Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Ectopic pregnancy is defined as a pregnancy implanted outside the uterus, and >98% implant in the Fallopian tube. It has a major clinical and socioeconomic impact worldwide. The diagnosis of ectopic pregnancy is often difficult and resource intensive owing to a lack of accurate biomarkers, and there is a need for improved medical management of ectopic pregnancy using new or adjuvant treatments. The aetiology of ectopic pregnancy is uncertain, but tubal implantation is probably due to retention of the embryo in the Fallopian tube owing to impaired embryo-tubal transport and alterations in the tubal microenvironment. This comprehensive review of the literature supporting current understanding of the endocrinology of Fallopian tube biology and tubal implantation focuses on genes expressed in the Fallopian tube regulated by oestrogen and progesterone and discusses their potential functions. It concludes with a discussion of how advances in this field are enabling the development of novel biomarkers and could lead to the identification of potential new treatments for ectopic pregnancy.
Successful implantation and early development require a union of healthy gametes and subsequent growth and development within an optimal uterine environment. The 48th RCOG Study Group comprised a national and international multidisciplinary expert forum that considered factors involved in preparation for implantation within the uterus, what makes a good egg and good sperm and hence a good embryo. Lessons from animal models and transgenic and genomic technologies received consideration. Attention was given to both sporadic and recurrent early pregnancy loss and to the scale of these distressing events. New treatment options were critically discussed and empirical approaches to management, without evidence of identifiable aetiological factors and rigorous evaluation, were cautioned against.
Assisted reproductive technologies have had a huge impact on the management of fertility problems over the past 25 years. Discussion included the arguments for singleembryo transfer and the developmental consequences of assisted reproductive technologies. The Group emphasised the need to continue to extend and refine the evidence base available for investigation and treatment options across the spectrum of early pregnancy management.
The ‘consensus views’ contained within this publication are not formal recommendations, but the conclusions of independent experts. Areas where future research is much needed have been identified. Emphasis is given to the multidisciplinary approach required if there is to be a substantial impact on our knowledge base, whether biological or clinical.The chapters herein have provided the authors with the opportunity to express further their individual views and to discuss issues in more detail and depth. We hope that this publication will provide a valuable resource for gynaecologists, specialist nurses, embryologists, basic scientists and all those with an interest in early pregnancy and development.
The multidisciplinary systems biology approach that is needed to assess endometrial receptivity should be used to understand the reciprocal dialogue between the embryo and the decidualised endometrium. This chapter focuses on human embryo research and the development of appropriate functional models of implantation that will allow the investigation of molecules mediating blastocyst-endometrial/decidual interaction. Ectopic pregnancy could be considered as a model to study the failure or the absence of mechanisms that limit implantation. Experience with cell nuclear replacement has identified the key role of cytoplasmic and nuclear factors for normal embryonic development. The conventional measurements of sperm concentration, motility and morphology only act as surrogate markers of fertility. Pre-implantation genetic diagnosis (PGD) should be carried out by specialist centres that have a multidisciplinary genetic support infrastructure including genetic counselling, and clinical pathology accreditation (CPA) qualified cytogenetics and molecular genetics laboratories.
Progesterone is essential for the transformation of an oestrogen-primed endometrium in preparation for implantation. With the advent of cDNA array technology, several researchers have applied this methodology to identify the various classes of genes that are upregulated during the window of implantation, both in animal models and human endometrium. The relative paracrine signalling of the individual prostanoids acting via their receptors to facilitate reproductive processes, such as implantation, has been largely unexplored. During adhesion of the implanting blastocyst to the endometrium, locally regulated uterine apoptosis is necessary to promote tissue remodelling and invasion of the epithelium. This process of programmed cell death is seen in rodents, where a progressive, continuous wave of induction of apoptosis is observed in the maternal tissues surrounding the conceptus in the rat. Over the past few years a great deal of progress has been made towards identifying the endocrine and local factors involved in implantation.
Successful implantation and early development need a union of healthy genes and an optimal uterine environment. The 48th RCOG Study Group, an international multidisciplinary expert forum, considered factors involved in preparation for implantation within the uterus; how to determine a good egg and good sperm; lessons from animal models; transgenic and genomic technologies; sporadic and recurrent early pregnancy loss; single-embryo transfer; and the developmental consequences of assisted reproduction technologies. This book presents the findings of the Study Group, with sections covering:• preparation for implantation - the uterine environment• the embryo• lessons from animal models (transgenics) and novel technologies• clinical sequelae.
Angela B. Thomson, Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, UK,
Hilary O.D. Critchley, Department of Developmental and Reproductive Sciences, University of Edinburgh, Edinburgh, UK,
Christopher J. H. Kelnar, Department of Developmental and Reproductive Sciences, University of Edinburgh, Edinburgh, UK,
W. Hamish B. Wallace, Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, UK
Tremendous therapeutic advances in the management of childhood malignancies mean that the majority of children can realistically hope for long-term survival. Cancer in childhood is rare, with about 1400 new cases per year in the UK and a cumulative risk of 1 in 650 by the age of 15 years (Stiller, 1997; Wallace, 1997). With survival rates in excess of 70%, it is estimated that by the year 2010, 1 in 250 of the young adult population will be a long-term survivor of childhood cancer (Fig. 32.1) (Bleyer, 1990). However, the successful treatment of cancer in childhood with chemotherapy and or radiotherapy is associated with a number of unwanted side effects in later life (Wallace et al., 2001). Therefore, the major challenge faced by paediatric oncologists today is to sustain the excellent survival rates while striving to improve the quality of life of the survivors.
One of the most important issues for the survivors of childhood cancer is the impact of their disease and its treatment on reproductive function and the implications for the health of their offspring. In the female, chemotherapy and radiotherapy may damage the ovary and hasten oocyte depletion, resulting in loss of hormone production, truncated fecundity and a premature menopause (Meirow, 2000; Thomson et al., 2002). Infertility is one of the most commonly encountered and psychologically traumatic late complications of treatment for childhood cancer, and consequently, strategies to preserve fertile potential are being pursued.
Email your librarian or administrator to recommend adding this to your organisation's collection.