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10 results

  • Chapter 18 - Treatment of hyperprolactinemia

  • from Section 5: - Alternatives to ovarian hyperstimulation
  • Edited by Mohamed Aboulghar, Botros Rizk, University of South Alabama
  • Book:
    Ovarian Stimulation
    Published online:
    05 August 2011
    Print publication:
    23 December 2010, pp 195-208

  • Summary

    Prolactin exerts many physiologic functions, perhaps the most prominent of which is inducing lobuloalveolar growth of the mammary gland, along with stimulation of lactogenesis or milk production after giving birth. The majority of prolactinomas contains only lactotroph cells and produce prolactin in excess. The major mechanism is a threefold increase in prolactin secretion, and a one-third decrease in metabolic clearance rate. Oligomenorrhea, amenorrhea, galactorrhea, infertility, hot flashes, vaginal dryness, headaches, and visual changes are clinical manifestations of hyperprolactinemia in premenopausal women. Women who have lactotroph microadenoma causing hyperprolactinemia and hypogonadism and cannot tolerate or do not respond to dopamine agonists and do not want to become pregnant can be treated with estrogen and progestin. Cabergoline is the most effective of the dopamine agonists but is the most expensive. Intravaginal administration of dopamine agonists reduces their side effects.

  • Chapter 33 - Cervical pregnancy

  • from Section 4: - Early pregnancy after infertility treatment
  • Edited by Botros R. M. B. Rizk, University of South Alabama
  • Book:
    Ultrasonography in Reproductive Medicine and Infertility
    Published online:
    07 September 2011
    Print publication:
    25 March 2010, pp 276-282

  • Summary

    The use of transvaginal ultrasound has not only revolutionized the diagnosis of cervical pregnancy (CP) but also dramatically improved patient survival and allowed physicians to consider other fertility sparing treatment options. Management of CP depends on a number of factors. These include the gestational age, patient stability, the desire to maintain future fertility, and the available resources and expertise where the patient is managed. Generally, if the gestational age is less than 9 weeks without fetal cardiac activity, systemic chemotherapy in the form of methotrexate alone is the first line of treatment. If there is fetal heart activity and the gestational age is less than 12 weeks, intra-amniotic potassium chloride injection (3-5ml of 2 mEq/ml) should be done first, followed by systemic methotrexate. Uterine artery embolization (UAE) has been used for many years in the treatment of symptomatic uterine fibroids and in acute obstetric hemorrhage.

  • 6 - Evaluation of the Infertile Female

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 55-69

  • Summary

    Female fertility begins to decline many years before menopause, despite continued regular ovulatory cycles. Decreased fecundity with increasing female age has long been recognized in demographic and epidemiological studies. Traditionally, the evaluation of the infertile female consists of: (i) ovulation assessment (ovulatory factors), (ii) evaluation of the uterine morphology (ovulation assessment) and tubal patency (tubal factors), (iii) assessment of the presence of pelvic pathology (by laparoscopy) (peritoneal factors), and (iv) postcoital test (cervical factors). Hysterosalpingography (HSG), laparoscopy are widely used in assessing infertility. Chlamydia antibody testing is a screening method for assessing tubal infertility. HSG, sonohysterography, hystero-salpingo contrast sonography (HyCoSy), magnetic resonance imaging (MRI) and hysteroscopy are used in assessment of uterine factors related to infertility. Currently, the best method to monitor ovulation is transvaginal ultrasound, which can be used to demonstrate the growth of a dominant follicle and provide presumptive evidence of ovulation and leutinization.

  • 66 - Preimplantation Genetic Diagnosis for Single-Gene Disorders

  • from PART III - ASSISTED REPRODUCTION
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 657-676

  • Summary

    There is a wide range of single-gene disorders that could be screened for using preimplantation genetic diagnosis (PGD). These mostly include Mendelian disorders like autosomal or X-linked disorders, whether recessive or dominant. The most common autosomal dominant diseases include myotonic dystrophy, Huntington disease, neurofibromatosis, and adenomatous polyposis coli. The aim of genetic counseling is to enable couples and families with genetic disadvantages to live and reproduce as normally as possible. Couples undergoing PGD should be advised to have protected intercourse or to abstain from sex to avoid the risk of spontaneous pregnancy during that cycle. Polar body biopsy is also known as preconception or pre-fertilization biopsy, and in some countries, it is the only form of PGD that is legally approved. Fluorescent in situ hybridization (FISH) is particularly useful when examining interphase nuclei, as with blastomeres.

  • 29 - Hyperprolactinemia

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 270-285

  • Summary

    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.

  • 8 - Microlaparoscopy

  • from PART II - INFERTILITY EVALUATION AND TREATMENT
  • Edited by Botros R. M. B. Rizk, University of South Alabama, Juan A. Garcia-Velasco, Hassan N. Sallam, Antonis Makrigiannakis, University of Crete
  • Book:
    Infertility and Assisted Reproduction
    Published online:
    04 August 2010
    Print publication:
    15 September 2008, pp 76-81

  • Summary

    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.