Table Of Content

LANDES BIOSCIENCE V LANDES V a d e m e c u m LANDES V a d e m e c u m a BIOSCIENCE d BIOSCIENCE e m e Reproductive Table of contents c u 1. The Menstrual Cycle 12. Reproductive Endocrinology Diagnostic m Endocrinology Imaging 2. Puberty and Its Disorders 13. An Overview of Female Infertility R and Infertility 3. Amenorrhea e p 4. Dysfunctional Uterine Bleeding 14. Surgical Treatment of Female Infertility ro d 15. Ovulation Induction u 5. ODviaagrny oSsyins darnodm Meanagement of Polycystic 16. Assisted Reproductive Technology ctive E 6. Obesity: Recognition and Treatment in 17. Alternative Medicine and Female Infertility nd Women o 7. Hormonal Contraception 18. Male Infertility crino 19. Your Environment; Your Fertility—Is There lo 8. Endometriosis a Link? g y a 9. Hyperprolactinemia n d 10. Premenstrual Syndrome In fe 11. Treatment of the Menopausal Woman rtility The Vademecum series includes subjects generally not covered in other handbook series, especially many technology-driven topics that reflect the increasing influence of technology in clinical medicine. The name chosen for this comprehensive medical handbook series is Vademecum, a Latin word that roughly means “to carry along”. In the Middle Ages, traveling clerics carried pocket-sized books, excerpts of the carefully transcribed canons, known as Vademecum. In the 19th century a medical publisher in Germany, Samuel Karger, called a series of portable medical books Vademecum. The Vademecum books are intended to be used both in the training of physicians and the care of patients, by medical students, medical house staff and practicing Le physicians. We hope you will find them a valuable resource. w is Lewis Vivian Lewis All titles available at ISBN 978-157059702-2 www.landesbioscience.com 9 781570 597022 v a d e m e c u m Reproductive Endocrinology and Infertility Vivian Lewis, M.D. Department of Obstetrics and Gynecology Division of Reproductive Endocrinology University of Rochester School of Medicine and Dentistry Rochester, New York, U.S.A. L A N D E S B I O S C I E N C E AUSTIN, TEXAS U.S.A. VADEMECUM Reproductive Endocrinology and Infertility LANDES BIOSCIENCE Austin, Texas U.S.A. Copyright ©2007 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Printed in the U.S.A. Please address all inquiries to the Publisher: Landes Bioscience, 1002 West Avenue, Austin, Texas 78701, U.S.A. Phone: 512/ 637 6050; FAX: 512/ 637 6079 ISBN: 978-1-57059-702-2 Cover artwork by Kristen Shumaker Library of Congress Cataloging-in-Publication Data Reproductive endocrinology and infertility / [edited by] Vivian Lewis. p. ; cm. -- (Vademecum) Includes bibliographical references and index. ISBN-13: 978-1-57059-702-2 (alk. paper) 1. Endocrine gynecology . 2. Infertility, Female--Endocrine aspects. I. Lewis, Vivian, M.D. II. Series. [DNLM: 1. Genital Diseases, Female. 2. Endocrine System Diseases. 3. Infertility, Female. WP 140 R4247 2007] RG159.R452 2007 618.1--dc22 2007001376 While the authors, editors, sponsor and publisher believe that drug selection and dosage and the specifications and usage of equipment and devices, as set forth in this book, are in accord with current recommendations and practice at the time of publication, they make no warranty, expressed or implied, with respect to material described in this book. In view of the ongoing research, equipment development, changes in governmental regulations and the rapid accumulation of information relating to the biomedical sciences, the reader is urged to carefully review and evaluate the information provided herein. Dedication I would like dedicate this book to my family whose love, support and patience have made it possible for me to pursue a career in academic medicine. My parents, Oswald Lewis and Vivian Lewis, encouraged and nur- tured a love of learning. My brothers and sister were crucial in providing an intellectually stimulating environment as I grew up. My husband, Rustam Tahir, and sons, Darius and Jason, have been understanding and supportive while I put in the long hours necessary to complete this project. I am grateful to you all. Contents Preface ......................................................................... xv Acknowledgements ..................................................... xvi Part I: Reproductive Endocrinology 1. The Menstrual Cycle......................................................3 John T. Queenan, Jr. GnRH....................................................................................................3 Follicular Phase.......................................................................................4 Luteal Phase............................................................................................7 The Endometrium: Proliferative and Secretory Phases............................8 2. Puberty and Its Disorders............................................10 Adelina M. Emmi and Lawrence C. Layman Normal Puberty Physiology..................................................................10 Somatic Changes.............................................................................10 Endocrinology of Puberty................................................................10 Abnormalities of Puberty......................................................................12 Precocious Puberty..........................................................................12 Delayed Puberty..............................................................................15 3. Amenorrhea.................................................................23 Michael Wittenberger and Alicia Armstrong Evaluation.............................................................................................23 Eugonadism, Uterus Present............................................................25 Hypogonadism (Prior Estrogen Exposure), Uterus Present.........................................................................25 Eugonadism, Uterus Absent ............................................................28 Hypogonadism, Uterus Present.......................................................29 Diagnoses.............................................................................................29 Eugonadotropic Amenorrhea (Normal FSH and LH)............................................................29 Hypogonadotropic Amenorrhea......................................................32 Hypergonadotropic Amenorrhea.....................................................33 Treatment.............................................................................................34 4. Dysfunctional Uterine Bleeding...................................36 William R. Phipps Differential Diagnosis and Mechanisms of Bleeding .............................37 History.................................................................................................39 Physical Examination............................................................................40 Laboratory, Imaging and Other Diagnostic Studies...............................40 Treatment.............................................................................................43 5. Diagnosis and Management of Polycystic Ovary Syndrome..........................................................47 Kathleen M. Hoeger Diagnosis..............................................................................................47 Epidemiology........................................................................................47 Clinical Features...................................................................................47 Pathophysiology....................................................................................48 Endocrine Evaluation............................................................................49 Impact of Obesity.................................................................................50 Metabolic Complications......................................................................51 Treatment Options...............................................................................51 Oral Contraceptives and Progestins.................................................53 Anti-Androgens...............................................................................53 Insulin Sensitizing Agents................................................................54 Lifestyle Modification......................................................................54 6. Obesity: Recognition and Treatment in Women ..........56 Erin E. Flaherty and Richard S. Legro Assessment............................................................................................57 Metabolic Syndrome.......................................................................57 Treatment.............................................................................................58 Diet and Exercise.............................................................................58 Pharmacotherapy.............................................................................58 Categories of Weight Loss Drugs.....................................................59 Other Medications and Herbal Supplements...................................60 Surgery.................................................................................................61 7. Hormonal Contraception ............................................65 Sarah Prager and Jody Steinauer Background..........................................................................................65 Assessing Evidence about Contraception...............................................65 Combination Hormonal Contraception...............................................67 Combination Oral Contraception...................................................67 Extended Use Combined Oral Contraception.................................70 Transdermal Contraceptive System..................................................72 Combined Contraceptive Vaginal Ring ...........................................73 Injectable Combined Hormonal Contraception..............................74 Progestin Only Contraceptive Methods................................................74 Progestin Only Pills.........................................................................74 Progestin Only Intramuscular Injection...........................................76 Implantable Progestin Contraception..............................................77 Levonorgestrel Intrauterine System.......................................................78 Emergency Contraception ....................................................................79 8. Endometriosis..............................................................84 Sireesha Reddy Definition and Epidemiology ...............................................................84 Pathogenesis..........................................................................................84 Diagnosis..............................................................................................84 Medical Treatment................................................................................85 Oral Contraceptives.........................................................................85 Progestins........................................................................................86 Gonadotropin Releasing Hormone Analogs.....................................86 New Therapies ................................................................................87 Surgical Treatment................................................................................87 9. Hyperprolactinemia.....................................................89 Ghassan Haddad and Michael A. Thomas Biochemistry.........................................................................................89 Etiology................................................................................................89 Physiologic......................................................................................89 Pharmacologic.................................................................................90 Pathologic .......................................................................................91 Prolactinomas.......................................................................................91 Evaluation.............................................................................................92 Galactorrhea.........................................................................................92 Treatment.............................................................................................93 Observation.....................................................................................93 Medical Treatment...........................................................................93 Surgery............................................................................................94 Radiotherapy...................................................................................94 Pregnancy Considerations.....................................................................94 10. Premenstrual Syndrome...............................................96 Stephanie A.M. Giannandrea, Linda H. Chaudron and Tana A. Grady-Weliky Risk Factors..........................................................................................96 Clinical Symptoms and History............................................................97 Differential Diagnosis...........................................................................98 Etiology................................................................................................99 Treatment.............................................................................................99 Lifestyle Interventions...................................................................100 Nutritional, Vitamin and Alternative/Complementary Treatment Strategies..............................................................100 Psychoeducation............................................................................101 Cognitive Behavioral Therapy (CBT)............................................101 Pharmacologic Interventions...............................................................101 Antidepressants..............................................................................101 Anxiolytics.....................................................................................104 Hormonal Treatments ...................................................................104 11. Treatment of the Menopausal Woman .......................107 Ghassan Haddad and Daniel B. Williams The Menopause..................................................................................107 The Transition...............................................................................107 Symptoms of Menopause....................................................................108 Vasomotor Symptoms ...................................................................108 Regimens for Hormone Replacement.................................................109 Alternative Treatments for Hot Flashes..........................................110 Alternative Medicine.....................................................................111 Genitourinary.....................................................................................112 Local Therapy (Vaginal or Topical Administration) .......................112 Osteoporosis.......................................................................................113 Pathophysiology............................................................................113 Risk Factors and Diagnosis............................................................113 Cardiovascular Disease........................................................................115 HERS Study and Secondary Prevention of Cardiovascular Disease......................................................116 WHI Study and Primary Prevention of Cardiovascular Disease.....116 Alzheimer’s Disease.............................................................................116 Risks of Homone Replacement...........................................................117 Estrogen Replacement Therapy and Breast Cancer........................117 Estrogen Replacement Therapy and Endometrial Cancer..............117 Venous Thromboembolic Events...................................................117 Benefits of Hormone Replacement.....................................................118 12. Reproductive Endocrinology Diagnostic Imaging.....120 Peter Klatsky and Victor Y. Fujimoto Principles of Ultrasound and Magnetic Resonance Imaging (MRI).....120 Ambiguous Genitalia..........................................................................120 Amenorrhea........................................................................................121 Secondary Amenorrhea..................................................................125 Infertility............................................................................................126 Anatomic and Tubal Factor Infertility............................................126 MR-Hysterosalpingography...........................................................135 Recurrent Pregnancy Loss...................................................................135 Ovulatory Disorders......................................................................136 Diminished Ovarian Reserve.........................................................137 Endometriosis.....................................................................................139 Fibroids ..............................................................................................141 Part II: Infertility 13. An Overview of Female Infertility..............................145 Sandra L. Torrente and Valerie Montgomery Rice Overview............................................................................................145 Ovulatory Disorders......................................................................146 Tubal Disorders..................................................................................149 Treatment......................................................................................150 Endometriosis ...............................................................................150 Uterine Disorders..........................................................................150 Cervical Disorders.........................................................................150 Unexplained Infertility..................................................................151 14. Surgical Treatment of Female Infertility ....................153 Mohammed Al-Sunaidi and Togas Tulandi Diagnostic Laparoscopy......................................................................153 Laparoscopy Promoting Fertility.........................................................154 Adhesiolysis...................................................................................154 Treatment of Endometriosis ..........................................................154 Treatment of Distal Tubal Occlusion.............................................156 Treatment of Proximal Tubal Occlusion.........................................158 Treatment of Mid-Tubal Occlusion...............................................159 Laparoscopic Treatment of Polycystic Ovary Syndrome (PCOS) ...159 Hysteroscopy in Infertility..................................................................161 Diagnostic Hysteroscopy...............................................................161 Operative Hysteroscopy.................................................................162 15. Ovulation Induction..................................................165 Jon C. Havelock and Karen D. Bradshaw Testing Prior to Ovulation Induction..................................................165 Ovulation Induction Monitoring........................................................167 Complications of Ovulation Induction...............................................167 Multiple Pregnancy .......................................................................167 Ovarian Hyperstimulation Syndrome (OHSS)..............................168 Methods of Ovulation Induction........................................................168 Weight Loss...................................................................................168 Clomiphene Citrate.......................................................................168 Metformin.....................................................................................170 Aromatase Inhibitors.....................................................................170 Laparoscopic Ovarian Diathermy..................................................171 Glucocorticoids.............................................................................171 Pulsatile Gonadotropin Releasing Hormone..................................171 Dopamine Agonists.......................................................................171 Gonadotropins for Ovulation Induction.............................................172 Background...................................................................................172 Follicular Maturation with hCG—The Terminal Act in Ovulation Induction.........................................................173 Gonadotropin Ovulation Induction in PCOS...............................174 Ovulation in Hypogonadotropic Hypogonadism...........................175 Gonadotropins in Controlled Ovarian Hyperstimulation (COH)......................................................176 COH with Gonadotropins in in Vitro Fertilization (IVF).............176 16. Assisted Reproductive Technology.............................178 Tiffany Von Wald and Kim Thornton Definitions .........................................................................................178 Infertility History and Evaluation.......................................................179 Indications for ART............................................................................181 Tubal Disease ................................................................................182 Endometriosis ...............................................................................182 Male Factor Infertility ...................................................................183 Ovulatory Disorders......................................................................183 Unexplained Infertility..................................................................184 Diminished Ovarian Reserve.........................................................184 Other Indications for ART............................................................184 Success Rates ......................................................................................184 Complications....................................................................................185 Multiple Gestation........................................................................185 Ovarian Hyperstimulation Syndrome (OHSS)..............................186 Ectopic Pregnancy.........................................................................186 Other Risks...................................................................................187 Fetal Risks.....................................................................................187 17. Alternative Medicine and Female Infertility...............189 Hey-Joo Kang, Pak Chung and Raymond Chang Acupuncture.......................................................................................189 Herbal Treatments ..............................................................................191 Vitamins and Dietary Supplements.....................................................191 Mind/Body Techniques.......................................................................192 18. Male Infertility...........................................................194 Stephanya Shear and Jeanne O’Brien Epidemiology......................................................................................194 Physiology..........................................................................................194 Differential Diagnosis.........................................................................195 Evaluation...........................................................................................196 History and Physical......................................................................196 Laboratory Studies.........................................................................197 Radiologic Studies.........................................................................198 Management.......................................................................................199 Post Evaluation—Follow Up Care.................................................199 Other Surgical and Medical Treatments for Infertility....................200 19. Your Environment; Your Fertility—Is There a Link? ..201 Shanna H. Swan The Environment and Reproductive Factors in the Male....................202 The Environment and Reproductive Factors in the Female.................203 Factors That May Alter a Couples’ Fertility.........................................208 Web-Based Resources..........................................................................209 Index..........................................................................213