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Ovulation is a complex process that after initiation by LH involves cascades of several pathways that interact within cell types and between cell compartments. Major functions of these pathways are to promote permeability and increased blood flow, to accelerate ECM remodelling leading to degradation of the follicular apex and restructuring of the cystic follicle into a solid corpus luteum, to induce...
An infertility evaluation is designed to detect problems responsible for preventing pregnancy and is traditionally divided into male and female evaluations. The purpose of this chapter is to discuss the clinical evaluation of female infertility. Causes of female infertility include failure to have or release oocytes, failure to possess a patent reproductive tract receptive to an embryo, or a coexisting...
Metformin has been used extensively in multiple reproductive settings to ameliorate hyperandrogenism and chronic anovulation, to treat infertility, to prevent miscarriage and to prevent later pregnancy complications as well. Metformin does result in modest improvements in the PCOS phenotype with reductions in circulating insulin and testosterone levels, weight loss, and improved menstrual/ovulatory...
Endometriosis is a common, benign, estrogen-dependent, gynecological disorder associated with pelvic pain and infertility. The prevalence of this condition can reasonably be assumed to be around 10%. Endometriosis should be suspected in women with dysmenorrhea, dyspareunia, chronic pelvic pain, or subfertility; it may also be asymptomatic and can be present as a chronic disease in a subset of patients...
This chapter reviews two of the most common endocrinopathies in reproductive medicine and highlights the unique associations with reproductive outcomes that should be appreciated by the reproductive endocrine clinic.
Uterine factor subfertility is defined as a structural or functional disorder of the uterus that results in reduced fertility. Between one and two percent of in vitro fertilization (IVF) procedures are recorded as being done for uterine factor in the United States as reported by Wright et al. (MMWR Surveill Summ 57:1-23, 2008). Live birth rates for isolated uterine factor are below average compared...
The Müllerian ducts (mesodermal origin) are primordial roots of the internal female reproductive organs and differentiate to form the fallopian tubes, uterus, uterine cervix, and upper one third of the vagina. The mean incidence of uterine malformations in the general population is 4.3%, while women with infertility have a 3-6% incidence of abnormality. Patients with recurrent miscarriage have an...
Recurrent miscarriage is a common pathology fond in 1% to 5% of reproductively active couples. This chapter discusses the possible causes of recurrent miscarriage, and delineates a cost effective, productive strategy for the clinical evaluation of couples with two or more miscarriages.
Phillip Bozzini is credited with the first description of endoscopy in 1805, as he attempted to view the urethral mucosa with a simple tube and candlelight. Pantaleoni used a cystoscope to identify uterine polyps in 1869, thus accomplishing the first hysteroscopy. Jacobaeus of Sweden performed the first laparoscopy in 1910, when he placed a Neitze cystoscope and used a candle to illuminate a hollow...
Turner syndrome (TS) or monosomy X, is the most common cause of hypergonadotropic hypogonadism in girls and young women. This chapter reviews the prevalence and different presentations of the syndrome and explains its chromosomal origins. The interpretation of chromosomal studies in diagnosis of and prognosis for TS, including prenatal testing, is reviewed. The most recent data on the TS phenotypic...
Errors in chromosome segregation occurring during human oogenesis and early embryogenesis are very common. Meiotic chromosome development during oogenesis is subdivided into three distinct phases. The crucial events, including meiotic chromosome pairing and recombination, take place from around 11 weeks until birth. Oogenesis is then arrested until ovulation, when the first meiotic division takes...
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