Current Women's Health Reviews - Volume 4, Issue 2, 2008

WHO definition of reproductive health reads: “Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.” “Implicit in this are the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.” A vast majority of articles of CWHR addresses subjects aiming at the improvement of reproductive health worldwide. The term healthy infant also has a broad significance. It implies not only a child that survives the process of pregnancy but also that he/she is healthy and does not suffer any intrauterine damage that could impair her/his future life and development. Many studies in the last half of the past century have shown the effect of maternal undernutrition on fetal growth and the consequences of intrauterine growth restriction (IUGR). In this context, maternal chronic undernutrition was linked with fetal chronic malnutrition characterized by newborns having both low weight and height. This is the category of IUGR having the greatest impairment in long term physical and intellectual development and the pattern most frequently found in developing countries. As a consequence, these girls having a chronic IUGR when becoming pregnant, will start their pregnancy with a lower weight and height having a greater chance of delivering a chronic IUGR involving a vicious circle of poor development. Most recent epidemiological studies have shown that children suffering impairment in their intrauterine life show an increase in the frequency of several diseases in adult life like hypertension and diabetes. These observations show how important fetal life is and the need to guarantee that women reach their pregnancy with the best physical, and psychological conditions and that the health system can provide them the best care to attain a healthy newborn that will have the higher potential of physical, health and intellectual development in her/his life span.

The endeavor to cryopreserve gonadal tissues and gametes in young patients who must undergo severe systemic anti-cancer treatment is entirely focused on the possibility of preserving their fertility potential. In this Review we deal with the development of ovarian tissue cryopreservation and the efforts to optimise the number of variables that appeared to affect frozen tissue survival, particularly the type and the concentration of the cryoprotectants that can best preserve the tissue integrity. We will discuss firstly the need to avoid both freezing and osmotic injury in cryopreserved tissues, secondly the question as to whether it is more useful to preserve follicles or whole ovarian tissue, and finally experiences in the animal model and in human tissues. The clinical application of these procedures are the ultimate focus of the whole discussion: what to do once a patient's disease is cured and a patient considers reproduction? The clinicians considerations as to whether an auto-graft to the patient or engraft to immunologically nude animals, or indeed an attempt to develop an oocyte to maturity in vitro? Currently, only autografting techniques are able to lead to the resumption of both follicular growth and endogenous hormone production and even to a small number of pregnancies, either spontaneous or IVF-induced. Finally, we review our past experiences of ovarian tissue cryopreservation, from the choice of propanediol as the best cryoprotectant to the choice of the protein support which best assists tissue cryopreservation, and the recent experiences on long-term cultures of follicles from primordial to antral stage.

Epithelial ovarian cancer is the leading cause of death from female genital malignancies, with more than half of the patients diagnosed at an advanced stage of the disease. E-cadherin ant the catenins play key roles in cell adhesion and motility. Little is known about the changes in expression of these molecules in the progression of ovarian carcinomas. This minireview summarizes our results obtained concerning the immunoexpression pattern of the cell adhesion complex E-cadherin, alpha, beta and gamma catenins in 154 Epithelial Ovarian Tumours and its association with clinicopathological features and patients'survival. The biological behaviour of the tumour varied according to the immunohistochemical expression of the proteins Ecadherin and β-catenin. Reduced β-catenin expression associated with aggressive clinicopathological features, whereas the absence of E-cadherin or β-catenin associated with poor patient prognosis. When the E-cadherin-catenin complex was examined in these tumours, severed intermolecular protein interactions were observed, demonstrating that the adhesive function of E-cadherin depends on the integrity of the entire structure. Conclusion: Our results demonstrate that alterations of E-cadherin and beta catenin play a role in epithelial ovarian cancer. Also, the observation that negative β-catenin expression associated with poor patient prognosis and was observed in early stage tumours, suggests that beta catenin may be a useful prognostic marker for the clinical assessment of epithelial ovarian cancer.

The mucosal immune system in the upper female reproductive tract is uniquely prepared to maintain a balance between the presence of commensal bacteria, sexually transmitted bacterial and viral pathogens, allogeneic spermatozoa, and an immunologically distinct fetus. At the center of this dynamic system are the epithelial cells that line the Fallopian tubes, uterus, cervix and vagina. Epithelial cells provide a first line of defense that confers continuous protection, by providing a physical barrier as well as secretions containing bactericidal and virucidal agents. In addition to maintaining a state of ongoing protection, these cells have evolved to respond to pathogens, in part through Toll-like receptors (TLRs), to enhance innate immune protection and, when necessary, to contribute to the initiation of an adaptive immune response. Against this backdrop, epithelial cell innate and adaptive immune function is modulated to meet the constraints of procreation. The overall goal of this review is to focus on the dynamic role of epithelial cells in the upper reproductive tract, with special emphasis on the uterus, to define the unique properties of these cells as they maintain homeostasis in preparation for successful fertilization and pregnancy while at the same time confer protection against sexually transmitted infections, which threaten to compromise women's reproductive health and survival. By understanding the nature of this protection and the ways in which innate and adaptive immunity are regulated by sex hormones, these studies provide the opportunity to contribute to the foundation of information essential for ensuring reproductive health.

Sexual transmission is the main route for Human Immunodeficiency Virus (HIV) spreading throughout the world. Heterosexual transmission of HIV is the predominant transmission modality among adults worldwide, while mother-to-child transmission accounts for the majority of HIV infections in children. Factors that affect genital tract shedding of the HIV virus or cell-associated provirus in women are probably important determinants of infectiveness, and hence of transmission risk during sexual contact or delivery. Cervical inflammation and genital ulcers have been associated with HIV shedding in the female genital tract. In fact, both ulcerative sexually transmitted infections (syphilis, chancroid and herpes) and non-ulcerative sexually transmitted infections (gonorrea and chlamydia) have been associated with high rates of transmission and acquisition of HIV. Bacterial vaginosis are associated with an increased prevalence of HIV1-RNA detection in cervicovaginal secretions. Although HIV infection is a well-known risk factor for cervical intraepithelial neoplasia (CIN), the influence of CIN on cervical shedding of HIV is poorly understood. Preliminary data suggest that CIN lesions represent a significant risk factor for genital HIV spreading. Additional factors associated with increased prevalence of HIV1-RNA detection are: advanced stage of the disease, hormonal contraceptive use, cervical ectopy, vitamin A deficiency, cervicitis and vulvovaginal candidiasis. In contrast to the lower female genital tract, the male genital tract is inaccessible to simple direct sampling. Poor detection and quantification of the HIV-1 virus in the semen have largely limited our knowledge of HIV infectivity in men. Symtomatic and asymptomatic urethritis are important cofactors for HIV shedding in the semen, suggesting that local genital tract infection are important determinants of HIV level in semen. Finally, the presence of HIV-RNA in blood strongly correlates with the detection of HIV-related nucleic acids in genital secretions but the shedding of HIV in the genital tract can occur in 20-30% of non-viremic subjects.

A woman with a growth restricted fetus should be surveyed appropriately and delivered at an optimal time. Pub Med and Cochrane databases have been used and searched for literature on fetal biophysical profile (BPP), cardiotocography (CTG), non-stress test (NST), contraction stress-test (CST) as well as Doppler investigation and indications for delivery. Surveillance of women with IUGR can include BPP, NST and appropriate Doppler blood flow examinations of umbilical arteries and different fetal vessels according to history. Timing of delivery depends on gestational age, degree of IUGR, progression of fetal detoriation, BPP, the NST pattern, the CST response, or fetal Doppler PI (arterial and venous); the indication for delivery must be decided individually. Delivery is indicated in IUGR near term with poor growth over a 2-4 week period, or associated severe maternal preeclampsia. The timing in preterm delivery is controversial. It may be difficult to decide on delivery when the gestational age is less than 32 weeks. If enddiastolic flow is present in UA Doppler flow, and other surveillance findings are normal, the pregnancy may be prolonged. Attempts to temporize intervention appear justified between 25 and 29 weeks' gestation because each day in utero may reduce neonatal mortality by 1-2 %.

Infusion of sterile saline solution into the amniotic cavity has been used to increase the volume of intrauterine fluid or to dilute potentially damaging substances in the fluid. Regarding the route of administration, amnioinfusion can be done transabdominally or transcervically, and with regard to the timing of the procedure, it can be performed before labor or during labor. The present review updates our knowledge of transcervical intrapartum amnioinfusion. Although this therapeutic procedure is widely known and used, it is currently considered controversial for certain indications. Its use is disputed for gestations with oligohydramnios and ruptured or intact membranes to reduce potential umbilical cord compression, for labor with a preterm fetus and ruptured membranes, and for meconium-stained amniotic fluid to reduce complications that can arise from aspiration of fecal matter into the fetal tracheobronchial tree. An exhaustive analysis of the literature shows that the procedure is useful for reducing the rate of operative deliveries and ensuring appropriate metabolic status of the fetus upon delivery.

Vitamins are obligatory nutrients to the developing fetus, these compounds being obtained from the maternal blood through placental transport. The strict importance of vitamins to fetal and pregnancy health is the motor for the current and emerging research on the molecular mechanisms of placental vitamin transport. This mini-review summarizes recent findings concerning the placental transport of the B-vitamins folate and thiamine.