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REPRODUCTIVE ENDOCRINOLOGY . . . CONT.

Notes

• fibrocystic breasts • obesity • smoking

Selective Estrogen Receptor Modulators (SERMS) e.g. raloxifene (Evista) mimics estrogen effects on cardiovascular system and bone avoids estrogen-like action on breast and uterine tissue does not relieve hot flashes (may make them worse)

INFERTILITY

Definitions infertility: failure to conceive after one year of regular unprotected intercourse primary infertility: no prior pregnancies secondary infertility: previous conception

Incidence 10-15% of couples 60% of couples achieve pregnancy within 6 months of trying 80% of couples achieve pregnancy within 1 year of trying

Etiology male factors (40%) female factors (50%) multiple factors (30%) unknown factors (10-15%) note: even when fertilization occurs, > 50-70% of resulting embryos are non-viable

Male Factors inadequate or abnormal production of sperm • congenital • trauma, e.g. sports injury • varicocele • infection - usually mumps orchitis • smoking, stress, heat, alcohol • rare: malignant disease, endocrine disease delivery problems • bilateral obstruction of epididymis or ducts • ejaculatory dysfunction, e.g. retrograde ejaculation • erectile dysfunction • abnormal position of urethral orifice diagnosis • semen analysis after 2-3 days of abstinence (2 specimens several weeks apart) • normal ejaculate • volume: 2-5 mL • count: > 20 million sperm/mL • motility: > 50% • morphology: > 60% normal forms • liquefaction: complete in 20 minutes • pH: 7.2-7.8 • WBC: < 10 per high power field oligospermia: count < 20 million/mL azoospermia: absence of living spermatozoa in the semen endocrine evaluation required if abnormal sperm

Female Factors o v u l a t o r y d y s f u n c t i o n ( 1 5 - 2 0 % ) e t i o l o g y h y p e r p r o l a c t i n e m i a ( e . g . p i t u i t a r y m i c r o a d e n o m a ) p o l y c y s t i c o v a r i a n d i s e a s e d r u g s ( e . g . c i m e t i d i n e , p s y c h o t r o p i c ) s y s t e m i c d i s e a s e s e . g . t h y r o i d , h e p a t o - r e n a l d i s e a s e , C u s h i n g s y n d r o m e c o n g e n i t a l - T u r n e r s y n d r o m e , t e s t i c u l a r f e m i n i z a t i o n , g o n a d a l d y s g e n e s i s , a n d g o n a d o t r o p i n d e f i c i e n c y l u t e a l p h a s e d e f e c t e x c e s s i v e e x e r c i s e ( e v e n i n a b s e n c e o f a m e n o r r h e a ) p r e m a t u r e o v a r i a n f a i l u r e - a u t o i m m u n e d i s e a s e

Gynecology 16

MCCQE 2000 Review Notes and Lecture Series

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