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Anatomy of the lower urinary tract, pelvic floor, and rectum

Pelvic anatomy Bones of the pelvis The bones of the pelvis are the rigid foundation to which all the pelvic structures are ultimately anchored. In the standing position, forces are dispersed to minimize pressures on the pelvic viscera and musculature and to transmit forces to bones that are better suited to the long-term, cumulative stress of daily life. In the upright position, the pubic rami are…

Way forward

Fertility awareness In our society, fertility awareness (FA) is deficient, since cultural and religious factors increase the prevalence of misconceptions and myths. Core factors encompass low education, persistent health-related issues, scarcity of resources for well-being, nonexistence of a developed public health system, and inadequate coverage by insurance policies. Contributing factors include poor access to fertility options, scarce knowledge about risk factors for infertility, and health warnings…

Assisted reproductive techniques

Introduction “Assisted reproduction” is the support provided to address infertility issues. It refers to all methods that assist infertile couples to achieve pregnancy and give birth to their own babies. Infertility rate in Pakistan is documented to be 21.9%, and the success rate is only 25% even after introduction of procedures like intracytoplasmic sperm injection (ICSI). “Assisted reproductive techniques (ARTs)” are procedures that represent an amalgamation…

Oxidative stress and oocyte microenvironment

Females inherit a reservoir of around 300,000 primordial follicles, with primary oocytes arrested at the first meiotic division. They attain maturation into the functional phase toward diversity periodically every month by regulators that govern them to survive or lead them toward apoptosis. As a consequence, few attain completion and reach ovulation to be fertilized by male gametes. In order to complete the development, a number of…

Pituitary disorders and subfertility

Introduction The pituitary gland, also called the master gland of the human endocrine system, is situated at the base of the skull within the sella turcica, a part of the sphenoid bone. Anatomically it is divided into two parts: (i) the anterior part, also called adenohypophysis, and (ii) the posterior part, also called neurohypophysis. The adenohypophysis part works closely with the hypothalamus to control the function…

Thyroid imbalance and subfertility

Introduction An optimal level of thyroid hormones is needed for reproductive health. This has been proved clearly in women who have a higher chance of having “autoimmune thyroid diseases (Hashimoto’s thyroiditis and Graves’ disease)” compared to men. Both overt and subclinical thyroid disease and thyroid autoimmunity (TAI) have been shown to be associated with infertility. Thyroid dysfunction can adversely affect follicular development, spermatogenesis, fertilization rates, embryo…

Endometriosis and subfertility

Introduction The lining of a woman’s uterus is made up of endometrial tissue that sheds in each menstrual cycle. In endometriosis, similar tissue develops on abnormal anatomical locations such as in the pelvis or abdominal cavity. This mislaid tissue shows a similar response to the hormonal changes of each cycle and sheds blood causing inflammation, swelling, and scarring. The discomfitures of endometriosis include dysmenorrhea, dyspareunia, chronic…

Polycystic ovary syndrome and subfertility

Introduction Polycystic ovary syndrome (PCOS) is a well-appreciated heterogeneous disorder of the endocrine system. It is usually detected in women of reproductive age group who present with a cluster of clinical features ranging from androgen excess (hirsutism, alopecia, and/or acne) and ovarian dysfunction (oligo-ovulation and/or polycystic ovarian morphology (PCOM) on ultrasound). More recently, obesity with its associated metabolic disorders has been recognized as one of the…

Impact of subfertility

Impact of subfertility Irrespective of the society, culture, class, division, and educational status of an individual, subfertility effects both the male and the female. Both have an equal sense of the debarment; nevertheless, it has been observed that for various reasons in different cultures, females are stigmatized for being responsible for this condition. Influence of infertility has resulted in the aggravation of medial, social, psychological, and…

Introduction to subfertility

Having babies is a right and wish of all the couples after marriage, but an intact hormonal system, psychological stability, and emotional composure are the merits for achieving due to maturation of the sperm and ovum leading to the fertilization followed by the birth of a healthy being. Fertility refers to the ability to conceive and bear offsprings, while fecundity expresses the prospect of women to…

Ovarian reserve

Introduction Our concept of human ovarian reserve presumes that the ovary develops several million nongrowing follicles (NGFs) at around 5 months of gestational age. Over the life span of a female, it undergoes a monthly cycle of oocyte maturation as well as integrated endocrine function, which results in a gradual decline of these NGFs. This process continues up to the age of menopause, around 50–51 years, when…

Reproductive cycle

Introduction Every healthy human female experiences reproductive cycles that organize their reproductive system for pregnancy. The reproductive cycles are under the dynamic influence of integrated action of hormones from hypothalamus, anterior pituitary, and gonadal ovarian steroids. Ovarian cycle is directly regulated and synchronized by the anterior pituitary follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Uterine cycle is controlled by a direct reaction to ovarian steroid hormones…

Reproductive endocrine physiology

Physiology of the male reproductive system Introduction The male reproductive physiology involves external structures (scrotum and penis) and internal structures (testis, epididymis, vas deferens, and prostate). These are well vascularized and supported by several other glands. The primary male androgen hormone is testosterone produced by Leydig cells in the testis, but other hormones like inhibin and Mullerian-inhibiting substance produced by Sertoli cells also contribute to the…

Anatomy and embryology of male and female reproductive systems

Embryology of the male and female reproductive systems Embryonic sexual differentiation is a very delicate process ( Fig. 1.1 ) that starts with the genotypic determination at the time of fertilization (i.e., XY or XX) and then concludes in a manner that depends on how the gametes influence the phenotype (i.e., culminating in final pubertal and brain development events). It is worth noting that most information—especially…

Pattern of Malformation Differential Diagnosis by Anomalies

The following lists were developed from the syndromes delineated in Chapter 1 . Listed for each anomaly are the syndromes in which this defect is a frequent feature, as well as those syndromes in which it is an occasional feature. Characteristics, such as mental or growth deficiency, are not considered because they are frequent features in a large number of disorders. The anomalies are set forth…

Normal Standards

The following compilation of normal measurements is set forth as an aid in determining whether or not a given feature is abnormal. Such data may be especially useful when the visual impression is potentially misleading. For example, when the nasal bridge is low, the visual impression may falsely suggest ocular hypertelorism; when the patient is obese, the hands may appear to be small. Besides comparing patient…

Minor Anomalies: Clues to More Serious Problems and to the Recognition of Malformation Syndromes

Minor anomalies are herein defined as unusual morphologic features that are of no serious medical or cosmetic consequence to the patient. The value of their recognition is that they may serve as indicators of altered morphogenesis in a general sense or may constitute valuable clues in the diagnosis of a specific pattern of malformation. Those who want a more detailed discussion of this subject or those…

Genetics, Genetic Counseling, and Prevention

The basic process of morphogenesis is genetically controlled. However, the ability of an individual to reach his or her genetic potential with respect to structure, growth, or cognitive development is affected by environmental factors in both prenatal and postnatal life. Review of the etiologies of those structural abnormalities and syndromes for which an etiology is known indicates that the majority of malformations and syndromes appear to…

Miscellaneous Associations

VACTERL Association An association is a term used to designate the nonrandom tendency of some malformations to occur together more commonly than would be expected by chance, without being components of a syndrome. VACTERL is an acronym that stands for v ertebral, a nal, c ardiac, t racheal, e sophageal, r enal, and l imb. VACTERL association defects include vertebral defects, anal atresia, cardiac defects, tracheoesophageal…

Spectra of Defects

Oculo-Auriculo-Vertebral Spectrum (First and Second Branchial Arch Syndrome, Facio-Auriculo-Vertebral Spectrum, Hemifacial Microsomia, Goldenhar Syndrome) The predominant defects in this spectrum represent problems in morphogenesis of the first and second branchial arches, sometimes accompanied by vertebral anomalies, renal defects, or ocular anomalies. The occurrence of epibulbar dermoid with this pattern of anomaly, especially when accompanied by vertebral anomalies, was designated as the Goldenhar syndrome, and the predominantly…