GEORGE OSOL, PhD, is Professor Emeritus in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Vermont Larner College of Medicine, Burlington, VT, USA; a University Scholar and an Established Investigator of the American Heart Association, specializing in vascular physiology and preeclampsia.

Acknowledgement ix

Key Concepts and Terms xi

Introduction 1

1 The Adult Male 3

1.1 Three Basic Requirements for Fertility in the Male 3

1.2 Endocrinology of the Male Reproductive System 4

1.3 Physiological Actions of Testosterone and Related Androgens 8

1.4 Spermatogenesis and Spermiogenesis 11

1.5 Production of Seminal Plasma 15

1.6 Testicular Thermoregulation; Varicocoele 16

1.7 Penile Erection 18

1.8 Cellular Mechanism of PDE-5 Inhibitors in Treating Erectile Dysfunction 20

1.9 Emission and Ejaculation 21

1.10 Infertility 22

2 The Nonpregnant Adult Female 25

2.1 The Menstrual Cycle: A Perspective 25

2.2 Oogenesis 26 2.3 Folliculogenesis 28

2.4 Follicular Production of Sex Steroid Hormones 31

2.5 Recruitment of the Dominant Follicle 32

2.6 Transition from the Follicular to the Ovulatory Phase: The LH Surge 33

2.7 The Luteal Phase 35

2.8 Corresponding Uterine Phases: Menstrual, Proliferative, Secretory 36

2.9 Estrogen 39

2.10 Progesterone 40

2.11 Putting It Together 41

3 Pregnancy, Parturition, Lactation 45

3.1 Fertilization and Early Embryogenesis 45

3.2 Implantation 51

3.3 Multiple Births 53

3.4 Placentation 54

3.5 The Endocrinology of Pregnancy 59

3.6 Prenatal Testing for Fetal Aneuplody and Other Maternal and Fetal Conditions 61

3.7 Maternal Adaptations During Pregnancy 63

3.8 Embryonic and Fetal Growth 65

3.9 Labor and Parturition 65

3.10 Lactation and Breastfeeding 68

3.11 Long-Term Health Effects of Pregnancy on Mother and Child 71

4 The Human Sexual Response 73

4.1 Desire Phase 73

4.2 Excitement Phase 74

4.3 Plateau Phase 75

4.4 Orgasmic Phase 75

4.5 Resolution Phase 77

5 Age-Related Changes in the Reproductive System 79

5.1 Childhood and Adolescence 79

5.2 Puberty 81

5.3 The Aging Male and Female 81

Appendix A: Detailed Anatomy of the Male and Female Reproductive Systems 83

Index 87