The world's population is growing at an unsustainable rate. From a baseline ?gure of one billion in 1800, global population is predicted to exceed nine billion by 2050 and 87. 8% of this growth will be localized in less developed countries. Such uneven population growth will yield a harvest of poverty, malnutrition, disease and en- ronmental degradation that will affect us all. Amongst the complex mixture of political, social, cultural and technological changes needed to address this issue, the development of improved methods of fertility regulation will be critical. The inadequacy of current contraceptive technologies is indicated by recent data s- gesting that the contraceptive needs of over 120 million couples go unmet every year. As a direct consequence of this de?cit 38% of pregnancies are unplanned and more than 50% end in an abortion, generating a total of 46 million abortions per annum particularly among teenagers. If safe, effective contraceptives were ava- able to every couple experiencing an unmet family planning need, 1. 5 million lives would be saved each year (UNFPA 2003). Progress in contraceptive technology should not only generate more effective methods of regulating fertility, but should also provide a range of methods to meet the changing needs of the world's population. Contraceptive practice was revo- tionized in 1960 in the US and 1961 in Europe by the introduction of the oral contraceptive pill by Gregory Pincus, MC Chang and colleagues, based on fun- mental hormone research conducted in Germany.

The optimal function of the placenta and thus fetal well being largely depends upon the integrity of both the fetal and maternal circulations of the placenta. Intense basic research concerned with placental vascularization and blood flow has been performed for the past 30 years, beginning with the classical morphological descriptions of the placental vessels by Boe (1953) and Arts (1961), as well as with the radioangiographic studies of maternal placental circulation in the human by Borell (1958) and in the rhesus monkey by Ramsey (1962). The scientific framework presented by these investigators has been filled and completed by numerous investigators, leading to more morphological details, functional considerations, and pathological understanding. For an extended period of time, this research has been of primarily academic interest by increasing our insights into one important system of the placenta, yet having nearly no practical importance. Recently, this situation has changed dramatically: in vitro studies of the isolated, dually perfused human placenta and in vivo studies of placental circulation for diagnostic purposes have raised an enormous interest in basic research data. New methods like Doppler Ultrasound and NMR became available. These technics have enabled the obstetrician to study fetal and placental hemodynamics in vivo. Meanwhile, such methods are becoming incorporated into the daily obstetrical routine, to some degree without an adequate background knowledge of placental vascularization and blood flow, since such experience is currently available to only a small group of experts.

This book is intended as a reference manual that will provide the busy clinician with up-to-date information on the diagnosis and treatment of uncommon and rare gynecological cancers. While standard textbooks briefly cover these tumors, this is intended as a more comprehensive yet easy-to-use guide. After opening chapters on epidemiology, pathology, and diagnostic imaging, the full range of infrequently encountered gynecological cancers (ovarian, uterine, cervical, vaginal, and vulval) is presented and discussed with the aid of high-quality illustrations. In each case, detailed attention is paid to both differential diagnosis and current treatment options. The book has been written by an international panel of experts and is the first to gather all the uncommon and rare gynecological cancers together within one volume.

Bladder Pain Syndrome: A Guide for Clinicians provides a comprehensive update in the pathophysiology, epidemiology, terminology, evaluation and treatment of patients with pelvic pain perceived to be related to the urinary bladder. The volume covers the tremendous evolution during the last decade in our understanding of pain syndromes and their diagnosis and treatment. It is now clear that Bladder Pain Syndrome belongs to the family of pain syndromes, and therefore treatment has moved from the treatment of the bladder to the treatment of a pain syndrome with the special problems this presents when the pain syndrome involves urinary symptoms. Interstitial Cystitis was poorly defined and the interpretation and patient selection differed enormously around the world in many ways, making exchange of information unreliable and confusing. Bladder Pain Syndrome is clearly defined and the result is a much better patient selection. This volume provides state of the art background for making a correct evaluation and diagnosis of patients with pelvic pain and voiding problems resulting in a more focused treatment to the benefit of the patients. The volume also covers the close relationship between different pain syndromes including those outside the pelvis. Bladder Pain Syndrome: A Guide for Clinicians will be of great utility to urologists, gynecologists and all health professionals dealing with patients with pelvic pain.

Operative Gynecologic Endoscopy, Second Edition is completely revised and expanded with 17 new chapters that provide, step-by-step, the latest operative techniques for both laparoscopic AND hysteroscopic procedures. New and updated chapters include: - laparoscopic assisted vaginal hysterectomy - vaginal prolapse and bladder suspension - ectopic pregnancy - tubal reconstructive surgery - assisted reproductive technologies - lymphadenectomy and urologic procedures - operative hysteroscopy. In addition, this volume includes comprehensive chapters on instrumentation, photo documentation, anesthesia, operating room personnel, credentialing, and legal issues. More than 350 superb illustrations - with many in full color - complement and clarify the operative techniques. For every surgeon and resident performing gynecologic procedures, this is the definitive, most up-to-date text on gynecologic endoscopy.

These two volumes are unique in that they take into consideration the enormous progress made in the field over the last few years. Expert knowledge is given by Professor Runnebaum, whose department was appointed WHO Collaboration Center for Research in Human Reproduction. These extensively illustrated books provide detailed information on the function and detection of new hormones and growth factors, on therapy with female sexual hormones, on environmental factors, and on the diagnostic and surgical techniques employed in reproductive medicine. This English edition of a standard German reference has been expanded to include an appendix containing a comprehensive list of pharmaceutical agents used in hormone therapy, including international and trade names and compositions.

Type 1 diabetes is a serious and common disease, afflicting one per 200 of the population worldwide. It is widely believed to cause harmful physical maldevelopment--congenital malformations--and other consequences in the unborn children of women with the disease. This book considers the history of the disease in pregnant women and this belief that it causes anomalies since the time of the discovery of insulin in 1921, and presents a profound and critical appraisal of the subject of its supposed prenatal harmfulness.

This concise drug guide lists 500 substances, such as pharmaceutical drugs, lifestyle drugs, and environmental toxicants, which show documented untoward effects on the male sexual organs and their functions. All substances are listed in user-friendly alphabetical order with a uniform structure throughout the book. Each listing includes evidence-based information with up-to-date references and all studies mentioned are evaluated and categorized according to study and sample types. This unique compendium provides more detailed information on each drug than any other standard pharmacology title.

Molecular biology emerged from advances in biochemistry during the 1940s and 1950s, when the structure of the nucleic acids and proteins were elucidated. Beginning in the 1970s, with nucleic acid enzymology and the discovery of the restriction enzymes, the tools of molecular biology became widely available and applied in cell biology to study how genes are regulated. This new knowledge impacted endocrinology and reproductive biology since it was largely known that the secretion of the internal glands affected the phenotypes, and expression of genes. Modern reproductive biology encompasses every level of biological study from genomics to ecology, encompassing cell biology, biochemistry, endocrinology and general physiology. All of these disciplines require a basic knowledge, both as a tool and as an essential aid to a fundamental understanding of the principles of life in health and disease. Overall, molecular biology is central to scientific studies in all living matter, impacting disciplines such as medicine, related health sciences, veterinary, agriculture and environmental sciences. In this book, the basic biochemistry of nucleic acids and proteins are reviewed. Methodologies used to study signaling and gene regulation in the endocrine/reproductive system are also discussed. Topics include mechanisms of hormone action and several endocrine disorders affecting the reproductive system. Professionals in the medical, veterinary and animal sciences fields will find exciting and stimulating material enhancing the breadth and quality of their research.

The body of any animal can be viewed as a society or ecosystem whose individual members are cells, reproducing by cell division and organized into collaborative assemblies or tissues. In this ecosystem, the cells are born, live and die under various forms of selection pressure such as territorial limitation, population size, source of nutrients provided, infectious agents, etc. The body is a highly organized society of cells whose main task is the maintenance of homeostasis of the whole organism. The failure of control mechanisms which make the cell the unit of society, marking the beginning of its asocial behaviour, is most frequently a malignant alteration. This process is not abrupt, nor is it based on a single event. It is, rather, a long-term process characterized mainly by mutation, competition and natural selection operating within the population of cells. The basic mechanisms controlling the cell sociability represent the first defence line against the altered cells, while the second line of defence is supposed to be made up of the immune system cells.Speaking in Darwinian terms, within the ecosystem of an organism, cells of the immune system operate as predators of the altered and mutated cells or cells infected by the intracellular parasites. The biological phenomena whose mechanisms are, at present, explored and largely understood, certainly had their own evolution. Searching for the origin and details of the evolution of advanced solutions as well as selection pressures that might justify their emergence and existence, we often fail to see that many such phenomena are, in fact, co-evolutionary by-products of evolutionary innovations. In other words, the evolutionary emergence of advanced solutions is sometimes, if not always, accompanied by certain by-products and by the co-evolution of compensatory mechanisms acting as a counterbalance to these. An example of the evolution of advanced solutions is the evolution of adoptive immunity, and co-evolution of auto-immunity and alloimmunity. Alongside the diversification of the mechanisms of adoptive immunity, auto-immunity and alloimmunity gain attributes of the evolutionary by-products and become sources of selection pressure.To that effect, alloimmunity could be a source of very strong selection pressure in mammals, simply because it is directly connected with the reproductive efficacy. At the same time, new forms of selection pressure that are connected with adoptive immunity gave rise to new mechanisms controlling killer machinery of the immune system. Finally, the last in a line of by-products in the processes of evolutionary modelling and re-modelling of vertebrate immune systems can be regarded as the failure of anti-tumor immunity. There is now much evidence that tumors can be immunogenic. Tumor cells very often express antigens in a form recognizable by the host immune system, but most frequently without consequences on tumor progression. This has been shown in many experimental models and different experimental conditions. Immediate mechanisms for the escape of tumors from the immune response are very similar to mechanisms for the escape of the fetoplacental unit (as allograft) from the maternal immune response. The similarity between these two mechanisms is so significant that any randomness must be banished.Mechanisms of anti-tumor immunity in mammals are probably substantially different from mechanisms of anti-tumor immunity in other classes of vertebrates. Moreover, the type of most frequent tumors in non-mammalian vertebrates is also significantly different. Finally, the incidence of malignant tumors in non-mammalian vertebrates is significantly lower than the incidence of malignant tumors in mammals. These facts indicate that the mammalian immune system during the anti-tumor immune response is tricked by the similarity between tumor cells and trophoblast or other placental cells. From this aspect, anti-tumor immunity failure in mammals can be defined as an immunoreproductive phenomenon, which is developed under the evolutionary pressure of auto-immunity and alloimmunity/reproductive effectiveness. It may be a specific evolutionary approach in the rendering of anti-tumor immunity failure in mammals, and a new possibility for anti-tumor immunotherapy.

For out of olde hokes, in good feyth, Cometh all this newe science that men lere. Geoffrey Chaucer The Parliament of Fowls During the past two decades knowledge of the human menstrual cycle and of normal and abnormal reproduc- tive function has increased at a dramatic rate. As rec- ognized in this volume, this explosion of knowledge is due in large measure to the development of radio- immunoassays for the measurement of the minute quantities of reproductive hormones found in the cir- culation. Yet the foundations for the many recent developments were laid well in advance. The concepts and hypotheses tested were often suggested even be- fore the hormones involved were identified and iso- lated. A consideration of the historic aspects of re- search in this field places recent research in the appropriate perspective. Moreover, as presented by Drs. vii viii FOREWORD Gruhn and Kazer, the history of progress in this field makes fascinating reading. A review of the history of reproductive endocri- nology should be required reading for all students of the subject and reproductive endocrinologists in train- ing. Dr. Griff T. Ross, a noted reproductive endocri- nologist, often instructed his students that every hy- pothesis he tested could be found in some form in the publications of previous scientists. The answers to present and future questions are often hidden in the lessons of the past.

Almost every aspect of energy and nutrient metabolism is altered by hormonal and other physiological changes during pregnancy and lactation. While it is evident that hormonal adjustments affect nutrient requirements, these are rarely considered when nutrient recommen dations are made for pregnant or lactating women, and often neglected during evaluation of nutritional status. In addition, changes in nutrient metabolism during the stages of pregnancy and oflactation are usually considered separately, while in reality events during pregnancy can have a major influence on nutritional status and nutrient requirements during lactation. The purpose of this volume is to describe changes in the metabolism of important nutrients during pregnancy and lactation, including the physiological basis for these changes and their implications for nutrient requirements and assessment. Authors have considered such issues as inter-relationships between endocrine changes and nutrient metabolism at the tissue, cellular and molecular level; alterations in nutrient binding proteins; the efficiency of nutrient absorp tion and retention; and the impact on maternal as well as fetal nutritional status. Another unique aspect of this book is the focus on pregnancy and lactation as a continuum."

Ovulation: Evolving Scientific and Clinical Concepts presents the proceedings of the International Symposium on Ovulation: Evolving Scientic and Clinical Concepts held in Salt Lake City, Utah. Internationally recognized experts provide new insights in the most recent developments in the area of mammalian ovulation, incorporating basic scientific and clinical concepts in the process. Topics include an overview of 37 years of research on ovulation, the follicle, the gonadotropin surge, the intraovarian steroid microenvironment, putative periovulatory intraovarian regulators and messengers, and clinical frontiers. More than 80 illustrations round out the text. The book is essential for all reproductive endocrinologists and Ob-Gyns.

Reproductive tract infections (RTis) have become a silent epidemic that is devastating women's lives. Each year, thousands of women die needlessly from the consequences of these infections, including cervical cancer, ectopic pregnancy, acute and chronic infections of the uterus and the fallopian tubes, and puerperal infections. For many women, this happens because they receive medical attention too late, if at all. The terrible irony of this tragedy is that early diagnosis of and treatment for many RTis do not require high-technology health care. For the hundreds of millions of women with chronic RTis acquired from their sexual partners, life can become a living hell. Infection is a major cause of infertility, and it leads to scorn and rejection in many countries. These women may experience constant pain, have festering lesions of the genital tract, be at enhanced risk of second ary diseases, and endure social ostracism. The problems associated with RT s have grown even greater in the past decade with the emergence of human immunodeficiency virus (HIV) and AIDS. Preexisting sexually transmitted disease, particularly when associated with genital tract ulcers, raises women's vulnerability to the transmission of HIV 3-5 fold."

Since 2005 a dozen states and more than 15 specialties have reported a physician shortage or anticipate one in the next few years. This anticipated shortage and a worsening of physician distribution are compounded by a projected increased demand for women's healthcare services.

Women's healthcare is particularly vulnerable, because the obstetrician-gynecologist workforce is aging and is among the least satisfied medical specialists. Furthermore, fellowship training in women's healthcare in internal medicine and in maternal child health in family and community medicine involves only a small portion of general internists and family physicians.

In response to this challenge, the Association of American Medical Colleges called for an expansion of medical schools and graduate medical education enrollments. As we cope with significant and rapid changes in organizations and reimbursement, academic departments of obstetrics and gynecology, family and community medicine, and internal medicine have opportunities to create a unified women's health curriculum for undergraduate students, share preventive health and well-woman expertise in training programs, provide improved continuity of care, instill concepts of lifelong learning to our graduates, and better develop our research programs.

This volume's chapters focus on strategic planning on behalf of academic faculty who will train the anticipated additional load of students, residents, and fellows in women's healthcare.
-changing demographics of faculty
-expanding roles of clinician educators
-physician investigators and their future
-the hidden value of part-time faculty
-faculty salaries
-required skillsets of academic leaders
-the meaning of tenure and faculty satisfaction and retention.

Recommendations presented here from authors with distinguished leadership skills indicate a consensus, but not unanimity. In furthering these goals, we summarize in the final chapter our collective expertise and offer ways to implement recommendations to better prepare for tomorrow's needs in academic women's healthcare.

This second edition of Intrapartum Care for the MRCOG and Beyond has been comprehensively updated to reflect current clinical practice and developments since the publication of the original edition. Six new chapters have been added on topics that have become increasingly important since the first edition of the book: improving intrapartum care; lower genital tract trauma; emergency obstetric hysterectomy; acute uterine inversion; disseminated intravascular coagulation; and acute tocolysis. The book outlines a concise and pragmatic approach to intrapartum care, with a focus on the fine clinical balance needed from midwives and obstetricians to provide the vigilant care necessary to prevent and manage the relatively rare adverse events during labour, yet support the wishes of the woman who wants minimal interference.

Gynaecological cancers are categorised as 'rare' diseases, although collectively they affect over 16,000 women each year in the UK alone. There is a lack of real understanding of these conditions compared with other malignancies, possibly owing to their relative rarity when viewed as individual diseases. The 60th RCOG Study Group brought together a range of experts to examine as many biological aspects of gynaecological cancers as possible, including both surgical and non-surgical therapies. This book presents the findings of the Study Group, with contents including: current understanding of the biology of gynaecological cancers translation of biology to the clinic state of the art in imaging and therapy current clinical trials advances in multimodal therapy individualised treatment."

In Vitro Fertilization, Embryo Transfer and Early Pregnancy is undoubtably the most exciting and onwardly progressing field in reproductive medicine today. It forms the major subject matter of this the second volume of the Proceedings and the first book of Related Communication papers given at the XI International Federation of Fertility Societies World Congress on Fertility and Sterility held in Dublin, Ireland from June 26th to July 1st 1983. The papers have been grouped into closely allied topics covering sequentially in three parts: Follicle and Ovum in the Human, Follicle and Ovum in the Animal Model, and Semen and Spermatozoa. Preceding a timely reminder on Ethical and Legal Aspects of IVF are some of the remarkable clinical results now been obtained throughout the world. The final section concerns various aspects of Pregnancy in Animals and Humans and is included in this volume because of its close relationship to the main subject matter. Related Communications sessions often produce the largest amounts of up-to-date information to be given on a particular subject during a Congress. IFFS Dublin '83 proved to be no exception. So although scientific and medical endeavour will ensure that knowledge and progress in the field will soom overtake many of the conclusions reached in these papers, nevertheless we hope you will agree in the merit of producing such a record of the state of the art at this time. Robert F. Harrison John Bonnar William Thompson Dublin 1983.

Male Reproductive Function gives an up-to-date review on the physiology and disease processes associated with the male reproductive system. The first few chapters describe the regulation of the functions of the testis and the integration of its components: germ cells, Sertoli cells and Leydig cells. This is followed by a description of puberty and aging, and the disorders or dysfunction that may be associated with these physiological processes. Discussions on the current methods for the diagnosis and treatment of male hypogonadism, male infertility and male sexual dysfunction follow, with detailed descriptions of types of androgen replacement and the benefits and risks of such treatment. The book concludes with the development of male contraception and the possible influence of the environment on the male reproductive system. Male Reproductive Function represents a conglomeration of the efforts of experts in andrology from all over the world, both in basic cellular/molecular biology as well as in clinical science and practice. This book is suitable for endocrinologists, urologists, general internists, gynecologists and other students in the field of male reproduction.

Proceedings of the 9th International Conference of the International Society for Research in Human Milk and Lactation (ISRHML), October 2-6, 1999, Bavaria, Germany. The quality of infant feeding is of major importance for child health development and well being, and breast feeding is the natural form of supplying food to the infant and is considered to be ideally adapted to the needs of both mother and child. This contributed volume therefore, brings together the research on the physiological foundations and on the biological effects of breast feeding, both short and long term. This book contains the work of scientists from over thirty countries, many of whom are leading researchers in their fields, and details papers presented by the invited speakers of the conference and short summaries of presentations of original research results.

Fetal and perinatal medicine is a rapidly expanding field, and noninvasive imaging by means of ultrasonography and MRI is playing a major role in refining diagnosis and therapy. Recent technological advances in these imaging modalities now allow unprecedented morphological depiction of the fetus and excellent insight into complex pathologic conditions, as well as yielding superior guidance for therapeutic fetal inter ventions. I am very pleased that Professor F. Avni , a leading international pediatric radiologist, was prepared to take on the challenging task of preparing and editing this comprehen sive and up-to-date overview of our knowledge in the area of fetal and perinatal imaging. He has been successful in engaging well-known experts with outstanding qualifications in fetal imaging to join him in this venture. I would like to congratulate Professor Avni and all contributing authors most sincerely for their excellent work. I am confident that this outstanding volume will meet with great interest not only from general as well as specialized pediatric radiologists but also from neonatologists and pediatricians. I trust it will enjoy the same success as many previous volumes in this series. ALBERT L. BAERT Leuven Preface Fetal and perinatal medicine would not have developed without the extensive use of obstetric ultrasound (US). In order to be efficient, the examination has to be performed very carefully and by sonologists fully conversant with the normal and abnormal development of the fetus.

course, also aware that many who use this volume One in every three slides examined by a general diagnostic pathologist in the United Kingdom, and will be well familiar with the classical, or 'textbook', in most other countries, comes from a gynaecological appearances of most of the more common conditions patient. Few pathologists can hope, therefore, to and have therefore often chosen an example which, escape a constant exposure to gynaecological path whilst being typical, is not necessarily classical. ology, and it is the aim of this atlas to lessen the We have deliberately chosen not to include any difficulties of this diagnostic burden by acting as an illustrations of gross specimens. This is partly because illustrated guide to the histological diagnosis of of ou r view that such illustrations are of I ittle real value female genital tract abnormalities. to any but the least experienced of pathologists, and Gynaecological pathology does, however, pose a partly because their inclusion would have narrowed number of specific problems: the range and scope of still further our selection of histological figures.