Table Of Contenti
A
OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Reproductive
Medicine and
Family Planning
ii 1
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iii
Oxford Handbook of
Reproductive
Medicine
and Family
Planning
Enda McVeigh
Senior Fellow in Reproductive Medicine
University of Oxford, UK
Professor Roy Homburg
Head of Division of Reproductive Medicine
Department of Obstetrics and Gynaecology
VU Medical Centre
Amsterdam
The Netherlands
Professor John Guillebaud
Emeritus Professor of Family Planning and
Reproductive Health
University College London, UK
iv 1
Great Clarendon Street, Oxford OX2 6DP
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v
Foreword
Reproductive Medicine in the twenty-first century is an exciting and fast
evolving field which sits as one of the subspecialties of Obstetrics and
Gynaecology, but which has evolved to have an important multi-professional
dimension, which includes embryology and andrology, nursing, endocri-
nology, social science, and basic reproductive sciences, as well as practical
ethics and law.
Thirty years ago, when I entered the field, the topics covered here might
all have been represented in a textbook, but the subject would have
been labelled as Gynaecological Endocrinology, or just Gynaecology.
What has changed is the explosion in understanding and in the treatment
possibilities for which the development of assisted reproductive technolo-
gies and endoscopic surgery have been transformational. The explosion
has not been restricted to the clinical field. The unprecedented access to
the ovary and to early human development has made possible a rapid
expansion of our biological understanding, and when this is combined
with the expanded horizons provided by reproductive and stem cell
technologies developed in animal species, the scientific perspective has
matured rapidly. The scale and diversity of reproductive medicine is now
such that most practitioners would not expect to encompass all of the
topic areas in their routine practice, but it is important that the coher-
ence of Reproductive Medicine is presented in textbook form for the
benefit of trainees and others, from whatever background, who need to
understand the scope and diversity of the field.
The title of this handbook separates out Family Planning for mention as a
separate topic, but in many ways it is an integral component of Reproduc-
tive Medicine. In practical terms the separate labelling is justified on the
basis that there is a significant community who practice within Family
Planning and Reproductive Healthcare, who do not generally practice
more widely in Reproductive Medicine, just as many in Reproductive
Medicine do not practice widely in Family Planning. Both groups can
benefit from a good overview of the whole of the field and the title sends
that signal to both groups.
In this handbook readers will find coverage of the whole spectrum. It is
logical that the developmental genetic factors and the structural devel-
opment of the reproductive tract and its abnormalities is the starting
point for this text, leading into an overview of the basics of the biochem-
istry relevant to reproduction. With this scene set the authors have
surveyed the topic areas in a sequential fashion, following the female life
cycle from menarche and disorders of adolescence, through chapters
covering the ovarian cycle and menstruation. This latter subject is followed
by the associated functional abnormalities, both of menstrual pattern and
intensity, as well as associated problems linked to androgens. Finally, in
vi 1FOREWORD
the coverage of the female life cycle, there is the menopause and its
management. The substantial subsequent coverage is in two important
topic areas, infertility and family planning, each of which is covered under
a range of appropriate chapters.
In my years as Editor-in-Chief of the journal Human Reproduction I sought
to ensure that we encompassed all aspects of the field, and I am pleased
to see that the authors here have taken the same approach. With increasing
specialization and fragmentation of the field, there will be many who see
their horizon as infertility and assisted reproduction, whereas others might
practice mainly in endometriosis and pain, or in the post-reproductive
area on the menopause and HRT. It is important that all have a broad
knowledge of the whole field, since the implications of our findings and
interventions may well be wider than our sub-subspecialty area. This
Oxford Handbook well serves the purpose of providing a good overview
of its subject for student and specialist alike, presented by authors of
international reputation.
Professor David H Barlow
Executive Dean of Medicine and Professor of Reproductive Medicine
Foreword The University of Glasgow
vii
Authors’ disclaimer and
statement of competing
interests
This book represents the personal opinions of the authors, based wherever
possible on published and sometimes unpublished evidence. When (as is
not infrequent) no epidemiological or other direct evidence is available,
clinical advice herein is always as practical and realistic as possible and
based, pending more data, on the authors’ judgement of other sources.
These may include the opinions of Expert Committees and any existing
Guidelines. In some instances the advice appearing in this book may even
so differ appreciably from the latter, for reasons usually given in the text
and (since medical knowledge and practice are continually evolving)
relates to the date of publication. Healthcare professionals must under-
stand that they take ultimate responsibility for their patient and ensure
that any clinical advice they use from this book is applicable to the specific
circumstances that they encounter.
Statement of competing interests
The authors have received payments for research projects, lectures, ad hoc
consultancy work and related expenses from the manufacturers of
pharmaceutical products.
EM
RH
JG
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ix
Contents
Detailed contents xi
Symbols and abbreviations xix
Part 1: Reproductive Medicine
1 Sexual differentiation 3
2 Steroid hormones 21
3 Menarche and adolescent gynaecology 31
4 Ovaries and the menstrual cycle 43
5 Polycystic ovary syndrome 57
6 Hirsutism and virilization 73
7 Amenorrhoea and oligomenorrhoea 89
8 Menopause and hormone replacement therapy 103
9 Initial advice to those concerned about delays
in conception 123
10 Defining infertility 133
11 Investigation of fertility problems 137
12 Management strategies for fertility problems 151
13 Male infertility 161
14 Ovulation induction 173
15 Tubal and uterine disorders 191
16 Medical and surgical management of endometriosis 199
17 Intra-uterine insemination 215
18 In vitro fertilization (IVF) and associated assisted
conception techniques 231
