In 1983 two doctors, one from each side of the world, decided to form a partnership, and so began a scientific adventure that would improve the odds that babies could be born healthy and whole. Neural tube defects that severely disabled or killed babies were epidemic in China (where the folk term was guai tai--roughly "monster baby"--for an infant whose embryonic neural tube doesn't completely close and whose head and neck may be misshapen or spine may protrude) and a significant problem in the United States, leading teams of researchers from the United States and China to combine forces to recruit more than 285,000 Chinese women and to follow nearly 250,000 pregnancies in an epidemiological study.

Sixteen thousand staff were involved in running the project, which encountered massive bureaucratic obstacles as well as cultural differences, politicking for study designs and funding, the crisis of Tiananmen Square, and testy debates over research ethics. Nevertheless, the researchers persevered in a collaboration that lasted more than three decades and led to landmark findings on the role of folic acid in preventing spina bifida. Fortifying cereal grain products with folic acid became routine in the United States and a growing number of nations around the world: that intervention was named one of the ten great public health achievements of the last decade.

Both theory and animal experiments often relate impairment of fertility and fetal development to the stress of hypoxia. This comprehensive, penetrating study includes critical reviews of theory and experiments as well as of previous studies of human birth weight and neonatal mortality at high altitudes in the United States. It also reports on studies of mothers, placentas, and the newborn in two Peruvian populations, one in the Andes, the other at sea level. It presents new evidence on the functional significance of various aspects of placental anatomy and on racial differences in maternal ability to nourish the fetus at high altitudes.

The exact process by which the fertilized mammalian ovum becomes implanted upon the uterine surface remains something of a mystery, and yet successful reproduction depends upon it. Two methods of contraception—the intrauterine device and the “morning-after pill”—are thought to be effective because they disrupt or prevent the process of implantation, but the biological basis of their effect is still imperfectly understood.

This book brings together authoritative accounts by leaders in the field of reproductive biology, researchers who have closely investigated implantation. The subject is approached from several angles: biochemical, endocrinological, pharmacological, anatomic, and immunological. A review of recent studies on implantation serves to put the individual reports in context. This book provides a needed perspective on an important area of reproduction research.