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Integrins as markers of endometrial receptivity
THURSDAY,
12 mediate oestrogen action whereas IGF-II gene expression is associated with endometrial differentiation. All IGFBPs are expressed in human endometrium, the most abundant being IGFBP-1. It is a major protein product of non-pregnant endometrium during the mid-late secretory phase and occurs in abundance in decidua. Its roles as an IGF-binding protein and as a trophoblast integrin ligand suggests that it may have multiple roles in endometrial development and in interactions between the decidua and the invading trophoblast. Available evidence suggest multiple roles for IGFBPs in supporting implantation, regulating the extent of decidualisation, modulating local events of vascular IGFs, and regulating uterine muscular growth. Better understanding of the IGF family and its function will aid our understanding of the mechanisms involved in implantation.
RM4.04.03 INTEGRINS AS MARKERS OF ENDOMETRIAL RECEmIVITY Bruce A. Lessey PhD, MD, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University North Carolina, Chapel Hill, NC 27599
of
Endometrial receptivity is the culmination of complex temporal and spatial modifications by the endometrium that is regulated by ovarian steroids. Synchronous development of the endometrium and the embryo allows for precise timing of implantation, a feature that is necessary for successful pregnancy. As part of evaluation of the infertile couple, it has been reported that numerous cases of sterility may be due to an inadequate endometrium. These include luteal phase defect (LPD), endometriosis, hydrosalpinges, and possibly polycystic ovarian syndrome (PCOS). The biomarkers that have used to address such defects includes the integrins which are heterodimeric glycoproteins made up of CIand fl subunits. Recently, other markers have been suggested including LIF, HB-EGF, HOXA10 and calcitonin. We are now in the process of correlating the usefulness of these markers alone or in combination with other markers such as integrins. The identification of true defects in uterine receptivity will likely lead to improvements in diagnosis and treatment of the infertile couple and enhance our ability to apply Assisted Reproductive Technologies (ART) to improve success rates and outcome. Much work still needs to be done in order to validate the use of biomarkers for this purpose and prospective randomized trials need to be designed that can ascertain the best way to use such biomarkers.
ss4.05
REACHING THE UNREACHABLE IN AFRICA: HOW CAN WE PROVIDE NEEDED REPRODUCTIVE HEALTH
ss4.05.01 INTRODUCTION TO THE SESSION Dr. Florence Mannuvu, Session Chair, Nairobi, Kenya This is an overview paper introducing the subject theme of the panel. The paper highlights the basic facts about women’s health in Africa. It poses the questions to be addressed by the panelists, namely: Who are the unreachable, the clients, the medical workers or the health institutions? Do the health services available respond to the needs of the community? What choices do the communities have when seeking health services? What health policies need to be in place in order to address the needs of those hard to reach? The paper briefly discusses the reasons behind the social environments that stratify communities in Africa, and suggests ways on how health policies might change in order to be responsive to the needs of the people they purport to serve. It examines the disease burden in RH in different social situations and addresses the gender disparities that deny women the enjoyment of the highest attainable standard of health. Finally the paper outlines how women’s health advocates could work in collaboration and in partnership with the health consumers and other stake holders in order to be effective in reaching the unreachable.
SEPTEMBER
ss4.05.02 THE FUTURE ROLE OF HEALTH MINISTRIES Eunice Brookman-Amissah, Ambassador of Ghana to the Netherlands, Past Minister of Health. Ghana Health service development in many African countries has been and continues to be state-led and centrally planned. Two common offshoots of this pattern of development are the undue bias towards cities and big towns; and the lack of recognition of the unique contribution of stakeholders other than Ministries of Health. Cities, big towns, and villages along major and trunk roads tend to be better served with health services than rural communities. Health service coverage in rural areas is either low or non-existent. This is well known and documented. Less well known are the increasing numbers of unreachable women in big towns and cities. As a result of economic migration, big cities attract a growing army of uneducated or poorly educated unskilled young people, who even though they work in cities, live in slums on the outskirts of these cities. Among this population, sexually transmitted disease, the use of abortion as a means of contraception, and repeated unwanted pregnancy are rampant and yet this increasing group of unreachables attract very little attention in the design of health services. An exciting development over the last two decades in developing countries has been the increasing contribution of the International donor community, the NGO and Private sector and the Research community in health sector development. In many African countries these groups contribute more than half the public health expenditure. The NGO communities with the Private for profit group together probably reach a larger proportion of the population than the Ministries of Health. Yet the role of the Ministries of Health have changed very little to reflect this new reality. These vital partners are still seen as competitors, are not included in the formulation of sector policies and are more or less left to continue to focus their efforts in isolated projects and areas. The limitations of Ministries of Health are not well known and there is no real dialogue between the different partners in the health sector. Funding for health services is scarce and in the main not efficiently or equitably utilized. This paper will examine how Ministries or Health can enter into new Partnership with other stakeholders to develop a holistic programme to meet the dual challenges of expanding health services to the unreached and also improving the quality of existing services.
ss4.05.03 THE ROLE OF PROFESSIONAL ORGANIZATIONS Dr. Fridav Okonofua, Secretary General, Society of Gynaecology and Obstetrics of Nigeria, and Professor of Obstetrics and Gynaecology, University of Benin, Nigeria. Several countries in sub-Saharan Africa are characterized by poor reproductive health with high rates of maternal mortality, unsafe abortion, sexually transmitted diseases including HIV, and infertility. A major factor that perpetuates the poor reproductive health in many of these countries is the limited access to reproductive health information and services of several disadvantaged populations. The most badly affected are adolescents, poor women who live in rural and suburban areas, and women and men with limited or no education. This paper describes the role that professional organizations in medicine and the social sciences can play in creating access to qualitative health care for a large segment of under-served populations in many African countries. Professional organizations can develop technical and ethical standards for the practice of reproductive health in Africa that would encourage increased utilization of services. They can foster relevant reviews of curricular and training for the widespread dissemination of modern concepts in reproductive health to practitioners across Africa. They can function as trainers of junior and medium level manpower in the formal and informal sector, and engender systematic integration of traditional and orthodox systems of reproductive health care. Finally, professional organizations can serve as advocates for improved health care delivery and costs alleviation, and encourage the enunciation of laws and statutes that would improve access to reproductive health for large populations in Africa. Clearly, the large burden of reproductive ill-health in Africa is a major professional challenge to practitioners in Africa. A measure of the success of professional organizations in Africa in the coming decades is an evaluation of the way in which they contribute to improving access to reproductive health to the large segment of underserved populations in the continent.
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12 mediate oestrogen action whereas IGF-II gene expression is associated with endometrial differentiation. All IGFBPs are expressed in human endometrium, the most abundant being IGFBP-1. It is a major protein product of non-pregnant endometrium during the mid-late secretory phase and occurs in abundance in decidua. Its roles as an IGF-binding protein and as a trophoblast integrin ligand suggests that it may have multiple roles in endometrial development and in interactions between the decidua and the invading trophoblast. Available evidence suggest multiple roles for IGFBPs in supporting implantation, regulating the extent of decidualisation, modulating local events of vascular IGFs, and regulating uterine muscular growth. Better understanding of the IGF family and its function will aid our understanding of the mechanisms involved in implantation.
RM4.04.03 INTEGRINS AS MARKERS OF ENDOMETRIAL RECEmIVITY Bruce A. Lessey PhD, MD, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University North Carolina, Chapel Hill, NC 27599
of
Endometrial receptivity is the culmination of complex temporal and spatial modifications by the endometrium that is regulated by ovarian steroids. Synchronous development of the endometrium and the embryo allows for precise timing of implantation, a feature that is necessary for successful pregnancy. As part of evaluation of the infertile couple, it has been reported that numerous cases of sterility may be due to an inadequate endometrium. These include luteal phase defect (LPD), endometriosis, hydrosalpinges, and possibly polycystic ovarian syndrome (PCOS). The biomarkers that have used to address such defects includes the integrins which are heterodimeric glycoproteins made up of CIand fl subunits. Recently, other markers have been suggested including LIF, HB-EGF, HOXA10 and calcitonin. We are now in the process of correlating the usefulness of these markers alone or in combination with other markers such as integrins. The identification of true defects in uterine receptivity will likely lead to improvements in diagnosis and treatment of the infertile couple and enhance our ability to apply Assisted Reproductive Technologies (ART) to improve success rates and outcome. Much work still needs to be done in order to validate the use of biomarkers for this purpose and prospective randomized trials need to be designed that can ascertain the best way to use such biomarkers.
ss4.05
REACHING THE UNREACHABLE IN AFRICA: HOW CAN WE PROVIDE NEEDED REPRODUCTIVE HEALTH
ss4.05.01 INTRODUCTION TO THE SESSION Dr. Florence Mannuvu, Session Chair, Nairobi, Kenya This is an overview paper introducing the subject theme of the panel. The paper highlights the basic facts about women’s health in Africa. It poses the questions to be addressed by the panelists, namely: Who are the unreachable, the clients, the medical workers or the health institutions? Do the health services available respond to the needs of the community? What choices do the communities have when seeking health services? What health policies need to be in place in order to address the needs of those hard to reach? The paper briefly discusses the reasons behind the social environments that stratify communities in Africa, and suggests ways on how health policies might change in order to be responsive to the needs of the people they purport to serve. It examines the disease burden in RH in different social situations and addresses the gender disparities that deny women the enjoyment of the highest attainable standard of health. Finally the paper outlines how women’s health advocates could work in collaboration and in partnership with the health consumers and other stake holders in order to be effective in reaching the unreachable.
SEPTEMBER
ss4.05.02 THE FUTURE ROLE OF HEALTH MINISTRIES Eunice Brookman-Amissah, Ambassador of Ghana to the Netherlands, Past Minister of Health. Ghana Health service development in many African countries has been and continues to be state-led and centrally planned. Two common offshoots of this pattern of development are the undue bias towards cities and big towns; and the lack of recognition of the unique contribution of stakeholders other than Ministries of Health. Cities, big towns, and villages along major and trunk roads tend to be better served with health services than rural communities. Health service coverage in rural areas is either low or non-existent. This is well known and documented. Less well known are the increasing numbers of unreachable women in big towns and cities. As a result of economic migration, big cities attract a growing army of uneducated or poorly educated unskilled young people, who even though they work in cities, live in slums on the outskirts of these cities. Among this population, sexually transmitted disease, the use of abortion as a means of contraception, and repeated unwanted pregnancy are rampant and yet this increasing group of unreachables attract very little attention in the design of health services. An exciting development over the last two decades in developing countries has been the increasing contribution of the International donor community, the NGO and Private sector and the Research community in health sector development. In many African countries these groups contribute more than half the public health expenditure. The NGO communities with the Private for profit group together probably reach a larger proportion of the population than the Ministries of Health. Yet the role of the Ministries of Health have changed very little to reflect this new reality. These vital partners are still seen as competitors, are not included in the formulation of sector policies and are more or less left to continue to focus their efforts in isolated projects and areas. The limitations of Ministries of Health are not well known and there is no real dialogue between the different partners in the health sector. Funding for health services is scarce and in the main not efficiently or equitably utilized. This paper will examine how Ministries or Health can enter into new Partnership with other stakeholders to develop a holistic programme to meet the dual challenges of expanding health services to the unreached and also improving the quality of existing services.
ss4.05.03 THE ROLE OF PROFESSIONAL ORGANIZATIONS Dr. Fridav Okonofua, Secretary General, Society of Gynaecology and Obstetrics of Nigeria, and Professor of Obstetrics and Gynaecology, University of Benin, Nigeria. Several countries in sub-Saharan Africa are characterized by poor reproductive health with high rates of maternal mortality, unsafe abortion, sexually transmitted diseases including HIV, and infertility. A major factor that perpetuates the poor reproductive health in many of these countries is the limited access to reproductive health information and services of several disadvantaged populations. The most badly affected are adolescents, poor women who live in rural and suburban areas, and women and men with limited or no education. This paper describes the role that professional organizations in medicine and the social sciences can play in creating access to qualitative health care for a large segment of under-served populations in many African countries. Professional organizations can develop technical and ethical standards for the practice of reproductive health in Africa that would encourage increased utilization of services. They can foster relevant reviews of curricular and training for the widespread dissemination of modern concepts in reproductive health to practitioners across Africa. They can function as trainers of junior and medium level manpower in the formal and informal sector, and engender systematic integration of traditional and orthodox systems of reproductive health care. Finally, professional organizations can serve as advocates for improved health care delivery and costs alleviation, and encourage the enunciation of laws and statutes that would improve access to reproductive health for large populations in Africa. Clearly, the large burden of reproductive ill-health in Africa is a major professional challenge to practitioners in Africa. A measure of the success of professional organizations in Africa in the coming decades is an evaluation of the way in which they contribute to improving access to reproductive health to the large segment of underserved populations in the continent.
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