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Human Assisted Reproductive Technology: Future Trends in Laboratory and Clinical Practice offers a collection of concise, practical review articles on cutting-edge topics within reproductive medicine. Each article presents a balanced view of clinically relevant information and looks ahead to how practice will change over the next five years. The clinical section discusses advances in reproductive surgery and current use of robotic surgery for tubal reversal and removal of fibroids. It looks into the refinement of surgical procedures for fertility preservation purposes. Chapters also discuss non-invasive diagnosis of endometriosis with proteomics technology, new concepts in ovarian stimulation and in the management of polycystic ovary syndrome, and evidence-based ART. The embryology section discusses issues ranging from three-dimensional in-vitro ovarian follicle culture, and morphometric and proteomics analysis of embryos, to oocyte and embryo cyropreservation. This forward-looking volume of review articles is key reading for reproductive medicine physicians, gynecologists, reproductive endocrinologists, urologists and andrologists.
The successful treatment of endometriosis-associated symptoms typically requires surgical as well as medical intervention. Progestogens are efficacious and inexpensive treatment of pelvic endometriosis. A variety of medications have been used as add-back therapy in addition to gonadotrophin-releasing hormone (GnRH) agonist for treatment of endometriosis which includes progestogen alone, progestogen and estrogen combination, or progestogen and bisphosphonates. GnRH antagonists have been used for the treatment of pelvic endometriosis; however, they have not been as widely accepted as GnRH agonists. Selective progesterone receptor modulators introduce a new dimension in the medical treatment of endometriosis. Aromatase inhibitors which inhibit estrogen production in endometriotic implants are an attractive option for the management of endometriosis. Antiangiogenesis therapy has been investigated in rodents, demonstrated that angiostatic agents prevent the development of endometriosis-like lesions in the chicken chorioallantoic membrane. Nonsteroidal inflammatory drugs are very helpful in pelvic pain and dysmenorrhea associated with endometriosis.
Microlaparoscopy offers the advantage of carrying out many diagnostic and operative gynecologic procedures in a rapid, minimally invasive approach. Proper patient selection is very important for the success of the procedure. Microlaparoscopy could be performed either with general anesthesia or with local anesthesia under conscious sedation, which is a state of depressed consciousness allowing communication with the patient during the procedure. An umbilical incision is made (a local anesthetic block is done first in a case of conscious sedation) through which the interlocking trocar with the Verres needle is introduced to the abdomen. Most of the patients can leave the office within one hour of the procedure. Microlaparoscopy is currently used for infertility assessment, surgical management of endometriosis, lysis of pelvic adhesions, ovarian drilling, gamete intrafallopian transfer, tubal embryo transfer, hydrosalpinx removal before in vitro fertilization (IVF), and management of ectopic and heterotopic pregnancy.
Hyperprolactinemia has a detrimental effect on fertility both in women and men, leading to galactorrhea anovulation, amenorrhea, oligomenorrhea, impotence, gynecomastia, and low semen profile. Men with hyperprolactinemia not only show abnormal semen analysis but also abnormal histological structure of the testicles with distorted seminiferous tubules and abnormal sertoli cells. Many physiological and or pathological changes involving lactotroph cells can result in hyperprolactinemia. The majority of prolactinomas contains only lactotroph cells and produce prolactin in excess. Antihypertensive drugs like methyldopa and reserpine increases prolactin secretion. A dopamine agonist drug should usually be the first line of treatment for patients with hyperprolactinemia of any cause including lactotroph adenomas of all sizes. Bromocriptine, cabergoline, pergolide are the available dopamine agonists to treat hyperprolactinemia. Dopamine agonists decrease prolactin secretion and reduce the size of the lactotroph adenoma in more than 90 percent of patients. Surgical and radiation treatment are also useful.
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