69: Infertility Work-Up

In Part 1 of our menopause series, we explore two fundamental questions: Why does menopause exist, and what physiologic changes drive the menopausal transition? Topics include: Definitions of perimenopause, menopause, and postmenopause Why humans are unusual among mammals in having a long post-reproductive lifespan The Mother and Grandmother hypotheses Chimpanzee and whale comparisons Oocyte development and follicular depletion AMH, inhibin B, FSH, and ovarian aging The hypothalamic-pituitary-ovarian axis Why menstrual cycles become irregular during perimenopause The physiologic foundation for menopausal symptoms This episode lays the groundwork for future discussions of vasomotor symptoms, mood changes, hormone therapy, and modern menopause management.   References Williams GC. Pleiotropy, natural selection, and the evolution of senescence. Evolution. 1957;11(4):398-411. doi:10.1111/j.1558-5646.1957.tb02911.x https://doi.org/10.1111/j.1558-5646.1957.tb02911.x Hamilton WD. The moulding of senescence by natural selection. Journal of Theoretical Biology. 1966;12(1):12-45. doi:10.1016/0022-5193(66)90184-6 https://doi.org/10.1016/0022-5193(66)90184-6 Hill K, Hurtado AM. Ache Life History: The Ecology and Demography of a Foraging People. New York, NY: Aldine de Gruyter; 1996. Hawkes K, O'Connell JF, Blurton Jones NG, Alvarez H, Charnov EL. Grandmothering, menopause, and the evolution of human life histories. Proc Natl Acad Sci U S A. 1998;95(3):1336-1339. doi:10.1073/pnas.95.3.1336 https://doi.org/10.1073/pnas.95.3.1336 Thompson ME, Jones JH, Pusey AE, et al. Aging and fertility patterns in wild chimpanzees provide insights into the evolution of menopause. Curr Biol. 2007;17(24):2150-2156. doi:10.1016/j.cub.2007.11.033 https://doi.org/10.1016/j.cub.2007.11.033 Jones KP, Walker LC, Anderson D, Lacreuse A, Robson SL, Hawkes K. Depletion of ovarian follicles with age in chimpanzees: similarities to humans. Biol Reprod. 2007;77(2):247-251. doi:10.1095/biolreprod.106.058156 https://doi.org/10.1095/biolreprod.106.058156 Faddy MJ, Gosden RG, Gougeon A, Richardson SJ, Nelson JF. Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Hum Reprod. 1992;7(10):1342-1346. doi:10.1093/oxfordjournals.humrep.a137570 https://doi.org/10.1093/oxfordjournals.humrep.a137570 Faddy MJ, Gosden RG. A model conforming the decline in follicle numbers to the age of menopause in women. Hum Reprod. 1996;11(7):1484-1486. doi:10.1093/oxfordjournals.humrep.a019425 https://doi.org/10.1093/oxfordjournals.humrep.a019425 Broekmans FJ, Knauff EA, te Velde ER, Macklon NS, Fauser BC. Female reproductive ageing: current knowledge and future trends. Trends Endocrinol Metab. 2007;18(2):58-65. doi:10.1016/j.tem.2007.01.004 https://doi.org/10.1016/j.tem.2007.01.004 Burger HG, Dudley EC, Robertson DM, Dennerstein L. Hormonal changes in the menopause transition. Recent Prog Horm Res. 2002;57:257-275. doi:10.1210/rp.57.1.257 https://doi.org/10.1210/rp.57.1.257

In this episode we dive into the world of insulins and the management of preexisting diabetes in pregnancy.   [email protected] Uteroplacental blood flow in diabetic pregnancy: Measurements with iridium 113m and a computer-linked gamma camera. L. Nylund et al. AJOG. 1982 Pre-existing diabetes, maternal glycated haemoglobin, and the risks of fetal and infant death: a population-based study . P. Tennant et al. Diabetologia. 2014 Large for Gestational Age Neonates: Antrhopometric Reasons for Shoulder Dystocia. H. Mondanlou et al. Obset & Gynecology 1982 Shoulder Dystocia: Incidence and Risk Factors. Clinical Obstetrics & Gynecology. 2016 History of Insulin. C. Quianzon et al. Journal of Community Hospital Internal Medicine Perspectives 2012  Insulin Analogues. I. Hirsch. NEJM. 2005 Insulin requirements during labor: a reappraisal. AJOG. 1982 Insulin and glucose requirements during the first stage of labor in insulin-dependent diabetic women. AJM. 1983 The use of continuous insulin infusion for the peripartum management of pregnant diabetic women. AJOG. 1978 Peripartum metabolic control in gestational diabetes. AJOG 2010 Constant intravenous insulin infusion during labor and delivery in diabetes mellitus. Diabetes Care. 1982 Labor Insulin Drip Protocol

Drs. Jillian Kurtz & Vai Umesh join me to discuss fertility equality.   Drs. Jillian Kurtz & Vai Umesh join me to discuss fertility equality. [email protected] Discord Server The Fight for Fertility Equality - NYT How Much does IVF Really Cost? CNY Fertility West Coast Surrogacy

Join us as we discuss "Intra-abdominal Irrigation at Cesarean Delivery" from a the Green Journal in 2012.   Guests: Dr. Jerry Ballas & Dr. Heather Link [email protected]

Dr. Jillian Kurtz walks us through an evidence-based approach to infertility.

Join myself and Dr. Jerry Ballas to discuss what life has been like for us as Ob/Gyn's in the last 6 months. We delve into what COVID has done to our units and give some tips on how to protect ourselves.   OB Leadership - CoVID Response

Dr. Heather Link joins me to discuss maternal mortality in Lousiana. Racial Inequities in Preventable Pregnancy-Related Deaths in Louisiana, 2011–2016 louisiana maternal mortality review report 2011-2016  

Drs. Jillian Kurtz and Caiyun Liao join me to discuss "Association Between Fertility Treatment and Cancer RIsk in Children" published 12/19 in JAMA  

Dr. Ballas joins me to discuss the PROLONG trial and discuss the role of progesterone in the prevention of preterm birth.   PROLONG Trial

Join us to discuss the changes in postpartum care and how we can help better support women.   ACOG Bulletin