Effects of Placental Corticotrophin Releasing
Hormone on the Physiology and Psychology of the Pregnant Woman
Murray Thomson
In response to stress corticotropin releasing hormone (CRH)
is secreted from the hypothalamus and travels to the anterior
pituitary where it stimulates the release of proteins derived
from the precursor protein, proopiomelanocortin (POMC), including
adrenocorticotropic hormone (ACTH) and β-endorphin.
β-endorphin
interacts with opioid receptors and relieves stress while
ACTH travels through the blood stream to the adrenal cortex
where it stimulates the release of cortisol. Cortisol’s
actions include releasing glucose from stored glycogen and
stimulating breakdown of fat from adipose tissue, induction
of gluconeogenesis and modulation of the immune system. As
a negative feedback control, cortisol inhibits CRH release
from the hypothalamus and ACTH from the anterior pituitary.
During pregnancy the placenta synthesizes and secretes CRH
into the systemic circulation causing a dramatic increase
in the circulating levels of CRH throughout pregnancy that
peaks at delivery and unlike the situation in the hypothalamus,
cortisol has a positive effect on placental CRH production.
While the CRH binding protein (CRH-BP) may attenuate the action
of placental CRH on the pregnant woman’s pituitary,
there is evidence that the CRH-BP does not completely cut
off access of placental CRH to the pituitary. For example,
CRH-BP levels decrease in late pregnancy lowering the ability
to decrease CRH activity. In late pregnancy when circulating
CRH levels rise dramatically and superimpose over falling
levels of the CRH-BP, the anterior pituitary may desensitize
to placental CRH so that ACTH and cortisol levels do not become
pathologically elevated. In non-pregnant individuals, disturbances
in the hypothalamic CRH - pituitary ACTH axis are associated
with mood disturbances and in pregnant women who have elevated
CRH levels during pregnancy an association with prenatal depression
has been shown. More work needs to be done to investigate
the possible roles of CRH in pregnancy related depression.
Besides effects on the pituitary, placental CRH may exert
physiological regulation on the uterus. Higher than normal
levels of CRH in mid-pregnancy are associated with preterm
pregnancy suggesting a role for CRH in the timing of parturition.
In preterm pregnancy when the uterus has to be kept quiescent,
CRH receptors are coupled to various cell signaling systems
including the cyclic AMP system that inhibits myosin light
chain phosphorylation in smooth muscle thereby dampening uterine
contraction. As the time for labour approaches, CRH receptors
may alter coupling to cellular signaling systems that phosphorylate
myosin light chain and initiate rhythmic contraction of the
uterus.
The possibility of using modulators of CRH action such as
CRH receptor agonists to correct pathological conditions in
the expectant mother provides a powerful motivation for future
studies to fully elucidate the roles of CRH in pregnancy.
[Back to top]
Placental Cytokines in the Pathogenesis of Preeclampsia
and Hellp Syndrome
Andrea Luigi Tranquilli, Alessandra Corradetti,
Stefano Raffaele Giannubilo, Beatrice Landi, Francesca Orici
and Monica Emanuelli
Preeclampsia and HELLP syndrome are placenta-dependent disorders
with both local and systemic anomalies that are responsible
for neonatal and maternal morbidity. The cytokines, produced
by the placenta in response to local ischemia/hypoxia, may
be involved in endothelial activation and dysfunction.
The adaptive immune system could play a key role in the etiology
of preeclampsia or HELLP by generating a pro-inflammatory
Th1 type immune reaction: the current pathophysiologic hypothesis
of preeclampsia is focused on maladaptation of immune responses
and defective trophoblast invasion. Also human decidual NK
cells recruited at the site of embryonic implantation induce
a number of cytokines with potential functions not yet clearly
established.
We reviewed recent studies on effect of pro-inflammatory cytokines
in preeclampsia, as well as on the role of regulatory cytokines
and chemokines and discuss evidence that cytokines continue
to be part of a paracrine/autocrine regulatory network in
the placenta and membranes throughout the different stages
of gestation.
In addition we reviewed the experimental basis for the possible
role of the immune system and proposed the hypothesis that
these conditions could be a placental inflammatory response
which can lead to a systemic and endothelial dysfunction,
resulting in hypertension, proteinuria and pathologies in
many organ systems.
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