Elena's Legacy. Texts written by Elena, excerpts from texts she liked, her artworks.

Tuesday, March 20, 2018

If a Couple Can’t Conceive

Late marriages and biological clock are frequent factors. Environmental toxins and previous surgery may also play a role at times, but about 1 out of every 12 prospective mothers in the United States has been reported unable to conceive in at least a year of trying. This is despite the fact that more than half those women already had at least one child. For couples frustrated by such fortunes, “every menstrual period is like a funeral,” in the words of one disappointed woman. “While the New England Journal of Medicine reports that medically assisted reproduction can success in more than 80 percent of the cases where it is attempted, few couples in fertility programs succeed because of financial strain and emotional fatigue from the process.

In some cases the causes of the infertility are clear-cut. Certain women do not release enough eggs and can be treated with a fertility drug such as Clomid (a scare linking Clomid to ovarian cancer turned out to be a false alarm, according to the American Society for Reproductive Medicine, but several ongoing studies are looking into its safety. At other ties couples simply need to adjust their schedules to conceive.

But many of the tests and treatments are much more expensive and demanding. For example, a post-coital test is commonly given to test the sperm’s ability to make its way to the fallopian tube, where fertilization usually occurs, and requires a couple to have sex just before the woman ovulates, which may be in the middle of the work week. Before washing, the woman must quickly have a pelvic exam at her doctor’s, wherever that happens to be. “When it is all over, neither you not your doctor really has a very good idea whether or not your eggs can be fertilized by your husband’s sperm,” writes fertility expert Dr. Sherman Silber in his book, How to Get Pregnant with the New Technology.

A good rule of thumb in judging a treatment’s efficacy, according to Joyce Zeitz of the Fertility Institute in Birmingham, Alabama, is, after following a procedure fox six full cycles without success – try something else.

The last resort for many... Photo: Elena

The last resort for many couples is medically assisted fertilization procedures, which have only a one-in-seven chance of producing a baby on one try, but have success rates of over 80 percent when six or seven attempts are made. Women over 40 typically experience the most difficulty.

If a Couple Can’t Conceive

The techniques include in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT). With GIFT, the sperm and egg are placed in the fallopian tubes, where fertilization occurs normally. For IVF and ZIFT, the fertilization of the eggs by the sperm takes place in the laboratory and the fertilized egg is placed directly into the woman’s uterus for IVF, or her fallopian tubes for ZIFT.

In all cases the woman must have daily hormone injections to control her body’s reaction by stimulating egg production, prompting the movement of the eggs out of the fallopian tubes and others to supply normal pregnancy hormones so that a miscarriage does not occur.

Some states require insurance companies to cover such procedures, which can cost much a try. Most successful treatment occur by the fourth attempt, and most clinics limit patients to a total of eight tries. Often patients only try once, however.

Finding a Fertility Doctor

What once seemed like simple body chemistry can become an overwhelming technical nightmare for millions of couples faced with infertility. When looking for a doctor to guide you through this maze, consider the following:

Resolve: A nonprofit infertility organization with member chapters and support groups around the country. Resolve collects data on doctors, including a physician referral list of those certified in reproductive endocrinology. The organization also surveys doctors about the area of expertise and type of patient treated.

American Society for Reproductive Medicine: A professional organization for fertility doctors and clinics. Serves as a clearinghouse for information on most U.S. Fertility treatment programs. Publishes annual reports of both the number of pregnancies in each program and the number of live births recorded in these programs. The ASRM recommends that before you select a fertility specialist or program, it is always a good idea to consult with other couples who have participated in the program to see what concerns they might have

Finding a Fertility Doctor

Treating Rh Sensitization

What to do when the fetus is allergic to its mother’s blood

When a pregnant woman’s blood lacks a protein called the Rh factor which helps trigger certain of the body’s immune responses, and the father’s blood contains that protein, the fetus’ blood can end up being incompatible with the mother’s blood. When that happens, the mother’s body may act as if it were allergic to the fetus and produce antibodies that attack the fetus’s red blood cells, resulting in anemia.

Known as hemolytic or Rh disease, the condition can be serious enough to cause death in the fetus or newborn. The condition occurs in about one in twenty pregnancies.

The best way to prevent this reaction is to inject the mother with a blood product called Rh immunoglobulin (Rhlg) before her body has had an allergic reaction to the fetus’s blood. Such a reaction, which is also known as sensitization, can occur any time the mother’s and fetus’s blood mix. (One prime chance for this to happen is during amniocentesis).

A protected lady. Photo by Elena

The protection from Rhlg usually lasts about twelve weeks, which means that the treatment may need to be repeated several times during a pregnancy.

Should sensitization occur and antibodies from the mother begin to attack the fetus’s blood, there is nothing Rhlg injections can do to remove these antibodies. The doctor will have to monitor the level of antibodies closely, and to conduct special tests on the fetus if too many antibodies are detected.

If anemia is found, the fetus may require a blood transfusion in the uterus, or if the mother is close enough to term, early delivery and treatment in an intensive-care nursery.

Monday, March 19, 2018

The Mineral Minder

Minerals help your body form bones, regulate the heart, and synthesize enzymes, but experts say too many, or too few, can lead to heart disease, diabetes, or even cancer. Here are the FDA's daily values and where to get them.

Calcium

Daily value - 1 gram.

1 cup hard ice cream - 0.18 g

1 cup nonfat milk - 0.3 g

2 oz. Cheddar cheese - 0.41 g

8 oz. Nonfat yogurt - 0.45 g

What it does: Helps form strong bones and teeth. Helps regulate heartbeat, muscle contractions, nerve function, and blood clotting.

What it may do: May reduce the risk of high blood pressure, high cholesterol, and colon cancer.

Food sources: Milk, cheese, butter and margarine, green vegetables, legumes, nuts, soybean products, hard water.

Supplementation: Most Americans don't consume enough calcium, but megadoses are not recommended. High intakes may cause constipation and increase some men's risk of urinary stones.

Iron

Daily Value – 18 milligrams.

1 slice whole wheat bread - 1 mg

3 scrambled eggs – 2.1 mg

3 oz. Lean sirloin steak, broiled - 2.6 mg

3 oz. Fried liver – 5.3 mg

1 packet instant oatmeal - 6.7 mg.

What it does: Vital in forming hemoglobin (which carries oxygen in blood) and myoglobin (in muscle).

Food sources: Red meat, poultry, liver, eggs, fish, wholegrain cereals, and breads.

Supplementation: Often (but not always) recommended for dieters, endurance athletes, strict vegetarians, menstruating women, pregnant women, infants, and children. Large doses may damage the heart, liver, and pancreas.

Energy saves the world. Photo by Elena

Phosphorus

Daily value – 1 gram.

6 scallops – 0.2 g

1 cup nonfat milk - 0.25 g

3 oz. Broiled trout - 0.26 g

1 cup tuna salad - 0.28 g

1 cup low-fat cottage cheese.

What it does: Helps form bones, teeth, cell membranes, and genetic material. Essential for energy production.

Food sources: Nearly all foods, including red meat, poultry, liver, milk, cheese, butter and margarine, eggs, fish, wholegrain cereals and breads, green and root vegetables, legumes, nuts, and fruit.

Supplementation: Not recommended. Deficiencies in Americans are virtually unknown. Excessive intake may lower blood calcium level.

Potassium

Daily value - 3,500 milligrams.

1 cup nonfat milk - 406 mg

1 banana - 451 mg

1 baked potato, with skin - 844 mg

1 cup cooked spinach - 839 mg.

What it does: Needed for muscle contraction, nerve impulses, and function of heart and kidneys, Aids in regulation of water balance in cells and blood.

What it may do: May fight osteoporosis and help lower blood pressure.

Food sources: Unprocessed foods such as fruits, vegetables, and fresh meats.

Supplementation: Not usually recommended. Take only under a doctor's supervision.

Iodine

Daily Value - 150 micrograms.

1 oz. Cheddar cheese - 12 mcg

1 tsp iodized salt - 400 mcg.

What it does: Necessary for thyroid gland function and thus normal cell metabolism. Prevent goiter (enlargement of thyroid).

Food sources: Milk, cheese, butter and margarine, fish, whole-grain cereals and breads, iodized table salt.

Supplementation: Not recommended. Widely dispersed in the food supply so even if you eat little iodized salt, you probably get enough iodine.

Magnesium

Daily value - 400 milligrams.

1 slice pumpernickel bread - 22 mg

1 tbsp. Peanut butter - 28 mg

1/2 cup peas - 31 mg.

1 baked potato - 55 mg

1/2 cup cooked spinach - 79 mg

What it does: Aids in bone growth, basic metabolic functions and the functioning of nerves and muscles, including the regulation of normal heart rhythm.

Food source: Milk, fish, whole-grain cereals and breads, green vegetables, legumes, nuts, and hard water.

Supplementation: Not usually recommended. Deficiency is rare.

Zinc

Daily value – 15 miligrams.

8 oz lowfat fruit yogurt – 1.52 mg

1 cup boiled lentils – 2.5 mg

3.5 oz. Roast turkey, dark – 4.4. mg

What it does: Stimulates enzymes needed for cell division, growth, and repair (wound healing). Helps immune system function properly. Also pays a role in acuity of taste and smell.

Food sources: Red-meat, fish, seafood, eggs, milk, whole-grain cereals and breads, legumes.

Supplementation: Not recommended, except by a doctor for the few Americans who have low zinc levels.

Copper

Daily Value - 2 milligrams.

2/3 cup seedless raisins – 0.31 mg

1 oz. Dry roasted pistachios – 0.34 mg

½ cup boiled mushrooms – 0.39 mg.

What it does: Helps in formation of red blood cells. Helps keep the bones, blood vessels, nerves, and immune system healthy.

Food sources: Red meat, poultry, liver, fish, seafood, whole-grain cereals and breads, green vegetables, legumes, nuts, raisins, mushrooms.

Supplementation: Not recommended. A balanced diet includes enough copper

Examining Babies Before Birth

Ultrasound is under fire, but there are other important new tests

For years, ultrasound testing has been as much a part of a pregnant woman’s experience as stepping on the scale at the ob-gyn’s. The test to diagnose birth defects is routinely given to over two-thirds of all mothers-to-be. But some studies show that the benefits of ultrasound may have been oversold.

Along with detecting anatomical abnormalities such as heart defects in the fetus, ultrasound has been used to determine a fetus’s age, rate of growth, heart and breathing rate, and position of the fetus and placenta within the womb. It is also a way of establishing the sex of the fetus, gauging the amount of amniotic fluid in the uterus, and determining whether there is more than one child on the way.

The new study by researchers at the University of Missouri at Columbia divided 15,500 women with low-risk pregnancies into two groups – those who had two ultrasound tests during their pregnancies, at four months and at seven months, and those who either didn’t have the test or had it only when there was a specific medical need.

The six-year study, the largest ever to examine prenatal testing, found that there was no difference between the two groups in the incidence of premature babies, lung failure, spinal chord injury, infection, problem deliveries, or prolonged hospital stays. What’s more, both groups had the same rate of birth defects – 5%. The study’s conclusion: Although ultrasound testing, or a sonogram as it is also known, detects more fetal abnormalities, getting the test doesn’t change the odds of delivering a baby with birth defects because most birth defects are not detected within 24 weeks of the onset of pregnancy, which is the cutoff time for an abortion in most states. “Our study shows that most normal pregnant women will have a healthy baby regardless of ultrasound screening,” says the study’s lead investigator, Dr. Bernard G. Ewigman.

While the routine use of ultrasound is being called into question, other prenatal tests for birth defects and genetic disorders have never shown more potential. They include amniocentesis, alpha-protein testing, and the latest procedure – percutaneous umbilical blood sampling, or PUBS.

The tests are regularly recommended for: women 35 and over; women with a family history of genetic disorders; women who have had a previous child with a birth defect; women who have been exposed to a virus known to cause birth defects; women who ingest substances such as alcohol or certain medicines during pregnancy or at the time of conception; and women who were insulin-dependent prior to pregnancy. A breakdown of the procedures:

Amniocentesis: The procedure can be done as early as the 12th and as late as the 18th week of pregnancy. The process requires that a needle be inserted into the woman’s abdomen and amniotic fluid withdrawn so that it can be tested. Since the genetic makeup of the cells in the amniotic fluid are the same as those of the fetus, the cells can be tested for several chromosonal abnormalities, including those indicating the presence of Down syndrome, a form of severe mental retardation, and spina bifida, a central nervous system disorder that prevents the spinal column from developing fully.

A baby, a sculpture in Toronto down-town. Photo by Elena

With amniocentesis, there is a 1 in 200 chance of miscarriage. Some women have cramps after the test, and, in rare cases, there is a chance that the fetus will be injured, according to the American College of Obstetricians and Gynecologists. And test results, which take two to four weeks, may show an inaccurate “abnormal” reading if the fetus is older or younger than had been estimated.

Alpha-Fetoprotein: This involves a simple blood test given to women who are 15 to 18 weeks pregnant. Also known as maternal seru screening, the simple test uses blood taken from a woman’s arm to measure the amount of alpha-fetoprotein – a protein produced by the fetus – in the mother’s blood. Unusually low levels of the chemical are linked to chromosome disorders. When levels of the chemical are higher than normal, it can mean that the fetus has a neural tube defect such as spina bifida. But alpha-fetoprotein levels can also be elevated if the fetus is merely older than originally thought, or if there are twins. When alpha-fetoprotein levels are suspicious, the test is usually followed by a second test such as amniocentesis.

Pubs: The percutaneous umbilical blood sampling procedure, introduced in 1983, uses blood drawn from the fetus to determine if it has chicken pox, anemia, a form of pneumonia known as cytomegalovirus, or toxoplasma gondii, a potentially fatal parasite. The test can also be used to identify several genetic defects, including Down syndrome and spina bifida. The process takes about five minutes, unless a blood problem is found in the fetus and a transfusion is required. Test results can be processed quickly – 2 days as opposed to at least 10 for amniocentesis, although the risk of fetal death from the test is slightly higher for PUBS – 1 to 1.5 percent as opposed to a half of 1 percent for amnio. Since amnio can be done as early as the twelfth week of pregnancy, and PUBS can’t be done until the 17th or 18th week, amnio remains the primary test for identifying potential genetic abnormalities.

Prenatal Screening Procedures

In an uncomplicated pregnancy, expect about a dozen doctor visits

First visit – Blood tests: To check the woman’s blood group and sometimes, to check for presence of hepatitis B virus, which might be transmitted to the baby. – Cervicalsmear test: To test for an early cancer of the cervix (if a test has not been performed recently). Also called a Pap smear.

First visit and throughout the pregnancy – Blood tests: To check for anemia in the woman, and in women with Rh-negative blood groups, to look for the presence of Rhesus antibodies. – Urine test: To check for proteinuria, which could indicate a urinary tract infection or preeclampsia. – Blood and urine test: To check for diabetes mellitus. – Blood pressure check: To screen for hypertension, which interferes with blood supply to the placenta and is sign of preeclampsia.

First visit and after any infection – Blood tests: To screen for rubella, which can cause defects in the baby, and fos syphilis and HIV (the AIDs virus) which can also be passed on.

First 12 weeks – Chorionic villus sampling: May be performed if there is a risk of certain genetic (inherited) disorders being passed on.

16 to 18 weeks – Ultrasound scanning: Is carried out to date the pregnancy accurately and to detect any abnormalities present in the fetus. – Amniocentesis: Carried out on older women and those with spina bifida or Down’s syndrome to detect possible abnormalities in the fetus. – Blood test: In some cases, the amount of alpha-fetoprotein in the blood is tested to determine whether the baby has spina bifida. – Fotoscopy and fetal blood sampling: In some cases, these are carried out if there is doubt about the normality of the baby.

High-risk or overdue pregnancies – Blood and urine tests: To assess placental function and fetus health. – Electronic fetal monitoring: To check on the fetal heart beat. – Ultrasound scanning: Extra scans may be recommended to assess fetal growth and development, location of placenta, amount of amniotic fluid.

Sunday, March 18, 2018

Neural Correlates of Love

The Neural Correlates of Love

Neural Substrates of Love

Few subjects have attracted as much attention as romantic love. However, the way romantic love is perceived in different cultures differs greatly. For example, in some countries people do not believe in romantic love, calling it instead an intoxication. Regardless, the purpose of the present short essay is to outline the neural correlates of love. As one knows from neuroscience, the human brain is an incredibly complex object mostly active in its entirety at any one time. But, using neuroimaging studies, scientists have been able to pinpoint the neural correlates of certain behaviours and even thought processes, such as the emotion and state of profound affection and attachment.

DeWall et al. (2011) point out that the need to belong is basic and common to all humans. Nevertheless, the particular way in which to satisfy that need varies among individuals. Using neuroimaging techniques and a simulated social exclusion paradigm, the authors show that different attachment styles (the reader is referred to Mary Ainsworth’s theory on attachment styles) result in distinct patterns of neural activation. Thus, the dorsal anterior cingulate cortex and the anterior insula, regions associated with rejection, were more active in individuals exhibiting attachment anxiety, than in participants showing attachment avoidance. Also, avoidance resulted in higher activity in the ventrolateral prefrontal cortex than did anxiety.

Facial expression are recognized worldwide. Smiling and greeting gestures (although unlike emotional expression these may vary) are interpreted by many as a positive sign of acceptance. However, species differ in their monogamous versus polygamous mating preferences. Image: Copyright © Elena

But what about romantic love? On the one hand, Xu et al. (2011) remind the reader of the argument that romantic love is a relatively recent invention of the Western world. The researchers also report that people from other cultures often associate the feeling with negative events, such as heartbreak and unwanted intrusive thoughts. Notwithstanding, to pinpoint neural correlates, the study compared brain activations in students from China, Beijing during infatuation. So, it turned out that relationship satisfaction at the beginning at the beginning correlates with union fulfillment after 18 months. As they themselves explained, their work was the first to include such a follow up. Cortical regions activated were consistent with the usual reward and motivation brain circuitry, and thus a detailed review is excluded from the present short essay.

On the other hand, Acevedo et al. (2011) examined neural substrates of prolonged marriages. Again, some opinions adavacned in the community, suggest that passionate love is either completely false or, at best, temporary. Once more, neuronal reward circuits were activated. Participants looking at a picture of a long-term spouse, for whom they still expressed strong feelings, showed activations in dopaminergic (reward) networks, mainly the ventral tegmental are, globus pallidus, substantia nigra, Raphe nucleus, thalamus, insular cortex, dorsal striatum, as well as, the posterior and anterior cingulate cortices.

Finally, in another neuroimaging study (fMRI – functional Magnetic Resonance Imaging), Stoessel et al. (2011) compared the neural states of people happily and unhappily in love. They found that brain activity was decreased in requited versus jilted or separated lovers. The regions exhibiting reduced BOLD (Blood Oxygen Level Dependent) changes were: the frontal lobe, anterior and posterior cingulate cortices, insula, precuneus and caudate nucleus (all regions associated with reward and emotional circuitry). Additionally, the insula is believed to likewise respond to maternal love. The authors hypothesize that happy partners experienced the stimuli (ex.: photography of beloved) as more rewarding than their dissatisfied counterparts.

What is love? Religion may provide some answers. Albeit a different kind than that experienced with partners, love may be likewise directed towards inanimate objects. For instance, persons will often name the emotion when expressing their admiration for material goods or concepts. Psychedelic art. Image: Copyright © Elena

References:

Acevedo, B. P., Aron, A., Fisher, H. E. & Brown, L. L. (2011). Neural correlates of long-term romantic love. Social Cognitive and Affective Neuroscience (SCAN), Advance Access (January 5): 1-15.

DeWall, C. N., Masten, C.L., Powell, C., Combs, D., Schurtz, D. R. & Eisenberger, N. I. (2011). Do neural responses to rejection depend on attachment style? An fMRI study. Social Cognitive and Affective Neuroscience (SCAN), Advance Access (July 14): 1-9.

Stoessel, C., Stiller, J., Bleich, S., Boensch, D., Doerfler, A., Garcia, M., Richter-Schmidinger, T., Kornhuber, J. & Forster, C. (2011). Differences and similarities in neuronal activities of people being happily and unhappily in love: A functional magnetic resonance imaging study. Neuropsychobiology, 64: 52-60.

Xu, X., Aron, A., Brown, L., Cao, G., Feng, T. & Weng, X. (2011). Reward and motivation systems: A brain mapping study of early-stage intense romantic love in Chinese participants. Human Brain Mapping, 32: 249-257.