Practical Patient Management
Practical Patient Management
1 Problems with puberty and its onset 1
Overview 1
Definitions 1
Numbers 1
Conclusion 4
1.1 How does puberty happen 4
1.2 Precocious puberty 6
1.3 Delayed puberty 8
1.4 Disorders of puberty causing reproductive problems 10
1.5 Summary 11
References 11
2 Understanding infertility 13
Overview 13
Definitions 13
Prevalence lncidence 13
2.1 Factors affecting the ability to conceive 13
2.2 Diagnostic categories 15
2.3 Barriers to seeking advice 15
2.4 Is infertility on the rise 16
2.5 Summary 17
References 17
3 Investigations in infertility 20
Overview 20
3.1 Consultations 20
3.2 The first appointment 21
3.3 Initial investigations For the woman 23
3.4 Initial investigations For the man 26
3.5 Further consultation and investigations 27
3.6 Consultation to decide diagnosis and discuss treatment 28
3.7 Treatment options in outline more details in Chapters 4-7 29
3.8 Counselling 30
3.9 Case study with a commentary 31
3.10 Summary 32
References 33
4 Influencing the sperm count 35
Overview 35
4.1 Semen analysis Descriptors and methods of comparison 35
4.2 Causes of low values on semen analysis 37
4.3 Hormonal stimuli leading to sperm production 38
4.4 Sperm transport and conditions where it is impaired 40
4.5 Chemical inhibitors and lifestyle choices Effect on sperm production
4.6 Treatments
4.7 Overcoming male reluctance refusal to have a sperm count
4.8 Case presentations and commentary
4.9 Summary References
Helping women to ovulate Overview
5.1 Women whose periods are absent or very infrequent
5.2 What are the categories of ovulation disorders
5.3 What are the approaches to treatment
5.4 How effective are the different treatments
5.5 How they all work together
5.6 Clinical conditions which can affect ovulation
5.7 Case studies
5.8 Summary
Appendix Physiology of ovulation
5A.1 Follicular recruitment and development
5A.2 Working towards ovulation
5A.3 Summary
References
Damage to the uterus, the fallopian tubes and the ovaries Overview
6.1 The uterus
6.2 Uterine fibroids
6.3 Intrauterine adhesions and polyps
6.4 Proximal and distal inner tubal damage
6.5 Adhesions around the tube and ovary
6.6 Case history
6.7 Summary References
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
Overview
7.1 Making the diagnosis of unexplained infertility
7.2 Management and treatment of unexplained infertility
7.3 Role of alternative and complementary therapies
7.4 Stress and its impact on fertility
7.5 Lifestyle choices which affect fertility
7.6 Case study
7.7 Summary References Assisted conception Overview
8.1 Introduction
8.2 In vitro fertilisation It s complex
8.3 What is appropriate when
8.4 The range of treatment options
8.5 Additional elements to the process of in vitro fertilisation and embryo transfer
8.6 At what cost
8.7 Risks and complications
8.8 Case study 129
8.9 Summary 130
References 131
9 Preserving fertility 136
Overview 136
9.1 Medical indications for preserving fertility 136
9.2 Women, men, adolescents 136
9.3 Pregnancy after cancer treatment 143
9.4 Social indications for fertility preservation What happens to fertility with increasing age 147
9.5 Summary 150
References 150
10 Global perspectives on reproductive medicine 155
Overview 155
10.1 What do we know about infertility across the globe 155
10.2 Attitudes of the major world religions towards infertility and assisted conception 157
10.3 Planning care with couples to incorporate their values and cultural background 160
10.4 Reproductive medicine in different environments 160
10.5 Personal experience 160
10.6 Conclusion 161
References 162
11 Reproductive biology in one other great ape the gorilla 164
Overview 164
11.1 Grappling with physiology 164
11.2 Summary 169
References 169
12 Research questions still unanswered — And further reading 170
Questions arising from the text of this book that have not been fully addressed not exclusive 170
Further reading 170
Overview 1
Definitions 1
Numbers 1
Conclusion 4
1.1 How does puberty happen 4
1.2 Precocious puberty 6
1.3 Delayed puberty 8
1.4 Disorders of puberty causing reproductive problems 10
1.5 Summary 11
References 11
2 Understanding infertility 13
Overview 13
Definitions 13
Prevalence lncidence 13
2.1 Factors affecting the ability to conceive 13
2.2 Diagnostic categories 15
2.3 Barriers to seeking advice 15
2.4 Is infertility on the rise 16
2.5 Summary 17
References 17
3 Investigations in infertility 20
Overview 20
3.1 Consultations 20
3.2 The first appointment 21
3.3 Initial investigations For the woman 23
3.4 Initial investigations For the man 26
3.5 Further consultation and investigations 27
3.6 Consultation to decide diagnosis and discuss treatment 28
3.7 Treatment options in outline more details in Chapters 4-7 29
3.8 Counselling 30
3.9 Case study with a commentary 31
3.10 Summary 32
References 33
4 Influencing the sperm count 35
Overview 35
4.1 Semen analysis Descriptors and methods of comparison 35
4.2 Causes of low values on semen analysis 37
4.3 Hormonal stimuli leading to sperm production 38
4.4 Sperm transport and conditions where it is impaired 40
4.5 Chemical inhibitors and lifestyle choices Effect on sperm production
4.6 Treatments
4.7 Overcoming male reluctance refusal to have a sperm count
4.8 Case presentations and commentary
4.9 Summary References
Helping women to ovulate Overview
5.1 Women whose periods are absent or very infrequent
5.2 What are the categories of ovulation disorders
5.3 What are the approaches to treatment
5.4 How effective are the different treatments
5.5 How they all work together
5.6 Clinical conditions which can affect ovulation
5.7 Case studies
5.8 Summary
Appendix Physiology of ovulation
5A.1 Follicular recruitment and development
5A.2 Working towards ovulation
5A.3 Summary
References
Damage to the uterus, the fallopian tubes and the ovaries Overview
6.1 The uterus
6.2 Uterine fibroids
6.3 Intrauterine adhesions and polyps
6.4 Proximal and distal inner tubal damage
6.5 Adhesions around the tube and ovary
6.6 Case history
6.7 Summary References
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
Overview
7.1 Making the diagnosis of unexplained infertility
7.2 Management and treatment of unexplained infertility
7.3 Role of alternative and complementary therapies
7.4 Stress and its impact on fertility
7.5 Lifestyle choices which affect fertility
7.6 Case study
7.7 Summary References Assisted conception Overview
8.1 Introduction
8.2 In vitro fertilisation It s complex
8.3 What is appropriate when
8.4 The range of treatment options
8.5 Additional elements to the process of in vitro fertilisation and embryo transfer
8.6 At what cost
8.7 Risks and complications
8.8 Case study 129
8.9 Summary 130
References 131
9 Preserving fertility 136
Overview 136
9.1 Medical indications for preserving fertility 136
9.2 Women, men, adolescents 136
9.3 Pregnancy after cancer treatment 143
9.4 Social indications for fertility preservation What happens to fertility with increasing age 147
9.5 Summary 150
References 150
10 Global perspectives on reproductive medicine 155
Overview 155
10.1 What do we know about infertility across the globe 155
10.2 Attitudes of the major world religions towards infertility and assisted conception 157
10.3 Planning care with couples to incorporate their values and cultural background 160
10.4 Reproductive medicine in different environments 160
10.5 Personal experience 160
10.6 Conclusion 161
References 162
11 Reproductive biology in one other great ape the gorilla 164
Overview 164
11.1 Grappling with physiology 164
11.2 Summary 169
References 169
12 Research questions still unanswered — And further reading 170
Questions arising from the text of this book that have not been fully addressed not exclusive 170
Further reading 170