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Following fertilization in the fallopian tube approximately 24 to 48 hours after ovulation, the zygote migrates through the fallopian tube to the uterine cavity at the stage of morula on day 18 of an ideal 28-day cycle . On day 19, a 32- to 256-cell blastocyst forms, sheds its zona pellucida (known as hatching), superficially apposes, and adheres to the endometrium . This is followed by trophoblast invasion through the endometrial epithelium and underlying stroma, the inner third of the myometrium, and the uterine vasculature, all of which finally result in placentation . The success of each step is crucial in order to advance toward the next stage.
Despite the efforts for conservative treatment for several benign entities, hysterectomy is the therapeutic cornerstone. The current chapter presents an overview of the surgical techniques, as these are applied via different surgical approaches: abdominal, vaginal and minimal access. Special emphasis is given to the potential complications encountered during the postoperative period. Several issues of controversy are also discussed and suggestions have been made according to the current guidelines. It is evident that hysterectomy should always be included in a training curriculum with the surgical skill being maintained via a minimum number of procedures performed yearly. Route selection is very important in reducing possible complications. In the same direction, whenever possible, an enhanced patient recovery scheme should be applied.
This chapter reports a variety of factors involved in the different stages of follicular development. Elucidation of the mechanisms that regulate follicular development may lead to the prevention of female reproductive disorders or other pathological conditions and to the development of new culture methods for oocytes for in vitro fertilization. Follicle-stimulating hormone (FSH) is considered to be the fundamental driver of folliculogenesis. Gonadotropins are even used in controlled ovarian stimulation (COS), which is an important component of assisted reproduction technology (ART). The main hormone product of the Corpus Luteum (CL) is progesterone, which induces the necessary endometrial modifications required for the acquisition of a receptive state, an anticipation of embryo implantation. If pregnancy does occur, regression must be inhibited since the CL is the main source of steroidogenesis, supporting the establishment and maintenance of a successful pregnancy.
Assisted reproductive technology (ART) is available to two-thirds of the world's population, and world-class experts, representing research from 18 different countries, have contributed to this groundbreaking textbook, detailing the techniques and philosophies behind medical procedures of infertility and assisted reproduction. This is one of the most rapidly changing and hotly debated fields in medicine. Different countries have different restrictions on the research techniques that can be applied to this field, and, therefore, experts from around the world bring varied and unique authorities to different subjects in reproductive technology. Encompassing the latest research into the physiology of reproduction, infertility evaluation and treatment, and assisted reproduction, it concludes with perspectives on the ethical dilemmas faced by clinicians and professionals. This book will be the definitive resource for those working in the areas of reproductive medicine world wide.
The past three decades have witnessed a transformation in reproductive medicine from science fiction to one of the most advanced medical disciplines. Our textbook is a confirmation of the tremendous achievements in scientific research that changed the course of our clinical practice. Thirty years of in vitro fertilization (IVF) was celebrated this year in Alexandria, honoring Robert Edwards specifically. More than four million IVF babies have been born worldwide. The doors that were opened by Robert Edwards and Patrick Steptoe lead to many miracles. Intracytoplasmic sperm injection, in vitro maturation, oocyte vitrification, pre-implantation genetic diagnosis, and ovarian transplantation are dreams that were fulfilled. Many couples still have no hope of having their own families and demand us to keep moving forward.
The authors of the chapters of this book have lead the world for the three decades. They contributed their finest and most advanced research. We find in every one of them a sincere desire to uphold the ethics and the respect in our society. The friendship and cordiality between them has been amazing. They represented the six continents truly, and many of them have worked in more than one continent. It is not surprising that they worked together in such an elegant and a unique way. The different chapters are individualized in style, but the spirit of the book has united them. From reproductive physiology to surgery and assisted reproduction, the authors move with great elegance. The ethical and moral issues have been thoughtfully considered.