Reproductive system – Wikipedia, the free encyclopedia

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The reproductive system or genital system is a system of sex organs within an organism which work together for the purpose of sexual reproduction. Many non-living substances such as fluids, hormones, and pheromones are also important accessories to the reproductive system.[1] Unlike most organ systems, the sexes of differentiated species often have significant differences. These differences allow for a combination of genetic material between two individuals, which allows for the possibility of greater genetic fitness of the offspring.[2]

Among all living organisms, flowers, which are the reproductive structures of angiosperms, are the most varied physically and show a correspondingly great diversity in methods of reproduction.[3] Plants that are not flowering plants (green algae, mosses, liverworts, hornworts, ferns and gymnosperms such as conifers) also have complex interplays between morphological adaptation and environmental factors in their sexual reproduction. The breeding system, or how the sperm from one plant fertilizes the ovum of another, depends on the reproductive morphology, and is the single most important determinant of the genetic structure of nonclonal plant populations. Christian Konrad Sprengel (1793) studied the reproduction of flowering plants and for the first time it was understood that the pollination process involved both biotic and abiotic interactions.

Fungal reproduction is complex, reflecting the differences in lifestyles and genetic makeup within this diverse kingdom of organisms.[4]

In mammals, the major organs of the reproductive system include the external genitalia (penis and vulva) as well as a number of internal organs including the gamete producing gonads (testicles and ovaries). Diseases of the human reproductive system are very common and widespread, particularly communicable sexually transmitted diseases.[5]

Most other vertebrate animals have generally similar reproductive systems consisting of gonads, ducts, and openings. However, there is a great diversity of physical adaptations as well as reproductive strategies in every group of vertebrates.

Vertebrate animals all share key elements of their reproductive systems. They all have gamete-producing organs or gonads. In females, these gonads are then connected by oviducts to an opening to the outside of the body, typically the cloaca, but sometimes to a unique pore such as a vagina or intromittent organ.

The human reproductive system usually involves internal fertilization by sexual intercourse. During this process, the male inserts his erect penis into the female's vagina and ejaculates semen, which contains sperm. The sperm then travels through the vagina and cervix into the uterus or fallopian tubes for fertilization of the ovum. Upon successful fertilization and implantation, gestation of the fetus then occurs within the female's uterus for approximately nine months, this process is known as pregnancy in humans. Gestation ends with birth, the process of birth is known as labor. Labor consists of the muscles of the uterus contracting, the cervix dilating, and the baby passing out the vagina (the female genital organ). Human's babies and children are nearly helpless and require high levels of parental care for many years. One important type of parental care is the use of the mammary glands in the female breasts to nurse the baby.[6]

The female reproductive system has two functions: The first is to produce egg cells, and the second is to protect and nourish the offspring until birth. The male reproductive system has one function, and it is to produce and deposit sperm. Humans have a high level of sexual differentiation. In addition to differences in nearly every reproductive organ, numerous differences typically occur in secondary sexual characteristics.

The male reproductive system is a series of organs located outside of the body and around the pelvis region of a male that contribute towards the reproduction process. The primary direct function of the male reproductive system is to provide the male sperm for fertilization of the ovum.

The major reproductive organs of the male can be grouped into three categories. The first category is sperm production and storage. Production takes place in the testes which are housed in the temperature regulating scrotum, immature sperm then travel to the epididymis for development and storage. The second category are the ejaculatory fluid producing glands which include the seminal vesicles, prostate, and the vas deferens. The final category are those used for copulation, and deposition of the spermatozoa (sperm) within the male, these include the penis, urethra, vas deferens, and Cowper's gland.

Major secondary sexual characteristics includes: larger, more muscular stature, deepened voice, facial and body hair, broad shoulders, and development of an adam's apple. An important sexual hormone of males is androgen, and particularly testosterone.

The testes release a hormone that controls the development of sperm. This hormone is also responsible for the development of physical characteristics in men such as facial hair and a deep voice.

The human female reproductive system is a series of organs primarily located inside of the body and around the pelvic region of a female that contribute towards the reproductive process. The human female reproductive system contains three main parts: the vagina, which leads from the vulva, the vaginal opening, to the uterus; the uterus, which holds the developing fetus; and the ovaries, which produce the female's ova. The breasts are involved during the parenting stage of reproduction, but in most classifications they are not considered to be part of the female reproductive system.

The vagina meets the outside at the vulva, which also includes the labia, clitoris and urethra; during intercourse this area is lubricated by mucus secreted by the Bartholin's glands. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the fallopian tubes. Each ovary contains hundreds of egg cells or ova (singular ovum).

Approximately every 28 days, the pituitary gland releases a hormone that stimulates some of the ova to develop and grow. One ovum is released and it passes through the fallopian tube into the uterus. Hormones produced by the ovaries prepare the uterus to receive the ovum. The lining of the uterus, called the endometrium, and unfertilized ova are shed each cycle through the process of menstruation. If the ovum is fertilized by sperm, it attaches to the endometrium and the fetus develops.

Most mammal reproductive systems are similar, however, there are some notable differences between the "normal" mammal and humans. For instance, most mammalian males have a penis which is stored internally until erect, and most have a penis bone or baculum. Additionally, males of most species do not remain continually sexually fertile as humans do. Like humans, most groups of mammals have descended testicles found within a scrotum, however, others have descended testicles that rest on the ventral body wall, and a few groups of mammals, such as elephants, have undescended testicles found deep within their body cavities near their kidneys.[7]

The reproductive system of marsupials is unique in that the female has two vaginae, both of which open externally through one orifice but lead to different compartments within the uterus; males usually have a two-pronged penis which corresponds to the females' two vaginae. Marsupials typically develop their offspring in an external pouch containing teats to which their newborn young (joeys) attach themselves for post uterine development. Also, marsupials have a unique prepenial scrotum.[8] The 15mm (5/8 in) long newborn joey instinctively crawls and wriggles the several inches (15cm), while clinging to fur, on the way to its mother's pouch.

The uterus and vagina are unique to mammals with no homologue in birds, reptiles, amphibians, or fish.[citation needed] In place of the uterus the other vertebrate groups have an unmodified oviduct leading directly to a cloaca, which is a shared exit-hole for gametes, urine, and feces. Monotremes (i.e. platypus and echidnas), a group of egg-laying mammals, also lack a uterus and vagina, and in that respect have a reproductive system resembling that of a reptile.

In domestic canines, sexual maturity (puberty) occurs between the ages of 6 to 12 months for both males and females, although this can be delayed until up to two years of age for some large breeds.

The mare's reproductive system is responsible for controlling gestation, birth, and lactation, as well as her estrous cycle and mating behavior. The stallion's reproductive system is responsible for his sexual behavior and secondary sex characteristics (such as a large crest).

Male and female birds have a cloaca, an opening through which eggs, sperm, and wastes pass. Intercourse is performed by pressing the lips of the cloacae together, which is sometimes knowna intromittent organ which is known as a phallus that is analogous to the mammals' penis. The female lays amniotic eggs in which the young fetus continues to develop after it leaves the female's body. Unlike most vertebrates female birds typically have only one functional ovary and oviduct.[9] As a group, birds, like mammals, are noted for their high level of parental care.

Reptiles are almost all sexually dimorphic, and exhibit internal fertilization through the cloaca. Some reptiles lay eggs while others are viviparous (animals that deliver live young). Reproductive organs are found within the cloaca of reptiles. Most male reptiles have copulatory organs, which are usually retracted or inverted and stored inside the body. In turtles and crocodilians, the male has a single median penis-like organ, while male snakes and lizards each possess a pair of penis-like organs.

Most amphibians exhibit external fertilization of eggs, typically within the water, though some amphibians such as caecilians have internal fertilization.[10] All have paired, internal gonads, connected by ducts to the cloaca.

Fish exhibit a wide range of different reproductive strategies. Most fish however are oviparous and exhibit external fertilization. In this process, females use their cloaca to release large quantities of their gametes, called spawn into the water and one or more males release "milt", a white fluid containing many sperm over the unfertilized eggs. Other species of fish are oviparous and have internal fertilization aided by pelvic or anal fins that are modified into an intromittent organ analogous to the human penis.[11] A small portion of fish species are either viviparous or ovoviviparous, and are collectively known as livebearers.[12]

Fish gonads are typically pairs of either ovaries or testes. Most fish are sexually dimorphic but some species are hermaphroditic or unisexual.[13]

Invertebrates have an extremely diverse array of reproductive systems, the only commonality may be that they all lay eggs. Also, aside from cephalopods, and arthropods, nearly all other invertebrates are hermaphroditic and exhibit external fertilization.

All cephalopods are sexually dimorphic and reproduce by laying eggs. Most cephalopods have semi-internal fertilization, in which the male places his gametes inside the female's mantle cavity or pallial cavity to fertilize the ova found in the female's single ovary.[14] Likewise, male cephalopods have only a single testicle. In the female of most cephalopods the nidamental glands aid in development of the egg.

The "penis" in most unshelled male cephalopods (Coleoidea) is a long and muscular end of the gonoduct used to transfer spermatophores to a modified arm called a hectocotylus. That in turn is used to transfer the spermatophores to the female. In species where the hectocotylus is missing, the "penis" is long and able to extend beyond the mantle cavity and transfer the spermatophores directly to the female.

Most insects reproduce oviparously, i.e. by laying eggs. The eggs are produced by the female in a pair of ovaries. Sperm, produced by the male in one testis or more commonly two, is transmitted to the female during mating by means of external genitalia. The sperm is stored within the female in one or more spermathecae. At the time of fertilization, the eggs travel along oviducts to be fertilized by the sperm and are then expelled from the body ("laid"), in most cases via an ovipositor.

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Reproductive system - Wikipedia, the free encyclopedia

‘Population Bomb’ Author Still Claiming Government Should Control Human Reproduction – Video

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#39;Population Bomb #39; Author Still Claiming Government Should Control Human Reproduction
YouTube: Planned Parenthood President Cecile Richards On When Life Begins http://www.youtube.com/watch?v=QcB2k3EoZ9c YouTube: Planned Parenthood Vice Preside...

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'Population Bomb' Author Still Claiming Government Should Control Human Reproduction - Video

The Rebirth of Choice: Getting family planning back on the agenda: Marleen Temmerman at TEDxLiege – Video

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The Rebirth of Choice: Getting family planning back on the agenda: Marleen Temmerman at TEDxLiege
In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. At a TED...

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Human Reproduction | Ovarian Cancer | Carcinoma

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Irene Maria Elena, MDObstetrics and Gynecology DepartmentFK UKRIDAReproductive Health The WHO defines reproductive health as a stateof complete physical, mental and social well-being, and not merely the absence ofreproductive disease or infirmity. Reproductive health involves all of thereproductive processes, functions and systems atall stages of human life. This definition implies that people are able tohave a satisfying and safe sex life and that theyhave the capability to reproduce and the freedomto decide if, when and how often to do so. Kesehatan Reproduksi , adalah kondisi sehatmenyangkut sistem, fungsi, dan proses alatreproduksi yang dimiliki .

NEUROSYPHILIS No single testing technique has been able to diagnose All adults with latent syphilis be evaluated clinically for aortitis,neurosyphilis, gumma, iritis (CDC recommended) Lumbar puncture for cerebrospinal fluid analysis should be donein any patient with latent syphilis of unknown or greater than 1 yrdurationin specific situatuonsCondyloma Acuminatum, Sexuallytransmitted disease of the vulva, vagina andcervix; Etiologic agent: Human papillomavirus High risk: HPV 16 and 18; Benign: HPV 6 and11Penyakit Radang Panggul Infeksi dan peradangan pada organ-organ disaluran genital wanita bagian atas Inflamasi yang terjadi merupakan suaturangkaian kesatuan yang terdiri dari uterus(endometritis), tuba falopii (salpingitis),ovarium (ooforitis), miometrium,parametrium (parametritis), rongga pelvis(peritonitis) RPR merupakan infeksi polimikrobial danbiasanya disebabkan oleh mikroorganismeN.gonorrhoeae dan C.trachomatis Bakteri masuk melalui vagina dan serviks(kolonisasi pada endoserviks) dan menjalar kerahim lalu ke tuba falopii. Dapat juga ditemukan virus, jamur(actinomyces israeli) dan parasit(skistosomiasis) Infeksi ini jarang terjadi sebelum siklusmenstruasi pertama, setelah menopausemaupun selama kehamilan Penularan yang utama terjadi melaluihubungan seksual, tetapi bakteri juga bisamasuk ke dalam tubuh setelah prosedurkebidanan/kandungan (mis pemasangan IUD,persalinan, keguguran, aborsi dan biopsiendometrium)Organisme penyebabPenyakit Radang PanggulAerob Anaerob VirusNeisseria gonorrheae Bacteroides sp Herpes simplexChlamydia trachomatis Peptostreptococcus sp EchovirusUreaplasma urelyticum Clostridium bifermentans CoxsackieGardneralla vaginalis Fusobacterium spStrptococcus pyogenesCoagulase negativestaphylococciEscherichia coliHaemophillus influenzaeMycoplasma hominisStreptococcus pneumoniaeMycobacteriumtuberculosisInfeksi Traktus Urinarius Etiologi : E.coli (80%), Proteus, Klebsiella danPseudomonas, Enterobacter, Streptococcusfaecalis, Staphylococcus saprophyticus,Enterococcus dan Chalamydia Infeksis dari uretra (uretritis) dan kandungkencing (sistitis) Gejala : kombinasi frekuensi, urgensi, disuria,piuria, hematuria, nyeri pelvik akut ataukronik, nyeri punggung dan demamHUMAN IMMUNODEFICIENCYVIRUS HIV infection is caused by an RNA retrovirus HIV is a RNA retrovirus that attches to the CD4receptor of the target cell and integrates intothe host genome When the CD4 all count falls below 200cells/L, patients are at high risk for AquiredImmunodeficiency Syndrome (AIDS) In females: Coexisting infections may have damaged normalanatomy and function of pelvic organs In males: HIV effects on semen Safe reproduction in couples with HIV Safe reproduction recommendations: Infected man + normal woman: semen washing + AssistedReproductive Technology (ART) Normal man + infected woman: IntarauterianeInsemination (IUI) Both HIV+: semen washing Anti-retrovirals, elective CS, no breastfeedingInduced Abortion Abortus dipakai untuk menunjukan ancamanatau pengeluaran hasil konsepsi sebelum janindapat hidup diluar kandungan, dan sebagaibatasan digunakan kehamilan kurang dari 20minggu atau berat anak kurang dari 500 gram. Abortus buatan (Induced Abortion) ialahpengakhiran kehamilan sebelum 20 mingguakibat tindakan (The delibrate termination ofpregnancy in a manner that ensures that theembryo or fetus will not survive) Komplikasi :- Perdarahan- Perfosi- Infeksi- SyokKontrasepsi Perencanaan Keluarga

2-4 tahun

Diafragma

MaleCondomSpermisidaCARCINOMACERVIXCERVIXthird most frequent malignancy Risk Factors:- early and frequent sexual contact- cervical viral infection particularly HPVCERVICAL INTRAEPITHELIALNEOPLASIA (CIN)

CIN 1 Mild atypia Atypical changes involvelower third ofepithelium

CervixCERVICAL INTRAEPITHELIALNEOPLASIA

CIN 2 Moderate atypia Atypical changes involve1/3 2/3 of epitheliumCERVICAL INTRAEPITHELIALNEOPLASIA

CIN 3 Severe atypia Atypical changes involve>2/3 or full thickness ofthe epitheliumCERVIXTwo types of malignancy:1. Squamous cell CA 8085%2. Adenocarcinoma 15-20%Degree of Differentiation of TumorsG1 = well differentiatedG2 = intermediateG3 = undifferentiatedCERVIXVerrucous Carcinoma- a rare type of squamous cell carcinoma- warty tumors appear as large bulbous masses- rarely metastasizeAdenocarcinoma- do not appear to be affected by sexually factorsassociated with squamous cell CACERVIXAdenoma malignum- microscopically innocuous appearing tumorsconsist of well-differentiated mucinous glandthat vary in size and shape and infiltrate thestroma- deeply invasive and metastasize earlyCERVIXClear Cell Carcinoma- histologically identical to ovary- uncommon in cervix- associated with intrauterine DES exposureAdenoid Cystic Carcinoma- rare; less aggressive- resemble Basal Cell CA of skinCARCINOMA of the CERVIX

Clinical Considerations- abnormal bleeding/brownish discharge followingintercourse or douching occurring spontaneouslybetween menstrual periods- back pain- loss of appetite- weight loss- age 40-60s (median 32 years)

CervixCARCINOMA of the CERVIXStaging:- pelvic exam- general physical exam- chest radiographic exam- IVP- CT ScanNatural History and Spread- initially a locally infiltrating carcinoma that spreadsfrom cervix to the vagina and paracervical andparametrial areas

CervixCARCINOMA of the CERVIX

Forms:- ulcerated- exophytic- endophyticSpread:- lymphatic- hematogenous (lung, liver, bone)

CervixUTERUSUTERUS Most common malignancyEpidemiology:- affects women in perimenopausal andpostmenopausal years- diagnosed between 50 65 years- younger than 40 (5%)- younger than 50 (10%) Complex Atypical Hyperplasia- results from increased estrogen stimulation of theendometrium and is a precursor to endometrioidendometrial carcinomaENDOMETRIAL CARCINOMARISK FACTORSIncreases the Risk Decreases the RiskUnopposed estrogen stimulation OvulationUnopposed menopausal estrogen Progestin therapyreplacement therapy (4-8x) Combined OCPMenopause after 52 yrs (2.4x) Menopause before 49 yearsObesity (2-5x) Normal weightNulliparity (2-3x) MultiparityDiabetes (2.8x)Feminizing ovarian tumorsPolycystic ovarian syndromeTamoxifen therapy for breastcancerENDOMETRIALHYPERPLASIA Results from excess of estrogen or an excess ofestrogen relative to progestin, such as occurs withanovulationTypes:1. Simple Hyperplasia2. Complex Hyperplasia without atypia3. Complex Hyperplasia with atypiaSimple Hyperplasia

UterusComplex Hyperplasiaw/o Atypia Glands are crowded withvery little endometrialstroma and a very complexgland pattern andoutpouching formation Considered lowpremalignant potential

UterusComplex Hyperplasiaw/ Atypia

UterusENDOMETRIALHYPERPLASIANatural History- the rate at which endometrial hyperplasia progresses toendometrial carcinoma has not been accuratelydetermined Rate of Progression to Cancer- complex atypical hyperplasia 29%- simple hyperplasia 1%- complex hyperplasia w/o atypia 3%

UterusENDOMETRIAL CARCINOMA

Symptoms:- postmenopausal and perimenopausal bleeding Diagnosis:- endometrial sampling- Fractional D&C- Pap smear detect endometrial CA (50%) Histologic Types:G1 = well differentiated (<6% solid components)G2 = intermediate (6-50% solid components)G3 = poorly intermediate (>50% solid components)

UterusENDOMETRIAL PRIMARYCARCINOMA

UterusENDOMETRIAL PRIMARYCARCINOMAAdenosquamous Carcinoma- squamous epithelium that co-exists with glandularelements of endometrial carcinomaUterine Papillary Serous Carcinoma- highly virulent and uncommonClear Cell Carcinoma- less common (5%)- tend to develop in postmenopausal womenand carry a prognosis much worse than typicalendometrial carcinomaUterusSTAGING of ENDOMETRIALCARCINOMAStages CHARACTERISTICSStage IA Tumor limited to the endometriumIB Invasion to less than half of the myometriumIC Invasion to more than half of the myometriumStage IIA Endocervical glandular involvement onlyIIB Cervical stromal invasionStage IIIA Tumor invades serosa and/or adnexae and/or positiveperitoneal cytologyIIIB Vaginal metastases

UterusOVARYOVARIAN CARCINOMASecond most common malignancyMajor contributing factor:- detection of disease after metastatic spreadIncidence increase with age

OvaryRISKS OFOVARIAN CARCINOMAIncreases DecreasesAge BreastfeedingDiet Oral contraceptivesFamily history PregnancyIndustrialized country Tubal ligation andInfertility hysterectomy with ovarianNulliparity preservationOvulationOvulatory drugsTalc?

OvaryCLASSIFICATION OFOVARIAN CARCINOMACLASS FREQUENCYEpithelial Stromal 65Germ Cell 20 25Sex Cord-Stromal 6Lipid Cell < 0.1Gonadoblastoma < 0.1Soft tissue tumorsUnclassified tumorsSecondary (metastatic)Tumor-like conditions

OvaryWHO Classification of OvarianNeoplasmCLASSIFICATION OFOVARIAN CARCINOMAEpithelial Stromal Tumors- most frequent- arise from coelomic epithelium Germ Cell Tumor- second most common- most common in young women- composed of extraembryonic elements or 3 embryonic layers(ectoderm, mesoderm or endoderm)- main cause of ovarian malignancy particularly in youngwomen teens

OvaryCLASSIFICATION OFOVARIAN CARCINOMA Sex Cord-Stromal Tumors- 3rd most common- contain elements that recapitulate the constituents of theovary and testis- secrete sex steroid hormones or may be hormonally inactive Lipid Cell Tumor- extremely rare; histologically resemble the adrenal gland Gonadoblastoma- consists of germ cell and sex-cord stromal elements- occur in individuals with dysgenetic gonadsparticulary when Y chromosome is present

OvaryCLASSIFICATION OFOVARIAN CARCINOMASoft Tissue Tumor- not specific to the ovary- hemangioma or lipomaUnclassified- Small Cell CA highly virulent affecting young womenSecondary Metastatic TumorsTumor-like conditions

OvarySerous Cystadenocarcinoma

OvaryMucinous Cystadenocarcinoma

OvaryEndometriod Tumors

IIC Tumor either IIA or IIB, but w/ tumor on surface of one or bothovaries, or w/ capsule ruptures, or if w/ ascitesStage IIIA Tumor grossly limited to the pelvis w/ negative nodes but w/microscopic seeding to the abdominal peritoneal surfaceIIIB Tumor of one or both ovaries w/ histologically confirmedimplants of abdominal peritoneal surfaces, none exceeding 2cm, nodes are negativeIIIC Abdominal implants greater than 2 cm and/or positiveretroperitoneal or inguinal nodesStage IVA Parenchymal liver metastasisTeratoma Mature Teratoma (Dermoid) Most common type of ovarianteratoma/ovarian neoplasms; and mostcommon neoplasm diagnosed duringpregnancy Composed of fully/well differentiated maturetissues from 3 germs cell layers, usuallyectodermal (skin, hair, sebaceous glands, glia)but also mesodermal and endodermalderivatives Occuring in woman ages 20-30 years Complications: torsion, rupture, infection,malignant transformation (2%)Teratoma Immature Teratoma The malignant counterpart of mature cysticteratoma or dermoid 2nd most common germ cell malignancy Proliferation of meiotic germ cell Neural elements that makes it malignant The amount of undifferentiated neural tissues(immature neural tissue present) is prognosticimportance and guidelines for chemotherapy They are usually unilateral, although thecontralateral may contain a mature teratoma These tumors often secrete fetoprotein(AFP)Torsion Cyst Adnexal torsion may be suspected in thewoman with an adnexal mass whoexperiences the sudden onset of pelvic pain Torsion of the adnexae can involve the ovary,tube, and ancillary structures, eitherseparately or together Commonly associated with a cystic neoplasm Symptoms include :Abdominal pain and tenderness, that usuallyare sudden in onset and result from occlusionof the vascular supply to the twisted organRuptured Cyst A ruptured ovarian cyst is a commonphenomenon, with presentation ranging fromno symptoms to symptoms mimicking anacute abdomen Each month, a mature ovarian follicleruptures, releasing an ovum so the process offertilization can begin Occasionally, these follicles may bleed into theovary, causing cortical stretch and pain, or atthe rupture site following ovulation Similarly, a corpus luteum cyst may bleedsubsequent to ovulation or in early pregnancy. As blood accumulates in the peritoneal cavity,abdominal pain and signs of intravascularvolume depletion may arise. The etiology of this increased bleeding isunknown, although abdominal trauma andanticoagulation treatments may increase therisk. Nonphysiologic cysts, such as cystadenomasand mature cystic teratomas (dermoid cysts),may, in rare cases, rupture and causesymptoms a diffuse chemical peritonitis can accompanyrupture of a dermoid cyst, presumably fromspillage of sebaceous fluidTorsion and Ruptured Cyst These symptoms :- severe or sharp pelvic pain- fever- faintness or dizziness- rapid breathingcan indicate a ruptured cyst or an ovariantorsion. Both complications can have seriousconsequences if not treated early. Williams obstetrics Williams gynecologic Clinical gynecologic oncology (De Saia) Medscape Current obstetrics and Gynecology Ed 11 WHO : Introduction to Reproductive Health and The Environtment Panduan penatalaksanaan infeksi pada traktus genitalis dan urinarius Buku ajar kependudukan dan pelayanan KB At a glance sistem Reproduksi Ed 2 Panduan pelayanan klinik Kanker Ginekologi Ed 3-2013 (HimpunanOnkologi Ginekologi indonesia)THANK YOU

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Labour of love: Taking the surrogacy route to parenthood – Irish Examiner

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The decision by Rosanna Davison and her husband to look for a surrogate to carry their baby shows the lengths to which some couples go to realise their dream, writes Sharon N Chonchir.

ROSANNA Davison experienced one of the happiest moments of her life when her daughter Sophia was born on November 21 last year.

It was the culmination of what had been a difficult journey to parenthood for the 35-year-old nutritionist and former Miss World and her husband Wes Quirke.

In February 2018, following years of fertility testing, treatment and multiple miscarriages, the couple decided that gestational surrogacy was the only way for them to have a biological child of their own.

They travelled to Ukraine, the only country in Europe that allows for legal commercial surrogacy, where a clinic arranged for a surrogate to carry their baby.

Davison was as emotional and exhausted as any new mother when she spoke to Feelgood recently.

Everything seems to take twice as long with a hungry newborn to feed around the clock, but motherhood has been amazing so far, she said.

The memory of the birth is still fresh in her mind. Watching Sophia being born and cutting her umbilical cord was the most overwhelming, emotional and terrifying experience. Our lives are all about her now.

Davison isnt the only celebrity who opted to use a surrogate as a solution to fertility problems. Nicole Kidman, Tyra Banks and Sarah Jessica Parker brought children into the world with the help of a surrogate.

And after suffering from complications during her second pregnancy, Kim Kardashian chose to use a gestational carrier for her third and fourth children with Kanye West.

In Ireland, surrogacy exists in a legislative vacuum. There is no legislation, which means its neither legal nor illegal.

This creates uncertainty for would-be parents, but it hasnt stopped those who see surrogacy as their only chance of creating a family.

According to figures released by the Department of Foreign Affairs, 137 emergency travel certificates were issued to children born abroad as a result of surrogacy arrangements in the years between 2015 and 2019.

Surrogacy happens in Ireland too, although its much rarer. On a recent episode of The Late Late Show, Becky Loftus Dore from Co Westmeath spoke about her experience.

The mother of four offered to carry a baby for a couple who had struggled to have a child. This act of altruistic surrogacy resulted in a baby boy being born last April.

So, what exactly is surrogacy? Essentially, its where a woman bears a child for another woman or same-sex couple.

An embryo is created using the mans sperm and an egg, says John Kennedy, medical director of the Sims Fertility Clinic in Dublin.

That egg could be donated in the case of same-sex couples or a woman with low ovarian reserve, or it could be the womans own egg. The embryo is implanted in a woman of proven fertility and good general health. The child is then handed over once its delivered.

In traditional surrogacy, the surrogate carried a child conceived using her egg and sperm from the intended father. This meant the surrogate was genetically related to the child, which complicated matters.

Gestational surrogacy is now more common. This is where the surrogate carries a child conceived using the egg of the intended mother or other egg donor. The resulting child then has no biological link to the surrogate.

Surrogacy can also be altruistic or commercial. Loftus Dore offered to do it for her friends and no money changed hands.

In the case of Davison and the 25 or so couples who travel abroad every year, their surrogates are paid for their services.

Rosanna Davison with husband Wes Qurike and their daughter Sophia

Surrogacys success rates are high.

Theyre higher than IVF because its the quality of the eggs that determine success, says Dr Kennedy. Because so many donor eggs are used in surrogacy, the success rate is anything up to 80% depending on the clinic.

Most Irish couples availing of surrogacy services abroad go to one of four countries: Ukraine, Cyprus, the US and Canada.

Cyprus has no regulation regarding surrogacy which means clinics here can transfer embryos to surrogates without technically breaking any law. The other jurisdictions have their own terms and conditions.

In Ukraine, surrogacy services cost approximately 40,000 but they are only available to married heterosexual couples who have medical proof that they havent been able to have children.

This means that same-sex couples have to travel to Canada or the US where surrogacy services can cost up to 150,000.

Cost is just one of the complicating factors. Tracy Horan is one of four family law solicitors specialising in surrogacy law. She believes the entire system needs to be overhauled.

People have most likely been through an incredibly difficult time trying to conceive before deciding to have a baby through surrogacy, she says. We need to make things more open and transparent for them.

Establishing parentage is one of the main hurdles under current Irish law. As it stands, the woman who gives birth to a child is the mother, regardless of who supplied the egg. This means the surrogate is the childs legal parent and guardian.

If the surrogate is married, her husband automatically becomes the childs legal father. This can be disproven using DNA testing, which has to be done before the Department of Foreign Affairs will issue an emergency travel certificate, which, combined with other legal documentation, will allow the intending parents to bring their baby home to Ireland.

Once they get home, they must start proceedings for a declaration of parentage. This can take up to 18 months, says Ms Horan.

But it only relates to the father. The mother can only apply to become the childs guardian after two years of residing with the child if she is married to the father or after three years if they are cohabiting.

The entire process can cost up to 15,000 and there are many potential pitfalls.

The mother is in a risky situation, says Dr Kennedy.

Theres a small chance the surrogate could come looking for the child. There could also be an acrimonious separation that turns ugly and the child could suffer as a result. It hasnt happened yet in Ireland but its only a matter of time.

John Waterstone, medical director of the Waterstone Fertility Clinic in Cork, agrees.

In the US, states that are pro-surrogacy have pre-birth orders giving everyone black and white legal rights and making the intending parents the legal parents from before the child is born, he says.

This protects everyone, including the surrogate. There was a case in 2014 when an Australian couple abandoned their baby when he was born with Down syndrome to a surrogate mother in Thailand. That wouldnt happen if the law was clearcut from the beginning.

Because the surrogacy process is so complicated, legal support is recommended from the very beginning. Psychological support may be needed too.

According to the National Infertility Support and Information Group, surrogacy can take a significant emotional toll.

People can feel at a loss as to where to turn and often will not even confide in family or friends, says Gillian Keegan, spokesperson for the group.

We hold regular surrogacy support group meetings where people can share experiences and emotions and receive peer-to-peer support from those on a similar journey.

John Duffy, 45 and from Co Louth, was one such person. After five years of failed IVF treatments, he and his wife Catriona had their son through surrogacy in 2014.

Those IVF treatments took a huge financial and psychological toll, but we still wanted to have a baby and we knew our only option was surrogacy, he says.

They chose a clinic in India. We went over on a medical visa, had IVF, and met our surrogate, says Duffy.

They found the process strange.

It was weird meeting her, knowing she was going to do something so intimate for us when she was a virtual stranger. Then we had to come home and endure the dreaded two-week wait, which as anyone who has had IVF treatment will know is torturous.

When we got news of a pregnancy, we were over the moon and from then on, we were kept informed with scans and updates sent by email.

We werent there when he was born but we were in India within 24 hours of the birth, so I have to say it was a very detached pregnancy.

This didnt detract from the pleasure he took in first setting eyes on his son.

It was a magical moment, all the more so because it had been such a long time coming, he says.

Parents who are considering embarking on similar surrogacy journeys may be interested in attending a conference in Dublin on March 22, run by international organisation Growing Families.

Its not the first such conference in Ireland. At our first event in 2015, we expected 60 attendees and over 130 came, all desperate for an answer to their family-building problems, says Sam Everingham, global director of Growing Families.

Since then, the demand for information and support has been massive.

There is an immediate need for surrogacy legislation in Ireland. Were currently working off guidelines issued in 2012 but we need clear legislation, says Ms Horan.

The Government is seeking to provide this in the Assisted Human Reproduction Bill 2017, which is working its way through the Oireachtas. However, there are concerns about the proposed legislation.

It only covers altruistic surrogacy in Ireland, says Dr Kennedy.

Because most people dont have someone who will voluntarily carry a baby for them, the majority will still have to travel. So, we are failing to address the actual situation and legislating for something that doesnt exist.

Dr Waterstone was president of the Irish Fertility Society in 2018 when it was asked to give feedback to the Oireachtas on the proposed legislation.

We felt it was so restrictive that it amounted to a practical ban on surrogacy, he says.

If implemented, it will make it illegal for couples to go abroad or advertise for surrogates in Ireland. It will penalise medical and legal professionals who advise couples on what to do and where to go, with potential fines of up to 100,000 and custodial sentences of up to five years.

The surrogate birth mother will still be recognised as the legal mother in the first instance and her partner will be presumed to be the father. As a medical professional, I believe it will infringe my duty to help people.

Horan believes the legislation in its current format will make things worse.

If it comes into law, it will drive surrogacy underground again, which is not what we want in modern Ireland, she says.

Dr Kennedy believes we need to have this conversation as a society, not just in the Dil.

The more people become aware, the more pressure that will be brought to bear on government to come up with real solutions that will help people, he says.

In the meantime, couples such as Rosanna Davison and Wes Quirke continue to overcome medical, legal and emotional hurdles that block their path to parenthood.

We decided to share our story to give hope to others in our position and to show that surrogacy is a feasible route to parenthood, says Rosanna.

Our surrogate was an incredible, strong lady and we feel immense gratitude to her for giving us the most amazing gift of all, she says.

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Labour of love: Taking the surrogacy route to parenthood - Irish Examiner

Pair bonding may be the foundation of human and primate societies – ZME Science

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New research into primate social structures offers insight into how human social life is organized.

Primates can develop quite complex social structures just look at ours, were primates too. But exactly what made this family of species move towards a group rather than individual lifestyle? Thats what Luca Pozzi from the University of Texas at San Antonio (UTSA) Department of Anthropology, in collaboration with Peter Kappeler at the German Primate Center-Leibniz Institute for Primate Research, set out to understand.

The duo identified pair bonding as a key transition system between solitary and community lifestyles.

The evolution of complex social systems in mammals, and more specifically in primates, is a challenging and exciting area of research. Our study shows that pair livingalthough raremight have played a critical role in it, says Pozzi.

Living as a pair represents an evolutionary puzzle in the evolution of mammalian social systems because males could achieve higher rates of reproduction if they did not bond to a single female.

Pozzi explains that social systems can work as an adaptive tool. Species need to adapt to their environmental conditions, he says, which is the same process that drives biological evolution. However, a modification of social behavior can accomplish the same goal at a much faster pace than natural selection. Among half of all primate species live in groups, he adds, while a third only form pairs; the rest (roughly one third) enjoy solitary lifestyles.

In order to understand what drives this behavioral adaptation process, which factors shape it, and how many times it occurred in the past, the team analyzed genetic data and behavioral observations of 362 primate species. The team found that the transition from a solitary way of life towards living in groups most often occurred through pair bonding. Thus, the propensity to form long-term pairs can be seen as the first step towards complex social structures, they explain.

There are two current hypotheses on the development of pair bonding, the team explains: the female spacing hypothesis and the paternal care hypothesis. The first hypothesis holds that females pursue reproductive strategies that are not limited by the number of mates but by access to resources, and that under certain conditions (such as high competition for food) females may spread out, limiting males ability to monopolize access to multiple females. The second one basically boils down to the idea that males may choose to focus on a single female because she either needs his help in raising the offspring (for protection, care, or provision) or to reduce the risk of strange males committing infanticide. Either way, the male in question enjoys greater net reproductive success even if he limits his mating opportunities. Evidence is mixed for both hypotheses, the team adds.

Up to now, the assumption was that these two hypotheses were mutually exclusive. But the team found that they were actually complimentary.

An initial ecological change led the females of a species to separate in space. Solitary males, which previously had several females living in their territory, were now only able to gain access to one female and started to invest more in their offspring to increase their chances of survival thus reinforcing pair living. A further transition to group living was made possible through an improvement of the ecological situation, which allowed related females to live in close proximity once again, and they could then be joined by one or more males.

However, the pair bond typical for humans within larger social units cannot be explained with our results, since none of our recent ancestors lived solitarily. Nevertheless, the advantages of paternal care also may have led to a consolidation of pair living in humans, said Kappeler.

The paper Evolutionary transitions towards pair living in non-human primates as stepping stones towards more complex societies, has been published in the journal Science Advances.

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Pair bonding may be the foundation of human and primate societies - ZME Science