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Conservative and functional surgery is increasingly used in surgical oncology. Its aim is to preserve organs’ functionality and to reduce radical resection. Development of new surgical procedures in oncologic gynecologic surgery is a perfect example of this evolution. Although radical surgery remains the gold standard in the treatment of ovarian cancer, a conservative approach can be considered in patients with early-stages disease, in order to preserve their fertility function. These procedures were proposed to selected patients, depending on histologic subtypes and prognostic factors. Ovarian cancers are classified in epithelial (including borderline and malignant tumors) and non-epithelial cancer.
The use of corticosteroids in the luteal phase of in vitro fertilization (IVF) cycles has been a classic theme in clinical research. The treatment schedules showed great variability but most studies started corticoid therapy from oocyte retrieval and kept it up for 14 days. It is important to mention that in assessing the studies one considered the following clinical outcomes: live birth rate; pregnancy rate; implantation rate; and adverse events. A randomized controlled trial (RCT) carried out in patients with endometriosis who had non-organ specific autoantibodies showed that the administration of glucocorticoids was associated with significantly higher pregnancy rates. Corticoid treatment is useful in improving ovarian response to stimulation in patients with a poor response. The additional benefit observed in patients who have undergone assisted hatching is of little clinical value as there are few indications for applying this technique, either routinely or in specific indications.
In the field of assisted reproductive technology, vitrification is becoming an increasingly popular method of cryopreserving cells, tissues and even entire organs. The possibility that water might be vitrified was first proposed by Brayley in the mid 1800s, but the idea of cryopreservation by vitrification was apparently not introduced until Stiles observed, that protoplasm is likely, at very high cooling rates, to form "a finely crystalline or even amorphous mass" that "in thawing, might be expected to give again the original system without change". Vitrification does not inherently rely upon very high rates of cooling because ice nucleation and growth rates go down as solute concentration goes up. Vitrification can be seen as the means by which an aqueous solution remains within the bounds of thermodynamic law. The negative effects of vitrification solutions (VSs) can arise, not only from true biochemical toxicity but also from osmotic effects.
The rationale behind intrauterine insemination (IUI) with partner sperm is bypassing the cervical-mucus barrier and increasing the number of motile spermatozoa with a high proportion of normal forms at the site of fertilization. This chapter examines the value and position of homologous intrauterine insemination in an assisted reproductive technology (ART) program. Some of the factors influencing IUI success include site of insemination, number of inseminations, exact timing of IUI, sperm preparation methods and fallopian tube sperm perfusion. Artificial inseminations can be done intravaginally, intracervically (ICI), pericervically using a cap, intrauterine (IUI), transcervical intrafallopian (IFI) or directly intraperitoneal (IPI). Most studies refer to IUI, which seems to be an easy and better way of treatment. IUI should be promoted as the best first-line treatment in most cases of subfertility provided at least one tube is patent and an IMC after sperm preparation of more than 1 million can be obtained.
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