RESUMEN
BACKGROUND: Approximately 20% of reproductive age couples have difficulty conceiving or maintaining an established pregnancy. The family physician is in a unique position to provide patient education, begin initial evaluation, make appropriate referrals, and offer ongoing counseling and support to couples who experience problems with fertility. METHODS: And extensive clinical review was conducted based on a MEDLINE search, the Cochrane database of systematic reviews, and other supporting evidence. RESULTS: Major physiologic influences affecting live birth rates include age, coital frequency, and duration of infertility. Male factor is associated with approximately 40% of these cases and should be addressed early in the evaluation. CONCLUSION: Many conditions once considered untreatable can now be routinely corrected. As managed care programs expand coverage to include infertility services, primary care providers will be asked to participate in the initial phase of this care. This article offers a practical approach.
Asunto(s)
Medicina Familiar y Comunitaria/métodos , Infertilidad/terapia , Atención Primaria de Salud/métodos , Aborto Habitual , Adulto , Consejo , Personas con Discapacidad/legislación & jurisprudencia , Femenino , Humanos , Infertilidad/etiología , Infertilidad/fisiopatología , Seguro de Salud , Masculino , Anamnesis , Examen FísicoRESUMEN
Three cases of nonphysiologic hyperprolactinemia associated with pituitary disease evidenced by galactorrhea are presented. Two patients had significant pituitary disease associated with low-level prolactin elevations. The third patient had only a history of infertility and expressible galactorrhea on examination. This patient was found to have high prolactin levels and a locally invasive pituitary tumor. Physicians need to be aware of the serious conditions associated with galactorrhea so that appropriate diagnostic studies can be done and treatment instituted.
Asunto(s)
Adenoma/complicaciones , Adenoma/diagnóstico , Galactorrea/etiología , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico , Prolactinoma/complicaciones , Adenoma/sangre , Adenoma Cromófobo/complicaciones , Adenoma Cromófobo/diagnóstico , Adulto , Femenino , Galactorrea/sangre , Humanos , Hiperprolactinemia/etiología , Neoplasias Hipofisarias/sangre , Prolactinoma/diagnósticoRESUMEN
Hypersensitivity reactions are a documented complication of urinary-derived gonadotropin therapy. In this report, a patient allergic to these older products is successfully treated with recombinant follicle-stimulating hormone.
Asunto(s)
Hipersensibilidad a las Drogas/etiología , Hormona Folículo Estimulante/administración & dosificación , Hormona Folículo Estimulante/efectos adversos , Gonadotropinas/efectos adversos , Infertilidad Femenina/tratamiento farmacológico , Adulto , Femenino , Humanos , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversosRESUMEN
Major congenital anomalies occur in approximately 4% of the newborn population. Although this risk is apparently the same for in vitro fertilization (IVF) pregnancies, couples having assisted reproduction therapy should receive appropriate genetic counseling, because coincidental maloccurrences are often erroneously linked to the technology. We report a case of newborn esophageal atresia with tracheoesophageal fistula occurring in an IVF pregnancy. Physicians are encouraged to educate all prospective parents regarding the rate of congenital anomalies in the general population so that they have realistic expectations concerning newborn outcome.