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INTRODUCTION

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ACTH Adrenocorticotropic hormone
AFC Antral follicle count
AIRE Autoimmune regulator gene
AIS Androgen insensitivity syndrome
AMH Anti-Müllerian hormone
APS Autoimmune polyglandular syndrome
ArKO Aromatase knockout
ART Assisted reproductive therapy
BBT Basal body temperature
BMD Bone mineral density
BMP Bone morphogenic protein
cAMP Cyclic adenosine monophosphate
CEE Conjugated equine estrogen
CRH Corticotropin-releasing hormone
DHEAS Dehydroepiandrosterone sulfate
DHT Dihydrotestosterone
DXA Dual-energy x-ray absorptiometry
ERA Estrogen Replacement and Atherosclerosis Trial
FGFR1 Fibroblast growth factor receptor 1
FMR1 Fragile X gene
FSH Follicle-stimulating hormone
FXTAS Fragile-X tremor ataxia syndrome
GH Growth hormone
GnRH Gonadotropin-releasing hormone
hCG Human chorionic gonadotropin
HDL High-density lipoprotein
HERS Heart and Estrogen-Progestin Replacement Study
HPO Hypothalamic pituitary ovarian
HSD Hydroxysteroid dehydrogenase
HRT Hormone replacement therapy
HT Hormone therapy
IGF-BP Insulin-like growth factor binding protein
IUI Intrauterine insemination
LDL Low-density lipoprotein
LH Luteinizing hormone
MBH Medial basal hypothalamus
MCR Metabolic clearance rate
MMP Matrix metalloproteinase
MPA Medroxyprogesterone acetate
MT Menopausal transition
OMI Oocyte maturation inhibitor
PCOS Polycystic ovarian syndrome
POF Premature ovarian failure
PR Production rate
PRL Prolactin
SERM Selective estrogen receptor modulator
SF-1 Steroidogenic factor-1
SHBG Sex hormone–binding globulin
SNRI Serotonin-norepinephrine reuptake inhibitor
SR Secretion rate
SRY Sex-determining region of the Y gene
SSRI Selective serotonin reuptake inhibitor
StAR Steroidogenic acute regulatory protein
STRAW Stages of Reproductive Aging Workshop
SWAN Study of Women’s Health Across the Nation
Tg Thyroglobulin
TGF Transforming growth factor
TPO Thyroid peroxidase
TRH Thyrotropin-releasing hormone
TSH Thyroid-stimulating hormone
VEGF Vascular endothelial growth factor
WHI Women’s Health Initiative

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EMBRYOLOGY AND ANATOMY

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No gene has yet been identified that generates an ovary from an undifferentiated gonad. It is only in the absence of the sex-determining region of the Y gene (SRY) that the gonad develops into an ovary. (For more details, see the discussion of sexual differentiation in Chapter 14.) Primordial germ cells, which give rise to oocytes or spermatogonia, are first identifiable in the yolk sac endoderm (hindgut) at 3 to 4 weeks of gestation. Once specified, they migrate and proliferate en route through the dorsal mesentery into the gonadal ridge, which is located lateral to the dorsal mesentery of the gut and medial to the mesonephros (Figure 13–1). Studies in mice have suggested that the process of proliferation and navigation to the gonad depends on several genes, including Steel (kit ligand and receptor), β1 integrin, pog (proliferation of germ cells), and many cytokines. Failure of primordial germ cells to develop or migrate into the gonadal ridge results in failure of ovarian development. In contrast, it is suggested that male gonadal development may continue to develop into functional testis despite the absence of germ cells.

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FIGURE 13–1

A. Schematic drawing of a 3-week-old embryo showing the primordial germ cells in the wall of the yolk sac, close to the attachment of the allantois. B. Drawing to show the migrational path of the ...

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