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In vitro fertilization
Key points For in vitro fertilization (IVF) with and without intracytoplasmic sperm injection, the delivery rate per cycle in which ova are retrieved is as high as 50%, depending on the age of the woman. The rate of pregnancy after…
Infertility: Etiology, Diagnostic Evaluation, Management, Prognosis
Key points Infertility is considered to be a disease and affects approximately 7% of all U.S. couples of reproductive age—more than 7 million women in the United States. A systematic evaluation of factors involved in infertility should be carried out…
Polycystic ovary syndrome
Key points Polycystic ovary syndrome (PCOS) is now diagnosed by the Rotterdam criteria, which are clinical end points, and is not a laboratory diagnosis . The diagnosis requires finding any two of the following: menstrual irregularity, hyperandrogenism (clinical or biochemical),…
Androgen excess in women
Key points The major androgen produced by the ovaries is testosterone and that of the adrenal glands is dehydroepiandrosterone sulfate; many potent 11-oxo androgens produced by the adrenal glands determine androgen action but are not currently measured. Androgen action is…
Hyperprolactinemia: Evaluation and management
Key points The main symptoms of hyperprolactinemia are galactorrhea and amenorrhea, the latter caused by alterations in normal gonadotropin-releasing hormone release. Pathologic causes of hyperprolactinemia include pharmacologic agents, hypothyroidism, chronic renal disease, chronic neurostimulation of the breast, hypothalamic disease, and…
Primary and secondary amenorrhea and precocious puberty
Key points Primary amenorrhea is diagnosed if no menstrual function has occurred by age 15, or 5 years after initial breast development. Menarche is delayed approximately 0.4 year for each year of premenarchal athletic training. Gonadal failure is the most…
Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder : Etiology, Diagnosis, Management
Key points Approximately 75% of all women complain of primary dysmenorrhea. Approximately 15% have severe symptoms. Education, supportive therapy, and nonsteroidal antiinflammatory drugs are the treatments of choice for primary dysmenorrhea. Combined oral contraceptives (COCs) reduce the prevalence and severity…
Gestational trophoblastic disease: Hydatidiform Mole, Nonmetastatic and Metastatic Gestational Trophoblastic Tumor: Diagnosis and Management
Key points Persistent abnormal bleeding after normal pregnancy, abortion, or ectopic pregnancy should lead to a consideration of the diagnosis of gestational trophoblastic disease (GTD). Pulmonary nodules present on chest radiographs after a normal pregnancy suggest GTD. Beta human chorionic…
Malignant diseases of the ovary, fallopian tube, and peritoneum
Key points Ovarian cancer is the leading cause of death from gynecologic cancer, but it occurs less often than endometrial cancers. Ovarian cancers in women older than 50 years are diagnosed at a more advanced stage, leading to a worse…