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In the first reported case of IVF and embryo development in the human, Rock and Menkin made the following description of the culture and development of a fertilized embryo: “The eggs were incubated in serum for 22.5 hours, being washed in salt solution before and after incubation, and then exposed to a washed sperm suspension in Locke’s solution for two hours at room temperature. They were again washed in Locke’s solution and cultured in fresh serum for 45 hours.
Just before Lesley Brown naturally ovulated on November 9, 1977, she underwent laparoscopic surgery to aspirate the fluid in her left ovary, which contained a single egg. It was fertilized with the sperm of Lesley’s husband, John. Three days later, the resulting embryo contained eight cells and was transferred into Lesley’s uterus. On July 25, 1978, history was made with the arrival of the first baby conceived via in vitro fertilization (IVF).
Address the future of innovative reproductive technologies with experts in the fields of IVF, fertility preservation and laboratory advances. This essential resource examines the changing roles of IVF, and moves beyond the basics of reproductive medicine. This book introduces the optimization of care, to improve patient outcomes, whilst facing ethical challenges that accompany new technologies, and applying the patient-centered care model to improve both patient and staff retention. By showcasing the future of the field in terms of clinical practice and innovative laboratory technologies, this guide will support clinics worldwide to provide high-quality customer experience, maintaining a competitive edge, following increasing standardization of clinical and laboratory protocols. This invaluable guide features chapters on patient evaluation, predictive modelling, advances in pharmacology, and laboratories of the future. Written by research and clinical leaders from around the world, it describes ground-breaking innovative treatments and technologies, encompassing the care model in a holistic way.
The inherent ease of laboratory assessment of various morphological markers makes it the preferred assessment technique of embryo transfer. Even with the adoption of more complex forms of assessment it remains as one of the main tools available for embryo selection. For a new assessment procedure to be acceptable in an in vitro fertilization (IVF) laboratory setting it must satisfy a number of criteria. The complete array of small-molecule metabolites that are found within a biological system constitutes the metabolome, which can be considered to reflect the functional phenotype. Using various forms of spectral and analytical approaches, metabolomics attempts to determine metabolites associated with physiologic and pathologic states. Investigation of the metabolome of embryos, by analysis of the culture media they grow in, using targeted spectroscopic analysis and bioinformatics, will plausibly assist in identifying the most viable embryo(s) within a cohort.
This chapter provides data to identify which day(s) of development the human embryo should be replaced in the uterus. By transferring the embryo post-compaction at the blastocyst stage, one not only synchronizes embryo development with the female reproductive tract, but also places the embryo in the uterus at a time when there are greatly reduced uterine contractions, thereby negating the possibility of the embryo being expelled. The first prospective randomized trial comparing human embryo transfer on either day 3 or day 5 in good prognosis patients revealed a significantly higher implantation and pregnancy rate when transfer occurred at the blastocyst stage. With the recent improvements in the in vitro fertilization (IVF) laboratory, combined with patient stimulation regimens designed to generate fewer, healthier oocytes, single embryo transfer (SET) is now a feasible patient treatment. The move to SET is especially relevant to good prognosis patients and oocyte donation programs.
Several medications have been found to increase implantation rates with in vitro fertilization (IVF) when given as adjuncts to follicle stimulating hormone (FSH) stimulation of the ovaries in preparation for oocyte retrieval. Gonadotropin-releasing hormone (GnRH) agonists, oral contraceptives (OCs), and estrogen pretreatment help to synchronize the follicular cohort resulting in an improved ovarian response. Metformin (MET) increases implantation in PCOS women having IVF and dramatically reduces the incidence of ovarian hyperstimulation syndrome (OHSS) in these women. Growth hormone (GH) markedly increases implantation in poor-responding women having IVF. Small doses of human chorionic gonadotropin (hCG) are used to provide LH activity allowing use of pure FSH products and the pen devices that deliver graduated FSH doses. Low-dose aspirin (ASA) increases ovarian response and implantation, and reduces the incidence of severe OHSS. Drugs such as letrozole that increase androgens may prove to be useful agents to increase ovarian response in poor responders.
Semen specimens usually are collected by masturbation into a wide-mouthed polypropylene container from a batch or lot tested for lack of sperm toxicity. Mixing a semen sample thoroughly is critical for accurate sperm counts, both initially and throughout each step of semen analysis. Sperm viability testing typically uses a nuclear exclusion stain to determine whether non-motile sperm are alive and not able to move. The component of sperm morphology is one of the most predictive measures of fertility potential and therapeutic outcome. The semen should be examined microscopically for the presence of bacteria, round cells, debris, agglutination, or aggregation. The influence of the female partner in human fertility plays a huge confounding role in both defining fertility and interpreting the association of specific semen analysis measures with fertility. Sperm motility quality controls are available in two formats: frozen aliquots of semen or video recordings on CD-ROM, tape, or digital file.