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In vitro fertilization (IVF) was initially developed to treat patients with damaged Fallopian tubes. IVF treatment has since been extended far beyond tubal infertility to treat a whole host of indications, including unexplained infertility, endometriosis, and male infertility. Infertility treatments include timed intercourse, ovulation induction, intrauterine insemination (IUI), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), IVF, and intracytoplasmic sperm injection (ICSI). Standard stimulation protocols require pituitary desensitization with a GnRH agonist, and this strategy has become almost a universal practise in assisted conception clinics with the induced hypogonadotropic hypogonadism enabling almost complete control over follicular development. The presence of endometrial polyps, submucous fibroids, and intrauterine adhesions may be associated with reduction in pregnancy rates and increase in risk of miscarriage with IVF. Cryopreservation of supernumerary good-quality embryos is vital to optimize pregnancy rates per cycle started without the need to superovulate the patient again.
In setting up a new in vitro fertilization (IVF) unit it is necessary to convince others that there is an economical need for one to be established. The two methods for procedure costing for the IVF unit are top-down approach and bottom-up approach. The calculation of likely activity is based on a number of factors that include market research, existing waiting lists, referral base, currently available service in the area and their activity. Assisted conception services fall into three categories: wholly private and independent; state funded units; and part academic-part patient funded units. This chapter describes the clinical and laboratory set-up requirements including quality control, laboratory set-up, entry restriction, air-filtration, laboratory lighting, safety and security, and generator back-up for an IVF unit. The IVF chamber is a controlled environmental chamber which is mobile and is specifically designed to maintain ideal temperature and pH during the handling of gametes and embryos.
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