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Despite the various advances and increasing success rates of assisted conception treatment in recent years, implantation continues to be a rate limiting step (). The first successful IVF treatment performed by the pioneers Patrick Steptoe and Robert Edwards which led to the birth of Louise Joy Brown in 1978, was achieved in a fresh embryo transfer cycle. The subsequent implementation of cryopreservation techniques in the IVF laboratory facilitated the cryopreservation and storage of supernumerary embryos which were not chosen for a fresh transfer. Laboratory techniques have improved significantly over the years and due to the improved survival rates of cryopreserved oocytes, cleavage and blastocyst-stage embryos, cryopreservation of gametes and embryos has become part of everyday routine clinical practice ().
Despite the notion that the first baby, Louise Brown, was born in 1978 following IVF performed in a natural menstrual cycle, ovarian stimulation became the golden standard of care in clinical IVF, since the number of oocytes retrieved is directly associated with pregnancy and life birth rates (, ). The aim should be to titrate the stimulation in such a way that the optimal number of follicles develops. Too few follicles (also referred to as low response) usually means poor IVF outcome, whereas too many developing follicles induce a risk for developing OHSS and possibly reduce the chance of success with increasing number of oocytes, if stimulation is not adjusted toward the end of the follicular phase (, ).
In ovarian stimulation cycles for IVF/ICSI, a defective luteal phase occurs in almost all patients as a result of the multifollicular development and supraphysiological hormonal levels, which inhibit the LH secretion by the pituitary via negative feedback actions at the level of the hypothalamic-pituitary axis. Progesterone is crucial to induce secretory transformation of the endometrium after previous estrogenization, a process which will finally result in a receptive endometrium. Consequently, luteal phase support (LPS) represents an essential part of ART treatment in case of a planned fresh embryo transfer, as it is crucial to counterbalance the luteal phase insufficiency.
The increasing understanding of individual differences in response to in-vitro fertilization (IVF) treatment, resulting from genetic and ethnical differences, has increased the potential for individualized treatment for patients, resulting in improved pregnancy and live-birth outcomes. This illustrated book summarizes, and provides updates on, the most recent developments in individualized infertility treatment and embryo selection techniques. Individualization is not only confined to the different steps in the ovarian stimulation process and the luteal phase support, but also to embryo selection techniques, which include, among others, the analysis of embryo development pattern and genetic testing. Chapters cover a multitude of topics, ranging from oocyte maturation and immunological testing to fertilization technique in the IVF laboratory and preparation for optimal endometrial receptivity in cryo cycles. Essential reading for IVF specialists and embryologists in IVF Clinics and also an important text for medical consultants specializing in reproductive medicine, gynecology and embryology.
Clinical case studies have long been recognized as a useful adjunct to problem-based learning and continuing professional development. They emphasize the need for clinical reasoning, integrative thinking, problem-solving, communication, teamwork and self-directed learning - all desirable generic skills for health care professionals. This volume contains a selection of cases on assisted reproduction that will inform and challenge reproductive medicine practitioners at all stages in their careers. Both common and uncommon cases are included. The aim is to reinforce diagnostic skill through careful analysis of individual presenting patterns, and to guide treatment decisions. Each case consists of a clinical history, examination findings and special investigations, before a diagnosis is made. Clinical issues raised by each case are discussed and major teaching points emphasized. Selective references are provided. The book provides a useful complementary adjunct to existing textbooks of reproductive medicine, and an excellent resource for teaching and continuing professional development.