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DISORDERS OF CENTRAL HYPOTHALAMIC PITUITARY - Pelvic infections can produce adhesions and
FUNCTION scarring of the endometrium or fallopian tubes
- Any change in the precise rate or amplitude of that may result in infertility.
GnRH secretion by the hypothalamus can result
in altered pituitary responsiveness (eg, down - The initial presentation typically includes
regulation of GnRH receptors or altered abdominal and pelvic (cervical and adnexal)
gonadotropin secretion). pain and with fever, an elevated white blood
cell count, or a positive endocervical culture.
- This altered pituitary function, in turn, results in Common infectious agents include gonorrhea,
disordered ovarian function (eg, inadequate anaerobic bacteria, and Chlamydia.
steroidogenesis with or without an ovulation)
and altered target tissue response (eg, - Multiple organisms are usually involved,
endometrial atrophy and menstrual
abnormalities). - Pelvic infections can develop into tubo-ovarian
abscesses requiring surgical drainage.
- Many central (eg. psychic stress) and peripheral
(eg. body fat content) inputs affecting pulsatile DISORDERS OF PREGNANCY
GnRH release are integrated in the
hypothalamus. - The normal events of pregnancy potentially set
the stage for a wide array of localized and
- Thus, altered GnRH release from the systemic disorders.
hypothalamus is a common cause of - Abnormalities in the process of implantation,
amenorrhea (eg. in athletic young women). for example, appear to predispose to recurrent
miscarriage and preeclampsia-eclampsia.
DISORDERS OF THE OVARY - In addition, genetic predisposition to diseases
- Proper ovarian function involves responsiveness that might otherwise remain latent for decades
to gonadotropins, intrinsic viability of follicles, may be manifested first—often transiently—
and a host of paracrine interactions within and during pregnancy.
between individual follicles. - A good example of the latter is the genetic
- Polycystic ovary syndrome (PCOS) is an example predisposition to development of diabetes
of ovarian dysfunction resulting from a self- mellitus
perpetuating cycle of altered feedback
relationships (see later discussion).
Disorders of the MaleReproductive Tract - However, aging and hormonal factors are both
clearly important. Age-related increases in
prostate size are evident at autopsy, and the
MALE INFERTILITY development of symptoms is age-related.
- Data from autopsy studies show pathologic
evidence of benign prostatic hyperplasia in less
than 10% of men in their 30s, in 40% of men in
their 50s, in more than 70% of men in their
60s,and in almost 90% of men in their 80s.
- Clinical symptoms of bladder outlet obstruction
are seldom found in men younger than 40 years
but are found in about one-third of men older
than 65 years and in up to three-fourths of men
at age 80 years.Prostatic androgen levels,
particularly DHT levels, play an important role in
development of the disorder.
Pathology
Etiology