Chapter 10: Pregnancy and Infertility

Pregnancy and Infertility details the hormonal shifts essential for maintaining pregnancy, highlighting the role of human chorionic gonadotrophin (hCG) in sustaining the corpus luteum and the subsequent placental transition for progesterone and oestrogen production. The text examines diagnostic screenings for fetal anomalies, such as alpha-fetoprotein (AFP) for neural tube defects and the quadruple test for Down’s syndrome, alongside invasive procedures like amniocentesis for assessing lung maturity through lecithin/sphingomyelin ratios or chromosomal status via karyotyping. Significant focus is placed on maternal physiological adaptations, including increased glomerular filtration rates leading to altered plasma levels of urea and creatinine, haemodilution affecting albumin and calcium concentrations, and the emergence of placental alkaline phosphatase. Furthermore, it addresses pregnancy-specific pathologies such as pre-eclampsia—characterized by hypertension and proteinuria—and the monitoring of trophoblastic neoplasia using serial hCG measurements. The discussion extends to the systematic investigation of both female and male infertility, categorizing hormonal imbalances like hyperprolactinaemia and gonadotrophic disorders while outlining therapeutic interventions such as clomiphene citrate for ovulation induction and assisted reproductive technologies like in vitro fertilization (IVF).