Ovulation, eventually.

I took vitex for about 5-6 days and it really did help stop my breasts from hurting. But then when it gave me a headache I stopped taking it. It took me an additional 5-6 days until my body ovulated this cycle which was on May 1 or 2, so no ovulation in April.

After I ovulated I was exhausted for a few days. Really, really exhausted. Like after a full nights sleep wanting to lay down in my office at work and nap. I wasn't on herbs or meds or anything. The second day of that I did go home in the afternoon and fell right asleep. I woke and went to a community meeting and then went back to bed for another 10 hours.

When I saw my acu for my weekly visit I asked him what was up. He said that my kidney yang was depleted, that is the warming energy that heats things up during the luteal phase. He did some moxa and other heated needle work on me and told me to have more cinnamon. That seemed funny to me too but it worked. I had a lot more energy on Thursday. Friday, well that was another story.

Friday I was dealing with a deadline and some really nasty horrible moody feelings. Kind of miserable really -- I can't be the only one who feels this way during their luteal phase. Saturday I was still a bit on a downer note but then in the afternoon I decided to kick my own a$$ and make myself do things that would make me feel better. I decided to cook dinner for our extended family and give some gifts. You know, it worked. Then I spent a good amount of time on Sunday exercising, washing the car, working on home improvement projects, and baking. I've been much better this whole week thank goodness.

My basel temps were awful though, not only that but they were tanking when they should have been at their peak for a non-pregnant cycle. I started using my natural progesterone cream Sunday night (it was part of my original plan for this cycle but I somehow didn't get around to it), and my temps have been up all week into a reasonable range. I think that this cycle is a total nogo but what the heck do I know. I'm on 10 dpo so technically I'm still in the reasonable range for implantation.

I'm tired of all the energy that I've put into TTC right now though. And with all the grief and healing that I had to do (physical and emotional) my work really bore the brunt and now we are all feeling it. I had to change my priorities, so for now I'm feeling a lot quieter.

Headaches and moving too much qi

My acu had me on a herb mix that contained bluplurum a while back. It gave me a headache so he put me on a different formula that contained dong quai which was bitter but I didn't get a headache. So, I know that headaches and herbs are related.

From a TCM standpoint he told me that bluplurum moves the liver qi, and I have stagnant liver qi, but the problem was that it was moving more liver qi than I had available to move.
I started taking vitex last week, which move the kidney yang and penetrates the liver. I was doing great until yesterday when I got another headache -- same as before, in the front of my forehead. I guess the vitex is moving too much qi as well so I will have to stop and figure out what to do next.

I found this page about headaches and TCM, it might be helpful to you in understanding why one gets headaches - Arterial Hypertension And Traditional Chinese Medicine In China

~~

Is anyone actually reading my blog? If you are can you please just do a little post so I know you are out there?

Progesterone cream and pregnancy/miscarriage

I was on 50mg suppositories twice daily at the start of my pg last year and I stopped all at once when I found out it was a blighted ovum and I didn't even spot -- nothing changed, and my pregnancy sure as heck didn't end. Obviously that is a different situation but it did change my impression of how difficult it was to end a pregnancy.

I looked up a lot to see if there was anyway I could get my body to miscarry and other than practically poisoning myself or giving myself a life-threatening uterine infection there really wasn't much I could do. Really, think about it this way, with all the women wanting to terminate their pregnancies when they don't want them, surely if using and stopping progesterone was an easy way out then lots of people would be doing it and it would likely become a controlled substance. No?

Vitex to the rescue

I was reading someone's post about B6 for PMS and decided to look up food sources of B6 and came up with this abbreviated list: "Vitamin B6 is found in beans, nuts, legumes, eggs, meats, fish, brewer's yeast, bananas, green leafy vegetables, wheat germ, wheat bran, milk, whole grains, and fortified breads and cereals."

I eat a good amount of B6 rich foods but I was still having similar problems -- lame LP, PMS, etc. I had my CD# bloodwork done again last week and my estradiol was high -- darn estrogen dominance anyway -- though it is totally part of the pattern that leads to fibroids. So I started looking up stuff about estrogen, and prolactin since having sore breasts for the past 3 weeks hasn't been any fun.

And then I did a search again and came across, of all things -- vitex and this:
quote:

Chaste berry (also spelled chasteberry) contains several different constituents, including flavonoids, iridoid glycosides, and terpenoids. Chaste berry (the fruit of a small Eurasian tree, also called Vitex agnus) does not contain hormones. The benefits of chaste berry stem from its actions upon the pituitary gland. Chaste berry keeps prolactin secretion in check. The ability to decrease mildly elevated prolactin levels may benefit some women with breast tenderness associated with PMS. Chaste berry may also be helpful in menopause and cyclic mastalgia. New research indicates that certain compounds in chasteberry may have activity similar to the brain chemical dopamine.
http://www.raysahelian.com/chasteberry.html

So I conferred with my acupuncturist and he said I could try it if I wanted to. I started yesterday morning and I was in a better mood than I had been in weeks and by evening my breast pain had dissipated. It had to be the vitex as drinking water, taking vitamins, exercise, low stress all had no affect. And it wasn't optimism either as there was the great news about my partner's sperm morphology (increase from 2% to 5% with supplements) and that didn't affect my mood for the better -- I still felt like growling at everyone in sight.

I looked up more about vitex and liver qi stagnation since that is my chronic diagnosis. I found a few things that mentioned it:

"Vitex (V. Agnus-castus) -- acrid, spicy, warm; goes to the Liver and Spleen. It contains essential oil, fatty oil, flavonoid casticin, iridoglyside and aucubin. It is used for menstrual irregularities and irregular symptoms associated with menopause. It stimulates progesterone production and regulates the menses. It effectively treats ovarian cysts and non-cancerous breast lumps. Dose: 3-9 gms"
http://www.planetherbs.com/articles/fivestag.html

"TCM Usage:regulates the Blood, nourishes the Kidney, moves Qi in the lower Jiao.
Contra Indications: Vitex is a bit hot, so use with this in mind (not for use in ovarian cysts?)."
http://www.rchm.co.uk/articles/western_herbs.html

In The Infertility Cure, Randine Lewis says that vitex is a kidney yang tonic, but since what happens in the kidneys affects the liver in chinese medicine it might make sense that it would help me out. Also my feet get really cold at night which is supposedly a sign of a kidney yang deficiency.

I'm just amazed! I know it doesn't work for everyone, evidently it isn't good to take if you have cysts, and even I haven't been psyched about how it worked when I took it previously but talk about a perfect fit for me right now.

Other than that, my acupuncturist told me that he still thinks I'm a bit blood deficient and that's why I'm craving chocolate, that and overthinking. Oh well.

Updated to add: it delayed my ovulation by as many days as I took it though I did end up getting pregnant again this same cycle. The delayed ovulation might have contributed to my subsequent miscarriage though that is entirely conjecture on the part of the NP at my RE's office.

Updated to add 4/6/06 -- it did help me with PMS and mastalgia during my LP

Vitex and herb form

After consultation with my acupuncturist, I am taking a liquid vitex (chase berry) extract from Herb Pharm, they are a reputable grower of medicinal herbs in Oregon. We aren't sure if it will work for me, my acupuncturist said it doesn't totally match my pattern in TCM but was okay with a trial.

I've heard that the less processed the herb or vitamins are the better, the best being cooked whole herbs, then liquid and then prepared capsules (unless they are custom prepared for you). I think that as long as they are high quality and agreeing with you though, so that you actually take them regularly is the most important thing.

I know that it is already working for me after less than one day (amazing but true as my breasts aren't hurting any longer) and I'm looking forward to even more benefits over the next few months if I don't get knocked up in the meantime.

Jumpin' Jiminy! Supplements work!

So don't think I'm an idiot for not knowing sooner, I got the last test results over the phone in May 2004 and we got pg that same cycle so it wasn't like we were having to pay too much attention.

I met with the nurse practitioner this morning and she was of the same opinion as my partner -- that my fibroid was a big impediment to our fertility so having it out really changes the lay of the land. She agreed that unless we were feeling really impatient that the best course of action is to just keep trying on our own and give things a chance to work on their own. She pulled up my partners last s/a results and I was surprised to see the results -- his last test did include a morphology check and it had jumped up to 5%!

Date	10/13/2003	5/18/2004
Viscosity	Normal	Normal
Volume	4	4.1
Concentration	49 mill/ml	36 mill/ml
Motililty	57%	57%
Morphology	2% Kruger	5% Kruger
Prog	Grade 2	Grade 2
Agglutination	Slight	None

So, I really need to look at this like we're just starting over. Being 34 means that our fertility is a bit less than prime but the nurse thought waiting until August before re-evaluating was totally reasonable. She advised me to go get a pelvic exam and a pap and then to just keep timing things properly and something should happen. I sure as heck hope so.

A little bit off

I've just started back in with infertility testing again and had my CD3 yesterday. So, my panel came back normal for FSH and LH, with just a teench more estrogen than normal. I want to get my prolactin tested as I think it might be a little bit high, perhaps in a subclinical way. I've looked up hyperprolactinemia in the past and have a lot of links. Today I was looking for the relationship between estrogen and prolactin and came across some interesting things that I thought I would share along with some other facts I've picked up along the way...

• Too much or too little prolactin causes infertility
  
• Prolactin excess can be stimulated by excess estrogen (this include using fertility drugs)
  
• Prolactin has been linked to low progesterone during the luteal phase
  
• Stress can elevate prolactin levels
  
• Dopamine regulates prolactin levels
  
• Stress can deplete dopamine levels in the brain
  
• Estrogen deprivation kills dopamine cells in the brain
  
• Excess estrogen leads to dopamine depletion
  
• Low progesterone leads to excess estrogen production
  
• Excess prolactin is linked to hypothyroidism
  
• Hypothyroidism and low progesterone can sometimes be linked to excess estrogen
  

And all of this could be on a subclinical level. Are you seeing the chicken and the egg here? So, for those of you who are relatively normal body weight and are experiencing infertility without other causes, such as IR or PCOS or a blockage, this might be one option for the hormonal imbalance that is impairing your fertility. A whole lotta little things being off just a little.

I'm going to explore this theory with my doctor in the coming weeks especially since I believe I have signs of excess prolactin.

Going Back in for Testing

I just called my RE's office to set up at "What Next" appointment after talking to the nurse there for a while. We haven't used any birth control since February 2000, and then it took us two years of fairly diligent trying (2002-2004) to finally get our BFP only to have it be a blighted ovum. In spite of the delay in our return to TTC until February (so the second half of 2004 was out) I still can't help but feel like there is something else at play. I haven't had my panels done since Feb 2003 and a lot has happened since then and I'm older now too.

I'm also going to get CD3 bloodwork done since that's tomorrow and I can just make sure that hormonally everything is swimming right (at the end of AF in my last cycle I had this odd temp rise that seemed unusual to me). The nurse said it might be time to have another HSG as well, not fun but I want answers.

My partner wasn't upset by the tests but he has this idea that my fibroid was the root of all evil and I'm not convinced that it was. When you can read stories about women having pregnancies with 5 tumors the size that I had (how they do it I don't know), it just boggles my mind. He keeps telling me that we just have to have a lot of sex. We have been having a lot of sex. I have three years worth of records of the majority of times we had sex -- somedays we even did it twice and you can't mark that down as a double in the charting program I use. Maybe I should do the math for him and tell him how many sperm he has deposited over the past three years and maybe then he will understand my frustration.

He wants me to just start over like it was the beginning again and we were just coming to this place where we are TTC in our lives. I don't know about you but I can't just erase three years of stress and heartache without a lobotomy. He got all pissed with me and said "I hate when you get like this" and I just said goodbye and hung up.

If we end up pg I can tell you it will be a result of all my hard work, research, hours of commiseration with my online buds, some surgery, some tests and not just because we had a lot of sex!

Charting for Three Years

I just passed my three year anniversary and it's been trippy. I have learned a lot along the way and at the end of the day charting, even in its most basic form give us data. I took the length of each of my cycles and made them into a chart in Excel and then enhanced it in Photoshop, it is interesting to see the forest and not just the trees.

Semen Analysis -- Helpful Details

Tapered refers to the head of the sperm, I found several references that mention testicular heat as a possible contributor to this defect:
Men with an elevated testicular temperature frequently due to a varicocele or exposure to excessive heat often have tapered sperm quality and may be missing the acrosome, the packet of enzymes at the tip of the sperm head that allow the sperm to bore through the coating of the egg.
From: An in-depth look at fertility

I also found this article: Deterioration Of Sperm Morphology In Men Exposed To High Temperature

Forward progression has to do with how well the sperm are at swimming forward. I don't know much about it but Vitamin E and Selenium are supposed to help with motility

Hypoosmolarity has to do with too much water being in the sperm cell I believe, remember osmosis from biology class in high school? I couldn't find anything that directly spoke to directly this but this quote points out some possible things to research more on:
In mammalian cells, hydration may change dynamically in response to hormones, ethanol, aniso-osmotic environments, oxidative stress or by cumulative substrate uptake.
from: Hepatocellular hydration: signal transduction and functional implications.

Here's a comprehensive guide to refer to: Semen Analysis in the Clinical Evaluation of Infertility

Semen Analysis

Here are some comprehensive guides to refer to: Semen Analysis in the Clinical Evaluation of Infertility

Semen analysis

The Fertility Guide: The Male Factor

Normal Ranges for a Semen Analysis from INCIID

Helpful Details

Morphology refers to the shape and structure of an object. Morphology may be even more important than count or motility in determining potential fertility. Abnormally shaped sperm cannot fertilize an egg. About 60% of the sperm should be normal in size and shape for adequate fertility.

The perfect structure is an oval head and long tail. Abnormally shaped sperm may include a number of variations:

A very large round head. (In one study, if 14% or more of sperm had round enlarged heads, the chances for pregnancy fell to about 20%. Such an abnormality indicates early unraveling of genetic material.)
An extremely small pinpoint head.
A tapered head.
A crooked head.
Two heads.
A tail with kinks and curls.
From Infertility in Men

Tapered refers to the head of the sperm, I found several references that mention testicular heat as a possible contributor to this defect:
Men with an elevated testicular temperature frequently due to a varicocele or exposure to excessive heat often have tapered sperm quality and may be missing the acrosome, the packet of enzymes at the tip of the sperm head that allow the sperm to bore through the coating of the egg.
From: An in-depth look at fertility

I also found this article: Deterioration Of Sperm Morphology In Men Exposed To High Temperature

Forward progression has to do with how well the sperm are at swimming forward (aka motility). I don't know much about it but Vitamin E and Selenium are supposed to help with motility

Hypoosmolarity has to do with too much water being in the sperm cell I believe, remember osmosis from biology class in high school? I couldn't find anything that directly spoke to directly this but this quote points out some possible things to research more on:
In mammalian cells, hydration may change dynamically in response to hormones, ethanol, aniso-osmotic environments, oxidative stress or by cumulative substrate uptake.
from: Hepatocellular hydration: signal transduction and functional implications.

A Shot at Improving Your Semen Analysis

(to a woman who's husband was just diagnosed with 2% morphology)

I wouldn't give up hope just yet, since your husband has been away there is a good chance that things got a bit sluggish and studies have shown that ejaculatory frequency can improve sperm quality. You guys should get busy and that's one step in the right direction.

There are a bunch of people on the boards who have gotten pg with 2% morphology. We did it too, though we had a blighted ovum.

I would suggest that since it takes 120 days to grow new sperm, that you repeat the test but after a few months of supplementation, healthy eating, destressing and regular intercourse. Then you could also do as Sonnet mentioned, using a condom to collect the sample -- how you collect the sample can influence what comes out and a longer pre-ejaculatory arousal period is associated with a greater quantity of sperm in the sample (I can't find the reference but its out there).

The UR had us do the SPA (Sperm Penetration Assay) test to see how the sperm reacted with the egg membrane. We did that test in May, the test results came back positive and we coincidently conceived the same cycle. He felt that the SPA (sperm penetration assay -- aka hamster egg test -- poor hamster) was useful as a next step in our diagnosis. This might show how your guys swimmers are performing IRL.

Laboratory Section - Sperm Penetration Assay
Sperm Penetration Assay

Also, having more sex prior to ovulation when you have fertile quality mucus means that you are pooling the available sperm which can make up some for the paucity in a single sample (see POOLED SPERM COUNTS)

Dr Perloe (guest host for chats here on the boards sometimes) suggested to us that the sperm DNA fragmentation test (SCSA) would be worthwhile but we got a BFP and didn't need to -- maybe soon we will do it if we don't get a BFP (having my fibroid out might have improved our fertility).

Supplements can help, we've seen some good results on the MFI board from various regimes that are all fairly similar. I expect that your DH hasn't been eating a lot of fresh veggies while he's been away, so he probably could do with a little extra for now.
I wrote up what supplements and doses my partner has been taking for another board member recently so I'm posting that here, other ppl might have additional recommendations:

Grapeseed -- 120 mg, 1 each day
L-Carnitine -- 250 mg, 1 each day sometimes
Arginine -- 500mg, 1 each day sometimes
Multi-vitamin -- 1 each day
Zinc -- (with c) -- 23mg, 1 each day sometimes
Rhodiola Rosea -- 300 mg, 1 each day

The ones marked sometimes he doesn't take every day, but instead several days a week. He senses that his body doesn't need it, which if your DH is in tune with his body he might find with some of the supplements as well. For starts though, I would do take all of these (rhodiola is optional though it might help as well, it is a potent anti-oxident and adaptogen which can help DH feel better after the stress he's been under -- they gave it to Russian fighter pilots in the Soviet Union to deal with the G-force better) -- he should do the supplement routine for three months and you should be able to see a difference in a subsequent analysis.

More information to check out:

Sperm

Male Infertility

Male Fertility or Infertility

Here's a shot of my myo scar 5 months after my surgery. Not bad at all.



Well, I don't know that I'll be doing any nude modeling but surely a little body makeup could make that just about disapppear.

And I know it's over still I cling I don't know where else I can go it's over, it's over, it's over I know it's over and it never really began but in my heart it was so real

I Know Its Over, The Smiths
from The Queen is Dead (1986)

Getting Calcium Without the Dairy

I looked up some info about calcium and thought I would share in response to this post:

Leafy greens contain vitamin C, A and D, magnesium -- along with calcium and folic acid -- and the combination is supposedly easier for your body to assimilate and use. There is also some evidence that too much calcium by itself actually isn't helpful to the body. Since the new USDA guidelines are for 7 servings of fruits and vegetables a day, everyone should probably drinking less milk and getting more vegetable sources of calcium in their diets.

Page 4 of the USDA Dietary Guidelines has a list of non-dairy sources of calcium

This was interesting as well to find out:

"While it is usually stated that calcium impairs iron absorption, the inconsistent results across experiments suggest that calcium-iron interactions are complex...It is likely that iron absorption can be protected by consuming calcium-rich foods and iron-rich foods at different meals."
http://www.mostproject.org/ISTD5.htm

I've been eating a lot more leafy greens over the past couple of years and have noted that if you can't get around to cooking them yourself that ethnic restaurants are a great way to incorporate some into your diet -- Indian, Chinese, Japanese, Ethiopian, Soul Food all have things like bok choy, spinach, or collard readily available. I actually feel better when I have less dairy, I will have some cheese if I'm craving it but otherwise I try to steer clear.

How long to take off for recovery post myomectomy

I was out of work for 3 weeks and then returned part-time at first and then worked up to full time. I did that in part to try to allow my body to focus on healing, all that thinking we do takes up valuable energy that the body could use to help heal itself. Also, it isn't comfortable as you are swollen and have lots of aches and pains in the first 6 weeks or so. It isn't too bad though, manageable really. It depends on many things --

* if you lose a lot of blood or go in anemic then healing will go slower, and you may be fatigued longer
* if you are in good shape your body should be able to heal you more quickly,
* if you eat really well you should heal better,
* if you really do take it easy for the time you are off you will heal better
* if you have any complications such as the incision opening then it will take longer
* some people say that the more quickly you are able to start walking again regularly that it can help promote healing -- but you can't do anything like yoga or running for at least 6 weeks.

I'm feeling like working from home today. Talking to my SIL really stirred up some emotion for me and I feel like I need to be away from people right now. My partner said to me last night that I've been grouchy for days, though I've only noticed that I've been very tired -- though I do get grouchy when I'm tired. I didn't tell him about my conversation with my SIL, just telling my online buddies about it was hard enough -- each time it just opens up the waterworks again and I just need a break from it. I've been almost feeling like I should take a break from charting and even the board too, though I know I couldn't do it easily. I think I need a vacation -- 10 days in Europe sounds nice. Do you know that I'm having a hard time at work right now too, I'm supposed to right all these proposals for new work and I just can't do it. I feel like nothing matters and I don't even understand what people in business want anymore -- it all seems so trivial and petty to me, like "who cares". It's probably just another phase of grief, recovery and acceptance.

The difference between medroxyprogesterone and progesterone

Medroxyprogesterone is a synthetic form of progesterone, it mimic the affects of progesterone on the body. It can cause side effects though that are similar though some of the s/e of progesterone, though it seems to affect more parts of the endocrine system than simple progesterone will cause (yellow eyes indicates liver problems, facial hair growth and loss of head hair indicate adrenal and thyroid involvement):

Medroxyprogesterone

Progesterone

Either way, large doses of hormones are tough on your system so make sure you eat a lot of fiber and drink water and include things like onions, garlic, leafy greens, artichokes and lemon in your diet to help support liver function.

I've been running/walking a mile each day with my dog for the past couple of weeks. I've been really good about keeping it up. I did fall off the wagon and I had hot cocoa and cheese over the weekend which made me feel awful. I'm not lactose intolerant, its just that my body doesn't like taking milk -- it causes more stagnation in my system. I'm trying to be good again and not slide off into my bad dietary habits. Want to know what they are? Well either way, I'm going to tell you -- they fall among the following:



not drinking enough fluids throughout the day

not eating breakfast

not eating breakfast and not eating lunch until after 2:30pm

eating chocolate when I have skipped breakfast and eaten lunch late

eating simple carbs and not enough protein or veggies

not going to the bathroom right away and holding it in (i have an aversion for public bathrooms, it is a problem)



My weekend... My partner's other brother is in town, visiting from France with his girlfriend. We spent a lot of time with them, they leave tomorrow afternoon. We were over at my SIL's house on Sunday and I boldly chose to stay behind with her when everyone else went to lunch, I figured that since she is staying home with the two little ones all the time this might help give her a break and make it so she wasn't feeling left behind. We chatted and eventually the conversation turned to my miscarriage. It was a very difficult and emotional conversation for us both and we both cried. She didn't understand why I couldn't talk to her for 6 months since my partner said I was fine (which wasn't true) -- she was a week behind me in getting her BFP so it was very difficult for me to see her. It was hard for me to have to open it up and explain it to her, but it had to be done as it was unresolved between us. I didn't tell her the nasty things, the really awful feelings I had along the way -- such as hating her, wishing her baby would die too, thinking she was selfish for only trying to reach out to me once. It is normal, I'm not the only one who has felt that way but I can't tell her that stuff. I told her instead that you worry enough when you are pregnant and that I didn't want her to see the dark side of pregnancy -- which is partially true as well.

She told me she was glad that I was accepting of my niece and that ultimately the pregnancy meant nothing -- we both agreed that, but I told her I just didn't need the constant reminders of the baby I wasn't having, the pregnancy that had failed.

Cervical Dysplasia & Cervical Cancer Info

My friend in NYC contacted me yesterday about cervical cancer, she knows someone who had dysplasia diagnosed as cancer and was looking for info (knowing that I'm big into women's reproductive health, she asked me to look it up). Anyway, I have a bunch of links you might want to share with your friend:

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From what I know the first sign of a problem is a bad pap smear. The results may show signs of cervical dysplasia. Cervical dysplasia means that there are some irregularities in how the tissue is growing, and this can be affected by hormonal imbalances.

An ob/gyn might then go in and do a colposcopy, which is look at the area with a magnifying device to investigate further. Typically the next step is to do a biopsy. The only concern about the biopsy is if your friend has not had children or desires to have more, that this can sometimes affect a woman's fertility.

It is scary but it is fairly common. It can be a pre-cancerous condition, but it does not mean cancer. I have read of it being successfully treated early on with progesterone supplementation (as per What Your Doctor May Not Tell You About Premenopause, by John Lee M.D.) She needs to find out how bad it is, I believe they give it some sort of rating.

Here are some links:

Cervical Dysplasia

She should join a group like this one, she'll get better information from women who have been there, and find out if she is being taken proper care of:
http://health.groups.yahoo.com/group/cervical_dysplasia/

The Reversal of Cervical Dysplasia With Vitamin Therapy

Cervical Dysplasia Treatment

Alternative Medicine site: Cervical Dysplasia

Xenoestrogens the cause of Cervical Dysplasia
(this is probably not the cause, though it might contribute)

http://www.cancer.gov/cancerinfo/types/cervical

"The prognosis for patients with cervical cancer is markedly affected by the extent of disease at the time of diagnosis."http://www.meb.uni-bonn.de/cancer.gov/CDR0000062759.html

http://www.cervicalcancercampaign.org/