Thinking outside the box: meeting the sexual health needs of women presenting for emergency contraception.

This was a retrospective audit of sexual health screening and advice for long-term contraception in 174 and 993 women attending genitourinary (GU) medicine and contraceptive services (CS), respectively, for emergency hormonal contraception (EHC) over a 21-month period (April 2007-September 2008). Assessment and screening for sexually transmitted infection (including HIV) were more comprehensive at GU medicine (78% offered screening at GU medicine versus 17% at CS) while contraceptive management was more complete at CS (ongoing contraception discussed in 99% at CS versus 78% at GU medicine). Follow-up was seldom recommended or attended. Local HIV prevalence necessitates a more pro-active approach to HIV testing. Women requesting EHC present to a variety of clinical settings, each with their own areas of expertise. In an age of integrated sexual and reproductive health, these women deserve a holistic approach to care.

Oogenesis and cell death in human prenatal ovaries: what are the criteria for oocyte selection?

Prenatal oogenesis produces hundreds of thousands of oocytes, most of which are discarded through apoptosis before birth. Despite this large-scale selection, the survivors do not constitute a perfect population, and the factors at the cellular level that result in apoptosis or survival of any individual oocyte are largely unknown. What then are the selection criteria that determine the size and quality of the ovarian reserve in women? This review focuses on new data at the cellular level, on human prenatal oogenesis, offering clues about the importance of the timing of entry to meiotic prophase I by linking the stages and progress through MPI with the presence or absence of apoptotic markers. The characteristics and responsiveness of cultured human fetal ovarian tissue at different gestational ages to growth factor supplementation and the impact of meiotic abnormalities upon apoptotic markers are discussed. Future work will require the use of a tissue culture model of prenatal oogenesis in order to investigate the fate of individual live oocytes at different stages of development.