Research
Risk Factors for Infertility in Children and Adolescents
Sickle cell Disease
- Nahata L, Caltabellotta NM, Ball K, O’Brien SH, Creary SE Desire for parenthood and reproductive health knowledge in adolescents and young adults with sickle cell disease and their caregivers. Pediatric Blood Cancer. 2018 Feb;65(2).
- Lukusa AK, Vermylen C Use of hydroxyurea from childhood to adult age in sickle cell disease: semen analysis. Haematologica. 2008 Nov;93(11):e67
Gender Diversity
- Chen D, Simons L, Johnson EK, Lockart BA, Finlayson C. Fertility Preservation for Transgender Adolescents. J Adolesc Health. 2017 Jul;61(1):120-123
- Nahata L, Tishelman AC, Caltabellotta NM, Quinn GP. Low Fertility Preservation Utilization Among Transgender Youth.J Adolesc Health. 2017 Jul;61(1):40-44.
Success Rates for Fertility Preservation
Patient Preferences and Parental Regret
On the Horizon: The Future of Fertility Preservation
Guidelines for Fertility Preservation in Children
American College of Obstetrics and Gynecology
Recommendations for Fertility Preservation in Children
American Academy of Pediatrics
Recommendations for Fertility Preservation in Children
Children’s Oncology Group
Recommendations for Fertility Preservation in Children
American Urological Association
Other
Orphanet J Rare Dis. 2015 Oct 21;10:136. doi: 10.1186/s13023-015-0332-8.
Immunosuppressive drugs and fertility.
Leroy C1,2, Rigot JM3, Leroy M4, Decanter C5, Le Mapihan K6, Parent AS7, Le Guillou AC8, Yakoub-Agha I9, Dharancy S10, Noel C11, Vantyghem MC12,13.
Abstract
Immunosuppressive drugs are used in the treatment of inflammatory and autoimmune diseases, as well as in transplantation. Frequently prescribed in young people, these treatments may have deleterious effects on fertility, pregnancy outcomes and the unborn child. This review aims to summarize the main gonadal side effects of immunosuppressants, to detail the effects on fertility and pregnancy of each class of drug, and to provide recommendations on the management of patients who are seen prior to starting or who are already receiving immunosuppressive treatment, allowing them in due course to bear children. The recommendations for use are established with a rather low level of proof, which needs to be taken into account in the patient management. Methotrexate, mycophenolate, and le- and teri-flunomide, cyclophosphamide, mitoxanthrone are contraindicated if pregnancy is desired due to their teratogenic effects, as well as gonadotoxic effects in the case of cyclophosphamide. Anti-TNF-alpha and mTOR-inhibitors are to be used cautiously if pregnancy is desired, since experience using these drugs is still relatively scarce. Azathioprine, glucocorticoids, mesalazine, anticalcineurins such as cyclosporine and tacrolimus, ß-interferon, glatiramer-acetate and chloroquine can be used during pregnancy, bearing in mind however that side effects may still occur. Experience is limited concerning natalizumab, fingolimod, dimethyl-fumarate and induction treatments.
CONCLUSION:
At the time of prescription, patients must be informed of the possible consequences of immunosuppressants on fertilityand of the need for contraception. Pregnancy must be planned and the treatment modified if necessary in a pre-conception time period adapted to the half-life of the drug, imperatively in relation with the prescriber of the immunosuppressive drugs.
PMID:26490561
Nephrology
Blood Purif. 2018;45(1-3):194-200. doi: 10.1159/000485157. Epub 2018 Jan 26.
Pregnancy and End-Stage Renal Disease.
Tangren J1, Nadel M1, Hladunewich MA2.
Abstract
Pregnancy is uncommon in women with end-stage renal disease (ESRD). Fertility rates are low in women on dialysis, and physicians still frequently counsel women with ESRD against pregnancy. Advancements in the delivery of dialysis and obstetric care have led to improved live birth rates in women on dialysis, so pregnancy for young women with ESRD is now more feasible and safer. However, these pregnancies remain high-risk for both maternal and fetal complications, necessitating experienced multidisciplinary care. In this article, we review fertility issues in women with ESRD, discuss pregnancy outcomes in women on dialysis, and provide an approach for management of pregnant women with ESRD.
KEYWORDS:
End-stage renal disease; Intensive hemodialysis; Pregnancy
PMID:29478065
Rev Endocr Metab Disord. 2017 Mar;18(1):117-130. doi: 10.1007/s11154-016-9385-9.
Gonadal dysfunction in chronic kidney disease.
Abstract
Sexual dysfunction is a common finding in both men and women with chronic kidney failure. Common disturbances include erectile dysfunction in men, menstrual abnormalities in women, and decreased libido and fertility in both sexes. These abnormalities are primarily organic in nature and are related to uremia as well as the other comorbid conditions that frequently occur in the chronic kidney failure patient. Fatigue and psycho social factors related to the presence of a chronic disease are also contributory factors. Disturbances in the hypothalamic-pituitary-gonadal axis can be detected prior to the need for dialysis but continue to worsen once dialytic therapy is initiated. Impaired gonadal function is prominent in uremic men while the disturbances in the hypothalamic-pituitary axis are more subtle. By contrast, central disturbances are more prominent in uremic women. Therapy is initially directed towards optimizing the delivery of dialysis, correcting anemia with recombinant erythropoietin, and controlling the degree of secondary hyperparathyroidism with vitamin D. For many practicing nephrologists sildenafil has become the first line therapy in the treatment of impotence. In the hypogonadal man whose only complaint is decreased libido, testosterone may be of benefit. Regular gynecologic follow up is required in uremic women to guard against potential complications of unopposed estrogen effect. Uremic women should be advised against pregnancy while on dialysis. Successful transplantation is the most effective means of restoring normal sexual function in both men and women with chronic kidney failure.
KEYWORDS:
Amennorhea; Anovulation; Dialysis; Erectile dysfunction; Estrogen; Gonadotropin deficiency; Impotence; Pituitary-gonadal axis; Sildenafil; Testosterone; Transplantation erectile dysfunction; Uremia
PMID:27586847
Pediatr Nephrol. 2015 Jul;30(7):1099-106. doi: 10.1007/s00467-014-2897-1. Epub 2014 Sep 5.
Fertility preservation in patients receiving cyclophosphamide therapy for renal disease.
Gajjar R1, Miller SD, Meyers KE, Ginsberg JP.
Abstract
Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to well-established methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.
PMID:25190492
Neurology
J Neuroendocrinol. 2008 Dec;20(12):1368-75. doi: 10.1111/j.1365-2826.2008.01791.x.
Evaluation of endocrine profile, hypothalamic-pituitary-testis axis and semen quality in multiple sclerosis.
Abstract
Several endocrine and sexual disturbances have been demonstrated in multiple sclerosis (MS) patients of both sexes. The endocrine profile, hypothalamic-pituitary-testis (HPT) axis and semen quality were evaluated in male patients with MS. A total of 68 male MS patients aged 18 years or older were recruited. Forty-eight age-matched healthy male volunteers served as controls. All subjects underwent complete physical examination and routine semen analysis. Two blood samples were drawn from each participant at 15-min intervals for the determination of the resting levels of: luteinising-hormone (LH), follicle-stimulating hormone (FSH), prolactin, testosterone, oestradiol and sex hormone binding globulin. The HPT axis was assessed using gonadotrophin-releasing hormone (GnRH) and human chorionic gonadotrophin tests. The mean basal serum levels for LH, FSH and testosterone in MS patients were significantly lower than the mean for normal controls (P = 0.01). The injection of GnRH analogue did not yield a significant increase in FSH and LH levels in the MS patients compared to normal controls (P = 0.001). Total sperm count, sperm motility and percent normal sperm morphology were lower in MS patients compared to controls. MS subjects with progressive disease had higher and more severe HPT axis abnormalities than that for patients with relapsing remitting MS. Most subjects with MS have hypogonadotrophic hypogonadism state and fertility impairment. It appears that the damage to HPT axis is both in pituitary and testicular levels. Further studies are needed to better elucidate the underlying pathophysiology of HPT axis dysregulation.
PMID: 19094084
Endocrinology/Gender/DSD/Genetics
Transgend Health. 2016 Jan 1;1(1):41-44. doi: 10.1089/trgh.2015.0010. eCollection 2016.
Preservation of Fertility Potential for Gender and Sex Diverse Individuals.
Johnson EK1,2,3, Finlayson C4,5.
Abstract
Gender and sex diverse individuals-transgender individuals and those with disorders of sex development (DSD)-both face medical treatments that may impair biological fertility potential. Young DSD patients also often have abnormal gonadal development. Fertilitypreservation for these populations has historically been poorly understood and rarely addressed. Future fertility should be discussed with gender and sex diverse individuals, particularly given recent advances in fertility preservation technologies and evolving views of fertilitypotential. Key ethical issues include parental proxy decision-making and uncertainty regarding prepubertal fertility preservation technologies. Many opportunities exist for advancing fertility-related care and research for transgender and DSD patients.
KEYWORDS:
disorders of sex development; fertility preservation; gender dysphoria; transgender
PMID:29159296
J Clin Endocrinol Metab. 2017 Nov 1;102(11):3869-3903. doi: 10.1210/jc.2017-01658.
Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine SocietyClinical Practice Guideline.
Hembree WC1, Cohen-Kettenis PT2, Gooren L2, Hannema SE3, Meyer WJ4, Murad MH5, Rosenthal SM6, Safer JD7, Tangpricha V8, T’Sjoen GG9.
Abstract
OBJECTIVE:
To update the “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2009.
PARTICIPANTS:
The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer.
EVIDENCE:
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
CONSENSUS PROCESS:
Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Societycommittees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.
CONCLUSION:
Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person’s genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person’s affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments-appropriately trained diagnosing clinicians (required), a mental health provider for adolescents (required) and mental health professional for adults (recommended)-should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.
Copyright © 2017 Endocrine Society
PMID:28945902
Pediatr Endocrinol Rev. 2010 Dec;8 Suppl 1:178-81.
Fertility preservation in adolescents with Klinefelter’s syndrome.
Abstract
Klinefelter’s syndrome (KS) is one the most common sex chromosomal abnormalities and is characterized by hypergonadotropic hypogonadism and infertility. Some men with non-mosaic syndrome have azoospermia and only few have oligospermia. In adult 47,XXY, germ cell aplasia, total tubular atrophy or hyalinising fibrosis and relative hyperplasia of Leydig cells are found. Occasionally, single foci of spermatogenesis do exist in the testes. The mechanisms leading to degeneration of seminiferous tubules are unknown. But this process accelerates dramatically at the time of puberty. Therefore, the preservation of reproductive potential for a chromosopathy that for years has been synonymous of sterility may offer to KS subjects the ability to father genetically own their child and may have significant psychological consequences in adulthood. In non-mosaic KS, pregnancy have been reported using intracytoplasmic sperm injection (ICSI) with ejaculated spermatozoa. In azoospermic KS men, ICSI using testicular spermatozoa retrieved with micro-testicular extracted sperm (TESE) is the sole mode of treatment that can be offered, besides sperm donation. These issues are addressed here with the aim of assisting physicians in the management of adolescents with KS.
PMID:21217610
Acta Endocrinol (Copenh). 1989 Feb;120(2):129-33.
Gonadal function and ovarian galactose metabolism in classic galactosemia.
Kaufman FR1, Xu YK, Ng WG, Silva PD, Lobo RA, Donnell GN.
Abstract
Evaluation of ovarian steroid secretion, histologic examination of ovarian tissue, and incubation studies with radiolabelled galactose in ovarian tissue slices were performed in a 21-year-old woman with galactosemia and incipient ovarian failure. After exogenous gonadotropin administration in an attempt to achieve fertility, there was no evidence of ovulation by ultrasound; estrogen and androgen production were deficient indicating ovarian unresponsiveness. Histologic examination of the ovary revealed that the ovarian stroma had an increase in fibrous tissue and that a few hyalinized atretic follicles were present with no intermediate or evolving Graafian follicles. After incubation with galactose-1-14C, there was absence of labelled CO2 production and only labelled galactose-1-phosphate was identified as compared to controls in which several labelled intermediates could be seen. The incorporation of galactose into the TCA-insoluble fraction was drastically reduced in the patient compared to controls, suggesting that there may be a deficiency of ovarian galactose-containing glycolipids, glycoproteins and mucopolysaccharides in the galactosemic ovary. Deficiency in the production of galactose containing compounds, or galactose-1-phosphate accumulation or both, may lead to the development of hypergonadotropic hypogonadism seen in women with galactosemia.
PMID:2492704
Eur J Endocrinol. 2018 Mar;178(3):285-294. doi: 10.1530/EJE-17-0862. Epub 2018 Jan 16.
Gonadal function in adult male patients with congenital adrenal hyperplasia.
Engels M1,2, Gehrmann K3, Falhammar H4,5, Webb EA6,7, Nordenström A8, Sweep FC2, Span PN9, van Herwaarden AE2, Rohayem J10, Richter-Unruh A10, Bouvattier C11, Köhler B3, Kortmann BB12, Arlt W6,7, Roeleveld N13, Reisch N14, Stikkelbroeck NMML15, Claahsen-van der Grinten HL16; dsd-LIFE group.
Abstract
CONTEXT:
Current knowledge on gonadal function in congenital adrenal hyperplasia (CAH) is mostly limited to single-center/country studies enrolling small patient numbers. Overall data indicate that gonadal function can be compromised in men with CAH.
OBJECTIVE:
To determine gonadal function in men with CAH within the European ‘dsd-LIFE’ cohort.
DESIGN:
Cross-sectional clinical outcome study, including retrospective data from medical records.
METHODS:
Fourteen academic hospitals included 121 men with CAH aged 16-68 years. Main outcome measures were serum hormone concentrations, semen parameters and imaging data of the testes.
RESULTS:
At the time of assessment, 14/69 patients had a serum testosterone concentration below the reference range; 7 of those were hypogonadotropic, 6 normogonadotropic and 1 hypergonadotropic. In contrast, among the patients with normal serum testosterone (55/69), 4 were hypogonadotropic, 44 normogonadotropic and 7 hypergonadotropic. The association of decreased testosterone with reduced gonadotropin concentrations (odds ratio (OR) = 12.8 (2.9-57.3)) was weaker than the association between serum androstenedione/testosterone ratio ≥1 and reduced gonadotropin concentrations (OR = 39.3 (2.1-732.4)). Evaluation of sperm quality revealed decreased sperm concentrations (15/39), motility (13/37) and abnormal morphology (4/28). Testicular adrenal rest tumor (TART)s were present in 39/80 patients, with a higher prevalence in patients with the most severe genotype (14/18) and in patients with increased current 17-hydroxyprogesterone 20/35) or androstenedione (12/18) serum concentrations. Forty-three children were fathered by 26/113 patients.
CONCLUSIONS:
Men with CAH have a high risk of developing hypothalamic-pituitary-gonadal disturbances and spermatogenic abnormalities. Regular assessment of endocrine gonadal function and imaging for TART development are recommended, in addition to measures for fertility protection.
© 2018 European Society of Endocrinology.
PMID:29339528
J Pediatr Urol. 2017 Aug;13(4):402-413. doi: 10.1016/j.jpurol.2017.06.002. Epub 2017 Jul 3.
Future fertility for individuals with differences of sex development: Parent attitudes and perspectives about decision-making.
Johnson EK1, Rosoklija I2, Shurba A2, D’Oro A2, Gordon EJ3, Chen D4, Finlayson C5, Holl JL6.
Abstract
BACKGROUND:
Children, adolescents, and young adults (children/youth) with differences/disorders of sex development (DSD) face challenges related to future fertility; this may be due to variations in gonadal development, and, for some, gonadectomy performed to reduce the risk of malignancy. Childhood may be the only time for preservation of biological fertility potential for children/youth who undergo gonadectomy or have early gonadal failure. Fertility-related decision-making for these patients is particularly complicated, due to the need for parental proxy decision-making, potential discordance between gender identity and gonadal type, and uncertain future assisted reproductive technologies.
OBJECTIVE:
This study aimed to assess: (1) attitudes regarding future fertility, and (2) healthcare needs for fertility-related decision-making among parents of children/youth with DSD.
STUDY DESIGN:
Semi-structured qualitative interviews about future fertility were conducted with parents of children/youth with DSD. Parents who had never discussed fertility with a healthcare provider were excluded. Grounded theory methodology was used to identify emergent themes and patterns. Demographics and clinical characteristics were assessed via survey and medical chart review.
RESULTS:
Nineteen parents were interviewed (participation rate: 60%, 14 mothers/5 fathers, median patient age at diagnosis 6 months (range 0-192), eight DSD diagnoses). The most common emergent themes are summarized in the Summary Table. Most parents identified fertility as a key concern, both at time of diagnosis and throughout development. Parents expressed difficulty with timing of disclosure about potential infertility to their children. Multiple preferences related to medical decision-making about future fertility and fertility preservation were expressed, including: a desire for step-by-step decision-making, and use of medically vetted information and research to guide decisions.
DISCUSSION:
This qualitative study provided new information about the perspectives of parents of children/youth with DSD regarding future fertility. Previous studies have suggested that the possibility of biological parenthood is important to many individuals with DSD. This study provided an in-depth parental perspective. This is important because many decisions that affect future fertility are made in childhood, and require parents to make decisions on behalf of their children. The study sample was limited in its geographic diversity. Strengths of the study included diversity in age of the child/youth, ethnic backgrounds, and the DSD diagnoses that were represented.
CONCLUSIONS:
Future fertility was a concern for many parents of children/youth with DSD. Parents expressed multiple priorities and preferences related to making difficult fertility-related medical decisions for their children. Many of the study findings could be incorporated into future best practices for discussions about fertility with families of children/youth with DSD.
Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:
Disorder of sex development; Fertility; Fertility preservation; Qualitative research
PMID:28713007
Gravholt CH, Andersen NH, Conway GS, Dekkers OM, Geffner ME, Klein KO, Lin AE, Mauras N, Quigley CA, Rubin K, Sandberg DE, Sas TCJ, Silberbach M, Söderström-Anttila V, Stochholm K, van Alfen-van derVelden JA, Woelfle J, Backeljauw PF; International Turner Syndrome Consensus Group.
Eur J Endocrinol. 2017 Sep;177(3):G1-G70. doi: 10.1530/EJE-17-0430. Review.
PMID:28705803
Transl Pediatr. 2017 Oct;6(4):313-322. doi: 10.21037/tp.2017.07.02.
Fertility counseling and preservation: considerations for the pediatric endocrinologist.
Abstract
Infertility is a distressing consequence of numerous pediatric medical conditions and treatments. The field of pediatric fertility preservation has expanded rapidly over the past decade, and clinical guidelines emphasize the importance of discussing infertility risk and fertility preservation options with patients and families in a timely manner. Understanding the various mechanisms and presentations of fertility issues across diagnoses is imperative to provide counseling to patients and families, and identify individuals who may benefit from fertility preservation. The goals of this manuscript are to outline current fertility preservation options in pediatrics, review populations at-risk for infertility that are seen in pediatric endocrinology, and discuss other important issues related to fertility preservation including ethical considerations.
KEYWORDS:
Infertility; fertility preservation
PMID:29184812
J Endocr Soc. 2017 Jun 1;1(6):638-645. doi: 10.1210/js.2017-00110.
The Ethics of Fertility Preservation for Pediatric Patients With Differences (Disorders) of Sex Development.
Campo-Engelstein L1, Chen D2,3, Baratz AB4, Johnson EK5,6, Finlayson C7,8.
Abstract
Differences (disorders) of sex development are diverse conditions with variations in chromosomal, gonadal, and/or genital development. Fertility potential in this population is variable. Recent investigations into fertility potential in those previously thought to be infertile suggest that the majority may have fertility potential through experimental protocols. Fertility preservation may be more successful if pursued in childhood. As fertility research and techniques advance, it is important to carefully consider pediatric ethical issues specific to this population, including gonadectomy, consent/assent, experimental treatment and false hope, cost and insurance coverage, genetic transmission to offspring, and gender dysphoria.
KEYWORDS:
differences (disorders) of sex development; ethics; fertility preservation
PMID:28944319
Hematology/Oncology
Suzuki N.
Int J Clin Oncol. 2018 Mar 26. doi: 10.1007/s10147-018-1269-4. [Epub ahead of print] Review.
PMID:29582194
Nahata L, Caltabellotta NM, Yeager ND, Lehmann V, Whiteside SL, O’Brien SH, Quinn GP, Gerhardt CA.
Pediatr Blood Cancer. 2018 Mar 14. doi: 10.1002/pbc.27019. [Epub ahead of print]
PMID:29537134
Benedict C, Thom B, Friedman DN, Pottenger E, Raghunathan N, Kelvin JF.
Support Care Cancer. 2018 Feb 1. doi: 10.1007/s00520-017-4006-z. [Epub ahead of print]
PMID:29387996
Levine JM, Whitton JA, Ginsberg JP, Green DM, Leisenring WM, Stovall M, Robison LL, Armstrong GT, Sklar CA.
Cancer. 2018 Mar 1;124(5):1044-1052. doi: 10.1002/cncr.31121. Epub 2018 Jan 16.
PMID:29338081
Balduzzi A, Dalle JH, Jahnukainen K, von Wolff M, Lucchini G, Ifversen M, Macklon KT, Poirot C, Diesch T, Jarisch A, Bresters D, Yaniv I, Gibson B, Willasch AM, Fadini R, Ferrari L, Lawitschka A, Ahler A, Sänger N, Corbacioglu S, Ansari M, Moffat R, Dalissier A, Beohou E, Sedlacek P, Lankester A, De Heredia Rubio CD, Vettenranta K, Wachowiak J, Yesilipek A, Trigoso E, Klingebiel T, Peters C, Bader P.
Bone Marrow Transplant. 2017 Oct;52(10):1406-1415. doi: 10.1038/bmt.2017.147. Epub 2017 Jul 24.
PMID: 28737775
Gynecology
Update on primary ovarian insufficiency in adolescents.
Gordon CM, Kanaoka T, Nelson LM.
Curr Opin Pediatr. 2015 Aug;27(4):511-9. doi: 10.1097/MOP.0000000000000236. Review.
PMID:26087426
Funny 😉
Int J Impot Res. 2004 Oct;16(5):385-8.
Sexual life in Pharaonic Egypt: towards a urological view.
Abstract
Sex is a basic human need, common to all people at all times. It is evident that the ancient Egyptians were real human beings, not only a people who built massive pyramids and made mummies of their dead. The ancient Egyptians had a rich and varied sexual life, which they found an opportunity to describe in words and pictures. As in the other early primitive civilizations, erotic matters were of prime importance and became an integral part of life. In Pharaonic times, the Egyptians described impotence and recorded several methods to increase the sexual power. In the present paper, we will shed light on some aspects of the sexual life in ancient Egypt that may be interesting to the urologists, including ancient Egyptian concepts of sex and erotic matters, their own way of treatment of impotence and Min, the Egyptian fertility God.
PMID:
15475944