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This chapter discusses the major reproductive tract cancers that occur in the human population. In males, evidence for risks of testicular and prostate cancer as a function of exposure to endocrine disrupting agents is examined while in females, cancers of the breast, ovaries, and endometrium is evaluated. In men, chronically elevated estrogens have been associated with increased risk of prostate cancer. Similar to the prostate, breast cancer is a hormonally driven cancer and one major identified risk factor for breast cancer is an increased lifetime exposure to estrogens. Unlike ovarian cancer, endometrial cancer presents with symptoms such as unusual vaginal bleeding, abnormal discharge, and pelvic pain. Since a major risk factor for endometrial cancer is estrogen action unopposed by progesterone, exposure to estrogens or estrogen agonists from pesticides, herbicides, and other environmental contaminants have the potential to play a role in endometrial cancer initiation or promotion.
In-vitro fertilization (IVF) has rapidly become a treatment for male factor infertility. Mature oocytes are inseminated in a Petri dish and examined 18 hours later for morphologic proof of fertilization. Gamete intrafallopian transfer (GIFT) is designated for women who have at least one functioning fallopian tube. Micromanipulation procedures progressed because of discouraging results with IVF for the male-factor patient. Although application of acid solutions or enzymes, and mechanical opening of the human zona pellucida have been developed, only partial zona dissection (PZD) has been successful in humans. One of the most significant risks associated with ART is the ovarian hyperstimulation syndrome (OHSS). Preimplantation genetic screening (PGS) for aneuploidies has been performed in patients with advanced maternal age, unexplained recurrent miscarriage, recurrent implantation failure, nonobstructive and obstructive azoospermia (NOA and OA), and severe sperm morphology anomalies.
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