Infertility: A Clinician’s Guide to Diagnosis and Treatment

291 Pages·1990·5.736 MB·English

by  Melvin L. Taymor M.D. (auth.)

Infertility
A Clinician's Guide to
Diagnosis and Treatment
An artist's conception of a normal fetus at term.
Woodcut from "Traites des Maladies des Femmes Grosses"
by Francois Mauriceau, Paris, 1681.
Infertility
A Clinician's Guide to
Diagnosis and Treatment
Melvin L. Taymor, M. D.
Professor of Life Sciences and Technology
Massachusetts Institute of Technology
Cambridge, Massachusetts
and Clinical Professor Emeritus of Obstetrics and Gynecology
Harvard Medical School
Boston, Massachusetts
Plenum Medical Book Company
New York and London
Library of Congress Cataloging-In-Publicatlon Data
Taymor, Melvin L.
Infertility, a cllnician's guide to diagnosis and treatment I
Melvin L. Taymor. -- Rev. and expanded ed.
p. cm.
Includes bibliographical references.
Inc I udes Index.
1. Infertility. 1. Title.
[DNLM, 1. Infert iIi ty--d i agnos is. 2. Infert iIi ty--therapy. WP
570 T247ial
RC889.T34 1989
616.6·92--dc20
DNLM/DLC
for Library of Congress 90-7659
CIP
ISBN-13: 978-1-4612-7899-3 e-ISBN-13: 978-1-4613-0627-6
001: 10.1007/978-1-4613-0627-6
This volume is a revised and expanded edition of Infertility
by Melvin L. Taymor, M.D., published in 1978 by Grune & Stratton, Inc.
© 1990 Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
Softcover reprint of the hardcover 1st edition 1990
Plenum Medical Book Company is an imprint of Plenum Publishing Corporation
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
To Betty
Preface
A little over 12 years ago I wrote a small volume entitled Infertility. It seemed to
me at that time that significant advances in the field called for the publication of
such a volume. The following is from the preface to that volume:
During the past 15 years considerable progress has been made in the field of
infertility diagnosis and management. It is perhaps a paradox that much of
this increased knowledge has come about because of Western medicine's
preoccupation with the search for a means to control reproduction. As a
result, we have achieved new insights into the physiologic mechanisms
involved in reproduction, and we have found better methods for measuring
physiologic changes in reproductive health and disease. To these advances
can be added improvements in the utilization of endoscopic and surgical
techniques, in the diagnosis and treatment of infections and endometriosis,
and in the treatment of hormonal disorders.
During this period, too, through workshops and conferences and in
journals and texts, these latest advances have been made available to physi
cians, an outstanding example being the two volumes of Progress in Infer
tility, edited by Drs. Jan Behrman and Robert Kistner. As necessary as
these publications are, they do not offer an overall view of infertility diag
nosis and management. Although the articles are usually written by the
outstanding specialists in the field, who set forth their particular interest
with scientific precision, for those primarily interested in the practice of
infertility, there is often more fine detail than can be absorbed or utilized.
The causes of infertility are often treated as single, isolated units and the
physician-reader's view tends to become fragmented.
The main purpose of this book is to provide the practicing physician,
vii
viii Preface
the resident, and the interested medical student with an overview that will
help guide him or her in caring for patients. This text combines the new with
the old. I have attempted to evaluate the significance and potential of some
new achievements in the light of the perspective of older literature. I hope
not only to provide a sequential unity to the recent advances in the field, but
to synthesize this progress with the many significant accomplishments of
the past.
This holistic approach, reflected through my 25 years of experience in
infertility diagnosis and management, is consistent with what I believe to
be the very essence of the management of the infertile couple: the need to
look at the couple as a whole throughout the course of treatment, and to
avoid concentrating on one partner, or one organ system within one partner.
To emphasize further this sense of unity, the chapters are presented, insofar
as possible, in the order in which the physician might approach the problem
of the infertile couple.
Since 1978 there has been an accelerated accumulation of knowledge of
reproductive science and a remarkable increase in our ability to help our infer
tile patients. Much of this new knowledge and practice has come from the
science and technology developed in relation to in vitro fertilization. Once
again, there is a need for a volume that will present to the practicing physician
the new science and technology, but weaving into it the still important basic
holistic approach to the infertile couple.
Much of the first part of this book is taken from the earlier volume,
Infertility. New developments in the subject areas covered by the earlier volume
are touched upon. However, chapters on immunology, endoscopy, ovulation
induction, endometriosis, and infertility surgery have been virtually rewritten.
Chapters on in vitro fertilization, gamete intrafallopian tube transfer, and unex
plained infertility have been added. Extensive references are available for the
reader who wants to explore an area in depth. It is hoped that this volume will
provide the practicing obstetrician-gynecologist with a complete view of the
field as well as a sound approach to diagnosis and therapy.
I am indebted to Dawn de Freitas and Nancy Soverino for their invaluable
help in the preparation of the manuscript.
Melvin L. Taymor, M.D.
Brookline. Massachusetts
Contents
Part I Introduction
1 Historical Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 The Specialty of Infertility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3 The Science and Art of Infertility. . . . . . . . . . . . . . . . . . . . . . . . . 9
4 General Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11
Part II Causes of Infertility
5 Causes in the Male. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21
6 Causes in the Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 29
7 Emotional Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 37
Part III The Basic Workup
8 History and Examination of the Couple. . . . . . . . . . . . . . . . . .. 45
ix
X Contents
9 Evaluation of the Cervical Factor. . . . . . . . . . . . . . . . . . . . . . . .. 51
10 Evaluation of the Tubal Factor. . . . . . . . . . . . . . . . . . . . . . . . . .. 65
11 Evaluation of the Ovulatory Factor. . . . . . . . . . . . . . . . . . . . . .. 75
12 Semen Analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 89
Part IV Management of the Infertile Couple
13 A Timetable of Management ............................. 101
14 Infertility Counseling .................................... 105
with Ellen Bresnick, MSW
Part V Special Areas and Special Diagnostic Tests
15 Laparoscopy and Operative Laparoscopy ........ , ........ 113
16 The Prediction of Ovulation .............................. 123
17 Immune Factors and Infections in Infertility. ............... 133
18 Uterine Factors ........................................ 145
19 Amenorrhea and Anovulation ............................ 157
20 Special Tests in the Male ....................... , ........ 163
Part VI Therapy
21 Treatment of the Male ................................... 175
22 Treatment of the Cervical Factor ......................... 185
23 Homologous Artificallnsemination (AIH and lUI) ........... 189
Contents xi
24 Therapeutic Donor Insemination (Artifical Insemination
Donor) ................................................ 203
25 Treatment of Luteal Phase Defect. . . . . . . . . . . . . . . . . . . . . . .. 211
26 Induction of Ovulation .................................. 217
27 Microsurgical Techniques and Pelvic Adhesions ........... 237
28 Tubal Microsurgery ..................................... 247
29 Endometriosis ......................................... 259
30 Unexplained Infertility. .................................. 269
31 In Vitro Fertilization and Gamete Intrafallopian Tube
Transfer ............................................... 277
Index ........................................................ 291