The practice of clinical reproductive medicine has practice in the era of managed care and coordinat gradually moved from its initial 1980-90 hospital ing ancillary offsite medical personnel. base to its present (circa 2001) office site of oper The objective of this text is to assist in this ongo ation. With this transition have been improvements ing endeavor by presenting in a clear, concise man in efficiency of practice often in response to ner many of the topics relevant to contemporary increased pressure to provide the most patient sat office-based infertility practice. The initial half of isfaction. An added challenge of office-based prac this text addresses topics which focus upon general tice has been taking on many of the responsibili concepts of infertility evaluation and practice. The ties of what had been traditionally the hospital's latter half is a practical approach to the execution domain. Some of these new responsibilities have of specific office-based infertility procedures. We included the ordering of operative supplies and hope this book will assist all medical personnel who equipment, the establishment of quality control dedicate their clinical effort in achieving what is programs, construction and maintenance of special most coveted by our patients, the birth of a healthy laboratory spaces, redesigning efficient methods of newborn. DAVID B. SEIFER, M. D. UMDNJ-Robert Wood Johnson Medical School ROBERT L. COLLINS, M. D. The Reproductive Center, Youngstown, Ohio October 2001 vii Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii . . . . . . . . . . . . . . . . . Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi . . . . . . . . . . . . . . . . . 1 Evaluation of the Female for Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Bryan D."

Leading researchers and experienced clinicians join forces not only to illuminate today's understanding of the endocrinology of menopause, but also to provide a sound basis for its successful management. These seasoned experts review in detail the cardiovascular, bone, brain, and genitourinary changes that accompany menopause and spell out the risks, benefits, and alternatives of conventional hormone replacement therapy. Selective estrogen receptor modulators (SERMs), androgen replacement, calcium supplementation, and the role of phytoestrogens are also fully reviewed. Menopause: Endocrinology and Management offers practicing physicians a comprehensive understanding of the menopause process, as well as an evidence-based approach to optimizing treatment strategies for the challenging medical problems accompanying this important period in women's lives.

Leading researchers and experienced clinicians join forces not only to illuminate today's understanding of the endocrinology of menopause, but also to provide a sound basis for its successful management. These seasoned experts review in detail the cardiovascular, bone, brain, and genitourinary changes that accompany menopause and spell out the risks, benefits, and alternatives of conventional hormone replacement therapy. Selective estrogen receptor modulators (SERMs), androgen replacement, calcium supplementation, and the role of phytoestrogens are also fully reviewed. Menopause: Endocrinology and Management offers practicing physicians a comprehensive understanding of the menopause process, as well as an evidence-based approach to optimizing treatment strategies for the challenging medical problems accompanying this important period in women's lives.

Office-Based Infertility Practice is an invaluable resource to all physicians treating infertile couples. The text emphasizes the practice of infertility in the office setting, reflecting the current trend away from the hospital into the outpatient environment. The most current and advanced therapies available are discussed by recognized experts in the field. The first half of the book is devoted to the evaluation and work-up of the infertile couple, including evaluation of the male, female, age-related infertility factors, and the roles of ultrasound, endometrium saline sonography, falloposcopy and diagnostic laparoscopy and hysteroscopy. The second half of the book presents the treatment and operative procedures for the infertile couple, including ovulation induction, IUI, tubal cannulation, treatment of cervical stenosis, the use of office laparoscopy and therapeutic hysteroscopy, male treatment as support for IVF, vas reversals, and testicular biopsy, as well as routine IVF, intratubal gamete transfer, and micromanipulation. With over 60 illustrations, this book is a must for all infertility specialists, obstetrician-gynecologists, fellows, and residents. Its practical, comprehensive approach will be of daily use to the office practitioner treating women of reproductive age.

This is the first book published that discusses state of the art research regarding AMH in human reproduction and medicine. This unique and vital protein impacts a variety of fundamental processes within the ovaries and testes. Since its discovery in 1947, every medical student has learned about the role AMH plays in embryonic sexual differentiation. However, the last fifteen years have witnessed AMH emerge from the bench to the bedside, from a scientific curiosity to a useful diagnostic tool with clinical utility and therapeutic applications. In female reproduction, AMH has undergone a virtual renaissance after it was discovered in the human ovarian follicle and later to reflect ovarian reserve. Since that time, much has been learned regarding the role of AMH in female reproductive aging and a number of other gynecological conditions. This is reflected by a number of peer-reviewed publications on AMH in human adult females, which has increased exponentially over the past three decades. It is only in the last decade that AMH has become an important marker of ovarian response, guiding clinical decision making in assisted reproductive technology (ART) as well as a useful aid in the diagnosis of polycystic ovarian syndrome (PCOS). In male reproduction, AMH has become a diagnostic tool in the complex evaluation of infants with intersex conditions, including ambiguous genitalia and cryptorchidism. The chapters of this book bring together experienced investigators with a variety of research interests in different aspects of AMH. Each contributor has conducted clinical, translational and/or basic research in the field of AMH. Each has an appreciation of what is known and an aspiration for solving what remains to be discovered. A better understanding of AMH pathophysiology may lead to the development of pharmacological treatments using AMH agonists and/or antagonists for a host of reproductive challenges. These include: the possible retardation of ovarian aging and menopause; a chemoprotectant for fertility preservation prior to chemotherapy; a tool to better control ovarian response to ART and/or to mitigate the deleterious effects of polycystic ovary syndrome; and a treatment for endometriosis, adenomyosis and/or endometrial and ovarian cancers. This book enables the reader to review the past, understand the present and consider the future of this multifaceted protein in the fields of reproductive medicine and gynecology.

Now in a completely newly revised and expanded second edition, this comprehensive text presents the current state of the art in our understanding and management of polycystic ovary syndrome (PCOS), the most common hormonal disorder of reproductive aged women. The numerous bothersome symptoms of PCOS include menstrual irregularities, hirsutism, acne, scalp hair thinning, weigh excess and infertility; additionally, as they age, women with PCOS are at a higher risk for metabolic abnormalities such as diabetes and dyslipidemias, as well as for cardiovascular disease and even certain cancers. Despite improvements in our understanding of this condition, the exact cause/s of PCOS remain elusive; genetic, hormonal, metabolic and environmental underpinnings are all suggested as relevant. All chapters have been updated, with eight new chapters added across seven thematic sections. Part one discusses the epidemiology of PCOS in both adults and adolescents. Part two covers the pathophysiology of PCOS, including genetics, the hypothalamo-pituitary-ovarian and the hypothalamo-pituitary-adrenal axes, insulin resistance, inflammation, and obesity. The next three sections present the various management strategies, medical and surgical, for harnessing the symptomatology, including PCOS-related infertility; these chapters include added case material to provide real-world examples of the treatments in action and their efficacy. Part six covers the comorbidities that women with PCOS commonly encounter, such as issues of mental health, sleep disturbances, endometrial hyperplasia, and cancer, as well as examines the economic burden of PCOS. The final section discusses emerging concepts surrounding possible mechanisms and potential therapeutic approaches to PCOS, including angiogenic dysfunction, the role of vitamin D, future potential therapies to targeted AMH signaling. The closing chapter, by familiarizing the readers with the intergenerational implications of PCOS and by raising awareness of potential "ripple effects", aims at alerting the community on a need for vigilance as regards the health of PCOS progeny. With contributions from leaders in the field, Polycystic Ovary Syndrome, Second Edition remains the gold-standard text on this common medical condition and a valuable resource for the wide range of healthcare professionals engaged in caring for the women with PCOS (including but not limited to reproductive endocrinologists, gynecologists, family physicians, dermatologists, mental health professionals), for the aspiring women's health providers of tomorrow, and for the researchers who are striving to unravel the mysteries of the complex entity that PCOS is.