Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ MENSTRUAL CYCLE ++ Figure 4-1 ++Figure 4-1Changes in the ovarian follicle, endometrial thickness, and serum hormone levels during a 28-day menstrual cycle. P, progesterone; E2, estradiol; LH, luteinizing hormone; FSH, follicle-stimulating hormone. (Used with permission from Hoffman BL, et al. Chapter 15. Reproductive endocrinology. In: Hoffman BL, et al., eds. Williams Gynecology. 2nd ed. New York, NY: McGraw-Hill; 2012) Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ INFERTILITY +++ Definitions ++ Infertility: Inability to conceive after 1 year of frequent unprotected intercourse (evaluation recommended after 6 months if age is over 35) Primary Infertility: When a woman has never been pregnant Secondary Infertility: Infertility after a prior pregnancy +++ Statistics ++ Affects 7% of married couples in which female partner is of reproductive age One-year prevalence of infertility is approximately 15% Infertility affects men and women equally 20% of infertility cases can be attributed to male factors 38% of infertility cases can be attributed to female factors 27% of infertility cases combined male/female 15% are unexplained Infertility and childlessness increase with age (Table 4-1) Risk of spontaneous abortion (SAB) also increases with age (Table 4-2) ++Table Graphic Jump LocationTABLE 4-1INFERTILITY INCREASES WITH AGEView Table||Download (.pdf)TABLE 4-1INFERTILITY INCREASES WITH AGE Age Group Percent Infertile % Chance of Remaining Childless 20–24 7 6 25–29 9 9 30–34 15 15 35–39 22 30 40–44 29 64 Source: Data from Menken J, Trussell IJ, Larsen U. Age and infertility. Science. 1986;233:1389–1394. ++Table Graphic Jump LocationTABLE 4-2RISK OF SAB WITH INCREASED AGEView Table||Download (.pdf)TABLE 4-2RISK OF SAB WITH INCREASED AGE Maternal Age Risk of SAB (%) 15–29 10 30–34 12 35–39 18 40–44 34 ≥45 53 Source: Used with permission from Gindof PR, Jewelewicz R. Reproductive potential in the older woman. Fertil Steril. 1986; 46:989–1001. +++ Male Factor Infertility ++ Incidence: 20% Etiology Hypothalamic pituitary disease (secondary hypogonadism): 1–2% Mechanism: Deficiency of GnRH or gonadotropin Congenital: Kallman syndrome, Prader–Willi syndrome Acquired: Pituitary/Hypothalamic tumors, sarcoidosis, tuberculosis (TB), trauma, aneurysm, infarction, hyperprolactinemia, estrogen or cortisol excess, medications Systemic: Chronic illness, nutritional deficiency, obesity Primary Hypogonadism: 30–40% Congenital: Klinefelter syndrome, cryptorchidism, androgen insensitivity Acquired: Varicocele, orchitis, medication (alcohol, tetrahydrocannibol (THC), ketoconazole, spironolactone, histamine antagonists, calcium-channel blockers, steroids), environmental toxins, trauma, torsion, systemic illness (renal failure, cirrhosis, cancer, sickle cell) Post-testicular defects (disorders of sperm transport): 10–20% Congenital: Absence of vas deferens (check for Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) mutation) Acquired: Infection, spinal cord disease, erectile dysfunction, premature ejaculation, retrograde ejaculation, vasectomy Obstruction: Benign prostatic hyperplasia (BPH), infection, and scarring Unexplained: 40–50% Evaluation: Semen analysis (... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.