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Liu F.,University of Rochester | Brazil C.,University of California at Davis | Drobnis E.Z.,Gynecology and Womens Health | Guzick D.,University of Rochester | And 5 more authors.
Fertility and Sterility | Year: 2010

Objective: To examine the association between stressful life events and semen parameters. Design: Cross-sectional analysis in a pregnancy cohort study. Setting: Prenatal clinics in five U.S. cities. Patient(s): Fertile men (n = 744) in the Study for Future Families, a cohort study of pregnant women and their partners. Intervention(s): None. Main Outcome Measure(s): Sperm concentration, percent motile, and percent normal morphology and classification above/below World Health Organization (WHO) cutoffs for semen quality. Result(s): After adjusting for confounders, men reporting 2+ recent stressful life events had an increased risk of being classified below WHO thresholds for "normal" defined by concentration, motility, and morphology criteria compared with men reporting <2 stressful life events (odds ratio [OR] = 2.06; 95% confidence interval [CI], 1.18, 3.61; OR = 1.54; 95% CI, 1.04, 2.29; OR = 1.93; 95% CI, 1.02, 3.66 for concentration, motility and morphology, respectively). Men experiencing 2+ stressful life events had lower sperm concentration (log scale, β = -0.25; 95% CI, -0.38, -0.11) and lower percent motile sperm (β = -1.95; 95% CI, -3.98, 0.07), but percent normal morphology was less affected. Conclusion(s): These results suggest that stressful life events may be associated with decreased semen quality in fertile men. The experience of psychosocial stress may be a modifiable factor in the development of idiopathic infertility. © 2010 American Society for Reproductive Medicine. Source

Mitwally M.F.,Gynecology and Womens Health | Diamond M.P.,Wayne State University | Abuzeid M.,Michigan State University
Fertility and Sterility | Year: 2010

Objective: To study the outcome of IVF-ET in women who used vaginal P (vaginal P4) versus those who used P in oil via IM injection (IM-P4) for luteal support. Design: Retrospective cohort. Setting: Tertiary referral infertility center. Patient(s): A cohort of 544 women. Intervention(s): In 145 women, vaginal P4 was used, while in 399 women, IM-P4 was used for luteal support. Main Outcome Measure(s): The primary outcome was ongoing pregnancy rate. Secondary outcomes included other IVF-ET outcomes: rates of clinical pregnancy and pregnancy loss (chemical and miscarriage) and serum P levels during the luteal phase and early pregnancy. Result(s): Women who used vaginal P4 for luteal support had ongoing pregnancy rates (odds ratio [OR], 1.0675; 95% confidence interval [CI], 0.7587-1.5020) and rates of total pregnancy loss (OR, 1.0775; 95% CI, 0.7383-1.5727) that were not statistically different from those who used IM-P4. During the luteal phase, women who used vaginal P4 had mean serum P levels that were not statistically different from those who used IM-P4. However, during early pregnancy, mean P levels in pregnant women who used vaginal P4 were statistically significantly higher. Conclusion(s): In women undergoing IVF-ET according to the GnRH agonist long protocol, luteal support with vaginal P4 was associated with treatment outcomes that were no different from those associated with IM-P4 luteal support. © 2010 American Society for Reproductive Medicine. Source

Schulz L.C.,Gynecology and Womens Health | Roberts R.M.,University of Missouri
Reproduction | Year: 2011

The hormone leptin, which is primarily produced by adipose tissue, is a critical permissive factor for multiple reproductive events in the mouse, including implantation. In the CD1 strain, maternally derived leptin from the oocyte becomes differentially distributed among the blastomeres of pre-implantation embryos to create a polarized pattern, a feature consistent with a model of development in which blastomeres are biased toward a particular fate as early as the two-cell stage. In this study, we have confirmed that embryonic leptin is of maternal origin and re-examined leptin distribution in two distinct strains in which embryos were derived after either normal ovulation or superovulation. A polarized pattern of leptin distribution was found in the majority of both CD1 and CF1 embryos (79.1 and 76.9% respectively) collected following superovulation but was reduced, particularly in CF1 embryos (29.8%; P<0.0001), after natural ovulation. The difference in leptin asymmetries in the CF1 strain arose between ovulation and the first cleavage division and was not affected by removal of the zona pellucida. The presence or absence of leptin polarization was not linked to differences in the ability of embryos to normally develop to blastocyst. In the early blastocyst, leptin was confined subcortically to trophectoderm, but on blastocoel expansion, it was lost from the cells. Throughout development, leptin co-localized with LRP2, a multi-ligand transport protein, and its patterning resembled that noted for the maternal-effect proteins OOEP, NLRP5, and PADI6, suggesting that it is a component of the subcortical maternal complex with as yet unknown significance in pre-implantation development. © 2011 Society for Reproduction and Fertility. Source

Shwayder J.M.,Gynecology and Womens Health
Obstetrics and Gynecology | Year: 2010

The malpractice environment has adversely influenced physicians' practice patterns. Although liability reform has had a positive effect in several states, recent court decisions finding statutory damage caps unconstitutional threaten ongoing adoption of effective liability reform.59 The threat of medical liability is always present in obstetrics and gynecology. Practicing contemporary, evidence-based medicine with compassion and excellent communication is both best for patient care and the best way to avoid an allegation of negligence. If an adverse event occurs, open communication, empathizing with patients, and addressing accountability and remediation may prevent a liability claim. However, if a suit occurs, the best defense comprises contemporaneous, comprehensive, and accurate documentation. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. Source

Bergemann T.L.,Medtronic | Starr T.K.,Gynecology and Womens Health | Starr T.K.,Masonic Cancer Center | Yu H.,University of Minnesota | And 6 more authors.
Nucleic Acids Research | Year: 2012

Insertional mutagenesis screens in mice are used to identify individual genes that drive tumor formation. In these screens, candidate cancer genes are identified if their genomic location is proximal to a common insertion site (CIS) defined by high rates of transposon or retroviral insertions in a given genomic window. In this article, we describe a new method for defining CISs based on a Poisson distribution, the Poisson Regression Insertion Model, and show that this new method is an improvement over previously described methods. We also describe a modification of the method that can identify pairs and higher orders of co-occurring common insertion sites. We apply these methods to two data sets, one generated in a transposon-based screen for gastrointestinal tract cancer genes and another based on the set of retroviral insertions in the Retroviral Tagged Cancer Gene Database. We show that the new methods identify more relevant candidate genes and candidate gene pairs than found using previous methods. Identification of the biologically relevant set of mutations that occur in a single cell and cause tumor progression will aid in the rational design of single and combinatorial therapies in the upcoming age of personalized cancer therapy. © 2012 The Author(s). Source

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