Carrie Buck was raped by a nephew of her adopted parents in Virginia at the age of 17. In an attempt to cover up the assault, her family committed her to the Lynchburg State Colony for Epileptics and Feebleminded. Soon later, the colony realized that Buck was pregnant with her assailant's child. At the colony, Dr. Albert Sidney Priddy examined Buck and deemed her to be unfit due to her feeblemindedness. Priddy recommended her for sterilization. This was brought to the courts in order to sanctify the sterilization order. Buck's biological mother was labeled as feebleminded, so Buck was used as "proof" that feeblemindedness was hereditary and sterilization was necessary for the common good. The Supreme Court voted 8-1 stating that being feebleminded led to promiscuity and sterilization was justified. Buck was then sterilized under the Virginia 1924 compulsory sterilization statue. [ 44 ]


The Supreme Court case of  Buck v. Bell  confirmed the constitutionality of sterilization of the feebleminded and "unfit". This case solidified that involuntary sterilization was not cruel or unusual punishment and it did not violate due process, but rather it helped the good of the country as a whole. Individual rights of reproduction were now able to be taken for the public good. Cases of involuntary sterilization rose significantly after this case in 1927. [ 44 ]


In the 1970s a group of Chicana women brought up a federal class action lawsuit against a hospital in Los Angeles County regarding their sterilizations. [ 45 ]  Women in the class were allegedly given false information regarding sterilization. [ 45 ]  The titular plaintiff, Dolores Madrigal, a Latina woman, was allegedly told several times by a medical professional that sterilization could be reversed. [ 45 ]   Other women involved in the case signed consent forms for their sterilizations because they were allegedly sedated or manipulated by doctors and medical staff. [ 45 ]   A common reason for forcing the sterilizations of these women was apparently the burden that their future children would be to "taxpayers". [ 45 ]  Many of the women did not discover that they had been sterilized until they visited a doctor. [ 45 ]


The judge deciding  Madrigal  held that it was a part of a doctor's practice to provide sterilizations to these women based upon their cultural backgrounds. [ 45 ]  The judge, Judge Curtis, stated in his ruling that miscommunication between the doctors and the women, rather than malice, resulted in the sterilizations. [ 45 ]  In the words of his final comment, the judge stated, "One can sympathize with them for their inability to communicate clearly, but one can hardly blame the doctors for relying on these indicia of consent which appeared to be unequivocal on their face and which are in constant use in the medical center." [ 45 ]


In 1979, the practice was abolished in California. [ 29 ]  It is estimated that approximately 20,000 women were sterilized in total. [ 46 ]


The 2021-22 state budget package included funding $7.5 million for the California Forced or Involuntary Sterilization Compensation Program legislation, [ 47 ]  to begin Jan. 1, 2022, administered by the California Victim Compensation Board (CalVCB), for survivors of state-sponsored sterilization 1909 through 1979 [ 48 ]  and survivors of involuntary sterilizations in women's prisons after 1979 [ 49 ]  to ask about and apply for compensation (www.victims.ca.gov/fiscp or reach out to CalVCB at 800-777-9229 or fiscp@victims.ca.gov). Researchers estimated hundreds of Californians are alive who might hypothetically qualify before the December 2023 deadline, but reportedly as of early September 2023, only 101 applications had been approved, with seven cases closed as incomplete, and 339 denied. [ 50 ]


In the 1960s and 1970s, the  Indian Health Service  (IHS) and collaborating physicians sustained a practice of performing sterilizations on  Native American  women, in many cases  without the free and informed consent  of their patients. In some cases, women were misled into believing that the sterilization procedure was reversible. In other cases, sterilization was performed without the adequate understanding and consent of the patient, including cases in which the procedure was performed on minors as young as 11 years old. A compounding factor was the tendency of doctors to recommend sterilization to poor and minority women in cases where they would not have done so to a wealthier white patient. [ 1 ]  Other cases of abuse have been documented as well, including when health providers did not tell women they were going to be sterilized, or other forms of coercion including threatening to take away their welfare or healthcare. [ 2 ]


In 1976, a U.S.  General Accountability Office  (GAO) investigation found that four Indian Health Service areas were noncompliant with IHS policies regulating consent to sterilization. [ 3 ]  Inadequate consent forms were a recurring problem; the most common form did not record whether the elements of informed consent had been presented to the patient or what they were told prior to obtaining consent, and physician misunderstanding of IHS regulations was widespread. [ 4 ]  The investigation found that these four service areas sterilized 3,406 women between the years 1973 and 1976, including 36 cases where women under the age of 21 were sterilized despite a declared moratorium on these sterilizations. [ 5 ]


Limitations of the GAO investigation were quickly noted. Senator  James Abourezk  pointed out that while even 3,406 sterilizations would represent a startling proportion of Native American women, this number was the result of a report which examined only four out of twelve IHS areas. [ 6 ]  Attempts to count the total number of sterilizations that happened during this period differ widely in their results. While the limited count by the GAO represents a minimum, studies have accused the IHS of sterilizing between 25-50% of Native American women from 1970 to 1976. [ 7 ]  Should the highest estimate be accurate, up to 70,000 women may have been sterilized over the period. In comparison, the rate of sterilization for white women over the same period was approximately 15%. [ 2 ]


Hysterectomies  and  tubal ligation  were the two main sterilization methods used. A hysterectomy is a procedure used to sterilize women where the uterus is removed through the women's abdomen or vagina. This operation was routinely used to sterilize Native American women during the 1960s and 1970s in the United States. [ 8 ]  Another common form of sterilization was tubal ligation, a sterilization procedure in which a woman's  fallopian tubes  are tied, blocked, or cut. [ 9 ]  For many women these procedures were done without consent, resulting in some approaching doctors for procedures like "womb transplants". [ 10 ]  In 1971, Dr. James Ryan stated that he favored hysterectomies over tubal ligations because "it's more of a challenge... and it's [a] good experience for the junior resident". [ 11 ]  This is suggestive of the attitude IHS doctors had towards their patients, as hysterectomies have a much greater rate of complications. [ 6 ]


Some forms of birth control other than sterilization were sometimes used, including  Depo-Provera  and  Norplant . Both of these are female contraceptives. The former entails receiving a shot every three months, whereas the latter, a form that is no longer used in the U.S., required the implantation of hormone-filled capsules beneath the skin. [ 12 ] [ 13 ]  Depo-Provera was used on  intellectually disabled  Native American women before it gained clearance from the FDA in 1992. [ 14 ]  Norplant, promoted by the IHS, was marketed by  Wyeth Pharmaceuticals  (who were sued over insufficient disclosure of side effects including irregular menstrual bleeding, headaches, nausea and depression). Side effects of these two forms of birth control included the cessation of the menstrual cycle and excessive bleeding. [ 15 ]


Using 2002 data from the  National Survey of Family Growth , the Urban Indian Health Institute found that among women using contraception, the most common methods used by urban American Indian and Alaskan Native women age 15–44 years were female sterilization (34%), oral contraceptive pills (21%), and male condoms (21%). However, among the urban Non-Hispanic Whites, the most common methods were oral contraceptive pills (36%), female sterilization (20%) and male condoms (18%). [ 16 ]


Today, although the  Indian Health Service  continues to use sterilization as a method of family planning, tubal ligation and  vasectomy , which is a male sterilization procedure, are the only procedures which may be performed for the primary purpose of sterilization. Today legally, the IHS requires the patient to give informed consent to the operation, be 21 years of age or older, and not be  institutionalized  in a  correctional  or  mental health facility . [ 17 ]


Native American women were not the only individuals to be subjected to forced sterilizations; black and poor women were also affected by these practices. [ 18 ]  The practice of  eugenics  stemmed from  Francis Galton's  writings on using  genetics  to improve the human race. [ 19 ] [ 20 ]  The eugenics movement became increasingly popular, and in 1907, Indiana was America's first state to enact a compulsory sterilization law. [ 20 ]  The practice became normalized and over the next twenty years fifteen more states would enact similar laws. [ 20 ]


In 1927, the Supreme Court case  Buck v. Bell  upheld a compulsory sterilization law in Virginia. The case involved three generations of women from the Buck family: Emma, Carrie and Vivian. By examining multiple generations of women from the same family, advocates for eugenics hoped to convince the Court that Carrie Buck had intellectual deficiencies that were hereditary and a danger to public welfare; they succeeded, and she was sterilized.  Oliver Wendell Holmes ' decision stated, "it is better for all the world if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sanctions compulsory vaccination is broad enough to cover cutting the Fallopian tubes." [ 20 ]  The case had the effect of legitimizing existing sterilization laws, resulting in greater acceptance of the practice. During the 1960s and 70s as sterilization practices increased there was no legislation that prohibited it and it was seen as a viable form of contraception. [ 21 ] [ 22 ] [ 20 ]


In the 1974 case  Relf v. Weinberger , a district court found that   Department of Health and Human Services  regulations on sterilization were "arbitrary and unreasonable" because they failed to adequately guarantee the consent of the patient. [ 17 ]  This case was part of a growing awareness during the 1970s that abuse of sterilization procedures was becoming a serious problem. Among other facts revealed in the case, it was found that 100,000 to 150,000 people were sterilized every year using money from federally funded programs. Exposure from the case resulted in recognition that the poor and minorities were at risk of being targeted for sterilizations they did not consent to, and this led to the legal requirement that informed consent be received before the operation. [ 23 ]


The  Indian Health Services  (IHS) is a government organization created in 1955 to help combat poor health and living conditions of Native Americans and Alaska Natives. The IHS still exists in the United States, and is a blend of various organizations created to combat specific health problems for Native American and Alaskan Natives. [ 17 ] [ 24 ]  The IHS's website states that "the IHS is the principal federal health care provider and health advocate for Indian people, and its goal is to raise their health status to the highest possible level. The IHS provides a comprehensive health service delivery system for approximately 2.2 million Native Americans and Alaska Natives who belong to 573 federally recognized tribes in 37 states." [ 24 ]  In 1955, Congress had given IHS the responsibility of providing these health services, but at the time they did not have enough physicians to conduct safe and proper procedures. After raising the pay for physicians' wages, safety improved, and they began to provide birth control treatment which ultimately led to the practice of sterilization. [ 17 ]


Native American women were not the only individuals to be subjected to forced sterilizations; black and poor women were also affected by these practices. [ 18 ]  In the 1970s, after being forced onto  reservations  by the United States government, or relocated into  urban areas  without adequate support, many Native Americans were struggling with  poverty . Native American people depended on government organizations like the IHS,  Department of Health , Education and Welfare (HEW) and the  Bureau of Indian Affairs  (BIA). [ 20 ]  The Indian Health Service (IHS) was their main health provider. Because Native Americans were dependent on these government organizations for health services, they were more at risk for forced sterilization than other groups. [ 20 ]


Six years after the passing of the Population Research Act of 1970, it is estimated that physicians sterilized perhaps 25% of Native American women of childbearing age. Evidence suggests that the numbers were higher. These high numbers could be linked to the law subsidizing sterilizations for patients who utilized Indian Health Service and Medicaid patients. [ 25 ]


Most of the physicians performing this procedure viewed sterilization as the best alternative for these women. They claimed it would improve their financial situation and their family's quality of life. [ 26 ]  Many of these physicians believed that Native American women were not intelligent enough to use other methods of birth control, wrote Jane Lawrence in  American Indian Quarterly . [ 27 ]  Thus, sterilizing these patients was seen as the most reliable birth control method. [ 20 ] [ 28 ]  When doctors were polled on their recommendations to patients they received in private practice, [ when? ]  only 6% recommended sterilization, while 14% would recommend it to those on welfare. [ 29 ]  When they were asked about their attitudes regarding birth control policies, [ when? ]  94% said they would approve of  compulsory sterilization  for a mother on welfare with three or more children. [ 29 ]  With fewer people applying for  Medicaid  and  welfare , the federal government could decrease spending on welfare programs. [ 17 ]  Poor women, the disabled, and the women of color were targeted for similar reasons. In addition, the influx of surgical procedures was seen as good training for physicians and as a practice for resident physicians. [ 11 ]


One theory suggests that IHS doctors were underpaid and overworked and they sterilized Native American women so they would have less work in the future. [ 30 ]  The average new IHS recruit made $17,000 to $20,000 a year and worked around 60 hours per week. [ 31 ]  In 1974 the ratio of doctors to patients was dangerously low, with "only one doctor to 1,700 reservation Indians." [ 20 ]  The problems caused by a lack of doctors were exacerbated even further when a program to draft doctors into the military was terminated in 1976. This directly affected the IHS because they recruited many of their doctors from the military. [ 20 ] [ 32 ]  Between 1971 and 1974 applications for vacant IHS positions went from 700 to 100 applications, meaning that the burden of additional work fell on an ever decreasing number of doctors. [ 31 ] [ 30 ]


One important distinction is between doctors who worked for the IHS directly and other doctors who performed sterilizations through a contractual arrangement with the IHS. For IHS doctors, there was no financial incentive to perform sterilizations, [ 20 ]  and therefore other considerations likely played the primary role. Doctors under contract were paid more when they sterilized women instead of giving them oral contraceptives, making a financial incentive more plausible. [ 30 ]  Even though there was no financial incentive for the IHS doctors to recommend sterilization, as previously discussed, sterilization was seen as the ideal form of contraception for Native American patients during the 1960s and 1970s. [ 22 ]  IHS doctors had mostly Protestant and middle-class views of family planning, with an emphasis on a  nuclear family  containing a small number of children. [ 20 ]  The presumption that Native American women desired the same family structure as middle class white Americans helped make sterilization abuse possible. [ 20 ]


A direct effect of sterilization of Native American women was that the Native American birth rate decreased. [ 20 ]  In 1970, the average birth rate of Native American women was 3.29, but it declined to 1.30 in 1980. The birthrate of  Apache  women fell from 4.01 to 1.78. In comparison, the average white woman birth rate fell from 2.42 to 2.14. [ 33 ]  By some counts, at least 25% of Native American women between the ages of 15 and 44 were sterilized during the most intensive period. [ 7 ] [ 25 ]  Native women lost economic and political power by not being able to reproduce at the same rate as their white counterparts. One potential effect of this is the increased risk of extinction of Native American cultures.


The decline in birth rate was a quantifiable effect. But sterilization impacted many Native American women in non-quantifiable ways as well. Within Native American culture a woman's  fertility  is greatly valued, leading to psychological and social consequences from sterilization. For a woman to be unable to bear children would cause shame, embarrassment and possible condemnation from the individual's tribe due to how Native American peoples view motherhood. [ 20 ]  In 1977, lawyer Michael Zavalla filed a case with Washington State after three  Cheyenne  women from Montana were sterilized without their consent. [ 20 ]  However, the sterilized women remained anonymous because they feared tribal repercussions. As Marie Sanchez, Chief tribal judge for the  Northern Cheyenne Reservation , explained, "even more discouraging than high legal bills is the risk of losing one's place in the Indian community, where sterilization has particular religious resonance." [ 20 ]  In some areas, the sterilization procedure was insufficiently sterile, which led to complications. When complications arose, additional medical treatment was required, but government funding only covered the procedure itself. Because most women could not afford follow-up medical care, in many cases they did not receive it, and some died as a result. [ 20 ]  Marie Sanchez equated the mass sterilization of Native Americans to genocide. [ 25 ]


Native American women and men do not fully trust the U.S. government due to forced sterilization, and remain skeptical of contraceptive technologies. [ 20 ]


The  women's health movement  ( WHM , also  feminist women's health movement )  in the United States  refers to the aspect of the  American feminist movement  that works to improve all aspects of  women's health  and healthcare. It began during the  second wave of feminism  as a sub-movement of the  women's liberation movement . WHM activism involves increasing women's knowledge and control of their own bodies on a variety of subjects, such as fertility control and home remedies, as well as challenging traditional doctor-patient relationships, the medicalization of childbirth,  misogyny  in the health care system, and ensuring  drug safety .


Notable organizations associated with the women's health movement include the  Jane Collective , the  Boston Women's Health Book Collective , the  Feminist Abortion Network , the  National Women's Health Network , the  Black Women's Health Imperative  and the  Native American Women's Health Education Resource Center . Other results of WHM activism are the creation of  feminist health centers , the  Dalkon Shield  lawsuit, the  DES daughters lawsuit , and the  Nelson Pill Hearings , which resulted in the inclusion of  medication package inserts  to insure  informed consent  for women taking  oral contraceptive pills . Notable books and media resulting from this movement include  Women and Madness  by  Phyllis Chesler ,  Our Bodies, Ourselves  by the Boston Women's Health Book Collective,  The Myth of the Vaginal Orgasm  by  Anne Koedt , and  La Operación .


The WHM is unique from the  abortion-rights movement  in that the WHM has a wider scope of issues in relation to women and their health. The health clinics, groups, and activists of the WHM also advocate "nonprofessional caregivers, self-help, emphasis on alternative (nonprescription) remedies when possible, demystification of health information and providers, and clinic administration and control by nonprofessional women." [ 1 ]


The women's health movement has origins in multiple movements within the United States: the  popular health movement  of the 1830s and 1840s, the struggle for women/midwives to  practice medicine  or  enter medical schools  in the late 1800s and early 1900s,  black women's clubs  that worked to improve access to healthcare, and various  social movements in the 1960s . [ 2 ]


Helen Marieskind argues that like the popular health movement of the 19th century, the WHM worked to redefine health care, empower women, and support "preventive health concepts, self-awareness... [a] knowledge of bodily processes, and... demystify[ing] medicine." [ 3 ]   Barbara Ehrenreich  and  Deirdre English , in their work  Witches, Midwives, and Nurses  (1972), also compare the two movements. [ 4 ]


The WHM shares ideology with other  New Left  movements. The  environmental  and  anti-nuclear  movements, like the WHM, oppose  militarism , critique corporations and government agencies, express the need to protect humans and the environment from  hazards , and stress the importance of  Nothing About Us Without Us . [ 5 ]   Women  and  gender studies  scholar Jennifer Nelson says that neighborhood health centers created by  civil rights  and other New Left activists were the "intellectual, political, and practical experiential precedents," [ 6 ]  for  feminist health centers , which were one major result of the women's health movement.


The women's health movement grew directly out of the  women's liberation movement  during the late 1960s.


Just as the  Women's Suffrage  movement grew out of the  Abolition Movement , the  Women's Liberation Movement  grew out of the struggle for  civil rights . [ 7 ] [ 8 ]  Though challenging  patriarchy  and the anti-patriarchal message of the Women's Liberation Movement was considered  radical , it was not the only, nor the first, radical movement in the early period of  second-wave feminism . [ 9 ]  Rather than simply desiring legal equality, members believed that the moral and social climate in the United States needed to change. Though most groups operated independently—there was no national umbrella organization—there were unifying philosophies of women participating in the movement. Challenging patriarchy and the hierarchical organization of society which defined women as subordinate, participants in the movement believed that women should be free to define their own individual identity as part of human society. [ 7 ] [ 8 ]  One of the reasons that women who supported the movement chose not to create a single approach to addressing the problem of women being treated as second-class citizens was that they did not want to foster an idea that anyone was an expert or that any one group or idea could address all of the societal problems women faced. [ 10 ]  They also wanted women, whose voices had been silenced, to be able to express their own views on solutions. [ 11 ]  Among the issues were the objectification of women, reproductive rights, opportunities for women in the workplace, redefining familial roles. A dilemma faced by movement members was how they could challenge the definition of femininity without compromising the principals of feminism. [ 7 ]  They were not interested in reforming existing social structures, but instead were focused on changing the perceptions of women's place in society and the family and women's autonomy. Rejecting hierarchical structure, most groups which formed operated as collectives where all women could participate equally. Typically, groups associated with the Women's Liberation Movement held  consciousness-raising  (CR) meetings where women could voice their concerns and experiences, learning to politicize their issues. To members of the WLM, rejecting  sexism  was the most important objective in eliminating women's status as second-class citizens. [ citation needed ]


By attending CR groups, women around the United States participated in "a process in which the sharing of personal stories led to a "click"--a sudden recognition that sexism lay at the root of their struggles." [ 12 ]  This process included sharing their healthcare experiences with each other. They discussed topics such as  illegal abortions ,  rape , negative experiences with doctors during childbirth and  gynecologist  visits,  sexuality ,  birth control , and other aspects of  women's health . [ 13 ] [ 3 ]   [ 14 ]  This led them to "campaign to change how doctors, the government, the media, and the medical field treat...women and their bodies." [ 15 ]


WHM activism covers topics such as access to reproductive technology and birth control,  sterilization abuse , advocating against unnecessary medical intervention during childbirth, increasing access to healthcare through the creation of  feminist health centers  and self-help clinics, teaching women about their bodies, discovering the history of  women in medicine , critiquing the  misogyny in the healthcare system , and creating  health advocacy  groups for women. [ 16 ] [ 17 ] [ 18 ]  Due to the political and collective nature of the WHM, Helen Marieskind calls the ideology of the movement  Feminist-Socialism . [ 3 ]


They view the relationship between women and their doctors (especially male gynecologists) as similar to women's second-class status in society. WHM activists argue that the institution of medicine is "embedded in, and an embodiment of," [ 19 ]  patriarchal society and is an institution of  social control . Nearly all of the early literature from the WHM argued that medicine and doctors work to subordinate women,  people of color , and  the poor ; doctors are too powerful; healthcare costs too much; and that conventional healthcare leaves patients with little to no dignity, right to health information, or ability to choose their treatment. [ 2 ]


The women's liberation movement, and consequently the WHM, were  grassroots , so there were many different groups of women organizing around women's health issues in the United States at the beginning of the  second wave of feminism . Anthropologist Sandra Morgen argues that there are four founding events of the WHM: the workshop and research that led to the writing of  Our Bodies, Ourselves  in  Boston , the founding of the underground abortion service by the  Jane Collective  in  Chicago ,  Carol Downer  and  Lorraine Rothman 's self-help gynecology in  Los Angeles , and  Barbara Seaman's  ( New York ) and  Belita Cowan's  ( Ann Arbor ) work to expose the health risks of the  oral contraceptive pill  and  diethylstilbestrol . [ 20 ]  Ninia Baehr includes the activism of  Patricia Maginnis  and the Army of Three–even though their activism around abortion began in 1959–because they were the first to frame abortion around  women's rights  and the idea that women, not doctors or lawmakers, should be the ones to make decisions around abortion. [ 21 ]


“We will never give over the control of our numbers to the women themselves. What, let them control the future of the human race? With abortions it is in our hands; we make the decisions, and they must come to us.” [ 22 ]


Patricia Maginnis  founded the Citizens Committee for Humane Abortion Laws (CCHAL) in 1962, while she attended  San Jose State University . In 1963, she moved the organization to San Francisco and Rowena Gurner joined CCHAL. In 1964, Gurner and Maginnis changed the organization's name to The Society for Humane Abortion (SHA) and in 1965 it was incorporated as a non-profit organization in California. [ 23 ]  SHA advocated for "elective abortion," [ 24 ]  that all women had the right to safe and legal abortion free of harassment, and that "[the] termination of pregnancy is a decision which the person or family involved should be free to make as their own religious beliefs, values, emotions, and circumstances may dictate." [ 24 ]  The SHA believed in the  repeal  of all abortion laws, including the 1963 Humane Abortion Act, which made abortion legal in cases of rape or incest. While still heading the Society for Humane Abortion, Maginnis set-up another organization in 1966 to carry on an underground feminist health referral system. The main mission of this organization, Association to Repeal Abortion Laws (ARAL), was to connect pregnant women with abortion providers in neighboring countries. [ 23 ]  Their list of abortion specialists was well-researched and depended on members' information and the feedback of the women they referred.


Together, the Army of Three (Maginnis, Gurner, and Lana Phelan) planned and executed  civil disobedience  actions in the late 1960s in order to overturn abortion laws in  California . In 1968, after multiple bouts of handing out pamphlets with information about contraception and  sexually transmitted infections  (which was illegal under  San Francisco 's Municipal Ordinance 188), Maginnis was arrested. The outcome of her case overturned this local ordinance, but the Army of Three wanted to challenge the state law. To do this, they created abortion 'classes,' which Maginnis was eventually arrest for in  San Mateo county . The case wasn't settled until after  Roe v. Wade  liberalized abortion laws in the United States, but they did succeed in overturning California's abortion law. [ 25 ]


Diethylstilbestrol  (DES) was discovered in 1938 and until 1971, it was given to pregnant women with the incorrect belief that it would reduce the risk of pregnancy complications and losses. [ 26 ]  In the late 1960s, a study published in  JAMA  endorsed the use of DES as an  emergency contraceptive , saying that it have no negative side effects. Belita Cowan began researching the side effects of DES as a morning after pill at this time, because it was she had read medical literature that said DES caused  clear cell carcinoma , a rare  vaginal tumor , in girls and women who had been exposed to this medication  in utero . [ 26 ]  She also heard from her friends that the pill caused severe nausea for a short period of time. [ 27 ]  Cowan brought together a group of female former patients at the  University of Michigan ’s student health center and organized Advocates for Medical Information. [ 28 ] [ 29 ]  This group aimed to educate women in the side effects of the DES pill and to oppose the use of it at the University Hospital and other health centers in the country. In 1971, the organization received a grant from the student government to undertake a survey of women who had taken DES. Out of the sixty-nine women who responded, only a quarter of them were contacted by doctors after taking the medication. [ 30 ]  This proved that the advertisements for DES were fraudulent. After concluding her research about the side effects of DES, Cowan believed that women around the country should know about the effects of the drug. [ 31 ]  She contacted  Ralph Nader  and other feminists to host a press conference in Washington, D.C., in December 1972.


When the  birth control pill  came on the market in 1960, Barbara Seaman was writing columns for women's magazines such as  Brides  and the  Ladies' Home Journal . She launched her career as a women's health journalist and brought a new kind of health reporting to the field, writing articles that centered more on the patient and less on the medical fads of the day. Seaman was first to reveal that women lacked the information they needed to make informed decisions on child-bearing,  breast-feeding , and oral contraceptives. She even went so far as to alert women to the dangers of the Pill, whose primary ingredient was  estrogen  (also the active ingredient in  Premarin , which had contributed to the death of her aunt). Prolific output and the popularity of her published articles won Seaman membership with the prestigious  Society of Magazine Writers . In 1969, Seaman completed her first book,  The Doctors' Case Against the Pill , which would become the basis for the Nelson Pill Hearings on the safety of the  combined oral contraceptive pill . [ 32 ] [ 33 ] [ 34 ] [ 35 ]  As a result of the hearings, a health warning was added to the pill, the first informational insert for any prescription drug. [ 36 ]  Robert Finch, Secretary of  HEW , praised Seaman saying, " The Doctors' Case Against the Pill ... was a major factor in our strengthening the language in the final warning published in the Federal Register to be included in each package of the Pill."


Officially known as the Abortion Counseling Service of Women's Liberation, the Jane Collective, or Jane, was an underground service in  Chicago, Illinois , affiliated with the  Chicago Women's Liberation Union  that operated from 1969 to 1973, when  abortion was illegal in the United States . [ 37 ]  The collective was started by activists in the women's liberation movement in an effort to address the increasing number of  unsafe abortions  being performed by untrained providers. Since illegal abortions were not only dangerous but very expensive, the founding members of the collective believed that they could provide women with safer and more affordable access to abortions.


The collective originated in 1969 with  University of Chicago  student  Heather Booth , who helped her friend's sister find an abortion provider. [ 38 ]  The founders of Jane initially focused their attention on providing women access to competent physicians willing to provide abortion services. They found a physician they called "Mike" who was willing to work with them. After creating a close relationship with Mike they found out that he actually wasn't really a physician and some Jane activists have characterized him as a "con man." However, many of the techniques he used were safe and effective. [ 37 ]  The women of Jane then decided to cut out the middleman and perform the abortions themselves. Mike taught the women how to perform  dilation and curettage  abortions, and from then on the women performed them themselves. During the years which Jane operated, the collective performed more than 11,000 abortions. [ 39 ]  They disbanded after  Roe v. Wade  made abortion legal throughout the United States in 1973.


"I'm not anti-doctor, that would only help set back attitudes on modern medical technology. Women instead have to demystify doctors by learning more about their own bodies, and can then ask questions about gynecological examinations which have never been discussed thoroughly by doctors and their patients."


In 1969 at Emmanuel College in  Boston ,  Massachusetts , at one of the first conference's for women's liberation,  Nancy Miriam Hawley  organized a workshop called "Women and Their Bodies." Twelve white, middle-class women between the ages of 23 and 39 attended the workshop, which allowed the women to discuss health. The discussion created a consciousness-raising environment; the strong discussion supplied the women with the necessary tools and ideas that led to the attendees organizing as "the doctors group" to research about women and healthcare. "We weren't encouraged to ask questions, but to depend on the so-called experts," Hawley told  Women's eNews . "Not having a say in our own health care frustrated and angered us. We didn't have the information we needed, so we decided to find it on our own." [ 41 ]  As a result of this goal, they spent the summer researching topics they were interested in and began teaching a course titled after the workshop, based on what they had learned and written about. It contained sections on abortion,  pregnancy ,  postpartum depression , sexuality,  anatomy  and  physiology , sexually transmitted diseases, and critiques of patriarchy, capitalism, and the healthcare system. The book also contained information intended to guide women on "how to maneuver the American health care system, with subsections called 'The Power and Role of Male Doctors,' 'The Profit Motive in Health Care,'" 'Women as Health Care Workers,' and 'Hospitals.' [ 42 ]  They put their knowledge into an accessible format that served as a model for women who wanted to learn about themselves, communicate with doctors, and challenge the medical establishment to change and improve the health of women everywhere. They used rhetoric that avoided describing the female reproductive system as passive, unproductive, helpless, or powerless, unlike any doctor or book at the time.


Their writing was so sought after that they started selling their research as a 35-cent, 136-page booklet called  Women and Their Bodies , published in 1970 by the New England Free Press. By 1973, 350,000 copies of the retitled  Our Bodies, Ourselves  had been sold without any formal advertising. [ 41 ]  As a result of their success, the women formed the non-profit Boston Women's Health Book Collective (which now goes by the name Our Bodies Ourselves) and published the first 276-page  Our Bodies, Ourselves  in 1973. The collective published it with the major publisher  Simon & Schuster , only on the condition that they would have complete editorial control and that nonprofit health centers could purchase copies at a significant discount. [ 42 ]  It featured first-person stories from women, and tackled many topics then regarded as  taboo .


Carol Downer joined a  NOW  chapter in California in 1969, where she learned about abortions and in 1970, helped refer women to  Harvey Karman 's illegal abortion clinic. [ 43 ]  The  Karman cannula  was of particular interest to Downer, as it did not require  cervical dilation ,  curettage , or powerful  vacuum suction . Karman let them observe several abortions and an  IUD  insertion, during which Downer saw a woman's  cervix  for the first time and was "amazed" [ 44 ]  at how close and accessible it was. This inspired her interest in performing abortions and to take a  speculum  home to perform a cervical examination on herself.


She and other women became interested in starting their own clinic after growing displeased with the male abortion providers’ behavior towards women. On April 7, 1971, a group of women (including Downer) interested in starting their own abortion clinic met at Everywoman's Bookstore in  Venice, California . [ 43 ]  Downer showed them what Karman used to perform abortions, but the women were afraid, and she knew that "until [she] demystified this for them, they were going to keep on thinking that abortion was this thing that you mostly would die of." [ 44 ]  Downer then laid down on a table in the room and performed her own cervical examination in front of all the women, who were initially surprised but then crowded around her, observing her cervix. A few women wanted to see their own cervix's as well, so they did self-exams on the table after Downer. [ 44 ]


Lorraine Rothman also attended the meeting at the bookstore and she found Karman's device promising, but unsafe. She designed a new type of manual  vacuum aspiration  device, which she patented as the Del-Em, and called the process  menstrual extraction  (ME). [ 43 ]  ME made its debut at the  National Organization for Women  conference in  Santa Monica, California , in August 1971. To Rothman and Downer's dismay, the organizers of the conference were "so appalled that they refused to give the women exhibit space." [ 45 ]  Instead, Downer and Rothman hung flyers around the conference, announcing a demonstration in their hotel room. The attendees were given a plastic speculum to begin their education. From the extensive mailing list collected during these demonstrations, Downer and Rothman began a national tour, going to 23 cities in the United States to teach women the new technique. [ 46 ] [ 47 ] [ 48 ]  This effectively began the movement of women's health self-help groups/clinics. [ 49 ]


In 1974, Belita Cowan,  Barbara Seaman ,  Phyllis Chesler ,  Mary Howell , and  Alice Wolfson  established the  National Women's Health Network .


After being diagnosed with breast cancer,  Rose Kushner  objected to the treatment which was then standard, in which a tumor  biopsy  and  radical mastectomy  (which involves removing muscle tissue and  lymph nodes  along with the breast) were performed in a single surgical operation while the patient was under  anesthesia . She had difficulty finding a doctor who would perform a diagnostic biopsy and allow her to decide what action to take next. [ 50 ] [ 51 ]  In order to have a less invasive procedure, she had found  Dr. Thomas Dao , who was willing to do a modified radical mastectomy. [ 52 ] [ 50 ] [ 53 ]


As Kushner recovered from her surgery, she started writing about her experiences with breast cancer. She traveled to  Europe  to learn about breast cancer treatment there, finding that the radical mastectomy was not used as widely as in the United States. Upon her return home, she published  Why Me?,  in 1975 under the title  Breast Cancer: A Personal History and Investigative Report,  which contained extensive medical information and advice for patients, including strong criticism of radical mastectomies and the practice of performing a biopsy and a mastectomy as a one-step surgical procedure. Her critique of prevalent breast cancer treatment included strong feminist themes, such  "No man is going to make another impotent while he's asleep without his permission, but there's no hesitation if it's a woman's breast." [ 53 ]  The book was strongly endorsed by Dr. Dao, but it was widely criticized by other doctors and the  American Cancer Society . [ 53 ]  Kusher became a relentless critic of the treatment of breast cancer by the medical profession. She attended numerous meetings of medical professionals, interrupting presentations, questioning conclusions, and speaking against the prevalent practices of one-step breast cancer surgery and radical mastectomy. [ 53 ]  In 1975 she was "booed off the stage" at a meeting of the Society of Surgical Oncology, whose members objected to her challenges to traditional treatments. [ 50 ]


In 1975 Kushner and Dorothy Johnston, established a  telephone hotline  called the Breast Cancer Advisory Center, based in  Kensington, Maryland , that operated until 1982, responding to calls and letters from thousands of women wanting information about breast cancer and its treatment. [ 52 ] [ 53 ]  The center's establishment was motivated in part by Kushner's desire to promote patient self-help and mutual support, thus displacing the medical profession and the American Cancer Society from their roles as information "gatekeepers". [ 54 ]


In spite of her unpopularity with the mainstream medical profession, Kushner's work was well received in the public and won increasing respect in official circles. In June 1977, she was the only  lay member  appointed to a ten-member  National Institutes of Health  (NIH) panel that evaluated treatment options for primary breast cancer. In 1979, the panel issued its findings, concluding that the Halsted radical mastectomy should no longer be the standard treatment for suspected cases of breast cancer, instead recommending total simple mastectomy as the primary surgical treatment. [ 55 ] [ 53 ]  Additionally, Kushner convinced her fellow panel members to include a statement calling for an end to the one-step surgical procedure. [ 56 ]  At the time of her death, Dr. Bruce A. Chabner of the  National Cancer Institute  said she was "probably the single most important person" in ending the practice of one-step surgery for breast cancer, because of her persistence and because she brought medical information to a wide public audience that otherwise might have remained unaware of the options. [ 50 ]


Two laws in the United States lifted restrictions for women in the medical field --  Title IX  of the Higher Education Act Amendments of 1972 and the  Public Health Service Act  of 1975, banning discrimination on grounds of gender. In November 1970, the Assembly of the Association of American Medical Colleges rallied for equal rights in the medical field. [ 57 ]


The 1970s marked a great increase of women entering and graduating from  medical school  in the United States. From 1930 to 1970, a period of 40 years, about 14,000 women graduated from medical school. From 1970 to 1980, a period of 10 years, over 20,000 women graduated from medical school. [ 57 ]  This increase of women in the medical field was due to both political and cultural changes.


One study surveyed physician mothers and their physician daughters in order to analyze the effect that discrimination and harassment have on the individual and their career. This study included 84% of physician mothers that graduated medical school prior to 1970, with the majority of these physicians graduating in the 1950s and 1960s. The authors of this study stated that discrimination in the medical field persisted after the title VII discrimination legislation was passed in 1965. [ 58 ]  According to this study, one third of physician daughters reported experiencing a form of gender discrimination in medical school, field training, and the work environment. This study also stated that both generations equally experienced gender discrimination within their work environments.


This article provided an overview on the history of gender discrimination, claiming that gender initiated the systematic exclusion of women from medical schools. This was the case until 1970, when the  National Organization for Women  (NOW) filed a class action lawsuit against all medical schools in the United States.  More specifically, this lawsuit was successful in forcing medical schools to comply to the civil rights legislation. This success was seen by 1975 when the number of women in medicine had nearly tripled, and continued to grow as the years progressed. By 2005, over 25% of physicians and around 50% of medical school students were women. The increase of women in medicine also came with an increase of women identifying as a racial/ethnic minority, yet this population is still largely underrepresented in comparison to the general population of the medical field. [ 58 ]  Within this specific study, 22% of physician mothers and 24% of physician daughters identified themselves as being an ethnic minority. These women reported experiencing instances of exclusion from career opportunities as a result of their  race and gender .


A sharp increase of women in the medical field led to developments in doctor patient relationships, changes in terminology, and theory. With higher numbers of women enrolled in medical school, medical practices like gynecology were challenged and changed. One area of medical practice that was challenged and changed was  gynecology . Wendy Kline discusses the blurring of the medical and sexual that occurred in the medical field in the late 40s into the 60s, particularly in gynecology. Kline says that "to ensure that young brides were ready for the wedding night, they [doctors] used the  pelvic exam  as a form of sex instruction." [ 59 ]  In Ellen Frankfort's book  Vaginal Politics , Frankfort talks about the "shame" and "humiliation" felt during a pap test; "I was naked, he was dressed; I was lying down, he was standing up; I was quiet, he was giving orders." [ 60 ]   One medical student is quoted in Kline's book as saying, "Since I experienced my own exams as a humiliating procedure, I feared inflicting the same humiliation on another person." [ 59 ]  In 1972 the University of Iowa Medical School instituted a new training program for pelvic and breast examinations. Students would act both as the doctor and the patient, allowing each student to understand the procedure and create a more gentle, respectful examination. This method was quite different from the previous practice in which doctors were taught to assert their power over patients. With changes in ideologies and practices throughout the 70s, by 1980 over 75 schools had adopted this new method. [ 61 ]


Tanfer Emin Tunc argues that the Army of Three, the Jane collective, and Downer and Rothman's menstrual extraction technique have contributed to abortion technology in America. [ 62 ]


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Amniotic fluid index  ( AFI ) is a quantitative estimate of  amniotic fluid [ 1 ]  and an indicator of  fetal  well-being. It is a separate measurement from the  biophysical profile . [ 1 ]


AFI is the score (expressed in  centimetres ) given to the amount of amniotic fluid seen on  ultrasonography  of a pregnant  uterus . To determine the AFI, doctors may use a four-quadrant technique, [ 2 ]  when the deepest, unobstructed, vertical length of each pocket of fluid is measured in each quadrant and then added up to the others, [ 3 ]  or the so-called "single deepest pocket" technique. [ 4 ]


An AFI between 8 and 18 cm is considered normal. [ 5 ]   Median AFI level is approximately 14 cm from week 20 to week 35, [ 6 ]  when the amniotic fluid begins to reduce in preparation for birth. An AFI smaller than 5–6 cm is considered as  oligohydramnios . [ 3 ]  The exact number can vary by gestational age. The fifth percentile for gestational age is sometimes used as a cutoff value. [ 7 ]
An AFI larger than 24–25 cm is considered as  polyhydramnios . [ 3 ] [ 8 ]


There are many things that can cause low AFI, these include:


Anterior shoulder  in  obstetrics  refers to that shoulder of the  fetus  that faces the  pubic symphysis  of the mother during delivery. Depending upon the original  position  of the fetus, either the left or the right shoulder can be the anterior shoulder. It is known as the anterior shoulder as it faces the  anterior  of the mother. This distinction between the anterior and the posterior shoulder is important as the anterior shoulder is delivered first. [ 1 ]


Assisted zona hatching  is a procedure of  assisted reproductive technology , mainly used in  IVF , which assists  zona hatching . To achieve this a small hole is made in the  zona pellucida  (mechanically, chemically or by laser) to facilitate hatching. [ 1 ]  Zona hatching is where the  blastocyst  gets rid of the surrounding zona pellucida to be able to  implant  in the  uterus .


A systematic review and meta-analysis came to the result that assisted zona hatching is related to increased rates of clinical pregnancy and multiple pregnancy in women with previous repeated failure or frozen-thawed embryos. [ 2 ]  However, it is unlikely to increase clinical pregnancy rates when performed in fresh embryos transferred to unselected women, to those without poor prognosis or to women of  advanced maternal age . [ 2 ]  Also, overall, there no evidence of a significant difference in  live birth rate  following assisted hatching compared with no assisted hatching. [ 3 ]


Sometimes, some embryos have a thickened or deformed zona pellucida that makes it difficult for them to come out and, therefore, can lead to implantation failures. To avoid this, this technique can be used.  Assisted hatching is not routinely done in all laboratories. It is recommended in some cases:


• Patients of advanced age (37 years or more)


• Implantation failure


• Anomalous zona pellucida (thick, partitioned,...)


• Thawed embryos since vitrification produces a hardening of the zona pellucida.


• Embryos with slow development. For example, when on day 3 they have less than 6 cells.


• To do a blastocyst biopsy


Those embryos biopsied to make PGD (preimplantation genetic diagnosis) will already have the hole made and, therefore, will hatch easily once they reach the stage of expanded blastocysts.  [ 4 ]


Mechanical assisted hatching: involves the use of micromanipulation techniques by using a needle. The zona pellucida is pierced with a needle and drilled by friction against a pipette. It is a technique that is rarely used because of the risk it has of damaging the embryo. It is also called "partial zona dissection".


Chemical assisted hatching: involves the use of specialized solutions (mostly acid, e.g. thyroid acid) in order to degrade the  zona pellucida . Because it can be toxic for the embryo, it needs to be washed.


"Laser assisted hatching" (LHA): a high energy laser is used to create an opening in the  zona pellucida , it is the most precise technique and safe for the embryo but it is the most expensive one.


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Baby fever  is a strong sudden desire for someone to have their own  child . It is prevalent within several cultures and is especially prevalent within women. [ 1 ] [ 2 ]


A  baby tower , also known as an  abandoned infant tower  or  baby girl tower , is an architectural structure found in various places in ancient China. [ 1 ]  They would typically take the form of a small stone or brick tower with an opening on the top. Dead, disabled, female, and unwanted infants could be thrown inside and abandoned. The baby tower is described as a donation from wealthy people in the countryside, as a more humane alternative to drowning babies in a river, common at the time. [ citation needed ]  The pagoda architectural style is intended to suppress the spirit of the children, to prevent them from being reincarnated. [ 2 ]


Gender selection  of children in China has been an issue for a long time due to the undesirability of female children in the Chinese  patriarchal society , and the perception of male children as being more valuable for work, especially among peasants.


Birth Control  (also known as  The New World ) is a  lost [ 1 ]  1917 American documentary film produced by and starring  Margaret Sanger  and describing her  family planning  work. It was the first film banned under the 1915 ruling of the  United States Supreme Court  in  Mutual Film Corporation v. Industrial Commission of Ohio , [ 2 ]  which held that the exhibition of films did not constitute free speech. [ citation needed ]


The banning of  Birth Control  was upheld by the  New York Court of Appeals  on the grounds that a film on  family planning  may be censored "in the interest of morality, decency, and public safety and welfare." [ 3 ]


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A  birthgasm  is a  female orgasm  that occurs during  childbirth . This is sometimes referred to as an "orgasmic childbirth." [ 1 ]  Some women use sexual stimulation to ease  contractions , instead of  anesthesia . [ 2 ]  More than 85% of midwives surveyed by Postel (2013) stated that a sexually pleasurable birth experience was possible, and 69% stated they had observed such a case. [ 3 ] [ 4 ]


A  boggy uterus  is a finding upon physical examination where the  uterus  is more  flaccid  than would be expected.


It can be associated with  uterine atony . [ 1 ]


It may also be associated with  adenomyosis . [ 2 ]


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Cherish Life Queensland  (originally known as  Queensland Right to Life [ 1 ] ) is a Queensland  anti-abortion  group. [ 2 ] [ 3 ]  It is non-denominational, non-party political anti-abortion organisation founded in  Brisbane  in 1970, before the emergence of similar organisations in other Australian states. Cherish Life Queensland is the state affiliate for the Federation of Right to Life Associations.


Cherish Life Queensland was formed in 1970 by a group of concerned  Christian   women  who saw what was happening in America in regards to the push for the legalisation of abortion and wanted to prevent its legalisation in their state. Since its inception as Queensland Right to Life, it has been funded by entirely by donations alone.


At the General Meeting on 21 June 2008, the members present voted for a change of name from "Queensland Right to Life" to "Cherish Life Queensland", which they believed would more accurately represent their opposition to embryonic  stem cell  research,  assisted suicide , as well as  abortion .


In May 2019, Anna Palmer, wife of Australian businessman  Clive Palmer  donated $20,000 to Cherish Life Queensland for electoral purposes. [ 4 ]


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Chorionic bump  is a rare medical condition defined as an irregular, convex bulge or protrusion from the choriodecidual surface into the  gestational sac . [ 1 ] [ 2 ]  It is medically defined as a separate entity from a  chorionic hematoma . [ 3 ]


Identification of a chorionic bump in early first trimester pregnancy represents a significant risk factor for pregnancy loss, given a live birth rate of less than 50%. [ 4 ]  The incidence rate for chorionic bump is estimated to be between 1.5 to 7 per 1000 pregnancies. [ 3 ]


It is believed that chorionic bump can start as a  hematoma  in the  intervillous space . [ 5 ]  Additionally,  Infertility treatments  may be associated with increased likelihood of chorionic bump. [ 4 ]


Existing literature suggests that chorionic bump causes first trimester pregnancy loss and doubles the  miscarriage  rate as compared to having no risk factors. [ 4 ]


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" Conjugal Lewdness or, Matrimonial Whoredom " (later retitled " A Treatise Concerning the Use and Abuse of the Marriage Bed " for propriety) is a 1727 essay by  Daniel Defoe .


The essay dealt primarily with  contraception , comparing it directly with  infanticide .  Defoe accomplished this through anecdotes, such as a conversation between two women in which the right-minded chides the other for asking for "recipes" that might prevent pregnancy.  In the essay, he further referred to contraception as "the diabolical practice of attempting to prevent childbearing by physical preparations." [ 1 ]


George Washington is known to have owned the book, as noted in the biography by Chernow.


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Cranioschisis  ( Greek :  κρανιον kranion , "skull", and σχίσις  schisis , "split") is a skull-related  neural tube defect . The skull does not close all the way in this deformity (especially at the occipital region). As a result, the  amniotic fluid  enters the brain, leading to eventual brain degeneration and anencephaly. [ 1 ]   Craniorachischisis  is on the extreme end of the dysraphism spectrum, wherein the entire length of the  neural tube  fails to close. [ 2 ]


dpc  ( Latin , short for  days post coitum  or  dies post coitum , meaning  days after sex ) is a term commonly used in medicine and biology to refer to the age of an embryo. [ 1 ]


Before the fertilized  ovum  reaches the  uterus , the  mucous membrane  of the body of the uterus undergoes important changes and is then known as the  decidua . The thickness and vascularity of the mucous membrane are greatly increased; its  glands  are elongated and open on its free surface by funnel-shaped  orifices , while their deeper portions are tortuous and dilated into irregular spaces. The interglandular tissue is also increased in quantity, and is crowded with large round, oval, or polygonal cells, termed  decidual cells . [ 1 ]   Their enlargement is due to glycogen and lipid accumulation in the cytoplasm allowing these cells to provide a rich source of nutrition for the developing embryo. Decidual cells are also thought to control the invasion of the endometrium by  trophoblast  cells. [ 2 ]


Experimentally, human endometrial stromal cells can be decidualized in culture by using analogs of  cAMP  and  progesterone . The cells will exhibit a decidualized phenotype and display upregulation of common  decidualization  markers such as  prolactin  and  IGFBP1 . [ 3 ]


This article incorporates text in the  public domain  from  page 59  of the 20th edition of   Gray's Anatomy   (1918)


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The  Dubowitz Score  is a method for estimating the  gestational age  of babies. It was devised by  Lilly Dubowitz , a Hungarian-born British  paediatrician , and her husband, the British  neurologist   Victor Dubowitz . [ 1 ] [ 2 ]


Ectopic decidua  are  decidual cells  found outside inner lining of the  uterus . This condition was first described in 1971 by Walker [ 1 ]  and the name 'ectopic decidua' was coined by Tausig. [ 2 ]  While ectopic decidua is most commonly seen during  pregnancy , it rarely occurs in non-pregnant people, accompanied by bleeding and pain. [ citation needed ]


Generally, ectopic decidua has no clinical symptoms, but it sometimes manifests as abdominal pain in pregnancy. [ 3 ]  Ectopic decidua most commonly occurs the  ovary ,  cervix  and  serosal  lining of the uterus. It rarely occurs in  peritoneum  also. In the peritoneum, ectopic decidua is formed due to metaplasia of subserosal stromal cells under the influence of progesterone. It regresses within 4–6 weeks after childbirth. Therefore, no treatment is needed for this condition. However, it is necessary to differentiate deciduosis from metastatic cancers and  mesothelioma . [ citation needed ]


Embryo Ranking Intelligent Classification Algorithm  ( ERICA ) is a deep learning [ 1 ]   AI  software designed to assist  embryologists  and clinicians during the embryo selection process leading to embryo transfer, [ 2 ]  a critical step of  in vitro fertilisation  treatments (IVF).


This AI-based software relies on  artificial vision  to extract features not identifiable with the use of conventional  microscopy . [ 3 ]  Following feature extraction, ERICA accurately ranks embryos according to their prognosis (defined as euploidy and implantation potential). In this way, ERICA removes the subjectivity inherent to previously existing classifications and, by efficiently assisting clinicians, increases the chances of selecting the one embryo with the best chances to become a baby. [ 4 ]


ERICA's algorithms and the EmbryoRanking.com associated software are cloud-based and base their ranking system on predicting individual embryo's genetic status in a non-invasive fashion. [ 5 ] [ 6 ]


In  medicine ,  Goodell's sign  is an indication of  pregnancy . It is a significant softening of the  vaginal  portion of the  cervix  from increased vascularization. This vascularization is a result of hypertrophy and engorgement of the vessels below the growing uterus. This sign occurs at approximately six  weeks' gestation.


The sign is named after  William Goodell  (1829–1874).


Holland–Rantos  was a company founded in the United States 1925 by  birth control  advocates that manufactured high-quality  contraceptives . Its primary product was the  diaphragm , which was  Margaret Sanger 's recommended method of contraception. [ 1 ] [ 2 ]    The company also sold a  lubricating jelly  under the name "vaginal jelly", based on a formula imported from Germany. [ 3 ]   In the 1940s, Holland–Rantos was bought by Young's Rubber Co., which manufactures the  Trojan Condom .  Around 2000, a new company  HR Pharmaceuticals  was founded, which sells lubricating jelly under the name "HR Jelly". [ 4 ]


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A  kick chart  is a form or  graph  used by a  pregnant  woman in the later stages to record the activity of her  fetus . [ 1 ]  If too few kicks are felt within a specified time (usually 12 hours) this could indicate a problem. [ 1 ]


A frequent question posed by midwives is how "many times has the baby kicked in the last twelve hours?" The unborn foetus should move five times per hour, [ 2 ]  or ten times in any twelve-hour period. [ citation needed ]  In the UK this is regarded as best indication of the health of the baby from the second trimester.


Once routine, use of these charts has declined, [ 3 ]  since women often forgot to complete them and fetal movement patterns are very varied, leading to unnecessary concern.


A more recent trend in the United Kingdom has been the replacement of the kick chart with jewelry-based counters. A pregnancy bracelet is a wearable form of kick counter.


The bracelets available work on similar principles: the baby kicks, the mother moves a marker. The idea is that this is more practical than using a pen and paper.


The two most widely advertised bracelets are currently undergoing the patent application process.


Kidding Aside  (The  British Childfree Association ) was founded in 2000 and exists in order to campaign for the rights of  British   childfree  people. It is thought to be the first politically active childfree movement in the world [ citation needed ]  and strives to introduce the childfree voice into relevant British political debate.  It also works to promote the childfree  lifestyle  as a legitimate and equal alternative to  parenthood , and campaigns for equality of opportunity for childfree people in employment and with regard to UK tax legislation. In addition to the voluntary childfree, the issues Kidding Aside speaks on also affect the lives of those who are involuntarily childfree.


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Kindara  is a  femtech  company headquartered in Colorado that develops apps that help  women identify  their fertile window. The products are used for women trying to get pregnant, or women who want to track their  menstrual cycle  for overall health. [ 1 ] [ 2 ]  Their latest product, Priya Fertility and Ovulation Monitor, maximizes a woman's chance of getting pregnancy by identifying her most fertile days. [ 3 ]


Kindara was founded in 2011 by husband-and-wife team Will Sacks and Kati Bicknell. [ 4 ]  The company launched its free mobile application in 2012. Kindara's mobile application allows women to track signs of fertility, such as  basal body temperature ,  cervical fluid , and the position of the  cervix  to determine when  ovulation  is occurring. [ 1 ] [ 2 ]  Kindara also sells a thermometer, Wink, which records basal body temperature and syncs automatically to the Kindara fertility application. [ 5 ]


Ladin's sign  is a  clinical sign  of  pregnancy  in which there is softening in the midline of the  uterus  anteriorly at the junction of the uterus and  cervix . It occurs and is detectable with a manual examination at about 6 weeks' gestation. [ 1 ]  Ladin's sign is often present during the woman's first pelvic exam when pregnancy is suspected. [ 2 ]  Cervical length is also significant in pregnancy and shorter or shortening length can increase chances of preterm labour and delivery as this shortening happens naturally at the beginning of labour. [ 3 ]  The cervix softens from conception and combined with other signs of early pregnancy, detecting Ladin's sign can assist clinicians in verifying a diagnosis of pregnancy. [ 4 ]


Abnormal softening of the cervix can also occur in pregnancy, so testing for abnormalities of uterine cervical softening, including sheer wave speed measurement, can be used as a method of distinguishing between normal and abnormal softening. [ 5 ]


Mesomelia  refers to conditions in which the middle parts of limbs are disproportionately short. [ 1 ]   When applied to  skeletal dysplasias ,  mesomelic dwarfism  describes generalised shortening of the forearms and lower legs. This is in contrast to  rhizomelic dwarfism  in which the upper portions of limbs are short such as in  achondroplasia .


Forms of mesomelic dwarfism currently described include: [ 2 ]


The  Mossman–Pacey paradox  is an  evolutionary   irony [ broken anchor ]  in which certain actions often taken by men to improve their  sexual attractiveness  end up lowering their  fertility . [ 1 ] [ 2 ] [ 3 ]


One of the most prevalent manifestations of this phenomenon is the use of  anabolic steroids  by some men (particularly if they go to the  gym ). These steroids can help build larger  muscles , but can also lead to side effects such as smaller  testicles ,  erectile dysfunction , and lower  sperm count . [ 2 ]  One of the main reasons for this is that anabolic steroids can stop the  pituitary gland  producing the  hormones   LH  and  FSH . [ 2 ]  It has been estimated that approximately 90% of anabolic steroid users are at risk of  infertility . [ 2 ]
 [ 4 ]


Another major example is that the use of  balding  medications such as  finasteride  can reduce fertility. [ citation needed ]


The term is named after Dr James Mossman and Professor Allan Pacey, who first discovered the phenomenon when they noticed a large number of muscular men needing fertility tests. [ 2 ]


Nägele's obliquity  is the presentation of the anterior  parietal bone  to the  birth canal  during  vaginal delivery  with the  biparietal diameter  being oblique to the brim of the  pelvis . [ 1 ]  The synonym for this presentation is anterior asynclitism. [ 2 ]  It was first described in 1777 by German Karl Nägele. [ 3 ] [ 4 ]


National Orgasm Day  is a celebration of  sexual climax  and raises awareness for issues surrounding sexual climax. It is typically celebrated on July 31 in places such as the  United Kingdom ,  Australia ,  United States ,  the Netherlands ,   Canada  and  South Africa . [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ]  National Orgasm Day is an off-shoot of International Female Orgasm Day (August 8). [ 8 ]


International Female Orgasm Day was first celebrated on August 8, 2007, in  Esperantina, Brazil . It was created by the Councilman Arimateio Dantas when he passed a municipal law establishing the holiday in order to raise awareness for  female sexuality  and reduce  stigma  and  taboo  surrounding it, as well as repaying a "sexual debt" to his wife. [ 9 ]  In addition to the holiday, several events were held in the town for the discussion of these usually taboo topics, with support from local and international communities and the local church. [ 9 ]


Participants often celebrate National Orgasm Day by:


No Kidding! International  is an international non-profit social club created for singles and couples who have never had children regardless of the reason. Such people are generally described as "childless" by society at large, but some of their members who are childless by choice prefer the term " childfree " in order to highlight the voluntary nature of their circumstance. The first chapter of this organization was begun by Jerry Steinberg (the "Founding Non-Father" of No Kidding!) in  Vancouver , British Columbia, in 1984. [ 1 ]  There are numerous chapters in Canada, the United States and several other countries. [ citation needed ]


The stated purpose of No Kidding! is to give childless and childfree adults a place to share common interests not involving children, as well as to provide the opportunity to make new like-minded friends. [ 2 ]  Anyone who has never been a parent, regardless of the reason, is permitted to join. The club organizes a wide range of activities, including biking, hiking, wine and cheese parties, dinners, Sunday brunches, community theater, and concerts. [ citation needed ]


The organization has annual conventions where people from all over the U.S. and Canada gather. Conventions were held annually between 2002 and 2006. So far, conventions have been held in  Las Vegas ,  New Orleans ,  Seattle ,  Philadelphia  and  Toronto . In 2010, the convention was in  Houston . [ citation needed ]


The group's founder, as well as representatives of various No Kidding! chapters, have made numerous appearances in international media, as well as in local newspapers, radio shows and TV programs. [ citation needed ]


This article about an organization in Canada is a  stub . You can help Wikipedia by  expanding it .


Oocyte selection  is a procedure that is performed prior to  in vitro fertilization , in order to use  oocytes  with maximal chances of resulting in pregnancy. In contrast,  embryo selection  takes place  after  fertilization.


Not all women can conceive naturally, leaving them with a need for technologies and research that can help them have children. Women who might not be able to have their kids naturally may have the option of in vitro fertilization. In vitro fertilization can be a series of treatments that involves the fertilization of a mature egg with a sperm in a laboratory. [ 1 ]  Oocyte selection is a part the process for in vitro fertilization. [ 2 ]  An Oocyte is an egg/ovum that is not fully mature or developed and has not been fertilized; Therefore an oocyte is an undeveloped ovum.


Selecting an oocyte for in vitro fertilization involves assessing the quality of the oocyte which is usually done by accessing the morphological features of the oocyte. The major parts of the oocyte that are accessed for quality in terms of morphological characteristics are the cumulus cells, zona pellucida, polar body, perivitelline space, and cytoplasm; These are the main parts of the oocyte and are usually assessed by conventional microscopy. [ 3 ]  The size of an oocyte is another factor of the quality of the oocyte; Larger oocyte are usually more quality than smaller ones.  [ 4 ]  Chromosomal evaluation may be performed. Embryos from rescued in vitro-matured  metaphase II  (IVM-MII) oocytes show significantly higher fertilization rates and more blastomeres per embryo compared with those from arrested  metaphase I  (MI) oocytes (58.5% vs. 43.9% and 5.7 vs. 5.0, respectively). [ 5 ]


Also, morphological features of the oocyte that can be obtained by standard  light  or  polarized light microscopy . However, there is no clear tendency in recent publications to a general increase in predictive value of morphological features. [ 6 ]  Suggested techniques include  zona pellucida  imaging , which can detect differences in  birefringence  between eggs, which is a predictor of  compaction ,  blastulation  and pregnancy. [ 7 ]


Potentially,  polar body biopsy  may be used for molecular analysis, and can be used for  preimplantation genetic screening . [ 8 ]


Otofacial syndrome  is an extraordinarily rare  congenital deformity  in which a person is born without a  mandible , and, consequently, without a  chin .


In nearly all cases, the child does not survive because they are unable to breathe and eat properly. Even with  reconstructive surgery , the  tongue  is extremely underdeveloped, making unaided breathing and swallowing impossible. However there are cases, where individuals are living longer. In such cases as in Joseph K. Williams (DJBrownSugarV).


The first challenge to survival is assisted breathing and tubal feeding. This is a lifelong affair, generally requiring the patient to spend nearly all of the time under direct hospital care.


American  surgeons successfully used bone from the hip of an  Irish  teenager named Alan Doherty to rebuild a jaw and chin. Surgeons began the procedures in June 2007 and completed the final of seven surgeries on 25 August 2008. Doherty is now able to smile, but is still unable to breathe, eat, or speak on his own. [ 1 ] [ 2 ]


In medicine,  Piskaçek's sign  is a physical indication of  pregnancy .


It is defined as asymmetry of the enlarged  uterus , palpable during  pelvic examination , after the first few weeks of pregnancy. It is attributed to lateral implantation of the  embryo , which can enlarge one  uterine horn  before the other. [ 1 ] [ 2 ]  It has also been described as focal softening of the uterus, contrasted to the firmness of the area where the  placenta  is implanted. [ 3 ]


It is named after obstetrician  Ludwig Piskaçek , who described it in Vienna in 1899, though it had already been noted by  Robert Latou Dickinson  of New York in 1892. A  similar physical sign  had been described by  Carl von Fernwald Braun . [ 2 ]  It comes from an era when laboratory tests for pregnancy had not been developed, but experience gained in pelvic examination during early pregnancy by western gynecologists led them to publish their physical findings, allowing clinical diagnosis of pregnancy. [ 3 ]  Other such signs of early pregnancy include  Goodell ,  Hegar ,  Hartman  and  Chadwick signs .


Postpartum chills  is a   physiological response  that occurs within two hours of  childbirth . It appears as uncontrollable  shivering . It is seen in many women after delivery and can be unpleasant. It lasts for a short time. It is thought to be a result of a nervous system response. It may also be related to  fluid shifts  and the actual strenuous work of labor. It is considered a normal response and there is no accompanying  fever . A fever would indicate an  infection . Reassurance is all that is needed and for the mother to be kept warm. It has been described as a fairly common and normal occurrence. [ 1 ] [ 2 ]  It is thought to be possibly related to the environmental temperature. [ 3 ]


Pyelectasis  is a dilation of the  renal pelvis . It is a relatively common  ultrasound  finding in  fetuses  and is three times more common in male fetuses.  In most cases pyelectasis resolves normally, having no ill effects on the baby. The significance of pyelectasis in fetuses is not clear. It was thought to be a marker for obstruction, but in most cases it resolves spontaneously. In some studies it has been shown to appear and disappear several times throughout the course of pregnancy. There is some discussion about what degree of pyelectasis is considered severe enough to warrant further investigation and most authorities use 6mm as the cut-off point.


Pyelectasis is considered to be a "soft marker” for  Down syndrome .  This, along with other factors such as age and abnormal maternal serum screening (exa, Integrated or Quad screen), may be grounds for a prenatal diagnostic test such as an  amniocentesis  to rule out Down syndrome.


Babies with unresolved pyelectasis may experience  urological  problems requiring surgery.


The word  pyelectasis  ( / p aɪ ə ˈ l ɛ k t ə s ɪ s / ) is derived from the prefix  pyelo- , meaning "[renal] pelvis", and  ectasis , meaning "dilation or distension".


Salivary gland atresia  is congenital blockage or absence of the orifice of a major salivary gland duct or part of the duct itself. [ 1 ]


It is a very rare condition. [ 1 ] [ 2 ]  The submandibular salivary gland duct is usually involved, having failed to cannulate during embryological development. The condition first becomes apparent in the first few days after birth where a submandibular swelling caused by a retention cyst is noticed. [ 2 ]


Shock of birth  is the transient depression of  muscle tone  and  deep tendon reflexes  that occurs in  newborns  after  birth . In 70% of newborns, it lasts less than 24 hours, and in 84.3% less than 48 hours. Its presence is not affected by whether birth happened through  vaginal delivery  or  cesarean delivery . [ 1 ]  The term was introduced in 1960. [ 2 ]


A  simulated pregnancy  is a deliberate attempt to create the impression of  pregnancy . [ 1 ] [ 2 ] [ 3 ] [ 4 ]  It should not be confused with  false pregnancy , where a person mistakenly believes that they are pregnant.


The  Taubaté pregnancy hoax  is a notable example of a simulated pregnancy that happened in Brazil in 2012. [ 5 ] [ 6 ]


People who wish to look pregnant, generally for social, sexual, psychological or entertainment purposes, have the option of body suits and the like to wear under their clothes. It can be done by using  pillows  or pads, or light-weighing, small balls with a round shape to simulate a pregnant abdomen.


This article about  biomedical engineering  is a  stub . You can help Wikipedia by  expanding it .


Spalding's sign  is a sign used in  obstetrics . [ 1 ]  It is named for  Alfred Baker Spalding . [ 2 ] [ 3 ]


It is an indicator of  fetal death . [ 4 ]  When fetal death has occurred loss of alignment and overriding of the bones of cranial vault occur due to shrinkage of cerebrum, [ 5 ]  abdominal sonar examination may reveal an overriding of the fetal cranial bones. [ 6 ]  Most
estimates place the precise time of fetal death at about 4–7 days before overlapping and separation of the fetal
skull bones appear. [ 7 ]


The  Spiegelberg criteria  are four criteria used to identify ovarian  ectopic pregnancies [ 1 ]  named after  Otto Spiegelberg .


Four criteria for differentiating ovarian from other ectopic pregnancies:


Srb's anomaly  is the clinical condition describing  synostosis , or fusion, between the first and second ribs. [ 1 ] [ 2 ]  It may be either a partial or complete fusion between the two ribs to create an entirely indistinguishable new rib. [ 3 ]


Srb's anomaly is commonly seen in people with  Klippel–Feil syndrome . [ 4 ]


This  human musculoskeletal system  article is a  stub . You can help Wikipedia by  expanding it .


A  stigma , also called  macula pellucida , in  mammalian reproductive anatomy , refers to the area of the ovarian surface where the  Graafian follicle  will burst through during  ovulation  and release the  ovum . [ 1 ]
As the follicle matures, the area between the follicle and the ovarian surface begins to thin and weaken under the influence of the  luteinizing hormone  and local  cytokines . At ovulation the stigma ruptures and the secondary oocyte is released along with surrounding granulosa cells, from the region of the cumulus oophorus, and follicular fluid. The secondary oocyte needs to be captured by the  fallopian tube  where it could be fertilized by a  sperm  cell. The stigma will heal and the residual follicle is transformed into the  corpus luteum .


Syngnathia  is a  congenital   adhesion  of the  maxilla  and  mandible  by  fibrous  bands. [ 1 ]


Time-lapse embryo imaging  is an emerging  non-invasive   embryo selection  technique used in  reproductive biology . It is used to help select embryos with lower risk of defects and/or greater potential of  implantation.  The procedure involves taking thousands of pictures of the growing embryo  in vitro  during incubation to study  morphology  and morphokinetic parameters. [ 1 ]


In terms of pregnancy rates, live births, or the risk of stillbirth or miscarriage there is a lack of evidence of sufficient quality to know if there is any difference between time-lapse embryo imaging and conventional embryo assessment in  in-vitro fertilisation (IVF) . [ 2 ]  Further trials are needed in order to determine whether time-lapse embryo imaging can impact on outcomes such as live-birth for couples undergoing IVF or ICSI. [ 3 ]


In  obstetrics  a  trial of labour  is the conduction of spontaneous labour in a moderate degree of  cephalopelvic disproportion . [ 1 ] [ 2 ]  It is performed under close observation by an  obstetrician  in order to assess a woman's chances of a successful vaginal birth. [ 3 ]  The physician may allow labor to continue against contraindications during birth or even stimulate labor with  oxytocin  when pelvic measurements are borderline to see if the fetal head will descend making vaginal delivery possible; if progressive changes in dilation and station do not occur, a cesarean delivery is performed.


Umbilical cord ulceration and intestinal atresia  is a rare [ 1 ]   congenital  disease that leads to  intestinal atresia , umbilical cord ulceration and severe intrauterine  haemorrhage . Only 15 cases have so far been reported, [ 2 ]  though newer studies are beginning to conclude that this disease has a higher incidence rate than has been previously reported. [ 3 ]  A particular study has given intestinal atresia and umbilical cord ulceration a clear link after 5 such cases were reported at the time of publication. [ 4 ]


This  gastroenterology  article is a  stub . You can help Wikipedia by  expanding it .


The  uterotubal junction  is the connection between the endometrial cavity of the  uterus  and the  fallopian tube  (uterine tube) at the proximal tubal opening, the beginning of the intramural part of the fallopian tube. Histologically, the endometrial  epithelium  changes over to  ciliated  tubal epithelium.


Patency of the uterotubal junction is necessary for normal reproduction. The tubes can get blocked here by infection ( salpingitis ) and surgical intervention may be necessary.


Mouse studies have indicated that selective passage of individual  spermatozoa  may occur at this junction, [ 1 ]  with abnormal morphology being identified as a significant selection criterion, leading to predominantly normal  sperm  passing towards the  ovum . [ 2 ]   Absence of the protein  calmegin  has also been suggested as a critical factor for reliable sperm passage. [ 1 ]


The uterotubal junction is accessible by  hysteroscopy  and the entry point for tubal  cannulation  and  falloposcopy . Contraceptive methods have been developed to block the uterotubal junction.


Von Braun-Fernwald's sign  is a  clinical sign  in which there is an irregular softening and enlargement of the  uterine fundus  during early  pregnancy . It occurs at 5–8 weeks gestation. [ 1 ]


The sign is named after  Karl von Braun-Fernwald .


Zadik–Barak–Levin syndrome (ZBLS)  is a  congenital disorder  in humans. Presenting conditions include primary  hypothyroidism ,  cleft palate ,  hypodontia , and  ectodermal   dysplasia . It is the result of an  embryonic  defect in the  mesodermal -ectodermal midline development.


Adrenocorticotropic hormone  ( ACTH ; also  adrenocorticotropin ,  corticotropin ) is a  polypeptide   tropic hormone  produced by and secreted by the  anterior pituitary gland . [ 1 ]  It is also used as a  medication and diagnostic agent . ACTH is an important component of the  hypothalamic-pituitary-adrenal axis  and is often produced in response to biological stress (along with its precursor  corticotropin-releasing hormone  from the  hypothalamus ). Its principal effects are increased production and release of  cortisol  and androgens by the zona fasiculata and zona reticularis, respectively. ACTH is also related to the  circadian rhythm  in many organisms. [ 2 ]


Deficiency of ACTH is an indicator of secondary  adrenal insufficiency  (suppressed production of ACTH due to an impairment of the  pituitary gland  or  hypothalamus , cf.  hypopituitarism ) or tertiary adrenal insufficiency (disease of the hypothalamus, with a decrease in the release of  corticotropin releasing hormone (CRH) ). Conversely, chronically elevated ACTH levels occur in primary adrenal insufficiency (e.g.  Addison's disease ) when adrenal gland production of  cortisol  is chronically deficient. In  Cushing's disease , a pituitary tumor leads to excessive production of ACTH, which stimulates the  adrenal cortex  to produce high levels of cortisol.


POMC , ACTH and β-lipotropin are secreted from  corticotropic cells  in the  anterior lobe  (or  adenohypophysis ) of the  pituitary gland  in response to the hormone  corticotropin-releasing hormone  (CRH) released by the  hypothalamus . [ 3 ]  The pre-pro-opiomelanocortin ( Pre-POMC ) is the precursor of POMC, its cleavage forms POMC. [ 4 ]  ACTH, on the other hand, is produced from the cleavage of POMC. The removal of the signal  peptide  during  translation  produces the 241-amino acid  polypeptide  POMC, which undergoes a series of  post-translational modifications  such as  phosphorylation  and  glycosylation  before it is proteolytically cleaved by  endopeptidases  to yield various polypeptide fragments with varying physiological activity. These fragments include: [ 5 ]


In order to regulate the secretion of ACTH, many substances secreted within this axis exhibit slow/intermediate and fast feedback-loop activity.  Glucocorticoids  secreted from the adrenal cortex work to inhibit CRH secretion by the hypothalamus, which in turn decreases anterior pituitary secretion of ACTH. Glucocorticoids may also inhibit the rates of POMC gene  transcription  and peptide synthesis. The latter is an example of a slow feedback loop, which works on the order of hours to days, whereas the former works on the order of minutes.


The  half-life  of ACTH in human blood is reported to be between ten and 30 minutes. [ 6 ] [ 7 ] [ 8 ]


ACTH consists of 39  amino acids , the first 13 of which (counting from the N-terminus) may be cleaved to form  α-melanocyte-stimulating hormone  (α-MSH) (this common structure is responsible for  excessively tanned skin  in Addison's disease). After a short period of time, ACTH is cleaved into α- melanocyte-stimulating hormone  (α-MSH) and CLIP, a peptide with unknown activity in humans.


In human body, total weight ACTH is 4,540  atomic mass units  (Da). [ 9 ]


ACTH stimulates secretion of  glucocorticoid steroid hormones  from adrenal cortex cells, especially in the  zona fasciculata  of the adrenal glands. ACTH acts by binding to cell surface  ACTH receptors , which are located primarily on adrenocortical cells of the  adrenal cortex . The ACTH receptor is a seven-membrane-spanning  G protein-coupled receptor . [ 10 ]  Upon ligand binding, the receptor undergoes conformation changes that stimulate the enzyme  adenylyl cyclase , which leads to an increase in intracellular  cAMP [ 11 ]  and subsequent activation of  protein kinase A .


ACTH influences steroid hormone secretion by both rapid short-term mechanisms that take place within minutes and slower long-term actions. The rapid actions of ACTH include stimulation of cholesterol delivery to the mitochondria where the  P450scc  enzyme is located. P450scc catalyzes the first step of steroidogenesis that is cleavage of the side-chain of cholesterol.
ACTH also stimulates  lipoprotein  uptake into cortical cells. This increases the  bioavailability  of  cholesterol  in the cells of the adrenal cortex.


The long term actions of ACTH include stimulation of the transcription of the genes coding for steroidogenic enzymes, especially P450scc, steroid 11β-hydroxylase, and their associated electron transfer proteins. [ 11 ]  This effect is observed over several hours. [ 11 ]


In addition to steroidogenic enzymes, ACTH also enhances transcription of mitochondrial genes that encode for subunits of mitochondrial oxidative phosphorylation systems. [ 12 ]  These actions are probably necessary to supply the enhanced energy needs of adrenocortical cells stimulated by ACTH. [ 12 ]


As indicated above, ACTH is a cleavage product of the pro-hormone,  proopiomelanocortin  (POMC), which also produces other hormones including  α-MSH  that stimulates the production of  melanin . A family of related receptors mediates the actions of these hormones, the MCR, or  melanocortin receptor  family. These are mainly not associated with the  pituitary - adrenal  axis. MC2R is the  ACTH receptor . [ 13 ]


While it has a crucial function in regulating the adrenal glands, it is also expressed elsewhere in the body, specifically in the  osteoblast , which is responsible for making new bone, a continual and highly regulated process in the bodies of air-breathing vertebrates. [ 14 ]  The functional expression of MC2R on the osteoblast was discovered by Isales et alia in 2005. [ 15 ]  Since that time, it has been demonstrated that the response of bone forming cells to ACTH includes production of  VEGF , as it does in the adrenal. This response might be important in maintaining osteoblast survival under some conditions. [ 16 ]  If this is physiologically important, it probably functions in conditions with short-period or intermittent ACTH signaling, since with continual exposure of osteoblasts to ACTH, the effect was lost in a few hours.


While working on her dissertation,  Evelyn M. Anderson  co-discovered ACTH with  James Bertram Collip  and  David Landsborough Thomson  and, in a paper published in 1933, explained its function in the body. [ 17 ] [ 18 ]


An active synthetic form of ACTH, consisting of the first 23 amino acids of native ACTH, was first made by Klaus Hofmann at the  University of Pittsburgh . [ 19 ]


Follicle-stimulating hormone  ( FSH ) is a  gonadotropin , a  glycoprotein   polypeptide   hormone . [ 1 ]  FSH is synthesized and secreted by the  gonadotropic cells  of the  anterior pituitary gland [ 2 ]  and regulates the development, growth,  pubertal maturation , and reproductive processes of the body. FSH and  luteinizing hormone  (LH) work together in the  reproductive system . [ 3 ]


FSH is a 35.5 kDa  glycoprotein   heterodimer , consisting of two  polypeptide  units, alpha and beta. Its structure is similar to those of  luteinizing hormone  (LH),  thyroid-stimulating hormone  (TSH), and  human chorionic gonadotropin  (hCG). The  alpha subunits  of the glycoproteins LH, FSH, TSH, and hCG are identical and consist of 96  amino acids , while the beta subunits vary. [ 4 ] [ 5 ]  Both subunits are required for biological activity. FSH has a beta subunit of 111 amino acids (FSH β), which confers its specific biologic action, and is responsible for interaction with the  follicle-stimulating hormone receptor . [ 6 ]  The sugar portion of the hormone is covalently bonded to  asparagine , and is composed of  N-acetylgalactosamine ,  mannose ,  N-acetylglucosamine ,  galactose , and  sialic acid .


In humans, the gene for the  alpha subunit  is located at cytogenetic location 6q14.3. [ 7 ]  It is expressed in two cell types, most notably the basophils of the anterior pituitary. The gene for the FSH beta subunit is located on chromosome 11p13, and is expressed in gonadotropes of the pituitary cells, controlled by  GnRH , inhibited by  inhibin , and enhanced by  activin . [ 8 ]


FSH regulates the development, growth, pubertal maturation and reproductive processes of the human body. [ 9 ]


Control of FSH release from the pituitary gland is unknown. Low frequency  gonadotropin-releasing hormone  (GnRH) pulses increase FSH mRNA levels in the rat, [ 10 ]  but is not directly correlated with an increase in circulating FSH. [ 11 ]  GnRH has been shown to play an important role in the secretion of FSH, with hypothalamic-pituitary disconnection leading to a cessation of FSH. GnRH administration leads to a return of FSH secretion. FSH is subject to oestrogen feed-back from the gonads via the hypothalamic pituitary gonadal axis.


FSH stimulates the growth and recruitment of immature  ovarian follicles  in the  ovary . In early (small) antral follicles, FSH is the major survival factor that rescues the small antral follicles (2–5 mm in diameter for humans) from  apoptosis  (programmed death of the somatic cells of the follicle and oocyte). In the luteal-follicle  phase transition  period the serum levels of progesterone and estrogen (primarily estradiol) decrease and no longer suppress the release of FSH, consequently FSH peaks at about day three (day one is the first day of menstrual flow). The cohort of small antral follicles is normally sufficient in number to produce enough  Inhibin  B to lower FSH serum levels. [ citation needed ]


In addition, there is evidence that  gonadotropin surge-attenuating factor  produced by small follicles during the first half of the follicle phase also exerts a negative feedback on pulsatile  luteinizing hormone  (LH) secretion amplitude, thus allowing a more favorable environment for follicle growth and preventing premature luteinization. [ 13 ]


As a woman nears perimenopause, the number of small antral follicles recruited in each cycle diminishes and consequently insufficient Inhibin B is produced to fully lower FSH and the serum level of FSH begins to rise.  Eventually, the FSH level becomes so high that  downregulation  of FSH receptors occurs and by postmenopause any remaining small secondary follicles no longer have FSH nor LH receptors. [ 14 ]