By Roy Homburg

Ovulation induction and regulated ovarian stimulation lie on the very middle of remedy for infertility, yet were topic to a bewildering number of diversifications and enhancements over fresh years. the second one variation of this hugely profitable publication updates the reader at the growth and advancements during this sector. moreover, it offers the busy clinician with a competent evaluation of the foundations concerned and the administration wanted. As with the former version, the emphasis all through this ebook is on logical facts and evidence-based strategies supplemented with Professor Homburg’s huge medical adventure gleaned from greater than 40 years operating within the box. a few hugely important algorithms and explanatory tables make stronger this method, making sure that the reader is gifted with easy-to-grasp, well-presented details that maximizes readability and knowing. This booklet bargains a concise, no-nonsense, useful consultant to ovulation induction and regulated ovarian stimulation and should be a vital source for the final gynaecologists, fertility experts and trainees, medical experts and students.

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Additional info for Ovulation Induction and Controlled Ovarian Stimulation: A Practical Guide

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Diagnosis and Causes of Anovulation Amenorrhea Prolactin High HYPERPROLACTINEMIA Medications? TSH MRI Normal Oestradiol Low FSH Normal HYPOTHALAMIC -PITUITARY DYSFUNCTION PCOS? 3 Low HYPOTHALAMIC PITUITARY FAILURE 2° sex characteristics Weight loss? Kalmann’s syndrome? Systemic diseases? 2 Scheme for the diagnosis of the cause of amenorrhea. TSH thyroid stimulating hormone, MRI magnetic resonance imaging, PCOS polycystic ovary syndrome defects (WHO Group V) which, while not usually associated with anovulation, are a cause of amenorrhea which must be taken into possible consideration.

Congenital adrenal hyperplasia, androgen secreting tumours and Cushing’s syndrome should be excluded complaining of infertility. The syndrome is associated with approximately 75 % of the women who suffer from infertility due to anovulation. The majority of women with anovulation or oligo-ovulation due to PCOS have menstrual irregularities, usually oligo/amenorrhea, associated with clinical and/or biochemical evidence of hyperandrogenism. Almost all these women will have a typical ultrasonic appearance of the ovaries.

Other causes include craniopharyngioma and debilitating systemic diseases. Not a few cases are idiopathic. The commonest ‘pituitary’ causes are hypophysectomy, radiotherapy for pituitary tumours and severe post-partum haemorrhage (Sheehan’s syndrome). 3 Causes of Anovulation 33 If the pituitary is intact and the hypothalamus is failing to function, ‘replacement therapy’ with pulsatile GnRH is highly effective. Direct stimulation of the ovaries with gonadotrophins also serves the purpose for ovulation induction whether the cause is of hypothalamic or pituitary origin.

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