Since the discovery of LHRH in 1971, research into the physiology and therapeutics of this compound can be divided into three dis tinctly different phases. In the first phase, attention was paid chiefly to the natural sequence hormone; efforts were channeled to explore its diagnostic use; and nearly all the clinical investigations were coordinated by a single pharmaceutical company. The successes in this area were quite limited and the interest in the promise of this agent as a diagnostic test has long since waned. This phase of research con sumed roughly the first seven years of clinical testing after the isolation and characterization of the compound by the two groups involved in the Nobel effort. With the appearance of long-acting LHRH agonists, the second phase of research on LHRH began in the late '70's. LHRH agonists were the only compounds available during this period of research and paradoxical desensitization was the predominant therapeutic basis for the discoveries. An ever-widening number of therapeutic applications using this approach were unearthed. A second theme which emerged during this second 5-7 year period was that the pulsatile administration of the natural sequence LHRH could be used to treat LHRH deficiency in men and women."

This monograph contains a selection of papers presented at the Xlth World Congress of Fertility and Sterility (Dublin, 1983); the central theme is ovarian function and treatment of its disorders. Cross-cultural research provides international congresses with their unique quality due to the world-wide exchange of views; we think this aim has been achieved and reflected in this book. During the past decade significant advances have been made in our understanding of the events surrounding human ovulation leading to the development of an increasing range of effective therapeutic agents and the more logical use of existing drugs. As a result infertile patients with disordered ovulation can now anticipate a more favourable out come. In addition more sophisticated diagnostic methods have revealed the presence of minor defects in ovarian function in some patients previously labelled as 'unexplained infertility'. The identification of such problems can only lead to further therapeutic success. The contents of this volume reflect many different aspects of the study of ovulation including the monitoring of both follicular growth and the luteal phase, the role of prolactin and the treatment of ovulatory dysfunction. We are sure that the wide range of topics will evoke continued interest in these subjects. We extend our thanks to the invited speakers for their excellent contributions in lecture and essay form and express our gratitude for the unfailing help we received from the staff of MTP Press in the preparation of this volume."

The role of prostaglandins in physiological events and pathological disorders related to human reproduction has been most actively investigated in the past decade. Their clinical use for fertility regulation, extensively evaluated, represents the most common clinical indication for the administration of these remarkable compounds. Thus, it is most appropriate to update the available information related to the use of prostaglandins in the regulation of human fertility to provide a background document for the benefit of clinicians and scientists. Invited experts of international reputation from various parts of the world have contributed, each in his own area of interest, to offer this book, which we hope will fill an existing gap. M. T. M. B. E. S. E. H. ix 1 Potential for prostaglandin use in controlling human reproduction K. T. KIRTON and F. A. KIMBALL BACKGROUND It was observed in 1930 that seminal plasma of a number of species contained very large amounts of substance(s) capable of altering uterine motility. These substances were subsequently demonstrated to be prostaglandins (PGs); this began the early and continued association of this group of compounds with reproduction. The activity was found to be associated with a fraction containing lipid-soluble acids, derived from prostanoic acid. Restrictions imposed by obscure sources and small amounts of material available for testing were initially impediments to their study.

These four volumes comprising "GnRH Analogues in Cancer and Human Reproduction" are a distillation of the presentations of the invited speakers at a landmark International Symposium bearing the same name, organized by one of us (B. L. ) and held in Geneva, Switzerland in February 1988. The Symposium was truly interdisciplinary spanning gonadal hormone dependent disease including various forms of cancer and ranging to control of fertility, both pro- and conception. The international flavor can be caught from the 480 participants and 259 contributors drawn from 14 countries. The Symposium, and therefore this book, would not have been possible without the backing of The International Committee for Research in Reproduction and the sponsorship of the International Society of Gynecologic Endocrinology, The Swiss Society of Fertility and Sterility, The University of Geneva School of Medicine, The Swiss Society of Endocrinology and The US Foundation for Studies in Reproduction Inc., and help from the World Health Organization. B. H. Vickery B. Lunenfeld June 1989 LIST OF CONTRIBUTORS TO THE SERIES H. Bartermann A. Abbondante First Institute of Obstetrics and Urologische Universitatsklinik Kiel Gynecology Arnold-Heller Strasse 7 University "La Sapienza" D-2300 Kiel 1, FRG Rome, ltaly M. Bartholomew P. Abel Department of Medicine/Endocrinology Department of Urology Milton S. Hershey Medical Center Hammersmith Hospital Pennsylvania State University DuCane Road PO Box 850, Hershey, PA 17033, USA London W12 OHS, UK D. Beck H.

These four volumes comprlslng "GnRH Analogues in Cancer and Human Reproduction" are a distillation of the presentations of the invited speakers at a landmark International Symposium bearing the same name, organized by one of us (B. L. ) and held in Geneva, Switzerland in February 19B8. The Symposium was truly interdisciplinary spanning gonadal hormone dependent disease including various forms of cancer and ranging to control of fertility, both pro- and conception. The international flavor can be caught from the 480 participants and 259 contributors drawn from 14 countries. The Symposium, and therefore this book, would not have been possible without the backing of The International Committee for Research in Reproduction and the sponsorship of the International Society of Gynecologic Endocrinology, The Swiss Society of Fertility and Sterility, The University of Geneva School of Medicine, The Swiss Society of Endocrinology and The US Foundation for Studies in Reproduction Inc., and help from the World Health Organization. B. H. Vickery B. Lunenfeld June 1989 xiii LIST OF CONTRIBUTORS TO THE SERIES A. Abbondante H. Bartermann First Institute of Obstetrics and Urologische Universitatsklinik Kiel Gynecology Arnold-Heller Strasse 7 University "La Sapienza" 0-2300 Kiel 1, FRG Rome, ltaly M. Bartholomew P. Abel Department of Medicine/Endocrinology Department of Urology Milton S. Hershey Medical Center Pennsylvania State University Hammersmith Hospital DuCane Road PO Box 850, Hershey, PA 17033, USA London W12 OHS, UK D. Beck H.

The image of obstetrics as a largely manipulative art has changed radically in recent years. The risk to a healthy mother of pregnancy and labour has been markedly reduced and morbidity not mortality is the yardstick by which the quality of maternal care is judged. We are now able to devote far more attention to the fetus whose growth patterns and behaviour in utero can be studied in detail by modern and sophisticated technical aids with a resultant improvement in perinatal mortality. A patient with a pre-existing general disease, however, still presents a problem which is best managed by close co-operation between obstetrician and physician. Essential hypertension, diabetes, heart disease, thyroid disease and epilepsy are examples of disorders which require great care throughout pregnancy and during labour if good maternal and fetal results are to be obtained. There are many questions still to be answered. What is the place of hypotensive therapy in essential hypertension complicating pregnancy? When should delivery take place in the pregnant diabetic? How should the patient be delivered? What should be her management during labour? What is the risk of fetal abnormality in the epileptic patient who becomes pregnant whilst on anti-epileptic drugs? These questions and others have been the subject of a recent symposium in the Institute of Obstetrics and Gynaecology.

This birefs examines mortality among young children in the period from the seventeenth to the nineteenth century. It does so using several types and sources of information from the census unit England and Wales, and from Ireland. The sources of information used in this study include memoirs, diaries, poems, church records and numerical accounts. They offer descriptions of the quality of life and child mortality over the three centuries under study. Additional sources for the nineteenth century are two census-derived numerical indexes of the quality of life. They are the VICQUAL index for England and Wales, and the QUALEIRE index for Ireland. Statistical procedures have been applied to the numbers provided by the sources with the aim to identify effects of and associations between such variables as gender, age, and social background. The briefs examines the results to consider the impact of children's deaths upon parents and families, and concludes that there are differences and continuities across the centuries.

A close look at stories of maternal death in Malawi that considers their implications in the broader arena of medical knowledge. By the early twenty-first century, about one woman in twelve could expect to die of a pregnancy or childbirth complication in Malawi. Specific deaths became object lessons. Explanatory stories circulated through hospitals and villages, proliferating among a range of practitioners: nurse-midwives, traditional birth attendants, doctors, epidemiologists, herbalists. Was biology to blame? Economic underdevelopment? Immoral behavior? Tradition? Were the dead themselves at fault? In Partial Stories, Claire L. Wendland considers these explanations for maternal death, showing how they reflect competing visions of the past and shared concerns about social change. Drawing on extended fieldwork, Wendland reveals how efforts to legitimate a single story as the authoritative version can render care more dangerous than it might otherwise be. Historical, biological, technological, ethical, statistical, and political perspectives on death usually circulate in different expert communities and different bodies of literature. Here, Wendland considers them together, illuminating dilemmas of maternity care in contexts of acute change, chronic scarcity, and endemic inequity within Malawi and beyond.

The use of human in vitro fertilization in the management of infertility is the outgrowth of years of laboratory observations on in vitro sperm-egg interaction. "The editors of this work have themselves contributed significantly to basic knowledge of the mammalian fertilization process. The observations of Don Wolf on sperm penetration, the block to polyspermy and, most recently, sperm hyperactivation in the monkey and human, Gregory Kopf's elucidation of the mechanisms of sperm activation during penetration and the reciprocal dialogue between sperm and egg, and Barry Bavister's definition of culture conditions and requirements necessary for in vitro oocyte maturation, fertilization and development in model mammalian systems including nonhuman primates have contributed greatly to our understanding of the mammalian fertilization process. Wolf, Kopf and Gerrity have enjoyed substantial interaction with clinicians in Departments of Obstetrics and Gynecology and have been directly involved with successful IVF programs. Both Wolf and Kopf have served as research scientists in the Division of Reproductive Biology at the University of Pennsylvania, which, for more than 22 years, has fostered co-mingling of clinically oriented and basic science faculty. It is through such interaction, which clearly exists at many institutions including the University of Wisconsin, that the process of technology transfer is best served. Without an exquisitely coordinated laboratory, there can be no consistent success in human in vitro fertilization. Quality control is pivotal, but close collaboration between the laboratory and the clinic is also essential as information is shared and correlated.

Atrophy of gonadotrophin producing cells Exogenously LH synthesis administered androgens and release or anabolic steroids are decreased Prostate Testes Normal function. Testosterone synthesis in The deficit of endogenously Leydig cells is decreased. The synthesized testosterone is exogenously administered compensated for by the steroid is not able to exogenously administered compensate for the deficit of steroid endogenously synthesized testosterone Figure 2 Intratesticular and serum testosterone concentrations after treatment with andro gens or anabolic steroids in order to substitute for the peripheral androgen deficiency and to achieve azoospermia. Because this steroid is alkylated in position 17, toxic effects on liver function can not be excluded. Danazol offers no advantages as compared with other anabolic steroids; rather, disadvantages. Numerous experiments of this type have been performed during the last 40 or 50 years. The outcome in each case was more or less identical: with a certain dose of an androgen or anabolic steroid it is possible to inhibit spermatogenesis without interfering with other androgen-dependent func tions, including libido (potentia coeundi) and accessory sexual glands. On the basis of this pharmacological-endocrinological background, androgens and anabolic steroids can be used for male fertility control, and several clinical trials have been performed during the last 10-15 years. Some of 1 these studies 2-23 are mentioned in Table 2."

Infectious diseases remain a major problem for physicians and other health professionals dealing with problems of the reproductive system. Accordingly, this two-volume comprehensive presentation of infectious diseases involving the male and female reproductive systems promises to be a major contribution in this field and to fill a much-needed vacuum. During the past three decades, the introduction of antimicrobial therapy has dramatically altered both the clinical presentation and the therapeutic approaches employed in dealing with the traditional infections of the repro ductive system. In addition, the changing demographics of infectious problems in the industrial countries and the developing world have been a source of concern. A good deal of important information on this topic is included in this series. In recent years, considerable attention has been given to the role of Myco plasma and Chlamydia in both male and female infertility and the problems related to genital herpes and human papilloma virus infections. Current clinical information is included on these infections as well as on newer aspects of diagnosis, such as the use of laparoscopy in the diagnosis and treatment of pelvic inflammatory disease. Also addressed is new information regarding the role of actinomycosis in pelvic infections; current problems such as toxic shock syndrome and acquired immune deficiency syndrome (AIDS) are reviewed as well. New concepts are included in these volumes to complement the clinical information. The attachment of microbial organisms to sperm may help to explain access of these and other organisms to the upper female genital tract."