By Lars Björndahl, Aleksander Giwercman, Herman Tournaye, Wolfang Weidner
A huge new overseas reference paintings on andrology from the EAU element of Andrological Urology – overlaying such concerns as male infertility, erectile disorder, late-onset hypogonadism, and reproductive cancers – that engages with modern difficulty for facts established perform, minimizing interventions, and selling male reproductive wellbeing and fitness.
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Extra info for Clinical Andrology: EAU ESAU Course Guidelines
There is also a very small risk of ovarian hyperstimulation syndrome (OHSS) (41). Metformin, an oral biguanide, is an insulin-sensitizing agent and has been used to increase ovulation rates. However, recent studies have shown it not to be as effective as clomiphene and it is now only recommended for those with glucose intolerance (42). A potential alternative may be aromatase inhibitors such as letrozole. They inhibit estrogen synthesis, thereby causing an increase in GnRH pulsatility and consequently increased FSH secretion.
If fusion fails this can then give rise to various degrees of congenital abnormalities. These can range from a small partial septum in the uterus to a didelphic uterus where there are two completely separate horns and cervices present. In Rokitansky–K¨uster–Hauser (RKH) syndrome there is complete absence of the uterus, vagina, and cervix. This differs from testicular feminization because in RKH syndrome the karyotype is XX and that of testicular feminization is XY. Therefore patients with RKH have normal ovaries and those with testicular feminization have intra-abdominal testes, which require removal because of the high risk of testicular cancer.
However, the risks of multiple pregnancy and ovarian stimulation need to be taken into account. The usage of clomiphene for ovulation induction has been used in women with unexplained infertility because by producing more eggs, it is thought, the likelihood of pregnancy is greater. Similarly, unstimulated IUI has also been advocated (NICE guidance). A recent study indicated that there is little evidence of benefit over the background pregnancy rate (54). The decision on management for the couple with unexplained infertility is dependent on the woman’s age, duration of infertility, and the patient’s wishes.
Clinical Andrology: EAU ESAU Course Guidelines by Lars Björndahl, Aleksander Giwercman, Herman Tournaye, Wolfang Weidner