Advances in Reproductive Health Care – serie

Uncontrolled population growth, a significant problem for many countries, depresses real living standards in all developing areas. As a corollary, un­ controlled population growth also stresses the ability to deliver adequate reproductive health care on both national and individual levels. To focus on this and related problems an International Congress to examine many aspects of male and female Reproductive Health Center Care was held on 10-15 October 1982 in Maui, Hawaii, USA. This volume is a result of the proceedings from the 'Symposium on Male Fertility and its Regulation' which was a part of the Reproductive Health Care Congress. The organizers of this symposium recognized the need to focus male reproductive understanding on contraceptive development. The ultimate objective was and still is to produce a variety of safe and effective male contraceptives similar to that accomplished in the female. Speakers were invited to review the state of the art in several areas related to male contra­ ception, reproductive toxicity and reproductive biology. The abstracts of these sessions were published as a special issue of Archives of Andrology (Vol. 9, No.1, August, 1982). Subsequently, this volume was assembled from key papers presented at the Symposium. Additionally, invited man­ uscripts from leaders in specific areas were solicited to provide additional range to the topics covered.

This volume contains a collection of papers based on presentations made at the Reproductive Health Care International Symposium held in Maui, Hawaii, USA, October 1982. The papers evaluate biologic interactions be­ tween intrauterine contraceptive devices and the host, examine the risks associated with the use of these devices and describe aspects of technical progress in the field. The contributing authors bring their knowledge and expertise from four corners of the world to the readers. The editors wish to express their appreciation to the authors for their valuable contributions, to Carolyn K. Osborn for helpful assistance in editing the manuscripts and to MTP Press for accurate preparation and fine presentation of the material. It is hoped that this volume will serve to expand knowledge and generate further interest among its readers in the dynamic and fascinating field of intrauterine contraception. April, 1984 H.M. Hasson, MD Chicago, Illinois, USA ix 1 Ultrastructure of the decidual response to a progesterone­ releasing IUD U.M. SPORNITZ. K.S. LUDWIG and M. MALL-HAEFELI INTRODUCTION The ever-increasing world-wide use of the IUD has prompted intensive research into the physiology of its contraceptive action. From these studies it has become clear that the alterations in morphology as well as in the physiological milieu produced by the IUD are manifold and differ greatly with the type of IUD used.

A. CORBIN Investigations on LHRH and its analogs have just completed their first decade. We have witnessed a veritable explosion of chemical, physiologic and pharmacologic data on this hypothalamic peptide and the approximately 1500 agonist and antagonist analogs that have been synthesized. In order to track this expanding field, I was asked to organize an international symposium on basic and clinical aspects of LHRH analogs as part of the Reproductive Health Care: CDS Symposium held in Maui, Hawaii, in October 1982. This meeting brought together a number of the leading investigators in the field. Much new state-of-the-art information was presented which I and my colleagues felt deserved a wider audience. Drs Vickery, Nestor, and Hafez consented to undertake this task. Upon review of the literature, it was apparent that there was no recent text which fully covered the breadth of developments in the field. Accordingly, the editors decided to use the symposium as a nucleus on which to build a singular, comprehensive state-of-the-art analysis of this rapidly growing discipline, and the application of such knowledge to reproductive medicine. As exemplified by the various areas of expertise provided by the individual contributors, it becomes obvious that the scope of the subject matter, while relating solely to a well-defined chemical class (LHRH analogs) and a circumscribed physiologic and pharmacologic entity (reproduction), has expanded enormously.

The role of prostaglandins in physiological events and pathological disorders related to human reproduction has been most actively investigated in the past decade. Their clinical use for fertility regulation, extensively evaluated, represents the most common clinical indication for the administration of these remarkable compounds. Thus, it is most appropriate to update the available information related to the use of prostaglandins in the regulation of human fertility to provide a background document for the benefit of clinicians and scientists. Invited experts of international reputation from various parts of the world have contributed, each in his own area of interest, to offer this book, which we hope will fill an existing gap. M. T. M. B. E. S. E. H. ix 1 Potential for prostaglandin use in controlling human reproduction K. T. KIRTON and F. A. KIMBALL BACKGROUND It was observed in 1930 that seminal plasma of a number of species contained very large amounts of substance(s) capable of altering uterine motility. These substances were subsequently demonstrated to be prostaglandins (PGs); this began the early and continued association of this group of compounds with reproduction. The activity was found to be associated with a fraction containing lipid-soluble acids, derived from prostanoic acid. Restrictions imposed by obscure sources and small amounts of material available for testing were initially impediments to their study.

This series of volumes dealing with reproductive health care has as its primary objective the improvement of the quality of human reproduction. The of knowledge and new technology give us opportunities as never explosion before to accomplish this end. The Editor has brought together contributors who are outstanding scientists from around the world. A number of the authors have personally made significant contributions to our body of knowledge in reproductive medicine. Bringing all this information together in an easily readable format is a great service. This is essential reading for all concerned with the control and improvement of human reproduction and the correction of its many deficits. xv P'art I Physio-anatom-ical Parameters 1 Uterine microvasculature and spontaneous abortion M. TAKADA In the implantation and subsequent development of a fertilized ovum, its integrity is most significant. However, with maternal local factors, i.e., unsatisfactory uterine conditions, implantation may not succeed even if the integrity of the fertilized ovum is excellent; if implantation is made, the maturation of the fetoplacental unit following implantation is disturbed, which leads to abnormalities in fetal development or to miscarriage. Thus, the uteroplacental unit, as well as the fetoplacental unit, plays an important role in the establishment and maintenance of pregnancy. Among the mechanisms of the utero placental unit, most significant is the physiological mechanism of the uterine microvasculature and its correspon­ dence to gestation. In particular, homeostasis of simultaneous cooperative development of the uterine wall and the placenta is most important.