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Menopause is defined as the permanent cessation of menstruation that occurs after the loss of ovarian follicular function. The name is derived from the Greek words menos meaning month and pausis (cessation). It marks the end of the reproductive lifespan and is accompanied by changes within the neuroendocrine system that manifest in clinical symptoms classically associated with menopause. Menopause can occur naturally (spontaneously) or be induced through a medical intervention (surgery, chemotherapy or pelvic radiation therapy).
Assisted reproduction technology (ART) encompasses fertility treatments which require manipulation of oocyte, sperm or both in vitro. This chapter aims to provide an overview of ART, including indications for treatment as well as the procedures involved. This will also include complications of ART as well as the evidence assessing the perinatal outcomes of children resulting from ART.
In November 1929, clinicians first attempted to develop an ‘ovary stimulating hormone’ extracted from the human placenta for the treatment of symptoms resulting from the menopause. The team at Montreal General Hospital named it ‘Emmenin’ and it had to be purified from the urine of pregnant women to be administered orally. It was later discovered that pregnant mares’ urine could provide an abundant supply of a compound with high estrogenic activity. This conjugated equine estrogen (CEE) was commercially produced as Premarin and made available as an oral estrogenic agent in 1939.
This chapter addresses issues related to patient selection and preparation prior to undergoing assisted reproductive technology (ART) techniques, and the role of regulatory control in ART and welfare of the child assessment. It discusses the special aspects of ART including gamete and embryo donation, pre-implantation genetic screening (PGS) and diagnosis (PGD) and fertility preservation. Before the processing of patient gametes or embryos, the couple should be screened for hepatitis B, hepatitis C and HIV to assess their risk of cross-contamination. In the UK, the regulatory control of ART lies with the Human Fertilisation and Embryology Authority (HFEA). The risk of implantation failure and pregnancy loss secondary to aneuploidy increases with advanced maternal age, particularly after the age of 35 years. Fertility preservation described in the chapter includes sperm cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation.
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