Practical Patient Management in Reproductive Medicine: Evidence- and Experience-Based Guidance

Description

This text will provide doctors both in training and in practice with useful advice on managing women and men who are having trouble conceiving and couples with infertility and related disorders. Its combination of scientific information and practical advice for tackling problematic cases make this an accessible handy reference in outpatient clinics or in revision for professional exams, as well as a fully referenced information resource. Contents: Glossary of terms * Problems with puberty and its onset * Understanding infertility * Investigations in infertility * Influencing the sperm count * Helping women to ovulate * Damage to the uterus, the fallopian tubes and the ovaries * What to do if nothing wrong can be found and how to answer when a couple asks 'what can we do to improve our fertility?' *Assisted conception * Preserving fertility * Global perspectives on reproductive medicine * Reproductive biology in one other great ape (the gorilla) * Research questions still unanswered - And further reading Cover......Page 1 Half Title......Page 2 Title Page......Page 4 Copyright Page......Page 5 Contents......Page 6 Introduction......Page 10 Acknowledgements......Page 11 Glossary of terms......Page 12 Numbers......Page 28 1.1 How does puberty happen?......Page 31 1.2 Precocious puberty......Page 33 1.3 Delayed puberty......Page 35 1.4 Disorders of puberty causing reproductive problems......Page 37 References......Page 38 2.1 Factors affecting the ability to conceive......Page 40 2.3 Barriers to seeking advice?......Page 42 2.4 Is infertility on the rise?......Page 43 References......Page 44 3.1 Consultations......Page 47 3.2 The first appointment......Page 48 3.3 Initial investigations: For the woman......Page 50 3.4 Initial investigations: For the man......Page 53 3.5 Further consultation and investigations......Page 54 3.6 Consultation to decide diagnosis and discuss treatment......Page 55 3.7 Treatment options in outline (more details in Chapters 4–7)......Page 56 3.8 Counselling......Page 57 3.9 Case study with a commentary......Page 58 3.10 Summary......Page 59 References......Page 60 4.1 Semen analysis: Descriptors and methods of comparison......Page 62 4.2 Causes of low values on semen analysis......Page 64 4.3 Hormonal stimuli leading to sperm production......Page 65 4.4 Sperm transport and conditions where it is impaired......Page 67 4.5 Chemical inhibitors and lifestyle choices: Effect on sperm production......Page 68 4.6 Treatments......Page 69 4.7 Overcoming male reluctance/refusal to have a sperm count......Page 71 4.8 Case presentations and commentary......Page 72 References......Page 75 5.1 Women whose periods are absent or very infrequent......Page 78 5.2 What are the categories of ovulation disorders?......Page 83 5.3 What are the approaches to treatment?......Page 84 5.4 How effective are the different treatments?......Page 89 5.6 Clinical conditions which can affect ovulation......Page 91 5.7 Case studies......Page 95 Appendix: Physiology of ovulation......Page 97 5A.1 Follicular recruitment and development......Page 98 5A.2 Working towards ovulation......Page 100 References......Page 102 6.1 The uterus......Page 105 6.2 Uterine fibroids......Page 106 6.3 Intrauterine adhesions and polyps......Page 111 6.4 Proximal and distal inner tubal damage......Page 112 6.5 Adhesions around the tube and ovary......Page 115 6.6 Case history......Page 117 6.7 Summary......Page 118 References......Page 119 7.1 Making the diagnosis of unexplained infertility......Page 123 7.2 Management and treatment of unexplained infertility......Page 126 7.3 Role of alternative and complementary therapies......Page 128 7.4 Stress and its impact on fertility......Page 129 7.5 Lifestyle choices which affect fertility......Page 130 7.6 Case study......Page 135 References......Page 136 8.2 In Vitro Fertilisation: It’s complex!......Page 142 8.3 What is appropriate when?......Page 145 8.4 The range of treatment options......Page 146 8.5 Additional elements to the process of in vitro fertilisation and embryo transfer......Page 150 8.6 At what cost?......Page 152 8.7 Risks and complications......Page 153 8.8 Case study......Page 156 8.9 Summary......Page 157 References......Page 158 9.2 Women, men, adolescents......Page 163 9.3 Pregnancy after cancer treatment......Page 170 9.4 Social indications for fertility preservation: What happens to fertility with increasing age?......Page 174 References......Page 177 10.1 What do we know about infertility across the globe?......Page 182 10.2 Attitudes of the major world religions towards infertility and assisted conception......Page 184 10.5 Personal experience......Page 187 10.6 Conclusion......Page 188 References......Page 189 11.1 Grappling with physiology......Page 191 References......Page 196 Further reading......Page 197 Index......Page 198