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How can one go about empowering patients with information in developing countries which have limited resources ? A free public health library can provide information directly to patients, and encourage them to make their own decisions, in partnership with their doctor. It can also serve as a resource center for doctors, who can use it to develop their own patient educational materials.

IVF and related assisted reproductive technologies (ART) offer great hope to infertile couples the world over. Because these techniques are so expensive, however, they are out of the reach of the vast majority of couples, and especially those in the developing world. This is because IVF programmes are too technology-intensive at present - anything which is complicated is bound to be expensive.

If you need treatment for fibroids, there are a number of options available to you. Your choices should be guided by the medical problems the fibroids are causing, your desire to have children, and your feelings and thoughts about surgery or other options. I think it is important for you to know all the options available.

Throughout history, menstruation has been associated with myth and superstition. Menstrual blood was felt to cure leprosy, warts, birthmarks, gout, worms and epilepsy. It has been used to ward off demons and evil spirits. Menstruating women have been separated from their tribes in order to prevent a bad influence on the crops or the hunt. As recently as 1930, the cause of abnormal menstrual bleeding was felt to be an undue exposure to cold or wet just prior to the beginning of the period.

Pelvic pain Menopause PMS Infertility Recurrent Pregnancy Loss Prolactin Polycystic Ovaries Pelvic SurgeryEndometriosis Fibroids Reversal of Tubal Ligation Ectopic Pregnancy Multiple Gestation Endometrial Polyps Preimplantation Genetic Diagnosis (PGD)

The purpose of this proposal is to outline suggested clinical pathways for the management of infertility and common reproductive endocrinology problems. The goal is to create an approach that provides the greatest success while using limited resources in the most cost-effective fashion.

A fact that makes reproductive medicine unique is a specific and quantifiable end point- a healthy baby. Each infertile couple and each and every assisted reproduction technology (ART) program are vitally interested in success rates. The stakes are high. Truly, success breeds success.

Polycystic ovary syndrome is characterized by enlarged ovaries, multiple peripherally arranged cysts and increased stromal density(1). Polycystic ovary syndrome is responsible for approximately 25-30% of infertility in women, which is mainly anovulatory(2). Ovulation can be induced with antiesterogens in many women but a proportion fail to respond and even in those who ovulate, the pregnancy rate is often low and the miscarriage rate is high.

Pregnancy loss is a frustrating and challenging problem for couples and clinicians alike. Although medical textbooks specifically target the recommended "work-up" towards those patients labeled as "recurrent" or "habitual aborters", it is important, in this author's opinion, to consider certain specific aspects of evaluation after any miscarriage.

In women with severe clomiphene-resistant PCOS, we proposed thatthe insulin-lowering agent troglitazone (Rezulin®) could have a positive impact on the ovarian microenvironment by supporting normal follicular growth, ovulation, and successful pregnancy.

Researchers have been investigating the role of various genes which may play an important role in PCOS. One of these candidate genes appears to be in the area and possibly in the insulin receptor gene of chromosome 19.

One of the most publicized papers of the 1999 American Society of Reproductive Medicine/ Canadian Fertility and Andrology Society was the research presented by Dr. Oktay, Dr. Karkujaya, Dr. Gosden and Dr. Schwartz from Cornell University in New York and and from the University of Leeds in the UK. They successfully auto-transplanted frozen-banked ovarian tissue and demonstrated the resumption of ovarian function.

Ectopic pregnancy, or preembryo implantation outside the endometrial cavity (i.e., fallopian tube, cervix, abdominal or pelvic cavity), is a potentially fatal condition with an incidence of 1:150 diagnosed pregnancies.

Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche (primary amenorrhea) or premature depletion of ovarian follicles before the age of 40 years (secondary amenorrhea).

Stein and Leventhal were the first to recognize an association between the presence of polycystic ovaries and signs of hirsutism, amenorrhea, oligomenorrhea and obesity. Subsequently, it was reported that after successful wedge resection of the ovaries in women diagnosed with Stein-Leventhal syndrome, menstrual cycles became regular and these patients were able to conceive.

Polycystic ovary syndrome is characterized by anovulation (irregular or absent menstrual periods) and hyperandrogenism (elevated serum testosterone and androstenedione). Patients with this syndrome may complain of abnormal bleeding, infertility, obesity, excess hair growth, hair loss and acne.

Ovarian cysts are the cause of a great deal of anxiety and concern for many women, and much of the time they are not truly a problem. The first thing a patient needs to understand is "what is a cyst"??

The uterus can lie in different positions in the pelvis, and it may vary from one woman to another. Most commonly, the uterus lies horizontally over the bladder, as do the ovaries. As the uterus enlarges with pregnancy, or perhaps with a large fibroid, it will cause increasing pressure on the bladder, and this results in increasing urinary frequency, pressure symptoms, and perhaps lower abdominal protrusion.

Hysteroscopy uses a hysteroscope, which is a thin telescope that is inserted through the cervix into the uterus. Modern hysteroscopes are so thin that they can fit through the cervix with minimal or no dilation. Although hysteroscopy dates back to 1869, gynecologists were slow to adopt hysteroscopy.

I have been involved in learning about and helping to develop alternatives to hysterectomy for many years. I have been instrumental in refining the use of the laser in an office setting to treat pre-malignant diseases of the cervix. I have treated thousands of women with the laser, many of whom would have otherwise had a more invasive treatment or hysterectomy.

A very common question of perimenopausal women is whether or not they are still able to get pregnant, and this inquiry may originate from one of two concerns. Some women in the perimenopausal range may still want to conceive, either to start a family or to add to an existing one, and are seeking information to help with that decision.

The majority of women in the perimenopausal period have completed their childbearing and resolutely do not want to conceive at this age. This gives rise to the question as to what contraceptive method they should use to prevent an unwanted pregnancy. At this stage in their lives, an unintended pregnancy would be devastating, and it is something they are usually very eager to avoid.

Hot flashes, hot flushes, power surges-- they go by a variety of names and are one of the most common symptoms of the perimenopause and menopause. Often a premenopausal woman will ask, "how will I know if I am having hot flashes"? This can be compared to the question a woman who has never had a baby asks, "how I will know if it's really a contraction"? If a woman is having significant hot flashes, she will not have to ask!

The benefits of using the patch for hormone replacement, with a few exceptions, are not significantly different from those when taken in a pill form. The choice should depend primarily upon the woman's preference, and for those choosing the patch there are a few small tricks for making it easier to use.

In the United States alone, it is conservatively estimated that there are between 10 and 20 million women suffering from the involuntary loss of urine! The large baby boomer population of the United States is now moving through the menopausal transition period when this involuntary loss of urine (urinary incontinence) often becomes worse, and consequently the number of women with incontinence will only increase.

If a doctor or health care professional recommends that a woman should have a hysterectomy and she elects to proceed, then there are certain decisions that need to made in planning the surgery. There are many reasons for deciding to have the uterus removed, and numerous articles and books have been written on this topic.

A hysterectomy is the surgical removal of the uterus. One talks of total hysterectomy, if the entire uterus is removed (cervix and corpus) and of subtotal if the cervix is kept in place. During this intervention the ovaries may be removed too.

Progesterone is a natural hormone which is produced by the ovary during the second half of the menstrual cycle. It's biological function is to change the lining of the uterus so that the cells which line the uterus can provide nutrition to the developing embryo during the earliest phases of development after conception.