Endorphins and other endogenous opioids appear to be the connecting link between reproductive functions and stress adaption of the human organism. This book contains the con- tributions of an international group of biologists, bioche- mists, and endocrinologists on the opioidergic control me- chanisms in reproduction and stress physiology. Main topics covered are: endogeneous opioids and the pituitary-gonadal system; ovarian endorphinsecretion; pregnancy-associated changes of plasma endorphin; and opioid control of the hypo- thalamo-pituitary-adrenal axis. Although all chapters give an excellent review on various studies in basic opioid re- search, there are numerous clinical implications mentioned in this book.

Doppler ultrasound is a hot topic at the present time. This is because studies of the uteroplacental and fetal circulation give fundamental information as to the physiology or pathology of placental function and the response of the fetal circulation to hypoxaemia. Dr. Arabin's clinical studies which are described in this book are an important contribution to knowledge in this field and will be of enormous interest not only to researches but also to clini cians interested in learning how this latest technology can be integrated into their clinical practice. London STUART CAMPBELL Foreword Although only three decades old, the field of perinatal medicine is marked by continuous new advances. Ultrasound diagnostic techniques comprise an important element of this new field. Dr. Arabin has taken the initiative to investigate the functional-diagnostic aspects of ultrasound. Among other things, she has further developed and refined the concept of "oxygen-con serving adaptation of fetal circulation" which originated in the Department of Obstetrics and Gynecology at the Neukolln Hospital Center in 1966. She thus has been able to show that the most reliable Doppler blood flow meas urement predictors of a high risk to the fetus are (1) a decrease in the flow volume of the descending thoracic aorta and the umbilical artery and (2) an increase in the flow volume of the common carotid arteries."

During the past 20 years, endometrial carcinoma has continued to increase in frequency and it is quite possible that this carcinoma will become the major gynecologic malignancy in the future. For many years, endometrial carcinoma was considered less malignant than other gynecologic malignancies, simple hysterectomy and bil ateral salpingo-oophorectomy or surgery combined with radiation being effective in certain circumstances. It is unfortunate to note that the global 5-year survival rate for patients with advanced or recurrent endometrial carcinoma has improved only slightly. Therefore any complacency regarding this 'benign malignancy' should be reconsidered. There is a growing awareness of the nature of end ometrial carcinoma, with advances in our knowledge ranging from its etiology through its epidemiology to its clinical findings. This volume has been designed to fill a hiatus in the literature in China. To achieve this aim, we have attempted to review the world-wide advances on endometrial carcinoma and summarize systematically and comprehensively this common gynecologic malig nancy, including the clinical experiences gathered at the Cancer Institute (Hospital) of the Chinese Academy of Medical Sciences since 1958 as well as a brief description of the psychological problems in patients with gyneco logic cancers."

The advent of ultrasound scans has made it possible to observe the fetus undisturbed in its natural surroundings. In this remarkable book, Dr Alessandra Piontelli describes in moving detail her observations of the behaviour of several children from very early stages in the womb, through birth, to infancy and childhood. By drawing on her experiences as a child psychotherapist and psychoanalyst as well as on her observational research, she is able to investigate issues relating to individuality, psychological birth and the influence of maternal emotions during pregnancy.
The first study of its kind, From Fetus to Child shows how observational and psychoanalytic data can offer different but complementary insights in attempting to answer fundamental questions about human development.

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The Project on Reproductive Laws for the 1990s began in 1985 with the realization that reports of scientific developments and new technologies were stimulating debates and discussions among bioethicists and policymakers, and that women had little part in those discussions either as participants or as a group with interests to be considered. With the help of a planning grant from the Rutgers University Institute for Research on Women, the Women's Rights Litigation Clinic at Rutgers University Law School-Newark held a planning meeting that June attended by approximately 20 theorists and activists in the area of reproductive rights. Project purposes, methods, and general shape took form at the meeting. Two goals have characterized the Project's work since then: first, to generate discussion, debate, and, where possible, consensus among those committed to reproductive autonomy and gender equality as to how best to respond to the questions raised by re ported advances in reproductive and neonatal technology and new modes of reproduction; and second, to ensure that those shaping reproductive law and policy appreciate the ramifications of these developments for gender equality. In meeting this twofold agenda, the Project focused on six areas: time limits on abortion; prenatal screening; fetus as patient; reproductive hazards in the workplace; interference with reproductive choice; and alternative modes of reproduction. The Project identified individuals to take respon sibility for drafting model legislation and position papers in the six areas (for the drafters, see the Appendix)."

A cutting-edge analysis of the global issues surrounding modern reproductive technologies Advances in assisted reproductive technologies have sparked global policy debates since the birth of the first so-called "test tube baby" in 1978. Today, mitochondrial replacement therapies represent the most recent advancement in assisted reproductive technologies, allowing some women with mitochondrial diseases to birth babies without those diseases. In the past decade, mitochondrial replacement therapies have captured public sentiment, reigniting debates around social views of reproductive rights and the appropriate legal and political response. Reproduction Reborn guides readers through the history and science of mitochondrial replacement therapies and the various attempts to control them. Leading experts from medicine, genetics, ethics, law, and policy explore the influence of public debate on the evolving shape of these technologies and their subsequent regulation. They highlight case studies from both developed and developing countries across the globe, including recent legislation in Australia and China. They further identify the ethical, legal, and societal norms that need to be addressed by policymakers and communities as more and more people seek to gain access to these treatments. Given the importance of reproduction in family life and cultural identity, clinicians and policymakers must understand how regulatory regimes around mitochondrial replacement therapies have evolved to illuminate the processes and challenges of governing reproduction in a fast-moving world. Informative and global in scope, Reproduction Reborn explores how advancements in assisted reproductive technologies challenge core values surrounding the rights and responsibilities of modern-day family units.

In 1953, at the grand age of 92, Ferdinand Hochstetter submitted his famous collection of photographs of human embryos entitled: "Uber die Entwicklung der Formverhaltnisse des menschlichen Antlitzes." Together with others papers, this contribution was published in 1955, a year after Hochstetter's death. In unbroken combativeness, Hochstetter discussed his results with regard to those of earlier embryologists and to those of his own lifetime. Thus, in an obituary, Elze (1956) reported about one of Hochstetter's letters from the year of his death (1954): "nur einige blodsinnige Behauptungen, die Fischel in seiner Ent- wicklung des Menschen verzapft hat, mochte ich vielleicht noch annageln," which may be translated as: "I would just like to pin down a few silly assertions that Fischel made in his Entwicklung des Menschen." In the first two paragraphs of his paper Hochstetter stated (in German, here translated freely): When I decided to write a detailed paper about the development of the morphology of the human face, too [in addition to a paper about morphology of the extremities in human embryos], I was especially moved by the fact that in none of the German manuals and textbooks on embryology known to me is there to be found a presentation of the development of the human face which could be considered - eveJ;l to a limited extent - rich in details, true, sufficiently illustrated, easy to understand by students as well as by scien-

Everyone involved in obstetric practice at the present time will be well aware oft he complexities of drug interactions in the mother and fetus, and newborn infant. Perhaps the most spectacular manifestations of these drug interactions are those that result in teratogenic effects, but the implications of drug therapy generally in pregnancy range far wider than the hazards of inducing fetal malformation. It must also be realised that there are hazards in withholding some therapeutic agents from pregnant women, and these hazards have to be weighed against the dangers of indiscriminate drug therapy. It is often very difficult to obtain relevant information about any given compound in relation to its use in pregnancy, and it is therefore appropriate to provide a handbook which brings together information about a wide variety of drugs in a form which allows ready access for the practising clinician. Rodney Ledward first discussed this project with me some years ago, and it seemed to me at the time that with his background as both a pharmaceutical chemist and an obstetrician that his talents were particularly well suited to this task. In conjunction with Professor Hawkins, he has produced a concise reference book for use in clinical practice, which I feel confident will prove to be invaluable to all those practising obstetrics at all levels of seniority. The book covers the use of drugs during pregnancy, but it also includes sections on the transfer of drugs into breast milk.

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss Itthem ": the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by of women is neither sought nor listened to. The men. So often the input and perspectives that women bring to the privileged insights consideration of technologies in human reproduction are the subject of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by W omen" (EIR TAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts. Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some.

Women most fully experience the consequences of human reproductive technologies. Men who convene to evaluate such technologies discuss "them": the women who must accept, avoid, or even resist these technologies; the women who consume technologies they did not devise; the women who are the objects of policies made by men. So often the input of women is neither sought nor listened to. The privileged insights and perspectives that women bring to the consideration of technologies in human reproduction are the subject of these volumes, which constitute the revised and edited record of a Workshop on "Ethical Issues in Human Reproduction Technology: Analysis by Women" (EIRTAW), held in June, 1979, at Hampshire College in Amherst, Massachusetts. Some 80 members of the workshop, 90 percent of them women (from 24 states), represented diverse occupations and personal histories, different races and classes, varied political commitments. They included doctors, nurses, and scientists, lay midwives, consumer advocates, historians, and sociologists, lawyers, policy analysts, and ethicists. Each session, however, made plain that ethics is an everyday concern for women in general, as well as an academic profession for some.

The rapid development of reproductive technologies has questioned many essential concepts belonging to our symbolic universe, such as human reproduction, motherhood and fatherhood; the transmission of the biological and cultural inheritance of mankind and the constitution of the psychic subject. These concepts, however, are supported by ideologies and value systems which hide that they are but theoretical constructions; consequently, they are taken as describing the "natural" function of reproduction. In this sense, the technological development takes the form of an increasing medicalization of the human body, of the life, sexuality and desire of people, especially of women. All this requires that we think critically about the conditions of possibility of these technologies and their psychological and ethical implications. In this book the author provides a detailed and rigorous analysis which locates the reproductive technologies in the historical context of the progressive technification of the management of human life, and their relation to the social and medical discourses on femininity, maternity and infertility. From a psychoanalytic point of view, culture and its discontents, violence, domination, are related intimately to the problematic character of sexuality, which includes the uncertainties of our desires. Social, medical, anthropological and literary discourses try to define "maternal desire" in order to control it: the definitions which capture it in their nets are means to dominate desire as an object and to "construct" the desiring subject. But psychoanalysis (through the associations of the subjects in question) shows that we face here an impossible question: one thing is the enunciated "demand", what is said about one's own desire ("I want a child"), and a very different one is the unconscious desire which disturbs the conscious discourse and shows that there can be psychological obstacles that interfere with the accomplishment of conscious wishes, conflicts and contradictions emerging through the women's words. In this book, the circulation of representations between the individual imaginary and collective myths is the basis of a multidisciplinary complex and original point of view, which confronts a variety of discourses arising from psychoanalysis, medicine, journalism, ethnology, mythology and literature.

While the practice of surrogacy has existed for millennia, new fertility technologies have allowed women to act as gestational surrogates, carrying children that are not genetically their own. While some women volunteer to act as gestational surrogates for friends or family members, others get paid for performing this service. The first ethnographic study of gestational surrogacy in the United States, Labor of Love examines the conflicted attitudes that emerge when the ostensibly priceless act of bringing a child into the world becomes a paid occupation. Heather Jacobson interviews not only surrogate mothers, but also their family members, the intended parents who employ surrogates, and the various professionals who work to facilitate the process. Seeking to understand how gestational surrogates perceive their vocation, she discovers that many regard surrogacy as a calling, but are reluctant to describe it as a job. In the process, Jacobson dissects the complex set of social attitudes underlying this resistance toward conceiving of pregnancy as a form of employment. Through her extensive field research, Jacobson gives readers a firsthand look at the many challenges faced by gestational surrogates, who deal with complicated medical procedures, delicate work-family balances, and tricky social dynamics. Yet Labor of Love also demonstrates the extent to which advances in reproductive technology are affecting all Americans, changing how we think about maternity, family, and the labor involved in giving birth.

This comprehensive text makes an important contribution to the study of surrogacy, developing a novel theoretical framework through which to understand the broader social contexts as well as individual decisions at play within surrogacy arrangements. Drawing on empirical research conducted by the authors and supplemented by secondary analyses of media, legislative and public accounts of surrogacy, the book engages with the key stakeholders involved in the practice of surrogacy. Specifically, it canvases the standpoints of women who act as surrogates, intending parents who commission surrogacy arrangements, children born through surrogacy, clinics that facilitate the arrangements, and politicians and journalists who engage with the topic. Through a focus on capitalism as a means of orientating ourselves to the topic of surrogacy, the book highlights the vulnerabilities that potentially arise in the context of surrogacy, as well as the claims to agency invoked by some parties in order to mitigate vulnerability. In so doing, the book demonstrates that the psychology of surrogacy must be broadly understood as an orientation to particular ways of thinking about children, reproduction and economies of labour.

Assisted Reproduction is a specialty undergoing rapid change as new technologies are introduced and new research challenges previous treatment options. This text examines a selection of controversial topics for both laboratory and clinical practice and tries to place them in perspective, so readers can understand how and why the current state of the question has come about and how future contributions to the debate should be measured. All physicians involved with the technologies concerned will learn from the expert contributions assembled here. CONTENTS: The use of ovarian markers * Use of molecular markers of endometrial receptivity * Use of GnRHa for triggering final oocyte maturation during ovarian stimulation cycles * Use of time-lapse embryo imaging in assisted reproductive technology practice * Use of cryopreservation for all embryos * Preimplantation genetic screening * The use of single embryo transfer * Use of luteal phase support * Measuring safety and efficiency in in vitro fertilization * To flush follicles during egg collection or not * Use of blastocyst culture * Use of mitochondrial donation * Controversies in recurrent implantation failure: From theory to practice * Fibroids: To remove or not? * Limitations of endometrioma surgery in in vitro fertilization: Possibilities of early disease control

Major advances in genetics, immunology, and endocrinology have necessitated a new edition of this best-selling text. However, despite the advances, recurrent pregnancy loss presents a frustrating clinical problem. There is still disagreement about the number of pregnancy losses which warrant investigation and treatment and about which investigations should be performed. This third edition provides an authoritative and comprehensive update on advances in the understanding and management of this troubling phenomenon, covering both basic scientific topics such as genetics and cytokines, and profiles major advances in immunology, endocrinology, and thrombotic mechanism. Clinical research is discussed, as is assessment of results when applying an evidence-based approach or a more personalised approach, which is now becoming possible due to advances in the diagnosis of cause. There are lively debates on the role of progestogens and immunotherapy, which remain controversial. Designed for specialists working in reproductive medicine clinics and those involved with maternal-fetal care, the book is also ideal for generalists and gynecologists seeking a comprehensive view of developments in the field.

Mammalian Endocrinology and Male Reproductive Biology provides comprehensive and current coverage of the area of endocrinology and male reproductive biology, covering not just humans, but mammals in general. Written by international experts in their respective fields, this multi-author book also covers the latest developments in genomics of androgen action and male infertility. The book begins by covering sexual dimorphism in the central nervous system; structure, control of secretion and function of GnRH; and gonadotropins of pituitary origin and their role in gonadal functions. This is followed by an account of hormonal regulation of spermatogenesis, and the role of apoptosis in this process. Subsequent chapters center around epididymis, regulation of growth and function, and sperm motility regulation. The last chapters in the book discuss the structure and function of male accessory sex glands with associated pathologies as well as recent updates in male contraception, mechanism of androgen action, and genomics of male infertility. Wherever necessary, tables and figures have been added for a better understanding. Each chapter is appropriately referenced and contains current information on the latest developments in the field.

Although there are far more opportunities for LGBTQ people to become parents than there were before the 1990s, attention to the reproductive challenges LGBTQ families face has not kept pace. Reproductive Losses considers LGBTQ people's experiences with miscarriage, stillbirth, failed adoptions, infertility, and sterility. Drawing on Craven's training as a feminist anthropologist and her experiences as a queer parent who has experienced loss, Reproductive Losses includes detailed stories drawn from over fifty interviews with LGBTQ people (including those who carried pregnancies, non-gestational and adoptive parents, and families from a broad range of racial/ethnic, socio-economic, and religious backgrounds) to consider how they experience loss, grief, and mourning. The book includes productive suggestions and personal narratives of resiliency, commemorative strategies, and communal support, while also acknowledging the adversity many LGBTQ people face as they attempt to form families and the heteronormativity of support resources for those who have experienced reproductive loss. This is essential reading for scholars and professionals interested in LGBTQ health and family, and for individuals in LGBTQ communities who have experienced loss and those who support them. See additional material on the companion website: www.lgbtqreproductiveloss.org/

Reproductive medicine has been very successful at developing new therapies in recent years and people having difficulties conceiving have more options available to them than ever before. These developments have led to a new institutional landscape emerging and this innovative volume explores how health and social structures are being developed and reconfigured to take into account the increased use of assisted reproductive technologies, such as IVF treatments. Using Sweden as a central case study, it explores how the process of institutionalizing new assisted reproductive technologies includes regulatory agencies, ethical committees, political bodies and discourses, scientific communities, patient and activists groups, and entrepreneurial activities in the existing clinics and new entrants to the industry. It draws on new theoretical developments in institutional theory and outlines how health innovations are always embedded in social relations including ethical, political, and financial concerns. This book will be of interest to advanced students and academics in health management, science and technology studies, the sociology of health and illness and organisational theory.

"Non-Invasive Sperm Selection for In Vitro Fertilization" summarizes and discusses the relevant literature on the various advanced sperm selection methods used in modern Assisted Reproductive Technologies (ART). Chapters review some of the major unresolved issues in the field, the feasibility and success of the various sperm selection methods, their safety and the effects they have on sperm quality and ART outcomes. The book makes recommendations on clinical applications and future research, while helping to elucidate the benefits and promise of non-invasive sperm selection techniques. A distinguished team of scientists, embryologists, and urologists, with expertise in male infertility and ART, contributes to this original and valuable reference guide meant for academics, researchers, and professionals in the field of reproductive medicine who need an update on the current status of the study and practice of non-invasive sperm selection techniques.

Epigenetics is the study of how certain genes are activated without modification at the DNA sequence level, resulting in genetically similar individuals having different clinical outcomes. As contemporary medicine increasingly aims to personalize the medical approach to a patient's genetic profile, the factors that can affect which genes are expressed also increase in importance and relevance to the clinician. This text from experts will give the clinician in Reproductive Medicine a reliable grounding in current thinking and research on this fast-moving topic, with many clinical implications.

In recent years increasing numbers of women from wealthy countries have turned to egg donation, egg freezing, and in vitro fertilization to become pregnant, especially later in life. This trend has created new ways of using, exchanging, and understanding oocytes-the reproductive cells specific to women. In The Oocyte Economy Catherine Waldby draws on 130 interviews---with scientists, clinicians, and women who have either donated or frozen their oocytes or received those of another woman---to trace how the history of human oocytes' perceived value intersects with the biological and social life of women. Demonstrating how oocytes have come to be understood as discrete and scarce biomedical objects open to valuation, management, and exchange, Waldby examines the global market for oocytes and the power dynamics between recipients and the often younger and poorer donors. With this exploration of the oocyte economy and its contemporary biopolitical significance, Waldby rethinks the relationship between fertility, gendered experience, and biomedical innovation.

"In 1968, a popular writer ranked the pill's importance with the discovery of fire and the developments of tool-making, hunting, agriculture, urbanism, scientific medicine, and nuclear energy. Twenty-five years later, the leading British weekly, the "Economist," listed the pill as one of the seven wonders of the modern world. The image of the oral contraceptive as revolutionary persists in popular culture, yet the nature of the changes it supposedly brought about has not been fully investigated. After more than thirty-five years on the market, the role of the pill is due for a thorough examination."--from the Introduction

In this fresh look at the pill's cultural and medical history, Elizabeth Siegel Watkins re-examines the scientific and ideological forces that led to its development, the part women played in debates over its application, and the role of the media, medical profession, and pharmaceutical industry in deciding issues of its safety and meaning. Her study helps us not only to understand the contraceptive revolution as such but also to appreciate the misinterpretations that surround it.

Reproductive health care professionals in fields such as Obstetrics and Gynecology, Family Medicine, and Pediatrics face difficult ethical issues because they work at the crossroads of patient decision-making, scientific advancement, political controversy, legal regulation, and profound moral considerations. The dilemmas these professionals face expose big-picture bioethics questions of interest to everyone. Yet for clinicians striving to deliver excellent patient care, the ethical questions that make daily practice challenging can be just as nuanced. This volume presents a carefully curated compilation of essays written by leading experts in the fields of medicine, ethics, and law, who address key issues at the forefront of reproductive ethics. It is organized into three main sections: I. Contraception and Abortion Ethics - Preventing Pregnancy and Birth, II. Assisted Reproduction Ethics - Initiating Pregnancy, and III. Obstetric Ethics - Managing Pregnancy and Delivery. Each section begins with a short introduction by the editors providing an overview of the area and contextualizing the essays that follow. This volume's primary aim is to be useful to practicing clinicians, students, and trainees by providing short and practical essays covering urgent topics-from race, religion and abortion, to legal liability, violations of confidentiality and maternal choices that risk future children's health. This collection provides clinicians at all levels of training with frameworks they need to approach the intimate and high-stakes encounters central to their profession.

Am I the Reason I'm Not Getting Pregnant? gets women struggling with infertility ready to unleash unshakable confidence and certainty on the road to motherhood. Am I the Reason I'm Not Getting Pregnant? reveals the secret to trading that fear for the unwavering confidence and certainty that women are truly doing everything they can. Rosanne Austin is the coach women around the world turn to when they want success on their fertility journey. In Am I the Reason I'm Not Getting Pregnant? Rosanne shares: The genius hack for getting back on the road to fertility success, regardless of age, past "failures," and scary statistics The secret to making fertility decisions like an expert, so women improve their chances of getting pregnant immediately and don't waste time or resources How to create the perfect Bump Squad, so women can finally get the support they really want - even from people they think won't "get" it What it takes to crush fear, doubt, negativity, and spinning in "what-ifs", so women don't wreck their results or set themselves up for soul-searing regret Daily practices that empower women to never have to utter the words, "What should I do," ever again