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 MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. 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 Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth