Yen & Jaffe's Reproductive Endocrinology: Expert Consult 6th Edition

Copyright Page......Page 1
Remembrance......Page 2
Contributors......Page 3
Preface......Page 7
ANTERIOR PITUITARY AS A SOURCE FOR GONADOTROPINS......Page 8
THE HYPOTHALAMIC–PITUITARY–GONADAL (HPG) AXIS......Page 9
HYPOTHALAMIC NEUROANATOMY AND LIMBIC INPUTS......Page 10
THE HYPOTHALAMUS AS A TARGET FOR HORMONE ACTION......Page 13
Afferent Inputs Controlling Oxytocin and Vasopressin Secretion......Page 14
Functional Significance and Regulation of AVP and Oxytocin Secretion......Page 15
Morphology. The morphologic features of GnRH neurons are peculiar in many ways. The cell bodies are usually ovoid, tapering on each end into single neurites. These neurites appear to contain all of the organelles of the cell body, except for the nucleus, making it dif19 In fact, neither neurite appears to contain the components associated with an axon hillock. GnRH neurites do contain both small, electron-translucent vesicles and larger, electron-dense vesicles. The fact that only some of the larger vesicles are immunopo......Page 16
Development. The development of the GnRH neurosecretory system has been the subject of intense investigation, primarily in the mouse. Originally, GnRH neurons in the forebrain were believed to arise from multiple precursor sites because they are scattered across areas 32-34 In the mouse, cells containing GnRH peptide are first seen within the nasal placode on embryonic day 11 (E11). Two days later (E13), fewer cells are found in the nasal placode. At this time, most of the cells are seen in the vicinity of the cribriform plaFig. 1-8). By E16, cells have begun to show up in their most caudal positions in the hypothalamus, and by birth, the final distribution of GnRH neurons in the mouse has been established.......Page 17
Molecular Phenotypes. Although all of the GnRH neurons in the rostral forebrain share a common site of origin, they end up in a variety of locations, participating in the positive and negative feedback regulation of gonadotropin secretion and possibly influencing reproductive b......Page 19
THE MEDIAN EMINENCE......Page 20
THE PITUITARY......Page 21
GONADOTROPINS......Page 22
ULTRADIAN RHYTHMS......Page 23
DIURNAL/CIRCADIAN RHYTHMS......Page 25
ANNUAL RHYTHMS......Page 26
NEGATIVE FEEDBACK......Page 27
A MODEL OF NEGATIVE AND POSITIVE FEEDBACK REGULATION OF GNRH BY KISSPEPTINS......Page 29
Exercise......Page 31
Lactation......Page 32
CIRCULATING METABOLIC SIGNALS THAT LINK NUTRITION, GROWTH, AND REPRODUCTION......Page 33
CENTRAL PATHWAYS THAT INTEGRATE METABOLISM AND REPRODUCTION......Page 34
NEURONAL CIRCUITRY......Page 36
ROLE OF HORMONES, CHROMOSOMES, AND GENES IN SEXUAL DIFFERENTIATION OF THE BRAIN AND BEHAVIOR......Page 37
References......Page 38
Amino Acid Sequences and Three-Dimensional Structures......Page 39
Glycosylation......Page 40
Folding, Assembly, and Secretion......Page 41
Amino Acid Mutations......Page 42
Protein Engineering......Page 43
Naturally Occurring Mutations in α, Lhβ, and Fshβ......Page 44
Transcriptional Regulation......Page 45
Expression in Physiologic and Pathophysiologic Conditions......Page 46
DIAGNOSTIC AND THERAPEUTIC APPLICATIONS OF GONADOTROPINS......Page 47
Amino Acid Sequences and Three-Dimensional Structures......Page 48
Glycosylation......Page 50
Genes......Page 51
Naturally Occurring Mutations of Lhcgr and Fshr......Page 53
Post-Translational Regulation......Page 55
EXPRESSION OF GONADOTROPIN RECEPTORS IN EXTRAGONADAL TISSUES......Page 56
Model 3......Page 57
SIGNALING PATHWAYS ACTIVATED BY GONADOTROPIN RECEPTORS......Page 58
Suggested Readings......Page 59
PROLACTIN GENE STRUCTURE AND REGULATION......Page 60
MEASUREMENT OF PROLACTIN......Page 61
Changes in Prolactin with Age......Page 62
Dopamine......Page 63
Serotonin......Page 64
PROLACTIN SHORT-LOOP FEEDBACK......Page 65
PROLACTIN EFFECTS ON GONADOTROPIN SECRETION......Page 66
PROLACTIN EFFECTS ON THE OVARY......Page 67
PROLACTIN EFFECTS ON BONES......Page 68
Hyperprolactinemia......Page 69
Neurogenic Stimulation......Page 70
Autopsy Studies......Page 71
PROLACTINOMAS IN MULTIPLE ENDOCRINE NEOPLASIA TYPE I......Page 72
Clinical Manifestations......Page 73
Surgery......Page 74
Medical Therapy......Page 75
Conclusions about Treatment......Page 78
EFFECTS OF DOPAMINE AGONISTS ON THE DEVELOPING FETUS......Page 79
RECOMMENDATIONS FOR MANAGEMENT DURING PREGNANCY......Page 80
Suggested Readings......Page 81
Steroid Hormone Structure and Nomenclature......Page 82
Acquisition, Storage, and ­Trafficking of Cholesterol......Page 83
Overview of Steroidogenesis......Page 85
StAR: The Principal Regulator of Gonadal and Adrenal Steroidogenesis......Page 86
Other START Domain Proteins......Page 89
The Cholesterol Side-Chain Cleavage Enzyme (P450scc Encoded by CYP11A1)......Page 90
17α-Hydroxylase/17,20-Lyase (P450c17)......Page 91
Aromatase (P450arom)......Page 93
21-Hydroxylase (P450c21 Encoded by CYP21B)......Page 94
3β-Hydroxysteroid Dehydrogenase/∆5-4 Isomerases......Page 95
17β-Hydroxysteroid Dehydrogenases: Multiple Enzymes with Specific Synthetic and Catabolic Roles......Page 97
20α-Hydroxysteroid Dehydrogenases: Regulators of Progestational Potency......Page 98
Sulfotransferases......Page 99
CATECHOL ESTROGENS......Page 100
Regulation of Expression of the Steroidogenic Machinery......Page 101
SYNTHESIS OF NEUROSTEROIDS......Page 102
Secretion, Production, and ­Metabolic Clearance Rates of ­Steroid Hormones......Page 103
Plasma Steroid Hormone–Binding Proteins......Page 104
Inhibitors of Steroidogenic ­Enzymes......Page 105
5α-REDUCTASE INHIBITORS......Page 106
Suggested Readings......Page 107
Evolution of Steroid Hormone ­Receptor Structure and Function......Page 108
GENE DUPLICATION OF ANCESTRAL STEROID HORMONE RECEPTORS......Page 111
Activation and Repression of Gene Expression......Page 112
ESTROGEN RECEPTOR......Page 113
ANDROGEN RECEPTOR......Page 114
MINERALOCORTICOID RECEPTOR......Page 115
HORMONE AVAILABILITY......Page 116
HORMONE BINDING AND CHANGES IN RECEPTOR CONFORMATION......Page 117
RECEPTOR PHOSPHORYLATION......Page 119
INTERACTION WITH COACTIVATORS AND COREPRESSORS......Page 120
SIGNALING VIA SECOND MESSENGER CASCADES......Page 121
Suggested Readings......Page 123
NOMENCLATURE......Page 124
PATHWAYS OF EICOSANOID BIOSYNTHESIS......Page 125
MAJOR PRODUCTS OF THE 5-LIPOXYGENASE PATHWAY: THE LEUKOTRIENES......Page 127
TRANSPORT AND METABOLISM OF EICOSANOIDS......Page 128
COX-1, COX-2, TRADITONAL NSAIDS, AND SELECTIVE COX-2 INHIBITORS......Page 129
EICOSANOID RECEPTORS......Page 130
Eicosanoids and Reproduction......Page 132
OVULATION......Page 133
CORPUS LUTEUM FUNCTION AND LUTEOLYSIS......Page 134
FERTILIZATION, IMPLANTATION, AND DECIDUALIZATION......Page 135
PARTURITION AND NSAID USE IN PRETERM LABOR......Page 136
DUCTUS ARTERIOSUS REMODELING......Page 137
OTHER LIPID MEDIATORS: LYSOPHOSPHATIDIC ACID AND SPHINGOSINE-1-PHOSPHATE......Page 138
LPA AND S1P IN REPRODUCTIVE FUNCTION......Page 139
Suggested Readings......Page 140
GONADOTROPIN-RELEASING HORMONES......Page 141
Neuromodulators of GnRH Secretion......Page 142
GONADOTROPIN-PRODUCING CELLS OF THE PITUITARY......Page 143
GONADOTROPIN-RELEASING HORMONE......Page 144
AUTOCRINE/PARACRINE REGULATION OF GONADOTROPINS: ACTIVIN, INHIBIN, AND FOLLISTATIN......Page 145
Negative Feedback......Page 146
CLINICAL CHARACTERISTICS......Page 147
GnRH DYNAMICS AND PITUITARY RESPONSIVENESS......Page 148
MIDCYCLE SURGE......Page 149
LUTEAL PHASE......Page 151
LUTEAL–FOLLICULAR TRANSITION......Page 152
Sources of Inhibin A and Inhibin B......Page 153
Regulation of Inhibin A and Inhibin B by Gonadotropins......Page 154
Evidence for an Endocrine Role of Inhibin A or Inhibin B......Page 155
Suggested Readings......Page 156
Germ Cells and Ovarian Morphogenesis......Page 157
GENETICS OF HUMAN OVARIAN DEVELOPMENT......Page 159
Oocyte-Specific Genes......Page 162
Granulosa Cell–Granulosa Cell and Granulosa Cell–Oocyte Communication via Gap Junctions......Page 163
Granulosa Phenotypic Heterogeneity......Page 164
THE THECA CELLS......Page 165
THE OVARIAN SURFACE EPITHELIUM......Page 166
INITIATION OF FOLLICULAR GROWTH......Page 167
OOCYTE GROWTH......Page 168
FORMATION OF ANTRAL FOLLICLES......Page 169
Endocrine Characteristics of Follicles on the Way to Dominance......Page 170
OVULATION......Page 171
Requirements for Progesterone......Page 172
Maintenance of Meiotic Arrest......Page 173
Nuclear Maturation......Page 174
ATRESIA......Page 175
Initial Stages of Corpus Luteum Formation......Page 176
The Role of Luteinizing Hormone......Page 177
Luteolysis......Page 178
FOLLICLE-STIMULATING HORMONE......Page 180
LUTEINIZING HORMONE......Page 181
Progesterone Biosynthesis......Page 182
Growth Differentiation Factor-9......Page 183
Role of Estrogens......Page 184
Role of Androgens......Page 185
THE INSULIN-LIKE GROWTH FACTORS......Page 186
INTERLEUKINS......Page 187
Endocrine Disruptors and Ovarian Function......Page 188
MECHANISMS OF NATURAL OVARIAN AGING......Page 189
ENDOCRINE ACTIVITY OF THE POSTMENOPAUSAL OVARY......Page 190
Suggested Readings......Page 191
MORPHOGENESIS OF THE FEMALE REPRODUCTIVE TRACT......Page 193
THE ROLE OF THE WNT FAMILY AND HOMEOBOX GENES......Page 194
STEROID HORMONE ACTION IN THE REPRODUCTIVE TRACT......Page 195
STEROID HORMONE METABOLISM IN THE REPRODUCTIVE TRACT......Page 198
THE TUBAL EPITHELIUM AND TUBAL FLUID......Page 200
The Early Secretory Phase......Page 202
The Midsecretory Phase......Page 203
MENSTRUATION......Page 204
Vascular Remodeling and Angiogenesis......Page 206
Extracellular Matrix Remodeling......Page 207
THE UTERUS IN THE CYCLE OF CONCEPTION AND PREGNANCY......Page 209
THE UTERINE CERVIX......Page 211
THE MYOMETRIUM......Page 212
LEUKOCYTES AND LYMPHOCYTES......Page 213
FACTORS REGULATING UTERINE IMMUNE CELL DYNAMICS......Page 214
Uterine Receptivity and Embryo Implantation......Page 215
GLYCODELIN......Page 217
INSULIN-LIKE GROWTH FACTOR–BINDING PROTEIN-1......Page 218
OSTEOPONTIN......Page 219
THE TGF-β FAMILY......Page 220
THE EGF FAMILY OF GROWTH FACTORS......Page 221
OTHER CYTOKINES PARTICIPATE IN ENDOMETRIAL GROWTH AND DIFFERENTIATION......Page 222
LEUKEMIA INHIBITORY FACTOR AND IL-11......Page 223
PROSTANOIDS AND OTHER LIPIDS......Page 224
Early Implantation Events in the Human......Page 225
BIOMARKERS OF ENDOMETRIAL RECEPTIVITY......Page 227
GLOBAL GENE EXPRESSION PATTERNS DURING THE WINDOW OF IMPLANTATION......Page 228
ENDOMETRIAL BIOPSY......Page 230
SONOHYSTEROGRAPHY AND THREE-DIMENSIONAL ULTRASOUND......Page 231
HYSTEROSCOPY......Page 232
Endometrial Neoplasia......Page 233
References......Page 235
Development of the Breast......Page 236
THE EFFECT OF PROLACTIN ON β-CASEIN GENE FUNCTION......Page 237
LACTATION AND STEROID CONTRACEPTIVES......Page 238
GALACTORRHEA......Page 239
GENETIC CONTRIBUTIONS......Page 240
REPRODUCTIVE RISK FACTORS......Page 241
THE ROLE OF PROLACTIN, INSULIN-LIKE GROWTH FACTORS, AND INSULIN-LIKE GROWTH FACTOR–BINDING PROTEINS......Page 242
HORMONE REPLACEMENT THERAPY AND BREAST CANCER RISK......Page 243
Breast Cancer Treatment......Page 244
THE ROLE OF TAMOXIFEN AND OTHER ­ANTI-ESTROGENS......Page 245
AROMATASE INHIBITORS......Page 247
CHEMOTHERAPY-RELATED AMENORRHEA......Page 248
Suggested Readings......Page 249
ENDOMETRIAL RECEPTIVITY......Page 250
IMPLANTATION......Page 251
DECIDUALIZATION OF THE ENDOMETRIUM......Page 252
PLACENTATION......Page 253
The Endocrine Placenta......Page 254
Other Actions of Human Chorionic Gonadotropin......Page 255
Historical Perspective on Nomenclature......Page 256
Human Placental Growth Hormone......Page 257
Biologic Actions of hPL and hPGH......Page 258
Corticotropin-Releasing Hormone......Page 259
NEUROPEPTIDE Y......Page 261
Progesterone and Estrogens......Page 262
HYPOTHALAMIC HORMONES......Page 266
PITUITARY HORMONES......Page 267
THE FETAL PITUITARY-ADRENAL AXIS......Page 268
THE FETAL PITUITARY-GONADAL AXIS......Page 269
Primary (Gonadal) Sex Differentiation......Page 270
Regulation of Fetal Gonadal Steroidogenesis......Page 271
FETAL PITUITARY PROLACTIN......Page 272
FETAL ORGAN MATURATION AND ­PREPARATION FOR EXTRAUTERINE LIFE......Page 273
Phase 1 (Transformation)......Page 274
THE HORMONAL CONTROL OF PARTURITION......Page 275
Functional Estrogen Activation......Page 276
CONTROL OF PROGESTERONE WITHDRAWAL......Page 277
ROLE OF PLACENTAL CRH IN THE CONTROL OF HUMAN PARTURITION......Page 278
ROLE OF UTEROTONINS IN HUMAN PARTURITION......Page 279
Prostaglandins......Page 280
Oxytocin......Page 281
Suggested Reading......Page 282
ESSENTIAL ROLES OF GNRH AND UPSTREAM KISS1 NEURONS......Page 283
GNRH AND GNRH RECEPTORS......Page 285
GONADOTROPINS AND COGNATE RECEPTORS......Page 286
TESTICULAR STEROIDOGENESIS......Page 287
Sex-Steroid Receptors......Page 289
ANDROGEN RECEPTOR IN TESTES......Page 290
SEX HORMONE–BINDING GLOBULIN: STEROID TRANSPORTER AND PUTATIVE LIGAND......Page 291
The Testes......Page 292
ACCESSORY ORGANS......Page 293
PROSTATE GLAND......Page 294
Spermatogenesis......Page 295
Sertoli Cells......Page 296
Decremental Changes in GnRH-LH-Te Axis in Aging......Page 297
Suggested Reading......Page 298
INNATE IMMUNITY AND INFLAMMATION......Page 299
Cellular Mediators of the Innate Immune Response......Page 300
Complement......Page 301
ADAPTIVE IMMUNITY......Page 302
B Cells......Page 303
Primary and Secondary Immune Responses......Page 304
Antigen Presentation......Page 305
PERIPHERAL AND MUCOSAL IMMUNE SYSTEMS......Page 306
CELLULAR AND SOLUBLE MEDIATORS OF IMMUNE RESPONSES AT THE MATERNAL-FETAL INTERFACE......Page 307
ANTIGEN PRESENTATION IN THE PLACENTA......Page 308
Evidence-Based Diagnosis and Treatment of Immune- Associated Reproductive Disorders......Page 309
Idiopathic Premature Ovarian Failure Associated with Adrenal Autoimmunity......Page 310
Idiopathic Premature Ovarian Failure in the Absence of Adrenal Autoimmunity......Page 311
Special Considerations in the Management of Idiopathic Premature Ovarian Failure......Page 312
ENDOMETRIOSIS......Page 313
UNEXPLAINED INFERTILITY......Page 314
Antisperm Antibodies......Page 315
Testing for ASAb......Page 316
IMMUNE-ASSOCIATED PREGNANCY LOSS......Page 317
The Timing of Pregnancy Demise......Page 318
Diagnostic Testing for Immune-Associated Pregnancy Loss......Page 319
Management of Immune-Associated Recurrent Pregnancy Loss......Page 321
Conclusion......Page 322
Suggested Readings......Page 323
Epidemiology......Page 324
Premature Ovarian Failure......Page 325
TYPES OF OVARIAN CHANGES......Page 326
Hormonal Changes with ­Established Menopause......Page 328
Central Nervous System......Page 332
Collagen......Page 335
Genital Atrophy......Page 336
Bone Loss......Page 337
Cardiovascular Effects......Page 340
Breast Cancer......Page 347
The Decision to Use Estrogen......Page 348
RISKS ASSOCIATED WITH ESTROGEN THERAPY......Page 349
HORMONE REGIMENS......Page 350
Androgen Therapy......Page 351
PHYTOESTROGENS......Page 352
Aging......Page 353
Suggested Readings......Page 354
Serum Testosterone Concentration......Page 355
Serum Estradiol Concentration......Page 356
Body Composition......Page 357
Sexual Function......Page 358
Muscle Strength......Page 359
POTENTIAL DELETERIOUS CONSEQUENCES OF TESTOSTERONE TREATMENT OF ELDERLY MEN......Page 360
Suggested Readings......Page 361
NORMAL HUMAN SEX DEVELOPMENT......Page 362
Sex Determination: Testes or Ovary?......Page 363
Sex Differentiation......Page 365
Turner Syndrome......Page 366
Klinefelter Syndrome......Page 368
46,XY Gonadal Dysgenesis......Page 369
Congenital Lipoid Adrenal Hyperplasia......Page 374
17β-Hydroxysteroid Dehydrogenase Deficiency......Page 376
Complete and Partial Androgen Insensitivity Syndrome......Page 377
Persistent Müllerian Duct Syndrome......Page 378
46,XX Ovotesticular Disorder of Sex Development......Page 379
Congenital Adrenal Hyperplasia......Page 381
MULTIDISCIPLINARY APPROACH......Page 382
GENDER ASSIGNMENT......Page 383
MENTAL HEALTH......Page 385
CANCER......Page 386
Suggested Readings......Page 388
PUBERTAL STAGING......Page 389
STEROIDOGENESIS......Page 392
ACTIVATION OF GONADARCHE......Page 394
NEUROBIOLOGY OF GONADARCHE......Page 395
PUTATIVE SIGNALS TRIGGERING GONADARCHE......Page 398
GENETICS AND PUBERTY GENES......Page 400
Disorders of Early Puberty......Page 401
Progressive Precocious Gonadarche......Page 402
Nonprogressive Precocious Gonadarche......Page 405
Feminizing Disorders......Page 406
Virilizing Disorders......Page 408
Approach to the Child with Precocious Pubertal Development......Page 410
Disorders of Delayed Puberty......Page 411
GnRH-DEPENDENT (HYPOTHALAMIC HYPOGONADOTROPISM)......Page 414
Kallmann Syndrome and Related Disorders......Page 415
Leptin-Dependent Obesity......Page 416
Developmental Anomalies of the Pituitary......Page 417
Histiocytosis X......Page 418
Other Syndromes Associated with Delayed Puberty......Page 419
17α-Hydroxylase/17,20-Lyase Deficiency......Page 420
MAYER-ROKITANSKY-KUSTER-HAUSER SYNDROME......Page 421
Approach to the Child with Delayed Puberty......Page 422
ESTROGEN REPLACEMENT......Page 423
Psychosocial Considerations for Precocious and Delayed Puberty......Page 424
Suggested Readings......Page 425
CHAPTER 18 - Nutrition and the Pubertal Transition......Page 426
The Normal Pubertal Process......Page 427
Other Potential Molecules That Communicate Metabolic Signals to the HPO Axis......Page 429
CHILDHOOD NUTRITION AND MODIFICATION OF PUBERTY......Page 430
Young Adult and Adult Associations......Page 431
Suggested Readings......Page 432
CHAPTER 19 - Physiologic and Pathophysiologic Alterations of the Neuroendocrine Components of the Reproductive Axis......Page 433
CONGENITAL DISEASE OF THE HYPOTHALAMUS......Page 434
Anosmic Idiopathic Hypogonadotropic Hypogonadism KAL1 Mutations......Page 435
Normosmic Idiopathic Hypogonadotropic Hypogonadism......Page 436
GnRH deficiency is appropriate. Management of Idiopathic Hypogonadotropic Hypogonadism......Page 438
STRUCTURAL DISEASE OF THE HYPOTHALAMUS......Page 439
Tumor......Page 440
Infiltrating Diseases......Page 442
Infections......Page 443
Radiation Therapy......Page 444
SEIZURE DISORDERS......Page 445
Physiologic Hypogonadotropic Hypogonadism......Page 446
Pathophysiologic Hypogonadotropic Hypogonadism......Page 447
Pituitary Adenomas......Page 466
Adenomas of Multiple Endocrine Neoplasia Type 1......Page 476
Carcinoma of the Pituitary......Page 477
PITUITARY APOPLEXY AND SHEEHAN SYNDROME......Page 478
PITUITARY HEMOCHROMATOSIS......Page 479
Suggested Readings......Page 480
PREVALENCE......Page 481
HIRSUTISM......Page 482
OVARIAN MORPHOLOGY......Page 483
INSULIN RESISTANCE......Page 485
OVARIAN DEVELOPMENT......Page 486
ADOLESCENT PCOS......Page 487
PREPUBERTAL DISPOSITION......Page 488
HYPOTHALAMIC–PITUITARY INTERACTION......Page 489
THECA CELL FUNCTION......Page 492
GRANULOSA CELL FUNCTION......Page 494
INSULIN RESISTANCE......Page 498
GENETICS OF PCOS......Page 499
Pathophysiologic Concept......Page 500
CANCER......Page 502
DYSLIPIDEMIA......Page 503
OVARIAN HYPERTHECOSIS......Page 504
LABORATORY EVALUATION......Page 505
ORAL CONTRACEPTIVES......Page 506
Suggested Readings......Page 507
A Statistical Model of Infertility......Page 509
Diseases Associated with Infertility......Page 510
Abnormalities in Oocyte Production......Page 512
WEIGHT ABNORMALITIES ASSOCIATED WITH ANOVULATION......Page 513
CLOMIPHENE......Page 514
CLOMIPHENE AND NONCLASSICAL ADRENAL HYPERPLASIA......Page 517
CLOMIPHENE AND METFORMIN......Page 518
GONADOTROPIN INDUCTION OF OVULATION......Page 519
ROLE OF LH IN GONADOTROPIN OVULATION INDUCTION......Page 520
GONADOTROPIN AND GnRH AGONIST OR ANTAGONIST ANALOGUES......Page 521
OVARIAN SURGERY FOR OVULATION INDUCTION IN PCOS......Page 522
Hyperprolactinemia......Page 524
THE AGING OVARY AND THE AGING FOLLICLE......Page 525
Anatomic Factors in the Female......Page 527
TUBAL FACTOR INFERTILITY......Page 528
Unexplained Infertility......Page 531
Empirical Treatment......Page 532
INTRAUTERINE INSEMINATION......Page 533
GONADOTROPIN INJECTIONS AND GONADOTROPIN INJECTIONS PLUS INTRAUTERINE INSEMINATION......Page 534
Environmental Exposures Associated with Infertility......Page 535
Social and Ethical Issues......Page 537
SEMEN EVALUATION......Page 539
FURTHER MALE FACTOR EVALUATION......Page 540
Oligospermia/Asthenospermia......Page 542
Azoospermia (Fig. 22-5)......Page 543
Unexplained Infertility......Page 544
Varicocele......Page 545
Vasovasostomy......Page 547
Hormonal or Oxidative Dysfunction......Page 548
SPERM RETRIEVAL TECHNIQUES......Page 549
Conclusions......Page 550
Suggested Readings......Page 551
OVERVIEW......Page 552
Prolactinoma and Hyperprolactinemia......Page 554
Acromegaly......Page 556
Lymphocytic Hypophysitis......Page 557
Cushing Syndrome......Page 558
Congenital Adrenal Hyperplasia: 21-Hydroxylase Deficiency......Page 560
OVERVIEW......Page 561
Hypothyroidism......Page 562
Hyperthyroidism......Page 564
Suggested Readings......Page 566
RETROGRADE MENSTRUATION AND IMPLANTATION......Page 567
DEMOGRAPHY......Page 568
Genomics, Genetics, and Epigenetics......Page 569
CYTOGENETICS OF ENDOMETRIOSIS......Page 570
Clinical Presentation......Page 571
VARIABLE LESION APPEARANCE......Page 572
ULTRASONOGRAPHY......Page 573
SERUM MARKERS OF ENDOMETRIOSIS......Page 574
HORMONE RESPONSIVENESS (STEROIDS AND NUCLEAR RECEPTORS)......Page 575
ANGIOGENIC FACTORS......Page 576
OXIDATIVE STRESS AND ENDOMETRIOSIS......Page 578
IMMUNOSURVEILLANCE......Page 579
Treatment......Page 580
SURGICAL THERAPY FOR PAIN ASSOCIATED WITH ENDOMETRIOSIS......Page 581
EXPERIMENTAL MEDICAL THERAPY......Page 583
ASSISTED REPRODUCTIVE TECHNOLOGY......Page 584
Suggested Readings......Page 585
CHAPTER 25 - Benign Uterine Disorders......Page 586
PATHOPHYSIOLOGY: ESTROGEN AND PROGESTERONE......Page 587
Genetic Influences: Clinical......Page 588
Cytogenetic and molecular genetics......Page 590
PRINCIPLES OF TREATMENT......Page 591
Urgical Therapies......Page 592
Medical Therapies......Page 594
Adenomyosis......Page 597
Endometrial Polyps......Page 598
Abnormal Uterine Bleeding......Page 599
Dysmenorrhea......Page 600
Suggested Readings......Page 601
INSULIN PRODUCTION AND ACTION CHANGES DURING PREGNANCY......Page 603
Placental Growth Hormone and Human Chorionic Somatomammotropin......Page 604
Progesterone......Page 607
Gestational Diabetes......Page 608
Pregnancy in Women with Type 1 or Type 2 Diabetes Mellitus......Page 612
OBESITY AND PREGNANCY......Page 614
PREGNANCY-ASSOCIATED CHANGES IN PITUITARY STRUCTURE AND FUNCTION......Page 615
ADRENOCORTICOTROPIC HORMONE......Page 616
Pituitary Tumors in Pregnancy......Page 617
GONADOTROPINS......Page 618
Pituitary Insufficiency......Page 619
LYMPHOCYTIC HYPOPHYSITIS......Page 620
Normal Thyroid Function......Page 621
Maternal Thyroid Function in Pregnancy......Page 622
Fetal Thyroid Function in Pregnancy......Page 623
Maternal Thyrotoxicosis......Page 624
Maternal Hypothyroidism......Page 625
Postpartum Thyroiditis......Page 627
Disorders of Calcium Metabolism......Page 628
Adrenal Diseases......Page 629
ADRENAL INSUFFICIENCY......Page 630
CUSHING’S SYNDROME......Page 631
CONGENITAL ADRENAL HYPERPLASIA......Page 632
Ovarian Endocrine Tumors......Page 633
Preeclampsia......Page 634
Parturition......Page 639
PRETERM LABOR......Page 644
POST-TERM PREGNANCY......Page 642
Suggested Readings......Page 645
Etiology......Page 647
HORMONAL RISK FACTORS FOR BREAST CANCER......Page 648
EXOGENOUS ESTROGENS AND BREAST CANCER RISK......Page 649
RELATIVE, ABSOLUTE, AND ATTRIBUTABLE RISKS FROM MHT......Page 652
ESTIMATING BREAST CANCER RISK......Page 653
Prevention of Breast Cancer......Page 654
GUIDELINES FOR BREAST CANCER PREVENTION......Page 655
DEVELOPMENT OF HORMONAL RESISTANCE......Page 656
Predictive Factors......Page 657
HORMONE ADDITIVE THERAPIES......Page 659
Medical Ablative Therapies......Page 660
Selective Estrogen Receptor Modulators......Page 662
Aromatase Inhibitors......Page 663
Hormone Additive Therapy......Page 665
Use of Chemotherapy Followed by Complete Estrogen Deprivation......Page 667
Emerging Therapies......Page 668
Adjuvant Therapy......Page 669
Postmenopausal Women......Page 670
Breast Cancer in Men......Page 671
Endometrial Cancer......Page 672
Suggested Readings......Page 673
Ovarian Hyperstimulation......Page 675
CONCEPTS OF FOLLICLE DEVELOPMENT REGULATION RELEVANT TO OVARIAN STIMULATION......Page 676
Gonadotropin Preparations......Page 677
Ovulation Induction......Page 679
Ovarian stimulation......Page 680
PRINCIPLES OF OVULATION INDUCTION......Page 682
CLASSIFICATION OF ANOVULATION......Page 683
Insulin-Sensitizing Agents......Page 684
Gonadotropins......Page 686
Pulsatile GnRH......Page 690
Opioid Antagonists......Page 691
Obesity......Page 692
THERAPEUTIC APPROACHES......Page 693
Gonadotropins......Page 694
THERAPEUTIC APPROACHES......Page 695
Clomiphene Citrate......Page 696
Gonadotropins......Page 697
Gonadotropin-Releasing Hormone Antagonist Co-treatment......Page 699
APPROACHES FOR INDUCTION OF FINAL OOCYTE MATURATION......Page 700
LUTEAL PHASE SUPPLEMENTATION......Page 702
NEW APPROACHES TO MILD OVARIAN STIMULATION FOR IVF......Page 703
Toward Individualized Treatment Algorithms......Page 705
Health Economics of Ovarian Stimulation......Page 708
Conclusions and Future Perspective......Page 709
Suggested Reading......Page 710
The Gametes......Page 711
Fertilization......Page 714
The Early Conceptus and Implantation......Page 715
Assisted Reproductive Technologies......Page 716
Indications for in Vitro Fertilization......Page 717
Selection of Patients......Page 719
Ovarian Stimulation......Page 721
Oocyte Retrieval......Page 725
Oocyte Meiotic Stage......Page 726
Evaluating Embryo Quality......Page 727
Embryo Transfer......Page 728
Luteal Phase Support......Page 731
Risks of in Vitro Fertilization......Page 732
Pregnancy Outcome......Page 733
Embryo Cryopreservation......Page 736
Impact of Gynecologic Diseases on in Vitro Fertilization Outcome......Page 737
Cost-Benefit Analysis of in Vitro Fertilization......Page 738
In Vitro Fertilization with Gestational Carrier......Page 739
Oocyte and Ovarian Tissue Cryopreservation......Page 740
Environmental Exposures and Life Style Factors in Assisted Rerpoductive Techniques......Page 741
Suggested Readings......Page 742
CHAPTER 30 - Gamete and Embryo Manipulation......Page 744
CURRENT INDICATIONS FOR ICSI......Page 745
OOCYTE HANDLING AND SPERM PREPARATION BEFORE ICSI......Page 746
ICSI PROCEDURE......Page 748
OUTCOME PARAMETERS OF ICSI: FERTILIZATION AND EMBRYO CLEAVAGE......Page 749
CLINICAL APPLICATION AND RESULTS......Page 751
Assisted Hatching......Page 752
THEORETICAL BACKGROUND......Page 754
EMBRYO BIOPSY PROCEDURES......Page 755
FISH AND PCR PROCEDURES......Page 756
CLINICAL APPLICATION AND RESULTS......Page 758
Suggested Reading......Page 760
Organization of Human Chromosomes and Methods of Study......Page 762
Metaphase Preparations of Cultured Cells......Page 763
Special Stains......Page 764
MOLECULAR CYTOGENETIC METHODS......Page 765
Array-Based Comparative Genomic Hybridization......Page 766
Chromosome Aberrations and Reproduction......Page 767
Review of Oogenesis and Spermatogenesis......Page 768
Meiotic Nondisjunction......Page 769
Clinical Outcomes of Meiotic Nondisjunction......Page 771
Errors of Recombination......Page 772
Mosaicism......Page 773
Constitutional Chromosome Anomalies Affecting Reproduction......Page 774
Translocations......Page 775
SEX CHROMOSOME ABNORMALITIES......Page 777
The Y Chromosome......Page 778
The X Chromosome......Page 779
Numeric Abnormalities of Sex Chromosomes......Page 780
Preimplantation Genetic Diagnosis......Page 782
Suggested Readings......Page 783
Principles of Hormonal Assays......Page 785
Precision......Page 786
Dissociation-Enhanced Lanthanide Fluorescence Immunoassay......Page 787
Measurement of Gonadotropins......Page 788
Gonadotropin-Releasing Hormone Test......Page 789
DYNAMIC TESTS FOR PROLACTIN EVALUATION......Page 790
Measurement of Androgens......Page 791
MEASUREMENT OF CIRCULATING ANDROGEN PRECURSORS IN WOMEN......Page 792
Gonadotropin-Releasing Hormone Agonist Test......Page 793
Measurement of Inhibins......Page 795
EVALUATION OF INSULIN RESISTANCE......Page 796
Fasting Glucose and Insulin Calculations......Page 797
EVALUATION OF FAT QUANTITY AND DISTRIBUTION......Page 798
Measurement of Growth Hormone and Growth Factors......Page 799
Measurement of Calcium-Regulating Hormones and Bone Markers......Page 800
Measurement and Blood Levels of Thyroid Hormones......Page 801
DEXAMETHASONE SUPPRESSION TEST......Page 802
DIAGNOSTIC PROCEDURE IN SUSPECTED CUSHING SYNDROME......Page 803
Diagnostic Procedure in Suspected Pituitary Tumors......Page 804
Pelvic Evaluation......Page 806
Suggested Readings......Page 807
VAGINAL ULTRASOUND AND PELVIC EXAMINATION......Page 808
CONTRAST-ENHANCED VISION OF THE UTERUS AND TUBES: SALINE INFUSION SONOGRAPHY......Page 809
ANATOMY AND MORPHOLOGIC MEASUREMENTS......Page 810
Endometrial Thickness: A Biomarker for Estrogen Action......Page 812
Endometrial Echogenicity: A Biomarker for Progesterone Action......Page 814
THREE-DIMENSIONAL VOLUME RECONSTRUCTION OF THE ENDOMETRIUM......Page 817
Principles and Applications......Page 818
Vascular Changes Related to the Menstrual Cycle and Hormonal Effects......Page 820
DYSFUNCTIONAL UTERINE BLEEDING: BENIGN AND MALIGNANT ENDOMETRIAL DISEASE......Page 821
THE MYOMETRIUM: PHYSIOLOGY AND PATHOLOGIC FINDINGS......Page 822
Hysterosonography......Page 823
Hysterosonography for Visualizing Endometrial Polyps and Fibroids......Page 824
Müllerian Anomalies and Recurrent Pregnancy Losses......Page 826
Contractility of the Nonpregnant Uterus......Page 828
Uterine Contractility during the Menstrual Cycle......Page 829
Effects of Uterine Contractility on ART Outcome......Page 830
IMAGING MARKERS OF ENDOMETRIAL RECEPTIVITY......Page 831
EMBRYO TRANSFERS......Page 833
The Ovary Before and After Puberty......Page 834
The Ovary in the Menstrual Cycle......Page 835
The Ovary through Functional Aging and Menopausal Changes......Page 836
ANTRAL FOLLICLE COUNT: A VIEW OF THE OVARIAN RESERVE......Page 837
Perfusion in the Maturing Follicle and Corpus Luteum......Page 840
Perfusion of the Ovarian Stroma......Page 841
Echographic Characteristics of PCOS Ovary......Page 842
The Ovarian Stroma in PCOS......Page 843
Ovarian versus Extraovarian Disease......Page 844
Ovarian Cysts and Tumors......Page 845
Technical Considerations......Page 846
The Uterine Cavity......Page 847
The Fallopian Tubes......Page 848
HYSTEROSONOGRAPHY......Page 849
ENDOMETRIOTIC CYSTS (ENDOMETRIOMA)......Page 850
ADENOMYOSIS......Page 851
Suggested Readings......Page 853
Contraceptive Effectiveness and Efficacy......Page 855
Microbicides......Page 856
CERVICAL CAP......Page 858
Steroid Contraceptives......Page 859
Pharmacology......Page 860
Mechanism of Action......Page 861
Cardiovascular Events......Page 862
Hepatic Proteins......Page 863
Breast Cancer......Page 865
TRANSDERMAL CONTRACEPTIVE SYSTEM......Page 866
Mechanisms of Action......Page 867
Bone Mineral Density......Page 868
POSTCOITAL CONTRACEPTION......Page 869
CONSIDERATIONS FOR IUD PLACEMENT......Page 871
Noncontraceptive Benefits of Hormonal Contraception......Page 872
OBESITY......Page 873
Suggested Readings......Page 874
A......Page 875
B......Page 878
C......Page 879
D......Page 881
E......Page 883
F......Page 885
G......Page 887
H......Page 889
I......Page 892
L......Page 894
M......Page 895
N......Page 897
O......Page 898
P......Page 899
R......Page 905
S......Page 906
T......Page 908
U......Page 909
Z......Page 910