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Polycystic ovarian syndrome (PCOS) affects up to 18% of women internationally, with widespread effects on their reproductive, metabolic and cardiovascular health. To date, the etiology of this syndrome remains unclear. Patterns of expression within family groups suggest a genetic inheritance but neither a clear inheritance pattern nor candidate gene(s) has been discovered to date. Animal studies have proven that in utero exposure to high levels of androgen can elicit PCOS-like traits in various mammals, including rhesus monkeys who share a similar reproductive biology with humans. An alternate mechanism for etiology is the epigenetic alteration in programming of the fetal ovaries in response to androgen exposure. This chapter summarizes the evidence available and hypothesizes possible mechanisms of action via which PCOS could be transmitted from an affected mother to her offspring. The origins of androgens in the fetal circulation as well as the role of AMH and luteinizing hormone (LH) are discussed as are the actions of the placenta and the difference in placental function and hormone secretion patterns in PCOS females compared to “normal” physiology.
Human reproduction is the most basic of human functions and is the foundation of our very existence. When considering the bodily mechanisms involved, from the delicacy of the interacting endocrine network to the wonder of the cyclical changes in the ovary and uterus and the mechanism of sperm production, it is a constant source of amazement that the integration needed to produce another human being does not go wrong more often.
One of modern healthcare's most controversial areas, reproductive medicine is an emerging discipline that fosters hugely divergent opinions on topics such as laboratory techniques, clinical management and ethical considerations. Highlighting over 50 contentious topics in reproductive medicine, this book presents expertly argued opinions are presented for and against, often with diametrically opposing views about management. Debates such as these are being increasingly used as learning tools, helping participants develop their critical thinking skills and showing that context is vital when making decisions. Issues discussed include limits on IVF provision, ethical queries about sex selection, embryology, and ovarian stimulation. Authors are authorities in their field, combining years of experience with fresh and innovative ideas to structure their arguments. Readers will gain an insight into topical controversies, critically evaluating the different sides to enhance their own clinical practice.
Ovarian endometriomas are a common and specific manifestation of the disease endometriosis. In vitro fertilization (IVF) treatment in the words of the European Society of Human Reproduction and Embryology (ESHRE) Special Interest Group (SIG) on Endometriosis appears to be appropriate in patients with advanced endometriosis, which is frequently associated with adhesions, ovarian endometriomas, and tubal obstruction. Ovarian responsiveness to hyperstimulation plays a crucial role in determining the success rate of IVF. There are currently insufficient data to clarify whether the endometrioma-related damage to ovarian responsiveness precedes or follows surgery. Elucidation of this point is of utmost interest since it would strongly impact on the decision of whether to operate on women with endometriomas and who are selected for IVF. At present, there appears to be evidence supporting both an endometrioma-related injury and a surgery-mediated damage. The physiological mechanisms leading to ovulation are abnormal in ovaries with endometriomas.