By Enda McVeigh, John Guillebaud, Roy Homburg
The Oxford instruction manual of Reproductive drugs and relations making plans, moment variation offers crucial sensible details within the care of the adolescent and reproductive age adult females and men. Evidence-based and concise, this guide is the must-have source for all practitioners, trainees, and scholars in sexual and reproductive healthcare. totally up-to-date for the second one version, this instruction manual now contains extra useful suggestions, algorithms and diagrams, a brand new bankruptcy on recurrent miscarriage, in addition to improved informaiton on issues resembling PCOs and hirsuitism. It follows chronological. Read more...
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Extra info for Oxford handbook of reproductive medicine and family planning
Testosterone is secreted to the plasma and also carried to Sertoli cells by androgen-binding protein (ABP). In Sertoli cells, the ∆-4 double bond of testosterone is reduced, producing dihydrotestosterone (DHT). Testosterone and DHT are carried in the plasma, and delivered to target tissue, by a speciﬁc gonadal steroid-binding globulin (GBG). In a number of target tissues, testosterone can be converted to DHT. DHT is the most potent of the male steroid hormones, with an activity that is 10 times that of testosterone.
Anterior pituitary: • FSH • LH. • Ovaries: • 17-β oestradiol • progesterone. In addition, ﬁne tuning is provided by inhibin, activin, follistatin, and various growth factors. Ovulation is achieved through the synchronization of the timing of release and quantity of the various hormones involved, which change throughout the cycle as a result of feedback mechanisms. Fig. 1 is a very simple representation of the origin, target organ, and feedback mechanisms involving the hypothalamic–pituitary–ovarian axis, and Fig.
If no bleed: • FSH—raised in premature ovarian failure, very low in hypogonadotrophic hypogonadism, normal or low normal in PCOS. • Prolactin (may be only slightly raised in PCOS). To exclude other causes of hyperandrogenism if suspected • If severe or rapid onset of symptoms/signs of virilization: • Total testosterone, free androgen index (normal to moderately raised in PCOS but very high with tumours), DHEAS (very high with adrenal tumours). Ultrasound/MRI examination of ovaries and adrenals where indicated.