The use of antiepileptic drugs (AEDs) can lead to decreased fertility and increased incidence of reproductive endocrine disorders in both men and women. A new study published in Epilepsia investigates the effects of withdrawal from two common AEDs, carbamazepine (CBZ) and valproate (VPA), on the sex-hormones of male and female AED users. The study finds that reproductive endocrine dysfunction resulting from AED use is reversible, even after years of treatment. After withdrawal from CBZ and VPA, sexual hormone levels returned to pre-treatment levels, and treatment-associated reproductive endocrine changes reversed.
Increases in serum testosterone concentration and decreases in estradiol, another sexual hormone, lead to improved sexual function for both men and women. Women who stopped using CBZ and VPA also saw a return to normal estrogen levels and decreases in body mass index (BMI). “These findings provide further evidence of the potentially negative effects of epilepsy treatment on reproductive endocrine functions in men and women, but they also show that some of these changes may be reversible,” says Morten I. Lossius, author of the study.
A history of maternal epilepsy and its associated treatment may be linked to impaired intelligence later in life, says a new study published in Epilepsia. Dr. Nina Oyen, M.D., of the University of Bergen and Norwegian Institute of Public Health, Bergen, Norway, investigated the I.Q. levels of sons born to mothers with and without epilepsy, and found a correlation between intelligence and the illness. Drawing on extensive data on maternal epilepsy reported to the Medical Birth Registry of Norway and adult I.Q. scores and anthropometric measures taken later in life, the study monitored male children until the age of nineteen, providing a long-term look at the possible effects of maternal epilepsy on fetal brain development. The study finds that almost twenty years after birth, the sons of mothers who suffered from epilepsy before or during pregnancy exhibited reduced I.Q. scores when compared to men whose mothers did not have epilepsy. A history of maternal epilepsy was also found to be associated with shorter height. “Our results underline the need for population-based registries with complete long-term follow-up of infants with prenatal exposure to phenobarbital and phenytoin, drugs that are still widely used in many countries,” says Oyen, noting that studying the effects of exposure to newer medications is also important. Information on the specific antiepileptic drugs used by the epileptic mothers of children in the study was not available. “It remains to be seen whether the newer antiepileptic drugs are safer to offspring exposed during fetal life.”
Friday, November 30, 2007
Thursday, November 29, 2007
Pesticides, Contaminants & Fertility
Methoxychlor (MXC), a common insect pesticide used on food crops, may interfere with proper development and function of the reproductive tract, leading to reduced fertility in women, researchers at Yale School of Medicine write in the journal Endocrinology. The researchers found that MXC, which was manufactured as a safer replacement for the now-banned DDT, alters the estrogen-regulated gene Hoxa10 in the reproductive tract and reduces the ability of the uterus to support embryo implantation. The researchers used mice and then human cell lines to confirm their findings. MXC is a man-made pesticide used to kill flies, mosquitoes, cockroaches and other insects, and is applied directly to food crops, livestock, home gardens and pets. It is one of a large number of chemicals that can mimic the action of hormones and in some instances interfere with endocrine function. Some of these endocrine disruptors bind estrogen receptors and adversely affect reproductive tract development, which is heavily influenced by estrogen. MXC and other chemicals like DDT have been shown in other studies to induce abnormalities in tissue development and function in the female reproductive tract. "MXC has an adverse effect on these mice similar to that of DES, a synthetic estrogen," said senior author Hugh S. Taylor, M.D., associate professor in the Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. "Female offspring of women exposed to DES were more likely to have an abnormally shaped cervix, were more prone to cancer of the vagina, miscarriages, early labor and other complications."
The contaminant bisphenol-A (BPA)--widely used to make many plastics found in food storage containers and dental products--can have long-term effects in female development, according to a recent study by Yale School of Medicine researchers. Lead investigator Hugh S. Taylor, said the study shows that BPA changes the expression of key developmental genes that form the uterus. Taylor explained that if pregnant women are exposed to the estrogen-like properties found in BPA, it may impact female reproductive tract development and the future fertility of female fetuses the mother is carrying. The study was conducted on pregnant female mice by administering a range of doses of BPA on days 9-16 of their pregnancies. The aim was to see what interaction BPA would have with the HOXA10 gene, which is necessary for uterine development.
Taylor and co-author Caroline C. Smith of the Department of Epidemiology and Public Health at Yale School of Medicine, found that BPA does, in fact, alter the expression of the HOXA 10 gene, implying that exposure to the popular plastics component may lead to infertility in humans. "The net effect is concerning," said Taylor. "We are all exposed to multiple estrogen-like chemicals in industrial products, food and pollutants." BPA is found in plastics, including baby bottles, epoxy resins used in canned goods and dental sealants. In addition to this new link to fertility and reproductive health, previous findings by Csaba Leranth, M.D., also in Yale Ob/Gyn, found that low doses of BPA in female rats inhibited estrogen induction in the brain. This can lead to learning impairment and, in old age, the onset of neurodegenerative disorders such as Alzheimer's disease.
The contaminant bisphenol-A (BPA)--widely used to make many plastics found in food storage containers and dental products--can have long-term effects in female development, according to a recent study by Yale School of Medicine researchers. Lead investigator Hugh S. Taylor, said the study shows that BPA changes the expression of key developmental genes that form the uterus. Taylor explained that if pregnant women are exposed to the estrogen-like properties found in BPA, it may impact female reproductive tract development and the future fertility of female fetuses the mother is carrying. The study was conducted on pregnant female mice by administering a range of doses of BPA on days 9-16 of their pregnancies. The aim was to see what interaction BPA would have with the HOXA10 gene, which is necessary for uterine development.
Taylor and co-author Caroline C. Smith of the Department of Epidemiology and Public Health at Yale School of Medicine, found that BPA does, in fact, alter the expression of the HOXA 10 gene, implying that exposure to the popular plastics component may lead to infertility in humans. "The net effect is concerning," said Taylor. "We are all exposed to multiple estrogen-like chemicals in industrial products, food and pollutants." BPA is found in plastics, including baby bottles, epoxy resins used in canned goods and dental sealants. In addition to this new link to fertility and reproductive health, previous findings by Csaba Leranth, M.D., also in Yale Ob/Gyn, found that low doses of BPA in female rats inhibited estrogen induction in the brain. This can lead to learning impairment and, in old age, the onset of neurodegenerative disorders such as Alzheimer's disease.
Wednesday, November 28, 2007
New Insight into Female Sexual Dysfunction (FSD)
The kids. The job. The house. The cell phone, blackberry and email. With all the responsibilities many women juggle, there is often no time for romance, and in many cases, even less desire. Well over a third (40 – 45%) of adult women experience at least one symptom of sexual dysfunction, and few feel they can talk about it. Researchers are working to change the condition and this way of thinking. “Women who have sexual dysfunction should realize this may be a treatable condition, not just a personal problem,” says Thuy-Tien L. Dam, M.D. “Many women don’t know that other women experience this too, and that it might be a diagnosable disorder called Hypoactive Sexual Desire Disorder or HSDD.” Dam, is conducting a clinical trial to see whether an investigational drug is safe and effective for women with low sexual desire. HSDD is the most common form of female sexual dysfunction, characterized by decreased sexual thoughts and feelings as well as a loss of desire for sex. About 17% to 55% of women have low levels of sexual interest, depending on age. “Candidates for the study are women who have desire problems; women who once had a healthy sex-drive who now notice a big difference in desire level, for some unknown reason,” says Dam. “If we can understand the physiologic process of what’s happening, we can tailor the treatment specifically for that.” Studies have shown that erectile dysfunction in men is sometimes caused by a physiologic problem, such as reduced blood flow. There is a school of thought that perhaps physiologic changes in the female brain may be associated with female sexual dysfunction. While male erectile dysfunction is widely known, publicly discussed and treated, the U.S. Food and Drug Administration has not approved any investigational drugs for treating similar disorders in women. This study is an important step in the therapeutic options to help women regain a satisfactory sex life, and to be able to talk about it, said Dam. Novel research published in a recent issue of The Journal of Sexual Medicine supports the claim that women with hypoactive sexual desire disorder or HSDD (persistent or recurrent deficiency and/or absence of sexual fanatasies/thoughts, and/or desire for, or receptivity to, sexual activity, which causes personal distress) show noted improvement in sexual desire and sexual function following low dose testosterone treatment.
Researchers at Yale School of Medicine and the Albert Einstein College of Medicine have found that female sexual dysfunction (FSD) affects 48.2 percent of women in a new study and that these women had decreased sensation in the clitoris, which increased the risk of sexual dysfunction. "There is a paucity of data available on FSD and this study brings attention to the possibility of a neurological cause for the dysfunction," said lead author Kathleen Connell, from the Yale School of Medicine.
Connell said previous epidemiological studies have shown that about 10 million women between the ages of 50 and 74 report abnormal sexual complaints, including decreased desire, inability to reach orgasm and increased pain with intercourse. In contrast to data on men, Connell said clinical trials evaluating the physiologic mechanisms responsible for sexual function in women are few, despite reports of other investigators, which suggest that sexual dysfunctions may be more common in women than men. "The sexual response is complex and involves interaction between the nervous system, the vascular system and the musculoskeletal system," said Connell. "Alterations in any of these systems could potentially cause FSD." The team studied the pudenal nerve, which provides nerve fibers to the pelvic floor muscles and is also responsible for sensation in the genital region. They evaluated the role of genital neurological integrity and sexual function in 56 women. They used a validated screening questionnaire to identify women between ages 18 and 68 with FSD and tested vibratory and pressure sensation in the genital region. The team found that almost half of the women studied reported sexual dysfunction. Of the women with FSD, 23.2 percent had more than one form of sexual dysfunction. Those with sexual dysfunction had decreased sensation in the clitoris compared to asymptomatic women. An investigational hormone patch developed by Proctor & Gamble and now in clinical trials may offer hope to women who have experienced a decline in sexual desire. The clinical trials of a thin, nearly-transparent patch worn discreetly on the abdomen are being conducted at University Hospitals of Cleveland and more than 150 other sites in the U.S. and Canada.
Researchers at Yale School of Medicine and the Albert Einstein College of Medicine have found that female sexual dysfunction (FSD) affects 48.2 percent of women in a new study and that these women had decreased sensation in the clitoris, which increased the risk of sexual dysfunction. "There is a paucity of data available on FSD and this study brings attention to the possibility of a neurological cause for the dysfunction," said lead author Kathleen Connell, from the Yale School of Medicine.
Connell said previous epidemiological studies have shown that about 10 million women between the ages of 50 and 74 report abnormal sexual complaints, including decreased desire, inability to reach orgasm and increased pain with intercourse. In contrast to data on men, Connell said clinical trials evaluating the physiologic mechanisms responsible for sexual function in women are few, despite reports of other investigators, which suggest that sexual dysfunctions may be more common in women than men. "The sexual response is complex and involves interaction between the nervous system, the vascular system and the musculoskeletal system," said Connell. "Alterations in any of these systems could potentially cause FSD." The team studied the pudenal nerve, which provides nerve fibers to the pelvic floor muscles and is also responsible for sensation in the genital region. They evaluated the role of genital neurological integrity and sexual function in 56 women. They used a validated screening questionnaire to identify women between ages 18 and 68 with FSD and tested vibratory and pressure sensation in the genital region. The team found that almost half of the women studied reported sexual dysfunction. Of the women with FSD, 23.2 percent had more than one form of sexual dysfunction. Those with sexual dysfunction had decreased sensation in the clitoris compared to asymptomatic women. An investigational hormone patch developed by Proctor & Gamble and now in clinical trials may offer hope to women who have experienced a decline in sexual desire. The clinical trials of a thin, nearly-transparent patch worn discreetly on the abdomen are being conducted at University Hospitals of Cleveland and more than 150 other sites in the U.S. and Canada.
Tuesday, November 27, 2007
India's First Same-Sex Couple Surrogacy Success Story
For the e-story, please go to http://www.hindustantimes.com/storypage/storypage.aspx?id=4d5e0c82-f576-4574-8e86-808de3e03980&&Headline=Gay+pair+has+twins+by+surrogate+mom
Monday, November 26, 2007
Men With Deep Voices Are More Fertile
Apparently, what attracts women more than a great physique or an attractive face could well be a deep voice, say researchers from Canada and the USA. Men with deep voices are also much more likely to have more children than men who do not have deep voices, the researchers say. You can read about this study in the journal Biology Letters. The scientists said a man's deep voice is a bit like a peacock's tail - it has no survival value, but attracts the female of the species. Testosterone masculinizes the voice at puberty.
Coren Apicella and team interviewed 52 women and 49 men from the Hadza tribe, Tanzania. They were aged from 18-55. There is no birth control in this very large tribe. The researchers chose the Hadza tribe because their lifestyles reflect those of humans thousands of years ago. They are hunter-gatherers. The females gather berries and search for wild plants. The males collect honey and hunt animals. Even though the Hadza are monogamous, extra-marital sex is common. During the interviews, which took place in Swahili, Apicella recorded the voices of the men and women. On studying the recording later they found that the deep voiced men had fathered more children than the non-deep voiced men. The man with the deepest voice had ten surviving children, while the one with the highest pitched voice had three. Apicella suggested that perhaps the males with the lower pitched voices had higher testosterone levels, which attracted them more to females or made them more attractive to them. It is also possible, Apicella added, that men with higher testosterone levels start reproducing earlier in life - they could also be better hunters (a better hunter would bring more food, allowing their wives to have shorter inter-birth intervals).
There was not much Apicella and team could glean from the interviews with the women. It is possible, said the team, that if vocal dimorphism evolved partly due to mate selection, that in the past men and women had more similar voices.
Coren Apicella and team interviewed 52 women and 49 men from the Hadza tribe, Tanzania. They were aged from 18-55. There is no birth control in this very large tribe. The researchers chose the Hadza tribe because their lifestyles reflect those of humans thousands of years ago. They are hunter-gatherers. The females gather berries and search for wild plants. The males collect honey and hunt animals. Even though the Hadza are monogamous, extra-marital sex is common. During the interviews, which took place in Swahili, Apicella recorded the voices of the men and women. On studying the recording later they found that the deep voiced men had fathered more children than the non-deep voiced men. The man with the deepest voice had ten surviving children, while the one with the highest pitched voice had three. Apicella suggested that perhaps the males with the lower pitched voices had higher testosterone levels, which attracted them more to females or made them more attractive to them. It is also possible, Apicella added, that men with higher testosterone levels start reproducing earlier in life - they could also be better hunters (a better hunter would bring more food, allowing their wives to have shorter inter-birth intervals).
There was not much Apicella and team could glean from the interviews with the women. It is possible, said the team, that if vocal dimorphism evolved partly due to mate selection, that in the past men and women had more similar voices.
Sunday, November 25, 2007
Before the whining drowns it out, listen to the new India
Good Morning India:) Rise and Shine. Usually on Sundays I dedicate this Blogpost to humor, but today I want you readers to imbibe every word of this fantabulous article by Arun Shourie. I hope you enjoy reading this as much as I did! Cheers & have a rocking Sunday!
"Twenty to twenty-five years ago, even 10 years ago, few of us had heard of Information Technology. Today, exports from this industry are worth $10 billion - that is, over Rs 45,000 crore a year. That figure is 20 per cent of our total exports. In spite of the fact that each of the markets to which we supply IT software and solutions has been in the trough of recession for years, IT exports have grown by 26 per cent this year. Infosys had not even been born 25 years ago. Wipro was a company selling vegetable oil. Indeed, other than the ''Tata'' in Tata Consultancy Services, there is scarcely a name in the IT industry that
was known then.
And guess what the average age is in the industry? Just 26 and a half! These 26/27-year-olds have changed the world's perception of India. It's not just a country of snake-charmers, it's a country against which protectionist walls have to be erected. Of course, we can also charm snakes.
And not just, to pluck a phrase of Malcolm Muggeridge, snakes in snakes' clothing!
And these 26-year-olds are changing India's perception also of itself: that India can; that, therefore, we should face the world with confidence. That is the situation in activity after activity. We lament the fact that, while we are ahead in software, we have lost out to China in IT hardware. That is true - as of the moment. We shooed away firms like Motorola when they approached us in the early 1990s for facilities to set up manufacturing operations in India. China welcomed them, it wooed them, it created every conceivable facility for hardware firms from Japan, of course, but also from Taiwan, a country at which 400 of its
missiles are aimed. It has thereby leapt ahead.
But the game is hardly over. That world-class hardware can be produced in India is evident. How many of us would have heard of Moser-Baer? Located in unprepossessing Noida, it is the world's third largest optical media manufacturer, and the lowest-cost producer of CD-Recorders. Its exports are close to Rs 1,000 crore. The firm sells data-storage products to seven of the world's top 10 CD-R producers. And it produces them so efficiently that, to shield themselves, European competitors had to file an anti-dumping case to stop and penalise its exports to Europe. Moser-Baer fought on its own.
And won. A firm most of us have not heard of. A firm that is manufacturing products at the cutting edge of technology. A firm exporting Rs 1,000 crore of products that require the utmost precision and technological sophistication. A firm that European firms fear. And equally important - the very international fora that our ideologues shout are instruments of exploitation hold against European firms, and in favour of this Indian firm. There is more. Moser-Baer has acquired Capco Luxembourg, a firm that owns 49 per cent of a Netherlands-based CD-R distributor. And it has set up Glyphics Media Inc. in the United States-for markets in North and South America. And here we are being made to shiver at the thought that foreign firms are about to swallow us!
Heard of Tandon Electronics? Its exports of electronic hardware are close to Rs 4,000 crore!
At a moment's notice, my friends Amit Mitra of FICCI and Tarun Das of CII send me particulars of firm after firm, in sector after sector, that has broken new ground. A sample: Fifteen of the world's major automobile manufacturers are now
obtaining components from Indian firms. Just last year, exports of auto-components were $375 million. This year they are close to $1.5 billion. Estimates indicate they will reach $15 billion within six to seven years. Hero Honda is now the largest manufacturer of motorcycles in the world-with an output of 17 lakh motorcycles a year. One lakh Indica cars of the Tatas are to be marketed in Europe by Rover, one of the United Kingdom's most prestigious auto-manufacturers under its - that is, Rover's - brand name.
Bharat Forge has the world's largest single-location forging facility - of 1.2 lakh tonnes per annum. Its client list includes Toyota, Honda, Volvo, Cummins, Daimler Chrysler. It has been chosen as a supplier of small forging parts for Toyota's global transmission parts' sourcing hub in Bangalore.
Asian Paints has production facilities in 22 countries spread across five continents. It has recently acquired Berger International, which gives it access to 11 countries, and SCIB Chemical SAE in Egypt. Asian Paints is the market leader in 11 of the 22 countries in which it is present, including India.
Hindustan Inks has the world's largest single stream, fully integrated ink plant, of 1 lakh tonnes per annum capacity, at Vapi,
Gujarat. It has a manufacturing plant and a 100 per cent subsidiary in the US. It has another 100 per cent subsidiary in Austria.
For two years running, General Motors has awarded Sundaram Clayton its 'Best Supplier Award'; the volumes it sources out of India are growing every year. Ford has presented the 'Gold World Excellence Award' to Cooper Tyres.
Essel Propack is the world's largest laminated tube manufacturer. It has a manufacturing presence in 11 countries including China, a global manufacturing share of 25 per cent, and caters to all of P&G's laminated tube requirements in the US, and 40 per cent of Unilever's.
Aston Martin, one of the world's most expensive car brands, has contracted prototyping its latest luxury sports car to an India-based designer. This would be the cheapest car to roll out of Aston Martin's stable.
Maruti has been the preferred supplier of small cars under the Suzuki brand for Europe. Suzuki has now decided to make India its manufacturing, export and research hub outside Japan.
Hyundai Motors India is about to become the parent Hyundai Motors Corporation's global small car hub. In 2003, HMC sourced 25,000 Santros from HMI's plant in India. By 2010 HMI is targeted to supply half a million cars to HMC. It was only in 1999 that HMI got its first outsourcing contract and already, in 2003, 20 per cent of its sales were what it supplied as
an outsourcing hub. It is exporting cars to Indonesia, Algeria, Morocco, Columbia, Nepal, Sri Lanka and Bangladesh.
Ford India got its first outsourcing contract in 2000. Within 3 years outsourcing accounted for 35 per cent of its sales. Ford India supplies to Mexico, Brazil and China. The parent Ford is sourcing close to $40 million worth of components from India, and plans to increase these in the coming years. Ford India is already the sole manufacturing and supply base for Ikon
cars and components. These are being exported to Mexico, China and Africa.
Toyota Kirloskar Motors chose India over competitive destinations like Philippines and China for setting up a new project to source transmissions as this option proved more economical.
Europe's leading tractor maker, Renault, has chosen International Tractors (ITL) as its sole global sourcing hub for 40 to 85 horsepower tractors.
Tyco Electronics India bagged its first outsourcing contract in 1998-99. So successful has it been that components and products others have contracted from it already account for 50 per cent of its total sales. It supplies to the parent, Tyco Europe.
TISCO is today the lowest cost producer of hot-rolled steel in the world.
TVS Motor Company has been awarded the coveted Deming Prize for Total Quality Management. Many of the largest of organisations, even American ones-like GE-have not managed that recognition yet!
India's pharmaceutical industry has come to be feared as much as its infotech industry. It is already worth $ 6.5 billion and it has been growing at 8-10 per cent a year. It's the fourth largest pharmaceutical industry in terms of volumes and 13th in value. Its exports have crossed $2 billion, and have increased by 30 per cent in the past five years. India is among the top five manufacturers of bulk drugs. Even more telling is another figure. We are always being frightened, ''Multinational drug companies are about to takeover.'' In 1971 the share of these MNCs in the Indian market was 75 per cent. Today it's 35
per cent!
There's another feature we should bear in mind: India's strengths are becoming evident across the technology spectrum: We are among the three countries in the world that have built supercomputers on their own, the US and Japan being the other two: two months ago, the fourth generation PARAM super-computer was inaugurated in Bangalore. We are among six countries in the world that launch satellites. We launch some of our own satellites of course; we have launched
satellites for others too, among them such countries as Germany and Belgium. We have the largest set of remote sensing satellites. Our INSAT system is also among the world's largest domestic satellite communication systems.
At the other end: India is one of the world's largest diamond cutting and polishing centres. CLSA estimates nine of every 10 stones sold in the world pass through India.
Trade of Indian medicinal plants has crossed Rs 4,000 crore. Here is proof positive that liberalisation has indeed worked. ''By
opening the economy before giving it a chance to become competitive, we have thrown our industry to the wolves,'' it used to be said. Quite the contrary. The success in exports, in fields such as IT in which competition is fierce, in which technological change is fast as lightning, success in auto-components, in pharmaceuticals shows that our industry has fought back, it has become competitive.
Remember all that shouting about Chinese batteries a year ago? ''Markets are closing down, thousands are being thrown out of their meagre businesses, factory after factory has shut down.'' That was the shouting just a few months ago. Where are those batteries from China? Yes, trade with China has grown-by 104% in the past year. But according to figures of the Chinese
Government, in the first five months of 2003, India has amassed a surplus in its trade with China, a surplus of close to half a billion dollars.
And China is just an instance. Exports as a whole, and in the face of an unrelenting recession in the West, have grown by 19 per cent in the year. In a word, what committees upon committees with their piles of recommendations would not have achieved, being actually exposed to actual competition has. Our foreign exchange reserves are at an all-time high-$82 billion. We have announced that we will not be taking aid from a string of countries. We are giving aid to 10 or 11 countries. We are pre-paying our debt. We have just ''loaned'' $300 million to the IMF! How distant the days when we used to wait anxiously for the announcement about what the Aid India Club meeting in Paris had decided to give us.
But there is the other side-equally telling. Why is it that so few among us know even the elementary facts about these successes? Why is it that so much of public, specifically political, discourse, when it is not whining is just wailing?"
Go on my brothers - Chak De India!!!!!!!!!
Saturday, November 24, 2007
Friday, November 23, 2007
Not Tonight Dear, I Have A Headache
Contrary to the popular cliché, "Not tonight, I have a headache," new research suggests that not all headache sufferers avoid sexual activity. In fact, migraine sufferers reported higher levels of sexual desire than those with other types of headaches, according to researchers from Wake Forest University School of Medicine and colleagues. "Our study suggests that sexual desire and migraine headaches may be influenced by the same brain chemical," said Timothy Houle, Ph.D., lead author and research assistant professor of anesthesiology. "The results support the idea that migraine, as a syndrome, is associated with other common phenomena. Understanding of this link will help us to better understand the nature of migraine and perhaps lead to improved treatment." The objective of the study was to examine the relationship between migraine headache and self-reported sexual desire. There is evidence of a complex relationship between sexual activity and headache. Both sexual desire and migraine headache have been linked to levels of serotonin, a brain chemical that also plays a role in depression. An excess of serotonin may be associated with decreased libido, and migraine sufferers are reported to have low system levels of the brain chemical. Serotonin has also been found to play a role in migraine attacks.
"Considering the circumstantial evidence linking both migraine and sexual desire to serotonin, we wanted to explore whether the two phenomena are actually related," said Houle. The researchers hypothesized that abnormalities in the serotonin systems of migraine sufferers may influence their sexual desire. Because high levels of serotonin are associated with low sexual desire, and migraine sufferers have low levels of the chemical, it was predicted that they would report higher levels of sex drive. The study involved 68 participants who reported having at least 10 headaches a year. Their mean age was 24 years. Participants underwent interviews to diagnose their headache type -- either migraine or tension -- and filled out a 14-item questionnaire to measure sexual desire. Males reported levels of sexual desire that were 24 percent higher than females. Migraine sufferers reported levels of sexual desire that were 20 percent higher than those suffering from tension headaches. Females with migraines had levels of sexual desire similar to males who had tension headaches. "The study demonstrated that migraine patients in general may experience higher levels of sexual desire than others," said Houle. "They appeared to be aware of this, rating their sex drive as being higher than others their age and gender." He said the results suggest that a serotonin link may be implicated in both migraine headaches and sexual desire. "This opens the door to consider other phenomena that have a similar neurochemical basis," he said. For example, there is an increased prevalence of depression in people with migraine, which is also theorized to be modulated by serotonin.
Houle said future research should focus on whether a cluster of migraine characteristics or symptoms can serve as markers of an altered serotonin system. Although the current study was not able to address whether the link may apply to middle-age or older adults with migraines, Houle said the finding appears to be quite general and is likely to be found in older patients as well.
Thursday, November 22, 2007
Menstrual Blood Banking
Dear Readers,
This piece below is fascinating. We are yet not convinced about cord-blood banking and oocyte banking & here comes the new consumerist banking movement from the mother of all consumerist countries - the USA! I read this on the web & this is one of those must-share articles for our loyal blogeurists:)
Happy Reading!
"As a consumerist society, we are fast becoming familiar with the idea that for a price, we can bank our stem cells in case they are needed in the future to potentially fight disease, grow replacement body parts and help develop clinical therapeutic options. First came the commercial cord blood industry, offering 'a biological insurance for the future' and 'a once in a
lifetime opportunity' to 'freeze a spare immune system'. Whilst cord blood stem cells have undoubtedly shown great promise in the treatment of certain blood disorders, the chances of ever using your own stored cells remains low and other treatment options, speculative. Regardless, the race was on to find alternative sources of stem cells in order to capitalise on the modern
day phenomenon of individuals with disposable income.
In 2006, American-based BioEden Inc. offered parents the chance to preserve cells from the pulp of their baby's milk teeth, which they claimed contained a source of adult stem cells. Earlier this year saw the launch of a service to store embryonic (ES) stem cells from excess IVF embryos by Californian storage facility, StemLifeLine. All three enterprises, however, met with strong criticism from medical experts, academics and the popular press alike, claiming that the persuasive advertising is exploitative and such ventures simply prey on the vulnerable. But such critics could not stem the flow of stem cell storage 'supply and demand'.
This week, another US firm jumped on the bandwagon. Cryo-cell International Inc. launched its proprietary cryopreservation service, C'elle, which offers women the unique opportunity to bank stem cells from their menstrual blood. Researchers have discovered that menstrual blood contains markers similar to those found in bone marrow and peripheral blood, but have the advantage of being able to differentiate more quickly and into a greater variety of cells. Preliminary research findings were presented at the annual Transcatheter Cardiovascular Therapeutics symposia on 21 October 2007 and proclaimed that menstrual stem cells have the potential to become neural, cardiac, bone, cartilage and fat cells. Moreover, it is claimed by
C'elle that these cells may be used for possible future medical regenerative and rejuvenation procedures.The C'elle website is particularly impressive. It shares remarkable similarities to the advertising techniques deployed by the cosmetic
industry, particularly those of leading brands such as L'Oreal. In the same way that beauty clinics offer customised beauty routines using a range of products, C'elle speaks of the storage of cells for 'customised therapies in the future'. With accompanying video footage, music and models, women are urged to bank now 'as these precious resources from menstrual fluid will certainly not last forever'. Nor apparently will their looks. In spite of the fact that menstrual cells have yet to be used outside of pre-clinical trials, and have been criticised by Peter Braude, Professor of London's King's College and Guy's and St Thomas' Hospital as being all 'hypothesis and hype', C'elle claims that stored cells may one day be used in cosmeceutical applications, such as anti-aging therapies. In the age of an image conscious society, it is little wonder that the use of such language has been declared as nothing short of preying on people's insecurities. Indeed, not only is their collection kit described as 'discreet' but also it's 'attractive'. Time is of the essence and these cells, say C'elle, should be saved before its too late - after all, 'it is indisputable that with each day your body ages and you will inevitably be older next month than you are today'.
On reflection, if someone has the spare cash to spend on the storage of body tissue 'just in case' it is needed in the future, is that really any different from other kinds of optional insurance policies? Of course, a conventional form of insurance has a monetary return, whereas the payout in the case of biological cryopreservation is a vial full of stem cells that may or may not be of any use to the recipient, particularly as at present, there is no evidence that menstrual stem cells will be viable in a clinical setting. Hardly a good return on your investment. But if you are affluent enough to take that risk, then there is every reason to be offered the choice, even though it is admitted that 'realistically, it may take several years for these menstrual stem cells to be developed into potential widely-available commercial therapies'. That said, then why, realistically, should women bother? The problem is that such a commercially driven service is founded upon too many vagaries and speculation to constitute a real choice - and to be economical with the truth is to offer no choice at all.
But with the media hysteria that has surrounded menstrual blood banking this week, it must be remembered that such a service option has yet to reach the UK. It may, however, be prudent to note that whilst the Human Tissue Authority has yet to be approached by a UK firm regarding a similar proposal, it was in the US that cord blood banking first emerged - a concept
that took just over five years to be offered here. One can only wonder how long it will be before the flow of what C'elle terms 'the monthly miracle' reaches our shores."
- Karen Devine, Kent Law School, University of Kent
Wednesday, November 21, 2007
New Source For Stem Cells
A method for persuading human eggs to start dividing as though they have been fertilised could provide a less controversial source of embryonic stem (ES) cells, say UK researchers. The scientists, based at the University of Wales in Cardiff, also say that the technique might help improve the success rate for couples undergoing intracytoplasmic sperm injection (ICSI) treatment. The researchers, who published their findings in the journal Reproduction, have discovered that human eggs injected with a substance called phospholipase C-zeta (PLC-zeta) will start dividing. PLC-zeta is a protein produced by sperm, discovered by the Cardiff team two years ago, New Scientist magazine reports. The injected eggs will grow for about 4-5 days, until they reach the 50-100 cell blastocyst stage of development. Because they only contain genes from the mother, such 'parthenogenetic embryos' could never develop further, but they could still be used as a potential source of ES cells.
Many scientists believe that ES cells hold great promise in the treatment of a wide range of diseases, since they can grow into any type of body tissue. However, human ES cell research is controversial, since it involves the destruction of embryos. Several groups are trying to find ways of growing ES cells without using embryos, either by creating parthenogenetic 'embryos', or using other approaches. US scientist William Hurlbut, who opposes embryo research, said it should be possible to create cloned human embryos that are incapable of growing a placenta. Since 'embryos' created using this 'altered nuclear transfer' technique would not be able to develop into a foetus, Hurlbut believes it could provide a way for American scientists to create new human ES cells with government funding. The use of federal funds for stem cell research involving the destruction of embryos has been prohibited by Bush since 9 August 2001.
The leader of the latest study, Karl Swann, hopes that his team will be the first to obtain ES cells from human parthenogenetic blastocysts. However, some pro-life groups might still object to this research. 'I'd be happier if it was beyond all reasonable doubt that it could not become a human life', said Josephine Quintavalle of Comment on Reproductive Ethics (Core). She added that women must not be exploited to provide eggs for this purpose.PLC-zeta could also help couples undergoing ICSI, a fertility treatment in which a single sperm is injected into an egg in the laboratory. Embryos produced in this way do not always start dividing and growing, possibly because the sperm has defective PLC-zeta. Adding some of this substance could overcome this problem, say the scientists.
Tuesday, November 20, 2007
Fatherless Families
A unique alliance of senior politicians and churchmen will tomorrow make a historic stand against an attempt by the Government of UK to "drive the last nail in the coffin of the traditional family". MPs and peers from all parties, backed by both Anglican and Catholic church leaders, will ambush legislation intended to let lesbian couples become parents to test-tube babies without any involvement of a father beyond donating sperm. The new law would remove the existing requirement on test-tube clinics to ensure that a father is involved in the upbringing of any child they help create. The alliance of church leaders and Tories - augmented by some Labour rebels - will oppose the new law when it comes up before the House of Lords tomorrow. Their campaign is being backed by MPs from all parties, led by former Tory leader Iain Duncan Smith. They believe that the battle will become as symbolic of changes in social attitudes as the debates about the Abortion Law in the Sixties and Clause 28 of the 1986 Local Government Act outlawing the "promotion" of homosexuality in state schools. Writing in The Mail on Sunday day before, Mr Duncan Smith, who has undertaken pioneering research into the critical role that fathers play in keeping youngsters out of trouble, says the proposed new law is "another nail in the coffin of the traditional family and another blow against fatherhood". Mr Duncan Smith and his allies say the measure is in line with covert moves by the Government to undermine traditional families by removing terms such as "marriage, father, mother, husband, wife and spouse" from the statute book - and even from official forms.
The new row has been provoked by the Human Fertilisation and Embryology Bill which introduces new regulations governing the creation of embryos outside the human body. The most controversial provisions govern IVF treatment. The current duty on the part of clinics to take account of "the welfare of the child" when providing fertility treatment will be retained - but crucially, the reference to "the need for a father" will be removed. It means lesbian couples can be regarded as joint legal parents of children conceived through the use of donated sperm, eggs or embryos. In addition the new registration forms refer to "father or second parent". In the case of lesbian couples, this would allow one woman to be registered as the "mother" and the second woman as "second parent" instead of the sperm donor father.
The Archbishop of York, Dr John Sentamu, is expected to speak against the Bill in the Lords. He has regularly spoken out about the importance of fathers in avoiding a breakdown in family life and argued recently: "If we do not get a lot of role models from fathers, I don't think we're going to turn the tide." He has also spoken out in favour of the traditional two-parent family, arguing: "The Government needs to undertake a policy reorientation that incorporates the benefits of marriage to society as a whole, rather than relegating it to just another lifestyle choice." The Catholic Archbishop of Westminster, Cardinal Cormac Murphy-O'Connor, said yesterday: "The Bill proposes to remove the need for IVF providers to take into account the child's need for a father when considering an IVF application. "This is profoundly wrong as it radically undermines the place of the father in a child's life and makes the natural rights of the child subordinate to the couple's desires."
The campaigners say a new poll commissioned by the charity Christian Action Research and Education shows nearly four out of five people think it is vital to consider a child's need for a father when processing lesbian applicants for IVF treatment. The new law means that where sperm donor fathers are excluded by lesbian parents, children brought up by lesbian couples and who wish to contact their fathers will have to wait until they are 18 to exercise their legal right to establish their identity. Campaigners claim the new law is the latest evidence of a secret drive to remove traditional family roles from the statute book. An investigation established that in recent years, a number of measures have been pushed through quietly to achieve this. In 2000, tax credit forms were changed requiring applicants to refer to their spouses as "partners" not husbands and wives. Tax and benefits forms now routinely refer to "partners" instead of husbands, wives or spouses. And four years ago, Home Secretary Jacqui Smith, then Equality Minister, was responsible for a Government report which said: "It is envisaged that Government forms currently asking for details of a person's 'marital status' would be altered to read 'civil status'."
Ben Summerskill, chief executive of the gay and lesbian rights group Stonewall, said last night: "At a time when three million children in this country are growing up in singleparent households, it seems odd there should be this obsession with a few hundred who have the opportunity to have a second loving parent. "This is simply extending the protection that already exist in respect of heterosexuals." In 2000 Tony Blair pushed through legislation to repeal Section 28. But the move was opposed by religious groups and the Conservatives. The passage of the 1967 Abortion Bill also led to furious Parliamentary debate. It legalised abortion on demand and remains the basis of the current legislation.
The best I culled from the British press is this sentence: Men already believe they have become marginalised as sperm factories, walking wallets and occasional au pairs. By deepening their belief that a feminised Britain views them as surplus to requirements, this measure will therefore act as a further spur to male irresponsibility.
Long Live the Queen:) Incidentally, the ICMR guidelines have allowed Lesbians to legally take all the above mentioned treatments in India & we have been offering Lesbians the entire range of Infertility Services at Rotunda.
Monday, November 19, 2007
Fibroids & Fertility
What are the effects of fibroids on fertility, and on the outcomes of assisted reproduction technology, and when is intervention warranted?
According to published estimates, about 30 percent of all women up to the age of 30 years, and half of all women of reproductive age, will develop fibroids. About half of affected women will be asymptomatic. Fibroids are estimated to be associated with infertility in 5-10 percent of women, and are possibly the sole cause of infertility in 2-3 percent. Because most women with fibroids are fertile (and many are asymptomatic), having fibroids does not necessarily mean that reproduction will be compromised. However, it is clear that fibroids could impair fertility and/or cause pregnancy loss, through various possible mechanisms.
These potential mechanisms, include:
-Distortion of the endometrial cavity, preventing or otherwise impeding sperm migration and reducing implantation rates.
-Reduced vascularity and possible discordant growth of endometrial tissue overlying an intramural fibroid, impairing implantation.
-Dysfunctional uterine contractility caused by submucous or intramural fibroids, affecting sperm migration, tubal contractility and embryo nidation.
-Changes in the endometrial cavity milieu, as a result of glandular atrophy or distortion, adenomyosis, separation of muscle fibers from the basal layer of the endometrium, secretion of vasoactive amines, and local inflammatory changes.
Whether or not fibroids affect fertility or the outcomes of assisted reproduction technology (ART) will typically depend on their number, location, and size of fibroids.There is a general consensus that submucous fibroids impede fertility, as well as being associated with miscarriage, and that the obvious benefits of hysteroscopic myomectomy, coupled with its low risks, suggest that the resection of submucous fibroids is warranted to enhance fertility in women with no other obvious cause of infertility or with recurrent pregnancy loss. There is increasing evidence that intramural fibroids may impair the outcomes of ART. Laparoscopic or conventional myomectomy should be carefully considered prior to ART in women with intramural fibroids “of considerable size” in whom other causes of subfertility have been eliminated. Subserosal fibroids, appear from published data to be unlikely to compromise fertility or cause miscarriage, although the number, location and size of the fibroids should be considered in treatment decisions.
Factors to be considered in formulating a plan of management in a subfertile woman with fibroids are an accurate estimation of the size, number and location of the fibroids, and whether or not the uterine cavity/anatomy is distorted. TVS [transvaginal sonography] and hysteroscopy can achieve a sensitivity and specificity of 100 percent in the evaluation of uterine cavity distortion. It is reasonable to consider a hysteroscopic myomectomy for submucosal fibroids in a subfertile woman as this entails relatively little morbidity compared with an open myomectomy. Open myomectomy should be considered where there are large subserosal/intramural fibroids and they are multiple (>5). Patients should be carefully counseled about the intra-operative risks, risks of recurrence of leiomyoma (15 percent), uterine rupture (1 percent), and increased likelihood of caesarean section (50 percent) in future pregnancies.
Sunday, November 18, 2007
Being a super-millionaire is a sure-fire recipe for unhappiness
I read this fascinating article on the web yesterday & thought it would be apt for our regular readers of Rotunda Ramblings. Non-medical article for a change, but opens up new vistas of thought. Enjoy the read & reflect!
Miserable? Bored? You must be rich
Helen Kirwan-Taylor
13 November 2007
For some people, flying first class represents the height of luxury. But not Prince Alwaleed bin Talal of Saudi Arabia, who has become the first person to buy an Airbus A380 superjumbo to use as a private jet. Given that the passenger version costs £145 million, the VIP edition – dubbed "The Flying Palace" – will surely cost a hefty chunk of change. Another, anonymous, billionaire spent £83 million on a flat in the Richard Rogers Partnership's new Hyde Park development – which was double the going rate.
Such excessive spending might not be a sign of conspicuous consumption but of addiction. "For the super-rich, houses, yachts, cars and planes are like new toys that they play with for five minutes and then lose interest in," says psychoanalyst Manfred Kets de Vries, one of the new breed of therapists treating the angst of the very rich. "Pretty soon, to attain the same buzz they have to spend more money. All the spending is a mad attempt to cover up boredom and depression."
According to de Vries, the super-rich are increasingly succumbing to what has been labelled Wealth Fatigue Syndrome (WFS). When money is available in near-limitless quantities, the victim sinks into a kind of inertia. Feeling any sort of excitement means taking more and more risks, financially and physically. Luxury holidays are replaced by abseiling in Australia and swimming with sharks. The first-class ticket of old becomes a private jet such as Prince Alwaleed's: Boeing has 11 standing orders for such wide-bodied "mobile mansions".
Frank James, the author of Richistan, a study of this new class, saw WFS up close. "The rich are never happy, no matter what they have," he told CNN. "There was this man who owned a 100ft yacht. I said: 'This is a terrific boat.' He said: 'Look down the harbour.' We looked down the marina, and there were boats two and three times as large. He said: 'My 100ft yacht today is like a dinghy compared to these other boats.' When else in history has someone been able to call a 100ft yacht a dinghy?"
The rich are no longer a tiny elite who hide behind electronic gates in Mayfair. There are half a million American households with assets of more than $10 million, and a study of 71 countries by Merrill Lynch and the consultancy firm Capgemini found that the fortunes of "high net worth individuals" increased by 11.4 per cent last year.
In Britain, the wealthiest self-made billionaires have trebled their fortunes over the past five years. But, as you draw up battle plans for surviving the credit crunch, spare a thought for the sufferers of WFS and how monumentally dull and isolating it is to live in a world where estates are traded like Pokémon cards. "A lot of my clients made money in commodities, and consequently everything – including houses and boats – is treated like shares," says Peter Grabham, a project manager for the rich and famous. "When the houses have outlived their purpose, they are sold." Gardens arrive on the back of trucks; art collections fill entire wings overnight, though the owners often can't recall the artists' actual names. I have seen 20-year-old cypress trees craned into gardens – and out again when the owner got bored with that year's fashionable look. One neighbour in Holland Park tore up her house, employing the most expensive interior designer in England. But after spending the better part of £2 million on refurbishment, she decided she was more a traditionalist than a minimalist, and tossed the contents into the skip outside.
A famous hedge fund manager spent the better part of £20 million building the most exquisite estate in Gloucestershire. As soon as he had thrown a few big parties to show it off, he sold it. "I need a new project," he muttered. Some of our friends have jumped from nice five-bedroom houses in South Kensington to gated mansions in St John's Wood, complete with hot and cold running staff. But many who join the super-rich find it hard to keep their old circles of support. Happiness studies have repeatedly shown that being marginally better off than your neighbours makes you feel good, but being a hundred times richer makes you feel worse. So either you change your friends or live with the envy of others. "When a relationship becomes unequal, it becomes difficult," explains Dr Brendan Burchell, a professor of economics and psychology at Cambridge University. "If you're out in a three-star restaurant, how do you split the bill when he is a super-millionaire? And if he has a driver and you consider a taxi a luxury, you stop having shared experiences."In the end, the super-rich become isolated – and the only way to find empathy is to surround themselves with people as rich as themselves."The poorer everyone else gets, relative to the rich, the more isolated the rich become," says Dr Burchell. "Soon you end up like the Russian oligarchs, needing bodyguards and electric gates outside your house."
The happiest nations, he says, are those where people feel most equal, even if that means being less wealthy. Pentecost, a tiny island in the South Pacific, has recently been voted the happiest place on earth. They don't have WFS – in fact, they don't have money; they use pigs' horns instead.In places such as Pentecost, people actually talk to each other – indeed, belonging to a community is one of the single most important prerequisites for happiness. But when you jet between the Scottish estate, the London mansion and the chalet in Aspen, there isn't much time to get to know the neighbours.
"One of the most common complaints among the super-rich is loneliness," says de Vries. "People stop calling them. They assume they're too busy, or they are simply too intimidated." Or they simply can't cut through the barricade of staff.
Families, too, can fall victim to WFS. As the men get richer, the wives are either tossed out in favour of a new model or become engaged in inane, busy-making activities. The post-nup is the new must-have among hedge funders.
"This world is full of gold-diggers, and rich men are highly suspicious," says de Vries. "Often, they develop a form of paranoia."Meanwhile, for the wives, shopping trips to Paris and Milan get tedious. "Super-rich wives are effectively unemployed, and have all the same mental issues as the real unemployed," says Jon Stokes, an organisational psychologist and executive coach with Stokes and Jolly.
Children are just as vulnerable. In America, upmarket brat camps offering psychological support for rich kids are now common. Suniya Luthar, a professor of psychology and education at the Teachers College of Columbia University, found that such children are just as prone to antisocial behaviour as those from inner cities.
One in five affluent American children also suffers from clinical depression. One of the reasons given was absent parents: "These kids just get sent from house to house on private jets with nannies and tutors on board," says a teacher who works for the very rich during the holidays. "No one engages with them who isn't staff."
According to de Vries, the only cure for the boredom and anxiety is to give something back. "These people need to return to small pleasures and to stop worrying about having bigger and better toys," he says. "It's not what you have but what you do that makes you ultimately happy."The problem, though, is that your day job becomes about staying rich. "All those people you employ, funds you have to manage and wealth advisers you have to meet must be exhausting," says Stokes.
And boring. And then there are the five new construction projects to visit. Choosing one set of curtains is a challenge: choosing them for 20 bedrooms would finish most of us off.
Bo Derek didn't suffer from Wealth Fatigue Syndrome. Her advice was simple: "Whoever said money can't buy happiness simply didn't know where to go shopping." Exactly. I find it hard to sympathise with those suffering from an excess of cash; in fact, I find it all too easy to picture myself in their designer shoes... I'd be chauffeur-driven in a Bentley Continental GT and tackle longer journeys in a private jet, launched from my own private runway. Then I'd buy a super-yacht, complete with gym, bars, cinemas, air-defence systems and submarine (for a quick getaway). I'd model mine on Roman Abramovich's £200 million Eclipse; currently under construction, it will be three times as long as Nelson's Column. If my iPod ran out of tunes once on board, I'd order a command performance from Rod Stewart for £500,000 or, for another £2.2 million, get in the Rolling Stones. I'd spread my wealth with some fractional shopping, the successor to timeshare, which involves a percentage share of ownership: £200,000 would buy me a one-sixteenth share of a Gulfstream jet (or 23 days' usage a year). Around £11,000 would get me a year's fractional ownership - 50 weekdays in winter or four three-day weekends in summer - in an Aston Martin Vantage Roadster. I'd spend the rest on fractional ownership of fine art, a racehorse, and two or three foreign properties - a villa in Tuscany, a serviced apartment in Milan and a little place in the Seychelles. For us non-billionaires, it's probably the closest to experiencing the terrible problems of being obnoxiously wealthy that we can get.
Miserable? Bored? You must be rich
Helen Kirwan-Taylor
13 November 2007
For some people, flying first class represents the height of luxury. But not Prince Alwaleed bin Talal of Saudi Arabia, who has become the first person to buy an Airbus A380 superjumbo to use as a private jet. Given that the passenger version costs £145 million, the VIP edition – dubbed "The Flying Palace" – will surely cost a hefty chunk of change. Another, anonymous, billionaire spent £83 million on a flat in the Richard Rogers Partnership's new Hyde Park development – which was double the going rate.
Such excessive spending might not be a sign of conspicuous consumption but of addiction. "For the super-rich, houses, yachts, cars and planes are like new toys that they play with for five minutes and then lose interest in," says psychoanalyst Manfred Kets de Vries, one of the new breed of therapists treating the angst of the very rich. "Pretty soon, to attain the same buzz they have to spend more money. All the spending is a mad attempt to cover up boredom and depression."
According to de Vries, the super-rich are increasingly succumbing to what has been labelled Wealth Fatigue Syndrome (WFS). When money is available in near-limitless quantities, the victim sinks into a kind of inertia. Feeling any sort of excitement means taking more and more risks, financially and physically. Luxury holidays are replaced by abseiling in Australia and swimming with sharks. The first-class ticket of old becomes a private jet such as Prince Alwaleed's: Boeing has 11 standing orders for such wide-bodied "mobile mansions".
Frank James, the author of Richistan, a study of this new class, saw WFS up close. "The rich are never happy, no matter what they have," he told CNN. "There was this man who owned a 100ft yacht. I said: 'This is a terrific boat.' He said: 'Look down the harbour.' We looked down the marina, and there were boats two and three times as large. He said: 'My 100ft yacht today is like a dinghy compared to these other boats.' When else in history has someone been able to call a 100ft yacht a dinghy?"
The rich are no longer a tiny elite who hide behind electronic gates in Mayfair. There are half a million American households with assets of more than $10 million, and a study of 71 countries by Merrill Lynch and the consultancy firm Capgemini found that the fortunes of "high net worth individuals" increased by 11.4 per cent last year.
In Britain, the wealthiest self-made billionaires have trebled their fortunes over the past five years. But, as you draw up battle plans for surviving the credit crunch, spare a thought for the sufferers of WFS and how monumentally dull and isolating it is to live in a world where estates are traded like Pokémon cards. "A lot of my clients made money in commodities, and consequently everything – including houses and boats – is treated like shares," says Peter Grabham, a project manager for the rich and famous. "When the houses have outlived their purpose, they are sold." Gardens arrive on the back of trucks; art collections fill entire wings overnight, though the owners often can't recall the artists' actual names. I have seen 20-year-old cypress trees craned into gardens – and out again when the owner got bored with that year's fashionable look. One neighbour in Holland Park tore up her house, employing the most expensive interior designer in England. But after spending the better part of £2 million on refurbishment, she decided she was more a traditionalist than a minimalist, and tossed the contents into the skip outside.
A famous hedge fund manager spent the better part of £20 million building the most exquisite estate in Gloucestershire. As soon as he had thrown a few big parties to show it off, he sold it. "I need a new project," he muttered. Some of our friends have jumped from nice five-bedroom houses in South Kensington to gated mansions in St John's Wood, complete with hot and cold running staff. But many who join the super-rich find it hard to keep their old circles of support. Happiness studies have repeatedly shown that being marginally better off than your neighbours makes you feel good, but being a hundred times richer makes you feel worse. So either you change your friends or live with the envy of others. "When a relationship becomes unequal, it becomes difficult," explains Dr Brendan Burchell, a professor of economics and psychology at Cambridge University. "If you're out in a three-star restaurant, how do you split the bill when he is a super-millionaire? And if he has a driver and you consider a taxi a luxury, you stop having shared experiences."In the end, the super-rich become isolated – and the only way to find empathy is to surround themselves with people as rich as themselves."The poorer everyone else gets, relative to the rich, the more isolated the rich become," says Dr Burchell. "Soon you end up like the Russian oligarchs, needing bodyguards and electric gates outside your house."
The happiest nations, he says, are those where people feel most equal, even if that means being less wealthy. Pentecost, a tiny island in the South Pacific, has recently been voted the happiest place on earth. They don't have WFS – in fact, they don't have money; they use pigs' horns instead.In places such as Pentecost, people actually talk to each other – indeed, belonging to a community is one of the single most important prerequisites for happiness. But when you jet between the Scottish estate, the London mansion and the chalet in Aspen, there isn't much time to get to know the neighbours.
"One of the most common complaints among the super-rich is loneliness," says de Vries. "People stop calling them. They assume they're too busy, or they are simply too intimidated." Or they simply can't cut through the barricade of staff.
Families, too, can fall victim to WFS. As the men get richer, the wives are either tossed out in favour of a new model or become engaged in inane, busy-making activities. The post-nup is the new must-have among hedge funders.
"This world is full of gold-diggers, and rich men are highly suspicious," says de Vries. "Often, they develop a form of paranoia."Meanwhile, for the wives, shopping trips to Paris and Milan get tedious. "Super-rich wives are effectively unemployed, and have all the same mental issues as the real unemployed," says Jon Stokes, an organisational psychologist and executive coach with Stokes and Jolly.
Children are just as vulnerable. In America, upmarket brat camps offering psychological support for rich kids are now common. Suniya Luthar, a professor of psychology and education at the Teachers College of Columbia University, found that such children are just as prone to antisocial behaviour as those from inner cities.
One in five affluent American children also suffers from clinical depression. One of the reasons given was absent parents: "These kids just get sent from house to house on private jets with nannies and tutors on board," says a teacher who works for the very rich during the holidays. "No one engages with them who isn't staff."
According to de Vries, the only cure for the boredom and anxiety is to give something back. "These people need to return to small pleasures and to stop worrying about having bigger and better toys," he says. "It's not what you have but what you do that makes you ultimately happy."The problem, though, is that your day job becomes about staying rich. "All those people you employ, funds you have to manage and wealth advisers you have to meet must be exhausting," says Stokes.
And boring. And then there are the five new construction projects to visit. Choosing one set of curtains is a challenge: choosing them for 20 bedrooms would finish most of us off.
Bo Derek didn't suffer from Wealth Fatigue Syndrome. Her advice was simple: "Whoever said money can't buy happiness simply didn't know where to go shopping." Exactly. I find it hard to sympathise with those suffering from an excess of cash; in fact, I find it all too easy to picture myself in their designer shoes... I'd be chauffeur-driven in a Bentley Continental GT and tackle longer journeys in a private jet, launched from my own private runway. Then I'd buy a super-yacht, complete with gym, bars, cinemas, air-defence systems and submarine (for a quick getaway). I'd model mine on Roman Abramovich's £200 million Eclipse; currently under construction, it will be three times as long as Nelson's Column. If my iPod ran out of tunes once on board, I'd order a command performance from Rod Stewart for £500,000 or, for another £2.2 million, get in the Rolling Stones. I'd spread my wealth with some fractional shopping, the successor to timeshare, which involves a percentage share of ownership: £200,000 would buy me a one-sixteenth share of a Gulfstream jet (or 23 days' usage a year). Around £11,000 would get me a year's fractional ownership - 50 weekdays in winter or four three-day weekends in summer - in an Aston Martin Vantage Roadster. I'd spend the rest on fractional ownership of fine art, a racehorse, and two or three foreign properties - a villa in Tuscany, a serviced apartment in Milan and a little place in the Seychelles. For us non-billionaires, it's probably the closest to experiencing the terrible problems of being obnoxiously wealthy that we can get.
Saturday, November 17, 2007
Friday, November 16, 2007
Obesity & Infertility
The British Fertility Society has issued new guidelines for the treatment of women with fertility problems that help doctors address the impact of obesity.
"Obesity reduces the chances that a woman will conceive naturally and decreases the possibility that fertility treatment will be successful," said Tony Rutherford, Chair of the BFS's Policy and Practice Committee.
The new guidelines recommend that clinicians inform their patients about the negative effects of extra weight on the chances of conceiving naturally. They also suggest that clinicians defer the provision of fertility treatment to women whose body mass index (BMI) is greater than 35 kg/m2.
Women younger than 37 years should be encouraged to reduce their BMI to less than 30 kg/m2 to maximize the effectiveness of fertility treatment and to reduce the associated risks associated with fertility treatment, the guidelines state.
They add that women should be assisted in this, with the provision of psychologic support, dietary advice, exercise classes and, where appropriate, weight-reducing agents or bariatric surgery.
"The BFS has produced these new guidelines to help doctors provide safer and more effective fertility treatment for women," said Rutherford.
"We want to work with our patients to improve their chances of becoming pregnant with minimum risk to their health and that of their child."
"Obesity reduces the chances that a woman will conceive naturally and decreases the possibility that fertility treatment will be successful," said Tony Rutherford, Chair of the BFS's Policy and Practice Committee.
The new guidelines recommend that clinicians inform their patients about the negative effects of extra weight on the chances of conceiving naturally. They also suggest that clinicians defer the provision of fertility treatment to women whose body mass index (BMI) is greater than 35 kg/m2.
Women younger than 37 years should be encouraged to reduce their BMI to less than 30 kg/m2 to maximize the effectiveness of fertility treatment and to reduce the associated risks associated with fertility treatment, the guidelines state.
They add that women should be assisted in this, with the provision of psychologic support, dietary advice, exercise classes and, where appropriate, weight-reducing agents or bariatric surgery.
"The BFS has produced these new guidelines to help doctors provide safer and more effective fertility treatment for women," said Rutherford.
"We want to work with our patients to improve their chances of becoming pregnant with minimum risk to their health and that of their child."
Thursday, November 15, 2007
Human chorionic gonadotropin
Human chorionic gonadotropin (hCG) is a peptide hormone produced in pregnancy, that is made by the embryo soon after conception and later by the syncytiotrophoblast (part of the placenta). Its role is to prevent the disintegration of the corpus luteum of the ovary and thereby maintain progesterone production that is critical for a pregnancy in humans. hCG may have additional functions, for instance it is thought that it affects the immune tolerance of the pregnancy. Early pregnancy testing generally is based on the detection or measurement of hCG. Because hCG is produced also by some kinds of tumor, hCG is an important tumor marker, but it is not known whether this production is a contributing cause or an effect of tumorigenesis.
Its primary role is to support the corpus luteum which secretes estrogen and progesterone. These hormones are necessary to support a pregnancy during the first trimester. hCG levels rise when pregnancy is established and it is the hormone measured by pregnancy urine test kits.
hCG products such as Profasi and Pregnyl are derived from human tissue. Ovidrel is a new pure product that is derived from mammalian cell DNA technology. It is injected subcutaneously facilitating patient administration. hCG is extensively used as a parenteral fertility medication in lieu of luteinizing hormone. In the presence of one or more mature ovarian follicles, ovulation can be triggered by the administration of hCG. As ovulation will happen about 40-45 hours after the injection of hCG, procedures can be scheduled to take advantage of this time sequence. Thus, patients who undergo IVF, typically receive hCG to trigger the ovulation process, but have their eggs retrieved at about 36 hours after injection, a few hours before the eggs actually would be released from the ovary. In a normal menstrual cycle, the release of LH is triggered when hormones (such as estrogen) reach the appropriate levels. This is governed by hormonal relationships mediated though the hypothalamic-adrenal-pituitary axis. As hCG supports the corpus luteum, administration of hCG is used in certain circumstances to enhance the production of progesterone.
In the male, hCG injections are used to stimulate the leydig cells to synthesize testosterone. The intratesticular testosterone is necessary for spermatogenesis from the sertoli cells. Typical uses for hCG in men include hypogonadism and fertility treatment. In the world of performance enhancing drugs, hCG is increasingly used in combination with various anabolic androgenic steroid (AAS) cycles. When AAS are put into a male body, the body's natural negative feedback loops cause the body to shut down its own production of testosterone via shutdown of the HPTA (hypothalamic-pituitary-testicular axis). High levels of AASs that mimic the body's natural testosterone trigger the hypothalamus to shut down its production of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Without GnRH the pituitary gland stops releasing luteinizing hormone (LH). LH normally travels from the pituitary via the blood stream to the testes where it triggers the production and release of testosterone. Without LH, the testes shut down their production of testosterone, causing testicular atrophy. In males, hCG mimics LH and helps restore / maintain testosterone production in the testes. As such, hCG is commonly used during and after steroid cycles to maintain and restore testicular size as well as endogenous testosterone production. However, if hCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.
During first few months of pregnancy, the transmission of HIV-1 from woman to fetus is extremely rare. It has been suggested this is due to the high concentration of hCG, and that the beta-subunit of this protein is active against HIV-1.
Its primary role is to support the corpus luteum which secretes estrogen and progesterone. These hormones are necessary to support a pregnancy during the first trimester. hCG levels rise when pregnancy is established and it is the hormone measured by pregnancy urine test kits.
hCG products such as Profasi and Pregnyl are derived from human tissue. Ovidrel is a new pure product that is derived from mammalian cell DNA technology. It is injected subcutaneously facilitating patient administration. hCG is extensively used as a parenteral fertility medication in lieu of luteinizing hormone. In the presence of one or more mature ovarian follicles, ovulation can be triggered by the administration of hCG. As ovulation will happen about 40-45 hours after the injection of hCG, procedures can be scheduled to take advantage of this time sequence. Thus, patients who undergo IVF, typically receive hCG to trigger the ovulation process, but have their eggs retrieved at about 36 hours after injection, a few hours before the eggs actually would be released from the ovary. In a normal menstrual cycle, the release of LH is triggered when hormones (such as estrogen) reach the appropriate levels. This is governed by hormonal relationships mediated though the hypothalamic-adrenal-pituitary axis. As hCG supports the corpus luteum, administration of hCG is used in certain circumstances to enhance the production of progesterone.
In the male, hCG injections are used to stimulate the leydig cells to synthesize testosterone. The intratesticular testosterone is necessary for spermatogenesis from the sertoli cells. Typical uses for hCG in men include hypogonadism and fertility treatment. In the world of performance enhancing drugs, hCG is increasingly used in combination with various anabolic androgenic steroid (AAS) cycles. When AAS are put into a male body, the body's natural negative feedback loops cause the body to shut down its own production of testosterone via shutdown of the HPTA (hypothalamic-pituitary-testicular axis). High levels of AASs that mimic the body's natural testosterone trigger the hypothalamus to shut down its production of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Without GnRH the pituitary gland stops releasing luteinizing hormone (LH). LH normally travels from the pituitary via the blood stream to the testes where it triggers the production and release of testosterone. Without LH, the testes shut down their production of testosterone, causing testicular atrophy. In males, hCG mimics LH and helps restore / maintain testosterone production in the testes. As such, hCG is commonly used during and after steroid cycles to maintain and restore testicular size as well as endogenous testosterone production. However, if hCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.
During first few months of pregnancy, the transmission of HIV-1 from woman to fetus is extremely rare. It has been suggested this is due to the high concentration of hCG, and that the beta-subunit of this protein is active against HIV-1.
Wednesday, November 14, 2007
Follicle Stimulating Hormone (FSH)
Follicle stimulating hormone (FSH) is naturally produced by the pituitary gland and stimulates the recruitment and development of the ovarian follicles located on the ovaries, each of which contains an egg. FSH is also referred to as a pituitary gonadotropin. The production of FSH and other reproductive hormones is controlled by the complex interaction of several hormones in a biologic feedback system known as the "hypothalamic-pituitary-adrenal" axis. The hypothalamus is the "master gland" in control of regulating these processes.
The first FSH containing commercial gonadotropin in India, Pergonal, was released by Serono Laboratories. Pergonal is derived from the urine of post-menopausal women and purified for injection. FSH levels are higher in women who are menopausal making their urine a good source for extraction. Pergonal also contains leutinizing hormone (LH) which produces many effects including higher estrogen levels.Newer FSH products include Gonal-F and Recagon which are obtained from mammalian cell cultures through recombinant DNA technology. These products are pure and do not contain the "contaminants" seen in Pergonal. Pergonal has to be administered by intramuscular injection while the newer medications are given subcutaneously with much less discomfort Both human and genetically derived products are difficult to obtain and manufacture and are therefore expensive.
Opinions differ as to the need for additional LH in FSH stimulated cycles. Some physicians prefer protocols that combine products containing LH with Gonal-F (pure FSH). When a patient is "down regulated" with Lupride, or especially Ovurelix, natural levels of LH are reduced to very low levels and some externally administered LH is believed by many to be beneficial.
Egg quality is difficult (at best) to judge but some embryologists believe pure FSH cycles produce "better quality" eggs.
In procedures such as in vitro fertilization, FSH is administered by injection to cause the development of numerous eggs which can be retrieved and fertilized. When FSH is used in stimulated intrauterine insemination cycles, there is less control over how many eggs are ovulated thus increasing the chances of multiple births. Most cases of quadruplets, or more, result from stimulated IUI cycles. Patients must be closely monitored by a Fertility Physician to minimize the risk of multiple births.
FSH should only be administered by a Fertility Physician thoroughly trained in its use. Serious side effects can occur and patients must be closely monitored with estradiol hormone level measurements and ultrasound. Hyperstimulation is a very serious, but rare, complication that can result in stroke and other like threatening events. Side effects are minimized when these products are monitored by specialists with extensive clinical training in their use.
The first FSH containing commercial gonadotropin in India, Pergonal, was released by Serono Laboratories. Pergonal is derived from the urine of post-menopausal women and purified for injection. FSH levels are higher in women who are menopausal making their urine a good source for extraction. Pergonal also contains leutinizing hormone (LH) which produces many effects including higher estrogen levels.Newer FSH products include Gonal-F and Recagon which are obtained from mammalian cell cultures through recombinant DNA technology. These products are pure and do not contain the "contaminants" seen in Pergonal. Pergonal has to be administered by intramuscular injection while the newer medications are given subcutaneously with much less discomfort Both human and genetically derived products are difficult to obtain and manufacture and are therefore expensive.
Opinions differ as to the need for additional LH in FSH stimulated cycles. Some physicians prefer protocols that combine products containing LH with Gonal-F (pure FSH). When a patient is "down regulated" with Lupride, or especially Ovurelix, natural levels of LH are reduced to very low levels and some externally administered LH is believed by many to be beneficial.
Egg quality is difficult (at best) to judge but some embryologists believe pure FSH cycles produce "better quality" eggs.
In procedures such as in vitro fertilization, FSH is administered by injection to cause the development of numerous eggs which can be retrieved and fertilized. When FSH is used in stimulated intrauterine insemination cycles, there is less control over how many eggs are ovulated thus increasing the chances of multiple births. Most cases of quadruplets, or more, result from stimulated IUI cycles. Patients must be closely monitored by a Fertility Physician to minimize the risk of multiple births.
FSH should only be administered by a Fertility Physician thoroughly trained in its use. Serious side effects can occur and patients must be closely monitored with estradiol hormone level measurements and ultrasound. Hyperstimulation is a very serious, but rare, complication that can result in stroke and other like threatening events. Side effects are minimized when these products are monitored by specialists with extensive clinical training in their use.
Tuesday, November 13, 2007
Medications for Down Regulation
Lupride and Ovurelix are fertility drugs that "down regulate" reproductive hormone production causing a reduction in levels of follicle stimulating hormone, luteinizing hormone, and estrogen. Lupride and Ovurelix both cause these effects, however, by different physiologic mechanisms.
Lupride is widely used for the treatment of endometriosis and was the first "down regulator" used in in vitro fertilization cycles. Endometrial cells are dependent upon estrogen for growth and Lupride dramatically lowers estrogen levels. Unfortunately, this lowering is accompanied by the same side effects as menopause. Lupride and Ovurelix are administered according to specific protocols in IVF to prevent premature ovulation, and in some cases to exacerbate the response to follicle stimulating hormone (flare protocol).
Lupride is a GnRH agonist which works at the hypothalamus (a small gland located at the base of the brain ) whereas Ovurelix is a GnRH antagonist which completely blocks the effect of gonadotropin releasing hormone at the pituitary gland thus creating a "more complete "down regulation". IVF cycles are precisely timed to insure that the follicles are optimally developed at the time of retrieval. FSH is administered and dosages are adjusted based upon periodic ultrasound scans and estradiol measurements. In a "normal" or "non-stimulated" cycle, luteinizing hormone surges to signal ovulation. If this occurs too soon in an IVF cycle, ovulation could be triggered before the eggs are mature and the cycle could be lost. The LH surge cannot occur while Lupride or Ovurelix are administered and thus premature ovulation is prevented. Once the follicles are mature, an injection of hCG is given 36-38 hours prior to retrieval to signal ovulation. The body responds to hCG in the same manner as it does to LH.
Many infertility clinics choose to use Lupride or Ovurelix because the down regulation is more complete and the dosing regimen is easier. Lupride is started 7 days before the next expected menses and Ovurelix is started after 4 to 6 days of FSH/hMG stimulation. Doses vary dependent upon patient specific protocols.
Lupride is widely used for the treatment of endometriosis and was the first "down regulator" used in in vitro fertilization cycles. Endometrial cells are dependent upon estrogen for growth and Lupride dramatically lowers estrogen levels. Unfortunately, this lowering is accompanied by the same side effects as menopause. Lupride and Ovurelix are administered according to specific protocols in IVF to prevent premature ovulation, and in some cases to exacerbate the response to follicle stimulating hormone (flare protocol).
Lupride is a GnRH agonist which works at the hypothalamus (a small gland located at the base of the brain ) whereas Ovurelix is a GnRH antagonist which completely blocks the effect of gonadotropin releasing hormone at the pituitary gland thus creating a "more complete "down regulation". IVF cycles are precisely timed to insure that the follicles are optimally developed at the time of retrieval. FSH is administered and dosages are adjusted based upon periodic ultrasound scans and estradiol measurements. In a "normal" or "non-stimulated" cycle, luteinizing hormone surges to signal ovulation. If this occurs too soon in an IVF cycle, ovulation could be triggered before the eggs are mature and the cycle could be lost. The LH surge cannot occur while Lupride or Ovurelix are administered and thus premature ovulation is prevented. Once the follicles are mature, an injection of hCG is given 36-38 hours prior to retrieval to signal ovulation. The body responds to hCG in the same manner as it does to LH.
Many infertility clinics choose to use Lupride or Ovurelix because the down regulation is more complete and the dosing regimen is easier. Lupride is started 7 days before the next expected menses and Ovurelix is started after 4 to 6 days of FSH/hMG stimulation. Doses vary dependent upon patient specific protocols.
Monday, November 12, 2007
Clomiphene Citrate
Clomiphene Citrate was one of the first infertility medications and is widely employed to induce ovulation. Originally, it was thought that it might hold potential as a birth control agent but research revealed its ovulation inducing properties.
Clomiphene Citrate works at the hypothalamus (a small organ located at the base of the brain) to cause the release of gonadotropin releasing hormone (GnRH) into the bloodstream. GnRH travels to the pituitary gland where it stimulates the release of follicle stimulating hormone (FSH). FSH stimulates the recruitment and development of eggs within the ovarian follicles. Clomiphene Citrate therapy should not be administered for more than 3- 6 months dependent upon many individual patient variables. Clomiphene Citrate studies have clearly demonstrated that pregnancy is most likely to occur during the first three months of therapy. There is little advantage to increasing the clomiphene dosage beyond that required to regulate ovulation.
Even though ovulatory dysfunction is present, a male semen analysis should be performed. Male factor is a contributor in over 47% of infertility cases and must be ruled out prior to treatment of the female. Clomiphene Citrate therapy is often administered by the non-specialist; however, it is not always the best choice and can produce unwanted side effects. Fertility physicians are trained to diagnose the various complex conditions that can cause ovulatory disorders, such as polycystic ovarian syndrome. There are also other alternatives to Clomiphene Citrate, especially in the PCOS patient where Metformin often is the drug of first choice. Clomiphene Citrate should not be administered to women over the age of 35 without a complete fertility evaluation. Fertility can decline rapidly in older female age groups. Once again, Clomiphene Citrate should not be prescribed without a male semen analysis.
Clomiphene Citrate is the most used and abused medication for infertility treatment. It was introduced to the clinical market in 1967 and almost immediately replaced the surgical procedure - wedge resection of the ovaries - for primary treatment of anovulation in patients with polycystic ovarian disease (PCOD). Clomiphene Citrate is still widely used by gynecologists for that purpose and others. It is important to remember that proper use of the medication will usually yield gratifying results while expanding its use to lesser indications may be counterproductive and often results in unsuccessful outcomes. Clomiphene Citrate's best and most common indication is for induction of ovulation in euestrogenic, normoprolactinemic, and anovulatory patients. The majority of these patients will have PCOD, which is a clinical diagnosis of chronic anovulation with symptoms and signs of Hyperandrogenism. The definition implies that there is adequate endogenous estrogen production and that hyperprolactinemia has been excluded. Patients with hypoestrogenic anovulation are not good candidates for Clomiphene Citrate as it works as an antiestrogen at the hypothalamus level.
Examples of patients with hypoestrogenism are those with premature ovarian failure, exercise-related amenorrhea, and low body weight with anorexia. Clomiphene Citrate does not work well in patients who are overweight. The second indication for clomiphene use is for the purpose of superovulation, in ovulating patients, in conjunction with assisted reproduction such as intrauterine insemination (IUI) or in-vitro fertilization (IVF). Clomiphene Citrate may also be used to treat patients with luteal phase defects in conjunction with progesterone supplementation in the luteal phase. The wide use of Clomiphene Citrate to treat patients with unexplained infertility can be counterproductive as Clomiphene Citrate can have adverse effects on the cervical mucus and on implantation at the endometrial level.
Clomiphene Citrate can be considered in young patients (< 30 years) but certainly for no longer than three cycles and with proper monitoring. Clomiphene Citrate is started at a dose of 50 mg / day for 5 days in anovulatory patients. It is important to remember that these patients do not have cycles and the conventional "cycle day 5 - 9" should not be used. Rather, the first day of clomiphene use can be conveniently called day 1 of the cycle. Patients should look for ovulation, wither by a BBT chart or using follicular studies, 7 to 10 days after the last clomiphene pill or on days 12 - 15 of the clomiphene cycle (first day of Clomiphene Citrate is day 1).
Clomiphene Citrate in some thin patients dosed at 25 mg / day for five days can be adequate. A post coital test can be performed in the first cycle of clomiphene use to check for adequate mucus production. If patients ovulate on the 50 mg clomiphene dose, they should be kept on it for 3 - 4 months before re-evaluation. If patients do not ovulate on the lower dosage,clomiphene should be increased in increments of 50 mg / day for subsequent cycles. It is important to remember that 70 -80% of patients who will respond to Clomiphene Citrate will ovulate on the 50 - 100 mg dosage and of those who get pregnant 80 - 90% will do so within 3 - 4 ovulatory cycles.
When clomiphene fails, it is extremely important to distinguish between ovulation and conception failure. Clomiphene Citrate Ovulation Failure is arbitrary defined as failure to ovulate on doses of 150 mg / day for 5 days (even though 10 - 20% of patients can ovulate on higher dosages, it is important to re-evaluate the patient at this stage)
What are our options to induce ovulation for these patients?
a)Clomid doses can be increased to a maximum of 250 mg / day for five days or consider increasing the duration (100 mg / day for 8 days).
b) Clomid does not work well in extremely obese patients (> 90 Kgs or BMI > 30).These patients usually have insulin resistance and those patients should be highly encouraged to lose weight before induction of ovulation. Insulin sensitizing agents such as Metformin (Glucomet) or Hyponidd should be the primary treatment. Metformin can be started at the dose of 850 mg / day for one or two weeks, increased to 1700 mg p.o., for the next week, and maintained at the same dose thereafter.
Clomiphene Citrate works at the hypothalamus (a small organ located at the base of the brain) to cause the release of gonadotropin releasing hormone (GnRH) into the bloodstream. GnRH travels to the pituitary gland where it stimulates the release of follicle stimulating hormone (FSH). FSH stimulates the recruitment and development of eggs within the ovarian follicles. Clomiphene Citrate therapy should not be administered for more than 3- 6 months dependent upon many individual patient variables. Clomiphene Citrate studies have clearly demonstrated that pregnancy is most likely to occur during the first three months of therapy. There is little advantage to increasing the clomiphene dosage beyond that required to regulate ovulation.
Even though ovulatory dysfunction is present, a male semen analysis should be performed. Male factor is a contributor in over 47% of infertility cases and must be ruled out prior to treatment of the female. Clomiphene Citrate therapy is often administered by the non-specialist; however, it is not always the best choice and can produce unwanted side effects. Fertility physicians are trained to diagnose the various complex conditions that can cause ovulatory disorders, such as polycystic ovarian syndrome. There are also other alternatives to Clomiphene Citrate, especially in the PCOS patient where Metformin often is the drug of first choice. Clomiphene Citrate should not be administered to women over the age of 35 without a complete fertility evaluation. Fertility can decline rapidly in older female age groups. Once again, Clomiphene Citrate should not be prescribed without a male semen analysis.
Clomiphene Citrate is the most used and abused medication for infertility treatment. It was introduced to the clinical market in 1967 and almost immediately replaced the surgical procedure - wedge resection of the ovaries - for primary treatment of anovulation in patients with polycystic ovarian disease (PCOD). Clomiphene Citrate is still widely used by gynecologists for that purpose and others. It is important to remember that proper use of the medication will usually yield gratifying results while expanding its use to lesser indications may be counterproductive and often results in unsuccessful outcomes. Clomiphene Citrate's best and most common indication is for induction of ovulation in euestrogenic, normoprolactinemic, and anovulatory patients. The majority of these patients will have PCOD, which is a clinical diagnosis of chronic anovulation with symptoms and signs of Hyperandrogenism. The definition implies that there is adequate endogenous estrogen production and that hyperprolactinemia has been excluded. Patients with hypoestrogenic anovulation are not good candidates for Clomiphene Citrate as it works as an antiestrogen at the hypothalamus level.
Examples of patients with hypoestrogenism are those with premature ovarian failure, exercise-related amenorrhea, and low body weight with anorexia. Clomiphene Citrate does not work well in patients who are overweight. The second indication for clomiphene use is for the purpose of superovulation, in ovulating patients, in conjunction with assisted reproduction such as intrauterine insemination (IUI) or in-vitro fertilization (IVF). Clomiphene Citrate may also be used to treat patients with luteal phase defects in conjunction with progesterone supplementation in the luteal phase. The wide use of Clomiphene Citrate to treat patients with unexplained infertility can be counterproductive as Clomiphene Citrate can have adverse effects on the cervical mucus and on implantation at the endometrial level.
Clomiphene Citrate can be considered in young patients (< 30 years) but certainly for no longer than three cycles and with proper monitoring. Clomiphene Citrate is started at a dose of 50 mg / day for 5 days in anovulatory patients. It is important to remember that these patients do not have cycles and the conventional "cycle day 5 - 9" should not be used. Rather, the first day of clomiphene use can be conveniently called day 1 of the cycle. Patients should look for ovulation, wither by a BBT chart or using follicular studies, 7 to 10 days after the last clomiphene pill or on days 12 - 15 of the clomiphene cycle (first day of Clomiphene Citrate is day 1).
Clomiphene Citrate in some thin patients dosed at 25 mg / day for five days can be adequate. A post coital test can be performed in the first cycle of clomiphene use to check for adequate mucus production. If patients ovulate on the 50 mg clomiphene dose, they should be kept on it for 3 - 4 months before re-evaluation. If patients do not ovulate on the lower dosage,clomiphene should be increased in increments of 50 mg / day for subsequent cycles. It is important to remember that 70 -80% of patients who will respond to Clomiphene Citrate will ovulate on the 50 - 100 mg dosage and of those who get pregnant 80 - 90% will do so within 3 - 4 ovulatory cycles.
When clomiphene fails, it is extremely important to distinguish between ovulation and conception failure. Clomiphene Citrate Ovulation Failure is arbitrary defined as failure to ovulate on doses of 150 mg / day for 5 days (even though 10 - 20% of patients can ovulate on higher dosages, it is important to re-evaluate the patient at this stage)
What are our options to induce ovulation for these patients?
a)Clomid doses can be increased to a maximum of 250 mg / day for five days or consider increasing the duration (100 mg / day for 8 days).
b) Clomid does not work well in extremely obese patients (> 90 Kgs or BMI > 30).These patients usually have insulin resistance and those patients should be highly encouraged to lose weight before induction of ovulation. Insulin sensitizing agents such as Metformin (Glucomet) or Hyponidd should be the primary treatment. Metformin can be started at the dose of 850 mg / day for one or two weeks, increased to 1700 mg p.o., for the next week, and maintained at the same dose thereafter.
Sunday, November 11, 2007
Saturday, November 10, 2007
Friday, November 9, 2007
Diwali
The word "Diwali" is derived from the Sanskrit word "Deepavali" - Deepa meaning light and Avali, meaning a row. It means a row of lights and indeed illumination forms its main attraction. Every home - lowly or mightly - the hut of the poor or the mansion of the rich - is alit with the orange glow of twinkling diyas-small earthen lamps - to welcome Lakshmi, Goddess of wealth and prosperity. Multi-coloured Rangoli designs, floral decorations and fireworks lend picturesness and grandeur to this festival which heralds joy, mirth and happiness in the ensuring year. Diwali is also known as the Festival of Lights. Light is significant in Hinduism because it signifies goodness. So, during the Festival of Lights, 'deeps', or oil lamps, are burned throughout the day and into the night to ward off darkness and evil. Homes are filled with these oil lamps, candles and lights. Diwali is celebrated on the last day of the last month of lunar calendar. This year it begins on October 21st and ends on October 25th. This weeklong festival is a tradition in every Hindu household around the world. It is the beginning of the New Year (2051), a start to a new fiscal year and a brand new beginning for all. Diwali is celebrated for five days, each day having it's own significance and ritual. Many legends and myths are also attached to each day. Each region of India celebrates Diwali in it's own unique way.
In northern India, especially in places like the Punjab, Diwali is dedicated to the worship of Lord Rama, who had been exiled from his empire, India, for 14 years. During that time Lord Rama fought and won tenuous struggles in the south part of the Indian sub-continent (what is now Sri Lanka). Diwali marks his victorious return to his kingdom. While in Bengal, Kali/Durga, the goddess of strength, is worshipped. This reverence is called "Kali Chaudas or Kal Chaturdasi". Strength is a positive attribute for one to have but it must be used to protect others from harm and used only in good and pure deeds. Also during Diwali, the goddess of wealth, Lord Lakshmi is worshipped. This practice is called "Dhanteras". It is believed that he or she who worships Lord Lakshmi during Diwali is bestowed wealth and prosperity. In Hindu society and culture, wealth is seen as a positive notion. It is not a corruptive contrivance used to harm others. What is corrupt is one's attitude towards wealth. Wealth equals power and power is good, as long as it does not harm another living creature. Wealth should be used in pure and good activities, not leading anyone down a path of destruction. Another practice during Diwali is "Bhai Dooj" or "Bhai Beej". On this day, women are given gifts from their brothers and held in the highest respect. The myth behind this begins when Bhagawaan Mahavir found nirvana, his brother Raja Nandivardhan was distressed because he missed him and was comforted by his sister Sudarshana. Since then, women have been revered during this festival.
Each of the five days in the festival of Diwali is marked with a significant worship or 'puja' of a certain deity that differs throughout India. Each is also separated by a different tradition. But what remains the same throughout is that this day is a celebration of life, joy and goodness. From darkness we enter into light, and light empowers us to do good deeds and bring us closer to divinity.
Diwali is the festival of Laxmi, the Goddess of prosperity and wealth. It is believed that Goddess Laxmi visit everyone during Diwali and brings peace and prosperity to all. On the night of diwali "Lakshmi-Pujan" is performed in the evenings. A traditional Puja is performed after sunset in all the homes. Five pieces of ghee diyas (lamps) are lit in front of the deities, Naivedya of traditional sweets is offered to the Goddess and devotional songs- in praise of Goddess Laxmi are sung.
After the Puja people light diyas (lamps) in their homes to usher in light, and clear the darkness from the world. In villages cattle's are adorned and worshipped by farmers as they form the main source of their income. In south cows are offered special veneration as they are supposed to be the incarnation of Goddess Lakshmi and therefore they are adorned and worshipped on this day.
Diwali or more aptly Deepavali is very enthusiastically celebrated for five continuous days and each day has its significance with a number of myths, legends and beliefs.
First Day : DHANTERAS or DHANTRAYODASHI.
It is the thirteenth day of the month of Ashwin. The word "Dhan" means wealth. As such this day of the five-day Diwali festival has a great importance for the rich mercantile community of Western India. Houses and Business premises are renovated and decorated. Entrances are made colourful with lovely traditional motifs of Rangoli designs to welcome the Goddess of wealth and prosperity. To indicate her long-awaited arrival, small footprints are drawn with rice flour and vermilion powder all over the houses. Lamps are kept burning all through the nights. Believing this day to be auspicious women purchase some gold or silver or at least one or two new utensils. "Lakshmi-Puja" is performed in the evenings when tiny diyas of clay are lighted to drive away the shadows of evil spirits. "Bhajans"-devotional songs- in praise of Goddess Laxmi are sung and "Naivedya" of traditional sweets is offered to the Goddess. There is a peculiar custom in Maharashtra to lightly pound dry coriander seeds with jaggery and offer as Naivedya. In villages cattles are adorned and worshipped by farmers as they form the main source of their income. In south cows are offered special veneration as they are supposed to be the incarnation of Goddess Lakshmi and therefore they are adorned and worshipped on this day.
A very interesting story about this day is of the sixteen year old son of King Hima. As per his horoscope he was doomed to die by a snake-bite on the fourth day of his marriage. On that particular fourth day of his marriage his young wife did not allow him to sleep. She laid all the ornaments and lots of gold and silver coins in a big heap at the entrance of her husband's boudoir and lighted innumerable lamps all over the place. And she went on telling stories and singing songs. When Yam, the god of Death arrived there in the guise of a Serpent his eyes got blinded by that dazzle of those brilliant lights and he could not enter the Prince's chamber. So he climbed on top of the heap of the ornaments and coins and sat there whole night listening to the melodious songs. In the morning he quietly went away. Thus the young wife saved her husband from the clutches of death. Since then this day of Dhanteras came to be known as the day of "YAMADEEPDAAN" and lamps are kept burning throughout the night in reverential adoration to Yam, the god of Death.
The SECOND day is called NARAK-CHATURDASHI or CHOTI DIWALI.
IT is about 'Narakasur Vadh' (killing of the demon Narakasur), and is held on the fourteenth day of the month of Aashwin. The story goes that the demon king Narakasur ruler of Pragjyotishpur ( a province to the South of Nepal) after defeating Lord Indra had snatched away the magnificent earrings of Aditi, the Mother Goddess and imprisoned sixteen thousand daughters of the gods and saints in his harem. On the day previous to Narakachaturdashi, Lord Krishna killed the demon and liberated the imprisoned damsels and also recovered those precious earrings of Aditi. As a symbol of that victory Lord Krishna smeared his forehead with the demon king's blood. Krishna returned home in the very early morning of the Narakachaturdashi day. The womenfolk massaged scented oil to his body and gave him a good bath to wash away the filth from his body. Since then the custom of taking bath before sunrise on this day has become a traditional practice specially in Maharashtra. In South India that victory of the divine over the mundane is celebrated in a very peculiar way. People wake up before sunrise prepare blood by mixing Kumkum in oil and after breaking a bitter fruit that represents the head of the demon King that was smashed by Krishna, apply that mixture on their foreheads. Then they have an oil bath using sandalwood paste. In Maharashtra also, traditional early baths with oil and "Uptan" (paste) of gram flour and fragrant powders are a `must'. All through the ritual of baths, deafening sounds of crackers and fireworks are there in order that the children enjoy bathing. Afterwards steamed vermiceli with milk and sugar or puffed rice with curd is served.
The THIRD day : Diwali
On the dark new moon night, the entrances to all homes are lit up and decorated with rangoli patterns to welcome Lakshmi, the radiant consort of Vishnu and the goddess of wealth and lustre. Lakshmi Puja is performed on this day. Diwali is the last day of financial year in traditional Hindu business and businessmen perform Chopda Pujan on this day on the new books of accounts. The day ends with a mega cracker bursting sessions. For 5-6 hours, every family burns fire crackers worth thousands of ruppees. Poplular fire crackers are sparkling pots, bombs, rockets etc.
The FOURTH day : New Year day or Bestavarsh
The day after the Lakshmi Puja, most families celebrate the new year by dressing in new clothes, wearing jewellery and visiting family members and business colleagues to give them sweets, dry fruits and gifts. Among the business communities of Gujarat, Rajasthan, Madhya Pradesh and Maharashtra, Diwali is the festival when the new business year begins. All business establishments and families perform muharat pujan or veneration of their books. Stock brokers do mahurat trading or symbolic auspicious business deals to Diwali. Diwali, one of the longest festivals in the Hindu year, is a time when everything in India comes to a standstill except family life, feasting and shopping. Diwali is considered auspicious for shopping, inaugurations of new homes, business deals or for starting any new ventures and projects.
The Fifth day of Diwali : Bhai Dhooj
The second day of the bright forthnight (Shukla Paksh) of Kartik is called "Bhaiya-Duj". It comes once a year - after Diwali. The name itself denotes the day of the festival i.e.Diwali falls on the absolutely dark night of Amavasya (new moon), Dooj comes two days after Diwali. Many years ago, in the Vedic era, Yama (Yamraj, the Lord of death) visited His sister Yamuna(Yami) and she put the auspicious tilak on his forehead, they ate talked and enjoyed together and exchanged special gifts as a token of their love for each other and Yamraj announced that anyone who receives tilak from his sister on this day will never be thrown. Since then it became imperative for the brother to go to his sister's house to celebrate Bhaiyaduj.On Bhai Dooj, the teeka is applied on the brother's forehead. It is a day dedicated to sisters. We have heard about Raksha Bandhan (brothers day). Well this is sisters day. The sister usually goes in the morning and does the puja in the mother's house, before the brothers leave for their places of study or work.
Enjoy your Diwali & Have a rocking Weekend.
In northern India, especially in places like the Punjab, Diwali is dedicated to the worship of Lord Rama, who had been exiled from his empire, India, for 14 years. During that time Lord Rama fought and won tenuous struggles in the south part of the Indian sub-continent (what is now Sri Lanka). Diwali marks his victorious return to his kingdom. While in Bengal, Kali/Durga, the goddess of strength, is worshipped. This reverence is called "Kali Chaudas or Kal Chaturdasi". Strength is a positive attribute for one to have but it must be used to protect others from harm and used only in good and pure deeds. Also during Diwali, the goddess of wealth, Lord Lakshmi is worshipped. This practice is called "Dhanteras". It is believed that he or she who worships Lord Lakshmi during Diwali is bestowed wealth and prosperity. In Hindu society and culture, wealth is seen as a positive notion. It is not a corruptive contrivance used to harm others. What is corrupt is one's attitude towards wealth. Wealth equals power and power is good, as long as it does not harm another living creature. Wealth should be used in pure and good activities, not leading anyone down a path of destruction. Another practice during Diwali is "Bhai Dooj" or "Bhai Beej". On this day, women are given gifts from their brothers and held in the highest respect. The myth behind this begins when Bhagawaan Mahavir found nirvana, his brother Raja Nandivardhan was distressed because he missed him and was comforted by his sister Sudarshana. Since then, women have been revered during this festival.
Each of the five days in the festival of Diwali is marked with a significant worship or 'puja' of a certain deity that differs throughout India. Each is also separated by a different tradition. But what remains the same throughout is that this day is a celebration of life, joy and goodness. From darkness we enter into light, and light empowers us to do good deeds and bring us closer to divinity.
Diwali is the festival of Laxmi, the Goddess of prosperity and wealth. It is believed that Goddess Laxmi visit everyone during Diwali and brings peace and prosperity to all. On the night of diwali "Lakshmi-Pujan" is performed in the evenings. A traditional Puja is performed after sunset in all the homes. Five pieces of ghee diyas (lamps) are lit in front of the deities, Naivedya of traditional sweets is offered to the Goddess and devotional songs- in praise of Goddess Laxmi are sung.
After the Puja people light diyas (lamps) in their homes to usher in light, and clear the darkness from the world. In villages cattle's are adorned and worshipped by farmers as they form the main source of their income. In south cows are offered special veneration as they are supposed to be the incarnation of Goddess Lakshmi and therefore they are adorned and worshipped on this day.
Diwali or more aptly Deepavali is very enthusiastically celebrated for five continuous days and each day has its significance with a number of myths, legends and beliefs.
First Day : DHANTERAS or DHANTRAYODASHI.
It is the thirteenth day of the month of Ashwin. The word "Dhan" means wealth. As such this day of the five-day Diwali festival has a great importance for the rich mercantile community of Western India. Houses and Business premises are renovated and decorated. Entrances are made colourful with lovely traditional motifs of Rangoli designs to welcome the Goddess of wealth and prosperity. To indicate her long-awaited arrival, small footprints are drawn with rice flour and vermilion powder all over the houses. Lamps are kept burning all through the nights. Believing this day to be auspicious women purchase some gold or silver or at least one or two new utensils. "Lakshmi-Puja" is performed in the evenings when tiny diyas of clay are lighted to drive away the shadows of evil spirits. "Bhajans"-devotional songs- in praise of Goddess Laxmi are sung and "Naivedya" of traditional sweets is offered to the Goddess. There is a peculiar custom in Maharashtra to lightly pound dry coriander seeds with jaggery and offer as Naivedya. In villages cattles are adorned and worshipped by farmers as they form the main source of their income. In south cows are offered special veneration as they are supposed to be the incarnation of Goddess Lakshmi and therefore they are adorned and worshipped on this day.
A very interesting story about this day is of the sixteen year old son of King Hima. As per his horoscope he was doomed to die by a snake-bite on the fourth day of his marriage. On that particular fourth day of his marriage his young wife did not allow him to sleep. She laid all the ornaments and lots of gold and silver coins in a big heap at the entrance of her husband's boudoir and lighted innumerable lamps all over the place. And she went on telling stories and singing songs. When Yam, the god of Death arrived there in the guise of a Serpent his eyes got blinded by that dazzle of those brilliant lights and he could not enter the Prince's chamber. So he climbed on top of the heap of the ornaments and coins and sat there whole night listening to the melodious songs. In the morning he quietly went away. Thus the young wife saved her husband from the clutches of death. Since then this day of Dhanteras came to be known as the day of "YAMADEEPDAAN" and lamps are kept burning throughout the night in reverential adoration to Yam, the god of Death.
The SECOND day is called NARAK-CHATURDASHI or CHOTI DIWALI.
IT is about 'Narakasur Vadh' (killing of the demon Narakasur), and is held on the fourteenth day of the month of Aashwin. The story goes that the demon king Narakasur ruler of Pragjyotishpur ( a province to the South of Nepal) after defeating Lord Indra had snatched away the magnificent earrings of Aditi, the Mother Goddess and imprisoned sixteen thousand daughters of the gods and saints in his harem. On the day previous to Narakachaturdashi, Lord Krishna killed the demon and liberated the imprisoned damsels and also recovered those precious earrings of Aditi. As a symbol of that victory Lord Krishna smeared his forehead with the demon king's blood. Krishna returned home in the very early morning of the Narakachaturdashi day. The womenfolk massaged scented oil to his body and gave him a good bath to wash away the filth from his body. Since then the custom of taking bath before sunrise on this day has become a traditional practice specially in Maharashtra. In South India that victory of the divine over the mundane is celebrated in a very peculiar way. People wake up before sunrise prepare blood by mixing Kumkum in oil and after breaking a bitter fruit that represents the head of the demon King that was smashed by Krishna, apply that mixture on their foreheads. Then they have an oil bath using sandalwood paste. In Maharashtra also, traditional early baths with oil and "Uptan" (paste) of gram flour and fragrant powders are a `must'. All through the ritual of baths, deafening sounds of crackers and fireworks are there in order that the children enjoy bathing. Afterwards steamed vermiceli with milk and sugar or puffed rice with curd is served.
The THIRD day : Diwali
On the dark new moon night, the entrances to all homes are lit up and decorated with rangoli patterns to welcome Lakshmi, the radiant consort of Vishnu and the goddess of wealth and lustre. Lakshmi Puja is performed on this day. Diwali is the last day of financial year in traditional Hindu business and businessmen perform Chopda Pujan on this day on the new books of accounts. The day ends with a mega cracker bursting sessions. For 5-6 hours, every family burns fire crackers worth thousands of ruppees. Poplular fire crackers are sparkling pots, bombs, rockets etc.
The FOURTH day : New Year day or Bestavarsh
The day after the Lakshmi Puja, most families celebrate the new year by dressing in new clothes, wearing jewellery and visiting family members and business colleagues to give them sweets, dry fruits and gifts. Among the business communities of Gujarat, Rajasthan, Madhya Pradesh and Maharashtra, Diwali is the festival when the new business year begins. All business establishments and families perform muharat pujan or veneration of their books. Stock brokers do mahurat trading or symbolic auspicious business deals to Diwali. Diwali, one of the longest festivals in the Hindu year, is a time when everything in India comes to a standstill except family life, feasting and shopping. Diwali is considered auspicious for shopping, inaugurations of new homes, business deals or for starting any new ventures and projects.
The Fifth day of Diwali : Bhai Dhooj
The second day of the bright forthnight (Shukla Paksh) of Kartik is called "Bhaiya-Duj". It comes once a year - after Diwali. The name itself denotes the day of the festival i.e.Diwali falls on the absolutely dark night of Amavasya (new moon), Dooj comes two days after Diwali. Many years ago, in the Vedic era, Yama (Yamraj, the Lord of death) visited His sister Yamuna(Yami) and she put the auspicious tilak on his forehead, they ate talked and enjoyed together and exchanged special gifts as a token of their love for each other and Yamraj announced that anyone who receives tilak from his sister on this day will never be thrown. Since then it became imperative for the brother to go to his sister's house to celebrate Bhaiyaduj.On Bhai Dooj, the teeka is applied on the brother's forehead. It is a day dedicated to sisters. We have heard about Raksha Bandhan (brothers day). Well this is sisters day. The sister usually goes in the morning and does the puja in the mother's house, before the brothers leave for their places of study or work.
Enjoy your Diwali & Have a rocking Weekend.
Subscribe to:
Posts (Atom)