Preface

Reproductive Medicine is the study of human fertility and reproduction. Clinically, Reproductive Medicine deals with the anatomy, physiology, diagnosis, and treatment of a variety of reproductive disorders, including infertility. The advent of Assisted Reproductive Technology (or A-R-T) has led to a rapid expansion in the field of Reproductive Medicine.

Reproductive Medicine is often considered one of the more challenging topics for medical students and clinicians. Reproductive Medicine requires an understanding of the anatomy, physiology, and pathophysiology of both the male and female reproductive tract. The purpose of this lecture will be to review the basic concepts of human reproduction and discuss the etiology, diagnosis, and treatment of common reproductive disorders. This course will provide listeners with a foundation to approach simple and complex clinical scenarios in Reproductive Medicine.

In chapter one, we will review the basic anatomy of the male and female reproductive systems. We will begin by discussing the anatomy of the female reproductive tract, which includes the ovaries, fallopian tubes, uterus, cervix, and vagina. Next, we will review the anatomy of the major organs of the male reproductive tract, including the testis, efferent duct, epididymis, urethra and penis. While not all disorders of fertility are related to abnormalities of the anatomical structures of the reproductive tract, any abnormality that exists will automatically impair fertility.

In humans, reproduction is dependent upon hormone signaling. The purpose of chapter two will be to discuss reproductive hormones. Reproductive hormones are part of the Hypothalamic-Pituitary-Gonadal Axis. The hypothalamus regulates hormone secretion from the pituitary gland. The hypothalamus synthesizes and secretes GonadotropinReleasing Hormone (or GNRH). GNRH is released from the hypothalamus in a pulsatile fashion. GNRH stimulates secretion of follicle stimulating hormone (or FSH) and luteinizing hormone (or LH) from the pituitary. Both FSH and LH play a role in steroid

hormone synthesis and secretion. The reproductive steroid hormones include Testosterone, Dihydrotestosterone (or DHT), Estrogens, and Progesterone.

Reproductive tract development will be covered in chapter three. Gonadal development begins around the seventh week of gestation. There are two basic embryologic structures that develop into the reproductive tract – the mesonephric ducts (also called the Wolffian ducts) and the paramesonephric ducts (also called Mullerian ducts). The male reproductive tract develops from the mesonephric or Wolffian ducts, and the female reproductive tract develops from the paramesonephric or Mullerian ducts.

In chapter four, we will discuss female reproductive physiology. This chapter will cover the physiology of female puberty, ovulation, menstruation, and menopause. Female reproductive physiology is complex and involves multiple changes that occur in puberty as part of female reproductive development, the different changes that happen as part of the normal menstrual cycle, and the changes a woman goes through as she reaches menopause. The different ways in which menopause is diagnosed are covered in this chapter.

Chapter five will include a discussion of female reproductive diseases, including endometrial and myometrial disorders, fertility-related issues, and causes of amenorrhea (or lack of menstruation) and dysmenorrhea. Each of these disorders will affect the menstrual cycle, menstruation, and fertility in different ways, which will be covered in the chapter.

In chapter six, we will switch gears to male reproductive physiology and pathophysiology. Chapter six will provide a general overview of male reproductive physiology and cover topics such as puberty and spermatogenesis. Because male reproductive physiology is generally less complex than female reproductive physiology, chapter six will also cover disorders of male reproduction, including congenital disorders and hypogonadism.

The purpose of chapter seven will be to review the principles of fertility and conception. We will also discuss the etiology and diagnosis of male and female infertility in this chapter. The normal fertilization of human oocytes to make a zygote is covered in this chapter along with how to work up infertility in the couple who cannot conceive. The

different types of fertility issues seen in both men and women are also discussed in this chapter.

Chapter eight in the course is devoted to issues related to the natural enhancement of fertility. While these are not often used in mainstream medicine for fertility enhancement, many infertile couples and naturopathic doctors promote things like natural ways to detect ovulation, issues related to optimizing nutrition for better fertility, herbal remedies for fertility enhancement, and even massage techniques designed to promote fertility. These are all covered as part of the discussion in this chapter.

Assisted reproductive technologies will be covered in chapter nine, including intrauterine insemination, in vitro fertilization, and intracytoplasmic injection of sperm. These techniques are advanced therapies for a variety of infertility issues and have been found to be effective in attaining a pregnancy when it would otherwise be essentially impossible under natural circumstances.

We will conclude this lesson by covering contraception (or birth control) in chapter ten of the course. Understanding available forms of contraception are critical to providing comprehensive reproductive care. Most are based on manipulating the hormonal milieu in women desiring to avoid pregnancy, although there are barrier methods and intrauterine methods, such as an IUD, that will effectively prevent pregnancy.