production and erectile function in men whose
blood testosterone levels are low. In women, fur-
ther treatment may include surgery to correct or
repair various situations that contribute to or
cause female factor infertility such as abdominal
adhesions, ENDOMETRIOSIS, UTERINE FIBROIDS, certain
uterine malformations, blocked fallopian tubes,
and OVARIAN CYST. Hormone supplementation may
regulate the MENSTRUAL CYCLE to encourage or
stimulate ovulation (“superovulation”) in women.
Some hormones used in this way are off-label (not
approved for infertility treatment though
approved for other uses) in the United States.
Fertility experts select hormone therapies
according to the underlying cause for ovulatory
dysfunction, the woman’s age, and any existing
health conditions. Hormone treatment for infertil-
ity may have serious side effects, risks, and com-
plications, including HOT FLASHES, mood swings,
ovarian cyst formation, increased risk for sponta-
neous ABORTIONearly in pregnancy (miscarriage),
and high risk for pregnancy with multiples (twins
or greater). The long-term risks associated with
fertility drugs, for the women who take them as
well as the children conceived with their assis-
tance, remain uncertain because the drugs have
not been in use long enough to allow comprehen-
sive studies.
MEDICATIONS USED TO STIMULATE OVULATIONbromocriptine
cabergoline
clomiphene citrate
FOLLICLE-STIMULATING HORMONE(FSH)
GONADOTROPIN-RELEASING HORMONE(GNRH) analogs
human chorionic gonadotropin (hCG)
human menopausal gonadotropin (hMG)
letrozole
metformin
ART methods to combine sperm and OVAmay
be appropriate when there are no measures to
correct the cause of infertility or attempted treat-
ments have not succeeded.
Risk Factors and Preventive Measures
The primary risk factor for infertility is age.
Though the time frame of fertility is clearly
defined in women, fertility diminishes to some
degree in men as they grow older. Lifestyle risk
factors include cigarette smoking, alcohol con-
sumption, environmental hazard exposure (such
as pesticides), and obesity. Lifestyle also influences
some health risks for infertility such as DIABETES,
ATHEROSCLEROSIS, and infection with STDs. Risks for
which there are no preventive measures include
GENETIC DISORDERS and chromosomal disorders,
CONGENITAL ANOMALYof the reproductive organs,
POLYCYSTIC OVARY SYNDROME(PCOS), PREMATURE OVAR-
IAN FAILURE(POF), endocrine disorders, and AUTOIM-
MUNE DISORDERS.
See also ADOPTION; AGING, REPRODUCTIVE AND SEX-
UAL CHANGES THAT OCCUR WITH; AMENORRHEA; BIRTH
DEFECTS; FETAL ALCOHOL SYNDROME; GENITAL TRAUMA;
KARYOTYPE; OFF-LABEL USE; PUBERTY; SMOKING AND
HEALTH; SMOKING CESSATION; SURGERY BENEFIT AND RISK
ASSESSMENT; TUBAL LIGATION; VASECTOMY.intraductal papilloma A benign (noncancerous)
tumor that grows within a lactiferous duct (milk
duct) of a woman’s BREAST. Intraductal papilloma
is the most common cause of nipple discharge,
which is its primary symptom. The discharge may
be milky, clear, or blood tinged. A woman may
notice only slight staining on her clothing. There
is usually no PAIN or discomfort associated with
intraductal papilloma.
The tumor causing symptoms may be too small
for the woman or her health-care provider to feel,
though may appear on MAMMOGRAMand usually
shows up on ULTRASOUNDof the breast. Other diag-
nostic procedures may include a contrast X-RAY
called a ductogram and laboratory analysis of the
nipple discharge. Biopsy of the papilloma, usually
in combination with its surgical removal, provides
definitive diagnosis. Intraductal papilloma occa-
sionally recurs.
See also BREAST CANCER; BREAST HEALTH; FIBROCYS-
TIC BREAST DISEASE.intraductal papilloma 295